PPT ON MENTALLY CHALLENGED CHILDREN OR MENTAL RETARDATION IN CHILDREN

PPT ON MENTALLY CHALLENGED CHILDREN OR MENTAL RETARDATION

1. BY
M. Sandeepkumar
MSC NURSING 2
ND
YEAR
SVIMS, TIRUPATI.
MENTALLY CHALLENGED
Thursday, January
28, 2016
1

2. INTRODUCTION……
Challengedconditionmakesthenormalfunctionof
individualverydifficultandleadstodependency.These
conditionsareincreasingdaybydayduetochanging
lifestyleandcomplicatedenvironment.
Challengedchildrenisonewhodeviatedfromnormal
healthstatuseitherphysically,mentallyorsociallyand
requiresspecialcare,treatmentandeducation.
Thursday, January 28, 2016
M. Sandeep kumar
2

3. CONCEPT OF CHALLENGED…….
AccordingtoWHOthesequenceofeventsleadingto
disabilityandhandicappedORchallengedconditions
areasfollows.
M. Sandeep kumar
INJURY OR DISEASE IMPAIRMENT DISABILITY
CHALLENGED OR HANDICAPPED
Thursday, January 28, 20163

4. IMPAIRMENT ….?
Itisdefinesasanylossorabnormalityofpsychological,
physiologicaloranatomicalstructureorfunction,e.g.
Lossofvision,lossofhearing,etc.Primaryimpairment
mayleadstosecondaryimpairment e.g.Defective
hearingresultsinlearningdifficultiesandpoorschool
performance.
Impairmentleadstodisability.
Thursday, January 28, 2016
M. Sandeep kumar
4

5. DISABILITY….?
Itdevelopsastheconsequenceofimpairment.E.g.Loss
oflimbsresultsininabilitytowalk.Disabilityisthe
inabilitytocarryoutcertainactivitieswhichare
consideredasnormalfortheageandsex.
Thursday, January 28, 2016
M. Sandeep kumar
5

6. HANDICAPED ORCHALLENGED ..?
Handicapisdefinedasadisadvantageforagiven
individualresultingfromanimpairmentoradisability,
thatlimitsandpreventsthefulfillmentofarolewhichis
normalforthatindividual,depending,onage,sex,social
andculturalfactors.primaryhandicapmayleadto
secondaryhandicapconditione.g.Blindnessleadsto
economicalhandicappedsituation.
Thursday, January 28, 2016
M. Sandeep kumar
6

7. Classification…..
Thursday, January 28, 2016
M. Sandeep kumar
7

8. 1. Physically challenged
physicallychallengedchildrencanbegrouped
accordingtoaffectedpartofthebody.Theseinclude
orthopedicallyhandicapped,sensoryhandicapped,
neurologicallyhandicappedandhandicappeddueto
systemicdiseases.
Thursday, January 28, 2016
M. Sandeep kumar
8

9. 2. Mentally challenged
Mentallychallengedisnowusedforthecondition
mentalretardation.Atleast2-3percentofIndian
populationarementallyhandicappedinanyoneform.
Cognitiveimpairmentisalsousedassynonym for
mentallychallengedormentalretardation.
Thursday, January 28, 2016
M. Sandeep kumar
9

10. 3. Socially challenged
Sociallychallengedchildrenarehavingdisturbed
opportunitiesforhealthypersonalitydevelopmentdue
tosocialfactorsleadingtonon-achievementoffull
potentialities.Socialdisturbancesarefoundinthe
formofbrokenfamily,parentalinadequacy,lossof
parents,poverty,lackofeducationalopportunities,
environmental deprivation and emotional
disturbancesaslackoftenderlovingcare.
Thursday, January 28, 2016
M. Sandeep kumar
10

11. Mentally challenged…,
Intellectualdisability(ID),alsocalledintellectualdevelopmentdisorder
(IDD)andformerlyknownasmentalretardation(MR).Mentalretardation
(MR)isadevelopmentaldisabilitythatfirstappearsinchildrenunderthe
ageof18.Itischaracterizedasalevelofintellectualfunctioning(as
measuredbystandardintelligencetests)thatiswellbelowaverageand
resultsinsignificantlimitationsintheperson'sdailylivingskills(adaptive
functioning).
ThetermMRasoffensiveandthetermintellectualdisabilityor
intellectuallychallengedisnowpreferredbymostadvocatesinmost
englishspeakingcountries.
M. Sandeep kumar
Thursday, January 28, 201611

12. Definition:-
Mentalretardationreferstosignificantlysubaveragegeneral
intellectualfunctioning(BELOW70)resultinginorassociated
withconcurrentimpairmentsinadaptivebehaviorand
manifestedduringthedevelopmentalperiod.
-American association on mental deficiency,1983.
Thursday, January 28, 2016
M. Sandeep kumar
12

13. KEY WORDS………….
Significantsubaverageisdefinedasanintelligencequotient(IQ)
of70orbelowonstandardizedmeasuresofintelligence.
Adaptivebehaviorisdefinedasthedegreeswithwhichthe
individualmeetsthestandardsofpersonalindependence and
socialresponsibilityexpectedofhisageandculturalgroup.The
expectationsofadaptivebehaviorvarywiththechronologicalage.
Thursday, January 28, 2016
M. Sandeep kumar
13

14. Adaptive
skill
areas.?
Thursday, January 28, 2016
M. Sandeep kumar
14

15. The deficient in adaptive behavior
1. During infancy and childhood
Sensory and motor skill development
Communication skill (including speech and language)
Self-help skills.
Socialization.
2. During childhood and adolescent
Application of basic academic skill to daily life activities.
Application of appropriate reasoning and judgment in the mastery of the
environment.
Social skill.
3. During late adolescent
Vocational and social responsibilities and performance.
Note:-developmental period is defined as the period of time between conception
and the 18
th
birth day.
Thursday, January 28, 2016
M. Sandeep kumar
15

16. Epidemiology…….?
3%oftheworldpopulationisestimatedtobementallyretarded.
InIndia5outof1000childrenarementallyretarded(Indianexpress13
th
march2001).More
than20millionchildrenaresufferingwithmentalretardation.
Mentalretardationismorecommoninboysthangirls.
Mortalityishighinsevereorprofoundmentalretardationduetoassociatedphysical
condition.
Commonintheagegroupof2-3years.Peakin10–12yearsofage.
Thursday, January 28, 2016
M. Sandeep kumar
16

17. Etiology
Genetic factors
1.Chromosomal abnormalities:-
Down’s syndrome
Fragile X syndrome
Trisomy X syndrome
Turner’s syndrome
M. Sandeep kumar
Thursday, January 28, 201617

18. Down syndrome.
Aboutone-halfofallcasesofmentalretardationarecausedby
knownbiologicalabnormalitieslikeDownsyndrome.
ThecauseofDownsyndromeisthepresenceofanextra
chromosome.
Ingeneral,childrenandadultswithDownsyndromefunctionwithin
themoderatetosevererangeofmentalretardation.
M. Sandeep kumar
Thursday, January 28, 201618

19. Fragile-X syndrome
Fragile-Xsyndrome,isthemostcommonknowngeneticcauseof
mentalretardation.
Fragile-Xsyndromeisindicatedbyaweakeningorbreakononearm
oftheXsexchromosomes,anditistransmittedgenetically.
Notallchildrenwiththefragile-Xabnormalityhavementalretardation.
Asinfragile-Xsyndrome,abnormalitiesofthesexchromosomesare
particularlynotable.
Thursday, January 28, 2016
M. Sandeep kumar
19

20. Etiology
2. Metabolic disorders:-
Phenylketonuria
Wilsons syndrome
Galactosemia
M. Sandeep kumar
Thursday, January 28, 201620

21. Phenylketonuria…..
 PKUiscausedbyabnormallyhighlevelsoftheaminoacidphenylalanine,
usuallyduetotheabsenceoforanextremedeficiencyinphenylalanine
hydroxylase,anenzymethatmetabolizesphenylalanine.
 ChildrenwithPKUhavenormalintelligenceatbirth.
 However,astheyeatfoodscontainingphenylalanine,theaminoacidbuilds
upintheirsystem.
 Thisphenylketonuriaproducesbraindamagethateventuallyresultsinmental
retardation.
 Retardationtypicallyprogressestotheseveretoprofoundrange.M. Sandeep kumar
Thursday, January 28, 201621

22. Etiology
3. Cranial malformation
Hydrocephaly
Microcephaly
4. Gross diseases of brain
Tuberous sclerosis
Neurofibromatosis
Epilepsy
Thursday, January 28, 2016
M. Sandeep kumar
22
Etiology

23. Etiology
Prenatal factors:-
Infections:-[ STORCH ]
Rubella
Cytomegalovirus
Syphilis
Toxoplasmosis
Herpes simplex.
Endocrine disorders:-
Hypothyroidism
Hypo parathyroidism
Diabetes mellitus
M. Sandeep kumar
Thursday, January 28, 201623

24. INFECTIONS….
Rubella (German measles) is a viral infection that may produce few
symptoms in the mother but can cause severe mental retardation and even
death in the developing fetus.
The human immunodeficiency virus (HIV) can be transmitted from an
infected mother to a developing fetus.
The effects on the child are profound, including mental retardation, visual
and language impairments, and eventual death.
M. Sandeep kumar
Thursday, January 28, 201624

25. INFECTIONS….
Syphilis is a bacterial disease that is transmitted through sexual
contact. syphilis produces a number of physical and sensory
handicaps in the fetus, including mental retardation.
Another sexually transmitted disease, genital herpes, can be
transmitted to the infant during birth and result in mental retardation.
Two infectious diseases that occur after birth, encephalitis and
meningitis, can cause mental retardation.
M. Sandeep kumar
Thursday, January 28, 201625

26. Etiology
Thursday, January 28, 2016
M. Sandeep kumar
26
Physical damage and disorders: -
Injury
Hypoxia
Radiation
Hypertension
Anemia
Emphysema
Intoxication:-
Lead
Certain drugs
Substance abuse

27. Etiology
Placentaldysfunction:-
Toxemiaofpregnancy
Placentaprevia
Cordprolapse
Nutritionalgrowthretardation
Thursday, January 28, 2016
M. Sandeep kumar
27

28. Etiology
Perinatal factors:-
Birth asphyxia
Prolonged and difficult birth
Prematurity (due to complications)
Kernicterus
Instrumental delivery (resulting in head injury,
intraventricular hemorrhage)
M. Sandeep kumar
Thursday, January 28, 201628

29. Etiology
Postnatal factors:-
Infections:-Encephalitis,
Measles,
Meningitis,
Septicemia.
Accidents.
Lead poisoning
Thursday, January 28, 2016
M. Sandeep kumar
29

30. Etiology
Pregnancy and birth complications
One major complication is Rh incompatibility.
Another pregnancy and birth complication that can cause
intellectual deficits is premature birth.
particularly anoxia, or oxygen deprivation; severe
malnutrition; and the seizure disorder epilepsy.
M. Sandeep kumar
Thursday, January 28, 201630

31. Etiology
Environmental and social-cultural factors:-
Cultural deprivation
Low socio-economic status
Inadequate caretakers
Child abuse
Thursday, January 28, 2016
M. Sandeep kumar
31

32. PREDISPOSING FACTORS
Low socioeconomic strata or poverty.
Low birth weight of children.
Advanced maternal age.
Consanguinity.
Extreme malnutrition.
Lack of stimulating environment Poor sensory experience.
Poor sensory experience
Thursday, January 28, 2016
M. Sandeep kumar
32

33. PREDISPOSING FACTORS
Defective low standard education due to defective scholastic
environment.
Psychological disadvantage. E.g. poor health practices, poor
housing, disuse of language, etc.
Parental deprivation
Prolonged isolation of care takers during developmental period.
Sensory deprivation and social deprivation.
Thursday, January 28, 2016
M. Sandeep kumar
33

34. Classification…….;
Intelligentquotientistheratiobetweenmentalage(MA)and
chronologicalage(CA).whilechronologicalageis
determinedfromthedateofbirth,mentalageisdetermined
byintelligencetest.
Thursday, January 28, 2016
M. Sandeep kumar
34

35. TYPES OF MENTAL RETARDATION
Type IQ range in mental retardation
1.Mild(Educable) 50 -70
2.Moderate(Trainable) 35 -50
3.Severe(Dependentretarded) 20 -35
4.Profound(Lifesupport) < 20
Thursday, January 28, 2016
M. Sandeep kumar
35

36. Mild retardation (Educable) (IQ 50-70):-
85-95%oftotalmentalretardationcasesbelongtomildmentalretardation.
Environmentalinfluences,psychosocialdeprivation,restrictivechildrearingpractices,
malnutrition,low-socio-economicclassarethecausesformildmentalretardation.
Theyhavedeficientinintellectualskills,studiesupto6-8
th
standard,probleminreadingand
writing,difficultinacademicschoolwork,normativelivingskills,walking,talking,toilet
training,languageabilities,anddevelopmentofdomesticskill,behavior,socialandemotional
adjustmentlikeanormalperson.
Canfullyadjusteducable,findsdifficultyincomplexideas,drawinggeneralization,canlearn
motorskillsbetterthanverbalskillandwriting,emotionallytheyarestable,overactive,temper
tantrumiscommon,canunderstandsimpleterms,theycanbetrainedinspecialschool.
Inadultlifemostofthemleadindependentlifeinnormalsurroundings.
Thursday, January 28, 2016
M. Sandeep kumar
36

37. Moderate retardation (Trainable) (IQ 35-50)
10%ofmentalretardationcasesbelongtomoderatementalretardation.
Childrencanbetrainable,aimedatself-helpskills,theycanspeakand
supportthemselves,abletoperformsemi-skilledorunskilledworkunder
supervisioncanlearnfewbasicskills.
Communication skillsdevelopmuchslowly,limitedprogressin
scholasticwork,studiesupto2
nd
grade,unawareofneeds,haveless
neuropathologicalcomplications,partiallydependsonothersfortheir
care.
Thursday, January 28, 2016
M. Sandeep kumar
37

38. Severe retardation (Dependent) (IQ 20-35)
7%oftotalmentalretardationcases,belongtosevereMR.
Slowmotordevelopmentinpreschoolyears,trainablefornormalliving
activities,allowthemtododailylivingactivitiesundersupervision,
contributespartiallytoself-maintenance,somechildrenmaylearnsocial
behavior,abletocommunicateinsimpleway,engagedinlimited
activities,delayedspeechandcommunicationskills.
Thursday, January 28, 2016
M. Sandeep kumar
38

39. Profound retardation (Life support) (IQ < 20)
1-2%ofmentalretardationcasesareprofoundtype.
considerableorganicpathology,nervoussystemisnoticed,
associatedconditionsare;blindness,deafness,seizuresare
common,delayedmilestones,motorimpairment,totally
dependent,cannotdoanythingontheirown.
Deathmayoccurduetovarietyofproblemsorcomplications.
Thursday, January 28, 2016
M. Sandeep kumar
39

40. Mental Retardation
Symptoms of Mental Retardation..
However, all definitions generally agree on the three major
criteria for mental retardation:
1)significant limitations in intellectual functioning,
2)significant limitations in adaptive functioning, and
3)onset before age 18 years.
M. Sandeep kumar
Thursday, January 28, 201640

41. SIGNS AND SYMPTOMS
Failuretoachievedevelopmentalmilestones.
Deficienciesincognitivefunctioningsuchasinabilityto
followcommandsordirections.
Reducedabilitytolearnortomeetacademicdemands.
Expressiveorreceptivelanguageproblems.
Psychomotorskilldeficits.
M. Sandeep kumar
Thursday, January 28, 201641

42. SIGNS AND SYMPTOMS
Difficultyperformingself-careactivities.
Neurologicimpairment
Medicalproblemssuchasseizures
Lowself-esteem,depressionandlabilemoods
Irritabilitywhenfrustratedorupset
Acting-outbehavior
Lackofcuriosity
Thursday, January 28, 2016
M. Sandeep kumar
42

43. Diagnosing MR……./
Thediagnosisofmentalretardationisusuallymadeaftera
periodofsuspicionbyprofessionalsorfamilymembersthatthe
child’sdevelopmentalprogressisdelayed.
Insomecasesitisconformedatbirthbecauseofrecognitionof
districtsyndrome.
Routinedevelopmentalscreeningcanassistinearly
identification.
Thursday, January 28, 2016
M. Sandeep kumar
43

44. Diagnosing MR…….//
Multidisciplinaryevaluationshouldbeindividuallytailoredtothe
child.Ateamofprofessionalslikepediatricneurologist,
developmentalpediatrician,psychologist,socialscientist,speech
therapist,physicaltherapist,specialeducator,socialworkerand
nursewillevaluatethechild.
Completehistoryiscollectedfromfamilymembersandcare
takers.
Thursday, January 28, 2016
M. Sandeep kumar
44

45. Diagnosing MR…….///
Mentalhistory
Physicalexaminationtoexcludephysicalillness.
Neurologicalassessment
Assessmentofmilestoneslikeintellectuallevels,cognitiveability,
languagepatternandcommunicationskills,hearing,conative
behavior.
Thursday, January 28, 2016
M. Sandeep kumar
45

46. Diagnosing MR…….////
Investigations,,,,,,
Urine and blood examination for metabolic disorders.
Hormonal studies-T
3, T
4, TSH when cretinism is suspected.
Culture for cytogenic and biochemical studies.
EEG to exclude seizures.
MRI, CT scan to study the structural abnormality of brain for example
tuberous sclerosis.
Thursday, January 28, 2016
M. Sandeep kumar
46

47. Diagnosing MR……./////
Investigations,,,,,,
Antibodies for diagnosing infections, LFT in Wilson’s disease.
Sensory test –assessment for vision, hearing.
Amniocentesis for pregnant mothers to detect chromosomal
abnormalities, chorionic villi sampling, chromosomal analysis.
Education evaluation-reading, writing, regularity in schooling, living
learning skills, daily living skills, social abilities.
Thursday, January 28, 2016
M. Sandeep kumar
47

48. Diagnosing MR…….//////
PsychologicalinvestigationincludesStanfordBinetintelligence
tests(mentalabilities)2yearsandmore.Wechler’sintelligence
scaleforchildrenWISC(above6years)
Throughthepsychologicaltestingthementalageofthechild
estimated.Theintelligencequotientisthendeterminedusing
theformula.
Thursday, January 28, 2016
M. Sandeep kumar
48

49. Early behavioral signs suggestive of
MR
1)Dysmorphicfeatures (e.g. down syndrome, fragile X
syndrome).
2)Irritability or unresponsiveness to contact.
3)Abnormal eye contact during feeding.
4)Gross motor delay.
5)Decreased alertness to voice or movement.
6)Language difficulties or delay
7)Feeding difficulties.
Thursday, January 28, 2016
M. Sandeep kumar
49

50. Treatment modalities for MR……
Behavior management.
Environmental supervision.
Monitoring the child’s developmental needs and problems.
Programs that maximize speech, language, cognitive,
psychomotor, social, self-care, and occupational skills.
Ongoing evaluation for overlapping psychiatric disorders, such
as depression, bipolar disorder, and ADHD.
Thursday, January 28, 2016
M. Sandeep kumar
50

51. Treatment modalities for MR
Family therapy to help parents develop coping skills and
deal with guilt or anger.
Early intervention programs for children younger than
age 3 with mental retardation
Provide day schools to train the child in basic skills, such
as bathing and feeding.
Vocational training.
Thursday, January 28, 2016
M. Sandeep kumar
51

52. PREVENTION:-
PRIMARY PREVENTION
SECONDARY PREVENTION
TERTIARY PREVENTION
Thursday, January 28, 2016
M. Sandeep kumar
52

53. PRIMARY PREVENTION ………
Preconception:-
Genetic counseling,
Immunization for maternal rubella.
Blood tests for marriage licenses can identify the presence of venereal
disease.
Adequate maternal nutrition can lay a sound metabolic foundation for later
childbearing.
Family planning in terms of size, appropriate spacing and age of parents can
also affect a variety of specific causal agents.
Thursday, January 28, 2016
M. Sandeep kumar
53

54. PRIMARY PREVENTION ……
During gestation:-
Prenatalcare:-
Adequatenutrition,fetalmonitoringandprotectionfromdiseases.
Avoidanceofteratogenicsubstanceslikeexposuretoradiationand
consumptionofalcoholanddrugs.
Analysisoffetusforpossiblegeneticdisorder:-
Byamniocentesis,fetoscopy,fetalbiopsyandultrasound.
Thursday, January 28, 2016
M. Sandeep kumar
54

55. PRIMARY PREVENTION ………
At delivery:-
Deliveryconductedbyexpertdoctorsandstaff,especiallyincases
ofhighriskpregnancy.
Apgarscoringdoneat1to5minutesafterthebirthofthechild.
Injectionofgammaglobulin,toprotectthechildnottogetRh-
incompatability.
Thursday, January 28, 2016
M. Sandeep kumar
55

56. PRIMARY PREVENTION ……
Childhood:-
Propernutritionthroughoutthedevelopmentalperiodand
particularlyduringthefirst6monthsafterbirth.
Dietaryrestrictionforspecificmetabolicdisordersuntilnolonger
needed.
Avoidanceofhazardsinthechild’senvironmenttoavoidbrain
injuryfromcausessuchasleadpoisoning,ingestionofchemicals,
oraccidents.
Thursday, January 28, 2016
M. Sandeep kumar
56

57. SECONDARY PREVENTION ……
Earlydetectionandtreatmentofpreventabledisorders.Forexample
phenylketonuria,hypothyroidismcanbeeffectivelytreatedatanearly
stagebydietarycontrolorhormonereplacementtherapy.
Earlyrecognitionofpresenceofmentalretardation.Adelayin
diagnosismaycauseunfortunatedelayinrehabilitation.
Psychiatrictreatmentforemotionalandbehavioraldifficulties.
Thursday, January 28, 2016
M. Sandeep kumar
57

58. TERTIARY PREVENTION ……
Thisincludesrehabilitationinvocational,physicalandsocial
areasaccordingtothelevelofchallenged.
Rehabilitationisaimedatreducingdisabilityandproviding
optimalfunctioninginachildwithmentalretardation.
Thursday, January 28, 2016
M. Sandeep kumar
58

59. CARE AND REHABILITATION OF MR
The prevention and early detection of mentally handicaps.
Regular assessment of the mentally retarded persons attainments and
disabilities.
Advice, support, and practical measures for families.
Provision for education, training, occupation, or work appropriate for
each handicapped person.
Housing and social support to enable self-care.
Medical, nursing, Psychiatric and psychological services those who
require them as outpatients, day patients or inpatients.
Thursday, January 28, 2016
M. Sandeep kumar
59

60. GENERAL PROVISIONS……
Thefamilydoctorandpediatricianaremainlyresponsiblefor
earlydetectionandassessmentofmentalretardationand
assessmentofmentalretardation.
Theteamprovidingcontinuinghealthcarealsoincludes
psychologists,speechtherapists,nurses,occupational
therapistsandphysiotherapists.
Thursday, January 28, 2016
M. Sandeep kumar
60

61. Mildly retarded….
Afewmildlyretardedchildrenrequirefostering,boarding
schoolsplacementorresidentialcare,butusuallyspecialist
servicesarenotrequired.
Mildlyretardedadultsmayneedhelpwithhousing,
employmentorwiththespecialproblemsofoldage.
Thursday, January 28, 2016
M. Sandeep kumar
61

62. Severely retarded……..
Incaseofseverelyretardedmayrequirespecialservicesthroughout
theirlives,whichmayincludeasettingservices,dayrespiteduring
schoolholidays,orovernightstaysinafosterfamilyorresidentialcare.
Themainprinciplenowguidingtheprovisionofresourcesisthatthe
retardedpersonshouldbeusetheusualcommunityservicesratherthan
toprovidespecialistsegregateservices.
Thursday, January 28, 2016
M. Sandeep kumar
62

63. Education and training…….
Theaimisthatasmanymentallyretardedchildrenaspossibleare
educatedinordinaryschoolseitherinnormalclassesorinspecial
classes.
Thereisnowanincreasinguseofmorespecialiststeachingandavariety
ofinnovativeproceduresforteachinglanguageandothermethodsof
communication.
Beforeleavingschool,thesechildrenrequirereassessmentand
vocationalguidance.
Thursday, January 28, 2016
M. Sandeep kumar
63

64. HINTS FOR SUCCESSFUL TRAINING…
Divideeachtrainingactivityintosmallstepsanddemonstrate.
Giverepeatedtrainingineachactivity.
Givethetrainingregularlyandsystematically.
Startsthetrainingwithwhatthechildalreadyknowsandthenproceedtothe
skillthatneedstobetrained.Bythisthechildwillhaveafeelingofsuccess
andachievement.
Rewardshiseffortsevenifthechildattainsnearsuccess.
Usethetrainingmaterialwhichisappropriate,attractiveandlocally
available.
Thursday, January 28, 2016
M. Sandeep kumar
64

65. HINTS FOR SUCCESSFUL TRAINING…
Rememberchildrenwilllearnbetterfromchildrenofthesame
age.
Rememberthereisnoagelimitfortrainingamentallyretarded
person.
Assessthechildperiodicallypreferablyonceinafourorsix
months.
Rememberamentallyretardedchildlearnveryslowly.Tellthe
parentsnottobedejectedattheslowprogress,norfeelthreatened
bythechildfailure.
Thursday, January 28, 2016
M. Sandeep kumar
65

66. VOCATIONAL TRAINING………
Vocationalactivitiesincludeinvocationaltrainingarework
preparation,selectiveplacement,postplacementandfollow
up.Forexample:-MITRAspecialschoolandvocational
trainingcenterforthementallyretarded,Bengaluru,
Karnataka.
Thursday, January 28, 2016
M. Sandeep kumar
66

67. HELP FOR FAMILIES……..
Helpforfamiliesisneededfromthetimethatthediagnosisisfirstmade.
Whenthechildstartsschooltheparentsshouldnotonlybekept
informedaboutthisprogress,butshouldfeelinvolvedintheplanning
andprovisionofcare.
Familiesarelikelytoneedextrahelpwhentheirchildisapproaching
pubertyorleavingschool.
Stagesinparentcounseling…
Thursday, January 28, 2016
M. Sandeep kumar
67

68. Stages in parent counseling…..
Stage-I:-impartinformationregardingconditionofthementallyretarded
child.Avoidgivingmisleadinginformationorbuildingfalsehopesinthe
parents.
Stage-II:-helptheparentsdeveloprightattitudetowardstheirmentally
retardedchild(topreventoverprotection,rejection,pushingthechildtoo
hard).Handleguiltyfeelingsinparents.
Stage-III:-createawarenessinparentsregardingtheirroleintraining
thechild.
Thursday, January 28, 2016
M. Sandeep kumar
68

69. Can I ask some questions…..?
Ismentalretardationsameasmentalillness?
No,mentallyretardedpersonsarenotmentallyill.Thementallyretarded
personsarejustslowintheirdevelopment.
Ismentalretardationcurable?
No.mentalretardationisaconditionwhichcannotbecurable.Buttimelyand
appropriateinterventioncanhelpmentallyretardedpersonlearnseveralskills.
Isittruethatthementallyretardedpersonscannotbetaughtanything?
No.mentallyretardedpersonscanbetaughtmanythings,buttheyneedtobe
trainedsystematically.Theycanperformmanyjobsundersupervision.
Thursday, January 28, 2016
M. Sandeep kumar
69

70. Can I ask some questions…..?
Canmarriagesolvetheproblemsofmentallyretardation?
No.manypeoplethinkthataftermarriage,thementallyretarded
personwillbecomeactiveandresponsibleorsexualsatisfactionwill
curetheperson.Thatisnotso.Marriagewillonlyfurthercomplicate
theproblem.Whenitisknownthatamentallyretardedperson
cannotbetotallyindependent,itwillnotbepossibletolookafterhis
family.
Thursday, January 28, 2016
M. Sandeep kumar
70

71. Can I ask some questions…..?
Domentallyretardedpersonsbecomenormal,astheygrowolder?
No.thementallyretardedpersonsmentaldevelopmentisslowerthan
thatofanormalperson.Thereforwhentheiractualageincreaseswith
time,thementaldevelopmentdoesnotoccuratthesamepacetocatch
upwiththeactualage.
Ismentalretardationaninfectiousdisease?
No.Interactionbetweenmentallyretardedchildrenandnormalchildren
ontheotherhand,helpsintheimprovementofmentallyretarded
children.
Thursday, January 28, 2016
M. Sandeep kumar
71

72. NURSING MANAGEMENT: -
Assessment:-
Assessmentofearlyinfantbehaviorforcognitivedisabilityincludenon-responsivenessto
contact,pooreyecontactandduringfeeding,slowfeeding,diminishedspontaneousactivity,
decreasedresponsivenesstosurroundings,decreasedalertnesstovoiceormovement,and
irritability.
Documentationofdailylivingskills.
Acarefulfamilyassessmentforinformationon
Thefamily’sresponsetothechild.
Presenceofothermemberswithimpairedcognitioninthefamily.
Degreeofindependenceencouragedathome.
Stabilityofthefamilyunit.
Thursday, January 28, 201672

73. NURSING MANAGEMENT: -
INTERVENTION :-
Thelongtermgoalsforthesechildrenarehighlyindividualizedandare
dependentonthelevelofmentalretardation.parentsshouldbeinvolvedin
establishingrealisticgoalsfortheirchild.Someofthesegoalscanbe:
Thechilddresseshimself
Thechildmaintainscontinenceofstoolandurine
Thechilddemonstrateacceptablesocialbehavior
Theadolescentparticipatesinastructuredworkprogram.
Thursday, January 28, 2016
M. Sandeep kumar
73

74. NURSING MANAGEMENT: -
Earlyinterventionprogramsareessentialtomaximizethepotential
development.
Thenursecanparticipateinprogramsthatteachinfantstimulation,activitiesof
dailylivingandindependentself-careskills.Asuccessfultechniqueintreatment
ofthementallyretardediscalledoperantconditioning.
Inadditionlearningsocialskillsandadaptivebehaviorassiststhechildin
buildingapositiveself-image.Forolderchildrenandadolescentassistance
isneededtopreparethemforaproductiveworklife.
Thursday, January 28, 2016
M. Sandeep kumar
74

75. MR REHABILOITATION CENTERS IN INDIA ……..
V.D. Indian Society for mentally retarded. Mumbai
The Association for the Welfare of Persons with a Mental Handicap in
Maharashtra (A.W.M.H. Male). Mumbai 400 023
NATIONAL INSTITUTE OF MENTALLY HANDICAPPED has three regional centers
located atNew Delhi, Kolkata, & Mumbai,
MITRA special school and vocational training center for the mentally retarded ,
Bengaluru, Karnataka.
Thursday, January 28, 2016
M. Sandeep kumar
75

76. MR REHABILOITATION CENTERS IN AP……..
1.Thakur HariPrasad Institute of Research & Rehabilitation for the Mentally
Handicapped, Hyderabad .
2.National Institute for the Mentally Handicapped ManovikasNagar,P.O.
Secunderabad.
3.RASS College of Special Education, RashtriyaSevaSamiti, SevaNilayam,
Tirupati .
4.B.S.R. College of Special Education for Mentally Retarded, Anantapur.
Thursday, January 28, 2016
M. Sandeep kumar
76

77. Thursday, January 28, 2016
M. Sandeep kumar
77