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ORIGINAL CONTRIBUTION |
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| Year : 1997 | Volume
: 51
| Issue : 2 | Page : 35-40 |
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A study of some etiological factors and morbid conditions in mentally handicapped children
JS Bhawalkar, NR Aswar, SN Wahab
Deptt of Preventive & Social Medicine. Govt. Medical College, Nagpur 18., India
Correspondence Address:
J S Bhawalkar
Deptt of Preventive & Social Medicine. Govt. Medical College, Nagpur 18.
India
PMID: 9355706
How to cite this article:
Bhawalkar J S, Aswar N R, Wahab S N. A study of some etiological factors and morbid conditions in mentally handicapped children. Indian J Med Sci 1997;51:35-40 |
How to cite this URL:
Bhawalkar J S, Aswar N R, Wahab S N. A study of some etiological factors and morbid conditions in mentally handicapped children. Indian J Med Sci [serial online] 1997 [cited 2013 May 21];51:35-40. Available from: http://www.indianjmedsci.org/text.asp?1997/51/2/35/11535 |
Mental handicap is a lifelong disability. The birth of an infant with mental handicap places heavy burden on the family, community and the medical care system. [1] In addition to the defects in the intelligence and adaptive behaviour some mentally handicapped children have medical problems or associated handicaps. Some of the most common medical problems encountered in these children are - epilepsy, hyperkinesis, physical handicaps and psychiatric problems such as psychosis, autism and neurotic disturbances. [2] In the present study an attempt was made to study the mentally handicapped children 1) To assess the degree of mental handicap and its causative factors and 2) To know the associated morbid conditions in these children.
| ¤ Subjects and Method | |  |
For the present cross-sectional study all 185 mentally handicapped children in the age group 5 to 18 years enrolled in the "Nandanvan" - a school for mentally retarded children, Nagpur, were taken. It is the , biggest school for such children in Vidarbha region.
Detailed history about mental handicap was obtained from the parents (mostly from mothers) of the handicapped children. This information was cross-checked with the medical records and school records. Detailed clinical and neurological examination were carried out for the assessment of degree of mental handicap. The standard intelligence quotient tests like Binet-Kamat verbal test and Seguin form board test were applied with the help of trained psychologist. [3],[4] Urine samples were taken for ferric chloride test for detection of phenylketonuria and other aminoacidurias and for toluidine blue paper spot test for detection of mucopolysaccharides. Blood samples were taken for chromosomal analysis. [5]
| ¤ Results | | |
All 185 mentally handicapped children were in the age group of 5 to 18 years. The male - female ratio was 4.7 :1. Out of 185 mentally handicapped children 83 (44.9%) were moderate, 57 (30.8%) were mild and 42 (22.7%) were severe mental handicaps. Two study subjects were having profound mental handicap while only one (0.5%) was having borderline mental handicap. The various factors responsible for the causation of mental handicap are shown in [Table 1]. These factors are - Down's syndrome (13.0%), cases, genetic conditions (14.0%), maternal diseases and infections (3.8%) cases, perinatal factors like birth trauma, birth amoxia, prematurity and cerebralpalsy (14.1%) and post infective condition (20.5%).
In our study Downs' syndrome was the causative factor in 24 (13%) study subject and we found that the maternal age at the time of birth of these children was above 30 years in 66.66% cases. In 33.4, study subjects the maternal age was below 30 years.
Further it was observed that delayed milestones was the main presenting symptom in 171 (92.4%)followed by lack of social since in 163 (88.1 %) and lack of self care in 158 (85.4%) study subjects. Speech defects mild or severe was present in 138 (74.5%) study subjects. Dull-nesses in daily life 52 (28.1%) and physical deformities 28 (15.1 %,) were the next common presenting symptoms.
It was also observed that associated behaviour problems were present in 61 (33%) study subjects i.e. Temper tantrum in 17 (9.2%), breath holding spells in 15 thumb sucking in 14 (7.6%) end eneuresis in 10 (5.4%) handicapped children and other associated behaviour problems like aggressive behaviour, psychosis, fuge etc. were observed in 5 (2.7%) study subjects.
[Table 2] shows the medical problems or morbid conditions were observed amongst the 47% mentally handicapped children. In some study subjects more than one morbid conditions were observed.
| ¤ Discussion | | |
The severity of mental handicap in the study subjects was estimated with the help of Binet-Kamat Verbal Test and Seguin form board lest. In the present study, most of the subjects belonged to moderate or mild degree of mental handicap. Similar results were also observed by Madhavan T. et al. [6] In such schools mostly trainable mentally handicapped children are admitted so that these children can be trained in self help skills like self help general, self help eating, self help dressing, self direction, socialization, occupation, communication and locomotion.
In the present study - the various - factors responsible for causation of mental handicap in children act during prenatal, pernatal and postnatal period. Similar factors were also observed by other workers. [7],[8],[9],[10]
Some of these causative factors tike Down's syndrome, famitiat mental handicap, consanguinity amongst the parents, post infective conditions like meningitis, encephalits and febrile convulsions and post traumatic conditions are preventable. People should be made aware and counselled about these conditions to prevent the mental handicap.
In the present study the associated behaviour problems like breath holding spells, temper tantrum, enuresis, thumb sucking, aggresive behaviour, psychosis, fuge were observed in a 33% study subjects. It is well documented that mentally retarded children have a greater risk of developing psychiatric disorders as compared to the children with normal intelligence. [11] Certain neurophysiological mechanisms have considered to be responsible for this vulnerability. Another psychological variable which has been shown to be related to emotional disorders in children in tempertantrum. Mentally retarded children with adverse temperament traits make them vulnerable to develop psychiatric disorders during course of development.
Other common morbid conditions like epilepsy, hypotonia, squint, recurrent respiratery infections, spastic quadriparesis were also present in these study subjects. Similar morbid conditions were also. observed by other workers. [6],[11] Early detection of such morbid condition and their treatment is essential to prevent the aggregation of these conditions anti behaviour abnormalities and to raise the health status of a mentally handicapped children.
| ¤ Summary | | |
In the present study most of the subjects belonged to mild and moderate degree of mental handicap i.e. 30.8%, and 44.9% respectively while severe degree of mental handicap was present in 22.7% subject. The factors responsible for mental handicap include prenatal factors (34.6%), perinatal factors (15.1%) and post natal factors (37.9%). In 12.4% cases etiology was not known. The associated behaviour problems were observed in 33% of the study subjects while other morbid conditions were present in 47% of the study subjects.
| ¤ References | | |
| 1. | Abramowicz HK, Richardson S. Epidemiology of severe mental retardation. Am J Mental Deficiency 1975;80:33-38.  |
| 2. | Madhavan T, Kalyan M. Mental retardation. A Manual for multi rehabilitation workers. National Institute for mentally handicapped, Manovikas Nagar, Bowenpally, Secunderabad-11; 1st edition 1988. |
| 3. | Madhavan, T, Kalyan MN, Peshawaria R, Narayan J. Mental retardation : A manual for psychologist: National Institute for mentally handicapped, Manovikas Nagar Bowenpally, Secunderabad-11, 1 st edition 1989. |
| 4. | Phatak P. Measuring intelligence by Draw - A-Man test for children : Anand agencies Shukra waripeth, Pune 02: 1st edition (Marathi) 1990. |
| 5. | Bradley M, Schumann G. Examination of urine : In : Todd, Sanford, Davidson. Clinical diagnosis and management by Laboratory methods. W.B. Saunders company, Philadelphia, 1st edition 1989:380-458. |
| 6. | Madhavan T, Narayan J. Epilepsy and Mental Retardation. Indian J Psychiatry 1P92;34:12-17. |
| 7. | Somasundarain 0. Some Etiological Problems in Mental Retardation - Solved & Unsolved, 1st All India Conference of Mental Retardation. Indian Pediat 19668:5:558-563. |
| 8. | Bhatt PS, Gupta HL. A study of Mental Retardation with special reference to inbornerror of Metabolism. Indian J Paediat 1968:23: 4669-472. |
| 9. | Sinclair S. Etiological Factors in Mental Retardation - A study of 470 cases. Indian Pediat 1972;9:391-396. |
| 10. | McDonald AD. In the prevention of Genetic Diseases and Mental Retardation : Milunsky A.: 1975: W.B. Saunder's Company West Washington Square. Philad,elphia : 1st Edition 1973:2.9 |
| 11. | Chaudhary S. Psychological Characteristics of the Handicapped Children. Indian J Pediat 1986: 53: 229-236. |
[Table 1], [Table 2]
| This article has been cited by | | 1 |
Molecular basis of X-linked non-specific mental retardation |
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| Pandey, U.B., Mittal, B. | | Indian Journal of Experimental Biology. 2004; 42(6): 549-557 | | [Pubmed] | |
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