Mentally retarded children of eastern India: A biosocial study

Abstract

Biosocial characteristics of 265 mentally retarded and 253 nonretarded children comprising 518 handicapped children from eastern India were studied to discern characteristics significantly associated with the retardates. The children studied were consecutive referrals between January 1977 and April 1981 to the Centre for Handicapped Children, Institute of Child Health, Calcutta. Comparison of retarded and nonretarded children showed the incidence of mental retardation to be significantly associated with age of children, age of mothers, parents’ socioeconomic class, family size, birth order, tempo of motor development, and family history of psychiatric illness. The proportion of retardates was higher among the handicapped girls than among boys, and the level of retardation was significantly associated with sex. Implications of findings are discussed.     

Postnatal Organic Causes of Mental Retardation

A study of 1137 retarded children from Western Ontario revealed 129 (11.3%) in whom retardation was first noted after a specific postnatal event. Eighty-three of these were boys. The most common cause of postnatal cerebral injury in this series was a syndrome of unknown etiology characterized by the sudden onset of fever, convulsions and coma which occurred in 45 patients. The nature of this syndrome is discussed and the necessity for early treatment emphasized. Other postnatal causes of retardation are classified according to frequency, as encephalitis, accidents, meningitis and a miscellaneous group consisting of epilepsy and tumours.     

In Memoríam

Mental retardation is a symptom of an underlying disease process. In California state hospitals for the retarded an accurate dynamic diagnosis is possible through utilizing the knowledge of neurology, psychiatry, pediatrics, psychology, social service, rehabilitation, education, the laboratory and trained psychiatric technicians. A program of "custody" is archaic and we are returning to the concept of training, treatment, and turnover. This kind of program is essential in order to avoid building new hospitals at the cost of millions of dollars every few years.Parent organizations for retarded children are expanding in ever increasing number. Special education programs in public schools, foster care homes and sheltered workshops may make admission to hospitals unnecessary and aid return of patients to the community.     

Frequency of the fragile X syndrome in institutionalized mentally retarded females in Japan

Summary The fragile X [fra(X)] syndrome was screened on 190 Japanese institutionalized females with moderate to severe mental retardation. Two inmates with severe mental retardation (IQ 20) had the fra(X) chromosome in 26% and 15% of the cells examined, indicating that the prevalence of the fra(X) syndrome was about 1% in all female inmates and was about 3.27% in severely mentally retarded females with known causes. However, no female with fra(X) syndrome was found in 35 moderately retarded females. Both had brothers with the fra(X) syndrome and the prevalence was 10% in females with a family history of mental retardation. In addition, the replication study of the fra(X) chromosome in the patients supported the proposal that an excess of the early replicated fra(X) chromosome is related to the mental capacity in heterozygous females. Therefore, the fra(X) syndrome should not be ignored even in severely mentally retarded females with a family history, though the heterozygotes are commonly normal to subnormal in their mental development. in addition, the replication study of the fra(X) chromosome may help to estimate mental development in the carrier children.     

PREVENTIVE ASPECTS OF MENTAL RETARDATION

Estimates of the incidence of mental retardation vary from 1 to 3 per cent of the population. Prevention of this disability requires different methods, depending on the cause. Retarded persons are of four broad categories: Those who are the low end of the normal distribution curve of intelligence in the general population, without any specific illness or defect; those in whom retardation is culturally and socially determined; those who are functionally retarded due to emotional disorder; and those with damage of the brain structure.More flexibility is required within our relatively complex society so that dull people can adapt themselves, achieve acceptance, and find a vocation within their range of ability.There is need for improved services for the early diagnosis and treatment of emotional disturbances in children, and for counselling with parents of slow learning children to make the family climate as favorable as possible.Certain diseases which cause organic defects in the brain are now sufficiently well understood to make possible the prevention of mental retardation in persons with these diseases—cretinism and congenital syphilis among them. More recently, an increasing emphasis on the preventive approach to mental retardation has been made possible through our understanding of the effects of German measles in early pregnancy, knowledge of such metabolic errors as phenylketonuria and galactosemia, of kernicterus caused by Rh incompatibility between mother and child, as well as by our increased knowledge of human genetics.     

The Management of the Retarded Child in Practice

The management of the retarded child in general practice is discussed. The necessity of a thorough medical and psychological assessment is stressed. The problem of the parents is described from the point of view of the emotional stages through which they pass and the defence mechanisms they commonly use. The factors involved in planning the future program for the retarded child are enumerated and depend on the degree of mental and physical handicap, the socio-economic and emotional climate of the family and the available services in the area. Since a large proportion of retarded children remain at home, a systematic follow-up program by the practising physician should be encouraged.     

Chronobiological aspects of stereotyped motor behaviour in mentally retarded children

Normally developed children show many diverse patterns of behaviour. By contrast, the behaviour of severely mentally retarded children is restricted mainly to primitive motor acts called stereotypes. Due to the severity of the mental retardation, these children are also markedly reduced in their susceptibility to environmental influences. Systematic observations of the pathological motor patterns of these children make it feasible to investigate possible endogenous mechanisms related to these primitive motor activities. The stereotyped motor behaviours of six severely mentally handicapped children were observed continuously for several days. Each child performed at least two forms of stereotyped behaviour. Using spectra of variance and cross-correlation analysis, the data were investigated with respect to underlying periodicities. A 2.5-hour cycle was consistently found in every stereotyped activity observed. Furthermore, stable phase relationships were revealed between the periodic variations of different stereotyped movements in one and the same child. Thus the temporal courses of hand and oral stereotypes were synchronous, whereas head and whole-body stereotypes were delayed by half a phase with respect to stereotyped hand waving. A possible relationship is discussed between the 2.5-hour periodicity of stereotyped behaviour and Kleitman's "Basic Rest Activity Cycle".     

Canadian departments of pediatrics and family medicine: in need of family therapy?

Whether and how much the departments of pediatrics in Canadian medical schools collaborate with the family medicine departments in training for child care were the focus of a survey conducted in 1983-84. Responses to a questionnaire sent to department heads indicated that in general the most supportive relationships existed in the western provinces, with progressively more problems uncovered from west to east. The responses concerning the roles of pediatricians and family physicians paralleled this trend, with the western view being that pediatricians are consultants and not competitors for primary care. Many respondents supported the expansion of family medicine, particularly into ambulatory and behavioural areas. The data provide some cause for concern about the future health care of children, as the forecasted oversupply of physicians is likely to encourage competition rather than consultation between the two groups. Also, many Canadian pediatricians accept the US model of pediatrics, which includes primary care, although in Canada the ratio of family physicians to pediatricians is six times that in the United States, and Canadian specialists are concentrated in urban centres. This means that family physicians will continue to provide most of the child care in Canada and need adequate training. They also need to develop cooperative, supportive relationships with specialists in child health care to enhance appropriate referral patterns.     

The load of genetic and partially genetic diseases in man. III. Mental retardation

This paper summarizes estimates of detriment associated with different etiologic categories of mental retardation (MR) in Hungary. The basic data derive from an earlier study carried out in Budapest on 1276 school-age mentally retarded children (with some etiologic reclassification based on recent studies). Detriment associated with these different categories of MR is expressed in terms of years of lost and impaired life. About 30 per 10(3) school-age children in Hungary are mentally retarded (mild + severe MR), one-tenth of whom have severe MR (IQ less than or equal to 50); 50% of the latter are institutionalized. The breakdown on the basis of etiology is as follows: gene mutations and chromosomal abnormalities, about 4 per 10(3); 'familial' (multifactorial) causes, 12 per 10(3); adverse pre-, peri- and post-natal causes, 11 per 10(3); and 'causes as yet unknown', the remainder. The estimates of mean number of years of lost life range from 42 to 68 (depending on the etiologic category), with an overall mean of 58. The total number of years of lost life is about 36,000 per 10(4) live births of which over 70% is due to pre-, peri- and post-natal causes, 18% due to 'familial' causes and the remainder due to Mendelian and chromosomal diseases. The total number of years of impaired life is about 7300 per 10(4) livebirths, 50% of which is due to 'familial' causes. While admittedly approximate, these estimates suggest that detriment associated with MR-related causes is not inconsiderable. Additionally, they provide some indication of causes of MR which are minimizable.     

The Interaction of Child Care and Family Risk in Relation to Child Development at 24 and 36 Months

Family risk factors (psychosocial, socioeconomic, and sociocultural), child care characteristics (quality and hours in care), and the interactions of these variables were examined as predictors of behavior problems, prosocial behavior, and language skills in a longitudinal sample of 943 children (assessed at 24 and 36 months) enrolled in child care as infants. Family risk variables were the strongest predictors of all outcomes. Child care quality was a significant predictor of 36-month caregiver-reported social skills and 36-month language skills. Contrary to expectations, limited evidence was found to suggest child care experiences moderate the negative associations between family risk and child outcomes. Family risk interacted with child care quality in only 1 of the 5 analyses, and did not interact with child care quantity in any of the analyses. One interaction between family risk and child care was significant. Children from minority and single-parent families were rated as less prosocial by their mothers when in low-quality child care.     

The Problem of Mental Retardation (A Tentative Working Hypothesis)

Within the general problem of mental retardation, the focus has traditionally been on the child's intellectual inadequacy, his feeblemindedness. This is entrenched in the very term used to designate these children, who are usually called feebleminded, or mentally retarded. All the other aspects of the personality of such a child are usually seen as phenomena arising secondarily as a function of the basic intellectual defect. Many investigators do not even see any essential affective and volitional differences between these children and normal children. …     

Childhood Psychosis or Mental Retardation: A Diagnostic Dilemma: II. Pediatric and Neurological Aspects

A pediatric and neurological study of 62 retarded psychotic children revealed more family psychopathology, complications of pregnancy, and serious postnatal illness than in a control group. Motor development and speech development were slow in psychotic children, but obstetrical complications at the time of birth were not significantly more frequent than in controls. Abnormal physical findings in psychotic children were mainly congenital anomalies. Neurological deficits included mental retardation, speech defects, strabismus, and other non-localizing signs. EEG tracings were abnormal in 27 of 51 psychotic patients. At least 46 of the 62 psychotic children studied had evidence of organic brain disease.Although an inadequate family background may be associated with the development of psychosis, a severe disturbance of temporal and frontal lobe function may produce psychotic symptoms with or without familial predisposition.     

Some problems in the genetics of X-linked mental retardation

X-linked mental retardation has recently become one of the most interesting genetic anomalies. Studying this group of conditions has led to many insights into the mechanisms involved in normal and abnormal gene actions in humans. Since the early 1980s, the number of disease entities for which the responsible genes could be localized on the X chromosome has increased from year to year; at the Ninth International Workshop on Fragile-X-Syndrome and X-linked Mental Retardation, 199 such disease units were counted (Hamel, 1999). Conventionally, these units were subdivided into two groups: syndromal and non-syndromal types. The syndro- mal types are characterized by external features, neurological signs, and/or metabolic anomalies. The non-syndromal types do not show such specific features; here, the X-linked mode of inheritance is the only indicator. Due to the reduced reproduction of mentally severely retarded males, a relatively high fraction of new mutants among cases of a specific type must be expected. It cannot be the purpose of the present short article to review sufficiently well the entire field; this would require a complete book. Rather, it is our intention to point to some open problems and possible ways for their solution.     

A Comparison of the Wellbeing of Orphans and Abandoned Children Ages 6–12 in Institutional and Community-Based Care Settings in 5 Less Wealthy Nations

Background

Leaders are struggling to care for the estimated 143,000,000 orphans and millions more abandoned children worldwide. Global policy makers are advocating that institution-living orphans and abandoned children (OAC) be moved as quickly as possible to a residential family setting and that institutional care be used as a last resort. This analysis tests the hypothesis that institutional care for OAC aged 6–12 is associated with worse health and wellbeing than community residential care using conservative two-tail tests.

Methodology

The Positive Outcomes for Orphans (POFO) study employed two-stage random sampling survey methodology in 6 sites across 5 countries to identify 1,357 institution-living and 1,480 community-living OAC ages 6–12, 658 of whom were double-orphans or abandoned by both biological parents. Survey analytic techniques were used to compare cognitive functioning, emotion, behavior, physical health, and growth. Linear mixed-effects models were used to estimate the proportion of variability in child outcomes attributable to the study site, care setting, and child levels and institutional versus community care settings. Conservative analyses limited the community living children to double-orphans or abandoned children.

Principal Findings

Health, emotional and cognitive functioning, and physical growth were no worse for institution-living than community-living OAC, and generally better than for community-living OAC cared for by persons other than a biological parent. Differences between study sites explained 2–23% of the total variability in child outcomes, while differences between care settings within sites explained 8–21%. Differences among children within care settings explained 64–87%. After adjusting for sites, age, and gender, institution vs. community-living explained only 0.3–7% of the variability in child outcomes.

Conclusion

This study does not support the hypothesis that institutional care is systematically associated with poorer wellbeing than community care for OAC aged 6–12 in those countries facing the greatest OAC burden. Much greater variability among children within care settings was observed than among care settings type. Methodologically rigorous studies must be conducted in those countries facing the new OAC epidemic in order to understand which characteristics of care promote child wellbeing. Such characteristics may transcend the structural definitions of institutions or family homes.     

PKU screening — Is it worth it?

Ontario''s program for PKU screening of newborn infants reached 94.5% of the newborn population from 1966 to 1971. There were 70 infants identified by the program, 47 of whom were classical cases and 23 atypical cases of phenylketonuria. The incidence was 1:16,700 live births for classical cases and 1:34,000 live births for atypical cases. Since the beginning of the program 44 children have been identified in infancy as having PKU and have been treated successfully. Retardation has become evident in only three infants, two of whom were missed by the screening program.The cost of identification and care of one child for five years is about $7000, much less than the $250,000 needed to provide lifetime institutional care for one severely retarded individual.     

A Survey of Toxoplasmosis Among Mentally Retarded Children

To determine what role, if any, toxoplasmosis plays in the mental retardation of children, sera from 345 mentally retarded children were tested for the presence of antibodies to Toxoplasma gondii. The serological tests employed were the complement-fixation, the Sabin-Feldman dye test and the immunofluorescence test. The donors were also skin-tested with toxoplasmin.Of 345 mentally retarded donors nine gave a positive skin reaction, 15 possessed complement-fixing antibodies, 21 had immunofluorescent antibodies and 45 had dye test antibodies to T. gondii.The incidence of antibodies to T. gondii in the mentally retarded group was approximately the same as in the normal control group of the same age, and less than in the group suspected of having toxoplasmosis. It is concluded that in the children in this study toxoplasmosis played little or no role as a predisposing factor in the occurrence of congenital mental deficiency.     

Gender differences in child survival in contemporary rural China: a county study

Using data from a survey of deaths of children less than 5 years old conducted in 1997 in a county in Shaanxi Province, China, this paper examines gender differences in child survival in contemporary rural China. First, excess female child mortality in the county in 1994-96 is described, followed by an analysis of the mechanisms whereby the excess mortality takes place, and the underlying social, economic and cultural factors behind it. Excess female child mortality in this county is probably caused primarily by discrimination against girls in curative health care rather than in preventive health care or food and nutrition. Although discrimination occurs in all kinds of families and communities, discrimination itself is highly selective, and is primarily against girls with some specific characteristics. It is argued that the excess mortality of girls is caused fundamentally by the strong son preference in traditional Chinese culture, but exacerbated by the government-guided family planning programme and regulations. This suggests that it is crucial to raise the status of girls within the family and community so as to mitigate the pressures to discriminate against girls in China's low fertility regime. Finally, the possible policy options to improve female child survival in contemporary rural China are discussed.     

Recent Advances in Medical Knowledge of Causes of Mental Retardation

A steady reduction of mortality owing to advances in medicine has altered the patterns of disease, increasing the proportionate importance of certain types of disease in the very young and the very old.Neonatal and infant mortality rates in mongolism remain very high. The mortality has nevertheless fallen considerably and this may well be so for other diseases causing mental retardation.Despite dramatic advances in the fields of biochemistry and cytogenetics, revealing many new causes of mental retardation, a large proportion of mentally retarded patients are still undiagnosable in respect of etiology.Other principles of causation, not so often discussed in the medical literature, deserve consideration, e.g. isoimmunization due to other antigens than those of the blood groups and diseases due to deficiency of some trace element. Peculiarities of distribution, geographical, seasonal, occupational or social, merit examination, and recent research along these lines has led to significant results. Whole classes of causes may not have occurred to us, and it may prove fruitful in this respect to turn our minds toward less fashionable paths of thought.     

Male fertility attitudes: a neglected dimension in Nigerian fertility research

A sample of 202 male Nigerians enrolled in colleges and graduate schools in the state of Kansas were surveyed to determine their perceptions of population problems in Nigeria; attitudes toward family planning, divorce, and male children; and attitudes toward family size. A major limitation of Nigerian-based fertility research has been the neglect of the role of men in couples' reproductive behavior. The majority of Nigerian students surveyed in this study did not think overpopulation is an impending crisis in Nigeria: 40% thought there are just enough people and 13% indicated there are not enough people. 53% supported the concept of a government population policy, but 67% felt the government should not interfere with family size decisions. Although 84% endorsed the idea that family planning services and information should be available, 69% felt women should not practice family planning without the consent of their husbands. 43% believed a man should divorce his wife if the woman is infertile, unable to produce a male child, or unable to bear the number of children demanded by her husband; in addition, 35% indicated a man should marry a second wife or continue to have children if the couple has 5 daughters and no son. In terms of the value of children, 62% stated that children are wealth or better than wealth, whereas 38% claimed that children use up wealth. Duration of stay in the US was inversely correlated with the number of children considered too many, and the number of male children already born was an important determinant of future family size expectations. In general, it appears that level of education and exposure to US standards do not have a major impact on fertility values among Nigerians, particularly the desire for male children. Educated Nigerian men are an important target for population education, however, because they dominate and control many of the structural, behavioral, and cultural dimensions of fertility behavior.     

Does there exist a correlation between the number of whorls of the finger tips and birth order of sibs? (author's transl)]

It was stated by Birdsong and Rashad (1972) that the child of birth order number six of Korean families has significantly more true whorls on the finger tips than older brothers and sisters. To verify this assertion we studied a sample of all members of 43 normal German families with 5 or more legitimate children. The findings of the epidermal finger pattern types and those of the toe patterns were analysed. Results indicate a different conclusion regarding the number of digital whorls which were not increased statistically with increasing number of sibs. The number of whorls were randomly distributed within the heritable range of variability of the particular family. It appears of importance that, due to our analyses, the value of information of the characteristic "number of whorls" is not reduced and does not require a specific consideration regarding birth order. Furthermore, it can be stated preliminarly that there is no hint pointing to an influence of the maternal age on the number of whorls in their offspring.