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Mental Handicap

About one child in a hundred is born with a severe abnormality of the brain. About half of these infants die soon after birth or before the age of seven, so that after this age four children per thousand are severely mental handicapped. Mild mental handicap is more common, and occurs in two to three per cent of the population, The mildly­mentally handicapped are not very different in appearance and behaviour from ordinary people, but are poor scholars and the disability tends to be discovered at school.

Causes of mental handicap

The severer forms of mental handicap are usually due to an abnormality of brain structure. The condition may be hereditary - due to fault genes or to an abnormal or additional chromosome - or congenital, caused by an infection in pregnancy such as German measles. The birth process itself is critical for the brain, which may suffer during delivery from lack of oxygen, or later from an excess of bile pigment or sodium in the blood, The importance of nutrition in the newborn child, especially the premature infant, as regards mental development is now recognized. After birth, infections such as meningitis can damage the brain. A few children become severely retarded following head injury, lead poisoning or other environmental factors.

Little is known about the causes of mild mental handicap, Social and cultural factors are important: children from underprivileged groups, those with ill mothers, those whose mothers are shorter than average, or those whose mothers smoked during pregnancy are at greater risk.

The parents of a backward child often first become concerned because of the child's delay in reaching the various stages of development. The baby may be quiet. sleep a lot, show little energy, take feeds without enthusiasm, or be slow to gain weight, take notice, smile, sit up and crawl and later on, standing, walking and talking may not occur until well after the ages of the usual milestones.

Down's syndrome

Down's syndrome (trisomy 21) occurs in about one birth in 600, and' is due to the presence of an additional chromosome in each body cell. The birth weight of such babies tends to be low, they are 'floppy', with the nose and facial skeleton poorly developed, and there may be a number of additional physical signs of the disorder, For more information.

Errors of metabolism

There are several errors of metabolism (problems concerned with the body's chemical functioning) that may lead to mental handicap, Phenylketonuria, the most common, is the inability to break down a certain amino acid, phenylalanine, completely because of the lack of the necessary enzyme. By-products of the incomplete breakdown of the phenylalanine then accumulate in the body, eventually causing brain damage. The condition is diagnosed by testing the blood at birth (the Guthrie test). and is treated by a special diet low in the amino acid. PKU affects about one in 10.000 children and is inherited.

Another chemical abnormality is homocystinuria, which is also characterized by an excess of one particular amino acid in the blood and urine. The condition can be recognized by looking at the child: one of the characteristics is dislocation of the lenses of the eyes.

Treatment of mental handicap

There is little scope for curative treatment in the field of mental handicap because, to be successful, the treatment must be given before mental handicap has developed. Children with mild mental retardation should not, in general, be treated differently from normal children, even if they have other defects such as poor sight, hearing faults or epilepsy. Parents of the more severely handicapped need sympathetic advice from all concerned. The attitude of the obstetrician, the children's specialist, the general practitioner and the nurses and other professionals will set the tone and determine the parents attitude. If these advisers are able to show sympathetic understanding and can find time for counselling, parents will be helped to accept their misfortune realistically and constructively. They may avoid the extremes of rejecting the child on the one hand and refusal to acknowledge his or her retardation on the other. Advice from a trained social worker should assist them in home care and in finding an appropriate school.

Backward babies have basically the same needs as other children, but develop at a slower pace: they remain babies longer. They demand infinite patience and a great deal of love. If parents can come to terms with the situation they can often achieve gratifying results: to see their child taking its first steps can be as rewarding for them as for other parents when their normal child has been awarded a scholarship or shows great sporting or music ability.

Prevention of mental handicap

The prevention of mild mental handicap is largely a social and national or community problem. The findings of studies in the United States and Britain suggest that anything that improves the health of the mother and the environment of the child is likely to reduce the incidence of backwardness. The quality of obstetrical care is important as is the care of the newborn, especially for infants at risk: and visiting nurses may play an essential role here.

The prevention of severe mental handicap is only possible where the cause is at least partly understood. Would­be parents who know or suspect that some sort of inherited problem, such as Down's syndrome. runs in the family should ask their GP whether expert advice on genetic counselling is appropriate. When there are grounds for anxiety during pregnancy, the fluid surrounding the fetus can be sampled by the technique of amniocentesis to identify chromosomal and other defects: if the test is positive, the parents will be offered a termination of the pregnancy.

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