Development challenges
By Laura Dittmann, Ph.D.
- About 30 of every 1,000 children born in the United States are diagnosed
during infancy or later as developmentally challenged. The most severely challenged
are often discovered in infancy. Some are identified in their early
formative years. Others are found after they enter school.
The term developmental challenge covers a range of children with subnormal
mental ability—from nearly normal to totally dependent. Children are
considered developmentally challenged if they perform far below average, both
intellectually and behaviorally. They do not think, reason, remember,
and learn as well as other children the same age.
A number of other terms have been used to describe this condition, such
as mental deficiency, learning impairment, subnormal intelligence, and
incompetence. They all mean the same thing. But developmental challenge and
mental illness are not the same. developmental challenge means that a
person has subnormal mental ability. Mental illness means that a severe
emotional disturbance prevents a person with normal mental ability from
using the higher centers of the brain in a normal way. (See [Behavioral
disorders in children] in For Special Consideration.)
A developmentally challenged child who is neglected, treated badly, or forced
into unmanageable situations, may develop emotional problems and become
mentally ill.
Mentally challenged children are not just “slow learners.” They can never
catch up to the average child. In fact, they fall further behind as they
grow older. But, except in cases of extreme retardation, parents and
teachers can help developmentally challenged children
develop strategies so that they need not be totally dependent on others
to survive. The way the family and others treat a developmentally challenged
child has a lot to do with whether or not the child can remain
emotionally healthy and well adjusted.
What causes developmental challenge?
Many causes of developmental challenge have been discovered. A child may be
mentally challenged as the result of heredity, birth defects, illness, or
accident.
For example, if a child inherits certain defective genes from one or
both parents, the brain may not develop completely. Brain damage may
also be caused by an infection of the central nervous system before
birth, during infancy, or in early childhood. If a pregnant woman
contracts German measles or if she experiences severe malnutrition, her
baby’s development may be seriously damaged. Extensive injury to the
baby’s brain during an extremely difficult birth may also cause mental
retardation.
Even a child who has a healthy start in life may, in the formative
years, have an illness that produces a high, long-lasting fever or a
brain injury that interferes with mental development.
Some experts in the field of mental retardation believe that neglect,
malnutrition, surroundings that are dull and monotonous, and lack of
love and attention may also retard a child’s normal ability to learn. In
some instances, when these abnormal life conditions are improved, the
child’s mental development also improves.
Types of developmental challenge
developmental challenge is classified as severe, moderate, or mild.
Severe retardation can often be detected in infancy, possibly at
birth. The severely challenged infant may have difficulty learning to suck
and to swallow. The child may be slow to hold up the head, roll over,
and sit up. Some degree of independence in eating, toilet habits,
dressing, and self-care may be achieved. But usually, the severelchallengeded remain dependent throughout life. Sometimes, blindness,
impaired hearing, heart disease, epilepsy, or malformation of limbs are
also present.
Moderate retardation causes a child to develop more slowly than
normal. A few moderately challenged children may seem normal, except that
they are much slower to learn to speak, or their speech may be
unintelligible. Generally, they can learn to take care of their personal
needs, and those who are well adjusted may be able to live semi-
independently. They can be trained to do simple work.
Mild retardation may not be recognized until a child begins to have
difficulty at school. The child may not be able to pay attention as well
as other children. Simple directions may be impossible to follow. The
child may be unable to use scissors, crayons, pencils, and other
materials the way normal children do. These children often require
special classroom placement, where some can achieve fourth- to
sixth-gi-ade reading levels.
What parents can do
Whenever parents are puzzled by their child’s development, they should
seek professional help. The family doctor or pediatrician can refer
parents to a special clinic for a detailed diagnosis and evaluation of
the child’s condition. As a rule, a good diagnosis will include a
thorough study of physical, psychological, and social factors involved
in the child’s behavior. When a thorough study has been made, parents
feel less compelled to go from one doctor to another in the hope of
finding an easy cure for the condition.
challenged children, like normal children, should get good medical care
and attention.
They need nourishing food, plenty of sleep, scheduled immunizations,
correction of any physical defects that can be corrected, and careful
nursing during illness. A periodic reassessment of the child’s condition
is important.
Few parents adjust easily to the idea that their child is mentally
challenged, but some react more extremely than others. Many parents find
that talking to others in the same situation can be a great comfort. The
National Association fochallengeded Citizens has parents’ organizations in
most cities. Parents and others who are interestedchallengedrded children
meet to exchange ideas, discuss problems, set up camps or schools, and
promote understanding of mental retardation. The local health and
welfare council or the department of health will supply information
about such groups in the community. (See [Agencies and organizations
interested] IN THE WELFARE OF CHILDREN.)
Living with the challenged child
The challenged child, like all children, needs to begin life with parental
love in family surroundings. Today there is greater understanding of
retardation and more help available in the community. Most experts
recommend keeping the child at home rather than in an institution. If
parents can help the child do more and more alone, they will begin to
see the child as a learning individual rather than a family burden.
The developmentally challenged child’s day should be kept simple and orderly. Let
the child know what is expected from day to day. Patient teaching is
required to help the retarded child learn what the average child of that
age learns quickly. You may have to repeat the same instructions,
activities, and simple lessons many times before a simple idea is
grasped. Do not push the child beyond ability. If overloaded, the child
may become confused and any efforts to learn will be blocked.
To determine ability, watch the child’s behavior and concentrate on
whether the child is ready to do certain things. When the child is
physically and mentally able to do one task, think of a related or
slightly more complex task that you can teach next. Does
the baby reach for the bottle when it is offered? Then try to teach the
baby to hold the bottle. Can the child take off shoes and socks? Then
maybe it’s time to learn to put them on. If a hand can move to the
mouth, chances are the child can learn to eat unaided. Begin with small
bits of food and don’t discourage the use of fingers. The child can be
taught to manage a cup if there is only a small amount of liquid in it
and the cup is easy to hold. In time, increase the amount of liquid and
change the type of container. Tell the child what you want in clear and
specific terms. But remember to ask the child to do only one thing at a
time.
After a while, most parents come to accept the fact that their challenged
child will never have normal mental ability. They begin to find
satisfaction with their child’s progress, even if it seems slow and the
accomplishments are small. They no longer make comparisons with other
children in the family. They judge progress by what thchallengeded child
can do today compared to last month or last year. In some cases,
however, there may be no progress at all.
Parents need patience to discipline the challenged child. The child needs
to learn rules, but what is expected should be based on the child’s
ability and development. Sometimes, parents demand better behavior from
the developmentally challenged child than from the other children in the family.
They do not want thchallengeded child to “achallengedrded. They expect far
more in the way of control and cooperation than the child can possibly
offer. As with any other aspect of learning, the demand for more than
the child is capable of giving will hinder rather than help.
The challenged child’s effect on the family
All challenged children are not alike. Some are easy to care for. Others
cannot be trusted out of sight for a minute. Some need special care and
equipment from the time they are born. Others seem normal at birth, and
do not show retardation until later. One child may be attractive and
physically healthy. Another may have physical as well as mental
handicaps.
While it is not always the case, the severity of the retardation may
determine its effect on the rest of the family. If the retardation is
severe, it may be necessary to leave the child in the care of a sitter
occasionally so that the rest of the family can get out. The other
children may become resentful if their activities are curtailed by the
challenged sibling.
It is a good idea to train a special caretaker, and to keep the same one
if possible. Students enrolled in special education courses at nearby
colleges are often eager to experience caring for a challenged child.
Usually the brothers and sisters reflect the attitudes and behavior of
their parents toward the challenged child. The developmentally challenged child can
become the scapegoat for any problems, even those the family would have
if the child were not present.
On the other hand, the challenged child can become a valued member of the
family, around whose needs the others can rally and become united more
strongly than ever.
Schools and institutions
Many people have been long concerned about the educational needs of
mentally retarded children. In 1975, the United States took a major step
forward in this area when a new public law was passed. The law protects
the rights of these children and their parents or guardians. What’s
more, through federal aid to the states, the law assures that all
handicapped children—regardless of how they are categorized—have a
free public education that is designed to meet their individual needs.
This law makes it possible for more mentally challenged children to attend
nursery and regular schools in their own neighborhoods. Nevertheless,
there are somchallengeded children and some families for whom a special
school or institution is a better choice.
In deciding what is best for all concerned, parents of a mentally
challenged child may find it worthwhile to talk with a family counselor, a
pediatrician, a public health nurse, or school personnel.
Mark S. Puczynski, M.D. Consulting Editor
