Upsala journal of medical sciences. Supplement最新文献

This paper sets out from an epidemiological point of view problems of measuring the prevalence of mild mental retardation. These include the problems always met in prevalence studies, of the validity of the classification, the completeness of ascertainment and the estimation of the size and characteristics of the denominator population. They also include difficulties peculiar to the condition of mild mental retardation, including the choice of method of classification whether by IQ testing or administratively; the heterogeneous nature of the individuals so characterised; and the confounding effects of social and biological factors and the changes in the implications for the affected individual of the condition, depending on age, sex and environment. It is concluded that normally measurements of prevalence can only be carried out on school age children and that these will change with age, and that we probably know very little about prevalence or implications of mild mental retardation at other ages.

Four birth cohorts born in 1969-1972 and living at the time of the census in Kuopio Province, Finland, were screened for mental retardation in two phases using school achievement tests in reading and mathematics. The criterion of mental retardation was established using psychological tests of verbal and visual perception abilities. The control groups of the two screening phases were randomly sampled from the studied birth cohorts. The case group was obtained on the basis of the mean and standard deviation of the control group scores in the psychological tests. A score of more than 2 SD under the mean (IQ less than or equal to 0.70) was the criterion of mental retardation. The overlap between the school achievement and psychological test matrices was explained with a general type canonical variate. The prevalence results were similar to earlier screening studies, but were clearly different from studies using only registered populations.

Behavior disturbance was found to be more frequent among mildly retarded (MMR) than a group of young adults matched during childhood for age, sex and social class. Reasons for this were examined. An unstable environment in childhood was found to be significantly related to behavior disturbance in both MMR and controls. The greater frequency of behavior disturbance among the MMR was due to their more frequently experiencing unstable environments in childhood than comparisons. Further, when stability of upbringing was held constant, differences in behaviour disturbance between the two groups were no longer found. Central nervous system damage was found not to be a contributory factor.

The relationship between mental retardation and psychiatric disturbance was studied by comparing the mentally retarded in the age group 20-60 years with matched controls. The mildly retarded showed a higher degree of neuroticism but did not differ significantly from persons of higher intelligence in the frequency of mental illnesses. By contrast the severely retarded showed an increased mental morbidity, mainly in the form of chronic psychoorganic syndromes, as compared with both the mildly retarded and controls.

According to a relative definition handicap arises in the relation between an individual (with a weakness, an impairment or a disability) and his/her environment. To identify handicap it is therefore necessary to use environmental criteria as well as individual ones. Several attempts have been made to take a relative definition as a basis for classification and research. These attempts, however, often end up using a traditional clinical perspective by reducing the highly complex environmental circumstances to the ability of the individual to handle those circumstances. This is the case with the terminology and classification schemes proposed by WHO (International Classification of Impairments, Disabilities and Handicaps: ICIDH). This is also what seems to have happened with the relative notion of mental retardation, presented 15 years ago in terms of "a social system perspective". One of the reasons might be the methodological problems involved in handling the complexity of social environmental factors. To transcend the clinical perspective and take the full consequences of the relative definition social and behavioral research need to focus on the social meaning of handicap as it manifests itself in daily life. This calls for an anthropological approach in studying the everyday lives of mentally retarded persons as well as studies of the role of the professional in labelling those persons.

In order to test some hypothesis of possible causes of different figures of prevalence reported for especially mild mental retardation ten Scandinavian studies 1961-1986 are reviewed, compared and critically analyzed. Theoretical definitions of mental retardation in these studies are found to correspond well. The operational procedures and measures used, in contrast, are much more heterogeneous and still more so the case-finding methods: sampling, screening or other identification procedures. It is concluded that case-finding methods are the most decisive factors for the resulting prevalence figures in epidemiological studies, especially concerning mild mental retardation. In an analogous way numbers of persons identified as mentally retarded within the special services (administratively classified by BPSMR) in different countries are determined by criteria for inclusion and social processes of different kinds.

A program for treatment--of high medical, emotional and social standard--for families with children with multiple congenital anomalies-mental retardation syndromes (MCA/MR) is presented. Using limited resources, 17 physician hours per family until the child reached the age of seven years, a total of 120 MCA/MR children (52 infants with Down's syndrome) were treated between 1975 and 1984. The medical care and support program included daily sessions with both the parents during the neonatal period, according to the principles of crisis therapy. Consultations were continued with the same doctor at the children's outpatient care unit. This article describes this support program and its outcome to date.