WORKING WITH A MENTALLY DISABLED CHILD AND HOMEOPATHIC MANGEMENT
Dr SANOOP.K.K, B.H.M.S, M.s.c, ND,DNHE
We shall discuss managing a mentally disabled child in three situations – at home, when the parents know that the child has a disability, homoeopathic management at our centre and at the early childhood education centre, when the child starts attending it. In both cases, you have an important role to play. You would need to guide the parents as how to stimulate the child at home, before she is mature enough to join the centre. At the centre, you as an educator can help the child to develop her abilities to the maximum.
We shall first describe some aspects that one must keep in mind when working with mentally disabled child. These methods are applicable in home setting as well as in the centre.
1) Begin to provide stimulation, training and education to the child as early as possible/as soon as the child is identified to have a mental disability
During early years, the child makes rapid strides in all areas of development and is receptive to positive (as well as negative experiences) . Time lost now is difficult to make up later on.
2) Praise the child, hug her or give her a prize when she does something correctly. Even the slightest attempt must be praised. Avoid giving sweets as rewards.
Praise makes the child happy and she works much better than when we scold her for failure. If she fails, encourage rage her to try again or ignore it for a while.
3) Make learning fun. Try to make learning experiences enjoyable. Play is the best way to combine fun and learning. Keep doing an activity as long as the child is enjoying it. When she looks disinterested, change it or stop it for a while.
Children learn best and are co-operative when they enjoy the activity they are doing.
4) Help the child only as much as is needed. Do not do all of child’s work. Even if she takes long, let her try to do as much as she can. This will challenge her to do things even when no help is around.
Providing full encouragement and partial assistance would be a good rule to follow to make all the child self-reliant gradually.
5) Be regular in teaching/stimulating the child
A mentally disabled child is slower in learning and understanding
6) Repeat the activity often.
She also has a shorter memory span and may forget what has been taught the previous day. If training stimulation is not regular, the child will forget what has been taught, earlier and you would need to begin all over again.
7) Break an activity in many steps and teach one step at a time. This is true of any activity in any area of development. Teach the second step only when the first step has been learnt well. When the second step is learnt, repeat the first and the second step so that the child perceivers them as continuous and it becomes a habit then go on to the third step.
This is the way learning takes place with most children. However, we do not perceive it in so many steps, because it happens quickly. Since mentally disabled children are slower in understanding more time will have to be spent on each step of learning
8) Be patient when working with the child. Do not force the child to learn. Do not laugh at or punish the child Put the activity aside for some time and then go back to it again. Do not expect results overnight. Do not give up, even if progress is slow.
Forcing the child even when she is not able to do something frustrates her. She loses confidence in herself and may hesitate to try again. Laughing or ridiculing the child will lower her self-concept
9) Most importantly, make the child feel loved, secure and wanted
Any child develops best in an emotionally fulfilling environment.
Let us now see what are the areas in which a mentally disabled child requires help and what can be done to help her improve her functioning – at the home and at the centre. Subsection describes how the parents can begin training the child at home. While it starts aspects to be kept in mind while working with the child in the centre, is applicable to the home situation as well.
How much difficulty a child experiences in each of these depends on the degree of mental disability. A mildly disabled child is likely to have only a little difficulty. In the some way, the amount of time you need to spend with the child to help her learn will be influenced by the degree of retardation. A child with moderate mental disability will be able to acquire these skill much faster than a severely retarded child.
Beginning Training at Home
a) Movement /Motor Coordination
All the children begin to use their bodies to move and look around themselves as they grow. A mentally disabled child will have difficulty in one or more of the following areas involving movement.
· Looking at different things
· Holding the head straight
· Sitting with or without support
· Standing with or without support
· Walking using a support
· Standing and walking independently
· Using the hands to hold objects.
Due to these, the child may find it difficult to function without the help of others.
The following are some activities that you can carry out to help the child with the above.
Lay the child on her back so that she is looking at you. Swing a colorful object in front of the child, such a colourful ribbon or a toy. Move the ribbon up and down, or in a circular motion. The child’s eyes will follow the movement.
Take the child along with you, wherever possible. Do not leave her alone in the room. Point out the various objects in the room/street. These will create an Interest in her and motivate her to look around.
Holding the head straight and rolling over
Let the child lie on the stomach. Sit in front of the child, so that the child can see you. Roll a coloured ball or any other colourful object back and forth. Help the child to turn her head to look at the ball. Putting a pillow under the chest will support the child’s head. You can add more pillows if you feel the child is not comfortable.
Do this activity two or three times a day. Carry out the activity each day. Talk to the child during the activity. This will hold her interest and also give her encouragement.
Once the child can balance her head, encourage her to roll over on her side by putting an attractive object some distance from her and encouraging her to reach for it.
Hold the child ’s hand when she is lying down. Gently, pull the child to a sitting position, supporting her back. You can put a pillow behind the child to give her support . Let the child sit only for a short time. Do this activity many times each day.
Gradually , over a period of days, help the child to use her arms to support herself while sitting. Hold the child from the back gently as the child may move her hands to play and so lose balance. Gradually, train the child to sit without your support.
Remember to talk to the child during these activities. This will make them enjoyable for her.
When the child learns to sit by herself, teach her to stand. For this, hold the child’s hand when she is sitting and lift her to standing position. Then let the child hold a stool or a table. Leave the child, but stand behind her in case she loses her balance . If you do this exercise in front of a mirror, where the child can see herself, she will get a feedback regarding what she is doing this will motivate her to try again.
Initially the child will not be able to stand for long. She will sit down quickly. But gradually the duration of being able to stand will increase. When the child’s balance improves remove the stool and encourage her to stand by herself.
The activities described till now lay the foundation for the child to walk. All the above steps have to be mastered before the child is able to walk. Before the child is able to walk, encourage her to crawl. Hold an object that the child finds attractive in front of her. This will motivate her to reach for it. Gradually, the child will be able to take a few steps. The child is bound to fall down as she practices walking. Reassure her and encourage her.
Strengthening arm and hand movements.
The child may have difficulty in coordinating the movements of her arms and hands. Encourage the child to reach for objects and grasp them. To strengthen the muscles of the hand, give a piece of clay and ask the child to squeeze it. You may need to put the objects in the child’s hand and curl her fingers around it, in order to explain to her how to hold it.
When helping the child to acquire these motor abilities, hold the child’s body whenever required. When teaching the child to use the hand, arm or leg movements , do not leave it to demonstration. Hold the child’s hand , arm or waist etc. and help her perform the movements. As in climbing a staircase, hold the child from behind and guide the leg movements with your hand . Telling the child how to perform is not sufficient. She needs actual physical experiences of doing something before she can repeat the action.
Sometimes a child may have a difficulty with movement because the child has weakness or stiffness of the muscles of the limbs. If this is so, then explain to the parents that they must show the child to a health worker/doctor/PHC. They may prescribe some exercise to help develop muscle tone. These exercises must be done regularly.
MENTALLY DISABLED CHILDREN LEARN IN THE SAME WAY AS OTHER CHILDREN, BUT THE LEARNING TAKES PLACE SLOWLY.
The extent to which a child is able to take care of her routine and basic needs will determine whether or not she is able to join a preschool centre or a school. For example, a child who cannot go to the toilet by herself, will not be able to join a child care centre and will miss out on many learning experiences. Therefore, it is important to explain to the parents the need to train the child to look after herself and how it can be done.
A child may have difficulty in one or more of the following areas :
· Eating and drinking independently
· Going to the toilet
· Indicating when she is hungry, thirsty or uncomfortable
· Dressing and undressing
It is important that the child is able to carry out at least the first three activities, if the parents want her to join a centre for children. The extent to which the child has difficulty in these areas and the time it takes or her to develop the requisite skills will depend on the degree of retardation.
Begin to train the child to feed herself when she is able to sit by herself, without support sometimes. A child may have difficulty in eating or drinking because the saliva drools from the mouth. If this is the case, then explain to the parents that they should consult a doctor/health worker. It may be that the child needs to be given medication. The doctor may also suggest some lip, tongue and chewing exercises that will help the child to control facial muscles and tongue.
When training the child to feed herself, make her comfortable. Spread a cloth or a newspaper to take care of spillage.
Most of us perform all these steps in one fluid movement . But a mentally disabled child may face difficulty in any or all of these movements. She has to helped to practice each movement, learning will take place one step at a time. For example
· Give the child the food item to hold in her hand – this may be a biscuit, a piece of Chappati. Alternatively, it may be a spoon.
· Take one of the same yourself and show the child how to hold it.
· Bite a portion, chew it and swallow it.
· As the child to chew and swallow it.
· Begin by giving the child a few morsels to eat by herself.
Gradually, let her finish the entire meal herself.
The child may take quite long in finishing each meal. You will need to be patient. Rushing her during eating will make her nervous and the movements will became even more uncoordinated. Explain to the parents that they will need to be patient.
To help a child to learn to drink from a cup or a glass, first train her to hold the glass with both hands. Help her to bring the glass to her month and let her take a few sips. There is bound to be spillage initially. The child may also try to chew on the water. These extra motions will be given up subsequently.
Remember to talk to the child during all these activities. Explain to her what she is doing.
Dressing and undressing
Undressing is easier for the child than dressing. First teach the child to remove simpler garments like socks, pyjamas and garments which open from the front. Removing a garment above the head, unbuttoning. Trying the cord of pyjamas and typing shoe lacks are more difficult.
Show the child how to do these activities by doing them your self. Encourage the child to dress or undress a puppet or a toy. This will give her practice in coordinating hand movements.
Once the child learns to remove some of her cloths, encourage her to learn to put on her dress. When teaching the child undressing begin with the simpler garments first . It will help the child if she dressed and undresses in front of a mirror. It may take some time for the child to recognize the front and back of a dress. You would need to show the child again and again how to dress and undress . Assist the child in these activities, but gradually, let her do more and more of these on her own.
This involves that
· The child recognize that she needs to go to the toilet
· Be able to undress and relieve herself at the right place
· Be able to wash herself and use the toilet appropriately
· Be able to dress again
In the beginning, observe the child’s toilet habits and note the pattern. Then start taking the child to the toilet 10 to 15 minutes before the time and encourage her to relieve herself at the right place. Take the child to the toilet at regular intervals. Often the parent tends to clean the child herself or himself , thinking the child will not be able to do it or that she will take tonger. Explain to the parents that they may guide the child and show her how to wash initially, but gradually let her do it herself. It will indeed take longer, but his is the only way the child will learn.
If the child wets her clothes and later comes and tells you, take it as a positive sign. It shows that the child is aware that she has not had control.
Explain to the parents that these are some areas where they should begin the training the child at home. Once a child is able to look after her basic needs, she can attend the preschool centre.
b) HOMEOPATHIC MANAGEMENT Homeopathic management of mentally retarded child involves complete physical, mental and social well being of the child. The homeopathy medicine help the child in the following areas
· Better Movement /Motor Coordination
· Greater Memory power
· Greater attention power
· Enhances language skills and therefore contribute to better communication
Working with the child in the centre
Let us now read about some aspects that you, as a child worker, must keep in mind when working with the child in the preschool centre. However, as we have said earlier, the discussion in this sub-section is also relevant for parents. It will help them in training the child at home, continuing the efforts initiated by the educator in the centre.
ENCOURAGE THE CHILD TO DO AS MANY THINGS AS SHE CAN, BY HERSELF.
In a programme of early childhood care and education (ECCE), children who have mild or moderate leaves of mental retardation can be taught along with normal children without much difficulty. In fact, children with special needs benefits gradually from interaction with non –handicapped peers and adults. Normal environments help them to exercise their abilities to the full, and thus become integrate in society.
For example, we know that once a child begins to talk, she learn new words rapidly. This is because she hears meaningful language around her. But, if the same child grows up in an environment where spoken language is hardly used, such as in a family where both parents are deaf, and use only signs for communication ,the same child will learn little speech. Similarly, a child with mental retardation may become slower than she actually is, if she does not receive stimulation to use her mind. The company of normal peers and adults who are sensitive and accepting of a special child make up a stimulating environment.
Once the child is among respectively, friendly and professionally trained people, the learning process becomes enjoyable for her. At this point, it is your responsibility as an ECLE worker to see that the special child’s needs are understood and care and education provided accordingly. Even though the child will play and learn along with other children, you will need to spend extra time with her to help her learn.
Severely and profoundly mentally disabled children would benefit more by attending a special school rather than a regular preschool centre.
Let us now read about the areas in which the special child requires help.
A mentally disabled child’s memory is not as efficient as that of normal child. This means that the child required several repetitions of an experience before she can remember what was done. For example, when you teach a song of four lines to your group of children, most of them would know the lines after it is sung a few times. The retarded child may recognize the words when you sing, but may not be able to repeat any of the words immediately. However, gradually this child would also begin to repeat few words, mostly the first and the last words in the line. It is only after several weeks or months that the child will learn all the four lines of the song.
This would be true of any activity you carry out whether it is recognizing colours, classifying objects or a discussion on animals.
MENTALLY DISABLED CHILDREN HAVE A MEMNORY, BUT THEY REQUIRE GREATER PRACTICE BEFORE THEY CAN MEMORISED ANYTHING.
If there are one or two mentally retarded children in the group that you handle, you will find that there is a gap in their ability and that of others in understanding things. Include them in all the activities, but also pay them extra attention individually. Let them sit near you, repeat once again to them what you have said to the group. For example, if you have said ‘show me your nose’ look at the special child, repeat the instruction again and help her to point to her nose.
One reason why most of us can leave new tasks is that we give serious attention to them. In this area , the child with mental retardation is weak. She had difficult in paying attention to tasks at hand, especially those that require setting down and concentrating. When the child does not attend to tasks , she is not doing so deliberately, as some of us may tend to think; rather she has a disability that interfere in the natural development of attending skills. So you must not get impatient with her or scold her.
Children with mental retardation begin to use speech much later to their childhood as compare to other children. It is possible that even by three years of age, the disabled child does not speak or is able to say only few words. She may use only gestures and sounds to communicate. While the milestone of language development may be delayed, the sequence in which language develops is the same as in normal development.
Once again, it has been observed that children with language deficits, who grow up in an environment that is rich in language, learn to use speech much between than those who grow up in an environment where language is not rich and varied. In your centre, it is important that a child with mental retardation should not be left to herself . She should be a part of all language activities such as singing , storytelling, conversation and play, even if it spears that she does not understand or does not participate.
A child who lacks the ability to speak tends to use her body and gestures to communicate. Other children and adults learn to accept such a mode of communication and sometimes, they themselves use gestures with the child. However, this would be a hindrance to the child’s language development. Parents and teachers have to be conscious that they have to encourage the child to speak simple words and phrases to express her needs. This is more likely to happen if the child hears conversation frequently addressed to her.
Talk a lot to the child
Speak clearly using simple sentence while looking at the child. Verbalise the actions you perform such as “’Here is my hand, here is yours. Lets join them together’ Before a child speaks she learns to listen and understand. So even if she does not speak, speaking to her about things will enhance language and cognitive development. Thus if the child points towards a carrot, do not simply give it to her. Rather, ask her: ‘Do you want the carrot?’ and then give it to her. Initially, the child may not respond or may not speak clearly, but do not worry about this. Continues with your efforts.
TALK TO THE CHILD REGULARLY EVEN THOUGH SHE DOES NOT RESPOND. GRADUALLY, ENCOURAGE THE CHILD TO SPEAK.
Dinesh was admitted to the balwadi at the age of 5 years by his parents because it became too difficult for them to manage him at home. They said that he did not sit still, did not obey them and did not have speech. He tended to beat his older sister. Dinesh was not only mentally retarded but also had behavior problems.
Many mentally retarded children show behaviors that are maladaptive, i.e. unacceptable. Why does the child show unacceptable behavior? Is she born with it? Do mentally disabled children develop more behavior problems than normal children ? By itself, low intelligence does not cause inappropriate behaviour . Behaviour problems occur in normal children as well. These develop in the child whether disabled or not mostly in response to the attitude of the caregivers towards her.
When a child does not get love and affection from the family members, she feels neglected. To get their attention she throws temper tantrums. Bangs her head or beats herself, throws things around or behaves badly in front of visitors. The child is then labeled as one with ‘behaviour problems’. When the parents are very strict with the child and scold her often, then too the child develops behaviour problems.
Helping the child develop Acceptable Behaviours
It is possible to help the child develop acceptable behaviours and give up the unacceptable ones. The guiding principles to bring about modification of behaviour and as follows
· The child should experienced love and acceptable and not rejection from care givers and peers. Give attention to the child.
· Expectations from the child should be realistic. Do not expect her to perform at the same level as ordinary children.
· It is not enough to tell the child what not to do. Explain and show to her what should be done. In other words, the child should be given positive guidance in simple steps.
· It is better to deal with one problem behaviour at a time. For example, while controlling her aggressive behaviour, do not start on toilet training at the same time.
· Be consistent and firm in your rules for the child. If you have said ‘no’ to something, do not change it to ‘yes’. The child may cry or throw a tantrum for some time, but will soon understand that you mean what you say.
· Explain to the child that if she behaves badly, what the consequence may be. For example , she will not get her favorite dish or be allowed to play with her toy. Do not verbally abuse or hit the child.
· If the child still behaves badly, be consistent.
· If the child stops bad behavior/shows positive behavior, reward her.
The above then were some areas where you would need to help the child. In general, a stimulating classroom for preschool children is good enough for mentally disadvantaged children too. There should be play material available to the child that she can manipulate, there should be picture books, pictures charts at eye level on the walls, there should be music and dance, puppetry and clay activity etc… in which the mentally disabled should be included.
IT IS POSSIBLE TO HELP THE CHILD DEVELOP ACCEPTANBLE BEHAVIOURS
The Parent’s prospective.
Yes, the parents of a mentally retarded child have to go through a lot of physical and psychological stress in bringing her up. The knowledge that the child may never be like other children brings disappointment and a sense of failure. Above all, the care of the child is strenuous and it tends to exhaust the parents. Hence , parents themselves need sympathy, care and support from all concerned people.
If their child shows progress in any way, the parents’ own confidence about the future receives strength . You can contribute in this effort by meeting the parents regularly, listening to what they have to say and guiding them wherever necessary. The parents, grandparents and siblings have an important role in supporting the programme at the centre, as they can contribute those activates at home that the educator introduces at the centre.
WHEN A MENTALLY RETARDED CHILD IS IN YOUR CHARGE, HOW WELL YOU TEACH, PLAY AND EXPRESS AFFECTION IS MORE IMPORTANT THAN HOW MUCH TIME YOU SPENT WITH HER.