|Year : 2021 | Volume
| Issue : 1 | Page : 74-78
Study of sociodemographic profile and psychopathology of mentally and physically handicapped children and their parents
Anup Rathi1, Pankaj Sanghavi1, Sagar Karia2
1 Department of Psychiatry, Dr. Ulhas Patil Medical College, Jalgaon Khandesh, Maharashtra, India
2 Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
|Date of Submission||29-Mar-2021|
|Date of Acceptance||29-Mar-2021|
|Date of Web Publication||18-Jun-2021|
Dr. Anup Rathi
Department of Psychiatry, Dr. Ulhas Patil Medical College, Jalgaon Khandesh - 425 309, Maharashtra
Source of Support: None, Conflict of Interest: None
If all chronic conditions causing disability of any degree in childhood are included, the prevalence of disability is remarkably high. Studies on families with handicapped children have indicated that both parents often experience psychological disorders such as anxiety and depression. Handicapped children too suffer from psychological illnesses. Hence, the present study was undertaken. The study aims to look at the sociodemographic profile and psychopathology of mentally and physically handicapped children and their parents and to compare it with that of nonhandicapped children. Materials and Methods: The sample consisted of 90 children of both sexes. Sixty of these were handicapped-30 physically and 30 mentally. Thirty children were nonhandicapped. A semi-structured proforma, IQ tests, and Childhood Psychopathology Measurement schedule (CPMS) were used for assessment. Chi-square test and Paired “t”-test were used in the analysis. Results: It was observed that a greater number of handicapped children belonged to the higher score groups as compared to the nonhandicapped group. Significantly higher incidence of morbidity was observed in the handicapped children as compared to nonhandicapped children. Fathers and mothers of handicapped children had higher degree of psychopathology as compared to those of nonhandicapped children. Mothers' psychopathology had a significant effect on the severity of CPMS scoring in physically handicapped children. Conclusion: Handicapped children showed more severe psychopathology as compared to nonhandicapped. Mothers of handicapped children had higher psychiatric morbidity as compared to those of nonhandicapped children. Psychopathology of mother significantly affected the psychopathology of children.
Keywords: Mentally handicapped, parents, physically handicapped, psychopathology
|How to cite this article:|
Rathi A, Sanghavi P, Karia S. Study of sociodemographic profile and psychopathology of mentally and physically handicapped children and their parents. Ann Indian Psychiatry 2021;5:74-8
|How to cite this URL:|
Rathi A, Sanghavi P, Karia S. Study of sociodemographic profile and psychopathology of mentally and physically handicapped children and their parents. Ann Indian Psychiatry [serial online] 2021 [cited 2022 Sep 30];5:74-8. Available from: https://www.anip.co.in/text.asp?2021/5/1/81/318680
| Introduction|| |
If all chronic condition causing disability of any degree in childhood is included the prevalence of disability is remarkably high. It has been stated that in the U. S., 30%–40% of children have one or more such disabilities and even if only physical disorders are included, 7%–10% of all children are affected. In the National Child Development study of nearly 16,000 children in England, Wales, and Scotland, born in 1 week in March 1958 (Davie et al., 1972), the prevalence of handicap in children alive till 7 years of age was stated to be 25.6/1000. The figure would have been substantially higher if other disabilities had been included.
The survey of children aged 9–12 years in the Isle of Wright indicated that one child in every six has a chronic handicap of a significant degree. Moreover, the Isle of Wright is a prosperous community and therefore the amount of handicap in less-favored parts of the world is probably underestimated. If the family is considered as an interdependent system, then stress such as the presence of disabled child modifies the responses and the psychological well-being of all family members. Previous studies on families with handicapped children have indicated that both mothers and fathers often experience psychological disorders such as anxiety and depression.,,
A common belief in this regard is that the presence of a disabled child has a negative effect on his family. Parental stress has been identified as a major affecter of caregivers' psychological well-being and a risk increaser for unwillingly placing children with disabilities in the care of others. Most parents had various support needs that were frequently unmet.
A timely intervention by trained professionals will help parents of disabled children to understand the disease and the ill child. This will help them cope better and improve the quality of life of family as a whole. Recent years have seen a tremendous growth and reconceptualization in approaches to understanding the impact of the disability on the children and their families. Hence, this study was carried out with the aim to study the sociodemographic profile and psychopathology of mentally and physically handicapped children and their parents and to compare with that of nonhandicapped children.
| Materials and Methods|| |
The sample under study consisted of 90 children of both sexes. Sixty of these were handicapped: 30 physically and 30 mentally and 30 children were nonhandicapped. Thirty physically handicapped children were selected from a school for the physically disabled. They were in the age-group of 8–12 years. Children with subnormal Intelligent Quotient were excluded from this study. Thirty mentally handicapped of the same age-group of 8–12 years attending a special school for the mentally handicapped were selected. Children with accompanying physical handicap were excluded from the study. Thirty nonhandicapped children matched on sociodemographic variables were selected from the relatives accompanying patients to various OPDs in a general hospital.
A semi-structured performa was prepared which collected details such as demographic data, details about illness-severity of the handicap, comorbidity present, possible biological cause as mother's age at childbirth, pregnancy complications, etc.
- Intelligence Quotient in the subject was assessed using the Colored Progressive matrices and the Goddard Form board,
- Childhood Psychopathology Measurement schedule (CPMS).
The CPMS, developed and standardized by Savita Malhotra and her colleagues, was administered to the parents of all the 90 children to assess the behavioral problems in the children. It measures eight psychopathological factors: Low intelligence with emotional problems, conduct disorder, anxiety, depression, psychotic symptoms, special symptoms, physical illness with emotional problems, somatization. The total score was calculated and so was the individual score on each subscale.
The data collected were entered in MS-Excel and subjected to statistical analysis. Chi-square test and Paired “t”-test were used as required.
| Results|| |
[Table 1] shows details of various demographic factors of sample population. [Table 2] describes various phenomenological aspects of study population. On studying the distribution of number of subjects in the CPMS score groups [Table 3] and [Table 4] it was observed that a greater number of handicapped children (Physical and Mental) belonged to the higher score groups as compared to the nonhandicapped group where the number of children in the corresponding group was much lower.
|Table 3: Childhood psychopathology measurement schedule score in each group|
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|Table 4: Childhood psychopathology measurement schedule sub score (mean) in each group|
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Significantly higher incidence of morbidity was observed in the physically handicapped and mentally handicapped children as compared to nonhandicapped children respectively. On comparison between the two handicapped groups, mentally handicapped had significantly higher score as compared to physically handicapped.
Fathers of mentally handicapped children had higher incidence of psychopathology as compared to those of physically handicapped children who in turn had higher incidence as compared to fathers of nonhandicapped children. Among fathers of physically handicapped children, three had anxiety disorder and three had alcohol dependence while among fathers of mentally handicapped children, three had dysthymia, one had anxiety disorder, and five had alcohol dependence. Among fathers of nonhandicapped children, three had alcohol dependence, one each had anxiety disorder and dysthymia.
On comparison incidence of psychopathology in fathers, none of the group significantly differed.
The incidence of psychopathology was more in mothers of mentally handicapped children as compared to physically handicapped children. Overall, both the handicapped groups had more incidence of psychopathology in mothers than the nonhandicapped group.
On comparison, when both the groups of handicapped children were compared individually with nonhandicapped children, the incidence of psychopathology in mothers was significantly high in the former.
Among mothers of physically handicapped children, 13 had dysthymia and three had anxiety where in mothers of mentally handicapped children 12 had dysthymia, five had anxiety, and one had depression.
As seen in the table psychopathology of mother had a significant effect on the severity of CPMS scoring in physically handicapped children, whereas no significant relation was found in other two groups.
No significant relation was found between the presence/absence of psychopathology of father and severity of child's psychopathology.
| Discussion|| |
Our study revealed consanguineous marriages in 50% of the mentally handicapped children but not significantly higher than the nonhandicapped children (general population), neither was it significantly higher than the physically handicapped. Narayanan et al. in 1987 found a history of consanguineous marriages in 30.2% of their study sample. Of these, 11.6% had mentally handicapped children as compared to families with nonconsanguineous marriages who only had 3.3% children with mental retardation. A detailed clinical examination revealed pre, peri, and post-natal complications as etiological factors in 20.7%. Sanghvi et al. and Dronamraju have reported similar prevalence of consanguineous marriages.,
Misra, et al. have found a close relationship of mentally handicapped to poor condition of mother during delivery and any type of injury sustained by mother during pregnancy. Furthermore, bleeding, unconsciousness, etc., show relevance to mental deterioration of developing child. Delivery by operation may be a factor in mental retardation. The children born after prolonged labour pain were retarded in 46.42% of cases. The children born at home suffered from retardation (58.03%) as against hospital deliveries (41.96%). Babies with delayed crying, icteric and blue babies, and babies below 2 kg in weight were associated with mental retardation. Children who show convulsion in infantile period may become retarded later as indicated by Nanda.
A higher incidence of pregnancy complications was observed in the present study too, in the mentally handicapped children. About 50% of mentally handicapped had pregnancy complications as compared to 33.3% in physically handicapped. Prevalence was significantly higher than in the nonhandicapped (20%).
Nanda found that father's age of maximum number of mentally subnormal children falls between 26 and 35 years and mothers age between 24 and 33 years. We found only seven of the mothers, i.e., 23.33% of the mentally handicapped to be more than 30 years of age as compared to only six, i.e., 20% in the nonhandicapped and only two, i.e., 6.7% of the physically handicapped.
In the study of Prabhu in 1968 on speech problems of the mentally handicapped, 44.68% of mentally handicapped children had speech defects. Narayanan et al. found a comorbidity of speech defects in 72.6%, seizures in 31.1%of mentally handicapped children, and a high incidence of various others such as visual defects, deafness, and incontinence.
The present study also shows a remarkably high incidence of comorbidity (speech defect and seizure disorder) in the mentally handicapped (70%) as compared to none in the nonhandicapped group and only 6.7% in the physically handicapped. Hence, mental retardation is not a single entity but a symptom complex.
Numerous studies have shown that physical illness and disability in childhood might have profound impact on the psychological adjustment in children. These children have significant behavioral, emotional, and social problems when compared to demographically comparable children. Despite their illness, some children adjust quite well, while others develop serious psychological and social problems.
Chaturvedi evaluated 62 mentally handicapped children to ascertain psychiatric problems and to co-relate them with clinical and socio-demographic variables. Psychiatric problems were found in 71% of children, common being hyperkinetic behaviors, neurotic and conduct disorders. Level of retardation had no significant association with psychiatric problems.
A significant higher incidence of psychiatric morbidity was observed in the two handicapped group in our study too. The physically handicapped children scored high on anxiety, special symptoms, conduct disorder, and depression. The mentally handicapped scored high on low intelligence with emotional problems, anxiety, conduct disorder, and special symptoms. The nonhandicapped did not score as high on any of the subscales.
The mentally handicapped children scored significantly higher on low intelligence with emotional problems, conduct disorder, psychotic symptoms as compared to both the other group. The scores on anxiety, special symptoms, physical disorder with emotional symptoms were significantly higher than the nonhandicapped. The physically handicapped scored significantly higher on depression as compared to other two groups. Physically handicapped also scored significantly higher on anxiety and conduct disorder as compared to the nonhandicapped.
The needs of mothers and fathers can be different. A study by Slopper and Turner in 1993 showed 67% of mothers and 39% of fathers scoring above the cut of point of 6 on the measure of parental distress indicative of high levels of emotional disturbance. The mothers were more severely affected and the severity of child disability was a significant factor for mothers. Wikler Lynn, 1981, found that mothers of children whose DQ was <65 reported significantly higher levels of stress than mothers of nonhandicapped children. As disabled children grow older, depression in parents was found to increase by Friedrich et al. in a study on mentally handicapped children.,
In a study, that compared mothers of healthy, chronically ill, and mentally handicapped children, Cummings et al. concluded that mothers of the mentally handicapped children were found to have higher levels of depression than either of the other two groups, whereas depression is very common in parents of children with ID in the Indian subcontinent. Similar findings were reflected in mothers of children with mental health problems.
In our study, the incidence of psychopathology in mothers in both the handicapped groups was significantly higher than the nonhandicapped group. Similar trend was not observed in fathers of handicapped children.
Among the physically handicapped 16 mothers suffered from anxiety and dysthymia and three fathers suffered from anxiety and depression. Thus, even our study found a higher incidence of anxiety-depression among the handicapped group.
Mishra, et al. in 1982 reported the association of alcoholism and drug addiction by parents of mentally handicapped children. In our study, 5 out of 28 (17.87%) fathers of mentally handicapped children had a diagnosis of alcohol dependence. The relation of all these factors discussed with severity of mentally handicapped would be an interesting extension of the present study.
The relation between a child with a behavior problem and a depressed mother is clearly multidirectional. Azeem et al. found association between severity of ID and depression, anxiety in mothers but not fathers. To observe this, the relation between the psychopathology in the mother and father with the psychopathology of the child was studied. The presence of psychopathology in the mother was found to have a significant effect on the severity of childhood psychopathology in the physically handicapped. No significant relation was found in other two groups. On the other hand, no similar trend was observed with the fathers. This aspect warrants remarkable further study.
| Conclusion|| |
- Handicapped children showed more severe psychopathology as compared to nonhandicapped children and within the handicapped children, mentally handicapped children had significantly higher score on CPMS than the physically handicapped
- The physically handicapped scored higher on anxiety, special symptoms, conduct disorder, and depression while mentally handicapped scored high on low intelligence with emotional problems, anxiety, conduct disorder, and special symptoms
- Mothers of handicapped children have higher psychiatric morbidity as compared to the nonhandicapped whereas same trend was not observed among the fathers
- Psychopathology of mother significantly affected the psychopathology of children whereas, no such relation was observed with the psychopathology in the fathers.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mattsson A. Long-term physical illness in childhood: A challenge to psychosocial adaptation. Pediatrics 1972;50:801-11.
Davie R, Butler NR, Goldstein H. From birth to seven. Longman; 1972.
Rutter M, Tizard J, Whitmore K, editors. Education, health and behaviour: psychological and medical study of childhood development. Harlow, Essex: Longman Group Limited; 1970.
Chouhan SC, Singh P, Kumar S. A comparative study of anxiety and depressive symptoms among parents of mentally retarded children. J Well Being 2016;10:17-28.
Cummings ST. The impact of the child's deficiency on the father: A study of fathers of mentally retarded and of chronically III children. Am J Orthop 1976;46:246.
Cummings ST, Bayley HC, Rie HE. Effects of the child's deficiency on the mother: A study of mothers of mentally retarded, chronically ill and neurotic children. Am J Orthop 1966;36:595.
Cramm JM, Nieboer AP. Psychological well-being of caregivers of children with intellectual disabilities: Using parental stress as a mediating factor. J Intellect Disabil 2011;15:101-13.
Carlson JS, Jensen CM. Reliability of the raven colored progressive matrices test: Age and ethnic group comparisons. J Consult Clin Psychol 1981;49:320.
Goddard HH. The Adaptation Board as a measure of intelligence. Training School Bulletin 1915;11:182-8.
Malhotra S, Varma VK, Verma SK, Malhotra A. Childhood psychopathology meausrement schedule: Development and standardization. Indian J Psychiatry 1988;30:325-31.
] [Full text]
Narayanan HS, Rao PM, Subhakrishna DK, Rao BS. Observation of mentally retarded cases with special reference to consanguinity. NIMHANS J 1987;5:121-3.
Sanghvi LD. Inbreeding in India. Eugen Q 1966;13:291-301.
Dronamraju KR. Caste and consanguinity in Andhra Pradesh. Eugen Q 1967;14:238-40.
Misra LS, Saxena NK, Pathak MP. Psycho-clinical symptoms and factors associated with natal history of mentally retarded children. Child Psychiatry Quarterly. 1982.
Nanda S. Some probable factors causing mental-retardation. Child Psychiatry Q 1978;11:106-11.
Prabhu GG. Speech problems of the mentally retarded. Indian J Mental Retard 1968;1:87-94.
Chaturvedi SK, Malhotra S. Psychiatric problems in mental retardation. Child Psychiatry Q 1983;16:96-101.
Verma RK, Kishore MT. Needs of Indian parents having children with intellectual disability. Int J Rehabil Res 2009;32:71-6.
Sloper P, Turner S. Risk and resistance factors in the adaptation of parents of children with severe physical disability. J Child Psychol Psychiatry 1993;34:167-88.
Wikler L. Chronic stresses of families of mentally retarded children. Family Relations. 1981:281-8.
Friedrich WN, Friedrich WL. Psychosocial assets of parents of handicapped and nonhandicapped children. Am J Ment Defic 1981;85:551-3.
Friedrich WN, Wilturner LT, Cohen DS. Coping resources and parenting mentally retarded children. Am J Ment Defic 1985;90:130-9.
Azeem MW, Dogar IA, Shah S, Cheema MA, Asmat A, Akbar M, et al
. Anxiety and depression among parents of children with intellectual disability in Pakistan. J Can Acad Child Adolesc Psychiatry 2013;22:290-5.
Gerkensmeyer JE, Perkins SM, Day J, Austin JK, Scott EL, Wu J. Maternal depressive symptoms when caring for a child with mental health problems. J Child Fam Stud 2011;20:685-95.
[Table 1], [Table 2], [Table 3], [Table 4]