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Abstract

The aim of the present study was to investigate the emotional indicators in the Human Figure Drawing of mentally retarded children with and without hyperactivity. It will help in finding out the emotional expression of mentally disabled children. The design of the study is descriptive. It was hypothesized that mentally retarded children with hyperactivity would score high on emotional indicators of Human Figure Drawing Test (HFD) as compared to mentally retarded non hyperactive children. A purposive sample of 60 mentally retarded children 30 with mild, and moderate severity and with hyperactivity and 30 with mild and moderate severity and without hyperactivity with the age range of 6-18 years, was taken from special schools of Karachi city. Human Figure Drawing Test (HFD) was applied to evaluate emotional problems and Attention-Deficit/ Hyperactivity Disorder Test (ADHD-T) was applied to explore the hyperactivity of the mentally retarded children. The percentage method of descriptive statistics was applied for statistical analysis. The results show that mentally retarded children with hyperactivity have more emotional problems than mentally retarded children without hyperactivity.
Bahria Journal of Professional Psychology, July 2014, Vol. 13, No. 2, 17 – 41
Emotional Indicators on Human Figure Drawing Test of Mentally Retarded Children
with and without Hyperactivity
Shazia Hasan*
COMSATS, Institute of Information Technology, Lahore Pakistan
Ummara Rauf and Noreen Begum
Institute of Clinical Psychology, University of Karachi, Karachi
The aim of the present study was to investigate the emotional indicators in the Human Figure
Drawing of mentally retarded children with and without hyperactivity. It will help in finding out
the emotional expression of mentally disabled children. The design of the study is descriptive.
It was hypothesized that mentally retarded children with hyperactivity would score high on
emotional indicators of Human Figure Drawing Test (HFD) as compared to mentally retarded
non hyperactive children. A purposive sample of 60 mentally retarded children 30 with mild,
and moderate severity and with hyperactivity and 30 with mild and moderate severity and
without hyperactivity with the age range of 6-18 years, was taken from special schools of
Karachi city. Human Figure Drawing Test (HFD) was applied to evaluate emotional problems
and Attention-Deficit/ Hyperactivity Disorder Test (ADHD - T) was applied to explore the
hyperactivity of the mentally retarded children. The percentage method of descriptive statistics
was applied for statistical analysis. The results show that mentally retarded children with
hyperactivity have more emotional problems than mentally retarded children without
hyperactivity.
Keywords: Emotional indicators mentally retarded, hyperactivity, mild and moderate severity
Emotional disturbances and psychological problems in mentally retarded children is
one area which effects their adjustment in school and life in general. Mental retardation is the
term used for disorders of intellectual functioning that should be significantly below the
average, that is, approximately or less than 70 after administering a standard test that
measures intelligence. The current adaptive functioning of the client must be impaired or
must show some deficit. DSM IV categorizes adaptive functioning into different areas such
as “care about one himself, communication, home living, relationship with others, and uses of
resources of community, self-direction, functional in academic area, in work, health, safety
and leisure”. Two of the areas of adaptive functioning are impaired and it shows early
symptoms before the age of 18 years (DSM- IV- TR, 2000).
Four subtypes of mental retardation are also categorized on the basis of the severity of
the deficit and the intensity of the level of intellectual functioning of the individual. Mild
mental retardation is one where the IQ level is 50 55 to more or less than 70. In moderate
mental retardation the IQ level is 35 40 to 50 – 55. In severe mental retardation 20 25 to
35 – 40 is the range of an individual’s IQ level. Profound mental retardation includes IQ level
below 20 or 25. When the intellectual functioning of the individual is not measured by the
standard tests that are particularly aimed for the testing of IQ levels, but there is strong
assumption of deficit in intellectual functioning, it is categorized as another type of mental
retardation known as severity unspecified (DSM IV TR, 2000).
The most recent American Association on Mental Retardation (AAMR) definition of
‘mental retardation’ (2002) states: “Mental retardation is a disability characterized by
significant limitations both in intellectual functioning and in adaptive behavior as expressed
in conceptual, social, and practical adaptive skills. This disability originates before age 18”.
However the term mental retardation has been replaced by the term of intellectual
disabilities. WHO (2007) collected data from 147 countries to know about the common
terminologies used in different countries associated with the mental retardation. It is found
that 76% of the country’s most common term is “mental retardation”, 57% of them use the
term “intellectual disability”, where as mental handicap or disability term is common in 40%
of the countries. Learning or developmental disabilities, mental deficiency or sub normality;
are terms used by some other countries.
Intellectual disability which is also known as intellectual developmental disorder is
the impairment in general mental functions. These general mental functions include
“reasoning, problem solving, planning, abstract thinking, judgment, learning from
experience, and practical understanding.” Adaptive functioning impairment is also under
consideration and these adaptive functions are categorized into different areas such as the
academic or conceptual area, the social area, and the functional area. Subtypes of intellectual
disability are specified by the levels of severity of intellectual functioning in three domains of
adaptive functioning (DSM 5, 2013).
Causes of mental retardation are unknown but in 25% cases of mental retardation, the
causes are known. Causes of mental retardation mentioned in Psychology Today (2010)
include any trauma such as loss of oxygen, exposure to alcohol, or injection before or during
the birth of the child. Genetic abnormalities are another cause of mental retardation which
can lead to chromosomal abnormalities such as the ones found in Down’s syndrome;
abnormal genes present during the neonatal period; fragile X syndrome; and phenylketonuria.
Poisoning of mercury or lead, issues related to diet, or severe undernourishment, getting sick
in early childhood such as whooping cough, measles, or meningitis (Psychology Today,
2010).
A study conducted in Pakistan by Durkin, Hasan and Hasan (1998) reveals that the
lack of mother’s education is a factor that is strongly linked with serious and mild mental
retardation. Some other factors depicted in this study are problems faced before birth,
infections at the time of birth, infections in the brain after birth, traumatic brain injury and
malnutrition. There is also an association between poverty and mental retardation among
children and is a risk factor of mental retardation (Emerson, 2007). Additionally,
somatogenic causes are linked with mental retardation in children (Bannikova & Sebirzianov,
2013).
According to DSM 5 (2013), the prevalence of intellectual disability is 1% with
reference to the overall general population. Rates of prevalence vary by age. Approximately 6
per 1000 is the prevalence rate of intellectual disability, severe level. Spiebl, Binder, Cording,
Klein, and Spiebl (2008) conducted a study between 1996 and 2002 on 9727 patients in a
psychiatric hospital having first admission. According to ICD 10, 2% (192 patients) are
diagnosed with mental retardation. Findings also reveal that 62%, 26% and 9% of the patients
suffered from mild, moderate and severe mental retardation respectively.
Prevalence of mental retardation in Pakistan is given in the study of Durkin, Hasan
and Hasan (1998). The aim of the study was to find out the prevalence of mental retardation
among Pakistani children. Results indicate that 19.0 per 1000 children are estimated to be a
part of the prevalence rates for severe mental retardation whereas 65.3 per 1000 are included
in the category of mild mental retardation.
Recently, the research and development department of Helping Hand for Relief and
Development (HHRD) Islamabad Pakistan (November, 2012) has developed a resource
document on the statistics of people with disabilities in Pakistan. Disability is categorized
into subtypes in this resource book such as crippled, multiple disabilities, blind, mentally
retarded, deaf and insane. The total rate of disability in Pakistan is 2.54%. Among all types of
disabilities, the population with mental retardation constitutes about 7.62% of the total
population with disabilities.
Mental retardation is the condition that always remains at a high risk of mental
disorders by association and psychopathology. This is also supported by some of the
researches on the topic (Stromme & Diseth, 2000). Further Kerker, Owens, Zigler and
Horwitz (2004) concluded that the prevalence of psychiatric disorders is greater in
individuals with mental retardation as compared to those studies carried out on administrative
data or based on data from different institutions. Common disorders in children with mental
retardation are attention deficit hyperactive disorder, developmental disorder, autism,
behavioral disorders and cerebral palsy (Shea, 2006).
Human Figure Drawing is used in this study to measure the emotional indicators of children
with mental retardation and with and without hyperactivity. Several researches with reference
to interpretation of Human Figure Drawing are reported by different researches. One of the
most commonly used techniques to evaluate emotional states of children is the Human Figure
Drawing (Hibbard & Hatman, 1990; Cates, 1991). It is also assumed by Koppitz (1968), that
the drawing of a human figure is a manifestation of the representation of the self of the child.
Malchiodi (1998) depicted that drawings are believed to be unique statements of a person that
characterize both their conscious and unconscious implications of their inner worlds. Good
enough (1926) explained that there are some aspects related to HFD of children that are not
related to intellectual maturity of children but appeared to be more related with personality of
children. The diagnostic and interpretative nature of drawings is not for interpreting cognitive
functioning but for the emotional conditions. Whatever a child draws would be related to the
real self or the ideal self or to some people who are important in his life (Hammer, 1958).
DiLeo (1973) assumed that those children who do not have anxiety and are adjusted well,
their drawings will not reflect their self but it would indicate the conception of humankind.
Similarly Koppitz (1986) believes that children will draw those who are important to them
and HFD regards the illustration as the self concept of the one drew the figure.
Dekker, Koat, Van den Ende and Verhulst (2002) examined high scores on the
depression scale, anxiety scores and somatic complaints in children with mental retardation
as compared to children without mental retardation. Problems related to the social domain,
problems with attention, problems related to aggression are the most prominent behavioral
problems found in educable children with mental retardation.
Emotional problems are also viewed in few researches as seen in a study aimed at
examining suicidal behavior of patients with mental retardation who were admitted in
psychiatric hospitals. Results reveal that there is statistical significance in attempting suicides
and it depends on the level of severity of mental retardation. Additionally, the way they
attempt suicide depicted in this study is by injuring the self (Bobinska, Florkowski,
Amigielski, & Galecks, 2009a).
There are several factors that are associated with the probability of psychiatric
problems or psychopathology among children with mental retardation/intellectual disability.
Emerson (2003) conducted a study to know about the prevalence of psychiatric disorders.
Results also revealed the factors linked with greater possibility of disturbance in psychiatric
conditions among children with mental retardation or intellectual disabilities, include sex,
age, deficiency of social skills, family composition, number of life events that remain
possibly stressful, psychological condition of the of the child’s caretaker, functioning of the
family and practices carried out for the management of the child. Some of the other risk
factors of psychopathology in children with mental retardation are related to the development
of language and its impairment; social deprivation; living with single (biological / natural)
organic parent; whose parents belongs to lower socio-economic class; and inadequacy of
adaptive behaviors (Koskentausta, Livanainen & Almqvist, 2007).
With the reporting of the prevalence of mental retardation among the universal
population, a vital concern arises in the minds of researchers and clinicians related to the
means by which this existing problem can be managed. Being clinicians we are required to
create various ways to make these individuals become independent and live in society. Some
of the contributions for enhancing the functioning of those with mental retardation have been
suggested in a few researches. Researchers have discovered a relationship in employed and
unemployed individuals with mental retardation, with respect to their cognitive and adaptive
functioning. Results show considerably improved performance among individuals who were
employed, on different subscales such as memory, attention, verbal comprehension, visual
perception, and adaptive behavior (Su, Lin, Wu, &Chen, 2008). Similarly, Pratt and
Greydanus (2007) also investigated intellectual disability/mental retardation and meaningful
strategies for those clinicians who are primary caregivers and are responsible to care for these
children and adolescents. According to them if individuals have gone through suitable
personalized support in their lives over a continued period of time, particularly during the
years that are influential in their lives; most of the youth as adults can live independently or
semi-independently.
Based on the detailed literature review outlined earlier, the aim of the present study
was to investigate emotional problems among mentally retarded children without
hyperactivity and mentally retarded children with hyperactivity. Hyperactivity in children
with mental retardation is therefore seen as associated with other emotional problems.
Method
Participants
The present study was conducted in various special and normal schools of Karachi.
The sample consisted of 60 mentally retarded children and was divided into two groups. The
first group comprised of 30 children with mild and moderate mental retardation with
hyperactivity, while the other group comprised of 30 children with mild and moderate mental
retardation and without hyperactivity. The age range was between 6 to 18 years. They
belonged to the lower, middle and upper socioeconomic class.
Measures
Demographic Data Sheet was designed asking the information about the child’s
name, educational level, number of siblings, birth order, father’s name and education, family
system, socioeconomic class, any other sibling with special needs, duration of school, and
any other treatment either medical or psychological.
Human Figure Drawing (Koppitz, 1968) is used to measure the emotional indicators
in children with mental retardation with hyperactivity and without hyperactivity. Human
Figure drawing (HFD) involves the drawing of a whole person by the child on the examiner’s
request. This test has no time limit but most of the subjects complete their drawing within 10
minutes whereas a few will complete it in just 1 or 2 minutes. It is applied on children
between the ages of 5 to 12 years. There are two different objective signs of this drawing with
reference to its scores. One is related to the age of children and their maturation level and
these signs are known as Developmental Items. Another is related to attitudes and concerns
of the children and these signs are called Emotional Indicators. Koppitz (1968) determined
the reliability of HFDs for emotional indicators. A total of 467 items for drawing were
checked by two examiners. 95% (444 items) of the items were scored by both examiners and
only 5% were checked by only one or other of the investigators. 19 items were scored for
each drawing. There were only one or two point differences between both examiners on the
scoring.
Attention deficit hyperactivity disorder test (Gilliam, 1995) was used to measure
hyperactivity in children with mental retardation. It is a checklist that is used to categorize
individuals with the attention deficit hyperactivity disorder and its purpose is to assess
persons who are referred for the behavioral problems. It has 36 items that illustrate the
behaviors and characteristics of the person. It is used for the persons with the age range of 3
to 23.
ADHD-T is designed for usage in homes and schools by teachers and professionals.
It requires 5 to 10 minutes for its administration. Respondents rate the extent of behavior to
which each statement describes them on a scale from 0 to 2 (0= not a problem, 1= mild
problem and 2= severe problem). There are three subtests of ADHD-T a. hyperactivity
subtest b. impulsivity subtest c. inattention subtest. Cronbach’s coefficient alpha (1951) was
used to investigate the reliability of internal consistency on 754 ADHD subjects from the
normalization sample. All correlations are above .90 and show a strong estimate of internal
consistency.
Procedure
In order to conduct the research and collect data, different special schools were visited
according to the convenience and purpose of the study. A letter of consent describing the
research project was provided to the concerned authorities of special schools along with the
demographic form and questionnaire. After getting the required permissions, participants and
their teachers were approached. The researcher established rapport with the teacher and told
them the purpose of the study in order to get the required sample that is 30 mentally retarded
children without hyperactivity and 30 mentally retarded children with hyperactivity. With the
help of teachers, instructions were given to the children. Many children with mental
retardation were able to draw without any help and but many of them who had no exposure of
drawing were first shown the nature of the drawing by sketching and then they were asked to
draw the figure. Attention Deficit Hyperactivity Disorder- Test was administered to the
teachers. After collecting the whole data all the scales were analyzed through standard
manuals.
Results
In order to interpret the results, the Human Figure Drawing was scored according to
the standard procedure given in the manual. Frequency distributions and the percentage
method of descriptive statistics was applied to assess the emotional indicators and
hyperactive behavior. Emotional indicators on HFDs can differentiate between the
drawings of mentally retarded hyperactive children and mentally retarded children. The
mentally retarded children with hyperactivity showed a wide variety of emotional problems
and symptoms thus confirming the assumption that they are more emotionally disturbed.
Overall results showed that out of 30 emotional indicators, the mentally retarded hyperactive
children scored high on 08 emotional indicators as compared to mentally retarded children.
Such a result is indicative of high emotional disturbance.
The results have been further categorized into three categories of emotional
indicators. First category relates to the qualitative signs (table 2) that include poor integration,
shading on face, shading on body, shading on hands, asymmetry, slanting figure, tiny figure,
big figure, transparency. The second category is of special features (table 3) with tiny head,
crossed eyes, teeth, short arms, long arms, arms clinging to the body, big hands, hands cut
off, legs pressed together, genitals, monster, three figures, and clouds. Last one is omissions
(table 4) and it is explained by no eyes, no nose, no mouth, no body, no arms, and no legs.
Table 1
Frequencies and Percentages of Different Emotional Indicators on HFDs of Mentally
Retarded Hyperactive Children and Mentally Retarded Non Hyperactive Children
Items
Emotional
Indicators
Mentally Retarded Hyperactive
children (n= 30)
Mentally
Retarded Non
Hyperactive
children (n= 30)
f % f
%
1 Poor
integration
29 96% 19 63%
2 Shading on
face
0 0% 0 0%
3
Shading on
body
2
6%
0
0%
4
Shading on
hands
0
0%
0
0%
5 Asymmetry 30 100% 29 96%
6
Slanting
figure
8
26%
7
23%
7 Tiny figure 5 16% 5 16%
8
Big figure
0
0
3
10%
9 Transparency
0 0 0 0
10 Tiny head 1 3% 1 3%
11
Crossed eyes
0
0
2
6%
12 Teeth 1 3% 4 13 %
13
Short arms
12
40%
9
30%
14 Long arms 1 3% 6 20%
15 Arms cling
to body
1 3% 0 0%
16 Big hands 0 0% 1 3%
17 Hands cut
off
29 96% 16 53%
18
Legs pressed
Together
0
0%
0
0
19
Genitals
0
0%
0
0
20 Monster 0 0% 0 0
21 Three figures 0 0% 0 0
22 Clouds 0 0% 0 0
23 No eyes 0 0% 1 3%
24 No nose 0 0% 5 16%
25 No mouth 0 0% 1 3%
26 No body 4 13% 1 3%
27
No arms
2
6%
3
10%
28
No legs
2
6%
0
0%
29
No feet
6
20%
4
13%
30 No neck 11 36% 6 20%
Table 2
Frequencies and Percentages of Quality Signs on HFDs of Mentally Retarded Hyperactive
Children and Mentally Retarded Non Hyperactive Children
Items
Emotional
Indicators
Mentally
Retarded
Hyperactive
children (n= 30)
Mentally Retarded
Non Hyperactive
children (n= 30)
f % f %
1 Poor
integration
29 96% 19 63%
2 Shading on
face
0 0% 0 0%
3 Shading on
body
2 6% 0 0%
4
Sh
ading on
hands
0
0%
0
0%
5 Asymmetry 30 100% 29 96%
6 Slanting
figure
8 26% 7 23%
7 Tiny figure 5 16% 5 16%
8 Big figure 0 0 3 10%
9 Transparency
0 0 0 0
Referring to table 2 it can been seen that mentally retarded hyperactive children
showed more emotional indicator of Poor Integration (Item No.1) (96%) as compared to
mentally retarded children (63%), a feature that appears to be associated with instability, a
poorly integrated personality, poor coordination, and an overtly aggressive and impulsive
nature.
Mentally retarded hyperactive Children showed higher scores on the emotional
indicator of asymmetry (Item No. 5) (100%) than mentally retarded children (96%) indicating
their poor coordination, and impulsiveness.
Mentally retarded hyperactive children also showed high frequency on the emotional
indicator of slanting figure (Item No. 6) (26%) as compared to mentally retarded children
(25%). This indicates that they are more instable and insecure.
Table 3
Frequencies and Percentages of Special Features on HFD of Mentally Retarded Hyperactive
Children and Mentally Retarded Non Hyperactive Children
Items
Emotional
indicators
Mentally Retarded
Hyperactive children
(n= 30)
Mentally Retarded
Non Hyperactive
children (n= 30)
f % f %
10 Tiny head 1 3% 1 3%
11 Crossed
eyes
0 0 2 6%
12 Teeth 1 3% 4 13 %
13 Short arms 12 40% 9 30%
14 Long arms 1 3% 6 20%
15 Arms
clinging to
body
1 3% 0 0%
16
Big hands
0
0%
1
3%
17 Hands cut
off
29 96% 16 53%
18 Legs
pressed
Together
0 0% 0 0
19 Genitals 0 0% 0 0
20 Monster 0 0% 0
0
21 Three
figures
0 0% 0
0
22 Clouds 0 0% 0
0
Table 3 shows that there is also a high frequency of responses on the emotional
indicator of hands cut off (Item No. 17) (96%) among mentally retarded hyperactive children
as compared to mentally retarded children (53%). This appears to be associated with feelings
of inadequacy or guilt over failure.
There is also a high frequency on the emotional indicator of short arms (Item No. 13)
(40%) among mentally retarded hyperactive children as compared to mentally retarded
children (30%) which indicates they have more difficulty in reaching out into the world, and
tendency to withdraw.
It is further noted that only 3% of mentally retarded hyperactive children made their
drawings with the emotional indicator of teeth (Item No. 12) whereas (13%) mentally
retarded children showed this indicator. This indicator reflects oral aggression.
Table 4
Frequencies and Percentages of Omission Responses on HFD of Mentally Retarded
Hyperactive Children and Mentally Retarded Non Hyperactive Children
Items
Emotional
Indicators
Mentally Retarded
Hyperactive children (n=
30)
Mentally Retarded Non
Hyperactive children (n=
30)
f % f %
23
No eyes
0
0%
1
3%
24 No nose 0 0% 5 16%
25 No mouth 0 0% 1 3%
26 No body 4 13% 1 3%
27 No arms 2 6% 3 10%
28 No legs 2 6% 0 0%
29 No feet 6 20% 4 13%
30 No neck 11 36% 6 20%
Table 4 indicates that there is also high frequency of the emotional indicator of
nobody (Item No. 26) (13%) among mentally retarded hyperactive children as compared to
mentally retarded children (10%) which indicates their psychopathology, severe immaturity,
and emotional disturbance with acute body anxiety.
20% of mentally retarded hyperactive children made their drawings without feet
(emotional indicator, Item No. 29) as compared to mentally retarded children (13%) which
can be related to feelings of insecurity, and helplessness. There is also a high frequency of
responses related to the emotional indicator of no neck (Item No. 30) among mentally
retarded hyperactive children (36%) as compared to mentally retarded children (20%) a factor
that is related to immaturity, impulsivity and poor inner control. This difference reflects that
those who are mentally retarded are also somewhat immature and have poor inner control.
Discussion
According to ICD – 10, clinically dual diagnoses are found in about 10% of the
sample with mental retardation than the other population (Kishore, Nizarie, Nizamie & Jahan,
2004). Similarly, it has been estimated that between 48% and 70% of individuals with mental
retardation have diagnosable psychiatric disorders (Szymanski, Madow & Mallory, 1990). If
these problems are not managed properly, they get strengthened. Most of the children with
mental retardation visit psychiatrists for their problems who are not trained in the field of
mental retardation or related problems. They have less or no exposure to training about the
diagnostic and therapeutic intervening techniques posed by mental retardation (APA, 1995).
Sometimes families or care givers of mentally retarded children not trust doctors and
prescribed medicines when they are referred for treatment (Szymanski, Madow & Mallory,
1990; Lipman, 1986). Individuals with MR are most influentially provided by psychiatrist
when they use the multidisciplinary team model (Hauser, 1997).
Overall results indicate that mentally retarded hyperactive children show more
emotional and behavioral problems (hyperactive and impulsive behavior) in multiple settings
whether the location is at home or at school. As shown in table 2, the poor coordination of
mentally retarded children with hyperactivity is due to their inattention and impulsive
behavior. It seems to be unable for them to concentrate on a task for a long time; they fed up
with one activity and try to indulge themselves in another one
abruptly. They soon lose their interest in one activity that’s why they always remain in a state
of shifting from one activity to other and in turn cannot perform a task adequately and have
difficulty in integrating objects. Hyperactivity and impulsive behavior is also supported by
several researches as it is depicted in the results. Silka and Hauser (1997) have explained
some of the changes that take place in the mental status of mentally retarded individuals.
These include “hyperactivity or irritability, confusion or distortion, lethargic or withdrawal,
psychotic symptoms, other changes in mood, energy and sleep patterns”. Sappok,
Diefenbacher, Bergmann, Zepperitz and Moren (2012) observed three categories of EDD.
First category includes showing self-injury, social withdrawal, and stereotyped behaviors.
The second category includes the disintegrative disorder and the third shows hyperactivity,
and attention seeking behavior.
At home they usually fail to complete chores, homework and other related activities,
fail to follow directions, and are not able to play for prolonged periods without supervision or
attention from others.
At school they usually have problems attending to the teacher and completing in-class
assignments. The child is often distracted by other events. However, they may attend at
length to some irrelevant stimuli - so the problem is more than just a short attention span; it
often seems to be a problem of allocating the right amount of time and focus to the
appropriate information. It is evident in the result and is supported by previous research
literature that mentally retarded hyperactive children tend to show more emotional problems.
Based on research conducted by Dekker, Koot, Van der Ende and Verhulst (2002) there were
prominent problems in the behaviors of children who were educable, including problems
related to social domain; problems with their attention; and their behavior was aggressive.
Similarly children with mental retardation who were trained had greater risk problems related
to social domains; withdrawals and problems in their thoughts than those children who were
without mental retardation. Aggressive behavior is found at 9.8% among people with mental
retardation / intellectual disability. Associated factors with this behavior are also ascertained
such as with low ability; without chromosomal abnormality (Down Syndrome), presence of
Attention Deficit Hyperactivity Disorder, and the identity of the caregiver not being from
amongst one’s own family members (Cooper, Smiley, Jackson, Finlayson, Allan, Mantry &
Morrison, 2009).
This can take various forms such as quick responding with numerous errors, not
stopping to think about consequences of their actions, placing themselves in dangerous and
risky situations. They usually fail to fully appreciate all the aspects of the instructions given
to them and are more likely to respond aggressively (verbally and physically) when frustrated
or emotionally hurt by others, they usually do not consider the impact of their actions or
statements on others. Such actions can lead others to see such children as immature and to
their being shunned by others. The impulsive child will also experience more punishment
than normal children and it will enhance his frustration and aggression. Such ideas are also
supported by a study conducted by Petty, Bacarese, Hamilton, Davies and Oliver (2014) on
the prevalence of some behaviors such as aggression, injuries to the self, and behaviors that
are destructive, as 64%, 51% and 51%, respectively. Results indicate that high scores on the
measures of overactive and impulsive behavior are the predictors of destructive behavior in
children with mental retardation. Most frequently observed behaviors found are psychosis
and impulse control disorders in psychiatric hospitals where patients with mental retardation
may visit. The most commonly expressed behaviors of patients with mental retardation are
aggression, low mood, psychomotor agitation, dysphoria, and irritability (Bobinska,
Florkowski, Smigialski & Galecki, 2009b).
10% of mentally retarded children showed indicators of big figure (Item No. 8)
whereas mentally retarded hyperactive children did not show this indicator. This reflects poor
inner control, and immaturity.
A few the emotional problems are also depicted in the results such as helplessness,
shyness, feelings of insecurity, feelings of inadequacy and guilt feelings. Some of these
problems can be seen in other studies as well. A qualitative study explored the life
experiences of the bereavement of 13 people with mental retardation/intellectual disability.
Disenfranchised grief was reflected in their experiences. It is also stated that this kind of grief
and bereavement is similar to the grief and bereavement of the general population in need of
talking to somebody and finding relief (McRitchie, McKenzie, Quayle, Harlin & Neumann
2013).
Conflicting tendencies, attitudes and emotional disturbances with acute body anxiety
are found on some of the items of emotional indicators. Green, Berkovits and Baker (2014)
examined such children by administering the Child Behavior Checklist and notied clinical
levels of anxiety and separation anxiety disorder with significantly higher rates among
children with mental retardation. Anxiety and co- occurring problems are externalize by this
population.
Overall, all the emotional problems discussed above are also problematic for the
families and caregivers. Depressive symptoms occur significantly among the caregivers of
people with mental retardation having poor quality of sleep (Lin, Hsu, Kuo, Wu, Chu, Lin,
2014). Average score of trait anxiety among siblings of children with mental retardation; and
due to the disability of sibling they also suffer from other difficulties is also explored in a
study conducted by Saban and Arikan (2013). Mental retardation in children results in social
and financial constraints on the supporting families and caretakers. Overall it is believed that
there is a relationship between poverty and mental retardation and that it plays a role in
experiencing social and health inequalities by the families of children with mental retardation
and their families (Emerson, 2007).
Similarly if these problems cannot be managed and handled on time, a day comes
when these lead to other kind of problems. This factor is supported by other contributors in
the field of research. Fair and not good health is reported by people with mental
retardation as compared to their peers. They also face disadvantages in socioeconomic areas
on a greater level and go through violence and discrimination (Emerson, Roberston, Baines &
Hatton, 2014). People with intellectual disabilities have increased chances of chronic
conditions that are similar to those with lifelong disabilities and these chronic conditions
reported by Dixon, Ibarra, and Hormer- Johnson (2014) are coronary heart disease, obesity
and diabetes.
It has been proposed on a higher level that we can help such populations with the
provision of services and implementing different effective strategies. It is important in mental
retardation and challenging behaviors to consider factors related to social, biological,
psychological and environmental areas for assessments and interventions. A multidisciplinary
approach remains the best, which may consist of psychological interventions and the
assessment by the psychiatrist (Sinai, Tenanbaum, Aspler, Lotan, Morad & Merrick, 2013).
Lloyd and Kennedy (2014) concluded approaches based on function; a variety of operant
functions of challenging behaviors, and treatments based on the concept of reinforcement that
are widely used developed because of challenging behaviors in people with mental
retardation. If these will not be implemented then it will affect the life quality and related
outcomes. McGilliuray and Kershaw (2013) found symptoms of depression and associated
risk factors in mild mental retardation. Cognitive behavioral therapy and behavioral
techniques are considered to be most effective in reducing these symptoms.
Conclusion
This research concludes that mentally retarded children with hyperactivity have
problems related to adaptive functioning, social problems or behavioral problems. Along with
these emotional problems are common among this population as compared to mentally
retarded children without hyperactivity. These emotional problems are aggression,
impulsivity, withdrawal, insecurity, hopelessness, immaturity, instability, guilt feelings,
shyness and conflicting tendencies. Emotional problems are not only limited to the ones
depicted in the study; there could be other kind of problems as well. Similarly hyperactivity is
not the only cause of emotional problems in children with mental retardation; other factors
are also there.
Implications
This study has a significant contribution for children with mental retardation and
associated problems, care givers, teachers, remedial schools, and other kinds of programs
designed for the training. Intervention and management of mental retardation and related
problems gets difficult when it is encompassed with emotional problems. Therefore assessing
emotional problems can help a specialist in the development of programs that helps to
minimize them. These can be addressed during training educable children with mental
retardation, and management programs should be valued in emotional factors in assessment
and child management practices. This can help children with mental retardation to lead an
emotionally sound life without social deprivation, withdrawal, aggression, and impulsivity.
This can also overcome hopelessness, guilt, self-injury and suicide; and at last they can live
semi-independently in adulthood. As it has been stated earlier in the literature review that
caregivers experience high stress and psychological disturbance; this can also be managed in
this manner.
Limitations and Future Recommendations
The present study has some limitations. Sometimes it gets difficult for the children
with hyperactivity to write and draw figures based on the level or severity of mental
retardation. The same issue was experienced while conducting this study. Only Human
Figure Drawing is not as sufficient in depicting all kinds of emotional problems.
Hyperactivity cannot be the only related issue; therefore we need to investigate other factors.
As this study was conducted on a small section of the population, it lacks generalization.
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... Em relação aos aspectos emocionais do DFH, a psiquiatra americana Koppitz observou que os sinais gráficos no DFH poderiam ser vistos tanto da maturidade mental quanto de problemas emocionais. Essa autora acreditava que as crianças representavam no desenho o seu autoconceito (Hasan et al., 2014;Silva, et al., 2015). Por meio de uma lista de indicadores emocionais, estruturou critérios para obter a validade clínica do desenho com o objetivo de diferenciar as crianças com e sem conflitos emocionais. ...
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