The Forgotten Patient: Medical Management of the Multiple Handicapped Retarded

Abstract

MEDICAL TREATMENT of the mentally retarded patient is one area of mental retardation that often receives minimum attention. In recent years many reports have been published concerning etiology and diagnosis and classification of mental retardation; for example, the classic article by Wright and Tarjan (1) or the three-part series on subnormality by Knobloch and Pasamanick (2). Other reports, such a,s that by the Group for the Advancement of Psychiatry (3), have been devoted to treatment of the family and to the physician's reactions when he enc,ounters a mentally retarded patient. Sorely lacking in this rapidly growing volume of literature are specific references to, lelt alone detailed accounts of, how the physiciarn can directly intervene in the medical problems or the continuing health care of the retarded. Perhaps the best example here is the excellent 192-page manual published by the American Association on Mental Deficiency (4) in which only 10 lines appear under the section titled Medical Care and Treatment. The physician's tra,ditional concern for his patient seems to have been displaced by his concern for the parents and other members of the patient's family or even the community. In other words, after he makes the initial diagnosis and neatly classifies the retarded, the, physician's role a,s it pertains to treatment becomes focused on the parents. According to the literature, the parent rather than the retardate seems to be in greatest need of treatment. This is not to question the need or importance of counseling for the family, but rather to point out what I believe is an important area of neglect; that is, the need for the physician's interest beyond the initial diagnosis and classification and parent counseling. First, this interest is required in the prevention and correction or at least amelioration of physical handicaps to permit full achievement of whatever functional potential 'may exist. Second, even where no improvement in function can be foreseen, increased personal comfort for the patient and increased ease of attendant care must be considered sufficient indication for medical or surgical intervention. It is generally acknowledged that the true capacities of children with severe physical or sensory handicaps cannot be measured by their inotor abilities. Even the child with normal intelligence appears to lag in development if he is severely handicapped. Korsch and associates (5), in a comparison between the of 81 pediatricians and the results of standard psychological tests given by experienced psychologists to 242 children, noted that about two-thirds of the estimates came within 15 points of the test scores. The one group consistently misjudged and underestimated was the children with major physical illnesses. For the retarded child, the effects of additional physical handicaps on developmental function may be almost catastrophic, because of his more limited ability to compensate. Correction or amelioration of the physical defects, therefore, becomes more imperative than for the child with normal mentality. Dr. Pearson, chief of the Mental Retardation Branch, Division of Chronic Diseases, Public Health Service, presented a version of this paper at the annual meeting of the American Orthopsychiatric Association, Cleveland, Ohio, March 1964.