Category: Mental Retardation

Statement of the problem

A study to assess the prevalence of mentally challenged children and evaluate the effectiveness of information booklet on knowledge regarding stress management among parents of mentally challenged children in selected urban areas of Jabalpur

Objectives

• Prevalence of mentally challenged children in selected urban area
• pre-test knowledge score parents of mentally challenged children
• post-test knowledge score parents of mentally challenged children
• Effectiveness of information booklet on knowledge regarding stress management among parents of mentally challenged children
• Determine the association between the pretest knowledge score with selected demographic variable

Operational definitions

1. Assess –In this study, assess refers to check the prevalence of mentally challenged children & knowledge regarding stress management among parents of mentally challenged children.
2. Prevalence – in this study the prevalence is a statistical concept referring to the no. Of cases of mentally challenged children that are present in a particular population at a given time.
3. Effectiveness-In this study effectiveness is the extent to which an information booklet producing a result or improving the knowledge of parents regarding stress management.
4. Knowledge – In this study, it refers to the responses of subjects on questionnaires on stress management.
5. Information booklet – Information booklet refers to the written material. In this study, the information booklet will be used as independent variable by the researcher.
6. It provides information about-

• Introduction of stress
• Sign of stress (physical & mental)
• Nature of stress
• Stress management techniques
• Short & long-term stress reduction techniques

1. Stress management -Stress management is a wide spectrum of techniques aimed at controlling a person’s level of stress, usually for the purpose of improving everyday functioning.
2. Mentally challenged children- It is characterized by below-average intelligence or mental ability & lack of skill necessary for day-to-day living.

Assumption

• Parents of mentally challenged children will express their knowledge regarding stress management techniques
• ·Information booklet increases knowledge regarding stress management among parents

Research Hypothesis

1. H1- significant difference in the mean pre-test & post-test knowledge score regarding stress management among parents
2. H2 – There will be significant association between pre-test knowledge scores with demographic variables.

Delimitation

• Limited time available for data collection
• 60 parents of mentally challenged children
• Samples belong to selected urban areas
• Samples willing to participate

Review of literature related to prevalence of mentally challenged children.

Ghising R., Shakya S., and Rizyal A (2013) conducted a study on Prevalence of refractive error in mentally retarded students of Kathmandu Valley according to the researcher A specific cause is identifiable in only about 25% of people who are mentally retarded, and of these only 10% have the potential for cure. In the remaining 75%, predisposing factors, such as deficient prenatal care, inadequate nutrition, poor social environment, and poor child-rearing practices, contribute significantly to mental retardation. Mental retardation has no cure but we can prevent before it develop or we can best manage with proper care.

Tizard and Grand (2008) conducted survey and made a comparative study of 150 families whose mentally retarded children were institutionalized and 10 families having retarded children at home. There was disturbed family functioning curtailment of social contact in 15% and 1/3 of another health problem in those families who had retarded at home.

Review of literature related to knowledge and attitude of parents regarding care of child with mentally challenged children.

Margalit M (2015) studied ethnic differences in expression of shame feeling by mothers of severely handicapped children. Shame on the part of parents of mentally handicapped children. Has pronounced effects on child-rearing practices. The aim of this study was to compare expressions of shame of different ethnic groups in Israel. The attitudes of 23 western mothers and 26 eastern mothers towards their moderately and severely retarded children were studied. Significant differences (P less than 0.05 – P less than 0.01) were found, suggesting that the eastern mothers strongly expressed their shame where as the western mothers felt ashamed to express it at all. The western mothers felt that the social norms that reject feelings at shame and their own personal feelings of embarrassment were in conflict.

Levy Shift (2010). conducted a survey was done in Hyderabad to assess knowledge of people about causes and treatment of mental retardation in children. In society, there is a stigma about mental illness as well as mental retardation. People believe that mental retardation is due to black magic, god’s disgrace, or the sins of ancestors. Even educated people believe that no treatment for mental disorder. Half of the population seek required treatment from traditional healers and religious institutions irrespective of the nature of the illness; 20% of the people seek medical treatment as well as religious care for mental illness, and Only 10% of the people go to mental hospital. People believe that going to mental hospital will reduce family dignity and have to face religious stress. The postnatal mother will keep semi-starve for 3 months it cause nutritional deficiency intern leads to mental retardation. Consanguineous marriage is most prominent cause for mental retardation in South India.

Review of literature related to stress & its management among parents of mentally challenged children.

Mita Majumdar, Yvonne Da Silva Pereira, and John Fernandes (2018) conducted a study was on Stress and anxiety in parents of mentally retarded children Background: Studies comparing the stress perceived by parents of mentally retarded and normal children are limited. Aim: (i) To find whether there exists a difference in the perceived stress between both the parents of mentally retarded children, (ii) to study whether these stresses occur more frequently in parents of mentally retarded children compared with those of normal children, and (iii) to find any correlation between the severity of perceived stressors and the anxiety state of these parents. Methods: This study was conducted in the Child Guidance Clinic of a tertiary care psychiatry hospital. The study sample, comprising 180 subjects, was categorized as group A (60 parents of profound to moderately mentally retarded children), group B (60 parents of mild to borderline mentally retarded children), and group C (60 parents of children with normal intelligence), which served as the control group. Each parent was evaluated using the Family Interview for Stress and Coping (FISC) in Mental Retardation, and the Hamilton Anxiety Rating Scale (HARS). Results: Parents in group A had a significantly higher frequency of stressors and level of anxiety as compared to those in groups B and C. A positive correlation was found between the level of anxiety and stressors.

Ntswane AM, Van Rhyn L. (2017) conducted a qualitative, exploratory, descriptive, and contextual design was followed to investigate mothers’ experiences of caring mentally retarded children at home. Phenomenological interviews were conducted with a 12 purposefully selected samples of mothers. Findings indicated various challenges experienced by mothers during the care in terms of feelings of shock, despondency, and sadness in the early young stages. During later years, as the children grown, mothers felt shame, fear, frustration, anger, disappointment, and worry but they accepted. Suggestions were on improvement of health care services and education of the mothers and their families.

Pradeep Rao (2017) conducted a study on psychopathology and coping in parents of chronically ill children in Mumbai, North India. 30 parents whose children who had thalassemia were randomly selected from the thalassemia daycare centre of a teaching general hospital. The parents were interviewed on a semi-structured Performa and rated on stress and mechanisms of coping scales. Chronic illness in children affects the psychological health of the parents. Active coping strategies are associated with fewer distress indices and thus if inculcated may improve the ability to bear the burden of the illness without becoming themselves affected by psychiatric illness.

Ehiemere E, (2017) conducted a study to assess the effectiveness of health teaching approach incorporating use of puppetry with respect to BCG immunization by purohith JJ in 1984. The data was collected from 49 mothers and 33 health personnel using interview schedule, compliance checklist, and questionnaire. The data was analyzed using descriptive and interferential statistics. Study results indicated that health teaching incorporating puppetry increased the knowledge related to and compliance with BCG immunization. The group accepted puppetry as a method of health teaching.

Raj Kumari Gupta and Harpreet Kaur (2017) conducted a study on stress among parents of children with intellectual disability. The study examines stress among parents of children with intellectual disability. 102 parents formed the sample of this study, 30 of whom had children without disability. A stress assessment test with internal validity of 0.608 was utilized. This test has two parts: physical and mental, former with 19 items and latter with 21 items. T-test was applied to check differences in stress, gender differences, and differences in mental and physical stress. Results show that most parents of children with intellectual disability experience stress, physical and mental stress are significantly correlated, gender differences in stress experienced occur only in the mental area, and parents have higher mental stress scores as compared to physical stress.

Douma JC, Dekkar MC, and Koot Tim (2016) conducted an Exploratory study with a sample of 745 youths (aged 10-24 years) with moderate to borderline ID, 289 parents perceived emotional and/or behavioral problems in their child. Inference done was most parents (88.2%) needed some support (friendly ear, respite care, child mental health care, and information) & those who perceived both emotional and behavioral problems in their child needed support the most & those who’s children with moderate ID or physical problems needed ‘relief care’, that is, respite care, activities for the child and practical/material help & these needs were met through parental counseling.

Methodology

Research Approach survey with evaluative research

1. Research Design

• Phase I Descriptive with non-experimental with cross-sectional
• Phase II Pre-experimental One group pre-test & post-test research
• The setting of the study urban areas (Tilwara & Adhartal)
• Sample 3-15 years mentally challenged children & their parents
• Sample size 60 parents
• Sampling Technique Non-probability convenient sampling
• Population mentally challenged children & their parents
• Target Population: mentally challenged children aged 3 to 15 years & their Parents
• Accessible Population: mentally challenged children aged 3 to 15 years & their parents

1. Research Variables

• Independent variables: Information booklet regarding stress management.
• Dependent variables: Knowledge of parents of mentally challenged
• Demographic variables: Age, Educational status, Types of family, Occupational status, Family income, previous knowledge regarding stress management

Sample selection criteria

1. Inclusion criteria

• Mentally challenged children.
• Parents who are willing to participate in the study & present during time of data collection.

1. Exclusive criteria

• Parents who are not available at the time of data collection.
• Development & description of the tool
• Preparation of the blueprint

Blue Print of the Content

• S.
• No.
• Content areas
• Question
• No.
• Total No. of Question
• Weightage
• (%)

1. 1 Knowledge

• 1,3,6,7,14,15,16,17,20,28,29.
• 11
• 36.67%

1. 2 Understanding

• 2,5,8,10,12,19,21,23,25,30.
• 10
• 33.33%

1. 3 Skill

• 4,9,11,13,18,22,24,26,30.
• 9
• 30%

1. TOTAL

• 30
• 100%

Description of the tool

Section A:

Socio-demographic data age, educational status of parents, types of family, occupational status, income & any previous information obtained about stress management.

Section B:

IQ TEST -Draw a man test (Mrs. Pramila pathak)

Section C:

A self-structured questionnaire effectiveness information booklet on stress management

Reliability of the Tool

Split half method (Karl Pearson’s correlation coefficient formula r = 0.87,

Pilot study

Ranjhi, 1st March to 20th March 2019., 10 samples, non probability convenient sampling technique., Post test conducted after 20 days.

Procedures for data collection

Permission obtain BMO, 60 samples, urban area (Tilwara & Adhartal)

The actual data was collected in 1/4/19 to 15/4/19 & 1/5/19 to 15/5/19. subject provided information booklet regarding stress management.

Planning for data collection

Knowledge regarding stress management among their parents

DRAW – A – MAN TEST (MRS. PRAMILA PATHAK)

Directions: “I want you to make a picture of a person. Make the very best picture that you can. Take your time and work very carefully. Try very hard and see what a good picture you can make.”

Time: No time limit. Usually, 10 minutes will suffice with young children.

This test is to be used primarily as a screening device. The drawings of bright children more than 10 years old or those who have had drawing lessons will result in an invalid evaluation of the child’s intellectual potential.

Scoring

Class A Preliminary Stage in which the drawing cannot be recognized as a human figure:

1. Aimless uncontrolled scribbling – score 0.
2. Lines somewhat controlled – approaches crude geometrical form – score 1.

Class B All drawings that can be recognized as attempts to represent the human figure. Each point is scored plus or minus. One credit for each point scored plus and no half credits given.

Gross detail

1. Head present
2. Legs present.
3. Arms present
4. Trunk present
5. Length of trunk greater than breadth.
6. Shoulders are indicated (abrupt broadening of trunk below neck)

Attachments

1. Both arms and legs attached to trunk.
2. Arms and legs attached to trunk at correct points.
3. Neck present.
4. Outline of neck continuous with that of head, trunk, or both.

Head detail

1. Eyes present (one or two)
2. Nose present
3. Mouth present
4. Nose and mouth in two dimensions, two lips shown.
5. Nostril shown
6. Hair shown
7. Hair on more than circumference of head and non-transparent – better than a scribble.

Clothing

1. Clothing present (any clear representation of clothing)
2. Two articles of clothing non transparent (ex. Hat, trousers)
3. Entire drawing free from transparencies – sleeves and trousers must be shown.
4. Four articles of clothing definitely indicated. *should include 4 – hat, shoes, coat, shirt, necktie, belt, trousers*
5. Costume complete with incongruities *business suit, soldier’s costume and hat, sleeves trousers and shoes must be shown*

Hand detail

1. Fingers present (any indication)
2. Correct number of fingers shown
3. Fingers in two dimensions – length greater than breadth, angle subtended not greater than 180 degrees
4. Opposition of thumb clearly defined
5. Hand shown distinct from fingers and arm

Joints

1. Arm joint shown – elbow, shoulder, or both
2. leg joint shown – knee, hip, or both

Proportion

1. Head not more than ½ or less than 1/10 of trunk
2. Arms equal to trunk but not reaching knee
3. Legs not less than trunk not more than twice trunk size
4. Feet in 2 dimensions – not more than 1/3 or less than 1/10 of leg
5. Both arms and lens in two dimensions

Motor coordination

1. Lines firm without marked tendency to cross, gap, or overlap.
2. All lines firm with correct joining.
3. Outline of head without obvious irregularities. Develop beyond first crude circle. Conscious control apparent.
4. Trunk outline. Score same as #3.
5. Arms and legs without irregularities. 2 dimensions and no tendency to narrow at point of junction with trunk.
6. Features symmetrical (more likely to credit in profile drawings)

Fine head detail

1. Ears present (2 in full face, 1 in profile)
2. Ears present in correct position and proportion.
3. Eye details – brow or lashes shown.
4. Eye detail – pupil shown.
5. Eye detail – proportion. Length greater than width.
6. Eye detail – glance – only plus in profile.
7. Chin and forehead shown.

Profile

1. Projection of chin shown – usually + in profile.
2. heel clearly shown
3. Body profile – head, trunk, and feet without error.
4. Figure shown in true profile without error or transparency.

Table of mental age equivalents of scores

• Score
• Ma
• Score
• Ma
• Score
• Ma
• Score
• Ma

1. 1

• 3-3
• 14
• 6-6
• 27
• 9-9
• 40
• 13-0

1. 2

• 3-6
• 15
• 6-9
• 28
• 10-0
• 41
• 13-3

1. 3

• 3-9
• 16
• 7-0
• 29
• 10-3
• 42
• 13-6

1. 4

• 4-0
• 17
• 7-3
• 30
• 10-6
• 43
• 13-9

1. 5

• 4-3
• 18
• 7-6
• 31
• 10-9
• 44
• 14-0

1. 6

• 4-6
• 19
• 7-9
• 32
• 11-0
• 45
• 14-3

1. 7

• 4-9
• 20
• 8-0
• 33
• 11-3
• 46
• 14-6

1. 8

• 5-
• 21
• 8-3
• 34
• 11-6
• 47
• 14-9

1. 9

• 5-3
• 22
• 8-6
• 35
• 11-9
• 48
• 15-0

1. 10

• 5-6
• 23
• 8-9
• 36
• 12-0
• 49
• 15-3

1. 11

• 5-9
• 24
• 9-0
• 37
• 12-3
• 50
• 15-6

1. 12

• 6-0
• 25
• 9-3
• 38
• 12-6
• 51
• 15-9

1. 13

• 6-3
• 26
• 9-6
• 39
• 12-9

In finding the IQ of retarded children who are more than 13 years old, the chronological age should be treated as 13 only, and the IQ recorded as “or below.”

It is not wise to attempt to use this test with bright children of more than 15 years of age.

Plan for data analysis

Descriptive

• Frequency and percentage distribution to analyze demographic variables.
• Mean, Mean percentage and standard deviation

Inferential statistics:

• t-test to compare pre and post test score of knowledge regarding stress management after information booklet
• Chi square to measure association between pre test knowledge score with socio-demographic variables.

Ethical consideration

Presented before the committee.

No subjects were harm

Informed consent from the parents of samples.

Analysis and interpretation of data

Organization of findings

1. Section I: Prevalence of mentally challenged children
2. Section II: distribution of parents of mentally challenged children according demographic variables.
3. Section III (A): pre-test Knowledge score
4. Section III (B): post test Knowledge score
5. Section IV: effectiveness of information booklet on stress management
6. Section V: association between pre-test knowledge scores with selected demographic variables

Prevalence of mentally challenged children

• S. No.
• Area
• Population

1. (Age 3- 15 years)

• No. of Mentally challenged children found
• Prevalence
• (%)

1. 1. Adhartal

• 2357
• 72
• 3.05%

1. 2. Tilwara

• 747
• 17
• 2.27%

population (age group 3-15 years) of Adhartal is 2357 & in Tiwara 747. 72 children in Adhartal & 17 children in Tiwara, found mentally challenged so the prevalence rate is 3.05% in Adhartal & 2.27% in Tiwara.

Frequency & percentage distribution of mentally challenged children according to their IQ level

• N=89
• S.N.
• IQ level
• Frequency (n)
• Percentage (%)

1. 1. Borderline (71-90)

• 8
• 8.99%

1. 2. Mild (50-70)

• 9
• 10.11%

1. 3. Moderate (35-50)

• 66
• 74.16%

1. 4. Severe (20-35)

• 4
• 4.49%

1. 5. Profound (below 20)

• 2
• 2.25%

Distribution of mentally challenged children through IQ test

8 (8.99%) children had borderline IQ, 9(10.11%) children had mild IQ, 66(74.16%) children had moderate IQ, 4(4.49%) children had sever IQ, 2(2.25%) child had profound IQ.

• SECTION-II: Distribution of subjects according to their selected demographic variables.

1. Age
2. Educational status
3. Types of Family
4. Occupational status of the Subjects
5. Family Income
6. Previous Information Related to stress management

• SECTION III(A): pretest knowledge score

1. pre-test knowledge score regarding stress management

• SECTION III(B): post-test knowledge score.

1. post-test knowledge score regarding stress management

• SECTION IV: effectiveness of information booklet on stress management among parents of mentally challenged children.

1. Comparison between pre-test and post-test Knowledge score subjects

• SECTION V: Association between pre-test knowledge score with selected demographic variables

1. S.No
2. Variables
3. Poor
4. Average
5. Good
6. Total
7. df
8. Chi-
9. value
10. P-
11. value

• Inference

1. 1. Age (in years)

• 6
• 7.539
• NS
• a
• 25-30 yrs
• 8
• 4
• 12
• b
• 31-35yrs
• 5
• 13
• 18
• 12.59
• c
• 36-40yrs
• 7
• 15
• 1
• 23
• d
• Above 40 yrs
• 3
• 4
• 7

1. 2. Educational status

• 8
• 7.659
• NS
• a
• No formal education
• 3
• 3
• 6
• b
• Primary school
• 8
• 5
• 13
• 15.51
• c
• Middle school
• 4
• 7
• 11
• d
• Higher school
• 4
• 10
• 14
• e
• Graduate
• 4
• 11
• 1
• 16

1. 3. Type of family

• 4
• 1.541
• NS
• a
• Joint
• 13
• 19
• 32
• 9.49
• b
• Nuclear
• 9
• 15
• 1
• 25
• c
• Extended
• 1
• 2
• 3

1. 4. Occupational status

• 6
• 30.83
• S
• a
• Non working
• 6
• 4
• 10
• b
• Self employed
• 12
• 16
• 28
• 12.59
• c
• Private job
• 4
• 14
• 18
• d
• Government job
• 1
• 2
• 1
• 4

1. 5. Family income

• 2
• 2.48
• NS
• a
• Below ₹ 10000 / –
• 17
• 26
• 43
• 5.99
• b
• Above ₹ 10000 / –
• 6
• 10
• 1
• 17

1. 6. Previous source of knowledge regarding stress management

• 6
• 5.24
• NS
• a
• Mass media
• 2
• 6
• 8
• 12.59
• b
• Health personnel
• 2
• 8
• 1
• 11
• c
• No information
• 18
• 19
• 37
• d
• Family & relatives
• 1
• 3
• 4

Significant- Occupational status

Not significant- Age, educational status, family types, family income & previous source of knowledge regarding stress management

Implication

Nursing practice:

• parents of mentally challenged children had always under pressure like stress related to care of their child.
• As a health professional, the nurses who are in hospitals have a responsibility in providing information regarding various stress management strategies. Nurses work in psychiatric hospitals they adopt the program & implement it for better outcome of the parents of mentally challenged children.

Nursing Administration

• Nursing administrator can make use of the facilities or educate with the existing hospital setting together with the nurses to utilize the stress management techniques for public.
• Administrators should take provision for in service education program regarding stress management for staff to update their knowledge.
• Nurse administrator should implement outreach program to make public aware about stress management.

Nursing Education

• Nurse educators need to be equipped with adequate knowledge regarding complimentary & alternative therapy for stress management.
• Nursing students should be made aware to evaluate the physical and psychological causes of the stress and about the various nursing interventions.

Nursing Research

• Disseminate the findings of research through seminar, workshop & publishing nursing journals.
• Nurses should be encouraged for conducting further research such as relaxation, teaching, counselling management of stress complementary health practices etc.

Recommendations

• A similar study may be replicated on a larger sample.
• A similar study could be done on their psychiatric conditions, depression etc.
• A similar study can be undertaken at different setting.
• A study may conduct to assess the knowledge and practice of staff nurses regarding stress management.

Limitations

The study was confined to a specific geographical area which imposes limits on generalization.

1. Long term effect of the intervention was not assessed due to lack of time.
2. Responses of the subjects were restricted to self structured questionnaire.
3. The study is time consuming.
4. The study tool is difficult to use on severe mentally challenged children.

Conclusion

Study aimed to assess the prevalence of mentally challenged children and evaluate the effectiveness of information booklet on knowledge regarding stress management among parents of mentally challenged children.

concluded undoubtedly that the administration of information booklet on stress management among parents of mentally challenged children increase the knowledge about stress management techniques.

• Research approach (survey with evaluative approach)
• Research design (descriptive with non experimental with cross sectional design & one group pre test & post test research design)
• Target population (mentally challenged children & their parents in selected urban areas of jabalpur city)
• Accessible population (mentally challenged children & their parents presented at the time of data collection)
• Sampling technique (non probability convenient sampling technique)
• Sample size ( 60 sample)

Forrest Gump is one of my all-time favorite movies because it shows a person with a disability and how they can overcome their struggles and achieve great things. For most of the movie of Forrest Gump. The complex character that Forrest Gump was can be seen by his strong bonds. He forms with other characters in the movie. Furthermore, this also influences individual behavior and reaction towards specific aspects of life (Jordan, 2011) Forrest had a complex relationship with the love of his life, Jenny, who Forrest was besotted with. Forrest supported Jenny during her own struggles

Forrest Gump is a classic movie when it comes to conveying meaningful messages and inspiration to people. According to Psychological Disorders (n.d.), ‘ it is are patterns of behavior or mental processes that are connected with emotional distress or significant impairment in functioning.’ Forrest Gump is a story about a man with a humorous IQ of 75 below average. The story tells by Gump and begins with the scene where Gump has a brace his legs because of his back arch. Not being able to walk normally with mental retardation caused Gump to be despised by everyone. The stated: “ Mental retardation (MR) refers to substantial limitations in present functioning. It is characterized by significantly subaverage intellectual functioning such as communication, social skill..” According to Emory University School of Medicine Department of Pediatrics, “ A Motor skill is a function which involves the precise movement of muscles with the intent to perform a specific act.” Since Forrest was a little boy he was known as “slow,” and it was continued into his adult years. Even though Forrest is considered “slow” he still experiences normal emotions such as sadness, love, nervousness, hate, and so on. According to DSM-IV, people who are mentally retarded have motor problems. Though throughout the movie, Forrest keeps getting more and more athletic. This means the movie was inconsistent with the characteristics of mental retardation. The DSM -IV also says that people who are mentally handicapped lack social skills. Which means Forrest was unable to pick up on social cues. Thanks to his mother, he was able to have a good educational environment. In his whole childhood life, he only had a friend, Jenny. She was a “beautiful thing in my life, like an angel”. As a person suffering from an intellectual disability and a pair of splints on his leg. He always became a target for other students to bully. They kicked him, and followed him. And then his leg brace unfolds, it’s like being fake, the freedom that comes after years of endurance. He rides in with the win in excitement as it was first moved like a normal person. According to Schenk, K. M. (2017, June 9), “Life is like a box of chocolate; you never know what you are gonna get.” His running skills grow every day when they bullied him. And he became an extremely fast person and caught the eye of a college football team. He was accepted to play for that school and graduated with a bachelor’s degree. He met the current US president. And after that time, Gump and Jenny are separate. Posttraumatic stress disorder (PTSD) that follows a distressing event outside the range of normal human experience. In this scene, we see this disorder portrayed by an individual who survived the Vietnam war. Because Gump is enlisted and join the Vietnam War, while Jenny was caught up in social evils. She has a loose life. During his enlistment, Gump made a new friend, who deeply influenced him later Bubba, and met Lieutenant Dan. When participating in the Vietnam war, Gump’s platoon was injured and he carried each of them to a safe place. He was carrying Bubba and followed by the bombardment made me feel extremely excited. Returning from the war, Gump was awarded the honorary medal. He met Jenny again, who was participating in the anti-war movement. Unlucky, they are separated.

Afterward, he set aside the bounty to help Bubba’s family. He became a multi-millionaire and the CEO of the Bubba Gump shrimp company. By analyzing crucial scenes in the movie and Lt. Dan’s behavior, you can form a diagnosis of his disorder and fully understand what it means. It was a big success and they made a lot of money. When everyone thought, everything would be smooth then his mother died. He followed his mother’s wishes and spent most of his money to build churches and schools. It shows that Gump is a very emotional person. Although he could not think like a normal person, he always had a warm heart. And then, Jenny came back. Gump feels extremely happy because the girls that he loves being back. They were happy, not a long time, Jenny was once again away from Gump. Jenny said she had suffered from a terrible disease and did not deserve to be with him. His life once again became uncertain. He decided to run, he kept running and running until he felt tired. When he came back home. he received a letter from Jenny and the story moved to the present. Most important, Forrest found the love of his life and manage to have a small happy family with her. Jenny died with the aforementioned disease. With love for his children, Gump has turned the loss into memory to start a new life better. The final image is a feather flying through the frame like a metaphor for his life. No matter how difficult, you will still fly and succeed if you try.

Throughout the movie, Forrest demonstrated many such good traits in which no average person with average IQ could have had, no matter what happened, people may call him stupid but “stupid is what stupid does.” Nothing could have to stop Forrest once he decided to do something, for instance, when he returned after his service at the military, nothing could have stopped him from being a shrimp boat captain, fulfilling his promise with his old friend Boba, even if he didn’t have a boat or have no experiment on sailing and scrimping whatsoever. Forrest is truly an inspiration to other people for not giving up hope and doing good things in life, living life to the fullest, every day. Forrest Gump maybe not smart in terms of IQ compared to other people but he always remembers one thing. He is finally able to defeat his PTSD and accept the circumstances that he must live with while fishing for a shrimp boat, Lt.dan comes to enlightenment and comes to peace. He is no longer a high-strung, anxious individual but one who has come to terms with his life and tragedy and betters himself from it. From that point, the next time we see Lt. Dan is at Forrest’s wedding where he shows up very well-dressed, clean-cut, and shaven, with his wife and a prosthetic leg. They think he was able to not only adapt to society but also thrive it. According to the DSM-IV, Forest was on the borderline of Mental retardation. In this movie Forrest Gump, the character Lieutenant Dan exhibits clear symptoms of PTSD. It is not just experienced by war veterans but also “ exposure to violence, harm, or threatening to use of the either, sexual abuse, childhood neglect or the experience an unprecedented disaster or death. Besides that, these five dimensions are extraversion, agreeableness, conscientiousness, emotional stability, and intellect. The big five models of personality will be used to get an insight into the character Gump forms the movie, Forrest Gump.

In conclusion, The film Forrest Gump teaches us that not only should we live with a calculating mind but open our hearts to live with our emotions and hearts, be sincere and wholeheartedly for the loved ones. This is a movie that is extremely worth seeing because it is imbued with the humanity of family love, the courage to live, friends, teammates, and deep love but not dogmatic, making its impressions also forever deep in the hearts of every viewer.

Reference

1. “Emory University School of Medicine Department of Pediatrics.” What Is Mental Retardation?(n.d). Retrieved from https://www.pediatrics.emory.edu/centers/pehsu/health/mental.html.
2. Emory University School of Medicine Department of Pediatrics. (n.d.). Retrieved from https://www.pediatrics.emory.edu/centers/pehsu/health/mental.html.
3. Groom, W., & Escott, J. (2001). Forrest Gump. Harlow, Essex, Eng: Pearson Education.
4. Schenk, K. M. (2017, June 9). Life: is it really a box of chocolates? Retrieved from https://writingcooperative.com/life-is-it-really-a-box-of-chocolates-2276480fb6e.

Introduction

Mental retardation is defined by the American Association on Mental Retardation (AAMR) as “significantly sub average intellectual functioning existing concurrently with related limitations in two or more of the following applicable adaptive skill areas: communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure and work,” with such limitations manifested “before age 181.

Mental retardation is one of the most common disabilities occurring in childhood2. Intellectual disability is one the great burden for the parents, caretakers, society, and finally to the nation because of limitations in the awareness and treatment hence present study has been taken to add something to existing therapies to manage this condition. In Ayurveda, there are ample evidence of many treatment modalities and nootropic drugs used for improvement and enhancement of mental sub capability, among various treatments Panchabhautika ghritha3 has been selected which is mentioned in Kashyapa Samhita to treat clinical conditions like Jadatva (Intellectual disability). It is well established in Ayurveda classics, that there is a close relationship between the nāsā (nose) and śiras (brain),nāsā is one among the pañcajñānendriyas (five sense organs) whose function is not limited to olfaction and respiration but is also the pathway to śiras. The medicine administered through the nostrils reaches up to śṛṅgāṭaka marma, spreads all over ūrdhvajatru, and eliminates the deep-seated doṣas4. Hence Nasya karma is been choosed and ghritha is best in Manasa vikara hence ghritha Nasya is selected. So Panchabhautika ghritha has been taken to validate/ prove its effect on mental retardation there by to make the child more enough to perform the activities of daily life by improving the mental sub capability.

Objectives

To assess the clinical effect of Pancha Bhautika ghritha Nasya in the management of intellectual disability.

Methodology

Study design

The children with intellectual disability attending to OPD and IPD of Kaumarabhritya dept, SJG Ayurvedic medical college and Hospital will be selected after taking consent from parents/guardians for the present study.

Sample size :

Total 15 children with intellectual disability will be selected for the present study

Selection criteria:

Inclusion criteria:

1. Children with intellectual disability in the age range of 05-16 years of either gender.
2. Children displaying symptoms of mild to moderate intellectual disability, like delayed milestones, speech disorders, hyperactivity and mental development and behavior not proportionate with chronological age as per the conditions laid down by Diagnostic and Statistical Manual of Mental Disorders – V, will be included.

Exclusion criteria:

1. Cases with uncontrolled epilepsy, hyperkinesis, psychosis, and organic brain diseases, aminoaciduria and other inborn errors of metabolism, encephalitis, etc.
2. Children with other severe systemic disorders.
3. Children of mental impairment other than intellectual disability.
4. Profound intellectual disability.

Drug preparation and posology:

Panchabhautika ghrita will be prepared as per Ghritha Kalapana mentioned in sarangadhara samhitha by using these drugs of jeevaka,vrishabaka, draksha, Madhukar, pippali, Bala, prapoundarika, brihati, manjista, twak, punarnava, sarkara, amshumati, medha, vidanga, neela, utpala, gokshura, saindhava, rasna, and nidhigdhika .

Posology:

• Dose of Nasya:

6-8 drops of ghritha will be instilled in each nostril in the morning with empty stomach according to age of the child.

• Duration of treatment:

Treatment is planned for 2 sittings with gap of 15 days.

Procedure will be carried out for 7 days continuously and same treatment will be repeated after 15 days from the last day of 1st sitting.

Follow-up period – 1 month from the last day of treatment.

Total study duration – 2 months

Assessment criteria:

Parameters will be assessed by using Wechsler′s Intelligence Scale for Children (WISC) before treatment (1st day)and after first sitting (7th day)and after 2nd sitting (30th day).and appropriate statistical test will be applied.

Implications

Mental retardation is one of the challenging problems in the society When the scientists all over the world are turning to other systems of medicine in fields where Allopathy has failed to make a dent with the hope of finding new therapeutic measures, drugs or procedures mentioned in Ayurveda are to be validated and they are worth experimenting hence present drug has been selected for nasya as many uses mentioned under this drug like muka,jadatva, various akshi roga nidra nasa,ardhitha can be treated effectively by using Nasya with panchabhoutika tail/ghritha, so initiative step has been taken to prove its efficacy.

And future research will be done on remaining diseases under the indications of this particular drug.

References

1. Kiely M. The prevalence of mental retardation. Epidemiol Rev. 1987;9:194–218.
2. Chen J, Simeonsson RJ. Prevention of childhood disability in the People’s Republic of China. Child Care Health Dev. 1993;19:71–88.
3. KashyapSamhita, edited by Shri SatyapalBhishagacharya with Hindi commentary Vidyotini, Reprint edition, Choukhmbha Sanskrit Series, Varanasi, Kalpa sthana,shatkalpa adhyaya /40 sloka.
4. Trikamji AJ, editor. 5th ed. Varanasi: Chaukhamba Sanskrit Sansthan; 2006. “25th Adhyaya” Chikisthasthana. Charaka Samhita.
5. Malin AJ. Malin’s intelligence scale for Indian children (MISIC) Manual. Lucknow: Indian Psychological Corporation; 1969

Narrative Study

Angrosino (1994) conducted a narrative research on the bus with Vonnie Lee Explorations in life history and metaphor. The purpose of the study was to use life history as a method of narrative research among unempowered people. The author describes and analyzes the life history of a man with mental retardation.

There was a large amount of published material based on the life histories of people with mental retardation, but, literature of those materials were having gap of an insider’s perspective. Much of that literature is more focused on the experiences of caregivers, the assumption being that the person with retardation is unable to speak on his or her own behalf. It was a narrative study and one participant life history was discussed in this research. The researcher used life history interviews with observation of behavior in natural setting, and attempts to make sense of life outside the institution.

The author had not given any suggestions for further researches. This technique may be not appropriate for all persons with mental disability, but when it can be used, it helps to demonstrate the proposition that mental retardation is not a monolithic condition whose victims are distinguished by random group of standardized test scores. It is only one of many factors that figure into a person’s strategy for coping with the world. Perhaps in his specialness and individual quirkiness, Vonnie Lee is typical after all-not of ‘mentally retarded persons’ but of human beings who learn how to use elements of the common culture to serve their individual purposes.

Phenomenological Study

The Anderson (2002) conducted a study about Cognitive Representations of AIDS. The purpose of the study was to Cognitive representations of illness determine behavior. How persons living with AIDS image their disease might be key to understanding medication adherence and other health behaviors. There was a huge literature review on this topic but no studies reported AIDS patients’ cognitive representations or images of AIDS. Consequently, this study focused on how persons with AIDS cognitively represented and imaged their disease. A purposive sample of 41 men and 17 women with a diagnosis of AIDS participated in this phenomenological study. All interviews were tape-recorded and transcribed verbatim. Eight participants drew their image of AIDS.

Many participants saw a connection between caring for themselves and the length of their lives. Some participants focused on the final outcome of death, whereas others spoke of the emotional and social consequences of AIDS in their lives. From 175 significant statements, 11 themes emerged. Cognitive representations included imaging AIDS as death, bodily destruction, and just a disease. Coping focused on wiping AIDS out of the mind, hoping for the right drug, and caring for oneself inquiring about a patient’s image of AIDS might help nurses assess coping processes and enhance nurse-patient relationships. Further research combining images of AIDS and objective measures of medication adherence, risk behaviors, and quality of life is needed to determine if there is an association between specific illness representations and adherence, risk behaviors, and/or quality of life.

Case study

Asmussen & Creswell (1995) conducted a case study about the incident occurred on the campus of a large public university in a Midwestern city. A gunman entered in the university. The study was consistent with an exploratory qualitative case study design. The study was bounded by time (eight months) and by a single case (the campus community). Consistent with case study design, researcher identified campus administrators and student newspaper reporters as multiple sources of information for initial interviews. The researcher gathered observational data, documents, and visual. The researchers were self-reported information and that researchers were unable to interview all students who had been directly affected by the incident so as to not intervene in student therapy or the investigation also poses a problem.

The findings of the study were issues such as leadership, communication, and authority emerged during the case analysis. Also, an environmental response developed, because the campus was transformed into a safer place for students and staff. The need for centralized planning, while allowing for autonomous operation of units in response to a crisis, called for organizational change that would require cooperation and coordination among units. The findings were helpful to campus personnel see the inter relatedness and the large number of units that may be involved in a single incident. The researcher suggested for future studies, such as the victim response, media reporting, the debriefing process, campus changes, and the evolution of a campus plan.

Grounded study

Morrow & Smith (1995) conducted a grounded theory study on Constructions of Survival and Coping by Women Who Have Survived Childhood Sexual Abuse. The researcher’s purpose was to understand the lived experiences of women who had been sexually abused as children and to generate a theoretical model for the ways in which they survived and coped with their abuse. Although the counseling literature is rich with descriptions of specific outcomes of childhood sexual abuse, this study is distinctive in its systematic examination of the survival and coping strategies from the perspectives of women who were sexually abused as children. The participants of study were 11 women who had been sexually abused as children. In-depth interviews, videotapes, focus group, documentary evidence, and follow-up participant checks and collaborative analysis were used.

The grounded theory model for surviving and coping with childhood sexual abuse, evolving from Strauss and Corbin’s (1990) framework and developed from the present investigation is following. Two types of causal conditions emerged from this research that was cultural norms and forms of sexual abuse. The phenomena of the research was threatening or dangerous feelings and helplessness, powerlessness, lack of control. The context of the research was sensation, frequency, intensity, duration, perpetrator characteristics. The intervening conditions of the study was cultural values, family attitudes, other abuses present, age of the victim, rewards that accompanied the abuse and outside resources. The strategy of the study was keeping from overwhelmed by threatening and dangerous feelings & managing helplessness, powerlessness and lack of control. The consequences of the strategies were survival, coping strategy, healing, empowerment and wholeness.

The results of this analysis were unique to the particular investigator, participants, and context of this study. The theoretical model for survival and coping takes place as the reader examines these results in the context of specific circumstances of interest. Given the prevalence of sexual abuse, adaptation to childhood trauma must be considered a part of the process of normal development for a large number of individuals. The present findings may facilitate a reevaluation of that adaptation and offer clients and their therapists a conceptual framework to facilitate healing. The researchers were not given suggestions for further researches.

Concept of Teaching and Learning

Teaching and Learning are two things that cannot be separated because both of them support each other. Teaching activities cannot do without involving learning activities. Here are the definitions;

a. Teaching

Teaching is a process of sharing the knowledge and experience from one person to let another person know and learn. Brown states that “Teaching is showing or helping to learn how to do something, giving instruction, guiding the study of something, providing with knowledge, causing to know or understand” (Brown, 2000). In short, teaching is showing or helping someone with new knowledge.

From the definition theories about teaching above, it can be concluded that teaching is about helping someone to learn how to do something. According to, Hornby (1986) defines teaching is giving instruction in order for somebody to know or be able to do something. It can be done by giving the learners instructions of how to do that or by guiding them in doing the thing that they expected to learn. Someone who does teaching is used to be called as a teacher, while the one who is taught is used to be called as a learner. The main purpose of teaching is indeed, to make the learners know or understand how to do something she/he expected to learn.

Teaching is not an easy matter. There are many skills needed in changing someone from not knowing anything into knowing or understanding how to do something. In most cases, students are studying just because they are forced to do that. They just do what their parents want them to do. Whereas, the first thing to do in acquiring knowledge or knowing how to do something is having a desire. Students must have a desire or at least a curiosity if they want to know how to do something. It is a teacher’s duty to implant a desire or a curiosity in his/her student’s mind. It can be done if a teacher knows how to make his/her lesson interesting for students. Besides that, a teacher has to create a good relationship with his/her students if he/she wants the teaching process runs well.

b. Learning

Learning is process of acquiring new knowledge. According to Brown (2000), learning is acquisition or getting, learning is retention of information skill, and learning involves some forms of practice, perhaps reinforced practiced”. Also, Copp (2009), states that learning is the lifelong process of transforming information and experience into knowledge, skills, behaviors, and attitudes. Someone can be said as a learner if he/she is intended to acquire knowledge of a subject or a skill by study. In the process of teaching, there are many practices involved. Someone cannot acquire knowledge just by a single practice. He/she has to do practices repeatedly. The main purpose of learning is to know or understand how to do something. In this case, the learner’s desire and motivation play so significant roles. Those two things determine whether the learner can really acquire knowledge or not.

Teaching Strategy

Teaching strategies refer to the structure, system, methods, techniques, procedures, and processes that a teacher uses during instruction. Smilansky (1968,1990) as cited in Perry (2011) defined teaching strategy as the way of teacher to play with children. Moreover, OECD (2010) also described teacher strategy as a combination of process where the teacher manages the class and used all the facilities to enhance students’ understanding. There are some types of teaching strategies such as expository strategies, cooperative learning, inquiry, contextual teaching and learning, and problem-based learning. All of those strategies are not fit for all the material. It depended on the context. One strategy might fit to one particular topic but it does not certainly fit to the other topic so that the teacher has to have the ability to choose the best one.

In addition, there are some factors that influence teaching strategies. Those factors are related to teacher, student, environment, and the lesson Balachandran (2015). The factors relating to the teachers include the knowledge to use the resources, the ability to manage the class, doing adjustments based on students’ learning styles. Moreover, the factors relating to the students are class composition, grade level, benefit from a certain instruction, and students’ engagement. Meanwhile, the factors relating to environment consist of the resources of learning that support the learning process. At last, the factor relating to the lesson is developing contextual learning which relates the lesson with the real life.

Disable

a. Definition of Disable

All children must have some difference either physically (some are shorter, some are higher, some are stronger and some are weaker) or intelligently (some learn quickly and are able to remember and use what they have learned in a new situation, while others need repeated practice and have difficulty maintaining new knowledge). Hence, children who showed these differences either physically or intelligently are called exceptional children. This term refers to children with learning or behavior problems, children with physical disabilities or sensory impairments, and children who are intellectually gifted or have a special talent. Wardani (2009) this term includes children who have difficulties in learning as well as those who have excellent performance that modifications in curriculum and instruction are necessary to help them fulfill their potential. Also according to World Health Organization stated that a disabled is any restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a being human being. In short, disability is a short from special education needs and is a way to refer to students with disable.

A learning disabled student has poor auditory memory both short term and long term, has a low tolerance level and a high frustration level, has a weak or poor self-esteem, is easily distractible, and finds it difficult, if it impossible, so stay in task for extended periods of time, is spontaneous in expression: often cannot control emotion, is easily confused, is verbally demanding, has some difficulty in working with other group settings, has difficulty in following complicated direction or remembering direction for extended period of time, has coordination problem with both large and small muscle group, has inflexibility of thought: is difficult to persuade otherwise, has poor had writing skills and has a poor concept of time.

b. Kinds of Disable

Based on the Individuals with Disabilities Education Act (IDEA), there are 13 categories of children with special needs such as Autism, Blindness, Deafness, Emotional Disturbance, Hearing Impairment, Intellectual Disability, Multiple Disabilities, Orthopedic Impairment, Other Health Impairment, Specific Learning Disability, Speech or Language Impairment, Traumatic Brain Injury, and Visual Impairment. (The National Dissemination Center for Children with Disabilities, 2012). According to Fisher and Cumings (2008), there are seven types of learning difficulties: problems in speaking and listening, in reading, in writing, difficulties in learning mathematics, in organization skills, and problems with social skills and motor skills.

The term students with disabilities are more restrictive than exceptional children because it does not include gifted and talented children. The categories of exceptional children according Heward (2006) are:

• a. Blind and Low Vision

Blindness is often thought to be complete loss of vision with no remaining perception of light. However, this ultimate form of blindness is rare. Far more students have a permanent loss of some, but not all, of their eyesight. Blindness can be either congenital (occurring before or at birth) or is acquired as a result of trauma or a medical disorder.

• b. Autism Spectrum

Autism Spectrum disorders are defined as neurodevelopmental disorders described as persistent deficits which limit the student’s ability to access the educational process. Symptoms must have been present in the early developmental period and caused limitations in social, academic, occupational, or other important areas of current functioning.

• c. Intellectual Disability (Id)

The definition of intellectual disability is a student who exhibits below-average intellectual functioning and potential for measurable achievement in instructional and employment settings.

• d. Learning Disability (Ld)

Deinition of learning disabilities is a persistent condition of presumed neurological dysfunction which may exist with other disabling conditions. This dysfunction continues despite instruction in standard classroom situations. Students with learning disabilities exhibit average to above average intelligence ability, severe processing deficits, severe aptitude-achievement discrepancies, and measured achievement in an instructional or employment setting.

• e. Deaf And Hard Of Hearing (Dhh)

Deafness refers to a profound hearing loss of 90 decibels or greater. Hard of Hearing refers to those students who have some residual hearing. Hearing loss may be conductive when there is a disruption of the transmission of sound through the outer and/or middle ear or sensor neural, which is due to sensory or nerve damage in the inner ear, auditory nerve, or auditory cortex of the brain. When the deafness is congenital (occurring before or at birth) or prelingual (before the age of about three when spoken language is normally acquired) the student will have significant communication impairments resulting from having a restricted exposure to language and social frame of reference when learning to speak, write, or lip read.

Intellectual Disability

Intellectual disability (South Africa, Australia), mental retardation (America) or learning disability (United Kingdom) all represent names which communities use to draw some sort of line between what is considered to be the difference between normal and subnormal intellectual functioning. Mental retardation (MR) refers to sub-average general intellectual functioning which originates during the development period of the child and is associated with impairment in adaptive behavior (Solanki et al. 2015). It is a genetic disorder manifested significantly below-average overall intellectual functioning and deficits in adaptive behavior (Armates 2009). Also according to AAMR (1994, 2002) Mental retardation is a sub-average intellectual functioning and limitation in adaptive skills such as communication, self-care, social skills, health, safety, and work and is manifested before the age of 18 years. Intellectual Disability is characterized by impaired intellectual, adaptive functioning, and has an IQ less than 70 with difficulty in daily living activity (ADL). It is a condition of incomplete development of the mind, which is generally characterized by impairment of skills and is manifested during the development period, which contributes to overall level of intelligence. In short, intellectual disability is a person with IQ less than 70.

In Indonesia, intellectual disability is also called Tuna Grahita. The words “Tuna Grahita” come from the word “Tuna” and “Grahita”. Tuna means lost, while Grahita means thought or mind. Besides that, there are some other terms which refer to Tuna Grahita such as Mental Retardation, Mental Deficiency, and Mental Defective (Somantri, 2007). It is said by Kemis and Rosnawati (2013:10) that Tuna Grahita is a disability of general intelligence function which is sub-average, that is below 70 based on standard intelligence test. This disability also affects the adaptable attitude which happens before the age of 18. Hence, intellectual disability in Indonesia also called Tuna Grahita.

Children with intellectual disabilities which is sometimes referred to as cognitive impairment or mental retardation can take longer to learn to speak, walk and take care of their individual needs such as dressing or dining (Ozmen and Atbasi, 2016). They are likely to have problems learning at school. They will learn, but it takes them longer though there may be some things they cannot learn. Children with mild intellectual disability (ID) have a lot of learning difficulties. They are developing according to the rules that apply to all children, but their development process is slower than usual and limited according to the level of the ID (Ajdinski, Keskinova, and Memedi, 2017). As a group, students with intellectual disabilities exhibit difficulties in a wide range of academic skills, including acquiring basic academic skills (Slikker, 2009). Like other types of disabilities, intellectual disability has different levels. These levels provide a good indication of the amount of attendance students will need to reach their full potential. An average child of 4, 5 or 6 years old should be able to speak intelligibly, and should also be able to do the basic life activities without the assistance from an adult person (Kuyini, 2015). However, when that is not the case, an adult who has the intellectual abilities and adaptive behavior skills of a ten (10) year old would be thought and considered to have a mild intellectual disability (ID). In short, children with intellectual disability have problems in learning at school and take longer time to learn.

Level of Intellectual Disability Students

Mental retardation students have varying degrees of severity. These are the level of mental retardation and its criteria according to Grossman (1973):

1) Mild Mental Retardation

At this level, a person takes longer to learn to talk, but can communicate well once he or she knows how fully independent in self-care, has problems with reading and writing, is socially immature, is unable to deal with responsibilities of marriage or parenting, may benefit from specialized education plans, has an IQ range of 50 to 69, may have associated conditions, including autism, epilepsy, or physical disability.

2) Moderate Mental Retardation

At this level, a person is slow in understanding and using language, has only a limited ability to communicate, can learn basic reading, writing, counting skills, is a slow learner, is unable to live alone, can get around on own, can take part in simple social activities, and has an IQ range of 35 to 49.

3) Serve Mental Retardation

At this level, a person has noticeable impairment, has severe damage to and/or abnormal development of central nervous system, and has an IQ range of 20 to 34.

4) Profound Mental Retardation

At this level, a person is unable to understand or comply with requests or instructions, must wear adult diapers, uses very basic nonverbal communication, cannot care for own needs, requires constant help and supervision, has an IQ of less than 20.

The Causes of Intellectual Disability

Generally, Intellectual Disability or Tuna Grahita is caused by some factors which have been built in from pre or post-natal, and each student has different causes which bring them to disability. According to Kemis and Rosnawati (2013: 15), those factors are:

1. 1) Genetic Factor

Genetic factor happens when there is Biochemical Disorder or Abnormality Chromosome in human body.

1. 2) Pre-Natal Factor

• a) Rubella Infection
• b) RhesusFactor

1. 3) Pre-natal accidents which happen during the process of birth.
2. 4) Post-natal accidents which are caused by infection such as meningitis and nutritient problems of which the children are lack of nutrients and proteins.
3. 5) Socio-Cultural Factor

This factor includes the ways of society and cultures affect disabled students in their self-development, particularly in their intelligence. These may come from family, friends, relatives, society, and certain cultures.

1. 6) Metabolism Disorders

Metabolism disorder is caused from chemical process in body which is not organized.

In conclusion, adult people have to know the causes of disabled student’s type Tuna Grahita in order to give early solutions, particularly the solution in learning process.

Previous Related Studies

There are several previous studies which are related to this study. The first study was conducted by Kurniawati, Indah. 2013. The Teaching and Learning Vocabulary Process to Children with Mental Retardation of the Fifth Grade Students in SDLBC Purwosari Kudus. The objective of the research in this study is to describe the process of teaching and learning English for children with mental retardation of the fifth-grade students in SDLB-C Purwosari Kudus and describe the problems appear in teaching and learning process. The writer observes teaching and learning process and does interview to the English teacher. The method which is used by teacher in SDLB-C Purwosari Kudus is Communicative Language Teaching. The use of CLT is characterized by the involvement of the students in teaching-learning process; in here is use of the question-answer technique. The problems appear come from the activity. They are: the different capability of the students, the students cannot developed their initiate, need long time to finish one topic, and the students still depend on the teacher to get new vocabulary.

The second related study conducted by Fitriana Kartika Sari, 2018 entitled “Process Of Teaching Vocabulary To Mentally Retarded Students By Using Flashcards At SLB Negeri Colomadu In 2017/ 2018 Academic Year”. This study aims to describe the teaching vocabulary process, how the process of teaching vocabulary to mental retardation and to know the problem faced by teacher in teaching vocabulary process by using flashcards. The method used in this research is descriptive qualitative method. The subject in this study was the teacher who taught mentally retarded students. Based on data analysis, the result of this study indicated that there were four aspects in teaching vocabulary process to mental retardation by using flashcards namely: a) the material, b) the technique, c) the media, and d) the procedure. The problems faced by teachers in teaching vocabulary process by using flashcards are a) limited facilities, b) required teacher creativity, and c) financial grounding.

The last related study conducted by Siti Mutiatun in her thesis Techniques of Teaching English as A Second Language for Students “With Different Ability” at SMPLB Siswa Budhi, Surabaya. This thesis explained about several techniques that are used for teaching English. The first technique is explanation which is used in every meeting in English class. The second technique used is discussion, even though it is different from typical class. The third technique is picture which is favored by the students. The fourth technique is drilling, this technique used along with pictures. And the last is reward, which can motivate the students in learning English more. The teacher already used several methods, but she has not a specific skill in English. This subject is consisting from some disability not specific to one disabled.