Environmental influences

Apart from the range of potential adverse psychosocial experiences that children in the general community might experience, children with mental retardation are more likely to experience further potentially adverse experiences such as respite and institutional care, social rejection, teasing and school adjustment problems, abuse, and neglect. Limited cognitive ability to understand and discuss socially stressful experiences may compromise adaptation and contribute to behavioural disturbance. Parental grief, guilt, hostility, ambivalence, and rejection, increased financial burden of care, and family stresses are further factors likely to impair attachment, relationships, and the quality of the care environment. (52> Behavioural problems, impaired responsiveness and capacity for reciprocal social interactions, communication difficulties, and low resilience, particularly in some vulnerable groups of children with mental retardation such as those with autism, further impairs attachment and parent-child interaction.(5 54»

Deprivation, lack of stimulation, and lack of opportunity for play and social interaction can further impair the personality development and emotional and behavioural adjustment of children with mental retardation. Mothers may experience higher levels of stress with a disabled child than fathers, who are more likely to avoid involvement and responsibility for care, (55> but this may be partly a culturally determined phenomenon. Although there is a relative lack of studies examining cultural differences in the care of children with mental retardation, cultural responses, expectations, and attitudes may influence parenting and emotional development and behaviour of children with mental retardation. (56> Observation and assessment of the child's interaction with family and carers, and a detailed history of the psychosocial context, environmental experiences and stresses, the development of attachment, and the opportunities for consistent care and stimulation is necessary to understand the contribution these factors might make to psychopathology and management. The important association between adverse psychosocial experiences and the development of emotional and behavioural problems in persons with mental retardation is recognized in Axis V of the draft ICD-10 guide for mental retardation.(l3»

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