Prevention Efforts

In the past 25 years, efforts to eliminate or reduce cases of mental retardation have been marked. Prevention has occurred across all three levels: primary, secondary, and tertiary. In short, primary prevention involves efforts to intervene such that one eradicates or minimizes the risk factors before a disabling condition develops. Primary prevention efforts often comprise the backbone of public health programs. Secondary prevention comprises efforts toward the early detection, diagnosis, and treatment such that the duration of the disease is shortened, secondary conditions are reduced, and discomfort is minimized. To achieve this goal, professionals must recognize the precursors of a disease or condition and intervene to limit its progression. For example, neonatal intensive care units act as an agent to limit the numerous consequences of premature births. For those who have an identified disability or disease, tertiary prevention is necessary. Tertiary prevention involves promoting maximal functioning among persons with identified disorders or diseases. The intervention efforts serve to provide for functionality or normalization within the least restrictive environment. One example is the array of community-based life skills training programs for persons with mental retardation.

The goal of prevention, despite successes, remains a daunting one due to multifactorial etiologies, competition for resources, and lack of client motivation and/ or empowerment for participation. Another challenge specific to the outcome of mental retardation is the long latency period between exposure to causal factors and the diagnosis of mental retardation. This latency period presents a challenge for determining the etiology of mental retardation (and other developmental disabilities). However, developmental epide-miological studies can assist in the challenge of dealing with the latency period between exposure to causal factors and the manifestations of a developmental outcome. This can be accomplished by using linked extant databases to examine causative and protective factors and their relation to the outcome of interest. This methodology effectively creates a longitudinal file for each individual for which all data points are available without having to wait multiple years for the outcome (e.g., mental retardation) to be manifested.

To date, prevention efforts have proven successful in eliminating congenital rubella by immunization and antibody screenings; eliminating retardation due to PKU, galactosemia, and congenital hypothyroidism by newborn screenings and dietary management; and eliminating kernicterus by the use of globulin therapy. Prevention efforts have also greatly reduced morbidity from prematurity through neonatal intensive care nurseries, the presence ofmeasles through vaccination, and Tay-Sachs disease through early screening and prenatal diagnosis. In addition, efforts have proven effective in reducing the incidence of neural tube defects by folic acid supplementation, fetal alcohol syndrome through public awareness and education, lead poisoning by environmental improvements and lead screenings, traumatic brain injury by using child restraints in automobiles, and child abuse and neglect through family education and supports. Finally, improvements have also occurred via early identification and intervention of young children at risk for developmental delays. With such efforts, various medical, allied health, and early intervention professionals have been effective in providing earlier identification and treatment for individuals with mental retardation.

1. Early Childhood Intervention

The provision of early childhood intervention services involves systematic efforts to provide at-risk children with additional educational and developmental experiences before school age. It also includes the provision of family services. Several investigations have attempted to quantify the impact of early intervention on the cognitive development of young children from disadvantaged backgrounds (e.g., Early Training Project, Perry Preschool Project, Houston Parent Child Development Center, Milwaukee Project, Carolina Abecedarian Project, and Project Care) and those with biological risk factors (e.g., low birth weight—the Infant Health and Development Project). Although these research projects defined disadvantage in slightly different ways, initiated intervention at varying ages, and included different intervention components, their collective results provide evidence that high-quality early intervention services prevent or minimize the potentially harmful effects of various environmental and biological risk factors for young disadvantaged children. These programs provide short-term benefits in the areas of cognitive functioning and long-term effects on decreased grade retention and special education placement. In addition, evidence from a few studies suggests that programs with the greatest educational intensity and duration maintain cognitive functioning benefits until adulthood. The positive cost-benefit ratio for society should not be underestimated in this regard.

In general, programs that begin earlier and continue longer afford greater cognitive functioning benefits than those that begin later and have shorter durations. Intervention studies that begin during infancy and preschool years, before at-risk children develop increasingly depressed cognitive/developmental scores, have demonstrated the largest impact on cognitive level of functioning. These intervention programs have shown that participating children continue to score in the average range on cognitive/developmental tests, whereas children not receiving the full intervention score in the low-average range. Programs that began at later ages, approximately 4 or 5, have shown that upon entry children's cognitive scores have already begun to decline. After 1 or 2 years of intervention, children's cognitive scores are higher, whereas the scores of children who did not receive the intervention have not changed. Although these types of interventions may lessen the morbidity associated with moderate and severe levels of mental retardation, they stand to impact most significantly on individuals with mild mental retardation with idiopathic etiologies.

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