A survey to assess awareness about intellectual disability disorder in students studying homoeopathy

INTRODUCTION

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V), ‘Intellectual Disability (Intellectual Developmental Disorder) (ID/IDD) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social and practical domains’.^[1]

The previously used term mental retardation was replaced by the term intellectual disability in the DSM V and the ICD 11 classifications to Disorders of Intellectual Development. This change was necessitated by the pejorative, negative and pessimistic connotations of the terms mental retardation, arrested mind development, idiocy, imbecility and mental deficiency, all of which were used previously. The use of the term intellectual is also in line with the current definition of the construct of intelligence encompassing a wide range of cognitive abilities, adaptive function and new learning abilities; this description has therefore gained wider acceptance with professionals, lay individuals and most health policy officials worldwide.^[2]

Over time, numerous changes have occurred in the management and care of individuals with IDDs. With the growing awareness in this area, the roles of special educators, therapists and medical service providers have also been refined and made more inclusive. Medical treatment of disabilities is a lesser explored area, both in conventional and complementary and alternative medicine systems. The main focus of intervention is rehabilitation and special education. Parents often approach practitioners of conventional as well as complementary and alternative systems. Very often, faith healers are consulted as well.

Clinical evidence supports the role of homoeopathy in the treatment of ID/IDD. Studies state that, with homoeopathy, existing symptoms such as restlessness, irritability, anger and behavioural problems including threatening and attacking others and physical symptoms such as stammering, enuresis and others can be controlled and medicines can prevent further worsening of the symptoms.^[3-8]

Homoeopathic colleges in India provide education and training for 5 years; their syllabi include the study of subjects of modern medicine along with those of homoeopathy. During undergraduate studies, the subject of the practice of medicine introduces students to pre-clinical and clinical subjects. This also includes the subject of paediatrics. IDD is introduced at the graduate level and further discussed at the postgraduate level. These students later become homoeopathic practitioners and play major roles in providing healthcare services at the primary, secondary and tertiary levels, including integrated care.

For homoeopathic physicians to provide treatment and support to persons with IDD, they need to understand the condition from not only the medical and homoeopathic perspectives but also the social, ethical and legal aspects. The attitude of students in homoeopathic medical colleges towards IDD and specifically people with IDD deserves considerable attention considering their potential role as future homoeopathic practitioners and family physicians. This survey was, therefore, undertaken to assess the knowledge and attitudes of the students towards ID/IDD as well as their level of awareness and misconceptions about the condition from a sociocultural perspective.

MATERIAL AND METHODS

RESULTS

A total of 143 undergraduate and postgraduate students participated in the survey; 30 were male and 113 were female. One participant who did not mention their age, sex and year of study was excluded from the analysis. The participants needed approximately 10 min to fill out the questionnaire. The baseline characteristics of the participants are detailed in [Table 1].

The responses received from the students are detailed in [Table 2]. The awareness was minimum regarding whether ID is a mental illness, whether children with convulsive disorders also have ID and if ID patients can lead a normal life.

Comparison of scores based on sex and qualification level is shown in Table 3.

A significantly higher score was seen in the male students in the direction of misconceptions, implying a comparatively lower level of awareness from social perspectives. Although there was no significant difference between the scores of undergraduate (6.50±3.35) and postgraduate students (5.72±2.60), a higher score in the graduate students implies a lower level of awareness [Table 4].

The overall misconception score was 6.22 ± 3.18 (95% confidence interval 5.69–6.75) suggesting a good level of awareness among the students.

DISCUSSION

The study identifies that while students have a high level of understanding and awareness of ID/IDD, certain areas from the rehabilitation perspective need to be explored further, particularly issues such as the extent of improvement or autonomy that can be achieved in the intellectually disabled after proper rehabilitative measures. The college posts its students to outpatient departments (OPDs) and peripheral OPDs, where ID/IDD cases are present occasionally. The college also posts its students at the National Institute for Empowerment of Persons with Intellectual Disabilities, Noida, an institute autonomous under the Ministry of Social Justice and Empowerment for undertaking MD thesis work, which provides integrated settings of care with psychological assessment, medical treatment and rehabilitation. The faculty, therefore, is well aware of the diagnostic constraints, management modalities and common misconceptions reported by the parents.

The incidence of ID/IDD is 1–2%, varying with age, region and socioeconomic status.^[14] However, the condition is frequently poorly understood and misdiagnosed; affected children and their families are often at a loss for accessibility and availability of healthcare and rehabilitative services.^[15]

Homoeopathic training in India covers both the modern understanding of the disease condition as well as its understanding in terms of homoeopathic principles and philosophy. Barring the methodology for choice of prescription, the overall management and assessment of condition and prognosis remain the same across systems. Several studies report that homoeopathy in conjunction with rehabilitative therapies has reduced distressing symptoms; homoeopathy has thus been identified as a useful alternative to relieve associated pathologies.^[3-6] Occasional case reports of ID and studies on related conditions such as autism spectrum disorder and attention deficit hyperactivity disorder also state that patients frequently seek homoeopathic treatment.^{[3,7,8,16-31]}

However, homoeopathic educational training usually does not cover various aspects of rehabilitation and special education, which is best left to the specialists in the concerned field. Further, homoeopathic practitioners need to be aware of the common sociocultural misconceptions regarding ID/IDD, such as it being caused by black magic or fate, whether it is contagious, or if those with ID/IDD can be ‘cured’ and become normal with treatments, or marriage or childbirth, etc. Homoeopathic practitioners must be adequately trained regarding the management of the social implications of ID/IDD as well. Practitioners, therefore, need to identify their misconceptions about ID/IDD and seek means of overcoming these in an effort to provide quality and compassionate service to their patients. The student years, therefore, provide the right opportunity to understand this aspect, where appropriate training can be imparted; thus, students are better prepared as practitioners to deal with the condition medically and socially and can guide the caregivers accordingly.

To the best of our knowledge, this is the first study identifying sociocultural awareness regarding ID/IDD among homoeopathic students. While studying the clinical aspects of this condition is important, it is equally important to understand the misconceptions, myths and stigma associated with the same. Practitioners need to educate caregivers about the condition, guide them regarding rehabilitative therapies and allay any myths and concerns.

One limitation of the study was that it was performed on a small sample of students from one college. The survey was conducted only with the students who were scheduled to attend the seminar on ID; other students, like those posted in the OPDs or the wards, were not included.

CONCLUSION

The surveyed sample of students had a good level of awareness about ID. However, further understanding of sociocultural aspects needs to be enhanced and myths and misconceptions related to the conditions need to be allayed, specifically those related to the capacity for self-care and independence that patients with ID can attain with rehabilitation and care.