Int
ern
at
i
onal
Journ
al of
P
u
bli
c Hea
lt
h S
c
ie
nce (IJPH
S)
Vo
l.
6
,
No.
4
,
D
ece
m
ber
201
7
, pp.
331
~
336
IS
S
N:
22
52
-
8806
,
DOI: 10
.11
591/
ij
phs
.
v
6
i
v
.
1
07
79
331
Journ
al h
om
e
page
:
https:
//
ww
w.i
aesco
re
.c
om
/j
our
nals/
ind
ex.
php/IJP
H
S
Having
Ch
ild
re
n
with
M
en
ta
l
Ret
ar
d
atio
n
Sri E
ndriy
an
i,
Y
u
nike
Hea
lt
h
Pol
y
tech
nic
,
Pal
embang,
Indone
sia
Art
ic
le
In
f
o
ABSTR
A
CT
Art
ic
le
history:
Re
cei
ved
Sep
1
9
, 201
7
Re
vised
N
ov
2
5
,
201
7
Accepte
d
Dec
13
, 201
7
Menta
l
R
et
ard
at
i
on
is
a
condi
t
ion
in
which
the
intele
g
ency
fun
ct
io
n
is
under
ave
rag
e,
which
bega
n
during
the
developm
ent
a
l
per
iod.
C
hil
dre
n
with
m
ent
al
l
y
re
ta
rd
e
d
have
li
m
it
ed
m
ent
a
l
func
ti
on
,
c
om
m
unic
at
ion
skill
s,
ab
il
i
t
y
to
m
ai
nt
ai
n
them
selve
s
and
s
oci
a
l
skil
ls.
Th
ese
cond
it
ions
impact
the
m
othe
s’s
they
respons
ibl
e
to
train
chi
ldr
en’
s
ability
to
be
inde
p
e
ndent
.
Th
e
purpose
of
th
is
stud
y
is
to
explore
th
e
m
othe
rs’
expe
r
ie
nc
e
h
aving
chi
ld
ren
with
m
ent
al
re
t
ard
ation
at
Spe
ci
a
l
School
for
m
ent
al
l
y
r
et
ard
e
d
(SLB)
of
Kar
y
a
Ibu
Pale
m
bang,
Indone
sia.
Th
is
is
a
qual
it
a
ti
v
e
rese
arc
h
wit
h
fen
om
enol
og
y
a
pproa
ch
from
fi
ve
par
t
isipa
nts
with
inde
p
t
inte
rvie
w.
Fiv
e
the
m
es
were
ge
t
inc
lu
ding
c
an’
t
acce
pt
reali
t
y
,
burde
n,
th
e
so
ci
a
l
stigm
a,
nee
d
support
from
rel
at
ive
s,
w
orr
y
about
th
e
future
,
and
a
dm
i
tt
ing
God’s
w
ill
.
Th
e
Adapt
at
ion
beh
avi
ors
found
in
thi
s
st
ud
y
ar
e
the
acc
ep
ta
n
ce
of
chi
ldr
en’
s c
ond
ition,
and lovi
ng
t
he
ch
il
dre
n
thor
oughl
y
.
Ke
yw
or
d:
Chil
dr
e
n
M
ental
ly
r
et
a
rd
ed
Pare
nts
Copyright
©
201
7
Instit
ut
e
o
f Ad
vanc
ed
Engi
n
ee
r
ing
and
S
cienc
e
.
Al
l
rights re
serv
ed
.
Corres
pond
in
g
Aut
h
or
:
Sr
i E
ndriy
ani
,
Healt
h
P
olyt
echn
ic
,
Jen
der
al
S
ud
ir
m
an
Street
K
M 3,5
Nu
m
ber 1
365
,
Palem
ban
g, S
outh
Su
m
at
era,
I
ndonesi
a
.
Em
a
il
:
sriend
ri
ya
ni@yah
oo.c
o.
id
1.
INTROD
U
CTION
Me
ntal
Re
ta
rdat
ion
rem
ai
ns
the
w
orl
d
pro
ble
m
par
ti
cularly
for
de
vel
o
pi
ng
co
untrie
s.
It
is
Estim
at
ed
that
the
incide
nce
of
se
ver
e
m
ental
retard
at
ion
a
ppr
ox
im
a
te
ly
0.
3
%
of
t
otal
popula
ti
on
a
nd
nea
rly
3
%
the
In
te
ll
ege
nce
Q
uo
ti
ent
(
IQ)
is
unde
r
70.
A
bout
0.1
%
of
t
ho
se
child
re
n
re
qu
ire
s
treat
m
ent,
guida
nc
e
an
d
prolo
ngs
s
upe
rv
isi
on
t
hro
ughout
th
ei
r
li
fe
.
Me
ntal
retar
dation
rem
ai
ns
a
dilemm
a,
le
adin
g
a
nxie
ty
for
fam
i
li
es
and
c
omm
un
it
ie
s.
Tthe
dia
gnos
is,
treatm
ent,
an
d
it
s
pr
e
ven
ti
on
for
c
hildr
e
n
wi
th
m
ental
lly
retard
e
d
are
rem
ai
ns
in
disti
nct
[
1]
.
Me
ntal
retar
da
ti
on
is
a
resu
lt
of
pat
ho
l
og
ic
process
i
n
th
e
br
ai
n
that
il
lustrate
s
the
li
m
it
a
ti
on
s
of
intel
le
ct
ual
and
ada
ptive
f
unct
ion
,
but
it
is
no
t
a
disease
.
Me
ntal
retard
at
ion
m
ay
oc
cur
with
or
w
it
ho
ut
disruptio
n
of
m
ent
al
ly
or
physi
cal
disorde
rs
[
2]
.
Me
nta
l
retard
at
io
n
c
la
ssifie
d
into
t
hr
ee
gro
up
s
i
nc
lud
in
g
m
il
d
(IQ
betw
een
52
-
68
Bi
ne
t
scal
e),
m
oderate
(
IQ
betw
een
36
-
51
Bi
ne
t
scal
e),
seve
r
e
(IQ
bet
ween
20
-
30
Bi
net scal
e an
d <2
0
Bi
net scal
e)
[
3]
.
More
tha
n
120
m
i
ll
ion
s
pe
ople
al
l
over
the
w
orl
d
are
ex
pe
ct
ed
s
uffer
i
ng
m
ental
r
et
ard
at
ion
[
4]
. P
rio
r
stud
ie
s
i
n
m
a
ny
co
untrie
s
r
eveale
d
t
hat
the
pr
e
valence
of
m
ental
retard
at
io
n
am
ong
m
il
d
and
m
od
e
rat
e
gro
up
s
a
ge
d
15
to
19
ye
ar
s
are
3
to
4
person
pe
r
10
00
people.
In
Un
i
te
d
Stat
e
of
A
m
erica,
3
%
of
th
e
popula
ti
on
ha
vi
ng
m
ental
retard
at
io
n,
i
n
Nether
la
nd
s
2.6%
,
in
Brit
ai
n
1
to
8%,
an
d
3
%
of
Asia
n
po
pu
l
at
ion
su
f
fer
i
ng
m
ent
al
retard
at
io
n
[
5]
.
I
n
Ind
on
esi
a,
of
222
m
il
l
i
on
s
of
total
popu
la
ti
on,
2.8
m
il
li
on
pe
op
le
(
0.7
%
)
are
disa
bled
. Am
on
g
them
290,837
a
re
c
hild
ren
w
it
h
m
ental
ly
retard
ed
(
13.
68
%)
, p
hysi
cal
disabili
ti
es
(33.7
4
%),
a
nd
blindn
ess (15.9
3 %)
[
6]
.
Me
ntal
retar
da
ti
on
is
a
c
ondi
ti
on
of
disabili
ty
char
act
erize
d
by
li
m
it
at
io
ns
i
n
intel
le
ct
ual
f
unct
io
n
and
ada
ptive
be
hav
i
or,
es
pecial
ly
in
con
ce
pt
ual,
s
ocial
an
d
ada
ptive
s
kill
s.
Chil
dre
n
wit
h
m
ental
ly
ret
ard
e
d
hav
e
li
m
i
te
d
m
ental
functi
on,
com
m
un
ic
at
ion
sk
il
ls,
abili
ty
to
m
ai
ntain
the
m
sel
ves
and
and
i
nd
e
pe
nd
e
nce
of
ch
il
dr
e
n d
ur
i
ng the
per
i
od of
de
velo
pm
ent
[7]
-
[
9].
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
6
, No
.
4
,
Decem
ber
20
1
7
:
331
–
336
332
Chil
dr
e
n
with
m
ental
retard
at
ion
require
i
nt
ensive
ca
re
by
par
e
nts
to
opt
i
m
iz
e
their
dev
el
opm
ental
sta
ges
su
c
h
as
condu
ct
in
g
m
edical
exam
inati
on
s,
co
unse
li
ng
an
d
coac
hing.
Old
pa
re
nts
and
oth
er
fam
i
ly
m
e
m
ber
s
are
the
m
os
t
i
m
po
rtant
par
t
f
or
c
hildr
e
n
with
m
ental
retard
at
io
n
to
be
a
ble
to
li
ve
their
li
ves
well
[7
]
,
[8
]
,
[10].
2.
RESEA
R
CH MET
HO
D
This
stu
dy
was
a
qu
al
it
at
ive
r
esearch
.
Q
ualit
at
ive
researc
h
is
a
researc
h
w
hich
is
co
nduct
ed
to
stu
dy
a
natu
ral
obj
ec
t,
wh
e
re
the r
es
earche
rs
as
the
key
instr
um
ent
[1
1],
[12]
.
T
his
researc
h
us
es
qu
al
it
at
ive
res
earc
h
with
descr
i
ptiv
e phen
om
eno
lo
gy appr
oac
h,
de
picti
ng
de
pth
conditi
on expe
rience
d by w
ha
t i
t i
s
.
T
rian
gu
l
at
ion
te
chn
iq
ue
is us
ed
to
obta
in v
a
li
dity
and
e
nr
ic
h
data
, w
hic
h
is
util
iz
ing
s
om
et
hin
g
el
se
in
com
par
ing
int
erv
ie
w
resu
lt
to
res
ponde
nt
in
the
form
of
intervie
w,
ob
se
r
va
ti
on
an
d
doc
um
ent
[12]
.
The
re
searc
he
r
us
e
s
tria
ngulati
on
of
source
a
nd
t
heory
that
is
c
om
par
ing
data
of
obser
vatio
n
res
ult
with
r
esult
of
inter
vi
ew
an
d
relat
ed
the
ory
.
D
at
a
analy
sis
was
co
nducte
d
inducti
vely
and
t
he
res
ult
of
a
qu
al
it
at
ive
researc
h
em
ph
a
siz
e
the
m
eaning
rat
he
r
than
ge
ner
al
isa
ti
on
.
T
his
stud
y
ap
plies
f
eno
m
eno
l
ogy
appr
oach.
Fenom
eno
log
y
a
ppr
oac
h
at
tem
pts
to
ex
plain
or
re
veal
the
m
eaning
of
t
he
c
on
ce
pt
or
ex
pe
rience
co
ns
ti
tuted
by
con
sci
ousn
e
ss
that
occure
d upo
n
s
om
e ind
ivid
ual
s
[
12
]
,
[13]
.
The
resu
lt
s
s
howe
d
that
5
par
ti
ci
pa
nts
are
quit
e
re
presenti
ng
al
l
inf
or
m
at
ion
s
ne
eded
by
t
he
researc
her
an
d
the
data
sat
ur
at
ion
has
bee
n
obta
ined
re
ga
rd
i
ng
t
he
par
e
nts’
e
xperie
nc
e
ha
ving
c
hild
ren
with
m
ental
r
et
ard
at
ion
.
T
his stu
dy
w
as
co
nducte
d
at
S
LB o
f Ka
rya I
bu Palem
ban
g
.
3.
RESU
LT
S
A
ND AN
ALYSIS
3.1.
Can n
ot
ac
cep
t
re
ality
T
her
e
are
sev
eral
cha
racteri
sti
cs
of
t
he
c
hildr
e
n
ha
ving
m
ental
retard
at
ion
incl
ud
i
ng
li
m
it
ed
of
intel
egen
cy
,
soc
ia
l
lim
it
ation
,
an
d
t
he
li
m
i
t
at
ion
of
ot
her
m
ental
functi
ons.
All
of
t
hes
e
lim
it
a
ti
on
s
i
nduce
den
ia
l
from
the p
a
ren
ts t
o
acc
ept the
reali
ty
tha
t t
heir
ch
il
d i
s h
a
ving m
ental
r
et
ard
at
i
on
[
4]
,[
8],[1
0]
.
This
stu
dy
ide
ntifie
d
the
i
niti
al
resp
onse
of
pa
ren
ts
a
s
they
noti
ce
tha
t
their
child
i
s
m
entally
-
retard
e
d.
T
he
par
e
nt
'
s
ps
yc
ho
lo
gical
respo
ns
e
is
den
ia
l
in
wh
ic
h
m
os
t
par
ti
ci
pan
ts
f
eel
ing
sorr
owf
ul
for
hav
i
ng
a
m
ental
ly
-
retard
e
d
child.
It
was
il
lustrate
d
by
the
crit
eria
of
the
par
ti
ci
pa
nts
by
feeli
ng
s
ho
c
ke
d,
an
d
m
israble.
So
m
e
par
ti
ci
pa
nts
rev
eal
e
d
that
they
wer
e
disa
ppoin
te
d
ha
ving
m
ental
l
y
ret
ard
e
d
child
re
n
,
there
al
so
f
el
t as
ham
ed havi
ng
chil
dr
e
n
with s
peci
al
n
eed
s
s
uch a
s m
ental
r
et
ardat
ion
.
This
fin
dings
are
si
m
il
ar
wit
h
the
ex
planati
on
that
kn
ow
i
ng
thei
r
childr
en
is
m
ental
ly
retard
e
d,
at
first,
m
any
wil
l
rej
ect
it
feeli
ng
inca
pa
ble
to
gro
w
a
nd
guide
their
c
hildre
n
[4
]
,
[7
]
.
Me
anwhil
e,
we
a
s
su
m
e
that
t
he
first
ps
yc
holo
gical
respo
ns
e
is
di
ff
ic
ult
t
o
acce
pt
the
reali
ty
as
they
know
their
child
ren
we
r
e
m
ental
ly
-
retard
ed
. Initi
al
ly
, t
he
pa
ren
ts
did
no
t
belie
ve
ab
out t
he
co
ndit
ion
of their
c
hild
ren, f
eel
in
g
m
i
serab
le
and
s
hoc
ked
is
the
i
m
pact
of
h
avi
n
g
c
hild
re
n
with
m
ental
retard
at
io
n.
T
he
y
al
so
feel
sad
,
angry,
guil
ty
fo
r
no
t
bein
g
a
ble
to
bear
a
norm
al
child
[8
]
,
[14]
.
Hav
i
ng
a
c
hild
with
m
ental
r
et
ard
at
io
n
m
akes
a
m
oth
er
fe
el
that
sh
e
has
no
sel
f
-
est
eem
,
us
el
essness
an
d
ca
us
es
t
he
disap
po
i
ntm
ent
of
t
he
c
ouple
a
nd
exten
de
d
fam
il
y
by
giv
in
g birt
h
to
a d
isa
bled
c
hild
[14],[
15]
.
The
pa
re
nts
w
onde
r
if
they
di
d
so
m
et
hin
g
wrong,
duri
ng
the
co
ur
se
of
t
he
preg
na
ncy
or
a
fter
bi
rth
,
wh
il
e
ta
ki
ng
c
are
of
the
chil
d.
T
hey
w
onde
r
if
God
is
punis
hing
them
for
thei
r
sins
[16],[
17]
.
Co
nsc
ie
nce,
par
e
nts
will
quest
io
n
w
hy
I
hav
e
t
o
face
s
uch
a
sit
uatio
n,
w
hy
m
e
and
wh
y
m
y
child,
did
I
do
s
om
et
hin
g
wrong
.
This
is
the
con
se
qu
e
ncy
of
the
une
xp
ect
e
d
child
r
en
by
the
fam
i
ly
[15]
.
The
pa
ren
ts
we
re
de
finite
ly
diff
ic
ult t
o
acc
ep
t t
hose c
ondi
ti
on
s
.
3.2.
Burden
T
he
pr
ese
nce
of
m
ental
ly
-
retard
e
d
c
hildr
e
n
i
m
pact
the
parents
an
d
t
heir
f
a
m
ily
and
ca
n
be
a
s
ourc
e
of
bu
rd
e
n
f
or
fam
i
ly
.
The
burd
e
n
ex
per
ie
nc
ed
is
su
bject
iv
e
and
obj
ect
i
ve
.
The
obj
ect
i
ve
bur
den
incl
ud
e
s
econom
ic
issues
(co
st
of
tre
atm
ent
and
m
a
intenanc
e),
job
loss,
lim
it
ed
and
l
os
s
of
op
portu
niti
es
for
so
ci
al
act
ivit
ie
s
and
interact
io
n
w
it
h
fam
ily
and
the
en
vir
on
m
ent.
The
s
ubj
ect
iv
e
burd
e
n
e
xp
e
rience
d
is
the
ps
yc
holo
gical
pro
blem
s
of
par
e
nts
a
nd
f
a
m
ily
in
caring
f
or
fam
i
ly
m
e
m
ber
s
with
m
ental
retard
at
io
n,
especial
ly
the
sp
eci
al
need
s
diff
e
re
nt
fr
om
oth
er
fam
il
y
m
e
m
ber
s
in
the
fo
rm
of
feeli
ng
s
of
guil
t,
sh
am
e,
un
ce
rtai
nty an
d depressi
on
[
8]
,[
14]
,[18
]
.
Li
m
it
ed
abili
ty
ex
per
ie
nced
by
childre
n
with
m
ental
retard
a
ti
on
ca
us
in
g
pr
ob
le
m
s
or
c
onf
li
ct
s
in
the
fam
i
ly
,
bla
m
in
g,
a
nd
acc
us
i
ng.
Co
ns
e
quentl
y,
the
retar
ded
childre
n
are
m
uch
m
or
e
co
m
pl
ic
at
ed
to
de
velo
p.
This
c
onditi
on
m
akes
pa
ren
t
s
feel
stresse
d
eve
n
at
risk
of
de
pr
essi
on
wh
e
n
th
ey
rea
li
ze
that
their
child
is
su
f
fer
i
ng fro
m
m
ental
retard
at
ion
[
18
]
,
[19]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
Ha
vi
ng Childr
en
wi
th Me
nt
al Retar
da
ti
on (
Sri
Endriya
ni)
333
Chil
dr
e
n
with
m
ental
retard
at
ion
e
xp
e
rien
ce
lim
i
ta
ti
on
s
in
com
m
un
ic
at
ion
,
sel
f
-
ca
re,
so
ci
al
an
d
interpe
rs
on
al
s
kill
s.
They
ha
ve
dif
ficult
ie
s
in
m
ee
ti
ng
the
need
s
of
daily
li
vin
g
an
d
f
un
ct
io
ning
in
so
ci
et
y
because
of
the
ir
intel
le
ct
u
al
abili
ti
es,
lim
i
ted
m
oto
r
s
kill
s
and
ada
ptati
on
to
th
e
e
nv
ir
on
m
ent
[8
]
,
[10]
.
Othe
r
stud
ie
s
hav
e
s
uggeste
d
that
par
e
nts
feel
as
ham
ed
of
ha
vi
ng
c
hildr
e
n
w
it
h
m
ental
ret
ard
at
io
n
be
cau
se
of
diff
ic
ulti
es
in
ov
e
rc
om
ing
beh
avi
or
prob
le
m
s
li
ke
screa
m
ing
,
c
ryi
ng,
ina
bili
ty
to
con
centrate
,
ag
gressi
ven
e
ss,
stubb
ornn
e
ss
e
tc
.
O
ften,
the
c
hild
m
igh
t
not
unde
rstan
d
how
disruptive
hi
s/her
be
hav
i
or
is
to
oth
e
rs
a
nd
wh
y
they
get
an
gr
y
.Th
is
pro
blem
m
ake
par
e
nts
even
hid
i
ng
childre
n
f
r
om
their
com
m
un
it
y
and
en
vir
on
m
ent.
Chil
dr
e
n'
s
m
ental
retard
at
ion
needs
to
be
s
pe
ci
fical
ly
con
sidere
d,
m
aking
par
e
nts
an
d
ot
her
fam
il
y
m
e
m
ber
s
diff
ic
ult
to
di
vi
de
their
ti
m
e
and
ca
re
f
or
th
ei
r
child
with
a
m
axi
m
u
m
[1
6],[17
]
.
T
his
be
com
es
the
burd
e
n
of
par
e
nts in
r
ai
si
ng and
ha
ving
an
im
pact o
n f
a
m
ily act
ivit
y in
see
king i
ncom
e
[16],[
18
]
.
Ther
e is n
o
do
ub
t t
hat m
ental
retard
at
io
n
is a li
fe
-
long d
isa
bili
ty
w
it
h
has
a
m
ajo
r
im
pact
o
n
the li
ves
of
the
c
hildr
e
n
and
their
fam
il
ie
s.
Ca
ring
child
w
ho
ar
e
m
ental
retard
a
ti
on
is
of
te
n
it
sel
f
stressf
ul
as
care
-
giv
in
g
a
ff
ect
s s
ever
al
as
pects o
f
ca
re
giv
e
r’
s
l
ife
ne
gativel
y
inclu
ding p
oor
p
hysic
al
a
nd
e
m
ot
ion
al
sta
te
.
More
sp
eci
fical
ly
,
m
oth
ers
of
c
hildr
e
n
with
MR
disp
la
ye
d
lowe
r
physi
cal
healt
h,
i
m
pair
m
ent
in
so
ci
al
relat
ion
s
hip
s
,
in
their
ps
yc
holog
ic
al
sta
te
a
nd
poor
e
r
pe
rc
eption
of
their
env
ir
on
m
ent
.
M
oth
er
s,
ex
pe
rience
m
or
e
burd
e
n
t
han
pa
ren
ts
of
ty
pical
ly
devel
op
in
g
c
hild
r
en
.
T
he
possibl
e
reas
on
s
f
or
this
co
uld
be
that
a
m
oth
ers
sp
e
nt
m
or
e
tim
e
wit
h
th
e
c
hildr
e
n
wh
il
e
ca
rin
g
f
o
r
them
;
m
os
t
m
oth
ers
we
re
ho
m
e
-
m
aker
s
withou
t
add
it
io
nal
hel
p
an
d
al
so
we
re
restrict
ed
t
o
hom
e
with
no
ti
m
e
or
pro
visio
n
f
or
le
isu
re
a
ct
ivit
y
[7
]
,[19
]
,[20
]
.
All
of
thes
e
si
tuati
on
s
m
ake
pa
ren
ts
an
d
f
a
m
ilies
feel
a
heav
y
bur
de
n
in
cari
ng
f
or
c
hildr
e
n
with
m
ental
retard
at
i
on. M
akes t
hem
f
eel
ti
red
a
nd f
eel
t
his
burd
e
n ne
ve
r
e
nd
i
ng
[
18
]
,
[19].
3.3.
The
so
ci
al st
i
gm
a
Sti
gm
a is a n
egati
ve
at
ti
tud
e
of
a
gro
up of
pe
op
le
w
ho
ca
use
p
r
ej
udic
e an
d
disc
rim
inati
o
n
a
gainst th
e
su
bg
rou
p.
Sti
gm
a
includes
th
e
cogniti
ve,
e
m
ot
ion
al
,
an
d
beh
a
vioral
asp
ect
s
of
pr
e
j
udi
ce,
an
d
disc
rim
inati
on.
Sti
gm
a
aff
ect
s
no
t
only
ind
i
vid
uals
w
ho
car
r
y
sti
g
m
at
iz
ation
la
bels,
but
al
so
oth
e
rs
who
directl
y
interac
t
with
them
[16]
.
Pr
oble
m
isolation
an
d
re
j
ect
ion
o
f
s
ociet
y
to
m
ental
reta
rd
at
io
n
m
ade
fam
i
li
es
feel
i
ncr
easi
ngl
y
heav
y
bur
de
n
feel
ve
ry
hard
to
li
ve
li
fe
.
C
ultur
es
that
de
velo
ped
in
the
com
m
un
it
y,
that
eac
h
in
div
i
du
al
is
so
m
ewh
at
different
from
the
norm
al
sta
te
w
il
l
deter
m
ine
t
he
extent
to
w
hich
the
in
div
i
du
al
was
acce
pted
by
the
pe
op
le
ar
ound
him
.
A
pe
rson
with
m
ental
retard
at
io
n
is
no
t
j
us
t
i
so
la
te
d
en
vir
onm
ent,
bu
t
al
so
they
exp
e
rience
r
e
di
cule an
d re
j
ect
ion f
ro
m
their
own
f
am
il
ie
s
[8
]
,[14
]
,
[20]
.
They
al
s
o
of
te
n
get
in
su
lt
s
da
n
rej
ect
i
on
of
the
neig
hbors
and
the
s
ociet
y
ar
ound
.
Re
su
l
ts
from
this
stud
y
that
ind
i
viduals
with
m
ental
retard
at
ion
obta
in
s
ti
gm
a
ver
bal
an
d
nonv
e
rb
al
,
as
exp
el
le
d
by
the
local
com
m
un
it
y.
T
hey
of
te
n
get
unpleasa
nt
treat
m
ent
and
disc
r
i
m
inati
on
in
soc
ia
l
interact
ion
and
dail
y
act
i
viti
es.
So
m
e p
arti
ci
pa
nts e
xpresse
d
t
heir
c
hild ca
n no
t
fr
eel
y
play
and g
et
t
og
et
he
r
wit
h
f
rien
ds
t
heir o
wn ag
e
.
The
rej
ect
io
n
of
ot
her
s
will
m
ake
them
feel
infe
rio
r,
w
it
hdr
aw
f
r
om
the
en
vir
on
m
ent
an
d
be
af
raid
to
interact
with
oth
ers
.
Pe
op
le
in
the
neig
hbor
hood
of
te
n
gi
ve
neg
at
ive
res
pons
es
to
m
ental
retard
at
i
on
c
hildr
e
n
su
c
h
as,
unde
restim
at
ing
,
in
su
lt
ing
an
d
e
xclu
ding
c
hild
ren
with
m
ental
retard
at
io
n
an
d
t
heir
fa
m
ilies,
especial
ly
m
oth
ers
w
ho
feel
the
im
pact
of
sti
gm
a.
Negat
ive
i
m
pact
exp
e
rience
d
i
n
the
f
or
m
of
f
eel
ing
un
c
om
fo
rtable
,
de
pr
esse
d,
an
d
ins
om
nia.
Th
ey
fin
d
it
dif
fic
ult
to
inte
ract
a
nd
m
ai
ntain
soc
ia
l
relat
ion
s
hip
s
in
so
ci
et
y
[16],[
19]
,[20
]
.
Sti
gm
a
hap
pe
ns
becau
se
of
m
isun
de
rstan
di
ng
s
a
nd
ig
nor
ance
relat
ed
to
disabili
ty
aris
ing
f
ro
m
an
il
lness
or
eve
nt
that
resu
lt
s
in
wo
rs
e
treatm
e
nt,
rej
e
ct
ion,
and
a
n
i
m
paired
ro
le
in
so
ci
et
y.
wh
e
n
so
ci
et
y
do
es
no
t
gi
ve
a
cha
nce,
they
reall
y
feel
a
lim
it
e
d
so
ci
al
li
fe,
aff
ect
in
g
their
pe
rsonal,
em
oti
on
al
an
d
physi
cal
li
fe
[16].
The
fin
di
ng
s
of
this
re
se
arch
i
nd
ic
at
e
the
i
m
po
rta
nce
of
inf
orm
at
ion
dissem
inati
on
ef
forts
a
nd
t
he
i
m
pr
ovem
ent
of
public
knowle
dge
ab
out
m
ental
retard
a
ti
on
diseases
,
im
pacts
and
ways
of
carin
g
al
so
the
par
ti
ci
patio
n
of
the
com
m
un
it
y
in
achievin
g
healt
h
a
nd
well
bein
g
de
gr
ees
bo
t
h
p
hysi
cal
ly
,
ps
yc
ho
l
og
ic
al
ly
and s
ocial
ly
.
3.4.
Need
s
upp
or
t
f
rom
r
el
ati
ves
The
pr
ese
nce
of
m
ental
l
y
-
retard
e
d
chil
dren
in
t
he
fa
m
ily
need
s
s
uppo
rts
f
ro
m
t
he
fam
il
y
or
su
r
rou
nd
i
ngs.
Wh
il
e
do
i
ng
their
du
ty
as
pa
ren
ts,
pa
rtic
ip
ants
we
re
assi
ste
d
by
fam
ily
(both
co
re
a
nd
big
fam
i
ly
),
an
d al
so
from
su
rro
undi
ngs e.
g. nei
ghbors
and
sp
e
ci
al
g
r
oups
i
n
t
he
c
omm
un
it
y.
The
fi
nd
i
ng
s s
howe
d
that em
os
io
nal
sup
por
ts wer
e g
ai
ne
d
from
the b
ig f
a
m
ily and
fro
m
oth
e
r
fam
ily
m
e
m
ber
s
w
hic
h
m
anifested
i
n
the
f
orm
of
at
te
ntion
an
d
com
passion,
as
well
as
f
rom
co
m
m
un
it
y
so
ci
al
su
pp
or
t
su
c
h
a
s
su
pp
or
t
from
the
neighb
or
s
and
the
c
ommun
it
y.
W
e
ass
um
e
that
su
pport
relat
ed
to
nu
r
turi
ng
and
trai
ning
th
e
m
ental
ly
retard
e
d
child
re
n
is
inescapa
ble.
If
the
s
upport
i
s
no
t
existe
d
le
ads
to
the
em
otion
al
al
te
rati
on
s
uc
h as an
ger,
depre
ssion, a
nd m
alad
aptive
beha
vi
or
.
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
6
, No
.
4
,
Decem
ber
20
1
7
:
331
–
336
334
The
res
ults
show
that
so
ci
al
su
pp
or
t
pro
vide
d
by
fam
ilies
and
the
en
vir
on
m
ent
can
he
lp
ov
e
rc
om
e
stress
a
nd
be
a
ble
to
see
posi
ti
ve
aspects
of
the
li
fe
they
l
ive
in
by
ha
vi
ng
a
child'
s
m
ental
retar
datio
n.
T
he
su
pp
or
t
pro
vide
d
m
akes
the
m
feel
valued
and
care
d
for,
this
can
m
ake
them
hav
e
a
posit
ive
sel
f
-
def
e
ns
e
m
echan
ism
and
be
a
ble
to
ad
apt
to
any
sit
ua
ti
on
a
nd
im
pact
arisi
ng
f
r
om
ha
ving
a
child
'
s
m
ental
retard
at
ion,
even to
preve
nt
the o
cc
urre
nc
e of a
nx
ie
ty
and
depressi
on
[
19]
.
.
This
is
in
li
ne
with
ot
her
st
udie
s
sho
wing
that
fam
ily
su
pport
is
a
co
ping
strat
egy
of
pa
ren
t
s
who
hav
e
m
ental
ly
retard
e
d
child
r
en
in
the
f
or
m
of
m
or
al
suppo
rt,
at
te
ntio
n,
sharin
g
a
nd
sym
pathy
[8]
.
I
n
a
dd
it
io
n
to
getti
ng
s
upport
from
the
fam
ily,
par
e
nts
a
lso
get
s
uppo
rt
from
peo
ple
t
hey
tru
st,
cl
os
e
fr
ie
nd
s
an
d
fr
i
ends
.
This is
w
hat m
akes t
hem
f
ee
l t
hat there
are
peop
le
w
ho alw
ay
s p
ay
att
ention,
resp
ect
a
nd
lov
e
h
im
[8
]
.
The
e
ff
ect
i
veness
of
va
rio
us
pro
gr
am
s
to
ta
ke
ca
re
a
nd
in
crease
t
he
qu
al
it
y
of
li
fe
of
c
hildr
e
n
a
nd
ado
le
sce
nt
w
ho
suffe
r
f
ro
m
m
ental
retard
at
ion
dep
e
nds
on
the
ro
le
a
nd
s
upports
of
the
entire
fam
ily,
because
the
s
uccessful
of
the
pro
gra
m
is
no
t
m
erely
the
res
ponsi
bili
ty
of
the
edu
cat
io
nal
i
nst
it
ution
.
In
a
dd
it
io
n,
su
pp
or
t
a
nd
ac
ceptance
of
ea
ch
fam
il
y
m
e
m
ber
of
will
pro
vid
e
t
he
e
nergy
an
d
c
onfide
nt
f
or
a
t
he
m
e
ntall
y
-
retard
e
d
c
hil
dr
en,
t
hat w
il
l ai
d
them
to
be
a
ble to liv
e in
de
pende
ntly
[9
]
,
[
21
]
,
[22]
.
3.5.
Worr
y
abou
t the
fu
t
ure
This
curre
nt
stud
y
fou
nd
th
at
the
exp
ect
at
ion
to
be
rea
ched
by
par
e
nt
s
in
te
r
m
of
nurtu
rin
g
or
trai
ning
in
or
de
r
the
child
re
n
be
a
ble
t
o
li
ve
ind
e
pe
ndentl
y
[9]
,
[10]
.
It
expresse
d
by
s
om
e
par
ti
ci
pant
s
was
bein
g
in
de
penden
t
a
nd
m
ake
the
par
e
nts
be
pro
ud.
I
n
fa
ct
,
te
achi
ng
child
re
n
t
o
be
in
de
penden
t
is
com
plica
te
d;
t
her
e
fore
pa
re
nts’
ex
pectat
ion
i
s limi
te
d
upon
the ind
e
pe
nd
e
nc
e o
f
the c
hild
it
sel
f.
C
i
h
ldre
n
with
sp
eci
al
nee
d
will
ada
pt
co
nt
inu
ously
th
r
ough
t
he
li
feti
m
e
to
gai
n
t
he
bette
r
le
vel
of
a
bili
ty
.
Thos
e
are
the
intenti
on
of
th
e
par
e
nts
to
in
crease
the
a
bili
ty
of
the
c
hild
r
en
to
ac
hieve
a
bette
r
li
fe
ei
th
er
f
or
c
hild
ren
or
t
he
fam
i
ly
, esp
eci
al
ly
m
ast
e
ring
the s
kill
s that th
e child
ren ha
ve
not h
a
d reac
he
d bef
or
e
.
Re
searche
rs
as
su
m
e
that
ever
y
par
ents
e
xp
e
ct
their
childre
n
gro
w
a
nd
de
velo
p
norm
al
l
y,
as
well
as
the
ex
pectat
io
n
of
pa
re
nts
whose
child
re
n
a
re
m
ental
lly
retarde
d,
the
y
al
ways
ex
pe
ct
their
c
hil
dren
gro
w
ind
e
pende
ntly
corres
pond
to
the
de
vel
op
m
ental
phase,
but
the
hope
is
ham
per
ed
by
t
he
lim
it
a
ti
on
s
of
the
childre
n
it
sel
f,
it
dep
le
ti
ng
pa
r
ents’
hope
f
or
t
he
c
hildr
e
n.
Ev
entutal
ly
,
pa
re
nts
can
only
ho
pe
that
t
he
c
hildr
e
n
that
they
raised
can
be
in
d
e
pe
nd
e
nt
an
d
capab
le
of
them
s
el
ves,
in
fact
s
om
e
of
the
m
s
ti
ll
rely
the
ai
d
fr
om
their
par
e
nts.
As
the
child
dev
el
ops,
m
any
fam
il
ie
s
mu
st
be
gin
to
face
lo
ng
-
te
r
m
un
certai
nties
ab
ou
t
t
he
functi
onin
g
of
child
ren
to
da
y
and
the
f
uture
a
nd
s
om
eti
m
es
their
qu
es
t
ion
able
validi
ty
,
eve
n
to
los
e
ho
pe
[8
]
,
[17]
.
T
he
bi
gg
est
c
on
ce
r
n
par
e
nts
feel
a
bout
ha
vi
ng
a
child'
s
m
ental
retard
at
i
on
is
how
t
heir
c
hildre
n
ar
e
able
to
li
ve
th
ei
r
li
ves
a
fter
t
hey
die.
Who
will
care
f
or
t
hem
with
aff
e
ct
ion
a
nd
patie
nce,
w
hethe
r
t
hey
can
su
r
viv
e
with
al
l
the
lim
i
ta
ti
on
s
they
ha
ve.
A
lt
ho
ug
h
they
do
not
know
w
ha
t
will
happen,
they
are
sti
ll
try
ing
hard t
o
care
for an
d
trai
n
the
a
bili
ty
o
f
c
hildre
n
to
b
e
in
de
pe
nd
e
nt in
li
ving
his life.
3.6.
Ad
mi
t
tin
g
god’
s wi
ll
Hav
i
ng
c
hildr
e
n’
s
with
m
enta
l
reta
rd
at
io
n
i
s
a
gr
eat
chall
en
ge
f
or
the
pa
re
nts
since
the
a
bili
ty
of
the
childre
n
de
pe
nds
on
the
a
bili
ty
of
par
e
nts
pro
vid
i
ng
the
t
r
ai
nin
g.
From
t
he
fiin
ding
il
lustrate
s
that
patie
nce
was
the
key
f
act
or
in
c
oac
hi
ng
the
i
ndepe
nd
e
ncy
f
or
ret
ard
e
d
c
hildr
e
n.
Par
ti
ci
pa
nts
m
us
t
rep
eat
al
l
the
trai
ning
pr
ogr
a
m
patie
ncely
,
add
e
d
with
discipli
ne.
Te
achin
g
m
entally
-
retard
e
d
c
hi
ldren
re
qu
ire
s
extra
patie
nce,
a
nd
un
c
onditi
onal
lov
e
.
A
m
ental
l
y
-
retar
ded
c
hild
is
hav
i
ng
a
dversit
y
to
obta
in
the
stim
uli
giv
e
n.
This c
onditi
on
cause
d by a sig
nificant
de
velo
pm
ental
d
isord
er
of
t
he
ce
ntra
l nerv
ou
s
syst
em
[9
]
,[
10]
.
This
reach
f
ou
nd
that
t
he
pa
rtic
ipants
c
ons
idere
d
that
ha
ving
a
retar
de
d
c
hildr
e
n
is
a
te
st
f
or
t
he
par
e
nts,
b
eca
use
the
pa
rtic
ip
ant
c
on
si
der
e
d
that
hav
i
ng
c
hildr
e
n
wit
h
m
ental
retar
datio
n
is
a
te
st
a
nd
a
tria
l
.
Partic
ipants
ac
cept
the
co
ndit
ion
of
t
heir
ch
il
dr
en
as
t
hey
per
cei
ved
t
hat
childre
n
are
a
gift
f
ro
m
God,
the
y
hav
e
acce
pted t
heir
c
hlidr
e
n
a
s they
wer
e.
The
oth
e
r
st
ud
i
es
sho
w
that
ha
ving
a
m
ental
retar
datio
n
c
hi
ld
is
a
tria
ls
of
li
fe,
m
us
t
rem
ai
n
grat
ef
ul
wh
at
e
ver
he
e
xp
e
rience
d
so
far,
acce
ptin
g
the
c
hild'
s
co
nd
it
io
n
as
it
is,
beco
m
ing
m
or
e
at
te
ntive,
m
or
e
unde
rstan
ding
of
t
he
m
eaning
of
li
fe
a
nd
m
or
e
patie
nt
in
par
e
nting
[
7]
,[
14]
.
S
pirit
ua
l
aspect
ince
ra
sed
th
e
confide
nce
of
wh
at
hav
e
bee
n
im
ple
m
ented
in
te
rm
of
ta
ki
ng
ca
re
the
re
ta
rd
e
d
child
re
n,
gro
wing
op
ti
m
i
s
m
and
f
os
te
rin
g
s
tro
ng
relat
ion
s
hip
am
on
g
t
he fam
i
ly
to
bu
il
d
m
utu
al
assist
ance in
ai
di
ng
a
nd
acc
om
pan
yi
ng
t
he
retard
e
d
c
hild
r
en
[14],[
20]
.
Mother
s
w
ho
hav
e
child
re
n
with
li
m
it
at
ion
s,
feel
t
heir
a
ffi
nity
with
reli
gion
I
nc
rease
t
ru
st
a
nd
get
cl
os
er
to
G
od,
so
as
to
acce
pt
this
as
a
te
st
f
ro
m
God
t
hat
t
he
c
hild
is
a
c
r
eat
ion
.
Pa
ren
ts
are
al
s
o
c
onvi
nced
that
li
fe
is
a
gift
from
Go
d,
s
o
they
are
op
ti
m
ist
ic
abo
ut
he
al
ing
f
or
t
heir
child
a
nd
a
ft
er
bei
ng
te
ste
d
with
hav
i
ng
a
m
ental
retard
as
c
hild.
S
om
e
par
ent
s
al
so
ta
ke
the
po
sit
ive
si
de
of
this
sit
uation
and
le
a
rn
to
be
m
or
e
gr
at
ef
ul
an
d
ac
cept
eve
ryt
hing
that
ha
ppen
s
and
li
ve
it
sin
cerely
.A
str
on
g
reli
gi
ou
sit
y
a
sp
ect
am
on
g
par
e
nts
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
Ha
vi
ng Childr
en
wi
th Me
nt
al Retar
da
ti
on (
Sri
Endriya
ni)
335
i
m
plica
te
d
behavio
r
an
d
the
think
i
ng
patte
r
n
of
the
par
e
nt
s,
thu
s
al
l
thing
s
wh
ic
h
occ
ur
e
d
beyo
nd
their
capab
il
it
y an
d t
heir
c
on
tr
ol
w
il
l be subm
itte
d
to
the
G
ods
Alm
igh
ty
[
8],[20
]
,
[23]
.
On
e
s
ource o
f
stren
gth
u
se
d
by
par
e
nts
w
ho
h
ave
c
hild
ren
w
it
h
m
ental
ret
ard
at
io
n
are
t
he
values
a
nd
belie
fs
they
ha
ve,
s
o
t
hat
the
y
are
able
t
o
t
hink
po
sit
ively
ab
ou
t
e
ve
ry
pro
visio
n
that
God
has
desti
ned.
I
n
pr
e
vious
resea
r
ch
sta
te
s
that
m
oth
ers
who
ha
ve
childr
en
w
it
h
m
ental
reta
rd
at
io
n
see
al
l
even
ts
is
the
fa
te
and
te
st
of
God.
T
o
be
stron
g
in
this
te
st,
they
are
dili
gen
t
to
wors
hip
wit
h
pr
ay
e
r.
W
it
h
reg
ula
r
pr
ay
e
r
and
recit
at
ion
they
feel m
or
e cal
m
, s
tr
ong
a
nd
ha
pp
y
[
8]
.
4.
CONCL
US
I
O
N
Pare
nts
at
tem
p
t
to
acce
pt
the
reali
ty
and
con
side
r
that
havi
ng
child
re
n
w
it
h
m
ental
reta
rd
at
io
n
is
a
te
st
as
par
ents, an
d
c
onsider
t
ha
t
chlidren
as m
and
at
e
from
God.
T
hus
the
par
e
nts
are
at
te
m
pt
ing
to
acce
pt
the
reali
ty
sincerely
.
The
t
hem
es
that
em
erg
e
de
scri
be
the
proces
s
of
t
he
adap
ta
ti
on
of
th
e
pa
re
nts
to
ward
s
changes
.
The
a
dap
ta
ti
on
be
ha
vior
is
including
the
acce
ptan
ce
of
child
ren’
s
conditi
on
an
d
ha
ving
com
passion
to the c
hild
ren
hear
ty
.
ACKN
OWLE
DGE
MENT
We
would l
ike
to tha
nk to
SL
B Kar
ya
I
bu
P
al
e
m
ban
g
,
a
nd
al
l
per
s
on cont
rib
uted
i
n
this
stud
y t
hat
we
ca
n
not
m
ention o
ne by
one.
REFERE
NCE
S
[1]
S.
Salmiah
,
“
Menta
l
Retarda
ti
on
Facul
t
y
of
Den
tis
tr
y
,”
2010
.
[2]
W
.
Judarwant
o,
“
Menta
l
Re
ta
rd
a
ti
on:
Pr
eve
nt
ion and
Tr
eatm
ent
,”
2009
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[3]
S.
Som
ant
ri,
“
Psy
cho
log
y
of
Ex
c
ept
ion
al
Ch
il
dre
n
,”
B
andung
,
Re
fika
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ta
m
a,
20
12
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[4]
A.
Supatri,
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ar
ent
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Chil
dr
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ho
Have
Ment
al
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et
ard
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,”
2014
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[5]
M.
Fadil
ah
,
“
Rel
a
ti
ons
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o
f
Pare
nts
W
it
h
Chil
dre
n
Inde
pende
nc
e
Le
v
el
Menta
l
Retard
at
ion
in
YP
AC
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m
bang,
”
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14.
[6]
The
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istr
y
of
Socia
l
Affai
rs
,
“
Socia
l
W
el
far
e Devel
opm
ent
,
”
J
aka
rt
a
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y
of
Social
Affa
irs,
2012
.
[7]
M.
Janna
h
and
N
.
Anita
,
“
Experie
nc
e
of
Pare
n
t
s
W
ho
Have
Chil
dre
n
Men
ta
l
R
et
ard
at
ion
in
Pekal
ongan
C
ity,”
2012.
[8]
B.
A.
Prasa,
“
Stress
and
c
op
i
ng
P
are
nts
wi
t
h
A
C
hil
d
'
s
M
ent
a
l
R
e
ta
rd
at
io
n
,”
EMPATH
Y
,
The
Journal
of
Psyc
holog
y
,
v
ol
/
issue:
1
(
1
)
,
pp.
1
-
10,
2012
.
[9]
M.
Saifusin,
“
R
ole
of
Fam
ily
w
it
h
Abil
ity
to
C
are
of
Med
ium
Menta
l
Retarda
ti
on
Chi
ldre
n,
”
Journals
of
Ner
s
Comm
unit
y
,
v
ol
/
issue:
4
(
1
)
,
pp.
3
6
-
43,
2013
.
[10]
R.
Parikh,
e
t
al
.
,
“
Perform
anc
e
of
Chil
dre
n
wi
th
Menta
l
R
et
ar
dat
ion
with
and
without
Dow
n's
Sy
ndrom
e
on
Stand
ard
i
ze
d
W
al
king
Obs
ta
cle Cours
e,
”
IOSR J
ournal
of
Den
tal and
Me
d
ic
a
l
S
cienc
es
,
,
pp
.
20
-
24
,
2013
.
[11]
H.
B.
Su
topo,
“
Quali
t
at
iv
e
R
es
e
arc
h
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e
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Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
6
, No
.
4
,
Decem
ber
20
1
7
:
331
–
336
336
BIOGR
AP
HI
ES
OF
A
UTH
ORS
Sri E
ndri
y
a
ni
is
working
as
l
ectu
rer
in
Hea
lt
h
Po
l
y
technic
of
Pa
lem
bang
,
Indone
si
a
.
Sh
e ca
n be c
on
ta
ct
ed
thr
ough
her em
ail:
sriendr
i
y
ani
@
y
ahoo
.
co.
id
Yunike
is worki
ng
as
l
ecture
r
in
Hela
th
Pol
y
tech
nic
of
Pal
embang
,
Indone
si
a
.
Sh
e ca
n be c
on
ta
ct
ed
thr
ough
her em
ail:
Caby
_deh@
y
a
hoo.
c
om
.
Evaluation Warning : The document was created with Spire.PDF for Python.