The Educationally Handicapped Child—The Physician's Place in a Program to Overcome Learning Disability

Under California Assembly Bill 464, special classes may be provided by school districts for children designated as educationally handicapped. An educationally handicapped child is not mentally retarded or physically disabled. He may have neurological handicap or emotional disorder, but he must show impaired achievement in relation to his tested abilities.A physician may be asked to participate in the program, either as a specified member of the admissions committee of the school district or to provide a medical clearance for entrance of one of his own patients into the program.He does a thorough history and physical examination but adds special examination of attention, activity, coordination and attitudes.The educationally handicapped child is helped most by the physician who does not reject the idea of educational handicap even if the medical examination is negative; who treats his minor ills; who medicates, when it is indicated, for hyperactivity, distractibility or extreme anxiety; who cooperates with parents and school personnel.     

The physician,the parent and the retarded child

The problem of the retarded child and his parents is one confronting practicing physicians more and more frequently. Current estimates indicate that state hospital facilities for retarded persons in California are short nearly 6,000 beds. There are long waiting lists for available facilities. Many families are in desperate need of help. To advise a family to send their child to a State hospital is not a real solution nor one possible in the great majority of instances. The responsibility of the physician goes beyond this. Parents' groups have developed in the last few years and are making a real contribution to a resolution of the problem. Local community resources have increased and will further increase. A more accurate clinical understanding of the retarded child has been formed and his treatment needs more clearly defined. Physicians, parents, community and State agencies must work together to effect a coordinated program.     

Iminoglycinuria in a child in Czechoslovakia

Summary The child with iminoglycinuria is in our observation. Hyperprolinuria was seen at 5 months by screening program. The child was repeatedly examined in the hospital and was seen last time at 16 months. IQ was 67, in the urine were excessive amounts of glycine, proline a hydroxyproline. In the blood aminoacids were in normal levels. In the child was noticed the same increase of proline in the blood as in the control child of the same age following loading test with L-proline, indicating normal intestinal absoption. Both parents and father's sister's 2-year-old mentally retarded child exhibit excessive glycinuria. The father, his sister, father's father, and grandfather are partialy, congenitaly deaf.     

Familien mit geistig behinderten Kindern

When a child is born with a mental handicap, his or her parents are usually confronted with a complicated and demanding process of adaptation and emotional coping, as well as with profound restructuring of their family life. Professional experts, including physicians and psychosocial specialists, can support the parents in terms of supplying them with information, but they inherently lack the experience of parents who have equally affected children and who have learned to master everyday problems and challenges. Filling that gap is the main purpose of self-support groups, whose number and importance have continuously grown since the 1970s. Internet databases are valuable signposts to self-support groups concerning particular, and even rare, types of handicaps. A study on Down syndrome exemplifies the self-support group experiences of parents of mentally retarded children. We conclude with suggestions for better conjunction of professional and self-support activities.     

The problem of the poor reader

Children who are retarded readers may present a complex problem involving physical impediments, emotional distress, or teaching methods. A child with specific reading disability has spatial confusion, an exaggeration or persistence of a normal childhood tendency to reversal of letters and symbols, ambidexterity, normal intelligence, and poor visual recall of words. Children with these characteristics fail to learn to read in a teaching system in which the main emphasis is on visual associations. Treatment of such reading difficulties, as well as prophylactic measures, is outlined.     

Counseling Parents of Retarded Children

Recently pediatricians have become more interested in the retarded child and his family and have come to realize that they have been ill-prepared to face the many problems that continually arise. A basic understanding of the role of parents and their aspirations, coupled with a knowledge of interviewing, techniques will enable them to face these problems with greater assurance. In addition, a knowledge of the community facilities and resources is necessary. This will entail direct contact with schools, parent groups, state hospitals for the retarded as well as state and local agencies which deal with the retarded.     

PKU screening — Is it worth it?

Ontario''s program for PKU screening of newborn infants reached 94.5% of the newborn population from 1966 to 1971. There were 70 infants identified by the program, 47 of whom were classical cases and 23 atypical cases of phenylketonuria. The incidence was 1:16,700 live births for classical cases and 1:34,000 live births for atypical cases. Since the beginning of the program 44 children have been identified in infancy as having PKU and have been treated successfully. Retardation has become evident in only three infants, two of whom were missed by the screening program.The cost of identification and care of one child for five years is about $7000, much less than the $250,000 needed to provide lifetime institutional care for one severely retarded individual.     

MANAGEMENT OF JUVENILE RHEUMATOID ARTHRITIS—The Problem of Long-Term Rehabilitation

A program for the management of juvenile rheumatoid arthritis should permit the child an optimal developmental experience despite the persistence of potentially crippling inflammatory disease. Drugs are useful, although no more than palliative, and all are significantly toxic. Physical measures should be directed toward the improvement of joint alignment and mobility and the restoration of muscular strength. The emotional, social and educational needs of a child with such a chronic disability deserve the most thoughtful attention.     

Management of juvenile rheumatoid arthritis; the problem of long-term rehabilitation

A program for the management of juvenile rheumatoid arthritis should permit the child an optimal developmental experience despite the persistence of potentially crippling inflammatory disease. Drugs are useful, although no more than palliative, and all are significantly toxic. Physical measures should be directed toward the improvement of joint alignment and mobility and the restoration of muscular strength. The emotional, social and educational needs of a child with such a chronic disability deserve the most thoughtful attention.     

Congenital Anomalies of the Limbs: Part II. Psychological and Educational Aspects

As a preparatory step towards the development of a complete habilitation program for children with congenital limb anomalies associated with maternal ingestion of thalidomide, the medical records of all patients with congenital limb anomalies referred to the Rehabilitation Institute of Montreal in the past decade were studied, and an examination and a thorough reassessment were made of 41 patients (21 males and 20 females). The medical and prosthetic aspects were dealt with in Part I of this paper. Part II describes, in a joint report, the results of psychiatric, psychological and educational assessments.There was no evidence of major emotional disorder in any of the patients, although conflicts were intensified by the presence of the physical anomaly. No relation was found between intelligence, emotional adjustment and disability. The patient''s attitude towards his disability and prosthesis is definitely influenced by the degree of parental acceptance of the handicap and by the character of the emotional undertones in the total environment. In order to favour the occurrence of the healthiest modes of development in these children, the authors believe that the medical profession should be made fully aware of the physical and emotional problems which may arise after the birth of a deformed child. It is considered very important that the mother should receive psychotherapeutic support as soon as possible after the child is born.     

Experiencing infertility--social work dilemmas in child adoption procedures

The research deals with experiencing infertility and its consequences in the adoption of a child and focuses on infertile couples that have wished to adopt a child and joined a program preparing them to be foster parents. The results show that most of the infertile couples experience infertility very much as being different from couples with children as well as having to cope with the feelings of deep emotional loss resulting from the inability to reproduce biologically. There is therefore the question whether these facts should be taken into account by the profession (i.e. social workers) when dealing with child adoption as, according to most of the respondents of our survey, the process of coming to terms with infertility and its consequences is an important factor in establishing healthy family relationships and the child's identity within the adoptive family. We concluded from the results of the research that the infertile couples preparation program for adopting a child carried out by the Society of Adoptive Families "Deteljica", is a comprehensive autopoietic social workers' answer to the needs of participants for a successful adoption of a child, as it makes it possible to supply these future adoptive parents with the requisite information and experience and provides support to the entire family upon accepting a child in its midst, while its fundamental attribute is offering help to couples in overcoming the traumas resulting from their infertility.     

Mental Retardation: Methods of Diagnosis and Some Recently Described Syndromes

Reduction of intelligence should be differentiated from interference with the use of intelligence by such non-intellective factors as partial deafness and emotional disturbance. The parents of a retarded child want an assessment, a prediction of the eventual achievement level, and a causal explanation if possible. There are varying degrees of knowledge of causation, from recognition of reduced intelligence only, to an understanding of the mechanism of causation in considerable detail from primary cause to ultimate consequence, as in phenylketonuria or isoimmunization. A diagnosis should be as complete as possible, using available modern techniques of investigation, such as chromatography and cytogenetic studies.Among the recently described syndromes associated with mental retardation are: (1) spastic paralysis and congenital ichthyosis; (2) Rud''s syndrome; (3) deaf-mutism, infantilism, ataxia and a disturbance of hormone metabolism; and (5) sex-linked deaf-mutism.     

The Teaching of Psychiatry as Applied to Pediatrics: Proposals Based on a Report Prepared by the Education Committee,Canadian Paediatric Society

With changing patterns of pediatric practice, the practising physician needs to acquire a deeper understanding of the emotional and intellectual development of the child. Skill is also required in the techniques of interviewing and counselling parents, and, with a knowledge of the origin of behavioural disorders, in treating these disorders. The Education Committee of the Canadian Paediatric Society was asked to survey the present teaching of psychiatry as applied to pediatrics in all Canadian medical schools. Based on this survey and other studies, a training program for undergraduate medical students and graduates is proposed.     

Mental Retardation Today

Mental retardation is an impairment of intellect in which the intelligence quotient is less than 85. It is a symptom which has more than 100 known causes. Mental retardation should be diagnosed early in life. There are many specific conditions for which therapy is available and many less specific contributing causes which may be obviated by sound medical care. Many of these are reviewed. Since 90% of retarded children will remain in the community, suggestions for management of the child and the problems of the family were included. The function of the special clinic for retarded children was briefly stated. Early separation of the child from the family was discouraged, and the principal reasons for long-term residential care were stated.     

Cerebral palsy; an approach to the problem

A program for the cerebral palsied child has been developed in California which has been made possible through the cooperation of the state and local departments of education, the state and local departments of health, the Children's Hospital and Orthopedic Hospital at Los Angeles and the University of California School of Medicine in San Francisco. An attempt is being made to deal with not only the medical and educational needs of the cerebral palsied but also the social and emotional aspects.     

CEREBRAL PALSY—An Approach to the Problem

A program for the cerebral palsied child has been developed in California which has been made possible through the cooperation of the state and local departments of education, the state and local departments of health, the Children''s Hospital and Orthopedic Hospital at Los Angeles and the University of California School of Medicine in San Francisco. An attempt is being made to deal with not only the medical and educational needs of the cerebral palsied but also the social and emotional aspects.     

Biochemical Genetics and Mental Retardation

The known cases of mental retardation which exhibit a genetically determined biochemical lesion were reviewed. Twenty-two inborn errors of metabolism with associated mental defect have been described to date, 12 of these within the past decade. Improved procedures for diagnosis and therapy make this area of investigation a promising one for clinicians, biochemists and geneticists. During a screening program for amino aciduria, a “new” metabolic defect, citrullinuria, was detected in a mentally retarded child. This condition is characterized by the presence of citrulline in the urine, blood and cerebrospinal fluid in concentrations 50- to 100-fold greater than normal. Although the amounts of citrulline excreted appear to be related to the protein intake, it was not possible to reduce the high citrulline concentration in the blood by dietary restrictions.     

Estimation of short musical fragments in normal subjects and patients with chronic depression

Emotional estimation of short fragments of classical music was analyzed in healthy subjects and patients with depressive neurosis and retarded depression (the depressive phase of maniac-depressive psychosis). The values and stability of point estimates varied between the studied groups. Narrowing of the range of emotional estimates was found in depressed patients. Standard deviation of estimates was related to musical key and tempo in normal subjects and patients with retarded depression.     

Trisomy 13 in a 4-year-old child

Summary The karyotype 47,XY,13+ was observed in a mentally retarded four-year-old child, with numerous abnormalities and the typical dermatoglyphics of a trisomy 13. Banding analysis showed a complete extra chromosome 13.