Spina Bifida Children Attending Ordinary Schools

From September 1971 to September 1973 a policy was actively followed in South Gloucestershire of placing spina bifida children in ordinary schools wherever possible. This was achieved successfully in 14 cases out of a possible 24. Special attention was paid to the selection of children and schools. The main contraindications to attendance at ordinary school were: below average intelligence, special perceptual problems, the need for intensive physiotherapy, and problem incontinence—particularly infaecal continence. Success often depended on special provisions—for example, transport, aids to mobility, peripatetic physiotherapists. Personal attendants (welfare assistants) could be allocated to each of the more severely handicapped children. The lack of facilities for handicapped pupils in comprehensive schools is a matter needing urgent review.     

A five-year immunological follow-up study of the institutionalized handicapped children vaccinated with live varicella vaccine or infected with natural varicella

Twenty-two institutionalized handicapped children who were susceptible to varicella were vaccinated with live varicella vaccine of the Oka strain and their immune status was followed for 5 years under conditions without exposure to natural varicella. Simultaneously, 7 children infected with natural varicella were followed. Of the 22 vaccinees, 16 showed sero-positive conversion by the fluorescent antibody to membrane antigen (FAMA) test, the other 6 remaining seronegative during 5 years of observation period. All the 16 cases showing seroconversion had detectable antibody for 5 years after vaccination, and 14 of them gave a positive reaction in the varicella skin test. All the 7 cases after natural varicella gave positive reactions in both the FAMA and skin test. These results suggest that immunity conferred by the vaccination would persist long even in the absence of exposure to natural varicella, though further follow-up studies are needed.     

Exeter Project for Handicapped Children

A project in Exeter has tried to increase the contribution of the paediatric department of a district general hospital to the long-term care, support, and treatment of handicapped children and their families. They include an infant care unit, day units for handicapped children, and holiday projects, and are based on close links with the educational and social services. The availability of such a family support unit may diminish the strain on the families of handicapped children and help them to maintain normal family and social relationships.     

Vaccinations and the physically handicapped child.

The vaccination status of 98 physically handicapped children was examined to identify factors associated with an inadequate vaccination status. Of the 98 children, 57 had cerebral palsy, 14 had myelomeningocele, 3 had muscular dystrophy and 24 had myelomeningocele, 3 had muscular dystrophy and 24 had other motor disabilities. According to the available vaccination records, only 17 children had received all the recommended injections on schedule; 26 had missed at least one injection, and 3 of them had never been vaccinated. The overall rate of vaccination in our study group (63%) was lower than expected. The children with moderate to severe limitation of function due to cerebral palsy were significantly less likely (P less than 0.05) than those with less severe limitations to have received a basic series of vaccinations. Health departments must ensure that physically handicapped children receive the preventive health measures viewed normal and appropriate for other children.     

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.     

EMOTIONAL FACTORS IN PHYSICALLY HANDICAPPED CHILDREN

The staff of the Reiss-Davis Clinic for Child Guidance has been concerned with the emotional factors in physically handicapped or chronically ill children. It is felt by the staff that work with these children must include not only the known procedures to improve or correct their physical condition, but also efforts directed toward preventing or removing any evidence of emotional or psychological crippling.The symbolic or unconscious meaning of the disability is of great importance in this work. Attitudes of the parents may seriously interfere with the handicapped child''s ability to develop his maximum level of functioning and adjustment. Individual and group psychotherapy was found of value in helping these parents.     

Mentally retarded children of eastern India: A biosocial study

Abstract

Biosocial characteristics of 265 mentally retarded and 253 nonretarded children comprising 518 handicapped children from eastern India were studied to discern characteristics significantly associated with the retardates. The children studied were consecutive referrals between January 1977 and April 1981 to the Centre for Handicapped Children, Institute of Child Health, Calcutta. Comparison of retarded and nonretarded children showed the incidence of mental retardation to be significantly associated with age of children, age of mothers, parents’ socioeconomic class, family size, birth order, tempo of motor development, and family history of psychiatric illness. The proportion of retardates was higher among the handicapped girls than among boys, and the level of retardation was significantly associated with sex. Implications of findings are discussed.     

Respite care on a children's ward.

In March 1984 a short term respite care facility for handicapped children was opened in a children''s ward catering primarily for acute medical and surgical problems. The facility was based on a four bedded room designed so that if beds became short in the main ward it could revert immediately to the care of acutely sick children. Three nurses were appointed specifically to staff the facility, the nursing budget for the rest of the ward being reduced proportionately. Conversions were funded by charities and some of the conversion work done by volunteers. The main users were totally dependent children aged under 5 with severe mental and physical handicaps. Parents found the service invaluable, and in addition to planned admissions it was usually possible to accept a child at short notice--for example, when some domestic crisis occurred. Only very rarely was admission impossible because of the needs of acutely ill children. A short term respite care facility not only helps parents cope and may provide beneficial experience for a handicapped child but is also a useful training ground for medical students and junior staff.     

Care of cerebral-palsied children; the special role of pediatricians

Because the cerebral-palsied child is also a growing person whose development should be encouraged along as normal a course as possible, the pediatrician may well take the lead in coordinating orthopedic, psychiatric, educational and vocational services for such children. In El Centro this policy has been followed in a school for handicapped children serving 30 with cerebral palsy, 15 of them pupils at the school. Those with sufficient intelligence and milder physical handicap attend a regular public school, while others are unable to attend even the special school. Emphasis has been placed on working with children who are less seriously affected. As to children with severe neuromuscular and intellectual handicap, the chief effort is to prevent contractures and maintain function. The pediatrician confers monthly with all workers concerned with the child, and maintains liaison with the family physician who treats acute illnesses, including palsy seizures. Special effort has been made to investigate family circumstances such as foreign background which make it more difficult to evaluate the palsied child's true capabilities.     

Discussion: pre-zygotic rights

Silverman uses Warnock's article "Do human cells have rights?" (Bioethics 1987 Jan; 1(1): 1-14) as the springboard for a brief discussion of decision making in the care of handicapped newborns. He argues that the parents of these children should have a major role in deciding for or against life-prolonging treatment, because they must live with the consequences. Silverman does not find it surprising that, in reaching their decision, parents are inclined to weigh the competing interests of family members, including those of children not yet conceived whose rights are foreclosed by the drain on the family of an existing handicapped child.     

Experimental Philosophy (E.V. Ilyenkov and A.I. Meshcheriakov)

Evald Vasil'evich Ilyenkov was only two months younger than Aleksandr Ivanovich Meshcheriakov—a doctor of psychological sciences and posthumous winner (with his teacher Ivan Afanas'evich Sokolianskii) of the USSR State Prize in 1980 for their work to set up a system for training and educating deaf and blind children. Ilyenkov outlived Meshcheriakov by less than four and a half years. These men were the closest of friends. Ilyenkov not only followed Meshcheriakov's work but participated in it in an extremely active way. After the latter died, Ilyenkov directed and completed the training of four of Mescheriakov's deaf and blind students in the department of psychology of Lomonosov Moscow State University. The author of this article was one of these students.     

Physical fitness of blind and sighted children

Twenty-seven children (age 7-17 years) with varying degrees of blindness but with no other known disorder were assessed for physical fitness. Twenty-seven randomly selected children with normal eyesight were also assessed. Maximum oxygen uptake (VO2max) was measured directly during a progressive exercise test on a treadmill. There was a significant and substantial reduction in VO2max in totally blind children (mean +/- standard deviation 35.0 +/- 7.5 ml X min-1 X kg-1) compared with normal children (45.9 +/- 6.6 ml X min-1 X kg-1). Partially sighted children had a significant but smaller reduction in VO2max. Fitness assessed by a step-test was significantly reduced in the visually impaired children, and skin-fold thickness was also significantly greater in totally blind children. The level of habitual physical activity for each child, as assessed by a questionnaire, correlated with VO2max (r = 0.53, p less than 0.0001). Blind children were significantly less active than normal children, and the difference between mean VO2max for blind and normal children became non-significant when their different activity levels were taken into account. It is concluded that totally blind children are less fit than other children at least partly because of their lower level of habitual activity.     

CARE OF CEREBRAL-PALSIED CHILDREN—The Special Role of Pediatricians

Because the cerebral-palsied child is also a growing person whose development should be encouraged along as normal a course as possible, the pediatrician may well take the lead in coordinating orthopedic, psychiatric, educational and vocational services for such children. In El Centro this policy has been followed in a school for handicapped children serving 30 with cerebral palsy, 15 of them pupils at the school. Those with sufficient intelligence and milder physical handicap attend a regular public school, while others are unable to attend even the special school.Emphasis has been placed on working with children who are less seriously affected. As to children with severe neuromuscular and intellectual handicap, the chief effort is to prevent contractures and maintain function. The pediatrician confers monthly with all workers concerned with the child, and maintains liaison with the family physician who treats acute illnesses, including palsy seizures. Special effort has been made to investigate family circumstances such as foreign background which make it more difficult to evaluate the palsied child''s true capabilities.     

A FIVE-YEAR STUDY OF PREMATURITY

To get a comprehensive picture of prematurity and neonatal death or survival, all factors on the maternal and fetal records that might be pertinent were recorded. This information, having to do with factors such as age, gravida of the mother, blood group incompatibility, period of gestation, weight at birth, type of delivery, medication and anesthesia administered to the mother, is presented in tabular form.In the study of perinatal mortality it was noted that failure to establish normal pulmonary ventilation is the most common cause of death in the neonatal period. Maternal history of relative infertility, that is, previous abortions, stillbirths and premature deliveries, was the most impressive finding in the stillborn series.In the follow-up study of premature infants who survived the neonatal period, 8.5 per cent were found to be severely handicapped. In four cases the handicap was due to congenital anomalies, in two others probably to infection, leaving 12 with complications possibly ascribable to prematurity. Six of these had retrolental fibroplasia as a major handicap. In seven, mental retardation was the presenting problem. Most of the handicapped children had multiple handicaps, which included spasticity, delayed motor development, strabismus, etc. The incidence of the necessity for corrective measures for feet and legs appeared relatively high.In general, survivors compared favorably with the rest of the childhood population. Complications and twinning were associated inordinately often.     

Developing the Bias Blind Spot: Increasing Skepticism towards Others

Two experiments with eighty-eight 7- to 10-year-olds examined the bias blind spot in children. Both younger and older children rated themselves as less likely than a specific other (Experiment 1) or an average child (Experiment 2) to commit various biases. These self-other differences were also more extreme for biased behaviors than for other behaviors. At times, older children demonstrated stronger self-other differences than younger children, which seemed primarily driven by older children’s judgments about bias in others. These findings suggest that, although the bias blind spot exists as soon as children recognize other-committed biases, what changes over development is how skeptical children are towards others.     

Differential response by males and females to manipulation of partner contribution in the great tit (Parus major)

1.  In birds with bi-parental care, handicapping is often assumed to decrease the amount of parental care of the handicapped partner. We discuss how handicapping could alter the shape of the handicapped bird's survival–effort curve (theoretical curve relating the survival of a parent to its effort) and show that the optimal response could yield a decrease, no response or even an increase in effort of the handicapped bird.
2.  Male or female great tits Parus major (L.) were handicapped during the nestling period by clipping a number of feathers in order to study the effects on parental care and body condition.
3.  Handicapped males significantly decreased their feeding rates, while handicapped females did not. Condition of handicapped females significantly deteriorated, while condition of handicapped males did not change during the experiment. Females with a handicapped partner fully compensated for their partner's decrease in work rate, while males with a handicapped partner did not show any compensation and even tended to decrease their feeding rates.
4.  Using an inverse optimality approach, we reconstructed the theoretical curve relating the survival of a parent to its effort on the basis of the experimental effects. The handicapped male's survival–effort curve appeared to be slightly steeper than that of handicapped females. This suggests that handicapped males suffer more from an increase in effort than handicapped females.     

Eye Defects of Mentally Handicapped Children

Among 171 children who received routine ophthalmic and orthoptic examinations as part of their evaluation for suspected or known developmental handicap it was found that there was an unusually high incidence of ocular defects. Especially prevalent were high refractive errors (52%) and squints (40%), but there were also a number of other serious eye defects ranging from nystagmus and cataracts to microphthalmos.Because of this high incidence of eye defects it was considered essential that ophthalmic and orthoptic examinations should be part of the routine evaluation of developmentally handicapped children by the team of workers in an assessment centre.     

Tapetoretinal Degeneration in Childhood Presenting as a Disturbance of Behaviour

Four children presented at the age of 6 years with progressive disturbances of behaviour due to increasing visual handicap. In three of them routine ophthalmological examination was carried out in the early stages, but no objective evidence of eye disease was found. The severity and nature of the visual defect and its causal relationship to the behaviour disorder went unrecognized for periods ranging from 18 to 30 months. Eventually the development of retinal changes enabled a diagnosis of tapetoretinal degeneration to be made which was confirmed by the finding of extinction of the electroretinographic response. Transfer of the children to schools for the visually handicapped resulted in improvement in their behaviour disorder.Electroretinography is of great importance in the early diagnosis of juvenile tapetoretinal degeneration.     

Adaptation of children to a chronically ill or mentally handicapped sibling.

The presence of a chronically ill or mentally handicapped child in a family can be a stress for the child''s siblings, who often are ill informed about the nature and prognosis of the illness, may be uncertain what is expected of them in the caregiving role, may feel their own identities threatened, and may experience ostracism by their friends and misunderstanding at school. Although individual reactions vary widely, feelings of anger, guilt, resentment and shame are commonly reported. Excessive responsibility and concern about one''s identity may add to these feelings and culminate in psychologic problems in the sibling. The physician caring for the family must be alert for symptoms of emotional disturbance or social maladjustment among the siblings of chronically ill or mentally handicapped children and should be prepared to counsel the family or refer them to a counsellor experienced in this area. In general, the first step is to be sure that the sibling is fully informed about the condition and to encourage frank discussion between the parents and the handicapped child''s siblings.     

Negotiation of parental care when the stakes are high: experimental handicapping of one partner during incubation leads to short-term generosity

1. Most game theoretical models of biparental care predict that a reduction in care by one partner should not be fully compensated by increased work of its mate but this may not be true for incubating birds because a reduction in care could cause the entire brood to fail.
2. I performed the first handicapping experiment of both males and females during incubation, by placing small lead weights on the tails of male and female northern flickers Colaptes auratus , a woodpecker in which males do most of the incubation.
3. Females responded to the acute stressor (handling and handicapping) by tending to abandon more readily than males and staying away from the nest longer in the first incubation bout. Among pairs that persisted, both males and females compensated fully for a handicapped partner, keeping the eggs covered nearly 100% of the time.
4. Partners did not retaliate by forcing their handicapped mate to sit on the eggs with a long incubation bout length subsequent to having a long bout length themselves. Instead, during the 24 h immediately after handicapping, males behaved generously by relieving handicapped females early.
5. Such generosity was probably not energetically sustainable as these male partners took on less incubation in the 72 h following handicapping compared to female partners of handicapped males. Males and females are probably generous in the short-term because of the high cost of nest failure during incubation but maintaining increased work loads in the longer term is probably limited by body condition and abandonment thresholds consistent with game theory models.