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.     

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.     

The Management of the Retarded Child in Practice

The management of the retarded child in general practice is discussed. The necessity of a thorough medical and psychological assessment is stressed. The problem of the parents is described from the point of view of the emotional stages through which they pass and the defence mechanisms they commonly use. The factors involved in planning the future program for the retarded child are enumerated and depend on the degree of mental and physical handicap, the socio-economic and emotional climate of the family and the available services in the area. Since a large proportion of retarded children remain at home, a systematic follow-up program by the practising physician should be encouraged.     

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.     

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 mentally defective child

Continued effort is necessary not only to prevent mental deficiency but to find methods of treating it. Meanwhile, physicians must have a keener appreciation of the feelings of the parents about their retarded children and must interpret the implications of the problems in a way the parents can understand. Further community effort is necessary to provide institutional and foster home care for those who need it. Educational and training programs should be extended and developed for all those who can benefit from such programs. The problem of mental deficiency is not that of the parents alone, nor of physicians, nor of the psychologists, nor of the social workers, nor of the educators. It is a problem which requires the cooperation of all these groups for solution.     

Psychiatric Programs: Their Medical Integration

The basic premise that psychiatry and medicine are one and the same discipline is advanced. Patients present with symptoms: sometimes largely the result of structural change, sometimes largely the result of emotional perturbation, but most frequently a mixture of both. The physician can never do his job satisfactorily without attention to the emotional problems of his patient, which is essentially the subject matter of psychiatry. He must have adequate training during his medical school years in order to recognize and handle emotional problems. The psychiatrically oriented general practitioner and the psychiatrist, who live in the community, are most valuable mental health resources and must have treatment facilities in the general hospital. Furthermore, hospital and medical insurance plans must be devised that will not penalize either doctor or patient when mental illness is recognized and dealt with in the most appropriate manner.     

Anglo-Canadian Exchange in General Practice: British View of Canadian General Practice

The Canadian general practitioner is remunerated by an item-of-service system of payment which encourages servicing demands rather than needs, discourages delegation of work to paramedical workers, and involves his staff in a massive amount of paper work. He has an excellent hospital attachment, which unfortunately is overdone. His community facilities are piecemeal and his office organization is rudimentary. There are few incentives for good general practice in the community. He spends an inordinate amount of time examining well people. The university departments of general practice are extremely good and much should be heard from them very quickly. The patient''s attitude towards his doctor is quite different from the one prevailing currently in Britain.I returned happily to British general practice.     

Child development; problems of discipline,authority and rebellion

It is only through the love and approval of the significant adults in a child's life that he is able to give up his primitive behavior for that which meets the demands of social living. Conflict over authority is only one of many conflicts. There are conflicts which arise inherently in a child's development. The task of the parents in the education of the child in our society is to enable the child to tolerate a certain amount of frustration and also a necessary degree of control of impulses so that he can live in a group and in conformity with the required standards. Increased rebelliousness and defiance are normally characteristic of certain periods of development in healthy children. These are when concerted discipline begins, and in early adolescence. But other events also may reactivate or stimulate attitudes of defiance and rebellion. Even in his rebellion, a child needs and expects his parents to stand for order, as well as for love. He expects that the parent will save him from the consequences of his own destructive impulses, which he as yet may not have the strength to withstand.Deep-seated or submerged factors in the parents may play a significant role in the discipline to which they subject their children. True permissiveness means allowing a child to develop according to his own rate of speed and his own potentialities as a unique individual. It includes refusing the child any type of behavior that will bring danger to him or to others.A parent who uses harsh and rigid forms of discipline may force a child into submission, rather than acceptance and understanding. This produces only surface conformity which hides insecurity and violent underlying destructiveness.     

Observations on Community School Facilities for the Mentally Retarded and Admissions to Institutions in Ontario, 1954-63

The relationship between community school facilities and first admissions of mentally retarded children to Ontario Institutions was investigated for the period 1954-1963. The number of educable (I.Q. 50-75) mentally retarded children aged 6-16 years in community schools rose consistently (92.1/100,000 population in 1954 to 190.1 in 1963), while first admissions of educable mentally retarded persons aged 5-19 years to Ontario Hospital Schools showed no consistent trend (2.0/100,000 in 1954 and 2.0 in 1963). The number of trainable (I.Q. 20-50) mentally retarded children aged 5-18 years in community retarded children''s schools rose steadily (10.9/100,000 population in 1954 to 42.8 in 1963), while first admissions in this category aged 5-19 years demonstrated no consistent trend (2.6/100,000 in 1954 and 2.2 in 1963).No indication was found that the age distribution of these first admissions had changed from 1954 to 1963. Any effect that increased school facilities might have had in reducing first admissions may have been nullified by the very large demand for a limited number of beds.     

The role of psychiatry in a craniofacial team

The psychosocial assessment of the child in the context of his family and community is, we believe, an essential factor in the decision for and the timing of major reconstructive surgery. A severe congenital facial deformity does not usually affect a child's body-image, but it can have a great impact on the total self-image (which is related to social reactions). Surgery should be performed ideally before the early school years, when the child is subjected to the most teasing, provided both parents and the patient have realistic expectations and really want the major reconstruction.     

Costs and benefits of a community special care baby service

Between January 1981 and December 1986 3829 low birthweight (<2500 g) infants and 1980 other high risk infants were cared for at home after they were discharged from hospital by a specialist neonatal nursing service. Of the infants who were referred to this service, 720 (12%) weighed under 2000 g and 1919 (33%) under 2250 g at the time of discharge home. The infants were visited by the community neonatal sisters on an average of 11 occasions, but the number of visits varied from six to over 100 depending on the needs of the child and parents. There was close liaison with other community and hospital staff. Two hundred and thirty (4%) referred infants were readmitted to hospital while under the care of the specialist nursing service. In 1985 the cost of the service was £127 000, or £123 for each infant referred. Providing this specialist support at home allowed much earlier discharge of low birthweight infants from hospital. When compared with the cost of providing continuing inpatient neonatal care earlier discharge was estimated to have saved roughly £250 000 in 1985.Low birthweight infants have an increased risk of serious illness or death that extends beyond the neonatal period. Many are born to young and socially disadvantaged parents who can benefit from expert guidance and support at home. A community neonatal nursing service has advantages for high risk infants and their parents, is cost effective, and allows more efficient use of limited hospital resources.     

THE PROBLEM OF THE MENTALLY DEFECTIVE CHILD

Continued effort is necessary not only to prevent mental deficiency but to find methods of treating it. Meanwhile, physicians must have a keener appreciation of the feelings of the parents about their retarded children and must interpret the implications of the problems in a way the parents can understand. Further community effort is necessary to provide institutional and foster home care for those who need it. Educational and training programs should be extended and developed for all those who can benefit from such programs.The problem of mental deficiency is not that of the parents alone, nor of physicians, nor of the psychologists, nor of the social workers, nor of the educators. It is a problem which requires the cooperation of all these groups for solution.     

CHILD DEVELOPMENT—Problems of Discipline,Authority and Rebellion

It is only through the love and approval of the significant adults in a child''s life that he is able to give up his primitive behavior for that which meets the demands of social living. Conflict over authority is only one of many conflicts. There are conflicts which arise inherently in a child''s development. The task of the parents in the education of the child in our society is to enable the child to tolerate a certain amount of frustration and also a necessary degree of control of impulses so that he can live in a group and in conformity with the required standards.Increased rebelliousness and defiance are normally characteristic of certain periods of development in healthy children. These are when concerted discipline begins, and in early adolescence. But other events also may reactivate or stimulate attitudes of defiance and rebellion. Even in his rebellion, a child needs and expects his parents to stand for order, as well as for love. He expects that the parent will save him from the consequences of his own destructive impulses, which he as yet may not have the strength to withstand.Deep-seated or submerged factors in the parents may play a significant role in the discipline to which they subject their children. True permissiveness means allowing a child to develop according to his own rate of speed and his own potentialities as a unique individual. It includes refusing the child any type of behavior that will bring danger to him or to others.A parent who uses harsh and rigid forms of discipline may force a child into submission, rather than acceptance and understanding. This produces only surface conformity which hides insecurity and violent underlying destructiveness.     

Day-care versus inpatient pediatric surgery: a comparison of costs incurred by parents.

The cost-effectiveness for parents of day-care pediatric surgery was assessed by comparing time and financial costs associated with two surgical procedures, one (squint repair) performed exclusively as a day-care procedure, the other (adenoidectomy) performed exclusively as an inpatient procedure. All but 1 of 165 eligible families participated. The children underwent surgery between February and July 1981. The day-care surgery group (59 families) incurred average total time costs of 16.1 hours, compared with 37.1 hours for the inpatient surgery group (105 families), as parents in the latter group remained with their child during the longer hospital stay. Parents from out of town incurred the greater time and financial costs. In both groups parents of younger children tended to spend more time at the hospital than parents of older children. Type of surgical management was not a significant factor in out-of-pocket expenses. Loss of income was associated with employment of the mother as a professional or a manager and may reflect inequalities in access to compassionate leave between men and women in equivalent positions. Opening day-care surgery facilities on weekends might reduce the financial burden on working mothers. Overall, day-care surgery was found to be cost-effective for families.     

Differential facial resemblance of young children to their parents: who do children look like more?

In humans, paternal investment is highly variable and is modulated by paternity uncertainty. Facial phenotypic similarity between a father and a child is one possible paternity indicator. However, whether such paternal-biased traits are expressed in children is unclear, as previous empirical results are contradictory. Therefore, we quantified the facial resemblance between a child and each of his or her parents, from birth to 6 years old. Resemblance was assessed from pictures of the face by nonrelated judges. We found that, at all ages, children resemble both their parents more than would be expected by chance, although there is a differential resemblance toward one or the other parent depending on the age and sex of the child. For newborns, boys and girls resemble their mothers more, this differential resemblance persisting through time for girls. For boys, an inversion occurs and they resemble their fathers more between 2 and 3 years of age. The resemblance ascribed by the parents shows that, at birth, mothers ascribe a resemblance to the father, as previously found, although assessment by external judges revealed the opposite. These results suggest that facial appearance is a cue for kin recognition between a father and a child. Patterns of differential resemblance are discussed within the context of evolutionary theories on parental investment.     

THE MISTREATED CHILD

“The battered child” has recently attracted the attention of physicians and social workers, but despite the fact that inflicted trauma produces characteristic x-ray changes, physicians are often reluctant to admit this cause. The neglected child may be more difficult to diagnose and is probably more common. The most typical example is the infant who is admitted to the hospital for “failure to thrive,” yet gains weight rapidly while away from his parents.The parents of both types of children are likely to be immature and inadequate, but much more study is required before the factors common to these parents are known, to say nothing of the means required for prevention and treatment.When the physician suspects that the parent is causing the difficulties manifested by the child, he should seek the help of a social worker in clarifying the situation and in contacting the appropriate social or legal agency. A greater awareness of the problems of these children should result in more rapid recognition of the condition, the establishment of well-defined methods of handling such cases, and ultimately better legislation to safeguard the child''s rights to a safe and healthy childhood.     

The Role of the Primary Physician in Mental Retardation

Practicing physicians are called upon with increased frequency for the diagnosis and treatment of the mentally retarded. The syndrome is a complex health, education, social and vocational problem. Classification is generally based on the degree of impairment, the causation and the symptomatology. There are two major types of mental retardation. In one, the impairment is more severe and concomitant physical signs are frequent. In the other, the impairment is mild and somatic signs are absent.Diagnosis calls for careful developmental history, examination and a judicious use of laboratory and other tests. Early diagnosis and the establishment of cause have important therapeutic and preventive implications. Counseling of parents is an essential part of clinical work.     

NEUROLOGICALLY HANDICAPPED CHILDREN—The Role of the Pediatrician in Rehabilitation

In the application of the broad services now available to assist a child having a major neurologic impairment, the pediatrician occupies an important role owing to his ability to consider the problem of the handicapped child in the context of his specialized knowledge of the developmental process. He thus has a large responsibility for interpretation of the problem to the child, to the parents and to his professional colleagues and for guidance of the rehabilitation regimen within the limits of the child''s developmental readiness for new experiences.The pediatrician has the opportunity to contribute significant clinical observations which may provide stimuli for future basic research and to exercise his skill as a practitioner of preventive medicine.Goals for the future achievement of the child having a major neurologic impairment must be set realistically and with great caution.     

Psychiatric reform revisited

The trend towards the establishment of community psychiatric services seems to be universal. However, before closing down a mental hospital, it is necessary to establish the appropriate alternative facilities in the community. Every de-institutionalization program should have a diachronic component, and cultural issues should be taken into consideration. Care for each patient has to be decided upon on the basis of the characteristics of that patient. Finally, de-institutionalization is just one aspect of psychiatric reform. Primary psychiatric prevention is equally or even more important