Handicapping Conditions in Children

Bill Gillham

• Publisher: Routledge
• Year: 2022
• ISBN:
  9781000536911
• Edition: 1
• Topic: Education
• Subtopic: Educational Psychology

First published in 1986, Handicapping Conditions in Children provides an accessible overview of a wide range of handicapping conditions and their remediation, and gives a balanced perspective on the medical, educational and social issues. It will therefore be of value to a wide audience in these professions as well as to students and parents. Each chapter deals with one specific area but is presented to cover: description of the condition and its aetiology; its prevalence in the population and relatives; developmental characteristics; special problems and needs; educational and social provision; the potential for the future; and further reading lists. The book does not include every possible condition, but concentrates on those that are most frequent or problematic.

This book is a reissue originally published in 1986. The language used is a reflection of its era and no offence is meant by the Publishers to any reader by this republication

CHAPTER 1 Mental Handicap

DOI: 10.4324/9781003261964-1

BILL GILLHAM

That an account of mental handicap is the first chapter in this book is no accident of organisation. Of all our faculties intelligence is the most fundamental: it enables us to adapt to and manage the environmental demands that are made on us, to exploit our personal resources and to overcome or bypass our limitations. Impairments of vision, of hearing, of the ability to move around, are all serious: but the handicaps posed by these disabilities can be reduced by the adaptiveness of our intelligence.

In our society we tend to think of intelligence as something to do with academic achievement, and ‘intelligence’ tests are commonly validated against school attainments and examination performance. But this is an excessively narrow view of human intelligence, which in fact manifests itself in a range of social-survival skills. Everyday living makes continuous demands on our intellectual judgement, and one of the weaknesses of intelligence tests is that they usually take little account of these aspects of being intelligent.

Legislation has always construed mental handicap in terms of social as well as academic competence. In the UK the Mental Health Act of 1983 represents a major advance on the earlier Acts of 1959 and 1913, but retains a broadly based definition of mental handicap — which it refers to as ‘severe mental impairment’ — describing it as ‘a state of arrested or incomplete development of mind which includes severe impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned’.

Note that this definition is, in part, for certain purposes of the Act, i.e. to provide a statutory basis for control or institutionalisation, and so must not be taken as an adequate or reasonable general description of mentally handicapped people.

Who Are The Mentally Handicapped?

As might be expected from the above there is no ‘tight’ definition of mental handicap that is generally accepted. Indeed, whether someone comes to be defined as mentally handicapped is a social process as much as anything else: other people have to have a reason or purpose for applying the label. With severe conditions there is usually consensus, but not always (e.g. ‘He’s not mentally handicapped, he’s autistic’), but with milder conditions the label becomes problematic. For example, should all children with Down’s syndrome be described as ‘mentally handicapped’?

Assessment on intelligence tests provides the simplest formulation, especially when the results are expressed in terms of an intelligence quotient or IQ. Linked to the IQ range are descriptive labels: the range 50-75 has usually been described as ‘mild mental handicap’; 30-50 as ‘severe mental handicap’; and below IQ 30 (or ‘untestable’) as ‘profound mental handicap’. In the UK prior to the early 1970s the IQ 50 point was of great significance because children with scores below that were deemed ‘ineducable’ and excluded from the education system. A similar distinction obtained in the United States, where ‘mental retardates’ were classified as either ‘educable’ or ‘trainable’ (EMR or TMR).

IQ is a useful descriptive shorthand but it is no more than that. We cannot measure intelligence directly so the term ‘intelligence’ test is a misnomer. Intelligence is something we infer from performance, and we do it all the time. Intelligence tests sample attainments which are claimed to provide an adequate basis for this inference. However, no two intelligence tests are the same (although there is usually substantial overlap) so results vary. A person’s IQ depends on which test he has been given.

The modern intelligence test originated in Paris in the first decade of this century. Alfred Binet and a collaborator devised an age-scale (composed of items that seemed to reflect developing intelligence at successive age-levels) and which enabled him to say, for example, whether a 10-year-old child was performing at that level or at a lower or higher level. If the child could pass test items only up to the 5-year-old level, then it might be reasonable to describe him as ‘mentally retarded’.

The age-scale and the IQ score relate to one part of the basic definition of mental handicap: someone who is performing substantially below his or her age-level on intellectual attainments. In the example given above, and using a ratio formula:

When an intelligence test is based on an age-scale — which only makes sense in relation to children — IQ can be seen as an index of slow development. IQ, however, does not explain the condition, nor is it a measure of ‘capacity’, although it has traditionally been seen as such. Nor is slowness of development a sufficient definition of mental handicap. We shall return to this point later.

By school age virtually all cases of severe and profound mental handicap have been identified. The incidence is approximately 1 in 250 children. In England and Wales these children are described as Educationally Subnormal (Severe) (ESN(S)). Most children in this category are identified long before school age, and the risk or probability of mental handicap may be recognised even at birth or soon after because of evidence of brain damage.

One major difference between children with IQs below 50 and those in the range 50-75 is that the former group is much more likely to show evidence of organic impairment. The other major difference is in the social-class composition of the two groups. Children who are classified as ESN(S) are scattered across all the social classes; children who become classified as Educationally Subnormal (Moderate) (ESN(M)) are almost entirely from social classes IV and V and have been found to contain a relatively high proportion of black children. Environmental causes are, therefore, clearly important. Indeed, the validity of this category must be considered suspect since many normal schools do not seek special placement or identification for children who might otherwise be described as ESN(M). For that reason the present chapter deals only with those children whose handicap is more severe.

Detection of Severe Mental Handicap

A number of factors determine when, and how early, mental handicap is detected:

• — recognisable conditions such as Down’s syndrome;
• — evidence of brain damage which alerts parents and professionals alike;
• — parental sensitivity: parents are often the first to detect that ‘something is wrong’, usually in their attempted interactions with the child;
• — quality of medical and educational services, especially the quality of routine screening.

Nobody expects to have a mentally handicapped baby, and all parents know that different children vary in the age at which they reach their developmental milestones and that some are more active than others. A significant proportion of children who turn out to be severely mentally handicapped have no significant physical defects and develop normally in terms of sitting up, crawling and so on, during the first year of life. Indeed, it may only be in the parents’ attempts to play with the child, and the child’s lack of responsiveness, that there will be grounds for doubt about his mental development.

By the second and third year of life, when we look for language development, more definite signs of mental handicap may be apparent. But again, there is considerable ‘normal’ variation, and boys are noticeably slower than girls in starting to talk. Hard-and-fast deadlines are not something one can offer with great confidence. But if a child is not producing single words by 21 months and word combinations by 27 months there is good reason for seeking some professional advice, especially when evidence of language comprehension is uncertain. Usually, however, there will be other evidence of delay — a failure to play, destructiveness, activity without apparent purpose, and so on.

Although, exceptionally, children who develop language around the normal time can still turn out to be mentally handicapped, delayed language is usually a key factor in the identification and definition of mental handicap. This does not mean that all language-delayed children should be seen as mentally handicapped. It is worth remembering that Carlyle did not speak until the age of 4 years (saying ‘What ails thee, Jock?’ when he saw another child crying). However, the strength of the association is shown in a study by Stevenson and Richman (1976). They took a 1 in 4 random sample of the total population of 3-year-old children living in one outer London borough. Of those identified as having language delay (language-age level below 30 months), 50 per cent also manifested retarded non-verbal mental abilities (non-verbal mental age less than two-thirds their chronological age). Thus, although it is important not to equate language retardation with mental retardation, the one warrants careful investigation of the possibility of the other.

Causes of Severe Mental Handicap

Down's Syndrome

About 25 per cent of mentally handicapped children have a chromosome disorder, and most of these are suffering from Down’s syndrome. It must be noted here that the terms ‘mongolism’ and ‘mongoloid’ are obsolete and are considered offensive by many people, especially parents, since it suggests that the children are a race apart, an alien category.

The risk of having a baby with Down’s syndrome is strongly associated with maternal age, i.e. around 1 in 1000 for women in their twenties to 1 in 100 for women in their forties. However, most Down’s babies are born to young women because it is at this age that the great majority of women have their children.

The cause of Down’s syndrome (a chromosomal abnormality — most usually an ‘extra’ chromosome 21 — hence ‘trisomy 21’) was first described as recently as 1959 by a group of French medical scientists. About 10 per cent of children with Down’s syndrome have chromosomal abnormalities slightly different from trisomy 21, but the basic character of the condition is the same.

We are most of us familiar with the typical appearance of children with Down’s syndrome, especially their facial characteristics: the slightly flattened nose and the epicanthal fold across the corner of the eyes. But there are, in fact, ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Original Title
• Original Copyright
• Contents
• Foreword
• Chapter 1. Mental Handicap
• Chapter 2. Disorders of Language and Communication
• Chapter 3. Hearing Impairment
• Chapter 4. Visual Handicap
• Chapter 5. Cerebral Palsy
• Chapter 6. Epilepsy
• Chapter 7. Spina Bifida
• Chapter 8. Autism
• References
• Notes on Contributors
• Index