R E 0 R

--

E S U M E

ED 014 833 .

EC 001 042

MENTAL RETARDATION, A NATIONAL PLAN FOR A NATIONAL PROBLEM.

CHART BOOK.DEPARTMENT OF HEALTH, EDUCATION AND WELFARE

PUB DATE AUG 63

EDRS PRICE MF-$0.50 HC NOT AVAILABLE FROM EDRS. 70P.

DESCRIPTORS- *MENTALLY HANDICAPPED, *EXCEPTIONAL CHILD

SERVICES, *NATIONAL PROGRAMS, *EDUCATIONAL NEEDS, *RESEARCH

NEEDS, STATISTICAL SURVEYS, MENTAL RETARDATION, ADOLESCENTS,

ADULTS, CHILDREN, ETIOLOGY, HEALTH NEEDS, INCIDENCE,

MINIMALLY BRAIN INJURED, REHABILITATION, SPECIAL EDUCATION,

TEACHER RECRUITMENT,

GRAPHS ARE USED IN THIS CHART BOOK TO SHOW PROGRESS AND

INDICATE NEEDS. SUGGESTED PRIORITY AREAS FOR ACTION

ARE--RESEARCH, PREVENTIVE HEALTH MEASURES, CLINICAL AND

SOCIAL SERVICES, IMPROVED CARE, A NEW LEGAL AND SOCIAL

CONCEPT OF THE RETARDED, SPECIAL EDUCATION, PERSONNEL

RECRUITMENT, AND PUBLIC INFORMATION PROGRAMS. THE PREVALENCE

OF MENTALLY RETARDED PERSONS, THE SCOPE OF THE PROBLEM,. THE

TYPES AND CAUSES OF RETARDATION, PERCENTAGE OF MULTIPLY

HANDICAPPED PERSONS, AND MEDICAL PROGRESS ARE DISCUSSED.

STATISTICS ON INSTITUTIONALIZATION, SPECIAL EDUCATION NEEDS,

AND PARENTAL CARE ARE PRESENTED. TEACHER RECRUITMENT NEEDS,

REHABILITATION PROGRAMS, AND GROWING PUBLIC AWARENESS ARE

DESCRIBED. THIS DOCUMENT WAS PUBLISHED BY SUPERINTENDENT OF

DOCUMENTS, U. S. GOVERNMENT PRINTING OFFICE, WASHINGTON, D.C.

20402. $0.45. (JA)

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Cha

rt B

ook

Men

tal R

etar

datio

n

A Nat

iona

l Pla

nfo

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l Pro

blem

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lishe

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r

The

Pre

side

nt's

Pan

el o

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enta

l Ret

arda

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by th

e

U.S

. DE

PA

RT

ME

NT

OF

HE

ALT

H, E

DU

CA

TIO

N,

AN

D W

ELF

AR

E

For

sal

e by

the

Sup

erin

tend

ent o

f Doc

umen

ts, U

.S. G

over

nmen

t Prin

ting

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ce

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hing

ton,

D.C

., 20

402

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e 45

cen

ts

TH

E P

RE

SID

EN

T'S

PA

NE

L

Cha

irm

anD

r. L

eona

rd W

. May

o, E

xecu

tive

Dir

ecto

r of

the

Ass

ocia

tion

for

the

Aid

of

Cri

pple

d C

hil-

dren

, New

Yor

k, N

. Y.

Vic

e-C

hair

man

Dr.

Geo

rge

Tar

jan,

Sup

erin

tend

ent a

nd M

edi-

cal D

irec

tor

of th

e Pa

cifi

c St

ate

Hos

pita

l,Po

mon

a, C

alif

orni

a

Judg

e D

avid

L. B

azel

on, U

.S. C

ourt

of

Ap-

peal

s fo

r th

e D

istr

ict o

f C

olum

bia,

Was

hing

-to

n, D

. C.

Mon

sign

or E

lmer

H. B

ehrm

ann,

Ass

ocia

te S

ec-

reta

ry f

or S

peci

al E

duca

tion

in th

e N

atio

nal

Cat

holic

Edu

catio

n A

ssoc

iatio

n, S

t. L

ouis

,M

isso

uri

Dr.

Eliz

abet

h B

oggs

, Res

earc

h C

hair

man

,N

atio

nal A

ssoc

iatio

n fo

r R

etar

ded

Chi

ldre

n,In

c., N

ew Y

ork,

N. Y

.

Dr.

Rob

ert E

. Coo

ke, P

rofe

ssor

of

Pedi

atri

cs,

The

Joh

ns H

opki

ns H

ospi

tal,

Bal

timor

e, M

ary-

land

Dr.

Leo

nard

S. C

ottr

ell,

jr.,

Staf

f -S

ocia

l Psy

-ch

olog

ist,

Rus

sell

Sage

Fou

ndat

ion,

New

Yor

k, N

. Y.

Dr.

Edw

ard

Doy

ens,

Dep

uty

Com

mis

sion

er,

Mar

ylan

d St

ate

Dep

artm

ent o

f Pu

blic

Hea

lth,

Bal

timor

e, M

aryl

and

Dr.

Llo

yd M

. Dun

n, C

oord

inat

or, E

duca

tion

for

Exc

eptio

nal C

hild

ren,

Geo

rge

Peab

ody

Col

lege

for

Tea

cher

s, N

ashv

ille,

Ten

ness

ee

Dr.

Lou

is M

. Hel

lman

, Dep

artm

ent o

f O

b-st

etri

cs a

nd G

ynec

olog

y, S

tate

Uni

vers

ity o

fN

ew Y

ork,

New

Yor

k C

ity C

olle

ge o

f M

edi-

cine

, Bro

okly

n, N

. Y.

Dr.

Her

man

E.

Hill

eboe

, Com

mis

sion

er o

fH

ealth

, New

Yor

k St

ate

Dep

artm

ent o

f H

ealth

,A

lban

y, N

. Y.

Dr.

Nic

hola

s H

obbs

, Cha

irm

an, D

ivis

ion

ofH

uman

Dev

elop

men

t, G

eorg

e Pe

abod

y C

olle

gefo

r T

each

ers,

Nas

hvill

e, T

enne

ssee

Dr.

Will

iam

Hur

der,

Ass

ocia

te D

irec

tor

for

Men

tal H

ealth

, Sou

ther

n R

egio

nal E

duca

tion

Boa

rd, A

tlant

a, G

eorg

ia

Dr.

Sey

mou

r K

ety,

Psy

chia

tris

t-in

-Chi

ef, H

enry

Phip

ps P

sych

iatr

ic C

linic

, The

Joh

ns H

opki

nsH

ospi

tal,

Bal

timor

e, M

aryl

and

Dr.

Jos

hua

Led

erbe

rg, D

epar

tmen

t of

Gen

etic

s,St

anfo

rd U

nive

rsity

Sch

ool o

f M

edic

ine,

Pal

oA

lto, C

alif

orni

a

Dr.

Reg

inal

d L

auri

e, D

irec

tor,

Dep

artm

ent o

fPs

ychi

atry

,C

hild

ren'

sH

ospi

tal,

Was

hing

-to

n, D

. C.

Dr.

Oliv

er H

. Low

ry, P

rofe

ssor

of

Phar

ma-

_tol

ogy,

Was

hing

ton

Uni

vers

ity S

choo

l of

Med

i-ch

ic, S

t. L

ouis

, Mis

sour

i

Dr.

Hor

ace

W. M

agou

n, D

epar

tmen

t of

Ana

t-om

y, U

nive

rsity

of

Cal

ifor

nia,

Sch

ool o

f M

edi-

cine

, Los

Ang

eles

, Cal

ifor

nia

Dr.

Dar

rel J

. Mus

e, D

ean,

Col

lege

of

Hea

lthR

elat

ed S

ervi

ces,

Uni

vers

ity o

f Fl

orid

a, G

aine

s-vi

lle, F

lori

da

Mr.

F. R

ay P

ower

, Dir

ecto

r, D

ivis

ion

of V

o-ca

tiona

l Reh

abili

tatio

n, C

harl

esto

n, W

est V

ir-

gini

a

Dr.

Ann

e M

. Ritt

er, D

irec

tor

of P

sych

olog

ical

Serv

ices

, Ken

nedy

Chi

ld S

tudy

Cen

ter,

New

Yor

k, N

. Y.

Dr.

Wen

dell

Stan

ley,

Pro

fess

or o

f V

irol

ogy,

Uni

vers

ity o

f C

alif

orni

a, B

erke

ley,

Cal

ifor

nia

Dr.

Har

old

Stev

enso

n, D

irec

tor,

Chi

ld D

evel

op-

men

t Res

earc

h, U

nive

rsity

of

Min

neso

ta, M

in-

neap

olis

, Min

neso

ta

Mr.

W. W

alla

ce T

udor

, Vic

e-Pr

esid

ent,

Sear

sR

oebu

ck &

Com

pany

, Chi

cago

, Illi

nois

Mr.

Hen

ry V

isca

rdi,

Jr.,

Pres

iden

t, A

bilit

ies,

Inc.

, Alb

erts

on, L

ong

Isla

nd, N

. Y.

Mrs

. Ire

ne A

sbur

y W

righ

t, Sp

eech

Pat

holo

gist

,A

lban

y, G

eorg

ia

Dr.

Ern

est P

. Will

enbe

ry, D

irec

tor

of S

peci

alE

duca

tion,

Los

Ang

eles

City

Boa

rd o

f E

duca

-tio

n, L

os A

ngel

es, C

alif

orni

a

CO

NSU

LT

AN

T T

O T

HE

PA

NE

LM

rs.

Sar

gent

Shr

iver

,V

ice-

Pres

iden

t,Jo

seph

P. K

enne

dy F

ound

atio

n;M

embe

r:C

hica

go C

omm

issi

onon

You

th W

elfa

re;

and

Boa

rd o

f G

over

nors

of

the

Men

ning

erFo

unda

tion,

Top

eka,

Kan

sas

Exc

erpt

s fr

om©

FA

BIA

N B

AC

HR

AC

H

TH

E P

RE

SID

EN

T'S

ME

SSA

GE

CR

EA

TIN

G T

HE

PA

NE

L O

N M

EN

TA

L R

ET

AR

DA

TIO

N

"We

mus

t und

erta

ke a

com

preh

ensi

ve a

nd c

oord

inat

ed a

ttack

on

the

prob

lem

of

men

tal r

etar

datio

n. T

he la

rge

num

ber

of p

eopl

e in

-vo

lved

, the

gre

at c

ost t

o th

e na

tion,

the

stri

king

nee

d, th

e va

st a

rea

of th

e un

know

n th

at b

ecko

ns u

s to

incr

ease

d re

sear

ch e

ffor

tsal

lde

man

d at

tent

ion.

"It i

s fo

r th

at r

easo

n th

at I

am

cal

ling

toge

ther

a p

anel

of

out-

stan

ding

phy

sici

ans,

sci

entis

ts, e

duca

tors

, law

yers

, psy

chol

ogis

ts,

soci

al s

cien

tists

and

lead

ers

in th

is f

ield

to p

resc

ribe

the

prog

ram

of

actio

n. I

am

sur

e th

at th

e ta

lent

whi

ch h

as le

d to

pro

gres

s in

oth

erfi

elds

of

med

icin

e an

d th

e ph

ysic

al s

cien

ces

can

enla

rge

the

fron

tiers

of th

is la

rgel

y ig

nore

d ar

ea.

"It s

hall

be th

e re

spon

sibi

lity

of th

is p

anel

to e

xplo

re th

e po

ssi-

bilit

ies

and

path

way

s to

pre

vent

and

cur

e m

enta

l ret

arda

tion.

No

rele

vant

dis

cipl

ine

and

no f

act t

hat w

ill h

elp

achi

eve

this

goa

l is

tobe

neg

lect

ed.

"The

pan

el w

ill a

lso

mak

e a

broa

d st

udy

of th

e sc

ope

and

dim

en-

sion

s of

the

vari

ous

fact

ors

that

are

rel

evan

t to

men

tal r

etar

datio

n.T

hese

incl

ude

biol

ogic

al, p

sych

olog

ical

, edu

catio

nal,

voca

tiona

l, an

dso

cio-

cultu

ral a

spec

ts o

f th

e co

nditi

on a

nd th

eir

impa

ct u

pon

each

stat

e of

dev

elop

men

tmar

riag

e, p

regn

ancy

, del

iver

y,ch

ildho

od, a

ndad

ulth

ood.

"The

pan

el w

ill a

lso

appr

aise

the

adeq

uacy

of

exis

ting

prog

ram

san

d th

e po

ssib

ilitie

s fo

r gr

eate

r ut

iliza

tion

of c

urre

nt k

now

ledg

e.T

here

are

alr

eady

man

y de

vote

d w

orke

rs in

this

fie

ld, t

rain

ed in

diag

nosi

s, tr

eatm

ent,

care

, edu

catio

n an

d re

habi

litat

ion.

The

pan

elsh

ould

asc

erta

in th

e ga

ps in

pro

gram

s an

d an

y fa

ilure

in c

oord

ina-

tion

of a

ctiv

ities

."T

he p

anel

will

rev

iew

and

mak

e re

com

men

datio

ns w

ith r

egar

d to

:

"1. T

he p

erso

nnel

nec

essa

ry to

dev

elop

and

app

ly th

e ne

w k

now

l-ed

ge. T

he p

rese

nt s

hort

age

of p

erso

nnel

is a

maj

or p

robl

em in

our

logi

stic

s. M

ore

phys

icia

ns, n

urse

s, s

ocia

l wor

kers

, edu

cato

rs, p

sych

olo-

gist

s, a

nd o

ther

trai

ned

wor

kers

are

nee

ded.

"2. T

he m

ajor

are

as o

f co

ncer

n th

at o

ffer

the

mos

t hop

e, a

ndth

e m

eans

, the

tech

niqu

es a

nd th

e pr

ivat

e an

d go

vern

men

tal s

truc

-tu

res

nece

ssar

y to

enc

oura

ge r

esea

rch

in th

ese

area

s.

"3. T

he p

rese

nt p

rogr

ams

of tr

eatm

ent,

educ

atio

n an

d re

habi

lita-

tion. "4

. The

rel

atio

nshi

ps b

etw

een

the

Fede

ral G

over

nmen

t, th

e St

ates

and

priv

ate

reso

urce

s in

thei

r co

mm

on e

ffor

ts to

elim

inat

e m

enta

lre

tard

atio

n.

"I a

m a

skin

g th

e pa

nel t

o re

port

on

or b

efor

e D

ecem

ber

31, 1

962.

"

3

INT

RO

DU

CT

ION

n O

ctob

er 1

961,

Pre

side

nt K

enne

dy a

ppoi

nted

a p

anel

of

dist

ingu

ishe

d sc

ient

ists

, edu

cato

rs, a

nd la

ymen

topr

epar

e a

natio

nal p

lan

to c

omba

t men

tal r

etar

datio

none

of

the

mos

tpe

rnic

ious

and

neg

lect

ed a

fflic

tions

of

man

kind

.

The

pan

el w

as a

sked

to r

evie

w p

rese

ntpr

ogra

ms

and

need

s;as

cert

ain

gaps

in r

esea

rch,

dia

gnos

is, t

reat

men

t, se

rvic

e, a

ndco

ordi

natio

n; a

nd to

rec

omm

end

a pr

ogra

m o

f ac

tion.

The

pan

el a

ccep

ted

this

man

date

and

, in

Oct

ober

196

2, s

ub-

mitt

ed it

s re

port

to th

e Pr

esid

ent.

Cop

ies

of th

e fu

llre

port

,en

title

d "A

Pro

pose

d Pr

ogra

m f

or N

atio

nal A

ctio

n T

o C

omba

t

Men

tal R

etar

datio

n,"

may

be

secu

red

from

the

Supe

rint

ende

nt

of D

ocum

ents

, U.S

. Gov

ernm

ent P

rint

ing

Off

ice,

Was

hing

ton,

D.C

., 20

402,

65

cent

s pe

rco

py.

The

pan

el's

mai

n re

com

men

datio

ns in

the

fina

l rep

ort w

ere

as f

ollo

ws:

1. R

esea

rch

in th

e ca

uses

of

reta

rdat

ion

and

met

hods

of

care

, reh

abili

tatio

n, a

nd le

arni

ng.

2. P

reve

ntiv

e he

alth

mea

sure

s in

clud

ing

(a)

a gr

eatly

stre

ngth

ened

pro

gram

of

mat

erna

l and

infa

ntca

re d

irec

ted

firs

t at t

he c

ente

rs o

f po

pula

tion

whe

repr

emat

urity

and

the

rate

of

"dam

aged

" ch

ildre

nar

e hi

gh; (

b) p

rote

ctio

n ag

ains

tsu

ch k

now

n ha

zard

s to

preg

nanc

y as

rad

iatio

n an

d ha

rmfu

ldr

ugs;

and

(c)

ext

ende

d di

agno

stic

and

scre

enin

g se

rvic

es.

3. S

tren

gthe

ned

educ

atio

nal

prog

ram

s ge

nera

lly a

nd e

x-te

nded

and

enr

iche

dpr

ogra

ms

of s

peci

al e

duca

tion

in p

ublic

and

priv

ate

scho

ols

clos

ely

coor

dina

ted

with

voca

tiona

l gui

d-an

ce, v

ocat

iona

l reh

abili

tatio

n, a

nd s

peci

fic

trai

ning

and

prep

-ar

atio

n fo

r em

ploy

men

t; ed

ucat

ion

for

the

adul

t men

tally

re-

tard

ed, a

nd w

orks

hops

gea

red

to th

eir

need

s.4.

Mor

e co

mpr

ehen

sive

and

impr

oved

clin

ical

and

soci

alse

rvic

es.

5. I

mpr

oved

met

hods

and

fac

ilitie

s fo

rca

re, w

ith e

mph

asis

on th

e ho

me

and

the

deve

lopm

ent o

fa

wid

e ra

nge

of lo

cal

com

mun

ity f

acili

ties.

6. A

new

lega

l,as

wel

l as

soci

al, c

once

pt o

f th

e re

tard

ed,

incl

udin

g pr

otec

tion

of th

eir

righ

ts; l

ife

guar

dian

ship

pro

vi-

sion

s w

hen

need

ed;

an e

nlig

hten

ed a

ttitu

de o

n th

e pa

rt o

f th

ela

w a

nd th

e co

urts

; and

cla

rifi

catio

n of

the

theo

ry o

f re

spon

si-

bilit

y in

cri

min

alac

ts.

7. H

elpi

ng o

verc

ome

the

seri

ous

prob

lem

sof

man

pow

eras

they

aff

ect t

he e

ntir

e fi

eld

of s

cien

ce a

ndev

ery

type

of

serv

-ic

e th

roug

h ex

tend

edpr

ogra

ms

of r

ecru

iting

with

fel

low

ship

s,an

d in

crea

sed

oppo

rtun

ities

for

gra

duat

est

uden

ts, a

nd th

ose

prep

arin

g fo

r th

e pr

ofes

sion

sto

obs

erve

and

lear

n at

fir

stha

nd

abou

t the

phe

nom

enon

of

reta

rdat

ion.

Bec

ause

ther

e w

ill

neve

r be

afu

lly a

dequ

ate

supp

ly o

f pe

rson

neli

n th

is f

ield

and

for

othe

r co

gent

rea

sons

, the

pan

elha

s em

phas

ized

the

need

for

mor

e vo

lunt

eers

in h

ealth

, rec

reat

ion,

and

Wel

fare

act

ivi-

ties,

and

for

a N

atio

nal S

ervi

ceC

orps

to s

timul

ate

volu

ntar

y

serv

ice.

8. P

rogr

ams

of e

duca

tion

and

info

rmat

ion

to in

crea

se p

ub-

lic a

war

enes

s of

the

prob

lem

of

men

tal

reta

rdat

ion.

In s

hort

in a

dditi

on to

a s

tron

gem

phas

is o

n re

sear

ch a

nd

prev

entio

n, th

e pa

nel h

as p

ropo

sed:

a. C

ompr

ehen

sive

and

impr

oved

ser

vice

s, in

clud

ing

ex-

tend

ed e

duca

tiona

l and

voc

atio

nalo

ppor

tuni

ties.

b. W

ell-

coor

dina

ted

serv

ices

ava

ilabl

e to

all r

etar

ded

per-

sons

.

e. C

omm

unity

cent

ered

, rat

her

than

isol

ated

, ser

vice

s,w

hich

wou

ld b

e cl

ose

to te

achi

ng a

nd r

esea

rch

faci

litie

s.

The

ulti

mat

e go

al is

pre

vent

ion

of m

enta

l ret

arda

tion,

but

man

y st

eps

mus

t be

take

n by

man

ype

ople

and

org

aniz

atio

ns,

by th

e St

ate

and

Fede

ral G

over

nmen

ts, a

nd p

artic

ular

ly b

ypr

ivat

e ci

tizen

s, b

efor

e th

at c

an b

e re

aliz

ed. T

he r

ecom

men

da-

tions

con

tain

ed h

erei

n in

dica

te s

ome

of th

e th

ings

nee

ded

tosp

ur a

n ex

amin

atio

n in

to th

e ca

uses

ofm

enta

l ret

arda

tion

and

impr

ove

the

care

and

edu

catio

n of

all

men

tally

ret

arde

d pe

ople

.R

esea

rch,

trai

ning

, pro

tect

ion,

edu

catio

n, p

erso

nnel

, par

ent

coun

selin

g, r

ehab

ilita

tion,

pub

lic in

form

atio

n, a

re a

ll m

eans

to

thes

e en

ds. T

he s

ame

oppo

rtun

ity f

or s

ocia

l dev

elop

men

t tha

tis

the

birt

hrig

ht o

f ev

ery

Am

eric

an m

ust b

e pr

ovid

ed f

or a

llm

enta

lly r

etar

ded

child

ren

and

adul

ts.

Whi

le th

e ch

arts

that

fol

low

sho

w th

at w

e ha

ve m

ade

prog

-

ress

in th

e pa

st 1

0 ye

ars

they

als

o in

dica

te th

at w

e m

ust w

ork

inte

nsiv

ely

to f

ill th

e ob

viou

s ga

ps in

cur

rent

kno

wle

dge

and

serv

ices

.

Aug

ust 1

963

5

6

enta

l ret

arda

tion

isa

cond

ition

, cha

ract

eriz

ed b

y th

efa

ulty

dev

elop

men

t of

inte

llige

nce,

whi

ch im

pair

san

indi

vid-

ual's

abi

lity

to le

arn

and

to a

dapt

to th

e de

man

ds o

f so

ciet

y.In

form

atio

n on

men

tal r

etar

datio

n is

inco

mpl

ete,

and

noad

equa

te m

eans

of

gath

erin

g fu

ll st

atis

tics

have

yet

bee

n de

-vi

sed.

How

ever

, usi

ng I

ntel

ligen

ce Q

uotie

ntas

one

mea

sure

,ex

peri

ence

sho

ws

that

mos

t peo

ple

with

I.Q

.'s b

elow

70

have

sign

ific

ant d

iffi

culti

es a

djus

ting

adeq

uate

ly to

thei

r en

viro

n-m

ent.

It is

est

imat

ed th

at a

bout

3%

of

the

popu

latio

n w

ould

scor

e be

low

this

leve

l. B

ased

on

1962

pop

ulat

ion

estim

ates

,ab

out 5

.4 m

illio

n pe

rson

s w

ould

be

affe

cted

.U

nles

s th

ere

are

maj

or a

dvan

ces

in m

etho

ds o

f pr

even

tion,

ther

e w

ill p

roba

bly

be o

ne m

illio

nm

ore

men

tally

ret

arde

dby

197

0.

TH

E N

UM

BE

RS

OF

EN

TA

LLY

RE

TA

RD

ED

AR

EIN

CR

EA

SIN

G

1955

1960

OU

T O

F A

PO

PU

LAT

ION

OF

164

MIL

LIO

N

5.4

MIL

LIO

N

OU

T O

F A

PO

PUL

AT

ION

OF

179

MIL

LIO

N

1970

4+k'

OU

T O

F A

PO

PU

LAT

ION

OF

214

MIL

LIO

N

6.4

MIL

LIO

N

7

At t

his

time,

126

,000

infa

nts

are

born

ann

ually

who

are

,

or w

ill b

ecom

e, m

enta

lly r

etar

ded.

App

roxi

mat

ely

4,20

0 (0

.1 p

erce

nt o

f al

l bir

ths)

will

be

reta

rded

so

seve

rely

that

eve

n as

adu

lts th

ey w

ill b

e un

able

toca

re f

or th

eir

own

need

s of

dai

ly li

ving

.A

bout

12,

600

(0.3

per

cent

of

all b

irth

s) w

ill r

emai

n be

low

the

seve

n-ye

ar in

telle

ctua

l lev

el.

The

rem

aini

ng 1

10,0

00 (

2.6

perc

ent o

f al

l bir

ths)

are

thos

e w

ith m

ild r

etar

datio

n an

d re

pres

ent t

hose

who

can

, with

spec

ial t

rain

ing

and

assi

stan

ce, a

cqui

re li

mite

d jo

b sk

ills

and

achi

eve

a hi

gh m

easu

re o

f in

depe

nden

ce.

8

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^t,4

-`4.

he s

cope

of

the

prob

lem

and

its

effe

ct is

app

aren

t in

the

larg

e nu

mbe

rs o

f pe

ople

aff

ecte

d by

this

con

ditio

n. M

enta

lre

tard

atio

n st

rike

s th

ose

leas

t abl

e to

pro

tect

them

selv

esch

ildre

n. T

hus,

men

tal r

etar

datio

n is

a se

riou

s pe

rson

al m

atte

rto

at l

east

one

out

of

ever

y ni

ne p

eopl

e.B

ecau

se o

f ch

angi

ng p

atte

rns

in th

e A

mer

ican

way

of

life,

man

y pr

oble

ms

of th

e m

enta

lly r

etar

ded

will

bec

ome

mor

eac

ute

in th

e fu

ture

:Fa

mili

es a

re g

row

ing

larg

er a

nd in

few

er in

stan

ces

will

a

reta

rded

chi

ld b

e an

onl

y ch

ild. P

aren

ts w

ill h

ave

less

tim

ean

d re

sour

ces

to d

evot

e to

a r

etar

ded

child

.C

hang

es in

fam

ily li

ving

will

con

tinue

. Mor

e fa

mili

esm

ove,

mor

e liv

e in

met

ropo

litan

are

as. R

elat

ives

are

no

long

er r

eadi

ly a

vaila

ble

to h

elp.

Mor

e of

the

burd

en f

orca

ring

for

the

child

ren

is b

eing

pla

ced

on th

e m

othe

r.M

ore

mot

hers

of

youn

g ch

ildre

n ar

e in

the

labo

r fo

rce.

Subs

titut

e ca

re f

or th

e re

tard

ed c

hild

is m

ore

diff

icul

t to

obta

in.

10

ME

NT

AL

RE

TA

RD

AT

ION

TO

UC

HE

S M

AN

Y P

EO

PLE

5.4

MIL

LIO

N P

EO

PLE

AR

E M

EN

TA

LLY

RE

TA

RD

ED

114

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11,1

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TH

EY

AN

D T

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IR F

AM

ILIE

S A

DD

UP

TO

15

TO

20

MIL

LIO

NP

EO

PLE

OR

AB

OU

T 1

0% O

F T

HE

PO

PU

LAT

ION

11

he r

atio

of

men

tal r

etar

datio

n to

the

tota

l pop

ulat

ion

per-

sist

s de

spite

the

adva

nces

in m

edic

al s

cien

ce.

On

the

othe

r ha

nd, s

uch

dise

ases

as

who

opin

g co

ugh,

dip

h-th

eria

and

sca

rlet

fev

er h

ave

been

alm

ost e

limin

ated

.T

uber

culo

sis

has

been

red

uced

30

perc

ent i

n fi

veye

ars.

Polio

has

bee

n dr

amat

ical

ly r

educ

ed.

Rec

ent s

tudi

es s

how

a d

imin

ishi

ng d

eath

rat

e an

d an

in-

crea

sed

life

span

for

the

men

tally

ret

arde

d bo

th in

and

out

of in

stitu

tions

. Thi

s ad

ds m

ater

ially

to th

e nu

mbe

r of

men

-ta

lly r

etar

ded,

par

ticul

arly

in th

e up

per

age

brac

kets

.

12

TO

TA

L

BLI

ND

NE

SS

PE

RM

AN

EN

TLY

CR

IPP

LED

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LIO

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RE

BR

AL

PA

LSY

RH

EU

MA

TIC

HE

AR

T D

ISE

AS

E

ME

NT

ALL

Y

RE

TA

RD

ED

3.5

ME

NT

L R

ET

AR

DA

TIO

N

VS

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HE

R C

ON

DIT

ION

SR

AT

ES

PE

R 1

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PE

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77IV

14.1

)1

13

he d

egre

e of

ret

arda

tion

vari

es g

reat

ly a

mon

g in

divi

d-ua

ls. I

t ran

ges

from

the

prof

ound

ly r

etar

ded

pers

on, w

hom

ust h

ave

prot

ectiv

e ca

re f

or li

fe, t

o th

em

ildly

aff

ecte

dw

ho c

an a

chie

ve a

mea

sure

of

inde

pend

ence

.T

here

is n

o fu

lly s

atis

fact

ory

way

of

char

acte

rizi

ng th

ede

gree

s of

ret

arda

tion.

At p

rese

nt, v

irtu

ally

all

clas

sifi

catio

nsy

stem

s re

ly h

eavi

ly o

n In

telli

genc

e Q

uotie

nt a

s an

inde

x.R

egar

dles

s of

the

clas

sifi

catio

n sy

stem

use

d, I

.Q. s

houl

dno

t be

the

only

fac

tor

in d

eter

min

ing

men

talr

etar

datio

n. O

ther

fact

ors

whi

ch s

houl

d be

con

side

red

are

soci

al a

dapt

abili

tyan

d em

otio

nal c

ontr

ol.

The

dev

elop

men

tal c

hara

cter

istic

s, p

oten

tial f

or e

duca

tion

and

trai

ning

, and

soc

ial a

nd v

ocat

iona

l ade

quac

y, a

ccor

ding

to

the

clas

sifi

catio

n w

hich

use

s fo

ur le

vels

of

reta

rdat

ion,

are

sum

mar

ized

on

the

oppo

site

pag

e.

In a

dditi

on to

thes

e fo

ur le

vels

, ano

ther

cla

ssif

icat

ion,

use

dfo

r ed

ucat

iona

l pur

pose

s, is

as

follo

ws:

LE

VE

LIN

TIL

LIG

INC

E Q

UO

TII

INT

Tra

inab

leA

bout

25-

50

Edu

cabl

eA

bout

50-

75

14

.

PR

OF

OU

ND

.

Gro

ss r

etar

datio

n; m

inim

al c

a-pa

city

for

func

tioni

ng in

sen

sori- re

mot

or a

reas

; nee

ds n

ursi

ng c

are.

..-

-

.

Obv

ious

del

ays

in a

ll ar

eas

of d

e-ve

lopm

ent;

show

s ba

sic

emot

iona

lre

spon

ses;

may

res

pond

to s

killf

ultr

aini

ng in

use

of l

egs,

han

ds a

ndja

ws;

nee

ds c

lose

sup

ervi

sion

.

Ie

1.

I1

VIM

.1%

1

e

May

wal

k, n

eed

nurs

ing

-car

e, h

ave

prim

itive

spe

ech;

usu

ally

ben

efits

from

reg

ular

phy

sica

l act

ivity

; in-

capa

ble

of s

elf m

aint

enan

ce.

SE

VE

RE

Mar

ked

dela

y in

mot

or d

evel

op-

men

t; lit

tle o

r no

com

mun

icat

ion

skill

; may

res

pond

to tr

aini

ng in

elem

enta

ry s

elf-

help

,e.

g.,

self-

feed

ing.

Usu

ally

wal

ks b

arrin

g sp

ecifi

c di

s-ab

ility

; has

som

e un

ders

tand

ing

ofsp

eech

and

som

e re

spon

se; c

anpr

ofit

from

sys

tem

atic

hab

it tr

ain-

ing.

Can

con

form

to d

aily

rou

tines

and

repe

titiv

e ac

tiviti

es; n

eeds

con

tin-

uing

dire

ctio

n an

d su

perv

isio

n in

prot

ectiv

e en

viro

nmen

t.

MO

DE

RA

TE

spon

ds

Not

icea

ble

dela

ys in

mot

or d

evel

:op

men

t, es

peci

ally

in s

peec

h; r

e-to

trai

ning

in v

ario

us s

elf-

help

act

iviti

es.

Can

lear

n si

mpl

e co

mm

unic

atio

n,el

emen

tary

hea

lth a

nd s

afet

y ha

b-its

, and

sim

ple

man

ual s

kills

; doe

sno

t pro

gres

s in

func

tiona

l rea

ding

or a

rithm

etic

.

Can

per

form

sim

ple

task

s un

der

shel

tere

d co

nditi

ons;

par

ticip

ates

in s

impl

e re

crea

tion;

trav

els

alon

ein

fam

iliar

pla

ces;

usu

ally

inca

pa-

ble

of s

elf m

aint

enan

ce.

MIL

D

Ofte

n no

t not

iced

as

reta

rded

by

casu

al o

bser

ver,

but

is s

low

er to

wal

k, fe

ed s

elf a

nd ta

lk th

an m

ost

child

ren.

Can

acq

uire

pra

ctic

al s

kills

and

usef

ul r

eadi

ng a

nd a

rithm

etic

toa

3rd

to 6

th g

rade

leve

l with

spe

-ci

al e

duca

tion.

Can

be

guid

ed to

-w

ard

soci

al c

onfo

rmity

.

Can

usu

ally

ach

ieve

soc

ial a

ndvo

catio

nal s

kills

ade

quat

e to

sel

fm

aint

enan

ce; m

ay n

eed

occa

sion

-al

gui

danc

e an

d su

ppor

t whe

nun

der

unus

ual s

ocia

l or

econ

omic

stre

ss.,

enta

l ret

arda

tion

may

res

ult f

rom

any

con

ditio

n w

hich

inte

rfer

es w

ith th

e pr

enat

al d

evel

opm

ent o

f th

e br

ain,

or

whi

ch in

jure

s its

str

uctu

re a

fter

bir

th. I

n ad

ditio

n, w

ithin

an

unfa

vora

ble

emot

iona

l or

cultu

ral e

nvir

onm

ent,

the

indi

vid-

ual's

inte

llect

ual d

evel

opm

ent m

ay b

e se

riou

sly

impe

ded.

16

1111

11.1

1111

.111

1011

11/1

1111

,111

.111

1111

1111

1111

1111

MIN

IPM

ER

EW

IN 3

OU

T O

F 4

ME

NT

ALL

YR

ET

AR

DE

D P

ER

SO

NS

,

TH

E C

AU

SE

S A

RE

NO

T Y

ET

CLE

AR

LY K

NO

WN

ON

LY

ON

E H

AS

KN

OW

N

BR

AIN

DA

MA

GE

17

18

n ap

prox

imat

ely

15 to

25

perc

ent o

f th

e ca

ses

of m

enta

lre

tard

atio

n, a

spe

cifi

c di

seas

e en

tity

can

be h

eld

resp

onsi

-bl

e. T

he im

pact

of

such

dis

ease

sca

n be

mos

t rea

dily

dem

on-

stra

ted

in th

ose

inst

ance

s w

here

ther

e ha

s be

engr

oss

brai

nda

mag

e an

d w

here

the

degr

ee o

f re

tard

atio

n is

pro

foun

dor

seve

re. I

t is

unce

rtai

n to

wha

t ext

ent t

hese

org

anic

fac

tors

oper

ate

to p

rodu

ce m

inor

impa

irm

ent a

mon

g th

e le

ss s

ever

ely

reta

rded

.W

hen

Ger

man

mea

sles

occu

rs d

urin

g th

e fi

rst t

hree

mon

ths

of p

regn

ancy

, it s

omet

imes

res

ults

in d

amag

eto

the

fetu

s.O

ther

infe

ctio

ns o

ccur

ring

dur

ing

preg

nanc

y ha

ve a

lso

been

impl

icat

ed.

Infe

ctio

us d

isea

ses

of in

fanc

y an

d ch

ildho

od, s

uch

as m

any

form

s of

men

ingi

tis, e

ncep

halit

is, m

easl

es,

etc.

, may

cau

seda

mag

e to

the

cent

ral

nerv

ous

syst

em, r

esul

ting

in r

etar

da-

tion. Ja

undi

ce o

f th

e ne

wbo

rn d

ue to

Rh

bloo

d fa

ctor

inco

mpa

ta-

bilit

y is

one

fac

tor.

Car

bon

mon

oxid

eor

lead

poi

soni

ng a

re

exam

ples

of

toxi

c ag

ents

inha

led

or in

gest

ed b

y th

e m

othe

rdu

ring

pre

gnan

cyor

by

the

child

aft

er b

irth

, whi

ch a

lso

caus

ebr

ain

dam

age.

Dis

ease

s du

e to

phy

sica

l or

trau

mat

ic a

gent

s in

clud

e in

juri

esoc

curr

ing

in d

iffi

cult

deliv

erie

s. L

ack

ofox

ygen

, par

ticul

arly

inth

e pr

emat

ure

baby

, is

anot

her

caus

e. B

rain

inju

ry in

Chi

ld-

hood

, par

ticul

arly

fro

m a

utom

obile

acc

iden

ts, i

san

add

edfa

ctor

.A

num

ber

of m

etab

olic

dis

orde

rs,

som

e of

whi

ch a

re d

e-te

rmin

ed b

y he

redi

ty, p

rodu

ce m

enta

l ret

arda

tion.

The

se in

-cl

ude

phen

ylke

tonu

ria,

in w

hich

ther

ear

e ab

norm

aliti

es o

fam

ino

acid

che

mis

try

in th

e bo

dy, a

nd g

alac

tose

mia

, whe

reth

ere

is a

car

bohy

drat

e ab

norm

ality

.D

isea

ses

due

toun

know

n pr

enat

alfa

ctor

sin

clud

eM

ongo

lism

, whi

ch r

esul

ts f

rom

abn

orm

al c

hrom

osom

algr

oup-

ings

pro

babl

y at

the

time

of th

e fo

rmat

ion

of th

eov

um in

the

mot

her.

In

addi

tion,

ther

e is

a si

zeab

le g

roup

in w

hich

the

caus

es o

f br

ain

path

olog

y ar

e pr

esen

tly u

nkno

wn.

BR

AIN

DA

MA

GE

CA

N B

E D

UE

TO

M N

Y C

AU

SE

S MO

NG

OL

ISM

& O

TH

ER

DIS

EA

SES

OF

UN

KN

OW

N O

RIG

IN

INFE

CT

IOU

SC

HIL

DH

OO

D D

ISE

ASE

S

INFE

CT

ION

OF

MO

TH

ER

DU

RIN

G P

RE

GN

AN

CY

TO

XIC

AG

EN

TS

AFF

EC

TIN

GM

OT

HE

R A

ND

CH

ILD

ME

TA

BO

LIC

DIS

OR

DE

RS

DIS

EA

SES

DU

E T

OPH

YSI

CA

L O

RT

RA

UM

AT

IC D

AM

AG

E

bout

75

to 8

5 pe

rcen

t of

thos

e no

w d

iagn

osed

as

re-

tard

ed s

how

no

dem

onst

rabl

e gr

oss

brai

n ab

norm

ality

. The

yar

e, b

y an

d la

rge,

per

sons

with

rel

ativ

ely

mild

deg

rees

of

re-

tard

atio

n.A

var

iety

of

fact

ors

appe

ar to

be

oper

atin

g w

ithin

this

larg

eca

tego

ry.

Min

or d

egre

es o

f br

ain

dam

age,

too

subt

le to

be

dem

on-

stra

ted

by c

urre

ntly

ava

ilabl

e te

chni

ques

, may

be

an u

nder

-ly

ing

fact

or in

som

e in

stan

ces.

How

ever

, unf

avor

able

env

iron

-

men

tal a

nd p

sych

olog

ical

infl

uenc

es a

re th

ough

t to

play

an

impo

rtan

t con

trib

utor

y ro

le a

mon

g th

is g

roup

. Suc

h in

flue

nces

incl

ude

inte

rfer

ence

with

nor

mal

em

otio

nal a

nd in

telle

ctua

lst

imul

atio

n in

ear

ly in

fanc

y, -

unfa

vora

ble

psyc

holo

gica

l or

emot

iona

l exp

erie

nces

in e

arly

chi

ldho

od, a

nd la

ck o

f no

rmal

20

inte

llect

ual a

nd c

ultu

ral e

xper

ienc

es d

urin

g th

e en

tire

de-

velo

pmen

tal p

erio

d.

At t

he p

rese

nt ti

me

it is

impo

ssib

le to

ass

ign

clea

r w

eigh

tsto

eac

h of

the

gene

ral c

ausa

tive

fact

ors.

In

man

y in

stan

ces,

mul

tiple

fac

tors

may

be

inte

ract

ing

with

ina

sing

le in

divi

dual

.A

ll of

them

, how

ever

, ope

rate

mor

e st

rong

ly a

mon

g un

der-

priv

ilege

d gr

oups

than

am

ong

thos

em

ore

favo

rabl

y si

tuat

edin

soc

iety

.M

any

of th

ese

envi

ronm

enta

l and

psy

chol

ogic

al v

aria

bles

can

be a

mel

iora

ted.

Som

e of

thes

e co

nditi

ons

are

prev

enta

ble

if tr

eatm

ent c

anbe

inst

itute

d ea

rly

enou

gh in

a ch

ild's

life

. Ear

ly id

entif

icat

ion,

ther

efor

e, is

ess

entia

l.M

ost o

f th

e re

mai

nder

can

also

be

amel

iora

ted

thro

ugh

aco

mbi

natio

n of

res

ourc

esm

edic

ine,

edu

catio

n, r

ehab

ilita

-tio

n, a

nd s

ocia

l wor

k.

SO

ME

EN

VIR

ON

ME

NT

AL

AN

D P

SY

CH

OLO

GIC

AL

FA

CT

OR

S

LEA

DIN

G T

O R

ET

AR

DA

TIO

N

DE

PR

IVA

TIO

NS

OF

EA

RLY

LIF

E1

I I

AC

K O

F IN

TE

LLE

CT

UA

LP

SY

CH

OLO

GIC

AL

CIR

CU

MS

TA

NC

ES

OF

ST

IMU

LAT

ION

LIF

E A

S W

ELL

AS

BR

AIN

DA

MA

GE

DU

E T

O P

HY

SIC

AL

HA

RM

OT

HE

R C

AU

SE

S

PA

RE

NT

AL

NE

GLE

CT

21

-J

22

Dat

a on

pat

ient

s in

inst

itutio

ns s

how

a h

ighe

r pr

eval

ence

of p

atho

logi

cal c

ondi

tions

amon

g th

e m

ore

seve

rely

ret

arde

d.C

urre

nt r

epor

ts f

rom

clin

ical

prog

ram

s de

alin

g w

ith r

e-ta

rded

chi

ldre

n un

der

six

year

s of

age

indi

cate

that

75

per-

cent

hav

e as

soci

ated

phy

sica

l dis

abili

ties.

Man

y of

thes

e re

tard

edpe

rson

s ar

e m

ulti-

hand

icap

ped.

The

incr

ease

d su

rviv

al r

ates

of

reta

rded

infa

nts

will

pro

b-ab

ly in

crea

se th

e nu

mbe

r of

ret

arde

dpe

rson

s w

ith a

ssoc

iate

dph

ysic

al h

andi

caps

.

A L

AR

GE

PE

RC

EN

TA

GE

OF

SE

VE

RE

LY M

EN

TA

LLY

RE

TA

RD

ED

HA

VE

AD

DIT

ION

AL

HA

ND

ICA

PS

SM

ALL

ER

TH

AN

AV

ER

AG

ES

IZE

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N

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ED

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AR

ING

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ft"%

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umi-

H,

PO

OR

MU

SC

ULA

RC

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RD

INA

TIO

N

PH

YS

ICA

LD

EF

OR

M IT

IES

Mod

em m

edic

al c

are

and

othe

r fa

ctor

s ha

ve h

elpe

d de

-cr

ease

the

infa

nt m

orta

lity

rate

in th

e U

nite

d St

ates

by

75pe

rcen

t in

the

past

20

year

s. A

t the

sam

e tim

e, th

e su

rviv

alra

te o

f th

e m

enta

lly r

etar

ded

has

incr

ease

d. M

ore

infa

nts

who

are

born

pre

mat

urel

y an

d w

ho h

ave

cong

enita

l han

dica

ps a

resu

rviv

ing.

Men

tal r

etar

datio

n is

one

of

the

cond

ition

s su

ffer

edby

som

e of

thes

e ch

ildre

n. N

ew r

esea

rch,

impr

oved

and

mor

eex

tens

ive

pren

atal

and

pos

tnat

al c

are,

cou

pled

with

dis

ease

and

radi

atio

n co

ntro

l, be

tter

drug

s an

d hi

ghpr

sta

ndar

ds o

fliv

ing

can

help

red

uce

reta

rdat

ion

from

suc

h bi

rth

abno

rmal

i-tie

s.

ME

DIC

AL

SK

ILLS

HE

LP M

EN

TA

LLY

RE

TA

RD

ED

SU

RV

IVE

P rog

ress

has

bee

n m

ade

in id

entif

ying

spe

cifi

c co

nditi

ons

and

dise

ases

and

in e

stab

lishi

ng b

asic

pro

blem

s of

beh

avio

ran

d le

arni

ng.

A c

hrom

osom

e ab

norm

ality

has

bee

n di

scov

ered

in M

on-

golis

m, b

ut th

e ca

use

is s

till u

nkno

wn.

Whi

le m

any

rese

arch

proj

ects

are

now

und

erw

ay, m

uch

broa

der

know

ledg

e m

ust

be a

chie

ved

befo

re th

ere

will

be

adeq

uate

und

erst

andi

ng o

fth

e pa

thol

ogic

al, g

enet

ic, p

sych

olog

ical

, env

iron

men

tal a

ndot

her

aspe

cts

of m

enta

l ret

arda

tion.

26

BIO

LOG

ICA

L B

RE

AK

TH

RO

UG

HS

IN T

HE

PR

EV

EN

TIO

N O

F

ME

NT

AL

RE

TA

RD

AT

ION

HY

DR

OC

EP

HA

LUS

CR

AN

IO S

TE

NO

SIS

CO

NT

RO

LLE

D T

HR

OU

GH

DIE

T

1a

MI6

'*

GA

LAC

TO

SE

MIA

JAU

ND

ICE

DU

E T

OR

H F

AC

TO

RP

HE

NY

LKE

TO

NU

RIA

27

ccur

ate

diag

nosi

s is

an

esse

ntia

l pre

lude

to th

e tr

eat-

men

t of

men

tal r

etar

datio

n. H

owev

er, o

nly

gros

s im

pair

men

tis

evi

dent

in e

arly

chi

ldho

od. T

his

gene

rally

invo

lves

fai

lure

to w

alk

and

talk

at a

ppro

pria

te ti

mes

.

Surv

eys

show

that

in m

ost i

nsta

nces

, int

elle

ctua

l def

icit

does

not

bec

ome

appa

rent

unt

il th

e ch

ild g

oes

to s

choo

l. T

his

gene

rally

bec

omes

evi

dent

by

inab

ility

to p

erfo

rm k

inde

r-ga

rten

or

firs

t-gr

ade

wor

k.So

cial

inad

equa

cy is

fre

quen

tly n

ot r

ecog

nize

d un

til a

do-

lesc

ence

.

28

TH

RE

E M

JO

R M

EA

NS

BY

WH

ICH

TH

EE

NT

ALL

Y R

ET

AR

DE

D

CA

N B

E ID

EN

TIF

IED

c

I,.

ME

DIC

AL

DIA

GN

OS

ISM

OST

LY

OF

TH

E S

ER

IOU

SLY

RE

TA

RD

ED

AT

PR

E-S

CH

OO

L A

GE

room

mor

...,

I 1

Iit

SC

HO

OL

TE

ST

S A

ND

e )

loto

quih

n

RE

CO

GN

ITIO

N O

F

UN

DE

R A

CH

IEV

EM

EN

TS

OC

IAL

INA

DE

QU

AC

Y

i

29

IE

30

here

are

som

e 21

0,00

0 m

enta

lly r

etar

ded

patie

nts

inre

side

ntia

l ins

titut

ions

.In

196

0 ap

prox

imat

ely

160,

000

wer

e in

Sta

te in

stitu

tions

for

the

reta

rded

; 40,

000

wer

e in

hos

pita

ls f

or th

e m

enta

llyill

; and

10,

000

wer

e in

pri

vate

inst

itutio

ns.

The

re a

re a

ppro

xim

atel

y 10

per

cent

mor

e m

enta

lly r

e-ta

rded

pat

ient

s in

res

iden

tial i

nstit

utio

ns th

an th

ere

wer

e 5

year

s ag

o.T

he a

vera

ge w

aitin

g lis

t con

tinue

s to

gro

w a

nd th

e qu

ality

of s

ervi

ce o

ften

suf

fers

fro

m li

mite

d bu

dget

s, lo

w s

alar

yle

vels

, and

sev

ere

pers

onne

l sho

rtag

es.

ST

AT

E IN

ST

ITU

TIO

NS

FO

R M

EN

TA

LLY

RE

TA

RD

ED

AR

E O

VE

RS

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ND

OV

ER

CR

OW

DE

D

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.

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3,0

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DR

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AV

ER

AG

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AIT

ING

LIS

T: 3

40

AV

ER

AG

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AIT

ING

TIM

E: 3

YE

AR

S

31

In r

ecen

t yea

rs, t

hose

bei

ng a

dmitt

ed to

inst

itutio

ns a

rem

ore

seve

rely

ret

arde

d an

d of

you

nger

age

than

for

mer

ly.

At

pres

ent:

App

roxi

mat

ely

67 p

erce

nt o

f ad

mis

sion

s ar

e ch

ildre

n un

-de

r 15

year

sof

age.

New

adm

issi

ons

are

larg

ely

less

than

9ye

ars

ofag

e.T

he m

edia

n of

adm

issi

on is

und

er 1

1ye

ars

ofag

e.

32

TW

O O

UT

OF

TH

RE

E F

IRS

TA

DM

ISS

ION

S

IN S

TA

TE

INS

TIT

UT

ION

S

FO

R M

EN

TA

LLY

RE

TA

RD

ED

AR

E C

HIL

DR

EN

UN

DE

R 1

5

17%

50%

UN

DE

RB

ET

WE

EN

5 A

ND

15

YE

AR

S5

YE

AR

S

33%

OV

ER

15 Y

EA

RS

BA

SE

D O

N 1

959

FIG

UR

ES

vJ

34

duca

tion

is v

ital i

n he

lpin

g to

prep

are

the

men

tally

reta

rded

for

pro

duct

ive

lives

.W

hile

the,

num

ber

of m

enta

lly r

etar

ded

enro

lled

in s

peci

aled

ucat

iona

l cla

sses

has

dou

bled

ove

r th

e pa

st d

ecad

e, m

any

mor

e su

ch f

acili

ties

mus

t be

prov

ided

. Onl

y ab

out 2

0 pe

rcen

tof

ret

arde

d ch

ildre

n ha

ve a

cces

s to

spe

cial

edu

catio

n.So

me

Stat

es d

o no

t pro

vide

any

cla

sses

for

the

"tra

inab

le"

reta

rded

, and

no

Stat

e ha

s su

ffic

ient

cla

sses

for

the

"edu

ca-

ble"

ret

arde

d. I

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All

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Prio

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Exp

ande

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biol

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xten

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ain

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sear

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entio

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the

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need

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insu

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ble

prot

ectio

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mot

hers

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chi

ldre

n. F

orex

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ampl

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ll x-

ray

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pmen

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uld

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orou

ghly

and

reg

ular

lych

ecke

d to

elim

inat

e th

e po

ssib

ility

of

"lea

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at m

ight

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arm

ful d

urin

g pr

egna

ncy

and

child

hood

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sent

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ing

proc

edur

es f

or d

rugs

sho

uld

be r

igor

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y re

view

ed to

det

er-

min

e w

heth

er th

ey f

urni

sh s

uffi

cien

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pos-

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ssh

ould

inst

itute

a c

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veill

ance

over

the

prob

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aint

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stio

n by

chi

ldre

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d in

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pai

nt u

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sim

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tain

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ded

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ysic

ians

to th

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yw

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sure

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ed to

be

refi

ned

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nded

for

the

earl

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tect

ion

and

trea

tmen

t of

such

met

abol

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isor

ders

as p

heny

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onur

ia, t

he g

alac

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mia

s an

d ot

hers

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rese

arch

adds

to o

ur p

rese

nt k

now

ledg

e, o

ther

pre

vent

ive

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type

will

be

poss

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Com

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acili

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Res

iden

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are

mus

t be

chan

ged

to m

ore

adeq

uate

lym

eet t

he n

eeds

of

the

reta

rded

. Sm

all,

resi

dent

ial u

nits

hav

ing

500

beds

, acc

essi

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to o

r in

urb

an a

reas

, and

com

bine

d re

si-

dent

ial a

nd d

ay c

are

units

sho

uld

grad

ually

rep

lace

larg

ein

stitu

tions

isol

ated

fro

m th

e ce

nter

s of

pop

ulat

ion.

Spec

ial e

ffor

ts s

houl

d be

mad

e to

ret

urn

the

inst

itutio

n to

the

com

mun

ity. R

egio

nal c

ente

rs w

ithin

eac

h St

ate

will

req

uire

a co

mbi

natio

n of

pro

gram

s, in

clud

ing

resi

dent

ial,

day

care

,di

agno

stic

and

par

ent c

ouns

elin

g se

rvic

es to

all

who

nee

d it

in th

e re

gion

. Em

phas

is s

houl

d be

on

care

in th

e ho

me

and

deve

lopm

ent o

f a

wid

e ra

nge

of c

omm

unity

fac

ilitie

s.Su

ch f

acili

ties

shou

ld b

e cl

ose

to te

achi

ng a

nd r

esea

rch

faci

litie

s.

50

CH

AN

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RE

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OM

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PRO

POSE

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OF

TH

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EIR

OW

N H

OM

ES

51

IIA

nri

ched

and

exp

ande

dpr

ogra

ms

of s

peci

al e

duca

tion

for

the

reta

rded

in p

ublic

and

pri

vate

sch

ools

are

esse

ntia

l.T

hese

sho

uld

be c

lose

ly c

oord

inat

ed w

ith v

ocat

iona

l gui

danc

ean

d sp

ecif

ic p

repa

ratio

n fo

r em

ploy

men

t (or

a pr

oduc

tive

occu

patio

n) b

y a

plan

ned

wor

ksho

p ex

peri

ence

.A

ppro

pria

te a

dult

educ

atio

n sh

ould

be

prov

ided

for

the

men

tally

ret

arde

d w

ho h

ave

not h

ad e

arlie

r ed

ucat

iona

lop

-po

rtun

ities

, or

who

can

pro

fit b

y ad

ditio

nal o

ppor

tuni

ties.

Whi

le e

very

Sta

te n

ow h

as s

ome

spec

ial e

duca

tion

prog

ram

for

men

tally

ret

arde

d pu

pils

,no

Sta

te p

rovi

des

mor

e th

an a

frac

tion

of n

eces

sary

ser

vice

s. F

eder

al g

rant

s to

Sta

tes

for

spec

ial s

choo

l ser

vice

s fo

r th

e re

tard

ed s

houl

d be

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inis

-te

red

thro

ugh

an e

xpan

sion

and

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ovem

ent

prog

ram

and

awar

ded

on th

e ba

sis

of c

ompe

titiv

e ap

plic

atio

n.

I

Edu

catio

n

52

EN

RIC

HE

D P

RO

GR

AM

OF

SP

EC

IAL

ED

UC

AT

ION

FO

R T

HE

RE

TA

RD

ED

IN P

UB

LIC

AN

D P

RIV

AT

ES

CH

OO

LS

SPE

CIA

L E

DU

CA

TIO

N C

LA

SSE

S

VO

CA

TIO

NA

L G

UID

AN

CE

& W

OR

KSH

OP

CL

ASS

ES

EX

TE

NSI

ON

CO

UR

SES

FOR

AD

UL

TS

53.

54

Edu

catio

n

here

is a

ser

ious

sho

rtag

e of

teac

hers

of

the

men

tally

reta

rded

.L

iber

al s

chol

arsh

ips

shou

ld b

e pr

ovid

edto

stu

dent

s w

how

ill b

e tr

aine

das

spe

cial

edu

catio

n te

ache

rs. P

rom

isin

g st

u-de

nts

shou

ld b

e en

able

d to

app

ly f

or s

chol

arsh

ipgr

ants

toun

iver

sitie

s an

d co

llege

s ha

ving

qua

lifie

d st

affs

. The

maj

orsc

hola

rshi

p st

ipen

d sh

ould

be

prov

ided

for

trai

ning

bey

ond

the

four

yea

rs r

equi

red

for

a ba

ccal

aure

ate

degr

ee. A

s a

recr

uitm

ent i

ncen

tive,

whe

re in

tere

st is

indi

cate

d, m

odes

tst

ipen

ds m

ight

be

mad

e to

juni

ors

and

seni

ors

in c

olle

ge.

Car

eful

atte

ntio

n sh

ould

be

paid

to th

e ex

peri

ence

of

thos

eSt

ates

now

exp

erim

entin

g w

ith o

ffer

ing

spec

ial

bonu

ses

tote

ache

rs o

f th

e re

tard

ed.

INC

EN

TIV

ES

TO

SP

UR

RE

CR

UIT

ME

NT

OF

TE

AC

HE

RS

FO

R T

HE

RE

TA

RD

ED

I

L

I

LIB

ER

AL

SC

HO

LA

RSH

IPS

FOR

INC

RE

ASE

D A

PPR

OPR

IAT

ION

S FO

R

TR

AIN

ING

IN

SPE

CIA

L E

DU

CA

TIO

NIM

PRO

VE

ME

NT

AN

D E

XT

EN

SIO

N O

F C

LA

SSE

S

umia

mm

i I

55

Reh

abili

tatio

n

Voc

atio

nal r

ehab

ilita

tion

and

wor

ksho

p fa

cilit

ies

mus

t be

grea

tly e

xpan

ded.

One

met

hod

is to

incr

ease

pur

chas

eof

serv

ices

by

Stat

e re

habi

litat

ion

agen

cies

fro

msh

elte

red

wor

k-

shop

s an

d ot

her

priv

ate

reha

bilit

atio

n se

rvic

es.

Plan

s fo

r a

long

-ran

ge p

rogr

am s

houl

d be

initi

ated

to p

ro-

vide

suf

fici

ent f

unds

for

con

stru

ctin

g an

d re

mod

elin

gre

habi

li-

tatio

n fa

cilit

ies

and

the

purc

hase

of

appr

opri

ate

equi

pmen

t.

Gra

nts

for

intr

amur

al r

esea

rch

shou

ld b

e ap

prop

riat

ed o

na

broa

der

and

mor

efl

exib

le b

asis

.T

rain

ing

of s

kille

d pe

rson

nel m

ust b

e ex

tend

ed th

roug

hsc

hola

rshi

ps.

Voc

atio

nal g

uida

nce

and

spec

ific

em

ploy

men

t pre

para

tion

are

need

ed.

Com

mun

ities

and

em

ploy

ers

mus

t be

info

rmed

abou

t the

em

ploy

men

t pot

entia

ls o

f th

e re

tard

ed.

56

RE

HA

BIL

ITA

TIO

N A

ND

TR

AIN

ING

RE

CO

MM

EN

DA

TIO

NS

FO

R M

EN

TA

LLY

RE

TA

RD

ED

WO

RK

SH

OP

OP

PO

TU

NIT

IES

TO

SP

EC

IAL

NE

L.ni

n"......

.

R

FIT

IMP

RO

VE

ME

NT

EM

PLO

YM

EN

TIN

EA

RN

ING

PO

WE

R

DS

rS

CH

OLA

RS

HIP

S

FO

R T

RA

ININ

GO

F C

OU

NS

ELO

RS

57

Leg

al

new

lega

l as

wel

l as

soci

al c

once

pt o

f th

e re

tard

ed is

need

ed. T

his

conc

ept s

houl

d in

clud

e:*

Prot

ectio

n of

the

civi

lri

ghts

of

the

reta

rded

.L

ife

guar

dian

ship

pro

visi

ons

whe

n ne

eded

.A

n en

light

ened

atti

tude

by

the

polic

e an

d th

e co

urts

inca

ses

of m

inor

con

flic

tw

ith th

e la

w.

Cla

rifi

catio

n of

the

theo

ry o

f re

spon

sibi

lity

in c

rim

inal

acts

as

appl

ied

to th

e re

tard

ed.

58

A N

EW

LE

GA

LC

ON

CE

PT

OF

TH

ER

ET

AR

DE

D

PRO

TE

CT

ION

OF

HIS

CIV

IL R

IGH

TS

1

f

4 CL

AR

IFIC

AT

ION

OF

RE

SPO

NSI

BIL

ITY

IN C

RIM

INA

L A

CT

S

LIF

E G

UA

RD

IAN

SHIP

WH

EN

NE

ED

ED

"1"1

1711

C!

AN

EN

LIG

HT

EN

ED

AT

TIT

UD

EO

N T

HE

PA

RT

OF

TH

E L

AW

AN

D T

HE

CO

UR

TS

f

4 t1

59

Pers

onne

l

An

incr

ease

in th

e pr

ofes

sion

al m

anpo

wer

poo

l is:

vita

lto

exp

ande

d se

rvic

es f

or th

e m

enta

lly r

etar

ded.

The

sup

ply

ofm

edic

al, r

esea

rch,

teac

hing

, reh

abili

tatio

n an

d gu

idan

ce p

er-

sonn

el m

ust b

e en

larg

ed.

A s

tepp

ed-u

p pr

ogra

m o

f re

crui

ting,

util

izin

g su

ch in

cen-

tives

as

scho

lars

hips

, fel

low

ship

s, a

nd tr

aine

eshi

ps, i

s es

sen-

tial.

60

EC

RU

ITIN

G A

ND

TR

AIN

ING

OF

PE

RS

ON

NE

L

rig

scvi

ovas

tuPs

De,

TR

AIN

EE

SHIP

S

CA

RE

ER

FE

LL

OW

SHIP

S

PRO

FESS

OR

SHIP

S

62

The

Rol

e of

the

Vol

unte

er

oung

peo

ple

and

mat

ure

adul

ts, b

y vo

lunt

eeri

ng th

eir

serv

ices

, can

hel

p m

an n

eede

d co

mm

unity

pro

gram

s. T

hey

can

cont

ribu

te to

incr

ease

d ed

ucat

ion

and

reha

bilit

atio

n an

dca

re o

f th

e m

enta

lly r

etar

ded

in e

very

com

mun

ity.

A N

atio

nal S

ervi

ce C

orps

is s

ugge

sted

as

a m

eans

of

re-

crui

ting

and

plac

ing

volu

ntee

rs in

this

and

rel

ated

fie

lds.

f.

CR

EA

TIO

N O

F A

NA

TIO

NA

L S

ER

VIC

E C

OR

PS

0111

1111

1111

1111

ft

From

all

wal

ks o

f lif

e to

hel

p

man

com

mun

ity s

ervi

ces

VO

LU

NT

EE

R H

EL

P IN

IN

STIT

UT

ION

S

DA

Y C

AR

E C

EN

TE

RS

RE

CR

EA

TIO

N P

RO

GR

AM

S

AN

D

VO

CA

TIO

NA

L W

OR

KSH

OPS

63

Publ

ic'a

re e

ss

he f

indi

ngs

and

reco

mm

enda

tions

of

the

diff

eren

t tas

kfo

rces

of

the

Pres

iden

t's P

anel

on

Men

tal R

etar

datio

n ne

edto

be

inte

rpre

ted

to a

ppro

pria

te p

rofe

ssio

nal o

rgan

izat

ions

on

an o

rder

ly, p

lann

ed a

nd c

ontin

uous

bas

is.

The

rol

e of

par

ticul

ar p

rofe

ssio

ns in

the

fiel

d of

men

tal

reta

rdat

ion

need

s to

be

dem

onst

rate

d.Pr

ofes

sion

al g

roup

s sh

ould

be

kept

info

rmed

abo

ut th

ene

wes

t adv

ance

s an

d te

chni

ques

in th

eir

fiel

ds w

hich

rel

ate

to r

etar

datio

n.

Am

ong

the

natio

nal v

olun

tary

org

aniz

atio

ns a

nd p

rofe

s-si

onal

soc

ietie

s w

hose

inte

rest

s an

d ac

tiviti

es r

elat

e cl

osel

yto

prob

lem

s of

the

reta

rded

are

the

follo

win

g (p

artia

l lis

ting)

:

64

Am

eric

an A

cade

my

ofG

ener

al P

ract

ition

ers

Am

eric

an A

cade

my

ofN

euro

logy

Am

eric

an A

cade

my

ofO

bste

tric

s an

d G

ynec

olog

y

Am

eric

an A

cade

my

ofPe

diat

rics

Am

eric

an A

ssoc

iatio

n on

Men

tal D

efic

ienc

y

Am

eric

an M

edic

al A

ssoc

iatio

n

Am

eric

an N

euro

logi

cal

Ass

ocia

tion

Am

eric

an O

rtho

psyc

hiat

ric

Ass

ocia

tion

Am

eric

an P

sych

iatr

icA

=ci

atio

nA

mer

ican

Psy

chol

ogic

alA

ssoc

iatio

n

Am

eric

an P

ublic

Hea

lthA

ssoc

iatio

n

Am

eric

an P

ublic

Wel

fare

Ass

ocia

l.on

Chi

ld W

elfa

re L

eagu

e

of A

mer

ica

Cou

ncil

on S

ocia

l Wor

k

Edu

catio

nFa

mily

Ser

vice

Ass

ocia

tion

of A

mer

ica

Gro

up f

or th

e A

dvan

cem

ent

of P

sych

iatr

y

Nat

iona

l Ass

ocia

tion

for

Men

tal H

ealth

Nat

iona

l Ass

ocia

tion

for

Ret

arde

d C

hild

rena

nd96

0 L

ocal

Aff

iliat

es

Nat

iona

l Ass

ocia

tion

ofSc

hool

Boa

rds

Nat

iona

l Ass

ocia

tion

ofSo

cial

Wor

kers

Nat

iona

l Com

mitt

ee f

orR

esea

rch

in N

euro

logi

cal

Dis

ease

Nat

iona

l Edu

catio

n A

ssoc

iatio

n,in

clud

ing

the

Cou

ncil

for

Exc

eptio

nal C

hild

ren

Nat

iona

l Hea

lth C

ounc

il

Nat

iona

l Rec

reat

ion

Ass

ocia

tion

Nat

iona

l Reh

abili

tatio

nA

ssoc

iatio

n

Nat

iona

l Soc

ial W

elfa

reA

ssem

bly

ED

UC

AT

ION

AN

D IN

FO

RM

AT

ION

PR

OG

RA

M

FO

R P

RO

FE

SS

ION

AL

GR

OU

PS

owPU

BL

ICA

TIO

NS

IN

PRO

FESS

ION

AL

JO

UR

NA

LS

1

PAR

TIC

IPA

TIO

N I

NPR

OFE

SSIO

NA

L M

EE

TIN

GS

PRE

PAR

AT

ION

OF

EX

HIB

ITS

0141

,,

PRIN

TE

DM

AT

ER

IAL

S

PRO

DU

CT

ION

OF

TR

AIN

ING

FIL

MS

65

Publ

ic A

war

enes

s

Org

aniz

atio

ns w

hich

aff

ect p

ublic

opi

nion

sho

uld

know

mor

e ab

out t

he p

rese

nt s

tatu

s an

d po

tent

ial o

f w

ork

with

the

reta

rded

. The

se o

rgan

izat

ions

usu

ally

fun

ctio

n at

the

loca

lle

vel.

The

ir in

crea

sed

awar

enes

s w

ill h

elp

get s

uppo

rt a

ndim

prov

ed p

rogr

ams

and

serv

ices

for

the

reta

rded

in lo

cal

com

mun

ities

.

DIS

SE

MIN

AT

ION

OF

INF

OR

AT

ION

TO

OP

INIO

N-M

AK

ING

GR

OU

PS

P.T

.A.'s

WO

ME

N'S

. CLU

BS Y

OU

TH

OR

GA

NIZ

AT

ION

S

RE

LIG

IOU

S G

RO

UP

S

PU

BLI

C A

ND

PR

IVA

TE

SC

HO

OLS

HE

ALT

H &

WE

LFA

RE

OR

GA

NIZ

AT

ION

S

Ar

Air

CO

LLE

GE

S A

ND

UN

IVE

RS

ITIE

S-

.rte

SE

RV

ICE

& F

RA

TE

RN

AL

OR

GA

NIZ

AT

ION

S

' 111

1111

0111

1111

101.

68

Coo

rdin

atio

n of

Ser

vice

s

espo

nsib

ility

mus

t be

desi

gnat

ed b

y th

e Fe

dera

l, St

ate,

and

loca

l aut

hori

ties

for

the

plan

ning

, dev

elop

men

t, an

dad

min

istr

atio

n of

ser

vice

s to

the

men

tally

ret

arde

d. A

llse

rv-

ices

nee

d to

be

coor

dina

ted

to p

rovi

de c

ompr

ehen

sive

,.co

n-tin

uous

and

impr

oved

car

e, a

nd to

insu

re c

omm

unity

-cen

tere

dra

ther

than

isol

ated

ser

vice

s. C

oord

inat

ion

of s

ervi

ces,

inad

ditio

n to

des

igna

tion

of r

espo

nsib

ility

, sho

uld

impr

ove

rese

arch

, car

e, tr

eatm

ent,

trai

ning

, edu

catio

n, r

ehab

ilita

tion,

coun

selin

g, r

ecru

iting

, em

ploy

men

t ser

vice

pla

cem

ent a

ndfi

nanc

ing

of p

rogr

ams

for

men

tally

ret

arde

dpe

rson

s.

,r

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