mental retardation and developmental disabilities3a978-1-4684...mental retardation d developmental...

Mental Retardation and Developmental

Disabilities Volume 13

A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher. Inquiries about earlier volumes of this series, published by Brunner/Mazel, New York, may be directed to the Editor.

Mental Retardation d Developmental

Disabilities Volume 13

Editbd by

Joseph Wortis. M.D. State University of New YorL <It Stony Brook

Stony Brook, New York

ENUM PRESS • NEW YORK AND LONDON

ISBN-13: 978-1-4684-4612-8 e-ISBN-13: 978-1-4684-4610-4 001: 10.1007/978-1-4684-4610-4

Library of Congress Card No. 73-647002

©1984 Plenum Press. New York Softcover reprint of the hardcover 1 st edition 1984

A Division of Plenum Publishing Corporation 233 Spring Street. New York. N.Y. 10013

All rights reserved

No part of this book may be reproduced. stored in a retrieval system. or transmitted. in any form or by any means. electronic. mechanical. photocopying. microfilming.

recording. or otherwise. without written permission from the Publisher

Contributors

BASKIN, BARBARA H., Ed.D.-Director, Office of Special Education, State University of New York at Stony Brook, Stony Brook, New York 11794

BERKSON, GERSHON, Ph.D.-Professor, Department of Psychology, University of Illinois at Chicago, Chicago, Illinois 60680

COLEMAN, MARY, M.D.-Director, Children's Brain Research Clinic, and Georgetown University School of Medicine, Washington, D.C. 20008

FRIEDE, REINHARD L., M.D.-Professor, Department of Neuropathology, University of Gottingen, D-3400 Gottingen, Federal Republic of Germany

HARRIS, KAREN H., M.A.-Professor, Department of Curriculum and Instruction, University of New Orleans, New Orleans, Louisiana 70148

HILL, A. LEWIS, Ph.D.-Research Scientist, Institute for Basic Research in Mental Retardation, Staten Island, New York 10314

KIRMAN, BRIAN H., M.D.-Consultant Psychiatrist, Bodey's Park Hospital, Chertsey, Surrey KT16 OQA, England

KOLODNY, EDWIN H., M.D.-Associate Director, Eunice Kennedy Shriver Center for Mental Retardation, Waltham, Massachusetts 02254

LANDESMAN-DWYER, SHARON, Ph.D.-Associate Professor, Department of Psychiatry and Behavioral Sciences and Child Development and Mental Retardation Center, University of Washington, Seattle, Washington 98195

v

VI CONTRIBUTORS

MENNINGER, HEATHER S., M.H.S.M.-Transportation Project Director, California Department of Developmental Services, Planning and Evaluation Division, Sacramento, California 95814

RIMLAND, BERNARD, Ph.D.-Director, Institute for Child Behavior Research, San Diego, California 92116

WOLFF, SULA, M.D.-Consultant Psychiatrist, Department of Child and Family Psychiatry, Royal Hospital for Sick Children, Edinburgh EH9 1 LL, Scotland

Contents

INTRODUCTION: QUALITY OF LIFE. joseph Wortis . .................. xvii

CLINICAL ASPECTS. Brian H. Kirman. . . . . . . .. . . . . . .. . .. . .. . . .. . . . . 1

PERINATAL CEREBRAL DAMAGE. Reinhard L. Friede. . . . .. . .. . . . .. . .. 21

EARLY DIAGNOSIS. Mary Coleman. . . . . .. . . . . . . .. . . . . . . .. . . .. . . . . .. 47

LYSOSOMAL STORAGE DISEASES. Edwin H. Kolodny. . . . . . . . . .. . . . . . .. 59

SCHIZOID PERSONALITY. Sula Wolff.. . . . . . . .. . . . . . . . . . . . . ... . .. . .. 81

MENTAL RETARDATION IN JUVENILE FICTION. Barbara H. Baskin and Karen H. Harris. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 105

FRIENDSHIPS AND SOCIAL BEHAVIOR. Sharon Landesman-Dwyer and Gershon Berkson . ................................................ 129

IDIOT SAVANTS. Bernard Rimland and A. Lewis Hill . ................ 155

Vll

Vlll CONTENTS

TRANSPORTATION. Heather S. Menninger . ......................... 171

CUMULATIVE INDEX, Volumes 11-13 ............................. 207

Previous Volumes in This Series

VOLUME 1-1970

DEVELOPMENTAL PSYCHOLOGY. ZELDA S. KLAPPER

COMPARATIVE PSYCHOLOGY. GERALD TURKEWITZ AND HERBERT G.

BIRCH

CONDITIONING AND LEARNING. EUGENE A. SERSEN

CLINICAL ASPECTS. BRIAN H. KIRMAN

DOWN'S SYNDROME. BRIAN H. KIRMAN

NEUROLOGY. KYTjA VOELLER

NEUROPATHOLOGY. GEORGE A. JERVIS

NEUROPHYSIOLOGY. ROBERT J. ELLINGSON

METABOLISM. SELMA E. SNYDERMAN

EPIDEMIOLOGY. REMA LAPOUSE AND MARTIN WEITZNER

COMMUNITY ORGANIZATION: FOREIGN COUNTRIES. GUNNAR DYBWAD

AND ROSEMARY F. DYBWAD

COMMUNITY ORGANIZATION: U.S.A. LEOPOLD LIPPMAN

LEGAL ASPECTS. AUGUSTUS M. JACOBS

POVERTY AND RETARDATION: SOCIAL ASPECTS. HELEN WORTIS

POVERTY AND RETARDATION: BIOSOCIAL FACTORS. JOSEPH WORTIS

COMPLICATIONS OF PREGNANCY AND DELIVERY. CECIL M. DRILLIEN

TERMINOLOGY AND CLASSIFICATION. CHRISTOPHER SANDERS

CHRONICLE. ELIZABETH M. BOGGS

CALENDAR. IDA AXELROD

lX

x PREVIOUS VOLUMES IN THIS SERIES

VOLUME 2-1970

INTRODUCTION: WHAT IS MENTAL RETARDATION? JOSEPH WORTIS


PHENYLKETONURIA AND PHENYLALANINEMIA. L. 1. WOOLF

DERMATOGLYPHICS. G. F. SMITH AND JOAN SCHINDELER

NEUROLOGY. KYTjA VOELLER

NUTRITION. ZENA A. STEIN AND HANNAH KASSAB

PEDAGOGY. H.C.GUNZBURG

READING DISABILITY. LILLIE POPE AND ABRAHAM HAKLAY

ARCHITECTURE. ARNOLD G. GANGNES

GENETICS. ARNOLD R. KAPLAN

SOCIAL WORK. RUDOLF P. HORMUTH

PARENT ORGANIZATIONS. PHILLIP Roos

CHRONICLE. ELIZABETH M. BOGGS

CALENDAR. BRIAN M. MCCANN

VOLUME 3-1971


GUARDIANSHIP. KNUTE MARTIN

NEUROPATHOLOGY. GEORGE A. JERVIS


DENTISTRY. HAROLD DINER

RESIDENTIAL SERVICE. ELSIE D. HELSEL

FEDERAL LEGISLATION: 1955-1965. ELIZABETH M. BOGGS

OPERANT CONDITIONING. JAMES D. BLOCK

RECENT FRENCH LITERATURE. PSYCHOEDUCATIONAL ASPECTS.

ELEONORA jEDRYSEK

PEDIATRICS. CARL DRAYER AND GILDA GUZMAN-NEUHAUS

PSYCHIATRY. MICHAEL L. RUTTER

PREVENTION. JOSEPH WORTIS

CALENDAR 1971. ANGELA WILSON AND BARBARA SCHER

CHRONICLE 1970. ELIZABETH M. BOGGS

VOLUME 4-1972

INTRODUCTION AND ANNOUNCEMENT


PARENT COUNSELING. HELEN WORTIS

PARENTS AS TEACHERS OF THEIR OWN CHILDREN. NANETTE L. DOERNBERG

PREVIOUS VOLUMES IN THIS SERIES

SOME RECENT TRENDS: A PARENT'S VIEW. JOSEPH T. WEINGOLD

GENETICS. ARNOLD R. KAPLAN

PSYCHOPHARMACOLOGY. JOHN S. WERRY AND ROBERT L. SPRAGUE

NEUROLOGY. KYTJA VOELLER

NEUROPHYSIOLOGY. ROBERT J. ELLINGSON

AUDIOLOGY. LYLE L. LLOYD AND E. J. MOORE, JR.

FEDERAL LEGISLATION (CONCLUSION). ELIZABETH M. BOGGS

RECENT ITALIAN LITERATURE. GEORGE R. JERVIS

CHRONICLE. GEORGE SOLOY ANIS

CALENDAR. GEORGE SOLOY ANIS

VOLUME 5-1973

INTRODUCTION: THE ROLE OF EDUCATION IN MENTAL RETARDATION

WORK. JOSEPH WORTIS


PSYCHOMETRICS. C. E. MEYERS

BEHAVIOR. GERSHON BERKSON

NURSING. KATHRYN E. BARNARD

CEREBRAL PALSY. GABRIELLA E. MOLNAR AND LAWRENCE T. TAFT

CONGENITAL MALFORMATIONS: MICROCEPHALY. JOSEF WARKANY AND

PETER ST. J. DIGNAN

COMMUNITY SERVICE MODELS: Two FOREIGN SYSTEMS.

WEST GERMANY. TOM MUTTERS

NEW ZEALAND. R. G. MATHEWS

J APANESE LITERATURE AND DEVELOPMENTS. AKIHIKO TAKAHASHI

RECENT ADVANCES IN SOVIET DEFECTOLOGY. T. A. VLASOVA

CHRONICLE. GEORGE SOLOYANIS AND SUSAN YODER

CALENDAR. GEORGE SOLOYANIS AND SUSAN YODER

VOLUME 6-1974

Xl

INTRODUCTION: NATIONAL PRIORITIES AND THE HANDICAPPED. JOSEPH

WORTIS


GENETICS AND INTELLIGENCE. V. ELVING ANDERSON

CONGENITAL MALFORMATIONS: HYDROCEPHALY. PETER ST. J. DIGNAN

AND JOSEPH W ARKANY

DEVELOPMENTAL BIOCHEMISTRY. W. A. HIMWICH AND H. C. ARGAWAL

U.S. FEDERAL FUNDS: A POLICY STUDY. DAVID L. BRADDOCK

SOCIOLOGY. BERNARD FARBER

EDUCATION. JAMES J. GALLAGHER

XlI PREVIOUS VOLUMES IN THIS SERIES

SEXUAL BEHAVIOR. JUDY E. HALL

PHYSICAL EDUCATION AND SPORT. FRANK J. HAYDEN

EMPLOYMENT. BERNARD POSNER

LANGUAGE. RICHARD L. SCHIEFELBUSCH

THE VOLUNTARY ASSOCIATION ON THE INTERNATIONAL SCENE.

ROSEMARY F. DYBWAD

CHRONICLE: 1972-1973. GEORGE SOLOYANIS AND SUSAN YODER

CALENDAR: 1974. GEORGE SOLOYANIS AND SUSAN YODER

VOLUME 7-1975

INTRODUCTION: THE DRIFT OF EVENTS. JOSEPH WORTIS


DEVELOPMENTAL NEUROPHYSIOLOGY. GUENTER H. ROSE AND PETER E. TANGUAY


EPILEPSY. JOHN A. CORBETT, RUTH HARRIS, AND ROGER G. ROBINSON

CONGENITAL MALFORMATIONS: THE GENERAL PROBLEM. KENNETH L. JONES

CONGENITAL MALFORMATIONS: HYDRANENCEPHALY. JOSEF WARKANY

AND PETER ST. J. DIGNAN

EARLY STIMULATION. BETTYE M. CALDWELL, ROBERT H. BRADLEY, AND

RICHARD ELARDO

PUBLIC SCHOOLS. RONALD WIEGERINK AND RUNE J. SIMEONSSON

COMPUTERS IN EDUCATION . LAWRENCE M. STOLUROW

VOCATIONAL TRAINING. MARC W. GOLD

NORMALIZATION. HELEN R. ZIPPERLEN

SELF-HELP. ALFRED H. KATZ

PERSONNEL TRAINING. DONALD E. ZARFAS, BERNICE I. LOVERING, AND

HAROLD j. ROBBINS

SWEDEN: SERVICES AND DEVELOPMENTS. KARL GRUNEWALD

CHRONICLE: 1973-1974. GEORGE SOLOYANIS AND SUSAN YODER

CALENDAR: 1975. GEORGE SOLOYANIS AND SUSAN YODER

VOLUME 8-1976

INTRODUCTION: THE HISTORY OF INTELLIGENCE. JOSEPH WORTIS

THE RIGHT TO TREATMENT. MARSHALL J. COHEN


GENETICS AND GENETIC COUNSELING. JOSEPH M. BERG

HEREDITARY DISEASE: SCREENING AND DETECTION. R. G. CHITHAM, D.

j.T. STARR,ANDj.STERN

PREVIOUS VOLUMES IN THIS SERIES Xlll

OPHTHALMOLOGY. JAMES L. KENNERLEY BANKES

INFECTIONS IN RESIDENTIAL INSTITUTIONS. MEIR YOELI AND GEORGE

P. SCHEINESSON

CONGENITAL MALFORMATIONS: MEGALENCEPHALY. JACK H.

RUBINSTEIN AND JOSEF WARKANY

GERIATRICS. SARA FINN KRIGER

HEALTH AND LONGEVITY. B. W. RICHARDS

PERSONALITY: ONE VIEW. MANNY STERNLICHT

PERSONALITY: ANOTHER VIEW. MORTIMER GARRISON, JR!

LEARNING. L. BEERMANN

CURRICULUM DEVELOPMENT. EDWARD L. MEYEN AND R. DONALD

HORNER

RECENT FRENCH LITERATURE. GABRIEL V. LAURY

CHRONICLE: 1974-1975. DIANA MORRISON-SMITH

CALENDAR: 1976. DIANA MORRISON-SMITH

VOLUME 9-1977

INTRODUCTION: THE ROLE OF PSYCHIATRY IN MENTAL RETARDATION

SERVICES. JOSEPH WORTIS

WILLOWBROOK. CHRISTOPHER A. HANSEN

WILLOWBROOK: A VIEW FROM THE Top. FREDERIC GRUNBERG


INFECTIOUS DISEASES IN ETIOLOGY. MEIR YOELI, GEORGE P.

SCHEINESSON, AND BRUCE J. HARGREAVES

CONGENITAL MALFORMATIONS: THE CORPUS CALLOSUM. PETER ST. J. DIGNAN AND JOSEF WARKANY

PHYSICAL AND OCCUPATIONAL THERAPY. BILLIE LEVINE AND ANN

BIRCH

BEHAVIOR ANALYSIS. BEATRICE H. BARRETT

COGNITIVE DEVELOPMENT AND SOCIAL CLASS. BEVERLY BIRNS AND

WAGNER BRIDGER

ADMINISTRATION: PUBLIC AGENCIES. ROBERT M. GETTINGS

PEOPLE FIRST: A SELF-HELP ORGANIZATION OF THE RETARDED.

VALERIE SCHAAF, TERRY HOOTEN, TERRY SCHWARTZ, CHUCK

YOUNG, JEAN KERRON, AND DENNIS HEATH

INCOME MAINTENANCE: FEDERAL INCOME RESOURCES FOR PERSONS

WITH LONG-TERM DISABILITIES ORIGINATING IN CHILDHOOD.

ELIZABETH M. BOGGS

CHINESE-AMERICANS: ANOTHER MINORITY. AGNES LIN BURGER

LATIN-AMERICA: RECENT DEVELOPMENTS. MILENA SARDI DE SELLE AND

ALBERTO ABADI

CHRONICLE

XIV PREVIOUS VOLUMES IN THIS SERIES

VOLUME 10-1978

INTRODUCTION: How SPECIAL ARE SPECIAL SERVICES? JOSEPH WORTIS

THE RIGHT TO EDUCATION. LYNDA KATZ-GARRIS


GROWTH AND MATURATION. ALAN T. RUNDLE AND P. E. SYLVESTER

THE AUTISTIC SYNDROMES. MARY COLEMAN

CONGENITAL MALFORMATIONS: LISSENCEPHALY, AGYRIA, AND

PACHYGYRIA. PETER ST. J. DIGNAN AND JOSEPH WARKANY

DRUGS FOR BEHAVIOR MANAGEMENT, WITH COMMENT ON SOME LEGAL

ASPECTS. ROBERT L. SPRAGUE AND GLADYS B. BAXLEY

SOCIAL COMPETENCE. RUNE j. SIMEONSSON

CRIMINAL JUSTICE. DOUGLAS P. BIKLEN AND SANDRA MLINARCIK

PUBLIC ASSISTANCE IN HISTORICAL PERSPECTIVE. MARK E. LITVIN AND

PHILIP L. BROWNING

A TAXONOMY OF FEDERAL PROGRAMS AFFECTING DEVELOPMENTAL

DISABILITIES. ELIZABETH M. BOGGS

SERVICES IN THE UNITED KINGDOM. G. B. SIMON

VOLUME 11-1980

INTRODUCTION: DYSLEXIA, LEARNING DISABILITY, BRAIN DAMAGE,

ORGANICITY, AND OTHER NON-ENTITIES. JOSEPH WORTIS


EPIDEMIOLOGY. HOLGER HANSEN, LILLIAN BELMONT, AND ZEN A STEIN

DE INSTITUTIONALIZATION AND COMMUNITY SERVICES. ROBERT H.

BRUININKS, MARTHA L. THURLOW, S. KENNETH THURMAN, AND

JOSEPH S. FIORELLI

CONGENITAL MALFORMATIONS: HYPERTELORISM. JACK H. RUBINSTEIN

CONGENITAL MALFORMATIONS: ARHINENCEPHALY. JACK H.

RUBINSTEIN

THE CHROMOSOME SYNDROMES. CAROLYN TRUNCA

DEVELOPMENTS IN SOUTHEAST ASIA. G. G. PRABHU

THE LESS DEVELOPED WORLD: SOUTHEAST ASIA AS PARADIGM. ZENA

STEIN AND MERVYN SUSSER

VOLUME 12-1981

INTRODUCTION: QUESTIONABLE PRACTICES. JOSEPH WORTIS

SOME CURRENT TRENDS. BRIAN H. KIRMAN

COURT DECISIONS: THE IMPACT OF LITIGATION. BARBARA KENEFICK

PREVIOUS VOLUMES IN THIS SERIES

CONGENITAL MALFORMATIONS: CRANIUM BIFIDUM/ENCEPHALOCELE.

JACK H. RUBINSTEIN


COMMUNITY RESIDENCES: THE STAFFING. WILLIAM T. MCCORD

FERAL CHILDREN. SUSAN CURTISS

xv

Introduction: Quality of Life

JOSEPH WORTIS

The phrase "quality of life" came into circulation years ago in connection with dying patients whose lives were being sustained with respirators, intravenous feeding, morphine, or heroic surgery, all in the name of humanity, when the quality of their life no longer justified the effort. Over a century ago the British poet Arthur Clough wrote:

Thou shalt not kill, nor need'st thou strive Officiously to keep alive.

As often happens, a recent series of publicized cases created popular and official concern, and a right-to-die movement was initiated that led to permissive legislation in a number of states that allowed the suspension of life-sustaining measures in the case of moribund individuals whose quality of life made survival a burden.

The same principle was then invoked in a number of cases of newborn infants who were so hopelessly maimed and handicapped that their lives could only be a burden to themselves and others. Here however it was no longer a mature and responsible individual who could choose to die, but the parents of a helpless child who would make the decision. This complicated the ethical and legal dilemma, created serious proble.ms of definition and limits, and raised the threat oflegalized infanticide. In an effort to stop this kind of permissive infanticide, a federal law was then enacted forbidding the practice, but the law was nullified in court.

In the Indiana Baby Doe case findings, Judge Gesell declared that a XVll

XVlll JOSEPH WORTIS

peremptory generic ruling by a federal law that any and every severely and multiply handicapped child must be permitted to survive should not be permitted to interdict a decision jointly made by parents, their physician, the hospital, and the local court. Without detailing the specific merits of the case, it would appear that the concurrence of all these elements would be sufficient safeguard that justice had prevailed.

Our code oflaw, generally speaking, can be regarded as the expression of widely accepted ethical norms or value systems, and it becomes difficult to enforce laws-as we learned during the years of Prohibition-that conflict with popular beliefs. It is thus not surprising for example that even where suicide and murder are prohibited by law, mercy-killings, suicide, and euthanasia have generally been condoned and exonerated in our courts when circumstances have justified them. No matter what complex legal formula is applied, and no matter what commissions on ethics are created, it is hard to imagine a formalized legal sanction to murder (even when we wage war or inflict capital punishment) that is not liable to abuse. Nevertheless extralegal acts will continue to take place, as they always have in the past, at the peril of the perpetrators, who may have to defend their action ex post facto in court.

But nowadays we hear discussions of the quality of life in other connections, often in relation to services to the handicapped. Standards of care, now required by court rulings, not only demand proper food, shelter, clothing, and medical attention, but an overall quality of life that provides dignity, pleasure, and maximum freedom for the individual. In the recent period, in the face of economic decline, rampant inflation, and budgetary cutbacks, this has been increasingly difficult to achieve, and the courts have proven to be impotent when legislatures refuse to appropriate enough money to satisfy these needs.

Can we maintain a reasonable quality of care for the handicapped when the quality oflife for most of our population is declining? A few facts, gleaned mostly from the pages of The New York Times, give us the answer. Real income, measured in constant dollars, has decreased over 10% in the past twelve years. Thousands of small farmers have gone bankrupt. In 1981 the official threshold of poverty set by our government was an income of $9287 a year for a family of four. In that year the number of Americans thus classified as poor had risen to involve 14% of the population, the highest rate since 1967. In our black population it was 34.2%. All superficial impressions to the contrary, there is widespread hunger and malnutrition in the U.S:A., greatly exacerbated these past few years. Back in 1972 Public Law 92-433 authorized an initial program with a very modest $20,000,000 to provide food supplements to poor and hungry pregnant

INTRODUCTION: QUALITY OF LIFE XlX

women and their children to age four (known as WIC, the Women's Infants' and Children's Program), but the program has been consistently obstructed and stifled since then. Our Department of Agriculture has conservatively estimated that 9,600,000 women and children are eligible for, and need, food that WIC provides, but as of 1980 only 1,800,000 were receiving those benefits. President Reagan proposed to cut this case load by 30%.

The year 1980 brought the first decrease in life expectancy since 1967 in this country. Death rates for young people aged 15-24 have been steadily rising since 1976, mostly because of accidents and violence. Homicide is the cause of 39% of the deaths of young black males, while suicide rates have increased for everybody in this age group. Official unemployment is over 10%, not counting the partially and minimally employed, the demoralized, and the new unemployed additions to our labor force.

Our government has been drastically reducing all programs for the weak and disabled. Government's commitment to the social welfare state was supported to varying degrees by all previous Democratic and Republican presidents and remained on course until the arrival of President Reagan. Through various devices Congress has already approved cuts in Medicare and Medicaid of $25,000,000,000 between 1983 and 1987. One of the cruelist dispensations of our administration was the ruling that would reduce by 60% the Medicare benefits to the terminally ill. Through the evasive and obfuscating device of block grants to the states, human service programs are to be cut by 25%, and maternal and child care programs by 13%. Congress, to its credit, refused to submerge the funds for developmental disabilities into these truncated block grants, and specifically authorized $61,000,000 for this purpose. When the administration tried to slash support for the training of health professionals, it was forced to include $120,000,000 for that purpose in its fiscal 1984 budget.

Benefits under Title XX have been drastically reduced in the Reagan budget by $1,000,000,000, or one third of its total. Supplemental Security Income was curtailed in several ways to cut its current role of 4,000,000 people: over 250,000 people were dropped last year, and hundreds of thousands are threatened. On appeal many decisions were reversed, and more humane practices have been promised, but the cuts go on.

Because of these developments, aggravated by cutbacks in rent subsidies and other services, many disabled persons are without adequate services: their day care, work activity, sheltered workshops, counseling services, and transportation, all formerly funded through Title XX, are no longer available, and community life itself is often no longer possible.

One could go on, and tell of the failure of our educational system, the

xx JOSEPH WORTIS

rampant increase in crime, and the general decline in morale, but this is enough to describe the trend. Meanwhile, our expenditures for the dangerous and threatening nuclear arms race are enormous and appalling. If the Reagan administration has its way, it will amount to $214,800,000,000 in 1983, a 6 to lO% increase in 1984, and so on up to $370,000,000,000 by 1986. In these budgetary projections, if Social Security payments (which are self-funded) are excluded, nearly two thirds, or 63%, of all federal expenditures would go to the military. Only 24% is left to the states and localities, largely for human service programs, and the remaining 13% to government operations. In a recent subcommittee hearing of the Ways and Means Committee of the House of Representatives, our National Association for Retarded Citizens joined with other interested groups to declare:

We believe it is time to relieve the poor, disabled and elderly of their role as victims in the fight for national security and a balanced budget. How can they continue to care that their country is safe if they are not themselves safe from their own country?

mental retardation and developmental disabilities3a978-1-4684...mental retardation d developmental...

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