Amelioration Social environmental factors in the development of disadvantaged children and methods for remediating their effects constitute a major research effort. Investigators at the University of Kansas' Mental Retardation Research Center have developed a Responsive Teaching Model from research with such children which is now being applied in schools in nearly every state in the nation. The model, which is a scientific behavior management system, has been extended to the home and other settings with significant impact on social and academic behaviors of normal and handicapped children. The utilization of these techniques by parents and teachers should permit more developmentally disabled children to remain in their own homes and communities. The Kansas investigators have also developed a successful program to allow severely and profoundly retarded children to communicate without the use of speech and language. Children use geometric forms of various shapes as words and morphemes without requiring spoken responses. Such children are generally regarded as poor candidates for language training. Their potentials in this area are being further enhanced by the use of a motor imitation manual which serves as a basis for training in language skills. Center investigators at the University of Wisconsin have studied the effect of impulsiveness in retarded children. Study results indicate that learning. does not take place even after weeks of training and that discrimination performance is poor under impulsive behavior. The introduction of a simple five second delay period dramatically increased receptive language performance, suggesting that in many situations learning ability of the retarded has been vastly underrated, The study points to the need for more research on optimal training and testing procedures. Wisconsin investigators also have compared interactions of normal and retarded mother-child pairs in linguistic and social dimensions and the effectiveness of training to change the maladaptive and inappropriate communications noted in the mothers of retarded children. These interactions tend to deteriorate as the child grows older. Training of parents with children aged 18 months to 5 years has resulted in improved use of language and social competence in the child. An automated method for introducing severely retarded children to reading comprehension has been developed at the E. K. Shriver Center at Fernald State School. Children are taught to associate dictated words with pictures and then to printed words. They can then associate pictures and printed words, thus learning a basic reading vocabulary. These preliminary steps to reading are accomplished by use of a teaching machine; the automated methods identify candidates for reading instructions who would otherwise largely be overlooked. Organizational and other elements affecting the quality of care in institutions is being studied by investigators at this same Center. Unitization-the establishment of quasi-autonomous living units in large formerly centralized institutions--is one of the elements under study. Findings in one facility indicate only minor shifts toward resident orientation through such administrative change and that practices are still largely characterized by rigidity in routines, depersonalization and social distance between residents and staff. It has also been noted that IQ level of residents is strongly associated with the quality of care provided despite the higher staff ratios afforded the more severely disabled. This suggests the need to identify the personality traits of caretaker personnel conducive to resident-oriented care practice. Alcohol, Drug Abuse, and Mental Health Administration Research on mental retardation has been supported by the National Institute of Mental Health for over a quarter century. Although major responsibility for mental retardation was shifted to other Federal agencies a few years ago, the Institute's program continues to support and fund selected studies in the area. Some research projects deal directly with mental retardation many of these projects were started several years ago. Others have indirect or potential significance for retardation. Several studies are related to the prevention of mental retardation, especially environmentally induced mental retardation among children and youth. An effort to prevent cognitive defects is being carried out in the homes of disadvantaged children before they reach the age of 3. These investigators are attempting to alter the mother's teaching style, language style, and management procedures when necessary. In another preventive study, investigators in Oregon are identifying interaction patterns among families with retarded children, to determine how negative and positive behaviors are communicated, and how they alter behavior responses among members. Recognizing the complex interrelatedness between mental retardation and emotional development, other researchers using a school-based model are testing the ability of teachers to promote self-awareness and interpersonal functioning among their pupils, while at the same time decreasing pathological manifestations. Early detection and accurate classification of retardation have been found to be key factors in successful treatment and rehabilitation. NIMH is supporting research to assess the capabilities of low-IQ children in order to better differentiate among them. Besides measuring learning potential among the educable mentally retarded, it will develop another measure of learning potential for use with primary grade children; then it will initiate a longitudinal study of young nonlearners--their trainability in memory, learning, and speech functioning. Another study is comparing the emotional responses of mentally retarded children with those of normals to gain a more accurate perspective of the range and variability of emotional behavior among retardates. NIMH staff members, meanwhile, have developed a preschool test using prepositions as an instrument for screening children between ages 3 and 5 for mental retardation. Still being validated, the test has been used with promising results in Head Start classes and on disadvantaged populations. At present, it is being used on about 700 Maine youngsters to detect developmental lag, and preliminary reports are promising. In another project, the investigator is developing methods for differential diagnosis of reading disability, on the assumption that not all "retarded" readers are in the same category. This project is the outgrowth of earlier work on bisensory memory and audiovisual matching. Three separate, but related, studies on the social and behavioral aspects of mental retardation in school children were done by a California investigator. This research, which has produced over 200 articles, chapters, and volumes that It Another have been widely disseminated has been supported by NIMH for 7 years. Another area of NIMH support has been the training of mental health personnel in special treatment approaches and techniques found to be effective in rehabilitating mentally retarded children. One example is a study in Kansas which provides intensive training in special clinical techniques relevant to retarded children and youth, with emphasis on family therapy and effective utilization of community resources. Longitudinal investigations of the epidemiology of impaired competence is being studied by another NIMH investigator, while still another is trying to determine the epidemiology of exceptionality in school children. The latter considers children "exceptional" if they are educationally handicapped, gifted, mentally retarded, emotionally disturbed, or physically handicapped. She plans to relate clinical characteristics, such as IQ, adaptive role behavior, and physical disabilities, to modes of sociocultural characteristics for Black, English-speaking Anglo, and Mexican American children. Over the past years it often has been pointed out that classifying children, especially exceptional children, according to diagnostic categories may have deleterious effects. The "labels" or names may have unfavorable connotations and imply predictions of future behavior. Such labeling might be particularly important in some kinds of recordkeeping, as, for example, cumulative records in school system. The NIMH has sponsored a significant study of this problem, and a book "The Futures of Children: Categories, Labels, and Their Consequences" has been published. Biological studies are also underway that are directly or potentially relevant to mental retardation. For example, one researcher is studying the relationship between abnormal metabolism and mental disease including, among other subjects, infants with phenylketonuria (PKU) and mentally retarded individuals; emphasis is on identification of abnormal chemical reactions in mentally ill and retarded individuals, especially the metabolism of aromatic acids in tissues and urine. Another study is investigating the psychophysiology of sleep and dreaming in mentally handicapped, as well as other, individuals. Another basic research project is concerned with the structure, distribution, and metabolism of acid mucopolysaccarides in nervous tissue; this work should lead to a better understanding of the origins of central nervous system abnormalities, such as mental retardation. The Institute's research program in mental retardation while not currently extensive, covers areas of investigations with important relevance to the field. Especially in basic research efforts, ranging from studies of the effects of environment on behavior to analysis of nervous system tissue, knowledge is accumulating that will result in a more thorough understanding of the phenomena of mental retardation, and of ways to prevent it. HEALTH RESOURCES ADMINISTRATION Mental Retardation Construction and Consultation Activities in the Division of Facilities Utilization (Hill-Burton Program), Bureau of Health Resources Development P.L. 88-164, Mental retardation facilities have been eligible for and have received construction assistance from the Hill-Burton program since its inception 29 years ago. Up until the passage of the "Mental Retardation Facilities Construction Act" (1963) Title I, the Hill-Burton program was the primary source of Federal assistance for retardation construction, and administered the Act after enactment until August 1967. Since the advent of the specific construction programs for retardation facilities, the Hill-Burton program has been acting primarily as a back-up resource for construction aid. As of June 30, 1974, a total of 109 retardation projects have been assisted with $56.6 million in Federal funds since the Hill-Burton program began. Hill-Burton personnel in both the HEW Regional Offices and in the State Hill-Burton agencies have provided expert consultation to the retardation facility programs and to many retardation project sponsors or potential sponsors. Hill-Burton consultation is especially valuable where retardation services are to be provided in a comprehensive health care facility or in any combination with other health services. 50-132 O 75 pt. 1 - 26 SOCIAL AND REHABILITATION SERVICE Mental Retardation Introduction On August 15, 1967, the Social and Rehabilitation Service was established by the Secretary, Department of Health, Education, and Welfare, to join under a single leadership income support programs for needy Americans and the social and rehabilitation programs, including services for the mentally retarded. Four of the eight major components of the Social and Rehabilitation Service have responsibility for providing income maintenance, medical services, and social services, for the economically, physically, and mentally handicapped. These bureaus and offices administer the legislation concerned with the care and provision of services for retardates and their families in the following order: Assistance Payments Administration, Social Security Acts, Titles IV, Part A; and VI. Medical Services Administration, Social Security Act, Title XIX. Community Services Administration Title IV, Parts A and B and VI; and the Office of Planning, Research, and Evaluation, Title XI, Sections 1110 and 1115 and various other Acts or portions of Acts concerned with the health and welfare of the mentally ill or retarded. Following is a description of the Social and Rehabilitation Service's efforts on behalf of the mentally retarded. Assistance Payments Administration The Assistance Payments Administration has primary responsibility for grants to States for public assistance programs under the Social Security Acts, Title IV, Part A, Aid to Families with Dependent Children and Emergency Welfare Assistance; and Title XVI, Aid to the Aged, Blind and Disabled (Guam, Puerto Rico, and Virgin Islands only). It is in the disabled portion of the latter program that Federal financial participation is available to help needy individuals who also may be mentally retarded through territorially administered public welfare program. P.L. 92-603, enacted October 30, 1972, established a national program to provide supplemental security income to individuals who have attained age 65 or are blind or disabled except for Guam, Puerto Rico and Virgin Islands. The national program became effective as of January 1, 1974, at which time the Social Security Administration assumed responsibility for making Federal payments to eligible recipients formerly carried by the States and territories under Titles I, X, and XIV. Since the Assistance Payments Administration's authority to make payments to disabled recipients expired December 31, 1973, Federal expenditures shown in the Table of Obligations are for Guam, Puerto Rico, and the Virgin Islands only starting in 1975. |