func-

retardation, accurate measures ofintellectual

accompany these levelsofmental value
impairments. Morcover,whatever the
tioningare influenced by the physical the
use when measuring
of 1Q scores at the mildand moderate
level,theyhave little
who functionbelow the 1Qs of 40.
35 to

abilitiesand disabilities of individuals

can more usefully focus on determining pre-
Measurement at thislevelof severity perform,and
essential daily livingskillsthe individual currently
can
cisely which and
are most efficient for improvingdailyfunctioning
which learningtechniques willhave
with severe and profound mental retardation
health.Often individuals
ard his or her environmentsand
functional specificto the individual
evaluations
activities.

HISTORY OF THE FIELD

has been a partof human history, itwas only in
Althoughmental retardation always Jean-
sustainedstudy by professionals.
the late 1700s thatitbecame the focus of
we discussed in chapter1,began working
Marc-Gaspard Itard,the Frenchphysician
hislifein the wildwith animals.
in 1798 withthe boy, Victor,who had livedall
evidencethat it
Itard'swork and theprogress reportshe publishedprovidedtangible
was possibleto imnprove mentaldisability throughskilled teaching.
Johann Guggenbuhl created Abendberg, thefirst
Around 1840, inSwitzerland, this
menta! retardation residentialhabilitationprogram. Builtin the mountains,
diet,baths,massages, physical exer-
institutionprovidedfresh mountain air,good
and speech training.
cises,sensory stimulation, regularroutine,memory exercises,
the combined emphasis on education
and medicalcare was
Guggenbuhl believed
His beliefsare stillvalidtoday.Although favorablyreceivedat first,
important. financial and medical
Dr.Guggenbuhl came under firefor alleged
Abendberg and of "cures,"lack of
of mismanagement, misrepresentation
malpractice. Allegations of necessities,and
teachers,inadequatesupplies
insufficient
medical supervision,
dream (Kanner,1964; Scheerenberger,1983, 1987).
lackof records ruined the
1867.
Abendberg closedby had many problems, the idea of residential
institution
Although Guggenbuhl's Residential institutions
institutionshad taken root by the midnineteenthcentury.
and Great Britain. Inthe UnitedStates,Samuel Gridtey
appeared throughout Europe
for the Blindin Boston,developed
of the PerkinsInstitute
Howe, the firstdirector
 HISTORY OF THE FIELD 129

the firstAmerican mental

retardation
institution
in 1848. locatedin a Wing
Initially
of the Perkins Institute,itlaterbecame
known as
the Walter E. Fernald State Sch0ol. deinstitutionalization.
Decreas
Ironically,Howe clearly saw the
dangersof residentialinstitutions that isolated ing thenumber ofindividuals with
with mental living in large
people handicapsboth geographically
and socially.He wrote that thereshould retardation
be facilities.
only few residential
a
institutions
and they shouldremain small in size:
congregate

Grave errors.were community living arrange-

incorporated intothevery organic principles ment. A home ina typical
resi-
which of our institutions,
make them already too much dential neighborhood.
like asylums; which threatento cause real
asylums to
grow out ofthem, and to
..
engender other evils. allsuch institutions
are unnatural,

.
undesirable,and very liableto abuse. We should have as few of
them as
possible, and those few should be
kept as small as possible.
(Howe,1866)
Despite warnings to keep the number down and
spread over the United States until keep them small, institutions
by 1917, all but four stateshad institutions for
people with mental retardation. Howe's prophesy provedtrue.
Unfortunately, Wide-
spread abuses develóped in these residential
institutions.The 1970s and 1980s saw
many exposés of institutions for people with mental retardation.
conditionsand standardsfar below Citinginhumane
minimum, the courts ordered many closed be-
cause they violated residents'
constitutional rights.
At about the same time that residentialinstitutions were started,
of professionals and parentssprang up to ca!l attention to the needs organizations
of these citizens.
The American Associationon Mental Retardation
came the
(AAMR), founded in 1876, be-
largest and oldest interdisciplinary of professionalsinthefield
organization
of mental retardation. In 1954 the Association for Retarded Citizens
(ARC) was
founded by a group of parents.This
organization exerted great influence duringthe
years of change that followed. In 1961 President Kennedy founded the President's
Committee on Mental Retardation
(PCMR), leadingthefederalgovernment toward
a more
enlightenedview of this disability.
In the 1960s a new philosophy,normalization,appearedinScandinavia (Nirje,
1969). This philosophy held that people with mental retardation should have avail-
able to them "patternsof lifeand conditionsof which are as close as
everyday living
to and ways oflifeof society"
possible theregularcircumstances (Nirje,1976).The
of normalization
as well as the principle
of dignity of risk (Perske, 1972;
principle
Wolfensberger, 1972) helped provide a foundation for the civilrights case being
brought before the courts.These legalactionsbrought two importantpointsto the
attentionofthe general public:(1) thatpeople withmental retardation should live
as normal a lifeas possible,and (2) thatconditionsforpeople with mental retarda-
tionin residentialinstitutions were horrible.These courtactionsled to widespread
deinstitutionalization of people with mental retardation. These eventscoincided
withgreat successes in developing model programs that allowedpeople with mental
retardationto !ive in their own communities. Today, most peoplelivein community
living
arrangements.
of the 1800s in the
Althoughresidentialprograms were developed by themiddle
UnitedStates,the firstAmerican special class for"defective children"was not opened
was soon followed
until1896. This specialclass, in Providence,Rhode Island,
first
others in cities.
By the beginning of the 1900s, special classes dotted the
by large
the students theirentire
country.These earlyclasses were generallysegregated: spent
mental retardation.Most communities had no special
day withotherstudents with
childrenwiththe mildest
educationclasses at all.Some communitiespermitted only
since 1975 has specialedu-
to attend the specialeducation classes. Only
disabilities
of the Education for AllHandicapped
cation been widelyavail ble.The passage
CHAPTER 4 MENTAL RETARDATION

mental retardationto
allowed all children with
Children Act (EHA) in thatyear theirneighborhood schools
and
in.A poisonous substancethat of these childrenattend
cause
attendpublicschools. Most
immediate or
m to the body.
long-term withtheirnonhandicapped peers.
are integrated

PREVALENCE
forthe normal
Look again at the curve
How many studentshave mental retardation? of the curve estimatingmental
portion of
distribution ofintelligence, Figure4.1.(The Estimatesof the prevalence
of 70 to 75 and below, is very small. total
retardation, 1Qs to 3 percent of the
1 percent
mental retardationvary from approximately more than I percent (that
to the federalgovernment, slightly
population.According identified as having mental retar-
is
is, 1 in every 100) of the school-agepopulation of Education,
education services(U.S.Department
dation and requiringspecial children with
8-1989 school year, approximately 502,172
1990). During the far,most of these
the United States. By
mental retardation were servedthroughout all individuals with
In fact, 89 percent of
retardation.
studentshave mild mental of mental retarda-
Of the remaining levels
mental retardation have mild retardation.
3 percent have severemental
retardation,
moderate retardation,
tion,7 percent have While the numbers
retardation (Baroff, 1986).
and I percent have profound mental
districtof 40,000 studentscould expect
are rough estimates, thismeans that a school
with mental retardation.Of this total, 598
a totalof approximately 672 students
47 to have moderate mental
could be expected to have mild mental retardation,
20 tohave severe mental retardation, and only 7 to have profound
retardation,
mental retardation,

CAUSESAND PREVENTION OF
MENTA RETARDATION
Causes
can be caused by a varietyoffactors.Only rarelycan any one
of
Mental retardation
the factors
these factorsbe singledout as the cause of mental retardation. Typically,
interact in complex ways to cause mental retardation. We willidentifythe major
causes of mental retardation. Although these causes are divided into four groups, the
clear.For example, lead isa toxin,
dividinglinesbetween the groups are not always
but it isalso a socioeconomicand environmental factor.Similarly, malnutritionof a
woman is a socioeconoinic factor, but the damage to the baby is also
pregnant
biological. with this complexity in mind, we willattempt to categorize causes into
these major categories:

1. Socioeconomic and environmental factors

2. Injury
and toxins(poisons)
3. Infections
4. Biological causes

section in thischapter.You will

Turn back tothe definitions recall
thatwe defined
mental retardation subaveragegerneralintellectual
as "significantly functioningexist-
in
ing concurrentlywithdeficits adaptive
behavior and maifested during the devel
 example, a child's visualefficiency
where this childmust could affecthow the classroom is
be seated,
organized,
braillers)
is required,or whether additional equipment (miCrOcomputets,
ifadapted materials(textswith
enlargedprint)arenecessary
Althoughdiflerent statesand school
districtsvary in the criteria
used to deter
mine eligibility for special
between 20/70 and services,
typically people withvisual
20/200 inthe beter acuity
a vISual eye with correction measung
to have
thandicap(Rogow, 1988).These are considered
ment or low vision. individuals have a moderate visualimpair
These individuals are able to use
use itas their residualvisionand may
primarymeans of gaining their,
information.

HISTORY OF THE FIELD

Our knowledge
ofpeoplewithvisual
to the days of impairmentsinWestern civilizationdates back
Homer in ancientGreece.
Records from ancient
peoplewith visual Egypt confirm that
of attentionand impairments were accepted in
society.Despitethese indications
acceptance in earlysocieties of Western civilization,
Systematicattempt to educate and therewas no
integrate people who were blind into
societyuntil the
eighteenthcentury
Western
The firstschool forthe blind, the Instituiion for BlindYouth, was founded in
Parisin 1784
by Valentin Haüy, who also conceived a
printedpage. Unfortunately, system of raisedletterson the
his efforts
olutionbegan in 1789. In the developmental ended when the French Rev-
early 1800s, Louis Braille, a Frenchman who was
blind,developed a tactile
system forreadingand writing thatuses an embossed dot
code. Thissystem is stillused today.
The first
centerschoolforthe blindinthis
the Blind (now calledthe country,the New EnglandAsylum for
PerkinsSchool for the Blind), which was directedby
Samuel Gridley Howe, did not open until1829. Around 1832 theNew
forthe Blindand the York Institute
PennsylvaniaInstitution forthe Instruction ofthe Blindwere
begun. Followingthe norm of the time,these
nineteenth-century schools were
vately supported boarding schools usuallyattended pri
by children from wealthy
families.
The firstday classes began inScotlandin1872.The Scottish EducationAct called
for childrenwho were blindto be
integratedwith theirsightedclassmates and to
attend schoolsin their loca communities. Note,our
"mainstreamingmovement" is
not a new concept: its roots are deep in the historyof educationof childrenwith
handicaps. In thiscountry,the first concentratedattemptsto integrate studentswho
were blindinto localpublicschoolswas in Frank Hall,the
Chicago. superintendent
forthe Illinois School forthe Blind, came to Chicago in 1900, and convinced people
to allowstudentswho were blindto live at home. Halldeveloped a
plan thatdivided
Chicago into several regions. One local school ineach regionservedstudentswith
severe visual impairments.The studentsattended regularclasses,but also had a
specialeducation teacher who taught them to use braille and encouraged them to
participate in
fully regular education programs. To hisstudentsuse braille
help more
efficiently, Halldeveloped a mechanical braille writer,a machine that
helps individ-
ualstake notes and complete other written tasks.
Edward Allenbegan the first American classforthe partially sightedin 1913 in
Boston, and laterthat
year
Robert Irwin starteda classinClevelandforstudentswho
were partially sighted.These programs were modeled afterclasses inEngland where
schoolwork was exclusively oral.Reading and writingtasks were kept to a mini-
 PREVALENCE
34
mum, these classes inregular educationas much
but studentsattending participated
as
possible.
Classes that
followed this model and limited studentsuse of theirvision Hoover cane,Long,
were generally called"sight whitees.
saving classes." Thismethod was popularforalmost fiftyY used in the
mobility
and
years (tromabout 1915 to 1965), until Natalie tionsystemdeveloped inorien
Barraga's researchon visual efficiency
in 1964 changed the ficld.She 1944
RichardHooverto
proved thatpeopledo not have only so much sight, withvisual helppeople
which can be used up; rather, vision can become more limited impairments move
when it is not used. through the
environment
Many advancesthe generalpopulationuse and enjoyhave providedgreatben- independently.
ehts for people with visualimpairments.For
AlexanderGraham Bell in 1876, and example, thetelephone,developed by
the phonograph,inventedby Thomas Edison
in 1877, have
proven to be importanttechnologies forthose who are visually im-
paired. This equipment,
developed in part to assist people with disabilities, is so
available and inexpensivebccause of its
broadcast in 1906 in the United popularappeal.The firstradioshow was
States, and marked access to a formof
and
readyaccess to information entertainment
forthose with visual
Although readingand writing handicaps.
are present difficult tasks to many individuals who
visually impaired, anothermajor area of
and 1925, difficulty ismovement. Between 1918
dog guideswere trainedto
War I. Guide help French and German veteransof World
dogs (seeing e ye dogs) were
thisis not a introducedintothiscountryin1928,but
popularmethod ofassisting Less than 2
visual mobility. percentofpeoplewith
impairmentsuse secing eye dogs
around 1860, but Richard (Hill, 1986). Long canes were developed
Hoover,afterwnom the Hoover
ited with cane isnamed, iscred-
developinga mobilityand orientation
there was no system in 1944. Beforethistime,
systematic method for teachingindividuals
environments. to move freelyintheir
During the 1950s, medicaladvances
thathelped save the lives
prematurelyironically caused thedisease of infants born
talfibroplasia) in surviving retinopathy ofprematurity
infants. ROP resultsin visual
(ROP; retrolen-
from mildvisual impairmentsthatrange
impairmentsto blindness. Duringthe 1960s, the rubella
measles) epidemicleft
many children withvisual (German
in childrenwith visual impairments. The
impairmentsstrained the
dramaticincrease
which beforeWorld War II capacity of residential
served85 schools,
percentof all school-age children with visual
impairments (Sacks, Rosen, and
began to callfor Gaylord-Ross, 1990).At the same time
mainstreamingratherthan sendingtheir parents
was increased children away.The result
conmprehensive programsforchildren with visual
communities.Today,the
majority ofchildren w ith impairmentsinlocal
and attendlocal visual
publicschools. impairmentslive at home

PREVALENCE
According to the Tvelfth Annual Report
to-Congresson the
tion
forthe Handicapped Act,4 ofevery10,000 Inmplementationofthe Educa-
school-agechildren
icappedand receive specials ervices (UnitedStates Departmentof
are
visuallyhand-
It is difficult Education,1990).
to
get an accurate count of students
with visual
and Kirchner,1985; Kirchner,
1988a). For example,in the impairments(Packer
30,375 students were identified 1984-85 school
as visually
handicapped, in the 1987-88 year.
22.864 studentswere so reported, and in 1988-89 17,116 school yvear.
as visually studentswere
impaired.A primaryreason tor dillerences in Such counts is classified
states use differentdefinitionsand criteria in thatdifferent
determiningwho is eligible forspecial
services. Also,more thanhalfofthose identified as
havingsevere visual impairmen
irments
 HISTORY OF
THE

HISTORY OF THE FIELD

socialleaders
Empire,
Greeks and theearly
the
Roman people of
AS longago as thedays ofancient eary about issuesfacing
Ae Aristotle, the
orancient
Plasys Emperor Justinianwrote civilization
theirtime who were deaf. Over thehistory
atnueta
of Western ectedthemn, othersridiculed,
PCOple who were deafhavevaried. Some societies proteee
persecuted, and even put them to death. inseveral countries
about physicians de Leon (1520
1500s report
DOcuments datingback to the Ponce
deaf.Pedro ofstudents who were were
n Europe who worked with people who were
who ter
were dcal
first teacher of
william
a with beingthe and speak.
1584),
deaf
sh monk credited
his studentsto read,
write,
with beginning
Holder able successteaching
who livedduring
the 1600s, are
credited the Spanish
Like
Wallis, who were deaf. (a two-
in England for individuals communication
grams and manual
beforeth usingwriting schools torthe dcal
advOcated the 1700s
to teach speech. By in Edinburgh,
s diphabetsigningsystem) in England, Thomas Braidwood
Baker
sned by Henry
Michelde l'Epéein France,
and Samuel Heinicke United
the
in Germany
was
Charles school forstudents who were deaf in States
Deaf
87 the first
fortheEducationofthe
Connecticut.The America Asylum the etlorts
Hartiord, for the Deaf) was startedthrough
School was sent to England
dd Dumb (now theAmericana young divinity student who At
O
Thomas Hopkins Gallaudet, be opened in thiscountry.
so a school could
about deafness with
and France study
to meth-
were experimenting
time, theFrenchat theschool begun by I'Epée, was greatly inilu-
this language. Gallaudet
Ods of manual communication,mainly sign Clerc,a
of these methods and he brought Laurent
enced by the effectiveness the United
educatorof thedeaf,to
Frenchman who was deafand a wel1-known for the deaf in the
States.Clercis oftencredited with beingthe fatherof education and
deafeducation also went to Europe
United States.OtherAmericans interestedin in In most
education used Germany.
were impressedby the oralapproaches in deaf
use of form ofmanual communication or sign
oralapproachesof that day the any

language was greatly discouraged.

manual method of instruc-
The rootsofthe debate about whether the oralor the
from the beginningsof education for
tion and communication is better originate
initiated and fueledthrough the
those who aredeafinthiscountry.The battleswere
and AlexanderGraham Bell
debatesofEdward Gallaudet, Thomas Gallaudet's son,

Each of these men had deaf mother

a and a highly successful father. Bell invented
the telephone,the audiometer,and worked on thephonograph.Gallaudet was the
presidentof the nation'scollegeforthe deafand was a renowned legal scholar. These
two clashed. In 1883 and the next year, Bell wrotetwo papers critical ofpolicies and
practicesthatcontributed tosegregation ofindividuals who are deaffrom therestof
society.He believed that deafand sign languagefostered
residential schools forthe
Bell two adults
segregation. proposedlegislation thatwould prevent who were deaf
from marrying, eliminateresidentialschools, ban theuse ofmanual communicatiobn,
and prohibitthose who were deat from becoming teachers ofstudentswho were also
deaf,Gallaudetstrongly opposed these positions both his
in
The battle these two
writingsand in public
debates. between strongindividuals and theiropposing
raged in Congress,and even influenced federal
posi-
rams. fundingofteacherpreparation
Gallaudet's was
position supported by
to establish
Congress, and he receivedan
rapriation a teacher
preparationprogramthat ap-
emphasizedboth the oral
 HISTORY
OF
physicaldisability and health impairments,perhaps more than any other special THE
from
cducation area,demands ongoing collaboration by practitioners many profes
Sons tor proper
assessment and appropriate
educatiO

Significance
lace many
tudents with physicaldisabilities
and healthimpairmentsmust chal
are often at first
enges. Physicaldisabilities
and healthimpaiments obv1ous,even
are to deal
neeting.As a
consequence,individuals with these disabilities forced with
in
ofothers addition
theoftennegative orstereotypicalreactions to theirown feelings
and medical
about theirappearance,They must also address the actualphysical
of the tasks of school
quirements theirdisabilities and accomplish and dailylife.
Peclalcducatorscan help these youngstersmeet these important challengesand
shape satisfyinglivesforthemselves.
Studentswith physicaldisabilities and healthimpairments,because of severe
umitations on theirmobility,communication,and energy,frequentlyrequirethe
aSSIstanceof many professionals over the entirecourse of theirlivesto maintain
healthand liveindependently.Specialeducators playan important collaborative role
in providingthe servicesthestudents neced.

HISTORY OF THE FIELD

The historyof
physicaldisabilities and healthimpairments is as long as human
history.Anthropologists have discovered skeletonswith physical disabilitiesingrave
Sites over 11,000
years old (Frayer, 1987).The historyof treatment is as long.
Records of treatmentfor
spinalcord injuries go back to prehistoric times (Maddox,
1987).The earliest documented treatment was theapplication
the neck. ofmeat and honey to
Beginningwith Hippocrates (400 B.C.), treatmentusuallyincludedtraction
or even a
stretching rackto attempt to the back or push inthe
straighten
Spinal surgerywas used around a.D. deformity.
600, even though it was not
1800s that anesthesia became untilthe mid-
available and sterile
Even with these medical techniquesbegan to be used.
advances,peoplewith
soon aftertheir spinalcord injúries generallydied
injuries.New techniques of treatmentand
developed until World War I. These rehabilitation were not
cord injuries and theirmedical helpedmany more
people survivetheir spinal
treatment.
Ancient descriptions of conditions such as cerebral
found. For example, William J.Little, palsyand epilepsycan be
an
now known as cerebral Englishsurgeon,described
palsy in well-researched the condition
case studiesin
recognizedthatepilepsy in the 1861.
originated brain,but believed Hippocrates
severalfactors: blockageof the normal thatit was caused
phlegm being dischargedinto passage of by
warm blood,and "phlegm"from the brain,cold
brainby sitting too long in the sun unequal heat distribution
receiveattention in the
through the (Scheerenberger,
middleages. It 1983).Epilepsy
dation and individuals was continued to
who exhibited frequently linkedto mental
manner as those who exhibited epileptic seizureswere retar-
mental treatedinthe
behavioraldisorders, retardation. Like same
epilepsywas
immoralconductby themother oftenwrongly believedmental retardationand
orevil to have
The firstAmerican educational possessionofthe been caused
by
was
establishedin Boston in institution forchildrenindividual.
1893: the with
Industrial School for physical disabilities
Crippledand
Deformed
 .APTER 11 PHYSICAL DISABILITTES AND HEALTH IMPAIRMENTs
CHAP

Children for "crippled were

children"
1922).The
(Eberle, school classes
firstpublic

established inChicago at theturnofthecentury (La Vor, Later, schools were

1976).
established in NewYork City,Philadelphia, and Cleveland.
While children with physicaldisabilitiesand other health impairments have
always been with us, the causes of these disabilitiesand teachers' responsibilities
such as
have changed over the years. Concerns were different depending on factors
and science to
the overallhealthstatus ofchildrenin society,the ability of medicine
health. For
healthproblems,and general views
address certain toward children
and
in School (Dolch,
example, a textpublishedin 1948, Helping Handicapped Children
1948),included titled"Crippled Children" a nd "Health Handicaps."The
chapters
chapteron crippled childrenfocused primarily on heart trouble caused by rheumatic
are now
fever,measles, scarietfever,and diphtheria. These diseases,once common,
can be limitedby the
rare.Even when children get them, today the damage usually
But other causes of physicaldisabili-
use ofantibiotics and othermedical advances.
children"closes
tiesnow demand our attention.Dolch's1948 chapter on "crippled
accident rate, and
by urgingthe prevention ofphysicaldisabilities by decreasing the
and medical care for all children
by prenatal and obstetricalcare for allmothers
on health handicaps also ad-
pleas that continueto be heard today. The chapter
cold
dressed issues that were a sign oftheirt ime: infectedand decayed teeth, chronic
and malnutrition. While some of
and bronchitis, glandularproblems,tuberculosis,
be on the rise as
these problems are now less frequent in children, others may again
more childrenlivein poverty and unsafe circumstances.
The U.S. Congress passed significant legislationin this area after World War I
Act was passed in 1918 to offer
and World War II. The SoldiersRehabilitation
latera similar law
servicesto wounded soldiers.
Two
vocational rehabilitation years
for civilianswithpaysical disabilities
was passed: the Citizens Vocational Rehabili-
tation Act (La Vor,1976).(People with mental illnessand mental retardation were
notadded to thislaw until1943.)Additional advances were made followingother
wars such as the Vietnam War. Soldiersreturned withphysicalwar injuriesso
serious
that employers,family members, friends, and the individuals
forced major changes
inorder to reintegrate them intosociety.In 1965 the NationalCommission on Ar-
chitecturalBarierswas establishedto study the problems facing people withphysical
disabilities.
Inthe lasttwenty years,disabilityhas come to be understood inpolitical terms
(Kriegel, 1969).People withphysical have played an important
disabilities part in
changing the political, legal,and socialclimateforallindividuals withdisabilities.
For example, although Section 504 ofthe Rehabilitation Act (prohibiting discrimi-
nation) had passed in 1973, it was not until a wheelchair sit-inin the officeof
SecretaryCalifano at the Department of Health, Educationand Welfare (now Health
and Human Services)four years later thatthe were passed.
implementing regulations
The passage of the Americans with Disabilities
Act in
1990 is anotherexampleofthe
important rolepeople with physicaldisabilities have played in improvingsociety's
response to all people with disabilities.

PREVALENCE

According to the TwelfthAnnualReport to

Congress on
of the Handicapped Act,
Implementation ofthe Education
approximately1 percent (41,514)
of allchildren
specialeducation servicesare receiving
categorized as orthopedically
inmpaired; another1.2