Book Reviews
The Brain in Unclassified Mental Retardation. Edited
by D. B. Cavanagh. (Churchill Livingstone, 1972.
E5.00.)
Professor Cavanagh, in the preface to this book,
points out how little we know about mental retardation
in terms of definition of conditions and determination
of causes. Dr. Kirman, in the foreword, speaks of
how as a young man he was attracted to the subject
of mental handicap because of the little that was
known about it. At this moment in time, still only
little is really known of a subject that is still largely
neglected.
This book is a series of learned papers by experts in
their fields. It takes the form of six main topics in
each of which three experts make an individual
contribution followed by discusion, but each major
topic is rounded off by overall discussion led by an
expert. One is grateful for the book, but perhaps it
was even more important that this group of people
met together with the resultant interaction, stimulation
and sharing of knowledge, which may promote further
ideas and work in the field and attract other workers
of different scientific disciplines to enter this area of
concern.
Section 1 concerns The Developing Brain and
Control Mechanisms with Dr. D. H. M. Woollam
dealing with the Vascularisation of the developing
brain, Dr. M. Prestige with On numbers and neurones
and Professor Giroud on the Sensitivity of the
developing nervous system. These are articles which
deal with brain structure and growth and give an
understanding of how the developing brain can be
affected considerably by excess or lack of particular
nutrients or the presence of some injurious agent during
the formative period.
Section 2 concerns the Biochemical Aspects of the
Developing Brain. Dr. J. S . Wigglesworth deals with
The effects o f pre-natal growth inhibition on brain
composition, Dr. R. Balazs with Hormonal aspects of
brain development, and Dr. J. E. Cremer with Changes
in enzyme activity and the developing brain. These
articles concern experimental growth factors and the
importance of nutrition in the prenatal and postnatal
periods; how transient changes in hormonal balance
during development can cause permanent change in
brain function and its behavioural consequences, and
how animal studies explain brain adaption to environ-
ment vi3 the regulation of enzyme synthesis.
Section 3 concerns the Mutagenic Agents and their
Effects on the Developing Brain. Dr. I. Zlotnik deals
with Virus infection and brain development drawing
attention to the role of virus infection in the
developing central nervous system before birth or in
early life. He reviews existing evidence of human
prenatal and postnatal viral infections and describes
new animal work. Dr. P. Kleihues deals with
Alkylating agents and their effects on the adult
mammalian brain and reviews the neuro-oncogenic
effects of these substances to be followed by Dr. W.
WechsIer on the Teratogenic and oncogenic effects o f
ethylnitrosourea on the developing nervous system of
rats. Professor Magee helps to put this section in
perspective by explaining that such substances are
produced in the stomach by interaction of nitrites and
food amines.
Section 4 concerns the Aetiology arid Epidemiology
of Unclassified Mental Retardation with the long-
standing and on-going study of Dr. C. M. Drillien
“Perinatal factors affecting mental development of low
birthweight infants” now diffeientiated into three
different categories of such infants. Dr. A. T. Rundle
in Sonzatic growth it1 severe mental retardation pointing
to the deviance of growth in a high proportion of cases.
Dr. B. H. Kirman deals with the Psychiatric aspects o f
unclassified mental retardation and comes over as the
person throughout the symposium who puts the new
ideas and developments in perspective and who attempts
to make clear the issue of unclassified mental
retardation.
Section 5 concerns Psychological, Electrophysiological
and Biochemical Aspects of Unclassified Mental
Retardation with Professor B. E. Clayton in her
article Clinical biochemistry and unclassified mental
retardation stating that care of the mentally handicapped
includes proper biochemical investigation so that the
unclassified patients of today will be the specific
syndromes and biochemical disorders of tomorrow. Dr.
R. Harris looks at a large group of children in E.E.G.
aspects of unclassified mental retardation, whilst Dr.
N. OConnor considers Brain injury and mental
subnormality, stating the problem, reviewing the many
studies and leaving no doubt of the complexity of this
field and the diffuseness of the dysfunction.
Section 6 concerns Morphological aspects o f
Unclassified Mental Retardation with Dr. K. M.
Laurence in his article Defects in CSF pathways and
unclassified mental retardation examining causes and
effects of hydrocephalus and the relationship between
degree of hydrocephalus and intellectual deficit. Dr.
L. Crome considers “Non-specific Developmental
Abnormalities and Unclassified Mental Retardation”
and stresses the relative non-specificity of structural
change related to a wide range of harmful factors that
lies between inability and normal mentality. Professor
Jellinger deals with “Neuropathological features of
unclassified mental retardation” finding that the
majority of children with the more severe degrees of
mental retardation show structural brain lesions.
Overall a worthwhile collection of papers by people
with a worthwhile concern for and opinion about
mental handicap. Some confusion of definition and
an amazingly difficult field to define. A book for the
specialist, the library and the year, 1972.
Evan Jones,
Consultant Psychiatrist,
Lea Castle Hospital
23
Assessment for Learning in the Mentally Handicapped.
Editor: Peter Mittler. (Churchill Livingstone, 1973.
E5.50.)
This book is the fifth volume in a series stemming
from study groups on different aspects of handicap,
organised by the Institute for Research into Mental
Retardation.
The study group held five sessions covering assess-
ment strategies, content of assessment, treatment
programmes for children and adults, and recent and
future developments.
There are twelve individual contributions, each
followed by a transcript of the study group’s discussion.
Although this may be appropriate for a study group,
some readers may feel that the space devoted to
discussion could have been used more profitably.
Members of the group were fairly evenly divided
between research workers and practitioners in the
field, and one feels that this dichotomy is often seen
clearly in the discussions.
Mittler introduces the topic by discussing the social
and political implications of the current interest in
assessment of the handicapped. H e suggests that
psychologists must begin by examining their own roIe
and methods, and must consider if some traditional
activities should be discarded. H e reviews alternative
approaches to the formal psychometric assessment,
and later contributors expand on these alternatives.
Clarke and Clarke present evidence of the complete
failure of “single-shot’’ sampling to provide useful
long term guidance for the severly subnormal, and
this, coupled with the practical alternatives offered to
such inadequate procedures, must surely persuade
many practitioners to make a much firmer attempt to
convince their administrative colleagues that rushing
in and out of schools and clinics will never enable
worthwhile work to be done with the severely sub-
normal.
Throughout the book there is a general acknowledg-
ment of the inadequacy of most widely used assessment
procedures, although it appears that some contributors
would prefer current procedures to be modified, rather
than a much broader application of techniques to be
developed in experimental situations. The futility of
separating assessment from treatment is generally
recognised.
Topics covered in some depth include language,
personality assessment (a learning theory approach),
behaviour modification programmes, ethological tech-
niques of observation and functional analysis of
behaviour. All the contributors except Professor
and Dr. Bricker are British based.
Although there is some unevenness in the quality
of material presented, this book must encourage
practitioners and research workers to re-examine
their own approach to the assessment and treatment
of the handicapped. There are certainly more
questions posed than answered, but the overall picture
i s of a text which must encourage new developments
in the field. Certainly psychologists, psychiatrists and
educators - particularly those concerned with “assess-
ment centres” - must benefit from study of this
book.
Useful bibliographies are supplied.
A. C. M. Capie,
Principal Psychologist, Lea Castle Hospital.
24
NSMHC
publications
The LVcLtiorlulSociety for d4eritully Haiidicupped Chiltlreri
publishes books, reports, handbooks for both parents
and pi3ofessionalson a l l aspects of mental handicap.
Subnormality in the Seventies
A series arising out of and contributing to the growing
inter-disciplinary discussions on mental retardation.
Physicians, nurses, teachers, psychologists, therapists,
administrators, social workers will all find the series
a useful source of reference.
“The Quality of Care”
An account of a multi-disciplinary study tour in
Denmark in May 1970. It includes a summary of the
Danish provisions and excerpts from the training
curriculum for those working with young mentally
handicapped adults.
1971 64pp Price 50p
“The Team Approach”
A series of short papers presented at an inter-disciplinary
seminar in Leeds, 1971. Doctors, nurses, teachers,
therapists and administrators all contribute material of
a highly practical nature.
1971 98pp Price E1.OO
“Action for the Retarded”
Papers presented to the first Regional Conference of
the UK section of the World Federation of Mental
Health in Dublin, March 1971. Lively discussion on the
place of hospital care produced some controversial
views on the definition of a “hospital” and its future
role. Contributions from Scandinavia, Eire and UK.
1972 I21pp Price El.00
-
“Sexuality and Subnormality A Swedish View”
A translation of a booklet edited by Dr. Gregor Katz for
the Swedish National Board of Health and Welfare.
It examines relationships among the mentally
handicapped giving an honest and humane appraisal. It
will be of interest to all tho-se involved in the care and
education of the mentally handicapped.
1972 20pp Price 50p
“Eduaation and the Severely Handicapped Child”
Peter Cummings
A review of research and practice in the teaching and
training of severely mentally handicapped children
in hospitals for the subnormal.
1973 68pp Price 21.00
“Guide to Films on Mental Handicap”
Dr. Thomas L. Pilkington
The first comprehensive guide to films on mental
handicap available in Britain. Gives details of 174
films, classified by content and suggested audiences.
1973 38pp E1.OO
The Journal of Mental Deficiency Research
For consultants and research workers.
Editor: Dr. B. W. Richards.
Quarterly. E6.00 per annum.
Parent’s Voice
Quarterly publication for parents and professional
workers.
Editor: Christine Zwart. 50p per annum.
NSMHC Bookshop
The NSMHC Bookshop stocks a wide selection of books
on mental handicap from all over the world.
National Society for Mentally Handicapped Children,
Pembridge Hall, Pembridge Square, London, W2 4EP
5
Social Competence and Mental Handicap (2nd
Edition). Editor: H. C. Gunzburg. (Bailliere Tindall,
London, 1973. 238pp. E3.00.)
To those who ask the question “Is it really necessary
to read the second edition of a book which was
published five years ago?”, the answer is a firm yes -
even though most of its contents are unaltered and
some small sections of it are not free from criticism.
Dr. Gunzburg’s ideas and views on the need for and
content of a social education training programme
for the mentally handicapped are still as stimulating
and challenging to us all, and as applicable, as they
were in 1968.
This book sets out in some detail a programme of
training for mentally handicapped children and young
adults in those areas of social ability which are
essential for satisfactory living and working in the
community. It also clearly shows why, before the
programme can commence, there must be an accurate
and detailed assessment of a person’s social com-
petence in order to pinpoint his weak or missing areas
of such knowledge and skills.
A detailed explanation of the rationale behind and
development of the Progressive Assessment Charts is
given, and an indication of the part they can play in
assessment. There has been a considerable extension
of this section in the second edition in order to show
how the stated average achievement levels in the
social competence of mentally handicapped children
and adults were arrived at and the role they can play
in assessing progress, to clarify various points about
the PAC system, and to incorporate some recent and
important developments in it, e.g. the introduction of
the Primary Progress Assessment Chart and the
Progress Evaluation Indices.
The chapter The Framework is a disappointing one.
It is largely unaltered from the original and is not in
keeping with the forward-looking approach of the
rest of the book. It still refers to the need for
separate special care units for children who are
profoundly retarded, severely physically handicapped,
or have disturbed behaviour, when most, if not all of
these children, should surely be integrated into ESN(S)
schools. It states that the term “hospital school” is
a misnomer and there is a widespread tendency to
imitate the ordinary school approach and cling to an
academic curriculum in these schools. It still talks
of having a separate transition stage for children aged
13-plus to 18 years, and is somewhat pessimistic about
the adult training centres’ activities. It has not taken
into consideration the fact that the social education
training in adult training centres has developed since
1968.
However, these criticisms of one small section of the
book pale into insignificance when related to its
overall value. It has much to offer - not only to
teachers in ESN(S) schools and those engaged in social
education and training programmes for young
mentally handicapped adults in hospitals and the
community, but also to all concerned with their care
and education.
T. W. Pascoe, Headmaster,
Borocourt Hospital School, Reading.
Mental Retardation and Behavioural Research.
Institute for Research into Mental Retardation, Study
Group No. 4. Edited by A. D. B. Clarke and A. M.
Clarke. (Churchill Livingstone, 1973, 270 pp. E5.00.)
It is one of the unfortunate handicaps of the
publishing world that it takes so long for material to
appear in print that often by the time the reader
obtains his copy much of what he reads is already
outdated. This does not appear to be the case with
this book for, although taking nearly two years from
the date of the study group meetings, it has lost little
in the delay.
Professor Alan and Dr. Anne Clarke have drawn
together contributions from notable British workers
into a most readable and informative text. Each
chapter is an account of a study session in which two
prepared papers were discussed by a panel of experts.
The chairman’s remarks, and discussion comments
following each sessions, make up by far the most
exciting part of the book - so much so that they
could very nearly stand on their own merit.
Sessions of note include discussions of research
strategy and methodology, problems of institutional
management, teacher training and the learning process
in the young mentally handicapped. Individual
contributions of note are those of the Clarkes’ them-
selves discussing current problems and suggesting
possible solutions; Gunzburg has some sound
comments to make on the role of psychologists; Cave
discusses the training of teachers and, in doing so,
confirms a suspicion that whenever teacher training is
based upon a “discovery through free-play” philosophy
geared to nursery education, it is in many respects
largely irrelevant to the needs of severely subnormal
children. Drs. Clarke and Kiernan both expand this
point, producing some fruitful guidelines for future
policy. Cliff Cunningham presents a scholarly paper
on educational technology that elicits one of the most
productive discussion sessions of the whole study
group. Drs. Herriot and Serpell both concentrate on
academic erudition leaving the practical application to
others, but they, nevertheless, throw out many seeds
which may or may not fall on fertile ground.
25
 Language development is a sine qua non of such
symposia, and no one in this country can discuss it
better than Professor Mittler. He covers the area
from the specific research strategies involved to
discussion of practical intervention procedures to be
employed by teachers and parents alike. Brinkworth
presents an illuminating account of his novel work
with pre-school mongo1 children and their parents,
clearly filling a niche in present educational provisions
for such children.
The take-home message comes over clearly par-
ticularly from Professor Clarke himself, that structure
in learning so far outweighs any method used to date
that serious thought must be brought to bear on the
provision of buildings and staffing in order that the
individuals in our care can themselves benefit directly
from these researchers in far greater numbers than at
present. The ball is thrown clearly into the court of
the man holding the purse strings. One can only
hope he will be startled enough to loosen his grip on
the purse.
Following these presentations is a final discussion
paper and an overview, as though the book did not
know when to stop. This, however, proves to be
extremely valuable in drawing together the strands of
the various ideas presented until a whole is produced
that will surely prove invaluable to those working in
subnormality.
I do wonder, however, just how much someone in
the practical situation of having to “care” for large
numbers of individuals in large institutions is able to
extract from this book material of direct and relevant
use to his daily work at ward level. It is often the
case that research workers freely indulge in intellectual
banter whilst the behaviour of residents is actually
being controlled, shaped and modified, not by highly
trained academics, but by the nursing assistant, the
student and the domestic. Maybe one day a study
group can be formed by them to tell us about the
“behavioural sciences” and their relevance to
“practical probiems in mental retardation”. But who
would run the wards while they took three days off?
The research workers? I doubt it!
I n all, an excellent book and certainly one to be
re2d by anyone wishing to keep up with progress, but
the necessity for direct application into practical
terms so that everyone can benefit is sidestepped too
easily.
C. Williams, Research Psychologist,
Institute of Mental Subnormality.

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