Etextbook 978 1598571943 Children With Disabilities by Mark Batshaw M D

eTextbook 978-1598571943 Children
with Disabilities By Mark Batshaw M.D.

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DI SAB I L I TI E S / G E N E R A L D I SA B I L I T Y – P ED IAT R IC S
Batshaw
Roizen
Lotrecchiano
“Comprehensive in its overview of both the biomedical foundation of disabilities
and the psychosocial aspects of care...deserves to be on the desks and bookshelves
of those working in the health, education, and treatment communities.”
—Paul H. Lipkin, M.D., Johns Hopkins University School of Medicine
“A gem...clear, concise, and well written. I enthusiastically recommend

the seventh edition of Children with Disabilities for both practicing
professionals and students alike.”
—Heidi M. Feldman, M.D., Ph.D., Stanford University School of Medicine
“An invaluable resource covering the range of disabilities and interventions used
to treat them.... This new version remains an indispensable classic in the field.”
Children with
—Fred R. Volkmar, M.D., Yale University School of Medicine and Yale New Haven Hospital
Disabilities
C
omprehensive, authoritative information from the most WHAT’S NEW
respected experts: For 30 years, that’s what Children ■ All-new chapters on diagno-
with Disabilities has given the thousands of students, sis, neuropsychological as-
faculty, and professionals who rely on it. Bringing together the sessment, “new” disabilities
faced by survivors of previ-
latest research and developments, this seventh edition is the de-
ously fatal disorders, and
finitive compendium of knowledge about the critical issues pro- complementary and alterna-
fessionals will encounter in their work with children and families. tive medicine
■ 30+ new contributors from
Covering developmental, clinical, family, education, and inter- diverse fields
vention issues, Children with Disabilities retains and strengthens ■ Expanded chapters on
the student-friendly features of previous editions. Readers will autism and ADHD
get concise and accessible chapters, a helpful glossary, chapter ■ New developments in
overviews, case studies that bring key concepts to life, extensive neuroscience, genetics,
cross-referencing to make information easy to find, and resource and imaging
lists for every topic. ■ Greater focus on interdisci-
plinary collaboration
An unparalleled text from the leading voices in the disability field, ■ Considerations from the
DSM-5
Children with Disabilities is the cornerstone resource profession-
■ Thoroughly updated
als will keep year after year to support their important work with
content in every chapter
children and families.
ABOUT THE EDITORS: Mark L. Batshaw, M.D., is the “Fight for Children” Chair of Academic Medicine and Chief Academic
Officer at the Children’s National Medical Center in Washington, D.C., and Professor and Chairman of Pediatrics and Associ-
ate Dean for Academic Affairs at The George Washington University School of Medicine and Health Sciences in Washington,
D.C. Nancy J. Roizen, M.D., is Director of the Division of Developmental-Behavioral Pediatrics and Psychology at University
Hospital’s Rainbow Babies and Children’s Hospital in Cleveland. Gaetano R. Lotrecchiano, Ed.D., Ph.D., is a former Leadership
Education in Neurodevelopmental Disabilities Program Director and is Assistant Professor of Clinical Research and Leadership
and of Pediatrics at The George Washington University School of Medicine and Health Sciences, Washington, D.C.
90000
9 781598 571943 >

Contents vii
Ocular Development
Development of Visual Skills
Common Disorders of the Eye in Children with Disabilities
Disorders of the Visual Cortex
Strabismus and Ocular Motility Disorders
Refractive Errors in Children
Vision Assessment
Blindness
12 The Brain and Nervous System
Amanda Yaun, Robert Keating, and Andrea Gropman . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
The Brain and Spinal Cord
The Peripheral Nervous System
The Microscopic Architecture of the Brain
Techniques for Evaluating the Central Nervous System
13 Muscles, Bones, and Nerves
Peter B. Kang . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Components of the Neuromuscular and Musculoskeletal Systems
Symptoms and Signs of Neuromuscular and Musculoskeletal Disorders
Laboratory Testing and Radiography
Disorders of the Neuromuscular System
Disorders of the Musculoskeletal System
Principles for the Management of Neuromuscular and Musculoskeletal Disorders
14 Patterns in Development and Disability
Louis Pellegrino . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Defining Disability
Defining Development
Patterns in Development
Disturbances in Development
15 Diagnosing Developmental Disabilities
Scott M. Myers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Atypical Patterns of Development
Developmental Principles
Diagnostic Classification
The Diagnostic Process
16 Understanding and Using Neurocognitive Assessments
Lauren Kenworthy and Laura Gutermuth Anthony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
The Purpose of Neuropsychological Assessment
A Model for Developmental Neuropsychological Assessment
Domains of Functioning Assessed in Neuropsychological Evaluations
Ensuring that Assessment Informs Management
III Developmental Disabilities

17 Developmental Delay and Intellectual Disability
Bruce K. Shapiro and Mark L. Batshaw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Early Identification of Developmental Delay
Defining Intellectual Disability
Classification of Intellectual Disability
Prevalence of Intellectual Disability
Associated Impairments
viii Contents
Medical Diagnostic Testing

Psychological Testing
Treatment Approaches
18 Down Syndrome (Trisomy 21)
Nancy J. Roizen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Prevalence
Chromosomal Findings
Effects of Trisomy 21
Early Identification
Medical Complications in Down Syndrome
Neurodevelopment and Behavior
Evaluation and Treatment
Intervention
19 Inborn Errors of Metabolism
Mark L. Batshaw and Brendan Lanpher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Types of Inborn Errors of Metabolism
Mechanism of Brain Damage
Associated Disabilities
Diagnostic Testing
Newborn Screening
Therapeutic Approaches
20 Speech and Language Disorders
Sheela Stuart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Components of Communication
Typical Development of Speech and Language
Bilingualism
Communication Disorders
Assessment
Types of Communication Disorders
21 Autism Spectrum Disorders
Susan L. Hyman and Susan E. Levy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
Diagnostic Categories within the Autism Spectrum
Diagnostic Features of Autism Spectrum Disorders
Causes of Autism Spectrum Disorders
Epidemiology of Autism Spectrum Disorders
Early Identification of Autism Spectrum Disorders
Associated Conditions
22 Attention Deficits and Hyperactivity
Marianne Glanzman and Neelam Sell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
Diagnosis and Attention-Deficit/Hyperactivity Disorder Subtypes
Prevalence and Epidemiology
Clinical Presentation
Common Coexisting Conditions
Associated Impairments
Causes of Attention-Deficit/Hyperactivity Disorder
The Evaluation Process
Treatment of Attention-Deficit/Hyperactivity Disorder
Treatment with Coexisting Conditions
Alternative Therapies
Contents ix
23 Specific Learning Disabilities

M.E.B. Lewis, Bruce K. Shapiro, and Robin P. Church . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Defining Learning Disorders
Response to Intervention
Prevalence
Specific Reading Disability
Specific Mathematics Disability
Impairments Associated with Specific Learning Disabilities
Health Problems Simulating Specific Learning Disabilities
Assessment Procedures
Intervention Strategies
24 Cerebral Palsy
Alexander H. Hoon, Jr., and Frances Tolley . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423
What Is Cerebral Palsy?
What Causes Cerebral Palsy?
Epidemiology
Risk Factors
Diagnosis
Subtypes of Cerebral Palsy
Establishing the Etiology (Cause) of Cerebral Palsy
Associated Impairments in Cerebral Palsy
Comprehensive Management for Individuals with Cerebral Palsy
25 Neural Tube Defects
Gregory S. Liptak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451
Prevalence of Neural Tube Defects
The Origin of Neural Tube Defects
Prevention of Neural Tube Defects Using Folic Acid Supplementation
Prenatal Diagnosis
Treatment of Meningomyelocele in the Newborn Period
Primary Neurological Impairments in Children with Meningomyelocele
Associated Impairments and Medical Complications
Educational Programs
Psychosocial Issues for the Child
Interdisciplinary Management
26 Traumatic Brain Injury
Melissa K. Trovato and Scott C. Schultz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473
Incidence of Traumatic Brain Injury
Causes of Traumatic Brain Injury
Types of Brain Injuries
Concussions
Detection of Traumatic Brain Injury
Severity of Traumatic Brain Injury
Acute Treatment of Traumatic Brain Injury
Rehabilitation of Children with Traumatic Brain Injury
Outcome of Moderate to Severe Traumatic Brain Injury
27 Epilepsy
Tesfaye Getaneh Zelleke, Dewi Francis T. Depositaro-Cabacar,
and William Davis Gaillard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Epilepsy: Definitions and Classification
Diagnosis and Evaluation
Treatment
Multidisciplinary Care
x Contents
28 The New Face of Developmental Disabilities

Nancy J. Roizen and Adrienne S. Tedeschi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507
Sickle-Cell Disease
Cancer: Acute Lymphocytic Leukemia and Brain Tumors
Human Immunodeficiency Virus
Chronic Kidney Disease
29 Behavioral and Psychiatric Disorders in Children with Disabilities
Adelaide Robb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523
Prevalence of Psychiatric Disorders Among Children
with Developmental Disabilities of Specific Etiologies
Causes of Psychiatric Disorders in Developmental Disabilities
Psychiatric Disorders of Childhood and Adolescence
Vulnerability
Evaluation
Treatment
IV Interventions, Families, and Outcomes

30 Early Intervention
Toby Long . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 547
Principles of Early Intervention
Research Support for the Value of Early Intervention
Components of Part C of the Individuals
with Disabilities Education Improvement Act:
The Infants and Toddlers with Disabilities Program
Status of Early Intervention Services
Future Considerations
31 Special Education Services
Elissa Batshaw Clair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 559
Eligibility for Special Education
Special Education: A Description
The Individualized Education Program
Services Provided by Special Education Teachers
The Role of the Special Education Teacher in the General Education Curriculum
General Education Legislation Affecting Special Education Teachers
The School–Parent Connection
32 Behavior Principles, Assessment, and Therapy
Michael F. Cataldo, SungWoo Kahng, Iser G. DeLeon,
Brian K. Martens, Patrick C. Friman, and Marilyn Cataldo . . . . . . . . . . . . . . . . . . . . . . . 579
Operant Learning Principles and Practices
Behavioral Assessment of Problem Behaviors
Functional Assessment and Treatment Development
Preference Assessment and Reinforcer
Evaluation: From Basic Principle to Application
Common Behavior Problems
Severe Problem Behaviors
Practical Strategies for the Classroom
Behavioral Teaching Strategies
Behavioral Instruction Programs
33 Occupational and Physical Therapy
Philippa Campbell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 599
Therapy Types and Purposes
Contents xi
Intervention Frameworks Used by Physical and Occupational Therapists

Team Structures and Therapist Roles
Features of Pediatric Therapy Services and the Role of Therapists
Intervention Strategies
Evidence-Based Intervention
34 Physical Activity, Exercise, and Sports
Donna Bernhardt Bainbridge and James Gleason . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613
Health Risks of Children with Disabilities Related to a Lack of Physical Activity
Considerations for Specific Disabilities
Community Programs
Policies Affecting Participation in Physical Activity
Choice and Preparation for Physical Activity, Exercise, or Sports
Injury Risk in Children
35 Oral Health Care
H. Barry Waldman, Steven P. Perlman, and George Acs . . . . . . . . . . . . . . . . . . . . . . . . . . 631
Eruption of Teeth
Problems Affecting Development of Teeth
Contributing Factors to Oral Conditions of Individuals with Disabilities
Oral Diseases
Malocclusion
Prevention of Dental Caries and Periodontal Disease
Providing Dental and Orthodontic Treatment
Special Issues Regarding Dental Care
for Children with Specific Developmental Disabilities
The Challenge of Providing Dental Services to Individuals with Disabilities
36 Assistive Technology
Larry W. Desch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 641
Definitions and Overview
Technology for Medical Assistance
Assistive Technology for Disabilities—Principles and Examples
Assessment for Assistive Technology
Effects of Assistive Technology on the Family and Community
37 Caring and Coping: Helping the Family of a Child with a Disability
Michaela L. Zajicek-Farber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 657
Understanding Family Systems
How Families Cope with the Diagnosis
Long-Term Effects on the Parents
Effects on Siblings
Effects on the Extended Family
Effects on the Child with a Disability
Principles of Family-Centered Care: Role of the Professional
The Role of Society and Community
38 Complementary and Alternative Therapies
Michelle H. Zimmer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 673
Evidence of Treatment Efficacy
Approaches to Advising Families About Complementary and Alternative Medicine
39 Ethical Considerations
Kruti Acharya, Michelle Huckaby Lewis, and Peter J. Smith . . . . . . . . . . . . . . . . . . . . . . . 681
Basic Ethical Principles
The Relationship Between Law and Ethics
Ethical Dilemmas
xii Contents
Institutional Ethics Committees

Protection of Human Subjects in Research
40 Future Expectations: Transition from Adolescence to Adulthood
Nienke P. Dosa, Patience H. White, and Vincent Schuyler . . . . . . . . . . . . . . . . . . . . . . . . . 691
General Principles of Transition
Moving Toward Independence: Self-Determination
Moving from School to Work
Moving from Home into the Community
Moving from Pediatric- to Adult-Oriented Health Care
41 Health Care Delivery Systems and Financing Issues
Angelo P. Giardino and Renee M. Turchi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 705
The Concept of a Medical Home
Importance of Coordination of Care
Changes in Financing Health Care for CYSHCN
Looking Toward the Future
Appendix A Glossary
Arlene Gendron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 719
Appendix B Syndromes and Inborn Errors of Metabolism
Kara L. Simpson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 757
Appendix C Commonly Used Medications
Michelle L. Bestic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 803
Appendix D Childhood Disabilities Resources, Services, and Organizations . . . . . . . . . . 819
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 843
About the Online
Companion Materials
Attention Instructors! Online companion materials are available to help you teach a course
using Children with Disabilities, Seventh Edition.
Please visit www.brookespublishing.com/batshaw to access
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• All original illustrations from the book downloadable for easy use in your PowerPoint pre-
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• Study questions for every chapter to help students check their knowledge of key concepts
• Extension activities for class use, group projects, and homework to help students apply the
information from the text
• Extended case studies to enrich discussions of how concepts are interconnected
• Sample syllabi from various fields to help you determine what chapters and sequence best
suits the needs of your course
• Resource listings with functional links for easy access
xiii
About the Editors
Mark L. Batshaw, M.D., is the “Fight for Nancy J. Roizen, M.D., is Director of the
Children” Chair of Academic Medicine and Division of Developmental-Behavioral Pedi-
Chief Academic Officer at the Children’s atrics and Psychology at University Hospi-
National Medical Center (CNMC) in Wash- tal’s Rainbow Babies and Children’s Hospital
ington, D.C., and Professor and Chairman of in Cleveland. She is certified in neurodevel-
Pediatrics and Associate Dean for Academic opmental disabilities and in developmental
Affairs at The George Washington Univer- behavioral pediatrics.
sity School of Medicine and Health Sciences Dr. Roizen received her B.S. and M.D.
in Washington, D.C. degrees from Tufts University. After com-
Dr. Batshaw is a board-certified neuro- pleting an internship in pediatrics at Mas-
developmental pediatrician who has treated sachusetts General Hospital, she did a
children with developmental disabilities for residency in pediatrics at The Johns Hop-
more than 35 years. In 2006, Dr. Batshaw kins Hospital. Her fellowships were in neu-
received both the Capute Award for notable rodevelopmental disabilities at the Kennedy
contributions to the field of children with Krieger Institute and in developmental and
disabilities by the American Academy of behavioral pediatrics at University of Califor-
Pediatrics and the Distinguished Research nia, San Francisco. She then was a staff phy-
Award from The Arc. sician at the Child Development Center at
Before moving to Washington in 1998, Oakland Children’s Hospital for 8 years, fol-
he was Physician-in-Chief of Children’s Sea- lowed by 16 years as Chief of the Section of
shore House, the child development and Developmental Pediatrics at the University
rehabilitation institute of The Children’s of Chicago. Then, at SUNY Upstate Medi-
Hospital of Philadelphia. Dr. Batshaw is a cal University, she was Vice Chair of Pediat-
graduate of the University of Pennsylvania rics, Professor of Pediatrics, and Chief of the
and of the University of Chicago Pritzker Division of Neurosciences for 4 years. Next
School of Medicine. Following pediatric res- stop was the Cleveland Clinic, where she
idency at the Hospital for Sick Children in was the Chief of the Department of Develop-
Toronto, he completed a fellowship in devel- mental Pediatrics and Physiatry for 2 years.
opmental pediatrics at the Kennedy Krieger Dr. Roizen has published more than 100
Institute at The Johns Hopkins Medical articles, chapters, and reviews on her clinical
Institutions. and research interests in Down syndrome and
Dr. Batshaw continues to pursue his hearing loss, and on collaborations in con-
research on innovative treatments for inborn genital toxoplasmosis and velocardiofacial
errors of metabolism, including gene ther- syndrome. She lives in Shaker Heights, Ohio,
apy. He has published more than 150 articles, with her husband. They have a daughter who
chapters, and reviews on his research inter- is working on a postdoctorate fellowship in
ests and on the medical aspects of the care organic chemistry at Stanford University and
of children with disabilities. Dr. Batshaw was a son who is a fellow in pediatric endocrinol-
the founding editor-in-chief (1995–2001) of ogy at Children’s Hospital of Philadelphia.
the journal Mental Retardation and Develop-
mental Disabilities Research Reviews.
Dr. Batshaw lives in Washington, D.C. Gaetano R. Lotrecchiano, Ed.D., Ph.D., is
He and his wife Karen have three children a former Leadership Education in Neurode-
and six grandchildren. velopmental Disabilities Program Director
xiv
About the Editors xv
and is presently Academic Director of Trans- of Education for the Khalifa Bin Zayed al
lational Science Programs as Assistant Pro- Nehyan Foundation initiative to create a
fessor of Clinical Research and Leadership sustainable rehabilitation center and profes-
and of Pediatrics at The George Washington sional education in the Eastern United Arab
University School of Medicine and Health Emirates. Dr. Lotrecchiano focuses on pro-
Sciences, Washington, D.C. fessional development through his dedication
Dr. Lotrecchiano received a Ph.D. in to those who care for children with special
ethnomusicology in 2005 from the Univer- needs. As a result, his scholarly interests have
sity of Maryland and an Ed.D. in human and focused on complexity leadership, transdisci-
organizational learning in 2012 from The plinarity team science, and blended-learning
George Washington University Graduate models in professional development, which
School of Education and Human Devel- he feels are key aspects of contemporary pro-
opment. He is a member of the Center fessional health care. Recently recognized as
for Neuroscience Research at Children’s a Morton A. Bender Teaching Scholar, Dr.
National Medical Center and the Center for Lotrecchiano has dedicated his entire career
the Study of Learning at The George Wash- to excellence in teaching and instruction. His
ington University. He has served in a number recent published material is in the Interna-
of positions administering disabilities and tional Journal of Transdisciplinary Research and
rare disease programs throughout his career, VINE: The Journal of Information and Knowl-
including the Intellectual and Developmen- edge Management Systems and Integral Leader-
tal Disabilities Research Center (IDDRC), ship Review. Dr. Lotrecchiano and his partner
the Rare Diseases Clinical Research Center Paul live in Beltsville, Maryland, with a his-
(RCDRC), and the Child Health Research toric home in Snow Hill, in the lower Del-
Center (CHRC). Presently, he is the Director marva Peninsula.
Contributors
Kruti Acharya, M.D. Michael J. Bina, Ed.D.
Assistant Professor of Pediatrics and President
Medicine The Maryland School for the Blind
University of Chicago 3501 Taylor Avenue
950 East 61st Street, SSC Suite 207 Baltimore, MD 21236
Chicago, IL 60637
Pamela Buethe, Ph.D.
George Acs, D.M.D, M.P.H Director of Audiology
ACS Consulting and Publishing Children’s National Medical Center
7120 Chilton Court Children’s Hearing and Speech Center
Clarksville, MD 21029 111 Michigan Avenue, NW
Washington, D.C. 20010
Laura Gutermuth Anthony, Ph.D.
Assistant Professor Philippa H. Campbell, Ph.D.
The George Washington University School Professor
of Medicine and Health Sciences Thomas Jefferson University
Children’s National Medical Center 6th Floor Edison, Suite 663
111 Michigan Avenue, NW 130 South 9th Street
Washington, D.C. 20010 Philadelphia, PA 19107
Marilyn Cataldo, M.A.

Donna Bernhardt Bainbridge, B.S., M.S., Director of Behavioral Services in Education
Ed.D. Case Manager (Educational Manager &
Special Olympics Global Advisor for Clinical Instructor)
FUNfitness & Fitness Programming, Kennedy Krieger Institute
Faculty, MPH Program, University of 707 North Broadway
Montana Baltimore, MD 21205
Adjunct Faculty, University of Indianapolis
Special Olympics, Universities of Montana Michael F. Cataldo, Ph.D.
and Indianapolis Director of Behavioral Psychology
1133 19th Street, NW Kennedy Krieger Institute
Washington, D.C. 20036 707 North Broadway
Baltimore, MD 21205
Stephen Baumgart, M.D., FAAP
Senior Staff Physician Taeun Chang, M.D.
Professor of Pediatrics Director, Neonatal Neurology
Department of Neonatology, Children’s Children’s National Medical Center
Hospital National Medical Center 111 Michigan Avenue, NW
The George Washington University Washington, D.C. 20010
111 Michigan Avenue, NW
Washington, D.C. 20010 Robin P. Church, Ed.D.
Senior Vice President for Education
Michelle Bestic, Pharm.D. Associate Professor of Education
Clinical Pharmacologist/Toxicologist Kennedy Krieger Institute
Akron Children’s Hospital Johns Hopkins University
1 Perkins Square 3825 Greenspring Avenue
Akron, OH 44308 Baltimore, MD 21211
xvi
Contributors xvii
Elissa Batshaw Clair, Ed.S., M.Ed. Patrick C. Friman, Ph.D., ABPP

School Psychologist Director of the Boys Town Center for
Special School District Behavioral Health
12110 Clayton Road Boys Town
St. Louis, MO 63131 Youth Care Building
13603 Flanagan Boulevard
Iser DeLeon, Ph.D. Boys Town, NE 68010
Associate Professor
Kennedy Krieger Institute
Johns Hopkins University School of William Davis Gaillard, M.D.
Medicine Professor, Neurology and Pediatrics
3825 Greenspring Avenue Chief Division Neurophysiology, Epilepsy,
Baltimore, MD 21211 Critical Care Neurology
The George Washington University Medical
Dewi Frances T. Depositario-Cabacar, M.D. Center
Assistant Professor, Neurology and Children’s National Medical Center
Pediatrics 111 Michigan Avenue, NW
The George Washington University Medical Washington, D.C. 20010
Center
Children’s National Medical Center
111 Michigan Avenue, NW Chrysanthe Gaitatzes, M.D., Ph.D.
Washington, D.C. 20010 Neonatology Attending Physician
Holy Cross Hospital
Larry W. Desch, M.D. 1500 Forest Glen Road
Clinical Associate Professor of Pediatrics, Silver Spring, MD 20910
Director of Developmental Pediatrics
Chicago Medical School, Rosalind Franklin Brooke E. Geddie, D.O.
University Pediatric Ophthalmologist
Advocate Hope Children’s Hospital Helen DeVos Children’s Hospital
4440 West 95th Street 330 Barclay, Suite 104, MC 183
Oak Lawn, IL 60453 Grand Rapids, MI 49503
Nienke P. Dosa, M.D., M.P.H.
Associate Professor of Pediatrics Arlene Gendron
Center for Development, Behavior and Project Lead
Genetics Children’s National Medical Center
Department of Pediatrics 111 Michigan Avenue, NW
SUNY Upstate Medical University Washington, D.C. 20010
750 East Adams Street
Syracuse, New York 13210
Angelo P. Giardino, M.D., Ph.D., M.P.H.
Adré du Plessis, M.D., MBChB, M.P.H. Chief Medical Officer/Clinical Professor
Chief of Fetal and Transitional Medicine, Texas Children’s Health Plan/Baylor College
Children’s National Medical Center, of Medicine
Professor of Pediatrics and Neurology 2450 Holcombe Boulevard, Suite 34L
The George Washington University School Houston, TX 77021
of Medicine
Washington, D.C. 20010 Marianne M. Glanzman, M.D.
Clinical Associate Professor of Pediatrics
Peggy S. Eicher, M.D. Division of Child Development
Medical Director, Center for Pediatric Rehabilitations and Metabolism
Feeding and Swallowing Disorders The Children’s Hospital of Philadelphia
St. Joseph’s Children’s Hospital The University of Pennsylvania School of
DePaul Ambulatory Care Center Medicine
11 Getty Avenue 3550 Market Street, 3rd Floor
Paterson, NJ 07503 Phildelphia, PA 19104
xviii Contributors
James Gleason, PT, M.S. Peter B. Kang, M.D.

Associate Director, University Centers for Director, EMG Laboratory
Excellence in Developmental Disabilities Assistant Professor of Neurology
Eunice Kennedy Shriver Center Children’s Hospital Boston
University of Massachusetts Medical School Harvard Medical School
200 Trapelo Road Department of Neurology
Waltham, MA 02452 300 Longwood Avenue
Boston, MA 02115
Andrea Gropman, M.D.
Associate Professor
The George Washington University of the Robert F. Keating, M.D.
Health Sciences Professor and Chief
Children’s National Medical Center Children’s National Medical Center
Department of Neurology The George Washington University School
111 Michigan Avenue, NW of Medicine
Washington, D.C. 20010 111 Michigan Avenue, NW
Rebecca M. Haesler, M.S., RD, LD

Clinical Dietitian Lauren Kenworthy, Ph.D.
Texas Children’s Hospital Pediatric Neuropsychologist
6621 Fannin St. Director, Center for Autism Spectrum
Houston, TX 77030 Disorders
Associate Professor Pediatrics, Neurology,
Gilbert R. Herer, Ph.D., CCC-A/SLP Psychiatry
Director Emeritus, Children’s Hearing and Children’s National Medical Center
Speech Center The George Washington University Medical
Children’s National Medical Center, School
Professor Emeritus of Pediatrics 111 Michigan Avenue, NW
Brendan Lanpher, M.D.
Assistant Professor of Pediatrics
Alexander H. Hoon, Jr., M.D., M.P.H. Division of Genetics and Metabolism
Director, Phelps Center for Cerebral Palsy The George Washington University
and Neurodevelopmental Medicine Children’s National Medical Center
Kennedy Krieger Institute 111 Michigan Avenue, NW
3825 Greenspring Avenue Washington, D.C. 20010
Baltimore, MD 21211
Susan L. Hyman, M.D. Susan E. Levy, M.D.

Associate Professor of Pediatrics Associate Professor of Pediatrics
University of Rochester School of Medicine The Children’s Hospital of Philadelphia
Division of Neurodevelopmental and The University of Pennsylvania School of
Behavioral Pediatrics Medicine
Box 671 3550 Market Street, 3rd Floor
601 Elmswood Avenue Philadelphia, PA 19104
Rochester, NY 14642
SungWoo Kahng, Ph.D. M.E.B. Lewis, Ed.D.

Senior Behavior Analyst Director, Education Projects
Kennedy Krieger Institute Kennedy Krieger Institute
3825 Greenspring Avenue 3825 Greenspring Avenue
Baltimore, MD 21211 Baltimore, MD 21211
Contributors xix
Michelle Huckaby Lewis, M.D., J.D. Jerome A. Paulson, M.D.

Research Scholar Director, Mid-Atlantic Center for Children’s
Genetics and Public Policy Center, Berman Health & the Environment
Institute of Bioethics Children’s National Medical Center
Johns Hopkins University The George Washington University Schools
1717 Massachusetts Avenue, NW of Medicine and Public Health
Washington, D.C. 20036 2233 Wisconsin Avenue, NW, Suite #317
Gregory S. Liptak, M.D., M.P.H. Joan E. Pellegrino, M.D.

Upstate Foundation Professor of Pediatrics Associate Professor of Pediatrics
SUNY Upstate Medical University SUNY Upstate Medical University
Syracuse, NY 750 East Adams Street
Syracuse, NY 13210
Toby M. Long, Ph.D. Louis Pellegrino, M.D.

Associate Professor Assistant Professor of Pediatrics
Director of Training SUNY Upstate Medical University
Director of Physical Therapy Department of Pediatrics
Georgetown University 750 East Adams Street
Department of Pediatrics Syracuse, NY 13210
Center for Child and Human Development
Box 571485 Steven Perlman, D.D.S., M.Sc.D., D.H.L
Washington, D.C. 20057-1485 (Hon.)
Professor of Pediatric Dentistry
Boston University School of Dentistry
Brian K. Martens, Ph.D. Global Clinical Advisor and Founder
Professor of Psychology Special Olympics Special Smiles
Syracuse University 77 Broad Street
Department of Psychology Lynn, MA 01902
430 Huntington Hall
Syracuse, NY 13244-2340 Khodayar Rais-Bahrami, M.D.
Director, Neonatal-Perinatal Medicine
Fellowship Program
Marijean Miller, M.D. Children’s National Medical Center
Associate Professor The George Washington University School
Ophthamology and Pediatrics of Medicine
Children’s National Medical Center 111 Michigan Avenue, NW
Washington, D.C. 20010 Adelaide Robb, M.D.
Associate Professor Psychiatry and Pediatrics
Jocelyn Mills, RD, CSP, LD The George Washington University
Senior Pediatric Clinical Dietitian 111 Michigan Avenue, NW
Texas Children’s Hospital Washington, D.C. 20010
6621 Fannin Street
Houston, TX 77030 Rhonda L. Schonberg, M.S.
Clinical Instructor
The George Washington University School
Scott M. Myers, M.D. of Medicine and Health Sciences
Neurodevelopmental Pediatrician Genetic Counselor and Coordinator
Geisinger Health System Division of Fetal and Transitional Medicine
Clinical Assistant Professor of Pediatrics Division of Genetics and Metabolism
Temple University School of Medicine Children’s National Medical Center
100 North Academy Avenue 111 Michigan Avenue, NW
Danville, PA 17822 Washington, D.C. 20010
xx Contributors
Scott C. Schultz, M.D. Sheela L. Stuart, Ph.D., CCC-SLP

Instructor Director, Children’s Hearing and Speech
Kennedy Krieger Institute Center
John Hopkins School of Medicine Children’s National Medical Center
707 North Broadway The George Washington University
Baltimore, MD 21205 111 Michigan Avenue, NW
Vincent Schuyler, B.S., FABDA
Director, Quality & Community
Adrienne S. Tedeschi, M.D.
Partnerships
Fellow, Developmental-Behavioral Pediatrics
Goldberg Center for Community Pediatric
Division of Developmental-Behavioral
Health,
Pediatrics and Psychology
Rainbow Babies and Children’s Hospital
Director
11100 Euclid Avenue, Walker Building,
District of Columbia Partnership to Improve
Suite 3150
Children’s Health Care Quality
Cleveland, OH 44106
Frances Tolley, R.N., B.S.N.
Neelam Sell, M.D. Nurse Clinician, Phelps Center for Cerebral
Fellow, Developmental-Behavioral Pediatrics Palsy and Neurodevelopmental Medicine
The Children’s Hospital of Philadelphia Kennedy Krieger Institute
3350 Market Street, 3rd Floor 801 North Broadway
Phildelphia, PA 19104 Baltimore, MD 21205
Bruce K. Shapiro, M.D.

Melissa K. Trovato, M.D.
The Arnold J. Capute, M.D., M.P.H.
Assistant Profeesor
Chair in Neurodevelopmental Disabilities
Professor of Pediatrics
John Hopkins School of Medicine
The Johns Hopkins University School of
707 North Broadway
Medicine
Baltimore, MD 21205
Vice President, Training
707 North Broadway Renee M. Turchi, M.D., M.P.H.
Baltimore, MD 21205 Associate Professor of Pediatrics and
Community Health and Prevention
Billie Lou Short, M.D. St. Christopher’s Hospital for Children
Chief, Division of Neonatology Drexel University School of Public Health
Professor of Pediatrics 3601 A Street
Children’s National Medical Center Philadelphia, PA 19134
The George Washington School of Medicine
Washington, D.C. 20010 Betty Vohr, M.D.
Director of Neonatal Follow-up
Professor of Pediatrics
Kara L. Simpson, M.S., CGC Women & Infants Hospital
Certified Genetic Counselor Alpert Medical School of Brown University
Children’s National Medical Center Division of Neonatology
111 Michigan Avenue, NW, #1950 101 Dudley Street
Washington, D.C. 20010 Providence, RI 02905
Peter J. Smith, M.D., M.A.
Assistant Professor of Pediatrics H. Barry Waldman, D.D.S., M.P.H., Ph.D.
University of Chicago Distinguished Teaching Professor
950 East 61st Street Stony Brook University School of Dental
SSC Suite 207 Medicine
Chicago, IL 60637 Stony Brook, NY 11794
Contributors xxi
Patience H. White, M.D., M.A. Tesfaye Getaneh Zelleke, M.D.

Vice President, Public Health Assistant Professor of Pediatrics and
Arthritis Foundation Neurology
Professor of Medicine and Pediatrics The George Washington University
The George Washington University School Children’s National Medical Center
of Medicine and Health Sciences 111 Michigan Avenue, NW
1615 L Street, NW Suite 320 Washington, D.C. 20010
Michelle H. Zimmer, M.D.
Amanda L. Yaun, M.D. Assistant Professor of Pediatrics
Assistant Professor, Neurosurgery Cincinnati Children’s Medical Center
Children’s National Medical Center 3430 Burnet Avenue MLC 4002
111 Michigan Avenue, NW Cincinnati, OH 45229
Michaela L. Zajicek-Farber, M.S.W., Ph.D.

Associate Professor
The Catholic University of America,
National Catholic School of Social Service
Shahan Hall #112
620 Michigan Avenue, NE
A Personal Note to the Reader
As it enters its seventh edition, Children with Nancy dates back to our training at Hopkins.
Disabilities has continued to evolve. The first Based on our areas of expertise, we divided
edition was derived from lectures I gave for the book up. I took the sections As Life
a special education course I taught at The Begins and The Developing Child, Nancy
Johns Hopkins University in Baltimore. The focused on Developmental Disabilities, and
book contained 23 chapters, and I authored Guy edited the chapters in the section Inter-
or co-authored virtually all of them. When I ventions, Families, and Outcomes.
started writing the first edition I was 3 years The book has also become somewhat of
out of my neurodevelopmental disabilities a family affair. My daughter Elissa, a special
fellowship training program, and I thought education teacher and school psychologist,
I knew everything about developmental dis- authored the chapter “Special Education
abilities! I also considered myself an expert in Services.” And Drew has continued his auto-
my own children’s development, having just biographical letters concerning the effect of
welcomed into our family our third child, attention-deficit/hyperactivity disorder on
Andrew. his life.
With this edition of the book the number It has been both personally and profes-
of chapters and pages has basically doubled sionally very rewarding to develop this book
since its inception, and I have authored but a over the past 30 years. Many of those rewards
few chapters. I have recognized the need for have come from the students, colleagues,
additional help and counsel and have brought and parents who have shared with me their
on two valued colleagues, Dr. Gaetano R. thoughts and advice about the book. It is my
Lotrecchiano and Dr. Nancy J. Roizen, to hope that Children with Disabilities will con-
coedit the book with me. Guy directed our tinue to fill the needs of its diverse users for
Leadership Education in Neurodevelop- many years to come.
mental Disabilities (LEND) program at
Children’s National, and my friendship with Mark L. Batshaw
xxii
Preface
One of the first questions asked about a resource, parents, grandparents, siblings, and
subsequent edition of a textbook is “What’s other family members and friends have used
new?” The challenge of determining what to the book. They have found useful informa-
revise, what to add, and, in some cases, what tion on the medical and rehabilitative aspects
to delete is always significant in preparing a of care for the child with developmental dis-
new edition in a field changing as rapidly as abilities.
developmental disabilities. Since the publi-
cation of the sixth edition in 2007, advances FEATURES FOR THE READER
in the fields of neuroscience and genetics We have been told that the strengths of previ-
have greatly enhanced our understanding of ous editions of this book have been the acces-
the brain and inheritance. This brings forth sible writing style, the clear illustrations, and
opportunities for treatments previously not the up-to-date information and references.
thought possible for children with devel- We have dedicated our efforts to retaining
opmental disabilities. The human genome these strengths. Some of the features you will
has been mapped and the brain probed by find include the following:
functional imaging techniques. The need to • Teaching goals—Each chapter begins with
examine and explain this increased knowl- learning objectives to orient you to the
edge and its significance for children with content of that particular chapter.
disabilities has necessitated an increase in the
depth and breadth of the subjects covered in • Situational examples—Most chapters include
the book. Yet, while the book is now more one or more stories, or case studies, to help
expansive and has several new chapters, we bring alive the conditions and issues dis-
have worked hard to ensure that it retains its cussed in the chapter.
clarity and cohesion. Its mission continues • Key terms—As medical terms are intro-
to be to provide the individual working with duced in the text, they appear in boldface
and caring for children with disabilities the type at their first use; definitions for these
necessary background to understand differ- terms appear in the Glossary (Appendix A).
ent disabilities and their treatments, thereby • Illustrations and tables—More than 200
enabling affected children to reach their full drawings, photographs, x rays, imaging
potential. scans, and tables reinforce the points of
the text and provide ways for you to more
THE AUDIENCE
easily understand and remember the
Since it was originally published, Children material you are reading.
with Disabilities has been used by students in
a wide range of disciplines as a medical text- • Summary—Each chapter closes with a
book addressing the impact of disabilities on final section that reviews its key elements
child development and function. It has also and provides you with an abstract of the
served as a professional reference for special covered material.
educators, general educators, physical thera- • References—The reference list accompa-
pists, occupational therapists, speech-lan- nying each chapter can be thought of as
guage pathologists, psychologists, child-life more than just a list of the literature cited
specialists, social workers, nurses, physicians, in the chapter. These citations include
advocates, and others who provide care for review articles, reports of study find-
children with disabilities. Finally, as a family ings, research discoveries, and other key
xxiii
xxiv Preface
references that can help you find addi- development, the birth process, and prema-
tional information. turity are explained. The next section of the
• Appendixes—In addition to the Glossary, book, The Developing Child, covers environ-
there are three other helpful appendi- mental causes of developmental disabilities
ces 1) Syndromes and Inborn Errors of and examines the various organ systems—how
Metabolism, a mini-reference of pertinent they develop and work and what can go wrong.
information on inherited disorders causing Nutrition, vision, hearing, language, patterns
developmental disabilities; 2) Commonly of development, and the brain and muscu-
Used Medications, to describe indica- loskeletal systems are discussed in individual
tions and side effects of medications often chapters. As its title implies, the third section,
prescribed for children with disabilities; Developmental Disabilities, provides compre-
and 3) Childhood Disabilities Resources, hensive descriptions of various developmental
Services, and Organizations, a directory disabilities and genetic syndromes causing dis-
of a wide range of national organizations, abilities and includes chapters on intellectual
federal agencies, information sources, self- disability, Down syndrome, inborn errors of
advocacy and accessibility programs, and metabolism, psychiatric disorders in develop-
support groups that can provide assistance mental disabilities, autism spectrum disorders,
to families and professionals. attention-deficit/hyperactivity disorder, spe-
cific learning disabilities, cerebral palsy, neu-
CONTENT ral tube defects, epilepsy, and traumatic brain
In developing this seventh edition, we have injury. The final section, Interventions, Fami-
aimed for a balance between consistency with lies, and Outcomes, contains chapters that
the text that many of you have come to know focus on various interventions, including early
so well in its previous editions and innovation intervention and special education services,
in exploring the new topics that demand our feeding, dental care, behavioral assessment
attention. All chapters have been substan- and support, assistive technology, and physi-
tially revised and many have been rewritten cal and occupational therapy. This section also
to include an expanded focus on psychoso- concentrates on the ethical, legal, emotional,
cial, rehabilitative, and educational inter- and transition-to-adulthood issues that are
ventions as well as to provide information common to most families of children with dis-
discovered through educational, medical, abilities and to professionals who work with
and scientific advances since 2007. In addi- them. The book closes with a discussion of the
tion, four new chapters have been added to prospects for providing health care in the 21st
address the following topics: 1) the new face century.
of developmental disabilities (long-term out-
comes of previously fatal disorders), 2) novel THE AUTHORS AND EDITORS
therapies and treatment efficacy (alternative Nancy J. Roizen joined me as an editor for
medicine), 3) understanding and using neu- the sixth edition of the text. Like me, she is
rocognitive assessment, and 4) diagnosing a a neurodevelomental pediatrician. Gaetano
child with developmental disabilities. They R. Lotrecchiano, an educator for interdisci-
focus on recently gained knowledge that is plinary training in developmental disabili-
transforming our understanding of the causes ties, joined as an editor on this edition. We
of developmental disabilities. have chosen physicians, psychologists, social
The chapters are grouped into sections workers, therapists, and other health care
and have been organized to help guide read- professionals who are experts in the areas
ers through the breadth of content. The book they write about as authors of Children with
starts with a section titled As Life Begins, Disabilities. Many are colleagues from Chil-
which addresses what happens before, dur- dren’s National Medical Center in Wash-
ing, or shortly after birth to cause a child to ington, D.C. Each chapter in the book has
be at increased risk to manifest a developmen- undergone editing at Paul H. Brookes Pub-
tal disability. The concepts and consequences lishing Co. to ensure consistency in style and
of genetics, embryology, infections and fetal accessibility of content. Once the initial drafts
Preface xxv
were completed, each chapter was sent for interventions, thus emphasizing the capa-
peer review by major clinical and academic bilities rather than the impairments of
leaders in the field and was revised according individuals with intellectual disability.
to their input. • “Typical” and “normal”—Recognizing
diversity and the fact that no one type
A FEW NOTES ABOUT of person or lifestyle is inherently “nor-
TERMINOLOGY AND STYLE mal,” we have chosen to refer to the gen-
As is the case with any book of this scope, the eral population of children as “typical” or
editor or author faces decisions about the use “typically developing,” meaning that they
of particular words or the presentation style follow the natural continuum of develop-
of information. We would like to share with ment.
you some of the decisions we have made for • Person-first language—We have tried to
this book. preserve the dignity and personhood of
• Categories of intellectual disability—This all individuals with disabilities by consis-
book uses the American Psychiatric Asso- tently using person-first language, speak-
ciation’s categories according to the term ing, for example, of “a child with autism,”
mental retardation (i.e., mild, moderate, instead of “an autistic child.” In this way,
severe, profound) when discussing medi- we are able to emphasize the person, not
cal diagnosis and treatment and uses the define him or her by the condition.
categories that the American Association As you read this seventh edition of Chil-
on Intellectual and Developmental Dis- dren with Disabilities, we hope you will find
abilities (formerly the American Associa- that the text continues to address the fre-
tion on Mental Retardation) established quently asked question “Why this child?”
in 1992 (i.e., requiring limited, inter- and to provide the medical background you
mittent, extensive, or pervasive support) need to care for children with developmental
when discussing educational and other disabilities.
Acknowledgments
We would like to thank our colleagues at Paul Seth Canion, Charles J. Conlon, Philip W.
H. Brookes Publishing Co. for their great Davidson, Carolyn Drews-Botsch, Ann-
help. Steve Plocher served as Associate Editor Christine Duhaime, Diana M. Escolar, Sara
for the text and Johanna Cantler as Acquisi- Helen Evans, Erynn S. Gordon, Karl F.
tions Editor, and both provided developmen- Gumpper, Michael J. Guralnick, William
tal oversight of the project; Danica Crittenden H.J. Haffner, Mark L. Helpin, Janet S. Isaacs,
assisted with the review process. A book such Dorothy O. Jones, Annie Kennedy, Carol
as Children with Disabilities is best understood A. Knightly, Alan E. Kohrt , Lisa A. Kurtz,
with illustrations that help to explain medical Mary F. Lazar, Sheryl J. Menacker, Gretchen
concepts. An expert medical illustrator is cru- A. Meyer, Linda J. Michaud, Gary J. Myers,
cial in this effort. Lynn Reynolds has contrib- Man Wai Ng, Jeffrey P. Rabin, Mark Reber,
uted to this endeavor in both past editions and Howard M. Rosenberg, Andrew J. Satin,
with new additions in this volume. We deeply Tomas Jose Silber, Harvey S. Singer, Annie
acknowledge her important contribution. G. Steinberg, Ana Carolina Tesi Rocha, Cyn-
We also gratefully acknowledge Arlene Gen- thia J. Tifft, Laura L. Tosi, Kenneth E. Tow-
dron, who helped organize the project as well bin, Symme Wilson Trachtenberg, Mendel
as contributed to the book’s appendixes. We Tuchman, Kim Van Naarden Braun, Shari L.
thank previous contributors whose work on Wade, Steven L. Weinstein, and Marshalyn
the sixth edition laid an excellent foundation Yeargin-Allsopp. Finally, many of our col-
for this text: Terry Adirim, Karen Batshaw, leagues reviewed and edited the manuscript
Michael Batshaw, Michael J. Bell, Nathan for content and accuracy, and we would like
J. Blum, Jill E. Brown, W. Bryan Burnette, to acknowledge their efforts.
xxvi
Why me?
Why me?
Why do I have to do so much more than others?
Why am I so forgetful?
Why am I so hyperactive?
And why can’t I spell?
Why me? O’why me?
I remember when I almost failed first grade because I couldn’t read. I

would cry hour after hour because my mother would try to make me read.
Now I love to read. I couldn’t write in cursive but my mother helped me
and now I can. I don’t have as bad a learning disability as others. At lest
I can go to a normal school. I am trying as hard as I can (I just hope it is
enough). My worst nightmare is to go to a special school because I don’t
want to be treated differently.
I am getting to like working. I guess since my dad is so successful and has
a learning disability, it helps make me not want to give up. Many people
say that I am smart, but sometimes I doubt it. I am very good at math, but
sometimes I read a number like 169 as 196, so that messes things up. I also
hear things incorrectly, for instants entrepreneur as horse manure (that
really happened). I guess the reason why a lot of people don’t like me is
because I say the wrong answer a lot of times.
I had to take medication, but then I got off the medication and did well.
Then in 7th grade I wasn’t doing well but I didn’t tell my parents because
I thought they would just scream at me. My dad talked to the guidance
counselor and found out. It wasn’t till a week ago that I started on the
medication again; I have been doing fine since than. As I have been getting
more organized, I have had more free time. I guess I feel good when I
succeed in things that take hard work.
This is my true story. . .
Andrew Batshaw
1989
xxvii
In applying to colleges during my senior year of high school, I found that
most had as an essay topic, “Tell us something about yourself.” I decided to
write about my ADHD and learning disability as it is a big part of who I am.
I wrote “I have found that while a disability inherently leaves you with a
weakness, adapting to that disability can provide rewards. I feel that from
coping with my disability, I have gained pride, determination, and a
strength that will be with me all of my life.” I guess Vassar College agreed;
they admitted me.
When it came time for high school graduation, we had a problem. My sister
was graduating from the University of Chicago on the same day that I gradu-
ated from high school in Philadelphia. The only solution was for one parent
to attend my graduation while the other one was with my sister in Chicago.
The decision as to who would go to which graduation was easy. My mother
insisted that she attend my graduation because it was a product of her hard
work as well as my own. I remember she said to me that day, “When I think
of the boy who cried himself to sleep because he could not remember how to
spell the word ‘who,’ it makes me so happy to see you now.”
My parents expressed themselves in different ways about my leaving for
college. My mother and I found ourselves getting into many arguments over
simple things (the old severing of the umbilical cord; I am the baby of the
family). My father, however, made sure to remind me to start my stimulant
medication 2 weeks before classes began!
The first semester I took four courses: Poetry, Linear Algebra, Computer Sci-
ence, and Music Theory. As the semester continued, I developed an increas-
ing interest in computer science, until finally I decided to become a computer
science major. I was very flattered, however, when during a meeting with my
English professor, she asked if I planned to be an English major. To think that
someone who could not read until the end of second grade would become a
member of the Vassar English department seemed almost unbelievable. Well,
I might have been proud but not that proud. I stuck with computer science.
On the whole, I would say that my freshman year was a good one. I learned a
great deal, both inside and outside of classes, about myself and others. What
will I do after college? What will I end up doing with my life? These are
questions that continually run through my mind. I have no clear answers,
but there is one thing of which I am sure: My disability will not keep me
from doing anything. I will not let it.
AndrewBatshaw
Andrew Batshaw
June 1996
1996
xxviii
As a college graduate, I find that my ADHD and learning disabilities are much
less of an issue; however, that was not the case during my early college years.
In my second year of college, I took a year-long introductory German class
that fulfilled my language requirement. Forgetting that languages don’t come
easily to me, I chose the intensive German class that met an extra day a week
and moved faster than the regular class. I watched my exam grades slowly slide
into the C range during the first semester and decided to switch to the regular
class for the rest of the year. While this was happening, some medical
warnings were issued concerning the stimulant medication I was taking,
so I decided to discontinue its use.
In the new German class, we had exams every other week, so I received regu-
lar feedback on how I was doing. Unfortunately, it was not positive feedback.
After receiving an F on the first quiz, I decided that I needed to work harder in
the class. I started studying more and was less than relieved when on my next
exam my grade rose to a D! Again, I studied even more and still received a
D on the test that followed. At this point, I began to doubt myself. I felt like
I was doing everything I could, and still I wasn’t improving. I said to myself,
“I know you have always told yourself that you could do anything you really
gave your all to, but maybe there are just some things you can’t do.” I was
disheartened, but felt that I had no choice but to just keep working. I received
a C and then a C+ on my next two exams, but my overall class grade was still
very low. My professor spoke to me and said that as long as I received at least a
C+ on the final exam, he would pass me. I did all I could to prepare for the test
and took the exam without reservation, simply willing to accept the results,
whatever they might be. I ran into my professor a week after the final exam
and was told that not only had I passed the final exam, but that I had received
an A, one of the highest grades in the class. As you might expect, I was
ecstatic. I looked back on the day when I had thought, “Maybe there really are
things that I just can’t do,” and smiled, because I proved myself wrong. On top
of that, I had accomplished it without the help of medication. That was when I
truly felt that I had overcome my ADHD and learning disabilities.
In fact, some of the most important activities in my life are things that at first
glance you wouldn’t think someone with ADHD would find attractive. I medi-
tate every day, which involves sitting in one place and not moving for long pe-
riods of time. When I meditate, I am actually watching how my mind works.
I see how easily I am distracted from simply sitting by thinking about all kinds
of things, like what I did yesterday or what I am going to do later. Neverthe-
less, I keep bringing myself back, over and over again, and sometimes my
mind becomes very quiet and clear. I find that this has had a positive impact
xxix
on all aspects of my life. I was talking with my older brother, Michael, after
attending my first 3-day meditation retreat, and he told me how proud he was
of me. He said that after seeing me bounce off the walls and have such diffi-
culty concentrating while growing up, he was amazed that I could sit still and
meditate for 3 days.
After 4 years, including 6 months at the University of York in England, I
graduated from Vassar College with a B.A. in Computer Science in May 1999.
After graduation, I worked for a year as a software engineer and then started
my own company with my brother and a friend. Unfortunately, after devel-
oping the company for a year, we became one of the many casualties of the
dot-com collapse. Naturally, I was very disappointed, but it was an incredible
experience that I will always value. It sparked in me a passion for entrepre-
neurship that led to my decision to attend business school.
Throughout the process of applying to business school, it became clear to me
how my learning disability had been transformed from a hindrance to an asset.
The work habits I had developed to overcome my disability allowed me to
stick to a rigorous preparation program for my business school entrance
exams. As a result, I scored in the 98th percentile. In addition, when preparing
my applications, I chose to include an essay about how overcoming a disability
had taught me to treat failure as a natural and necessary part of important
accomplishments. Furthermore, it instilled in me a drive to achieve and to
take calculated risks that are essential to being successful in business. I will be
attending the University of Southern California Business School with a full
scholarship.
Drew Batshaw
April
2002 2002
xxx
Five eventful years have passed since I wrote my foreword to the fifth edition
of this text. I graduated from business school, fell in love and married an amaz-
ing woman, and have been pursuing a career in business. Through all of these
experiences, my ADHD and learning disability continue to impact my life in
both subtle and not-so-subtle ways.
At the end of my last letter, I spoke about pursuing an MBA at the University
of Southern California. My experience in business school was positive, both
academically and socially. I’d come a long way from my childhood struggles;
my ADHD and learning deficits had little effect on my performance. I ex-
celled, my teachers respected me, and other students regularly sought me out
to work on projects with them.
For me, business school was easier than college for a number of reasons. The
subject matter was generally more engaging and played to my strengths: think-
ing on my feet, presenting ideas orally, and using analytical reasoning. In addi-
tion, much of the learning took place in an interactive and experiential envi-
ronment that kept my interest and attention. For example, we discussed real
situations that companies have had in the past and how we would have man-
aged them, and we role-played as consultants with 90 minutes to prepare a
thorough presentation for the class. Another significant factor was that writing
(which historically has been my most challenging form of communication) is
different and easier for me in a business setting than an academic one. In busi-
ness writing, lengthy discourse is discouraged and traditional writing rules are
far less important than presenting information in a clear and concise way; plus,
of course, I’d had many years to hone my writing skills since I entered Vassar.
Finally, I’d learned to manage my disability and identify environments like
business school where I would be most successful.
After graduating with my MBA, I launched a company that provided coaching
services for young executives and business owners. My job as a coach was to as-
sist clients in their effectively working through problems, as opposed to the
traditional consultant model of doing the work for them. After about 18
months, I realized that my heart was no longer in building the business; I
missed managing tangible projects and found coaching to be lonely. I had
many clients but no peers to interact with on a daily basis. I then moved to my
current job, where I run the operations and technology of an education tech-
nology company that helps low-income children improve their reading skills.
It is very satisfying to be involved in a business that helps children who have
reading difficulties like I had. In contrast to the coaching work, this job allows
me to manage many different projects and work with a great team.
xxxi
I have also found that I reap unexpected benefits from my ADHD. Profession-
ally, I am known for my ability to effectively problem-solve with limited infor-
mation. Unlike others who are intimidated by their lack of knowledge or in-
formation, I delight in jumping right into the problem and figuring it out as I
go (much like how I used to raise my hand all the time in grade school even
though I didn’t know the answer). In addition, I juggle many different projects
and priorities with finesse. I thrive in environments that offer variety, allow me
to wear many different hats, and require the use of a broad set of skills
throughout the course of each day. Perhaps because of this I have changed jobs
every 1 to 2 years since graduating from college (7 years ago): I have been a
software developer, a dot-com founder, a business school student, and an exec-
utive coach, and now I am a manager of technology and finance. When I first
start a job, I’m very excited and engaged in the work, but after I become profi-
cient, I start to itch to do something different. Does my ADHD cause me to
need a certain kind of sustained and varied stimulation that I have not yet
found? I’m not sure, but I do know that I require a high level of change and
stimulation to stay engaged and productive.
My ADHD impacted my early adulthood in other ways. For many years, no
matter how much I achieved or how well I succeeded, I was still left with the
shame of not being good enough during my formative years. As a child, my
disability affected my self-image as well as my academic performance. Despite
my mother telling me, “You are intelligent. It’s just your learning disability that
affects how you do in school,” I still measured my worth in comparison to
everyone else—for example, how far I got in a spelling bee, how long it took
me to read a book, or what grade I received on a writing assignment. Through
much of my twenties, when something didn’t go well in my life—profession-
ally, personally, or sometimes even when I was just sick—I would feel like that
little boy again who just couldn’t do anything right. I can see now that no
amount of achievement would have transformed those feelings of inadequacy.
What has helped me most in dealing with this legacy is counseling and reward-
ing intimate relationships. Counseling has helped me to recognize when this
old shame is triggered and how to notice it and move on. Through intimate
relationships, I’ve come to understand and own my worth in a greater sense—
how I offer so much more than just what I can achieve. For example, I have a
positive impact on others by just being in their lives, and I can move people
with my emotions and words. These things are all effortless. I don’t have to try
or work hard to make them happen. They simply occur as a natural result of
who I am inherently.
xxxii
My greatest teacher in this has been my wife, Amy. We were married in August
2005 after dating for 2 years. Her capacity for love, joy, and compassion
amazes me. While preparing this letter, I asked her how my disability impacts
our relationship. She smiled and said, “Well, you don’t like to wash the dishes
or go clothes shopping with me!” Much as I’d like to blame that on ADHD,
I’m not sure that would be fair. What I have noticed are some of Amy’s quali-
ties that make her an especially good match for someone like me with ADHD.
Professionally, she is a coach and organizing consultant, and, as a result, natu-
rally provides structure and organization to our lives. In addition, she gives me
a lot of space and honors the transition time I need between being by myself
and being with her. Finally, she is very accepting and offers me constant
appreciation and encouragement. I am a lucky man!
In sum, I lead an extraordinarily blissful life. I have a wonderful wife, my
current work is stimulating and meaningful, and my relationships with family
and friends are warm and fulfilling. I am immensely grateful for all I have been
given and all I have been able to accomplish—in spite of and because of my
disability.
Andrew Batshaw
2007
xxxiii
IReflecting
have also on found
the that
impactI reap unexpected
of my learning benefits
disabilityfrom and my ADHD ADHD. on my Profession-
current
ally,
life, I am known for my ability to effectively problem-solve
struck by how little impact I still feel. At the age of 33, I appreciate with limited infor-
mation.
the fact that my learning disability and ADHD are not at the heart of anyin-
Unlike others who are intimidated by their lack of knowledge or of
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deprived, it is really difficult to find energy for the activities that nourish our set of skills
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these activities. It has been worth the effort and I am delighted that as Gia ago): I have been a
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getting easier anda easier.
business school
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is something an exec-
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utive coach, and now I am a manager of technology
about being challenged not by my disability, but by things that are difficult and finance. When I first
for
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most parents with young kids.excited and engaged in the work, but after I become profi-
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stay engaged include:
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create theacademic performance.
best life that I can. So, Despite
I choose
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managing would have transformed
my disability shaped the those ways Ifeelings of inadequacy.
now automatically
manage myself, my work environment and
What has helped me most in dealing with this legacy is counseling my personal life. As a result, I can
and reward-
go months without even thinking about the fact that
ing intimate relationships. Counseling has helped me to recognize when this I have a disability (in fact,
Iold
amshame
tempted to say “had” a disability instead of “have”).
is triggered and how to notice it and move on. Through intimate
relationships,
The one trigger I’vethat
come to understand
reconnects me to and own my worth
the emotions in a greater
of growing up withsense—
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how I offer so much more than just what I can achieve. For example,
ability is witnessing others with disabilities. A few years ago, I happened I have a
across
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a Craigslist ad written by an older brother. He wanted to buy an inexpensivemove people
with
videomy emotions
game systemand words.
to play withThese things
his little are allwho
brother effortless. I don’t physical)
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who
a wayI to
amconnect
inherently.
and play because things were so challenging for his brother.
His thoughtfulness and commitment to creating joy for his brother still move
me today.
xxxiv
Another random document with
no related content on Scribd:
DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)
The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.
NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.
MAKONDE LOCK AND KEY AT JUMBE CHAURO

This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]
MODE OF INSERTING THE KEY
With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
“We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
BRAZIER
Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT
SMOOTHING WITH MAIZE-COB
CUTTING THE EDGE

FINISHING THE BOTTOM
LAST SMOOTHING BEFORE

BURNING
FIRING THE BRUSH-PILE

LIGHTING THE FARTHER SIDE OF
THE PILE
TURNING THE RED-HOT VESSEL
NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK
DRAWING THE BARK OFF THE LOG
REMOVING THE OUTER BARK

BEATING THE BARK
WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT
MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN

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eTextbook 978-1598571943 Children

with Disabilities By Mark Batshaw M.D.

“A gem...clear, concise, and well written. I enthusiastically recommend

9 781598 571943 >

III Developmental Disabilities

Medical Diagnostic Testing

23 Specific Learning Disabilities

28 The New Face of Developmental Disabilities

IV Interventions, Families, and Outcomes

Intervention Frameworks Used by Physical and Occupational Therapists

Institutional Ethics Committees

Marilyn Cataldo, M.A.

Elissa Batshaw Clair, Ed.S., M.Ed. Patrick C. Friman, Ph.D., ABPP

James Gleason, PT, M.S. Peter B. Kang, M.D.

Rebecca M. Haesler, M.S., RD, LD

Susan L. Hyman, M.D. Susan E. Levy, M.D.

SungWoo Kahng, Ph.D. M.E.B. Lewis, Ed.D.

Michelle Huckaby Lewis, M.D., J.D. Jerome A. Paulson, M.D.

Gregory S. Liptak, M.D., M.P.H. Joan E. Pellegrino, M.D.

Toby M. Long, Ph.D. Louis Pellegrino, M.D.

Scott C. Schultz, M.D. Sheela L. Stuart, Ph.D., CCC-SLP

Bruce K. Shapiro, M.D.

Patience H. White, M.D., M.A. Tesfaye Getaneh Zelleke, M.D.

Michaela L. Zajicek-Farber, M.S.W., Ph.D.

I remember when I almost failed first grade because I couldn’t read. I

Newala, too, suffers from the distance of its water-supply—at least

The water-supply of New Newala is in the bottom of the valley,

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAKONDE LOCK AND KEY AT JUMBE CHAURO

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

Some consolation was afforded me by a brassfounder, whom I

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

LAST SMOOTHING BEFORE

FIRING THE BRUSH-PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

MANUFACTURE OF BARK-CLOTH AT NEWALA

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