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Training for the moderately retarded child : the effects of habilitation work for the moderately retarded… Chapple, John Arthur 1962

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TRAINING FOR THE MODERATELY RETARDED CHILD The effects of habilitation work for the moderately retarded child on his social functioning and family acceptability. A preliminary survey, based on material from The Woodlands School, B. C , 1961 - 1962. JOHN ARTHUR CHAPPIE Thesis Submitted i n Partial Fulfillment of the Requirements for the Degree of MASTER OF SOCIAI WORK in the School of Social Work Accepted as conforming to the standard required for the degree of Master of Social Work School of Social Work 1962 The University of Bri t i s h Columbia In presenting this thesis in p a r t i a l fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make i t freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the Head of my Department or by his representatives. It i s understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of_ The University of British Columbia, Vancouver 8, Canada. Date Av/UJ g ( i i . ABSTRACT Experimental teaching techniques and classroom f a c i l i t i e s have recently been brought into use at The Woodlands School, to train the category of children resident i n The School who can be described as moderately retarded. An exploratory study has been conducted and the main features of this programme set out, to as-certain whether the progress of the children i s significant and whether this has had any influence on their family acceptability. With the cooperation of The Woodlands School Staff, and from the parents, a sample group of boys, aged eight to seventeen, was chosen for study. The boys are resident at the institution and attend the special training classes; their parents reside within a thirty-five mile distance from Vancouver. A Social Competency Rating Scale was adapted from one u t i l i z e d i n a San Francisco study and applied to two specific times, (a) before the child received training i n the special training classes and, (b) after at least one year's training. This scale permits an assessment of the degree of each child's progress i n social competency. A second rating scale, designed to assess the degree to which parental ac-ceptability of the child was influenced by the training and i t s results, was applied by u t i l i z i n g a projective interviewing tech-nique. It was found that the social competency of the sample group of boys has improved considerably; coincident with this, there has also been an opening up of areas of knowledge and experi-ence which are stimulating the children to more constructive use of their time, and giving them reward through greater enjoyment of l i v i n g . Parental acceptance of the children has noticeably inc-reased. The review suggests that more inclusive services, inclu-ding medical diagnostic and social work counselling, should be made available to parents of retarded children. Residential training f a c i l i t i e s should also be extended to non-metropolitan areas of the province. i i i . AOKHOWLE-GEMMTS Grateful thanks i s expressed to Dr. 1. A. Kerwood, Medical Superintendent of The Woodlands School, for his generous cooperation. Thanks too go to Mr. Julius Erdelyi for his t i r e -less and invaluable participation i n the project. Likewise thanks go to other members of The Woodlands School Staff including J. N. E l l i o t t , Dr. B. Leviczky, J. Markley, J. Wincentowich, T. Fisher, A. 0. Morrison, Mrs. C. Hawley, Miss H. Walter and B. M. Coles, for their continued interest and helpful suggestions. Gratitude i s extended to Mrs. Mary Tadych, Dr. D. McGann, Dr. S. R. Laycock and Dr. L. Marsh for their sound advice and heartening support. Last, but not at a l l least, appreciation i s expressed to the parents who, with such warm interest, gave freely of their time and effort. TABLE OF CONTENTS i . Chapter I The Moderately Retarded Child and his Problem page Causes of Mental Deficiency. Some Clin i c a l Types of Mental Deficiency. The Degree of Mental Defect. The Moderately Retarded Child. Special Training for the Moderately Retarded Child. Method 1 Chapter II Habilitation and Training of the Children The Purpose of the Institution. The Treatment Team. Casework Services. The Number of Mentally Retarded Persons. The Classrooms 27 Chapter III Measuring Movement Physical and Family Characteristics. Measuring the Habilitation Progress. Case Illustrations. Evaluation of Training. Positive and Negative Observations of Parents. Home Vi s i t s 45 Chapter IV What Does Institutional Training Offer? Parents Need More Help. The Social Work Liaison Role Between the Retardate's Family and the Community. The Social Work Liaison Role Between the Retardate's Family and the Institution. The Casework Process. The Need for Extended Services. Possible Research Projects. The Challenge 74 Appendices: A. Sample of Letter to Parents B. Social Competency Rating Scale C. Parental Acceptability Rating Scale D. Catalogue of Classroom Activities E. Bibliography TABLES IN THE TEXT Table 1. Population of Canada and Estimated Numbers of Mentally Retarded Persons 38 Table 2. Population of British Columbia and Estimated Numbers of Mentally Retarded Persons 38 Table 3. Social Competency, Ia, Self-Help 48 Table 4. Social Competency, lb, Self-Help 48 Table 5. Social Competency, I l a , Initiative - Responsibility 49 Table 6. Social Competency, l i b , Social S k i l l s 49 Table 7. Social Competency, l i e , Communication 50 Table 8. Parent Acceptability 51 Table 9. Composite of Social Competency and Parent Acceptability Scales Showing Gains and Losses After Retardate's Training 53 TRAINING- FOR THE MODERATELY RETARDED CHILD CHAPTER I THE MODERATELY RETARDED CHILD AND HIS PROBLEM The mentally defective child i s not just a symptom of our time despite a prediction that, because of pollution from atomic fallout, his ranks w i l l be increased. From ancient time he has been dealt with as an oddity. Certain cultures such as the Spartan and Roman saw him as an unmanageable threat and destroyed him. Other societies allowed him to live but projected condemning attitudes born i n h o s t i l i t y and fear. Ways of attending him were much modified with the coming of Christianity and he was given shelter and more humane care. Stanley notes that The anatomists and physiologists of the 16th and 17th centuries, who laid the foundations of rational medicine, established and argued the place of mental disorder i n the natural order of diseases of the nervous system, and began the slow education of the public mind away from the old savage concepts of the defective as^a subhuman being -degenerate, blighted by demonic forces. However, Masterman states: "It was not unti l the 19th century, when Itard made his exhaustive efforts to educate Victor, the 'wild boy of Aveyron', that the world saw the beginning of efforts 2 to educate the children of subnormal intelligence." There has been gradual progress since this time. Nevertheless, even today Stanley, J. C , Brief to the Royal Commission on Health  Services, Saint John, New Brunswick, 1959, p. 2. Masterman, Louis E., Attitudes Toward Children of Subnormal  Intelligence, Publication No 155, Community Studies, Inc., Kansas City, Missouri, and The State Division of Health of Missouri, Jefferson City, Missouri, June 1961, p. 101. - 2 -we find persons thinking of the defective child as one of "les i enfants du bon Ltieu", or as one " f i l l e d with Satan". And parents who produce a defective child often feel the stigma of being of 'a lesser breed'. It seems easier to accept physical handicap, how-ever severe, i f i t i s not accompanied by mental impairment. Accor-ding to our culture, the retardate i s one whose greatest value, his mind, has been disabled. Within the last few years there has been an increased public awareness of the mental retardation problem. There has been an upsurge of social concern for and from those directly involved. Mass and rapid communication has helped parents discover that their charge, that of a mentally retarded child, i s not an unique problem; and i t i s now realized that mental retardation affects as many Cana-dian people, directly or indirectly, as the whole population of the 2 Province of Br i t i s h Columbia. Local and national associations for retarded children have sprung up. Troubles, needs and ideas have been shared. Hew p o s s i b i l i t i e s for constructive home and community planning have been explored. The interest of fellow community mem-bers, including professional persons, has been aroused and a b i l i t i e s enlisted. Medical advances, both i n diagnosis and treatment, have resulted i n a lower mortality rate, while the birthrate has been i n -creasing. In 1958, the Canadian Association for Retarded Children Queen, Alfred S., Social Work in. the Light of History, J. B. Lippincott Co., Philadelphia, 1921, p. 155. 2 First Annual Convention, C. A. R. C , Calgary, Alberta Sept. 17 - 19, 1956, p. 1. - 3 -(herein after referred to as C. A. R. C ) , started plans to appoint "a Scientific Advisory Board of eminent specialists to outline and direct an energetic and vigorous program extending into a l l the basic sciences." More money has been available for research. As a result the problem has been brought into daylight and the public conscience i s awakening to the needs of families with retarded chiL dren. There i s a swing away from thinking that would isolate and emphasize segregation. Realism and more united seeking for methods and resources with which to constructively meet the situation are evident characteristics of this new movement. Noyes and Kolb define mental deficiency as "such a defect i n mental competency, resulting either from an inate fault i n de-velopmental potentiality or from an arrest i n developmental prog-ress, that i t i s impossible for the patient to make an adequate and 2 independent social adjustment." A monograph supplement to the American Journal of Mental Deficiency states: Mental retardation refers to subaverage general intellectual functioning which originates during the development period and i s associated with impairment i n one or more of the following: (1) Maturation, (2) learning, and (3) Social Adjustment .... Rate of maturation refers to the rate of sequential development of self-help s k i l l s of infancy and early childhood such as sitting, crawling, standing, walking, talking, habit training, and interaction with age peers .... Learning a b i l i t y refers to the f a c i l i t y with which knowledge i s acquired as a function of experience ... (and) Social Adjustment .... During the pre-school and school years social adjustment i s reflected, i n large measure, i n the level and manner i n which the child relates 1 Pirst Annual Convention, C. A. R. C , op. c i t . , p. 3. 2 Noyes, Arthur P., and Kolb, Lawrence C , Modern C l i n i c a l Psychiatry, W. B. Saunders Company, Philadelphia and London, I 9 6 0 , — •tr , w rT24. - 4 -to parents, other adults, and age peers .... In actual practice ... i t w i l l be found that a great percentage of individuals diagnosed as mentally retarded w i l l be impaired, or have a history of impairment, i n a l l three areas of adaptation. The mentally deficient person operates at a level below that of the general public i n his capacity to reason, show fore-sight and judgment, i n his a b i l i t y to modify behavior i n the light of experience, i n conceptualization and memory. Noyes and Kolb think that the term intellectually inadequate would be more suit-able than mentally deficient or mentally retarded. To them "mind" i s : "a collective designation for certain functional act i v i t i e s of the organism, particularly those of the organism as an i n d i v i -2 dual personality." They point out that some persons who are i n -tellectually deficient are emotionally mature and well adjusted, while some of average or superior intellectual a b i l i t y are emo-5 tionally under developed. It i s estimated that 30 of every 1000 children born i n Canada are mentally defected. Of these, approximately 25 are edu-catable, and after training may eventually engage i n simple occupa-tions and reach a level of self-support. About 4 of the 30 c h i l -dren w i l l f a l l i n the trainable category. These are the moderately retarded, and the subject of this thesis. One of every 1,000 c h i l -dren born w i l l be severely mentally handicapped and w i l l always re-quire help for even the simplest tasks.^ 1 Herber, Rick, "A Manual on Terminology and Classification i n Mental Retardation", A Monograph Supplement to the American Journal  of Mental Deficiency, September 1959, Vol. 64, Ho. 2, pp. 3 - 4. 2 Noyes and Kolb, op. c i t . , p. 324. l * o c * c i t . 4 Stanley, op. c i t . , p. 4. - 5 -Winthrop and Taylor speak of popular misconceptions re-garding the mentally retarded s t i l l held by the general public. These include beliefs that mental retardation i s curable, that retardates should be sterilized as a means of getting r i d of the whole problem. Also they show that there i s confusion between 1 retardation and mental disease. In regard to the latter i t should be pointed out that a mentally deficient person may, as anyone else, be arrested i n emotional development, or become mentally i l l ; however, i t i s important to understand that mental deficiency i s not synonymous with mental i l l n e s s . There are serious d i f f i c u l t i e s which face the retardate i n the developmental process - times when he i s misunderstood, laughed at, l e f t behind and bewildered. His behavior may become erratic or psychotic as any normal person's might when his emotional strength cannot cope with circumstances. Pauses of Mental Deficiency Mental retardation i s found i n a l l races. It appears that there may be greater incidence of one type i n some groups. For instance, Cretinism i s more prevalent i n Switzerland than i n Canada; and Mongolism i s more prevalent i n Caucasians than Negroes. Age of mothers during pregnancy seems to be a factor (more mongoloid c h i l -dren are born to mothers over thirty), but mental retardation i s seen i n a l l ages of children, and both sexes are affected. Also mental retardation occurs i n children of parents of a l l economic Winthrop, Henry, and Taylor, Howard, "An Enquiry Concerning the Prevalence of Popular Misconceptions Relating to Mental Retar-dation" , American Journal of Mental Deficiency, Vol. 62, No. 2, (1957), pp. m - "348. - 6 -brackets, and cultural, environmental and educational background. Causes Before Birth. Probably from 50 to 65% of mental deficiency results from causes existing prior to birth. It i s now considered that heredity contributes less than was formerly be-lieved. Masland, Sarason and Gladwin say, "In the case of mental retardation, we are not dealing with a single entity or t r a i t , but with a symptom common to many different conditions, some clearly inheritable, some involving inherited susceptibilities, and some i n which inheritance plays l i t t l e i f any part." Noyes and Kolb say: "It i s often d i f f i c u l t to determine whether toxic, infectious, en-docrine, traumatic, nutritional and other prenatal pathogenic fac-tors operating on the germ c e l l or within the pregnant mother tended to weaken or distort developmental capacity of the brain." EH (Rhesus) factor i n the mother's blood may be one of these pathogenic 4 factors. Antenatal, hereditary or congenital types of retardation 5 are initiated before birth. Among prenatal factors, virus infec-tion, especially that of rubella during the second or third month of pregnancy may be highly significant. It i s also believed that irradiation of the pelvis (x-rays) at this period may cause retar-dation. ^  Levinson, Abraham, and Bigler, John A., Mental Retardation  in Infants and Children, The Year Book Publishers, Inc., Chicago, 1960, pp. 49 - 50. Masland, L., et a l , Mental Subnormality, Basic Books, Inc., New York, 1958, p. 35. 3 Noyes and Kolb, op. c i t . , p. 325. 4 Tredgold, R. P. and Soddy, K., A Text-book of Mental Defi- ciency, The Williams and Wilkins Company, Baltimore, 1956, p. 28. 0 Levinson and Bigler, op. c i t . , p. 55. ^ Loc. c i t . - 7 -Causes At Birth. D i f f i c u l t labour resulting i n birth trauma or accidents can cause brain injury, either through mecha-nical damage or asphyxia, with resulting anoxia. Prematurity i s likewise sometimes associated with cerebral hemorrhage and eonse-1 quent brain damage. Causes After Birth. Forms of virus and bacterial ence-phalitis and of meningitis are the most frequent causes of mental retardation after birth. Head injury accounts for brain damage for some i n infancy and early childhood. Also, toxemia and vitamin deficiency i n infancy and early childhood may produce irreversible changes i n the cortex resulting i n varying degrees of mental re-tardation. Again, a reduced a b i l i t y to receive stimuli can result i n a certain degree of mental defect for the congenitally blind and deaf. 2 Emotional factors, without organic defect, may be the cause of retardation. The mysterious case of Kaspar Hauser, a sixteen or seventeen year old boy found May 26, 1828 near one of the gates of Nuremberg exemplifies i n a dramatic manner the effect of prolonged isolation upon the brain c e l l s . But more recent 3 4 findings i n studies by such persons as Spitz and Bowlby support this view. Noyes and Kolb, op. c i t . , p. 326. 2 Loc. cit> Spitz, Rene, and Wolf, Katherine A., "Grief - A Period i n Infancy", (film) 3 reels, 35 minutes. Silent. Rene Spitz, 1150 Fi f t h Avenue, New York 28. 4 Bowlby, J., Maternal Care and Mental Health, World Health Organization, Geneva, 1952. - 8 -Some Cl i n i c a l Types of Mental Deficiency Microcephaly. Microcephaly generally i s genetic i n origin. However, sometimes microcephaly i s caused by X-Ray or 1 radium given to a pregnant woman. The distinctive feature i s the smallness of the head which does not exceed 17 inches i n circum-ference. The shape of the head i s also characteristic. The fore-head i s markedly recessed and the back of the head (occiput) i s flattened. The chin recedes. The hair i s very wiry and grows low on the forehead. The brain i s markedly underdeveloped. The i n d i -vidual's stature i s small, though the body and face may be well 2 developed. Intellectual capacity varies considerably. Microce-phalics are found i n each of the three degrees of mental retarda-tion. Features common to most are "absence of any sensory defect, a general vivacity, restlessness and muscular activity. A consi-derable capacity for immitation and usually an ina b i l i t y for sus-3 tained effort." Tuberous Sclerosis. Tuberous Sclerosis i s characterized by epilepsy and adenoma sebaceum. Nodules may occur on face and neck 4 and a few pale pink spots on the cheeks. Though i t i s congenital, only about 0.5 percent of the retarded suffer Tuberous Sclerosis. Patients are usually backward from birth. Many never learn to walk or talk. Screaming i s common i n early years. Mental retardation Tredgold and Soddy, op. c i t . , p. 328. 2 Ifrid., P- 271. 5 !]___.» P- 272. 4 Ibid., p. 279. i s generally severe or moderate. As the individual grows there i s generally progressive mental deterioration and though some survive to adult age, most die before reaching maturity. Phenylketonuria. Phenylketonuria i s characterized by a genetic metabolic defect. Phenylalanine and i t s deritives, phenylypruvate and phenyllactate are excreted through the urine, not having been converted for body use. Mental retardation resul-ting i s progressive. Research has recently discovered that a lack of an enzyme necessary for the oxidation of phenylalanine i s the cause. A diet low i n phenylalanine can control the metabolic de-fect. Mental deficiency caused by this condition may be prevented 2 i f early treatment i s given. Detection of phenylalanine i s easily made by a simple urine "damp diaper" test shortly after birth of a child. Though mental retardation may be prevented by early adjust-ment of diet, brain damage caused before treatment i s permanent. Mongolism. It i s estimated that of each 1,000 births, 3 to 4 infants w i l l be mongoloid. Of a l l children diagnosed as men-ta l l y defective during the f i r s t year of l i f e , between 40 and 50 per-3 cent are mongols. Statistics support the observation that the mon-goloid i s more apt to be born to a relatively older mother. Most A mongols are born to mothers over the age of 36. The Mongol's brain i s underdeveloped. Often there are dis-orders of the endocrine glands and defects of the heart.^ He i s Tredgold and Soddy, op. c i t . , p. 279. 2 Noyes and Kolb, op. c i t . , p. 328. Tredgold and Soddy, op. c i t . . p. 296. 5 I D i d . . P. 300. - 10 -short i n stature. His head i s small and round, flattened both at the back (occiput) and the frontal regions. The skin tissue about his eyes is drawn and emphasizes an Asiatic appearance. His tongue which i s constantly protruded and withdrawn i s often quite large. His nose i s broad and short with a depressed bridge; hands are broad and stubby, flabby and clumsy looking. There i s an irregula-r i t y i n the length of fingers; hips are often thick; cheeks often coloured by a bright red flush. Ears may be small and underdeve-loped or large and protruding. The skin i s soft and smooth i n very early l i f e but later becomes rough. The hair i s soft at f i r s t and later i s dry and thin. The abdomen i s large. Blood circulation i s often poor so that the cold i s f e l t and the individual susceptable to colds and other infections. The voice i s often harsh and guttu-r a l . He i s flabby muscled and loose jointed. He tends to age quickly. The mongoloid has an inherent "good disposition". He i s most affectionate. He cannot understand and i s confused by c r i t i c a l judgment directed to him. Cretinism. It may be that there are two types of c r e t i -nism. In one, the mental and physical retardation are definitely due to hypothyroidism, and with treatment the patient becomes nor-mal; i n the other, mental retardation i s the essential condition, i hypothyroidism being an added complication. Early recognition and treatment are very important. Tredgold and Soddy, op. c i t . , p, 306. - 11 -The child's growth i s retarded. He i s apathetic and slow, does not easily laugh or smile. His tongue protrudes. Skin i s yellowish, loose and wrinkled and frequently puffy. Hair i s often scanty. The body i s characteristically dwarfed. The head i s large. Legs are short and bowed; hands and feet are stumpy and i l l formed. The nose i s broad and flattened, eyes widely separated; l i p s thick, mouth partly open and tongue thick, coarse and protru-r ding. The neck is usually short and thick. Balance i s poor, gait i s slow and a l l movements are laboured and clumsy. Persons suf-fering from cretinism are generally apathetic and there i s a lack of expression. Some are severely retarded, but most often these i persons are high i n the moderately retarded range. The Degree of Mental Defect The severely retarded (idiot) child has an I. Q. of from 0 to about 20. He i s a total care responsibility. The fact that i n adult years he may develop a maximum mental age of about two years indicates that he w i l l always be highly dependent. The mode-rately retarded (imbecile) child has an I. Q. of from about 20 to 50. This child may develop a mental age of from three to about seven years. He i s , to various degrees, trainable. That i s , through a systematic repetitious training process, he may be taught elemental health habits and to do many things which w i l l assist i n the economy of self-care. He can learn to enjoy l i f e through Tredgold and Soddy, op. c i t . , p. 308. socialization, and successful contribution to his own needs; and i n a limited manner he can learn to contribute to the needs or wishes of others. He w i l l always have defective speech but can learn a few simple words and to communicate i n other ways. He has potential for development and i n adult years can contribute partially to self-support under supervision. And he can develop self-protection s k i l l s to a minimal useful level i n controlled environment.^ The mildly retarded (moron) child has an I. Q. of from 50 to 70 and may develop a mental age of from eight to about ten years. He i s able to gain a simple command of the language, learn to do more demanding tasks with less supervision, and perform aca-demically up to about grade 4 i n his late teens, and perhaps fur-ther i n certain subjects. He has l i t t l e a b i l i t y for abstract thinking (the lower levels have none). With these various a b i l i -ties, many can reach a level near to self-sufficiency. Many mildly retarded adults are providing for themselves i n our society today. Some are capable of self-maintenance i n unskilled or semi-skilled jobs though they require guidance when under mild social or econo-2 mic stress. Those caring for the mentally deficient w i l l need to understand and accept the person's physical and mental condition as i t i s so that whatever the present rate and potential for social Herber, op. c i t . , p. 63. loc. c i t . functioning may be, expectations w i l l neither be too great nor too small. The Moderately Retarded Child The moderately retarded child's aggressive, destructive, withdrawn or other unacceptable behavior traits are frequently pro-cesses expressing feelings of anxiety, frustration and rejection. This behavior often evokes negative reaction from parents and sib-lings, and his frustrations are increased. He needs energy outlets which f a c i l i t a t e his being loved, recognized, accepted and successful i n some of his endeavours. His mental a b i l i t y i s not great enough to solve problems, but he does have the emotional capacity to become distraught by failure. Not to recognize and meet the retardate's needs w i l l result i n self-defeat for both the child and his parents. A child w i l l sense rejection and act out his anxiety. Quarrels be-tween parents, inconsistent discipline, favoritism amongst siblings and indifference, plus the compounding of economic and health prob-lems may well ensue and, i f not abated, sooner or later lead to family breakdown. Laycock l i s t s what he considers basic needs of a l l c h i l -dren including retardates. The following are related specifically to the retarded. Next to a reasonable degree of physical care, the most urgent need i s to feel that he i s a loved and cherished i n d i -vidual, especially i n his own home but also i n the school, church and community. Closely a l l i e d i s the need to belong, to feel a de-sired and desirable member of a family group, school group, church group or community group. There i s a need for independence. He - 14 -\ has a need to do things for himself. He also has a need to make his own decisions i n accord with his present stage of development. There i s a need for achievement, the t h r i l l of success which comes from accomplishment. There i s a need for recognition. Since the slow learning child has usually had many experiences of failure and has been made to feel inadequate, he often stands i n special need of praise and recognition or approval by others. There i s a need for a sense of self-worth, otherwise he w i l l spend a l l his available energy trying to reassure himself. Laycock concludes by observing that every individual has to attempt to understand and relate to the world around him i n some fashion. In the case of most retarded children i t w i l l largely be a relationship of feeling, not of reason. The Moderately Retarded Child's Role i n Family and Commu- nity. One of the f i r s t questions that often comes from parents of a newborn child i s , "Is our baby well?" They look to the child as the fulfillment of great expectations and fond dreams. They have already invested themselves to no l i t t l e degree i n this child. When the child i s 'normal1, dreams materialize. The parents often res-pond by modifying their habits, ways of thinking and values, so that these may more worthily encompass the needs of their child. When a diagnosis "this child i s defective" i s made, dreams may be shattered. Parents experience various degrees of disillusionment and heart-break. The shock i s severe even to the strongest of personalities laycock, Samuel R., Mental Hygiene i n the School, The Copp Clark Publishing Co. Limited, Toronto, 1%U, pp. 1U - _ 2 . - 15 -and may l e a d to i n e f f e c t i v e l i v i n g c h a r a c t e r i z e d by g u i l t y , h o s t i l e and b i t t e r d e p r e c i a t i o n o f themselves and o f f s p r i n g . The moderately r e t a r d e d c h i l d , who parents expected would be an i n v a l u a b l e a s s e t b o t h t o themselves and to s o c i e t y , w i l l always be a burden to h i m s e l f and o t h e r s . "The c r i t i c a l l i f e event o f having a r e t a r d e d c h i l d i s a c o n t i n u i n g c r i t i c a l event, not one t h a t happens, then i s over and ended." Stages o f acceptance range from a t t i t u d e s which are b a s i c a l l y d e f e n s i v e , to anxious and i n s e -cure, to r e a l i s t i c and p r a c t i c a l . Parents may or may not seek ad-v i c e on how to care f o r a r e t a r d e d c h i l d . I f they r e j e c t the i n i -t i a l d i a g n o s i s they may t r a v e l f a r , v i s i t many m e d i c a l s p e c i a l i s t s and c l i n i c s , become f i n a n c i a l l y i ndebted, and i n the meantime t r y to f o r c e the c h i l d beyond h i s c a p a b i l i t i e s . Sometimes d i a g n o s i s i s on l y p a r t l y accepted and parents r e a c t t o doubts and g u i l t s by being p r o t e c t i v e or v e r y p e r m i s s i v e w i t h t h e i r c h i l d . I f d i a g n o s i s i s accepted but the i m p l i e d r e s p o n s i b i l i t y shunned, parents may o v e r t l y r e j e c t t h e i r c h i l d . On the other band, i t may be accepted i n a manner which permits p r a c t i c a l p l a n n i n g and warm acceptance o f t h e i r c h i l d as he i s . The parent whose c h i l d i s moderately r e t a r d e d f i n d s t h a t much time passes b e f o r e the c h i l d demonstrates grov/th i n h i s mental p r o c e s s . Por example, i t w i l l take a c h i l d whose I . Q. i s about 30, s i x t e e n y e a r s to r e a c h h i s p o t e n t i a l mental age developmental l e v e l B l o d g e t t , H a r r i e t E., and W a r f i e l d , Grace J . , Understanding  M e n t a l l y Retarded C h i l d r e n , A p p l e t o n - C e n t u r y - C r o f t s , Inc., New York, ) 1959, p. 41. - 16 -of about four and a half years. He w i l l be ten years old by the time his mental age has reached three years. However, to say that a boy ten years of age with a mental age of three years w i l l behave as a normal three year old child i s to oversimplify. Such a retar-ded child may have developed well beyond the three year old i n some ways. In Chapter III, a brief history i s given on boy D of the sample group. This boy i s now nine and one half years of age (April, 1962). His I. Q. i s about 30, (Cattell Infant Intelligence Scale, Ap r i l , 1958), bis mental age equivalent, 3.7 years (Yineland Social Maturity Scale, April, 1962). Psychologists t e l l us that one of the main characteristics of the mentally retarded's test results i s the scattered score for various categories. Boy D, for instance, i n April 1962, tested at about the one year communication level (speech and gesture). During the same test situation he tes-ted at about the five year occupational level (ability to occupy himself unattended). It i s obvious, therefore, that though this boy now tests at the 3.7 mental age level, he functions below that point i n some ways and above i t i n others. For instance, boy D i s able to attend his t o i l e t care without assistance; the normal three year old child generally requires some help. Social and emotional concepts are quite important here. A child with an I. Q. of 20 or under cannot be expected to achieve independence i n social competency no matter how much training he i s given. On the other hand, the moderately retarded child may achieve independence i n significant areas and be taught to function i n ways - 17 -both, rewarding to himself and to others. By the time he reaches his potential mental age development (at about sixteen years, i f growth has not been interrupted before that time), i t i s li k e l y he w i l l be able to function at a level well beyond his mental age. Therefore, though psychological tests are useful guides, they com-plement rather than define the total developmental picture. It w i l l be important for parents or others i n charge of the child's care to have an understanding of what might and what might not be expected. Blundering may be thus avoided, and the possibility of negative reaction on the child's part to unappreciative adults, reduced considerably. What role i s the child to play? Can he be accepted on a two to three year old level when he i s eight years of age? He i s not able to keep up to normal children his own size and i s gra-dually pushed out of their group. When as a big boy he associates with small children, adults i n the neighborhood are upset. If they permit their l i t t l e children to associate, these soon grow past him and he loses his playmates. He i s often the object of vicious r i -dicule and laughter. In a world where the fast moving tempo i s often bewildering to the 'average' person, his most frantic efforts to keep up are p i t i f u l l y inadequate. That he does not understand why'emphasizes his dilemma. And i f those who care for him do not comprehend and try to force him, trouble i s compounded. Often too much i s expected of the child and, as a consequence, the child be-gins to see himself as 'inferior' and 'inadequate'. - 18 -At best, a c h i l d w i t h an I . Q. o f under 50 may develop a mental age of about seven y e a r s . Many w i l l not r e a c h t h a t l e -v e l . T h i s means t h a t he i s always going to be somewhat dependent, t h a t he w i l l never achieve complete s e l f - s u f f i c i e n c y . I t l i k e w i s e means t h a t he w i l l need to be amongst those who are on h i s own l e v e l o f i n t e l l e c t u a l f u n c t i o n i n g i f he i s to share companionship. I t i s obvious t h a t he w i l l not be ab l e t o p l a y w i t h normal f i v e y e a r o l d s throughout l i f e . T h i s suggests t h a t some k i n d of group l i v i n g , p o s s i b l y i n s t i t u t i o n a l , w i l l be important to him. Group l i v i n g i n i t s e l f w i l l not be enough. The r e t a r d a t e w i l l want to r e l a t e to the world about him. He w i l l need, w i t h i n h i s c a p a c i t y , to accomplish t h i n g s . Only thus can he be g i n to e s -t a b l i s h a sense o f p e r s o n a l i d e n t i t y , l e a r n to make s u f f i c i e n t r e l a t i o n s h i p s , and be motivated to f u r t h e r p o t e n t i a l i n t e l l e c t u a l and emotional growth. S p e c i a l T r a i n i n g f o r the Moderately Retarded C h i l d The s p e c i a l c l a s s examined i n t h i s study was set up to pr o v i d e t r a i n i n g i n s o c i a l competence a t a l e v e l a p p r o p r i a t e to the moderately r e t a r d e d c h i l d . Because the moderately r e t a r d e d c h i l d i s v e r y slow to l e a r n , many parents do not take s e r i o u s l y the i d e a of t r a i n i n g f o r t r a i n i n g ' s sake. Indeed, f a c t may w e l l s u b s t a n t i a t e t h i s t h i n k i n g . A r e c e n t study i n the U n i t e d S t a t e s concerning the e f f e c t o f s p e c i a l d a y - c l a s s t r a i n i n g on the s o c i a l competency o f these c h i l d r e n , showed no s i g n i f i c a n t f i n d i n g s to support an - 19 -hypothesis that t r a i n i n g i s b e n e f i c i a l i n increasing s o c i a l competence. The reader's unanswered questions here are: "Does the c h i l d ' s poor response to t r a i n i n g classes r e f l e c t his i n a b i l i t y to benefit, or does he need more adequate class settings and better q u a l i f i e d teachers to a s s i s t him achieve h i s potential?" Implica-t i o n of the study i s that the l a t t e r i s closer to the truth. C h i l -dren i n t h i s category are c a l l e d 'trainable'. This means that they do have capacity f o r development. I f they can develop there must be ways to a s s i s t and speed up t h i s development. The teaching ex-periment at The Woodlands School i s an attempt to f i n d better ways of helping these children improve t h e i r s o c i a l competence. The aim i s to help the c h i l d progress for a purpose. This purpose involves increasing h i s a b i l i t y to care for himself, to grow i n understanding of himself, h i s age peers, adults and the world about him, and to thereby increase his enjoyment i n l i v i n g . In turn, by doing some-thing productive f o r these childr e n i t i s hoped that t h e i r f a m i l i e s w i l l benefit - both from the knowledge that t h e i r children are get-t i n g something out of l i f e , and by actually sharing improved and increased intrafamily a c t i v i t y . The Setting. The setting for t h i s study i s The Woodlands School, New Westminster, a B. C. P r o v i n c i a l i n s t i t u t i o n f o r the mentally d e f i c i e n t . The buildings, old and new, overlook the picturesque Fraser River and i t s busy r i v e r t r a f f i c . The t o t a l Cain, Leo F., and Levine, Samuel, A Study of the E f f e c t s of  Community and I n s t i t u t i o n a l School Classes" for Trainable Mentally" Retarded Children, U. S. O f f i c e of Health, Education and Welfare, Contract l o SAE" 8257, June, 1961, pp. 158 - 159. - 20 -patient population i s 1,343 and includes persons from infancy to old age, a l l suffering various degrees of mental handicap. Some are non-ambulatory and completely dependent. Some are non-ambula-tory but can do many things for themselves. Others are able to tend some of their own needs, and some make a substantial contri-bution by performing various simple jobs within the institution. Patients are segregated into wards according to age, sex, mental and physical handicap, and level of socialization perfor-mance. Bach ward has i t s own scheduled programme adapted to the needs, capacities and potentialities of i t s residents. These schedules are correlated with the overall programme, and patients participate where they are able. This includes nursery classes, special training classes, academic school classes, recreational ac-t i v i t i e s , occupational therapies, sheltered workshops, ground maintenance and entertainment. Prom within this large institution a special group has been selected for study. It i s a group of ten moderately retarded boys who attend a special training programme daily. Role of the Social Worker The social worker has played a relatively minor role i n connection with services for the children included i n this study. At present the social worker provides a social assessment of his family when application i s made for permanent or temporary admission to the institution. He has direct contact with the family i f they reside i n the Vancouver d i s t r i c t , or correspondence with the social - 21 -w e l f a r e branch s o c i a l worker or p u b l i c h e a l t h nurse i f the family-r e s i d e s some d i s t a n c e away. There may be c o n s u l t a t i o n w i t h o t h e r s o c i a l w e l f a r e or p r i v a t e agencies and m e d i c a l and e d u c a t i o n a l sources. At the time o f i n t a k e d i a g n o s t i c c l i n i c , the s o c i a l wor-k e r p r e s e n t s h i s r e p o r t and c o n s u l t s w i t h other members of the me-d i c a l team as treatment i s proposed f o r a p a r t i c u l a r c h i l d . U s u a l l y a t the i n i t i a l admission of a c h i l d , the s o c i a l worker p r o v i d e s o r i e n t a t i o n of parents to the i n s t i t u t i o n i n gene-r a l , and to the p a r t i c u l a r ward i n which the c h i l d w i l l be r e s i d e n t . L i k e w i s e , p a r e n t s are i n t r o d u c e d to the s p e c i a l c l a s s t e a c h e r . They are a l s o encouraged to ' s i t i n ' on c l a s s a c t i v i t y to get an i d e a about the s p e c i a l t r a i n i n g t h e i r c h i l d w i l l s h o r t l y be r e c e i v i n g . P r o f e s s i o n a l c o n t a c t commenced a t admission between s o c i a l worker and parents may continue through correspondence, telephone, or i n f a c e to f a c e c o n t a c t s to c o n s i d e r f a m i l y problems and/or the c h i l d and h i s w e l f a r e i n the i n s t i t u t i o n . However, to date, s e r v i c e i s more o f a l i a i s o n one between the parents and the i n s t i t u t i o n than a casework r e l a t i o n s h i p . The l a t t e r type of r e l a t i o n s h i p i s more i n evidence i n the Vancouver a r e a where s u p p o r t i v e casework and o r i e n t a t i o n s e r v i c e may have been pr o v i d e d the f a m i l y before i n i t i a l a dmission. The f a c t t h a t admission to the i n s t i t u t i o n n e c e s s a r i l y takes p l a c e by and l a r g e on an emergency b a s i s , where circumstances of the home have become so complex and t h r e a t e n i n g t h a t parents simply must have r e l i e f , has p r e c l u d e d l o n g range p l a n n i n g w i t h p a r e n t s f o r admission o f the moderately r e t a r d e d c h i l d . S e r v i c e s to p a rents who a n x i o u s l y await i n f o r m a t i o n t h a t a bed i s a v a i l a b l e - 22 -for their child have "been for the most part of a 'stop gap' variety. That i s , parents are helped to carry on a l i t t l e longer under c i r -cumstances which are formidable and excruciating. Method This study i s explorative and descriptive. Its purpose i s to explore two hypotheses. The f i r s t of these i s : "Special class training conducted i n an institution can increase the social competency of trainable mentally retarded boys." The San Francisco 1 2 Social Competency Scale Form X 3 was adapted to measure develop-ment i n this area. The term "social competency" includes four areas of social functioning. These are: self-help, i n i t i a t i v e -responsibility, social s k i l l s and communication. The San Francisco Study defines these subscales as follows: (1) The Self Help subscale i s designed to measure the child's manipulative a b i l i t y or motor s k i l l s . The concern here i s solely with manipulation and not whether the child must be directed to do the s k i l l or whether he initiates the activity. The greater the child's manipulative a b i l i t y , as reflected by his Self Help score, the more socially competent is the child. (2) The Initiative-Responsibility subscale i s designed to measure the degree to which the child's behavior is self-directed. The child who must be directed to an activity i s defined as being less socially competent than the child who initiates that activity. It i s conceivable that two children of equal manipu-lative a b i l i t y w i l l d i f f e r i n the amount of respon-s i b i l i t y or i n the self-direction they assume. Cain and Levine, op. c i t . , p. 189. 2 ----------Prior to becoming aware of the San Francisco Study the writer observed the special class on several occasions. He catalogued class procedure and devised rating scales to test progress i n self-help and emotional growth. Upon examination of the San Francisco Social Com-petency Scale i t was decided to seek permission of the authors to use an adapted form of i t i n this study. The authors generously gave their consent. - 23 -(3) The Social S k i l l s subscale i s designed to assess the child's movement toward engaging i n inter-personal relationships with other children and adults. The more the child i s able to relate to others and to participate i n group situations, the more socially competent he i s . (4) The Communication subscale i s designed to measure the degree to which a child makes himself under-stood to people i n general. The greater the child's adequacy i n communicating his wants, the greater his social competence.^ The second hypothesis i s : "The improved social compe-2 tency of the boys w i l l positively affect their acceptability to their own families and non-institutional communities." There i s a need for much more research i n the area of attitudes toward retarded children. Blodgett says: We need to find out some of the most elementary informa-tion, not just about the retarded child, but about the ) families, about the normal children i n the families. about the possible reactions (negative and positive) that might be related to the presence of a retarded child i n the home. Much of this information i s not available, and we believe i t i s important ±o the formulation of s i g n i f i -cant questions yet to come.5 A study completed i n June, 1961 by the San Francisco State College on the effects of community and institutional school classes for trainable mentally retarded children, found, as mentioned ear-l i e r , that the social competency of trainable children was not sig-nificantly affected by present special training, either i n community Cain and Levine, op. c i t . , pp. 181 - 182. 2 Acceptability i s defined as the degree of favourable approval and reception represented i n expressions of affection for, pride in, and patience, with the child, i n overall family, neigh-bourhood and community relationships. Blogett, Harriet E., "Report of a Research Study at the Sheltering Arms, Minneapolis, Minnesota", First Winfield Institute: Research i n the Management of the Mentally Retarded Child, Winfield State Training School, Winfield, Kansas, October, 1956. - 24 -or i n s t i t u t i o n a l schools and t h a t the a d a p t a b i l i t y of parents to t h e i r c h i l d r e n was not s i g n i f i c a n t l y r e l a t e d to the c h i l d ' s a t t e n -dance at s p e c i a l c l a s s e s . However, i t d i d show th a t a d a p t a b i l i t y o f the p a rents to the c h i l d i s r e l a t e d to the s o c i a l competence 2 o f the c h i l d . A sample group o f t e n t r a i n a b l e boys was s e l e c t e d f o r study. Each boy i s between the age of e i g h t and seventeen, i s without severe p h y s i c a l or emotional handicap, has been r e s i d e n t i n the i n s t i t u t i o n and has attended s p e c i a l c l a s s e s f o r at l e a s t one y ear; who, a f t e r t h i s time, has v i s i t e d h i s home f o r a p e r i o d o f a t l e a s t f i v e c o n s e c u t i v e days and n i g h t s . Because a l l boys i n the above category a t t e n d s p e c i a l c l a s s e s i n the i n s t i t u t i o n , i t was not p o s s i b l e to s e l e c t a c o n t r o l group. The p r a c t i c a b i l i t y of u s i n g a c o n t r o l group of g i r l s was explored but decided a g a i n s t when i n a d d i t i o n to the sex v a r i a b l e , v a r i a b l e s o f I . Q., emotional h e a l t h , and age were pronounced. Other v a r i a b l e s i n t h i s study f o r b i d a n a l y s i s of The authors a t t r i b u t e three components to a d a p t a b i l i t y . ' F l e x i b i l i t y ' i s d e f i n e d i n both a t t i t u d i n a l and b e h a v i o u r a l terms; i t r e p r e s e n t s an a t t i t u d e which i n d i v i d u a l i z e s the c h i l d i n the l i g h t o f a s p e c i f i c s i t u a t i o n , as opposed to s t e r e o t y p i n g both the c h i l d ' s behaviour and the s i t u a t i o n . I t a l s o r e p r e s e n t s the a b i l i t y to employ a l t e r n a t i v e means of a c t i o n . 'Empathy' i s de-f i n e d as the p a rent's a b i l i t y to i n t e r p r e t h i s c h i l d ' s behaviour i n terms o f f e e l i n g s , thoughts and motives and to r e l a t e t h i s u nderstanding to the s p e c i f i c s i t u a t i o n i n which the parent and the c h i l d are i n v o l v e d . And 'motivation' i s d e f i n e d as a p a r t i c u -l a r form of d e r i v e d s o c i a l motive; s p e c i f i c a l l y i t i s the motiva-t i o n o f the parent to s o l v e i n t e r p e r s o n a l problems w i t h h i s c h i l d , p C a i n and l e v i n e , op. c i t . , p. 163. - 25 -i n f o r m a t i o n gathered f o r the sake o f a c t u a l l y p r o v i n g e i t h e r of the presented hypotheses. Rather, i n f o r m a t i o n was sought f o r des-c r i p t i v e and e x p l o r a t i v e purposes. I t i s hoped t h a t r e s u l t s sub-s t a n t i a t e the i d e a t h a t a more thorough and comprehensive study should be undertaken. Other v a r i a b l e s i n c l u d e : d i f f e r i n g amounts of time spent i n the i n s t i t u t i o n and i n the s p e c i a l c l a s s ; the e f -f e c t o f i n s t i t u t i o n a l i z a t i o n i t s e l f , and the l i v i n g r e l a t i o n s h i p amongst peers o f s i m i l a r i n t e l l e c t u a l and emotional development; the e f f e c t o f v a r i o u s o t h e r i n s t i t u t i o n a l programmes, i n c l u d i n g o c c u p a t i o n a l therapy, r e c r e a t i o n a l a c t i v i t i e s and group e n t e r t a i n -ment; the changing i n f a m i l y m a t r i x and c o n s e q u e n t i a l s h i f t i n g o f f a m i l y p r e s s u r e s , because of d i s c h a r g e of care r e s p o n s i b i l i t i e s f o r the c h i l d to the i n s t i t u t i o n a t the time o f and f o l l o w i n g h i s ad-m i s s i o n to the i n s t i t u t i o n . Procedure. L e t t e r s r e q u e s t i n g t h e i r p a r t i c i p a t i o n i n t h i s study were sent to the parents of each boy chosen to be a mem-ber o f the sample group (see Appendix "A"). The l e t t e r s were f o l -lowed up by telephone c a l l s , a t which time i n t e r v i e w s w i t h parents i n t h e i r home were scheduled. Each f a m i l y was then v i s i t e d by the same s o c i a l worker. The adapted S o c i a l Competency Scale (see Appendix "B") was e x p l a i n e d and p a r e n t s were requested to complete the Scale twice. T h e . f i r s t time they were to be guided by memory of t h e i r boy's s o c i a l f u n c -t i o n i n g b e f o r e h i s permanent admission to the i n s t i t u t i o n . The second time they were to complete the Scale from o b s e r v a t i o n of the c h i l d d u r i n g h i s r e c e n t v i s i t s home. The Scale was l e f t w i t h the parents so t h a t they might complete i t a t t h e i r l e i s u r e . A - 26 -self-addressed stamped envelope was also l e f t so that when forms had been completed, they could be dropped into the mail. After explaining this procedure, the second part of the research, inter-viewing parents concerning their attitudes of acceptability to the retardate was conducted. A projective interviewing technique was used. Parents were asked to,give their impressions as to how other parents i n circumstances similar to their own might feel to-ward their trainable mentally retarded child before and after training i n the institution commenced. Before and after feelings were discussed consecutively as each item on the Parental Accep-t a b i l i t y Scale (see Appendix "C"), (devised by interviewer), was considered. Pour mothers and one father were interviewed alone. Pour couples were interviewed together. Interviews lasted from I2 hours to 3 hours. Each item on both scales was scored from 1 - 4 or 5, on a low to high basis. The teachers of the special classes were asked to complete Social Competency Scales for 5 of the 10 boys as they now function. This was to check the r e l i a b i l i t y of parental observation of their child's present functioning. Information from institutional f i l e s was used to substantiate parental observation of past functioning. When, i n the course of the interview, the amount of time spent extended over one hour, i t was explained to parents that the interview could be terminated and continued on another occasion. However, i n every instance the parents preferred to go on. This may be an indication of the degree of their involvement. Only one interview was completed i n one hour's time. I CHAPTER II. HABILITATION AND TRAINING OP THE CHILDREN The Purpose of the Institution The severely retarded w i l l always require nursing care. Some require complete or specialized nursing care which i s avail-able only i n a hospital setting. Parents may be able to provide care during early years of l i f e ; however, demands w i l l be extre-mely heavy, and the rewards few. Permanent institutionalization w i l l probably be necessary for most of these patients. Some parents may lose or never have had the a b i l i t y to cope with the demands of the moderately retarded. The physical and emotional strain may so adversely affect the home as to s e r i -ously disrupt development of normal siblings, i n f l i c t impossible financial obligations on the family, engender marital s t r i f e , and perhaps lead to complete breakdown of home l i f e . Day care centres i n a few communities provide nursery service for children up to about age seven or eight. And some 50 Associations for Retarded Children chapter Schools provide classes for older children i n B. C. Again because of the B. C. Education Act amendment of 1959, more classes for the moderately retarded are being provided i n regular public schools. In spite of these services, many families find they cannot carry on and desperately pleadfor the admission of their children to the institution. , Planning i s going ahead i n some areas to provide - 2 8 -resources f o r care of the moderately retarded i n the community. For instance, near Chilliwack, B. C., a short stay hostel i s to be erected. A few children may stay i n residence here and attend sp e c i a l classes. I t may be that t h i s type of resource i s a f o r e -runner to a permanent community type residence. Here the modera-t e l y retarded trainable person w i l l l i v e with others nearer h i s own i n t e l l e c t u a l and s o c i a l a b i l i t y . I t i s of i n t e r e s t to note that t h i s venture was started by a private group of persons through t h e i r l o c a l A. R. C. B. C. chapter. An appeal to the P r o v i n c i a l Government was made for f i n a n c i a l help and rewarded by a government grant of 50$ of the c a p i t a l building costs. This has encouraged other chapters to consider b u i l d i n g residences too, i . e . , on Van-couver Island. The mildly retarded or educable receive academic t r a i n i n g and some vocational i n s t r u c t i o n i n the i n s t i t u t i o n . Most i n t h i s group are admitted because of behavior problems or other d i f f i c u l -t i e s that have made i t extremely hard f o r them to constructively f i l l i n t h e i r time within the community. C. A. R. C. reports that i n about 30$ of the mildly retarded, p s y c h i a t r i c disorders compli-cate the basic handicap. Much of t h i s may be attributed to mis-management of t h e i r care. There are few adequate resources i n the community where Stanley, J . C , C. A. R. 0. Report to the Royal Commission  On Health Services, St. John, New Brunswick, 1959, p. 4« - 29 -the mildly retarded may be given vocational training. For example, The Vancouver Vocational Institute requires grade X for entrance. Nor are there adequately planned social media i n which these per-sons may participate at their own intellectual level. Not being able to cope, many families have found i t necessary to arrange institutionalization. lack of community resources i s underlined every day by community requests that the mildly retarded be allowed to take part i n the institution's programme while continuing to liv e at home. This problem has also seriously restricted oppor-tunity for rehabilitation of those l i v i n g i n the institution. For, after receiving training and after maturing emotionally to the point where they might return to the community, resources to assist are inadequate. Because of lack of community resources, such as supervised residential f a c i l i t i e s , and lack of employment opportu-nities, many of the residents of the institution who could live outside i t s walls seem to be destined to a l i f e of gross dependency within the institution. The large provincial institution should probably even-tually be reserved more and more for the seriously intellectually, physically and emotionally handicapped. Zalelki says: "Ideally there should be very few permanent cases i n an institution. Only those so severely retarded that they are unresponsive to training and who would be an unfair burden for the family could be considered as permanent residents. Others should be admitted when there are some specific indications but returned to the community as soon - 30 -) as possible." At present, however, the institution i s making a significant contribution by providing resources which are not existent elsewhere. Wot the least amongst these are the training f a c i l i t i e s which are helping to establish training curriculum which may be adaptable to community programmes. Waiting l i s t and Prio r i t i e s for Admission. There are not enough beds to accommodate a l l children who seem to be raising formidable obstacles i n the path of family l i v i n g . The i n s t i t u -tion i s often able to admit only on emergency bases. New applica-tions arrive daily. At present, the waiting l i s t at The Woodlands School is more than half the size of the total patient population. As of March 1st, 1962, this l i s t totalled 761, while the patient population was 1,343. I Each application i s rated according to the needs of the child and the needs of the child's family. If the family resides in the Vancouver-lower Praser Valley area, a social worker from the institution calls at the home and e l i c i t s information required to evaluate the need. I f the family lives elsewhere i n B. C , the local Department of Social Welfare or Public Health Unit i s reques-ted to prepare a social history. Information so received i s asses-sed by a rating scale and points assigned. This method assures equal consideration to applications whether the family resides near the school or not. It also affords a measure of protection to the Zalelki, W. A., "Some Advantages and Disadvantages of Institutionalization", The Fourth Conference on Mental Retardation  C. A. R. C , Vancouver, September 26 - 28, 1961, p. 18. - 31 -admitting staff who may be subjected to pressure by parents, local physicians, council members, teachers, or other influential persons. .hough the waiting l i s t i s very large, the date of ap-plication i s only one determinant for admission. Therefore, i t i s d i f f i c u l t to estimate the length of waiting. For some i t may be six months, for others six years. The overall urgency for ad-mission i s the main c r i t e r i a . Despite a marked change i n public and professional a t t i -tudes over the past ten years regarding institutionalization of re-tarded children, there are s t i l l some physicians who recommend immediate admission of most children diagnosed mentally defective at birth. This practice i s gradually being modified i n l i e u of the studies mentioned by such persons as Rene Spitz, John Bowlby and others on the affects of maternal deprivation. For example, The Woodlands School has experienced a reduction in applications to have mongoloid children admitted within the f i r s t few months of birth. Another important piece of knowledge has been emerging as interaction between collateral social and medical agencies i s prompted. To the present time, there has been pressure on the ins-t i t u t i o n from many areas to accept the responsibility of d i f f i c u l t mentally deficient children. Community services, such as the ohild caring agencies and Public Health Units, whose staff members v i s i t families with a child on The Woodlands School waiting l i s t , are accepting more responsibility. It seems the trend i s towards - 32 -development of community resources. At one time considered the only resource, the institution w i l l probably be only one i n a whole spectrum of resources. These include: retarded children's schools (now under The Department of Education), kindergardens (now to be financed by The Department of Education), day centres, hostels, and sheltered work shops. As these resources develop, parents and agencies w i l l have some alternatives to institutiona-l i z a t i o n . This trend i s partially attributable to public education, much of this by parents' groups; and partially i t i s due to the hard, cold r e a l i t y that the institution w i l l never have enough beds, or other f a c i l i t i e s to handle the obvious needs. Legal Requirements. Up to 1954, any mentally defective person could be admitted to a mental hospital by Court Order after committal papers had been duly signed by two registered physicians. In 1954, however, The Mental Defective's Act was modified. Change provided for f i n a l decision concerning admission to be made by the Medical Superintendent of the institution. This was a big step forward. It allowed a firm priority basis for admission to be set up. The institution can now screen applicants and refuse admission to those who can be cared for i n the community. It also streng-thened the responsibility of institution diagnostic c l i n i c s , a fact quite evident i n the institution's present procedure of admission. Each patient i s now admitted on a temporary basis. Examination (including consultation with coinmunity collateral when so indicated) i s conducted and medical, psychological and social assessments - 33 -correlated. These i n turn are supplemented by ward and school observations made over a period of time. With such f i r s t hand observation, planning for permanent admission or for return to the family i n the community is being done on a r e a l i s t i c basis. Intake. Before any patient i s permanently admitted to the institution he i s admitted for a temporary period of thirty days. By the time arrangements for this have been made, informa-tion has been compiled from various sources. The social worker has prepared a social report. The physician has requested medical information from collaterals who have made previous medical exami-nation. Provincial laboratory tests have forwarded results of the child's urine and feces specimen tests. When parents arrive at the school with their child, they are met by the physician. The physician gathers further pertinent data, examines the child and arranges placement on the ward. If available, a social worker introduces parents to the ward staff, who i n turn show them where their child w i l l reside for the tem-porary stay. The social worker also answers questions concerning the total function of the institution, population, v i s i t i n g regula-tions, and channels of continued contact between the institution and the parents. Often parents have been ill-prepared for this ex-perience and are helped i f a social worker i s free to discuss feelings and attitudes. This i s a v i t a l l y important service. How-ever, shortage of staff has made i t physically impossible i n many cases. - 34 -) The Treatment Team The medical superintendent, a psychiatrist, i s the .coordinator of the team. Ward physicians examine, treat and pre-scribe for patients. They also conduct medical tests and may c a l l for consultant services. Ward nurses administer medication. As-sisted by ward 'aides, they attend to the nursing requirements of their patients, and observe ward self-help and social behavior of the patients. C l i n i c a l psychologists conduct tests to study the mental processes and behavior of the patients. Social workers maintain li a i s o n between treatment staff, families, and community social welfare and health services. Teachers observe the child i n the class. Occupational and physiotherapists, and recreation directors observe i n their departments. Toward the end of the thirty day admission diagnostic c l i n i c i s held. .The medical superintendent presides. - Reports are submitted by staff representing his or her treatment area. Medical diagnosis i s completed. This i s related to observed activity i n the institution and social circumstances of the family and commu-nity. A prognosis i s postulated and plans made for immediate, near future, deferred or no permanent admission. The conclusions of the c l i n i c are conveyed to the commu-nity medical practitioners involved by the patient's institution physician. If the child's parents reside i n the local area or are able to come to the institution, social data i n the light of c l i n i c a l assessment i s interpreted directly by the institution's | social worker engaged for the case. If parents are not able to be reached i n this manner, information i s interpreted to the Social Welfare Department and, or, the Public Health Unit concerned, who, i n turn, w i l l interpret to parents. I f the child i s to be immedi-ately admitted on a permanent basis, he (she) i s assigned to the appropriate ward according to age, sex, physical and mental clas-s i f i c a t i o n . Casework Services Social casework services to families with retarded c h i l -dren have been sporadic and somewhat inconsistent. Social welfare departments are too laden with other tasks, and on the whole are staffed by personnel lacking sufficient casework training to be able to give this type of service. Children's Aid Societies and Public Health Units have been i n a similar position. In practice, most families have been referred to the institution for help -often as an emergency measure and when casework service i n i t s e l f i s an inadequate resource. The institution's social service staff i s too limited to consider giving regular casework services to a l l those who require i t . Often i t s staff i s assigned the job of picking up the pieces of shattered family l i f e , a task fraught with failure. Family pressures, unrelieved over too long a period, mount up. Affection for the retarded child i s sometimes lost i n the maze of painful demands on parents and siblings alike, and the way opened for serious future family conflict. There has been a tendency to shy away from this problem because i t made even professional people uncomfortable (as mental illness has i n the past). Social workers rationalized that the retarded child was really a medical problem. They reasoned that they could not help other than to advise institutionalization and so worked with the family to help them accept institutionalization, and without re-gard to the fact that there were no beds available! Many physi-cians approached the problem as one being s t r i c t l y medical and recommended institutionalization as the only answer, again i n spite of the fact that the institution was f i l l e d to capacity. Public Health Nurses saw the emotional problems and sidestepped them because they were not caseworkers. Thus families generally have been rejected by professional people and agencies. There i s an emphasis now on provision of service from the community i n which the family resides. This, of course, means services w i l l have to be increased, correlated and mutually suppor-tive. The aim i s to provide help early enough to prevent family breakdown and to promote community responsibility. i The Number of Mentally Retarded Persons It has been estimated that of some 4,200,000 children born annually i n the U. S. A., 3$ (126,000) w i l l never achieve the i n t e l l e c t of a twelve year old child; 0.3$ (12,600) w i l l remain below the seven year intellectual level; and 0.1$ (4,200) w i l l , i f they survive, require total nursing care. Applying these Masland, L., et a l , Mental Subnormality, Basic Books, Inc., New York, 1958, p. 3. - 37 -percentages to Canada, i t means that of each 1,000 children born, about thirty w i l l be mentally deficient. C. A. H. C. estimates that of these thirty, twenty-five w i l l be mildly retarded, four moderately retarded and one severely retarded. For the estimated numbers of mildly, moderately and severely retarded now livi n g i n a l l of Canada, see Table 1. For those l i v i n g i n British Columbia, see Table 2. Of the 450,739 live births i n 1956 in,Canada2 i t i s es-timated that 11,268 are mildly retarded, 18030 moderately retarded and 4,507 severely retarded. The corresponding figures for British Columbia i n the same yeare are (of some 36,241 liv e births) 906, 157 and 36. There has, of course, been an increase i n the birth-rate. The total population of Canada has risen from 16,008,791 in 1956 to 18,238,247 i n 1961; i n Br i t i s h Columbia, i t rose from 1,398,464 to 1,629,082.5 This means that i n a l l of Canada there are now approximately 455,956 mildly retarded, 72,953 moderately retarded and 18,238 severely retarded. The corresponding figures for British Columbia are 40,727, 6,516 and 1,629. It i s of note that to December 31st, I960, 2,320 retarded children nineteen years and under were registered as residing i n their communities i n The B. C. Provincial Crippled Children's Stanley, op. c i t . , p. 5. Canada, Dominion Bureau of Statistics, Census Division, Census 1956, Vol. 1, part 9. Canada, Dominion Bureau of Statistics, Census (Demography) Division, Population Section, Census of Canada 1961, Advance Report, No. AP-1, March 16, 1962. - 38 -I Table 1. Population of Canada and Estimated Numbers of Mentally Retarded Persons Age Groups Population For Age Group Estimated Population For Mentally Retarded Mild Moderate Severe Total 0 - 4 1983563 49589 7934 1984 59507 5 - 9 1807052 45176 7228 1807 54211 10 - 14 1434594- 35865 5738 1435 43038 15 - 19 1162301 29058 4649 1162 34869 19 & up 969328I 242332 38773 9693 290798 Totals 16080791 402020 64322 16081 482423 Source: Canada, Dominion Bureau of Statistics Census Division, Census 1956 - Vol. 1, part 9. Table 2. Population of British Columbia and Estimated Numbers of Mentally Retarded Persons Age Groups Population , For Age Group Estimated Population For Mentally Retarded Mild Moderate Severe Total 0 - 4 156759 3919 627 157 4703 5 - 9 140588 3515 562 141 4218 10 - 14 108518 2713 434 108 3255 15 - 19 1 86433 j 2161 346 86 2593 19 & up 906166 i 22654 3625 906 27185 Totals 1398464 ; 34962 5594 1398 41954 Source: Canada,. Dominion Bureau of Vital Statistics, Census 1956 - Vol. 1, part 9. - 39 -) / Registry. According to estimates, there were a total of 14,769 retarded nineteen years and under i n British Columbia in 1956. Excluding the total institutional populations of The Woodlands School and i t s Annex, The Tranquille School (Tranquille, B. C ) , these figures would suggest that there are some 11,000 unregis-tered mentally defective children under the age of nineteen i n British Columbia. The Classrooms The special classroom, f i f t y feet by twenty-two feet i s situated on the basement floor of a boy's residence. The room i s divided only by p i l l a r s . Equipment for various acti v i t i e s i s ranged i n semi-permanent fashion i n different areas of the room. I This includes a grocery store bus area, a street cross-walk area, a multiple teaching area, and so on. Each area i s set up i n a manner closely simulating that presently found i n the com-munity at large. For instance, the grocery store i s decorated by sale pennants, signs, and so on. It i s stocked with real merchan-dise. Special equipment, such as a tape recorder, radio, t e l e v i -sion, slide projecture, record player and so on are arranged throughout the room without particular b u i l t - i n protecting devices. The boys are taught to respect property. Adjoining the special classroom i s a self-care room ap-proximately twenty-two feet by twenty-two feet. Its equipment i n -cludes a shoe polishing stand, dinner table, chairs, dishes, cut-I lory, glasses, beds, sink, a clothes rack and hangers, f u l l 'boy - 40 -size 1 dressing dolls, an individual window frame separated from the "building as such and containing glass, and so on. Next to this room i s a playroom approximately f i f t y feet by twenty-two feet. Except for p i l l a r s the room i s open and provides an area both for play and for practicing washing and cleaning methods learned i n the self-care room. Self-Care Room Ac t i v i t i e s . While the special class-room and the playroom are occupied, a group of twelve boys come to the self-care section for two hours training. They f i r s t go to the wash-room where they practice washing their hands and face, and brushing their teeth. From here they go to the self-care room i t s e l f where they cream their faces to avoid chapping. They then practice brushing and combing their hair with the use of a mirror. Approximately one hour's time i s spent doing these things. For the next hour, i n groups of two, the boys spend approximately five minutes on each of the following a c t i v i t i e s : making beds, folding clothes, washing window, setting the table, washing dishes, putting on clothes, lacing and shining shoes„ and dressing l i f e - s i z e dolls. On some days they are taught how to wash walls and polish floors. Under the direction of Mr. John Wicentowich. - 41 -Special Training Class Activ i t i e s . Class i s begun by a very simple prayer said by the teacher and repeated by the class as a group. Roll c a l l i s taken and activities begun. There i s no set sequence. It may be that the boys show more interest i n some projects than i n others on certain days. The teacher i s sen-sitive to their feelings and capitalizes on any evident motiva-tions for learning by encouraging the expression of these. The motto of the special class, "Play to learn" i s f o l -lowed (see Appendix "D" for classification of classroom a c t i v i t i e s ) . It may be that some games are more popular than others. I f the teacher feels that a child lacks interest i n a project, he seeks to stimulate i t , not only by making the activity as colourful and fun-filled as possible, but by rewarding the child's adequate par-ticipation by letting him later do a favourite game.- Besides the Under the direction of Mr. Julius Erdelyi. Mr. Erdelyi was born i n Hungary. As a young man he attended Teacher's College there for five years. Shortly before the war he became a member of the Szeged Opera Group and was a baritone soloist. He joined the Army i n 1936 and saw action on several fronts. When taken prisoner of war, he held the rank of Captain. After release, he worked as a labourer in Austria for two years and then went to England. There he worked at various jobs including those of ward aid i n hospitals for the chronically physically handicapped. In 1957 Mr. Erdelyi came to Canada. He was employed at hospitals i n Quebec, then 'came west' and attached himself to The Woodlands School. In retrospect, having become dedicated to his work, Mr. Erdelyi says, "The biggest break i n my l i f e came when Mr. E l l i o t t , chief psychiatric male nurse, asked me to start a special class for trainable boys." With a devotion and investment of self sur-passed by no other staff member of The Woodlands School, he began his class, personally equipped the classroom by getting donations from interested community members, and besides teaching, has con-tinued to develop classroom procedures, techniques and f a c i l i t i e s . He has aroused much community interest throughout the Province of British Columbia, both i n parents and professional persons alike. During 1961, nine hundred and forty-seven people visited his classroom. m o t i v a t i o n a l aspect i n v o l v e d when a c h i l d i s thus promised a f a v o u r i t e a c t i v i t y f o r a w e l l done l e s s popular one, most p r o j e c t s are interwoven w i t h others and serve to r e i n f o r c e and encourage c a r r y over of l e a r n i n g from one area to another. Dramatic p l a y i n g i s used e x t e n s i v e l y . C h i l d r e n d r e s s f o r t h e i r s p e c i a l p a r t s . Each has h i s t u r n , on d i f f e r e n t days, to take l e a d or p o p u l a r r o l e s . These r o l e s may be: bus d r i v e r s ( f o r t r i p s to farm, country, zoo, a i r p o r t , r a i l w a y t e r m i n a l , other i n s t i t u t i o n a l s e t t i n g s , park, and so on); mailman (to d e l i v e r " l e t -t e r s to each of the c l a s s members); mailboy (to d e l i v e r l e t t e r s i n t o the classroom m a i l box, or to d e p o s i t o f f i c i a l i n s t i t u t i o n a l m a i l i n an o f f i c i a l m a i l box); g r o c e r (to s e l e c t merchandise f o r shoppers); shopper (to take messages to the grocer f o r merchan-d i s e ) ; t e l e p h o n e r (to send s p e c i a l messages to the g r o c e r ) ; m i l k -man (to d e l i v e r m i l k , and s e l e c t proper s i z e c a r t o n s or b o t t l e s ) ; f i r e m a n (to prepare f o r and p r o p e r l y use f i r e equipment); f i s h e r -man (to encourage d e x t e r i t y ) ; camper (to r e l a t e schoolroom a c t i v i -t i e s to a c t u a l camping); newsboy ( t o buy newspaper from classroom honour boxes). Boys are taught to do errands i n the classroom. These may i n v o l v e as many as f o u r of the above a c t i v i t i e s a t once and so, a l s o , the concept of time. For example, a c h i l d i s i n s t -r u c t e d t o , "(a) Go to the s t o r e , (b) buy a b i g bag of oranges, (c) but b e f o r e , (d) m a i l t h i s l e t t e r , (e) a f t e r , buy a "Sun" news-paper." Boys are taught t r a f f i c r u l e s . They are taught to a s s o -c i a t e movements and sounds w i t h s p e c i f i c games (as ping-pong, - 43 -t e n n i s , rugby and so on). They p l a y s e v e r a l games to s t i m u l a t e v a r i o u s a b i l i t i e s . These i n c l u d e , "What i s m i s s i n g ? " (remembering f o u r o b j e c t s and one removed), "What i s h i s name?" (guessing c l a s s -mate's name from h i s v o i c e when b l i n d f o l d e d ) , "What i s i t ? " (gues-s i n g a r t i c l e s by sme l l when b l i n d f o l d e d ) , "Where does i t go?" (p u t -t i n g p u z z l e p i e c e s i n proper o r d e r ) . Boys are taught to count numerals 1-20, and i n a v a r i -e t y o f ways p r a c t i c e . They are taught how to use ste p s , to r e c o g -n i z e common s i g n s , t o t e l l time, t o manipulate window b l i n d s . They are g i v e n p h o n e t i c l e s s o n s . I n games they are taught s i z e concepts, c o l o u r s , shapes, new words, manual d e x t e r i t y ( b u t t o n i n g , l a c i n g , p u t t i n g b o l t s on screws, sawing wood, p o l i s h i n g wood and so on). Drawing and c o l o u r i n g games are r e l a t e d to o b j e c t s w i t h i n the c l a s s -room - which i n c l u d e , f o r example, a s t u f f e d duck ajid a mounted deer head. The boys are taught the care o f p e t s . L i v e animals and b i r d s are e x h i b i t e d i n the classroom from time to time. L i k e w i s e , they are taught the care o f p l a n t s , and when weather permits, the care o f g r a s s . The c h i l d r e n enjoy forms of simple music. They are taught, t o r e c o g n i z e and keep time t o c e r t a i n p i e c e s . A u d i o - v i s u a l a i d s are used to make each "P l a y to Learn" game as r e a l , s t i m u l a t i n g and i n t e r e s t i n g as p o s s i b l e . A l l a c t i v i t i e s are c o r r e l a t e d . Each r e q u i r e s i n d i v i d u a l and group p a r t i c i p a t i o n . Each i s designed to encourage body co-o r d i n a t i o n (motor s k i l l s ) , s e l f - c o n t r o l , s e l f - c o n f i d e n c e , i n i t i a t i v e , - 44 -d i s c r i m i n a t i o n , c o u r t e s y , s h a r i n g and r e s p e c t f o r p r o p e r t y . Sense p e r c e p t i o n s are s t i m u l a t e d and r e l a t e d s p e c i f i c a l l y ( s i g h t , sound, touch, t a s t e , s m e l l ) . Rules o f s a f e t y are a s s o c i a t e d w i t h p l a y l e a r n i n g . The use of words and numbers are taught. The process of f o l l o w i n g d i r e c t i o n s , completing t a s k s i s f a c i l i t a t e d . And throughout a l l there i s encouragement i n the care of s e l f , ( c l o t h e s grooming, hygiene and so on). The boys a t t e n d i n g the s p e c i a l c l a s s p a r t i c i p a t e w i t h enthusiasm and obvious enjoyment. They appear to be secure i n the knowledge t h a t they are important members of the group, t h a t they can share f r i e n d s h i p , t h a t they are accepted by the teacher and f e l l o w classmates. The emotional c l i m a t e of the classroom seems to be one i n which the boys may both r e l a x and at the same time be s t i m u l a t e d to perform t a s k s rewarding because of the sense of accomplishment. Those parents who have v i s i t e d have gone away not a l i t t l e comforted by the knowledge t h a t t h e i r c h i l d i s a member of t h i s t r a i n i n g c l a s s . CHAPTER III MEASURING MOVEMENT One of the c r i t e r i a for the selection of boys for the sample group was that they had visited home after receiving at least one year's training. In other words, each family had to already be showing interest, and each boy had to have the oppor-tunity to use his training i n his family home setting. Physical and Family Characteristics A l l families of the boys i n the sample group reside within thirty-five miles of Vancouver; and a l l ten have their own homes. Three of the families are of the lower income bracket and 1 houses are inadequate. A l l three of these, D, P, and J, are farm homes. One, G, i s in an established middle-class neighbourhood i n a city. Three, B, G, and I, are older houses i n a city working-class area. One, A, i s i n a relatively new working-class area. Two, E and H, are in new city residential areas. A l l families but one are dependent upon the father's income, the other on the mother's. The income of two families, D and A, i s under $3,000 per year. The income of five others, B, P, G, H, I and J, i s bet-ween 13,000 and $4,000 per year. For two others, C and E, the i n -come i s between $5,000 and $6,000. The father's type of employment Each of the ten boys in the sample group i s identified i n charts and script by one of the letters A to J. Each boy's family i s identified by the same letter. - 46 -include: boomman, A; lumber grader, G; roofer, B; construction laborer, P; fireman, E; salesman, H; chartered accountant, C; and farmer, D, P, and J. The fathers represent several nationality-backgrounds. These include: Swedish, A; Scottish, B; English, C; Ukranian, H; Irish, E; Dutch, P; Norwegian, G; and Lithunanian, H. The fathers' ages range from forty- four to fifty-eight years and mothers' from thirty-five to forty-nine years. In two instances, parents are separated and the normal children of these unions are now living with their mother. However, the father (A) shows con-tinuing interest in his retarded child and has him home for v i s i t s in one case, the mother (i) i n the other. There are siblings i n a l l but one family. They are listed as follows: A, aged fifteen, has a sister aged seventeen and a sister aged four and one-half. B, aged thirteen and one-half, has a sister aged ten and a brother aged seven. 0, aged thirteen, has a brother aged seventeen. D, aged nine and one-half, has a brother aged seventeen (retarded), a sister aged thirteen (retarded) and the sister's twin, a brother, aged thirteen (normal). E, aged seventeen, no siblings. P, aged seventeen, has eleven siblings aged eight to thirty-three. Seven of these are at home. Two others are retarded and some of the other siblings have been quite slow i n school. G, aged seventeen, has a sister aged thirteen. H, aged eight and one-half, has a brother aged twenty-seven and a sister aged fourteen. 1, aged seventeen, has a brother aged eighteen and a sister aged eleven. - 47 -J, aged twelve, has eight foster brothers and sisters aged twenty-one to one and one-half years. Measuring the Habilitation Progress At the time of admission, except for boys A and J, each parent reported their child to be functioning at a level of depen-dency inhibiting both to the boys and the family. Among the be-haviour problem t r a i t s , which affected parental attitudes to the boys, were: hyperactivity, withdrawal, destructiveness, babbling, screaming, biting, running away, noisy and attention demanding at night, anti-social mannerisms, and neighborhood problem a c t i v i t i e s . Much of this negative behaviour has disappeared since institutiona-lization. This may be partly due to special training. However, the number of other variables present i n this study forbid making any direct conclusions. It i s sufficient to suggest that special training may be significantly related to improved behaviour. Some improvement of each boy's functioning i n Self-Help (Tables 3 , and 4 ) , Initiative-Responsibility (Table 5) and Social S k i l l s (Table 6) was reported by a l l parents. In Communication (Table 7) two boys (A and I) showed no improvement, and one (E) showed less a b i l i t y . Parents of A and I noted their boy as having high communication ab i l i t y before admission to the institution. They assigned the same high rating after training. Boy E's a b i l i t y to use speech has regressed due to organic deterioration. Interviews with parents revealed that to a l l but two parents the boy i s more acceptable after institutionalization and training than before (Table 8). Seeing their child do things - 48 -Table 3« Social Competency: Ia. Self-Help: Items: 1 : Undressing. 2 : Removing outer clothing. 3 : Dressing. 4 ; Putting on shoes. 5 : Care of shoes. 6 : Washing (hands and face). 7: Care of fingernails. 8 : Combing or brushing hair. 9 : Brushing teeth. 1 0 : Blowing nose. (Comparison of Sample Group, Before and After Training) Ten cases listed alphabetically. Items Before Trainine Totals Before After Training Totals After A B c D E F G H I J * A B C D E F G H I J 1 4 3 l 1 1 2 2 2 4 3 23 4 4 4 2 4 4 4 4 4 3 37 2 k 3 l 1 2 2 3 1 4 3 24 4 4 2 3 4 3 4 3 4 3 34 3 4 3 l 1 2 2 2 2 3 2 22 4 4 3 2 3 2 4 5 5 2 34 4 3 3 i 1 1 1 2 2 2 4 20 3 3 4 2 4 3 3 3 4 4 33 5 3 1 l 1 1 2 3 1 1 2 16 3 3 3 3 4 3 4 3 4 2 32 6 3 2 l 1 1 1 1 3 2 19 3 4 3 3 4 3 3 4 4 2 33 7 3 1 l 1 1 1 1 1 1 1 12 3 1 1 1 1 1 1 1 1 1 12 ; 8 2 1 2 1 1 1 2 3 3 2 18 3 1 2 3 4 3 4 4 4 2 30 9 5 3 1 1 3 3 3 3 5 2 29 5 5 5 3 5 4 5 4 5 3 kk 10 4 l 2 1 i 1 2 3 3 1 19 4 3 2 1 1 4 3 4 4 1 27 Totals 35 21 12 10 14 16 21 22 29 22 202 36 32 29 23 34 30 35 35 39 23 316 The meaning of the items, and the "ratings", is explained in the text. Table 4. Social Competency: lb. Self-Help: Items: 11: Eating. 12: Use of knife. 1 3 : Serving food. 14: Passing food. 15: Clearing table. 16: Cleaning up (liquids). 17: Cleaning dishes. 18: Opening door. 1 9 : Sweeping. 20: Making bed., 21: Folding articles. (Comparison of Sample Group, Before and After Training) Ten cases listed alphabetically. Items Before Training Totals Before After Training Totals^ After j A B C D E F G H I J A B C D E F G H I J 11 ' 5 3 1 1 3 3 3 3 4 3 29 5 3 3 4 4 4 4 5 5 3 40 12 5 1 2 1 1 2 2 2 4 3 23 5 3 1 1 1 3 4 4 4 3 29 13 5 2 1 1 2 3 3 4 4 2 27 5 4 2 4 5 4 5 4 5 4 42 14 4 4 1 1 1 5 3 4 5 2 30 4 5 2 1 5 5 5 5 5 4 41 15 4 2 2 1 1 3 2 2 1 2 20 4 3 1 3 3 5 4 4 3 2 32 16 3 1 1 1 1 1 2 1 3 2 16 4 2 4 1 4 3 3 3 3 3 30 17 4 1 1 1 1 1 1 2 1 2 15 4 1 2 1 2 4 4 4 4 2 28 18 4 3 1 1 3 3 2 3 3 3 26 4 3 2 3 4 3 3 3 4 3 32 19 3 1 1 1 1 3 2 2 1 1 16 4 3 2 1 2 4 4 4 4 1 29 20 3 2 1 1 1 1 2 2 1 3 17 3 2 3 1 4 3 4 4 4 3 31 . 21 3 ,1 1 1 2 1 2 1 2 1 , 15 4 2 2 1 3 2 2 1 . 2 1 ! Totals k3 21 13 11 17 26 24 26 30 24 234 46 3 1 24 21 39 41 45 42 43 29 3611 The meaning of the items, and the "ratings", is explained in the text. - 4 9 -Table 5» Social Competency: Ha, Initiative-Responsibility: Items: 1: Washing hands and face. 2: Brushing teeth. 3'. Hanging up clothes. 4: Toileting. 5- Table setting. 6: Cleaning up mess. 7: Playing with others. 8: Initiating tasks. 9: Offering assistance. (Comparison of Sample Group, Before and After Training) Ten cases listed alphabetically. > Items Before Training Totals Before After Training Totals After : A B C D E F G H I J A B C D E F G H I J 1 2 1 1 1 1 2 1 1 2 2 14 3 2 1 2 2 3 4 2 4 2 25 2 2 1 1 1 1 2 2 1 3 1 15 2 2 1 1 2 2 4 1 4 1 20 3 4 1 1 1 1 1 3 1 2 2 17 4 2 2 2 3 3 4 3 4 2 29 4 4 3 1 1 1 1 2 1 3 1 18 4 4 4 4 3 3 4 4 2 2 34 5 5 1 1 1 1 3 4 3 1 2 22 5 3 3 1 4 4 5 5 4 2 36 6 3 1 1 1 1 3 1 2 2 2 17 3 1 1 3 3 3 3 3 4 3 27 7 2 1 1 4 1 1 3 2 2 21 4 3 3 2 4 3 2 3 3 2 29 8 5 1 1 1 l 3 4 2 5 27 5 l 1 1 3 4 5 3 5 4 32 9 4 1 1 i 3 3 2 3 3 25 4 4 1 2 3 3 4 4 3 4 32 Totals 33 15 9 9 12 19 21 16 23 19 176 34 22 17 18 2? 28 35 28 33 22 264 The meaning of the items, and the "ratings",, is explained in the text. Table 6. Social Competency; l i b . Social Skills: Items: 1: Telling time. 2: Sharing. 3' Playing with others. 4: Care of self. 5 : Telephone. 6: Going on errands. 7: Traffic signs. 8: Answering door. 9% Behaviour in public. 10: Attending tasks. (Comparison of Sample Group, Before and After Training) Ten cases listed alphabetically. Items Before Training j Totals j Before After Training Totals After A B C D E F G H I J A B C D E F G H I J 1 1 1 1 1 1 1 1 1 1 1 10 1 1 1 1 1 1 2 1 1 1 11 2 2 4 1 1 1 5 2 4 4 3 30 4 1 1 3 5 2 5 3 5 4 33 3 3 3 1 1 4 1 1 2 1 2 ! 19 3 3 2 1 4 3 3 2 1 2 24 ! 4 3 3 1 1 2 2 1 2 2 3 : 20 3 3 1 1 4 3 2 3 4 3 27 ; ! 5 3 1 1 1 1 1 1 2 1 1 13 3 2 2 1 1 1 '3 3 3 1 20 ' 6 , 3 1 1 1 1 1 1 1 1 2 13 4 2 2 2 1 2 4 3 2 2 24 : I 7 4 1 1 1 2 1 1 1 1 1 14 4 1 1 1 3 1 3 3 2 1 20 i 8 4 2 1 1 1 3 2 2 1 3 20 4 3 2 2 3 3 3 3 3 3 29 1 9 ; 3 2 1 1 4 2 1 4 4 2 24 4 2 3 1 4 3 3 4 4 3 31 I 10 ; 4 1 1 1 1 1 1 1 3 1 15 5 1 2 1 5 1 3 2 5 1 26 ! Totals 32 16 10 10 22 15 14 20 20 19 178 35 19 17 14 31 20 31 27 30 21 245 The meaning of the items, and the "ratings", is explained in the text. - 50 -Table 7. Social Competency: l i e . Communication: Items: 1: Delivering messages. 2: Answering questions. 3: Relating objects to action, 4: Use of language. 5: Spontaneous speech. 6: Following instructions. 7: Speaking to adults. 8: Going places. 9'. Playing with others. 10: Communicating unhappiness. 11: Answering door (Comparison of Sample Group Before and After Training) Ten cases listed alphabetically. Items Before Training Totals Before After Training Totals After A B C D E F G H I J A B C D E F G H I J 1 3 2 1 1 2 1 2 1 3 3 19 3 3 1 2 1 3 3 3 3 3 25 2 4 2 1 1 3 2 2 2 3 3 23 4 3 1 2 3 3 4 3 3 3 29 3 4 1 1 1 2 2 1 2 4 2 20 4 2 2 1 l 2 4 3 4 2 25 4 4 2 1 1 2 2 2 2 3 3 22 4 3 3 1 l 3 4 3 2 3 27 5 4 1 1 1 1 1 2 1 4 3 19 4 1 3 1 3 2 4 4 4 4 30 6 3 2 1 1 2 2 2 3 2 2 20 3 2 3 2 3 3 3 3 3 3 ' 28 7 4 2 2 1 4 4 4 4 4 4 33 4 2 3 1 4 4 4 4 4 4 : 34 8 4 2 1 1 2 3 3 3 3 3 25 4 3 2 1 1 3 4 3 3 4 : 28 9 4 2 1 1 2 2 1 1 1 3 18 4 3 4 2 2 4 4 1 1 4 ! 29 10 4 3 1 2 3 2 1 3 4 2 25 4 4 3 3 3 4 4 3 4 2 34 11 4 2 1 1 3 3 1 2 3 4 24 3 1 1 2 3 3 3 3 •4 27 Totals 42 21 12 12 26 24 21 24 34 32 248 i 42 29 26 17 24 34 41 33 34 36 316 The meaning of the items, and the "ratings", is explained in the text. - 51 -Table 8. Parent Acceptability: Items: 1: Playing with or teaching child. 2: Response to child's affection. 3: Parent's affection. 4: Comparing retardate to normal children. 5: Attitude to in-laws. 6: Attitude to friends or neighbours. 7: Attitude to strangers. 8: Planning after institutionalization of child. 9: Response to child initiating task performance. 10: Response to child's improved task performance. 11: Responses to child's failure in task performance. 12: Attitude to child in public places. 13: Attitude of neighbours to child. 14: Attitude of siblings in play with child. 15: Attitude of sib-lings to child itfhen friends present. (Comparison of Parent Sample Group, Before and After Retardate's Training. Ten cases listed alphabetically). Items «8-COOT UU Q)C0 £ E nso Parent Acceptability Before Training Totals Before Parent Acceptability After Training Totalsj After ; Items A B C D E F G H I J ( A B C D E F G H I J 1 F H 3 3 - 1 1 - 3 - - -- 3 2 1 1 2 4 4 4 4 11 25 3 3 - 3 3 - 3 - - -! - 3 3 3 3 3 4 4 4 4 15 31 2 F ,1-1 4 2 - 2 2 - 3 - - -- 4 4 2 2 4 4 4 4 4 13 32 3 3 - 3 3 - 3 - - -- 4 4 3 3 4 4 4 4 4 15 34 3 F: M! 4 2 - 1 3 - 3 - - -- 3 3 1 3 4 4 4 4 2 13 28 4 3 - 3 3 - 3 - - -i _ 4 4 3 3 i | , i j . i + z < . 3 16 33 1 4 3 2 - 1 2 - 2 - - -- 3 1 1 2 2 2 4 2 4 10 21 i 3 3 - 3 3 - 4 - - -i - 4 3 3 3 3 4 4 3 4 16 j 5 F M 3 4 - 2 3 - 4 - - -- 4 4 3 4 4 4 4 3 4 16 32 • 3 4 - 4 4 - 4 - - -_ i f i 1 . 4 j 4 . Z f 4 z j . 3 4 19; 35 i 6 F M 4 2 - 2 2 - 4 - - -- 2 2 2 2 3 4 4 3 4 14 26 4 4 - 3 4 - 4 - - -_ 4 4 3 4 4 4 4 4 4 191 35 I / ? F M 3 3 - 1 3 - 2 - - -- 3 1 1 3 3 2 4 3 4 12 24 3 4 - 3 4 - 3 - - -_ 4 3 3 4 4 4 3 4 4 17 33 8 F M 4 4 - 3 3 - 3 - - -- 4 3 3 4 4 3 3 4 4 17 - 32_ 4 4 - 4 3 - 4 - - -_ 4 4 4 4 4 4 4 4 4 19 .36. .* F M 4 3 - 1 2 - 2 - - -- 3 3 1 1 3 2 3 3 3 12 22 4 4 - 3 3 - 4 - - -_ 4 4 4 2 4 4 4 4 4 18 34 1 1Q F |M 4 3 - 2 2 - 3 - - -- 3 2 2 2 3 4 4 3 4 14 27 . 4 4 - 4 3 - 4 - - -_ 4 4 4 3 4 4 4 4 4 19 35 11 F M 4 3 - 2 2 - 2 - - -- 3 2 2 1 2 3 4 3 4 13 24 4 4 - 4 3 - 4 - - -- 4 4 4 2 4 4 4 4 4 19 ! _ 34 1 12 F M 4 2 - 1 2 - 2 - - -- 2 2 1 2 3 2 3 3 4 11 22 4 4 - 2 4 - 3 - - -- 4 4 2 4 3 4 4 4 4 17 | 3 3 ; ,13 F M 3 3 - 2 3 - 3 - - -- 3 1 2 3 2 3 4 2 3 14 23 3 4 - 3 4 - 4 - - -- 4 3 3 4 2 4 4 3 4 18 j 31 ! 14 F M 4 4 - 1 - - 3 - - -- 4 2 1 - 3 3 4 4 4 12 25 4 4 - 2 - - 4 - - -- 4 3 2 - 4 4 4 4 4 14 ! 29 15 F M 1 3 - 2 - - 2 - - -- 3 1 2 - 4 2 4 4 3 8 25 1 4 - 1 - - 3 - - -- 4 2 1 - 4 3 4 4 4 9 26 Totals F M 52 43 - 24 30 - 41 - - _ ! - 47 33 24 29 46 46 57 49 55 190 386 51 56 - 45 44 - 54 - - -- 59 53 46 43 55 59 59 57 59 250 490 The meaning of items, and "ratings", explained in the text. rewarding to himself and more pleasing to others i s instrumental i n improving parental feelings about having a defective child. They are less upset when the boy i s compared with normal children. They are less embarrassed with the child i n the presence of rel a -tives, neighbours, friends and strangers. They have more patience with the child and are more curious about his newest achievements. Siblings are somewhat more accepting. A l l but two of the parents are quite convinced that special training definitely helped their boy to do more things for himself and prepared the child for more acceptable social intercourse with family and others. One parent (j) stated that training definitely helped the boy do more things for himself but thought his acceptability (which was rated high before training) had not changed. Parent (A) rated the training unfavourably because the child had lost his a b i l i t y to write his name, a distinction he had learned while attending chapter school before institutionalization. Gains and losses i n the boys' social competency and the parents' acceptability are shown i n Table 9. Case Illustrations For purpose of i l l u s t r a t i o n , two children have been selec-ted. Selection was on the basis of changed parental attitude rather than change i n the boys' social competency as such. The boy whose parent has shown the least change and the boy whose parents have shown the most change w i l l be briefly described. Oase A. Johnnie was born May 1st, 1947, i n a British Columbia coastal village. He was very slow i n reaching his - 53 -Table 9. Composite of Social Competency and Parent Acceptability Scales  Showing Gains and Losses After Retardate's Training-(Ten Cases Listed Alphabetically) a s e s Gains of Child Gains of Parent Acceptability Gains of Parents and Child Self-Help Growth and Maturity Ia lb l i a Ub H e Total I & n Father & Mother One Parent Two Parents A 1 3 1 3 0 8 F -1 -1 A 7 M B 11 10 7 3 8 39 F 13 25 B 64 M 12 C 17 11 8 7 14 57 F 20 C 77 M 20 D <* 13 10 9 4 5 41 F 21 43 D 84 M 22 E 20 22 15 9 -2 64 F 14 28 E 92 M 14 F 14 15 9 5 10 53 F 9 F 62 M 9 G 14 21 14 17 20 86 F 13 26 G 112 M 13 •H 13 16 12 7. 9 57 F 2 H 59 M 2 I 10 13 10 10 0 43 F 8 I 51 M 8 J 1 5 3 3 4 F 4 J 20 M 4 T ? a .1 114 126 88 68 68 464 F 60 42 122 628 M 104 m o Rating After Training t Rating Before Training |_ Possible Gain 2170 1039 1131 824 576 248 2994 1615 1379 - 54 -m i l e s t o n e s . He s u f f e r e d e p i l e p t i c s e i z u r e s d u r i n g h i s f o u r t h y e a r . At f i v e y e ars he was admitted to the h o s p i t a l f o r s p e c i a l examination. When he was d i s c h a r g e d t o h i s home a few weeks l a t e r , h i s s e i z u r e s were s t i l l u n c o n t r o l l e d . He was diagnosed to have c o n g e n i t a l c e r e b r a l maidevelopment, n o n - s p e c i f i c , w i t h e p i l e p t i c s e i z u r e s due to encephalopathy o f unknown e t i o l o g y . Johnnie l i v e d w i t h h i s mother and f a t h e r , and a s i s t e r two y e a r s o l d e r than h i m s e l f . H i s f a t h e r worked f o r a lumber com-pany. Parents c o n s i d e r e d placement o f the boy e a r l y i n h i s l i f e but gave up the i d e a a f t e r b e i n g a d v i s e d by the p h y s i c i a n to wait u n t i l he was s i x years o l d . When he reached t h i s age, they made i n q u i r i e s about the p o s s i b i l i t y o f admission to an i n s t i t u t i o n . H i s s i s t e r was becoming r e s e n t f u l o f the amount of a t t e n t i o n g i v e n him by p a r e n t s . H i s mother was nervous and upset. R e l a t i o n s h i p s between parents were s t r a i n e d and d e t e r i o r a t i n g . A y e a r l a t e r the f a m i l y moved to a community near Van-couver so t h a t they might be c l o s e a t hand when Johnnie was p l a c e d . No beds were a v a i l a b l e i n the i n s t i t u t i o n . However, the f a m i l y was a s s i s t e d i n making arrangements f o r the boy to a t t e n d a s c h o o l f o r the r e t a r d e d . By t h i s time (aged seven) h i s s e i z u r e s were n e a r l y c o n t r o l l e d , he was t o i l e t t r a i n e d , and he was able to say a few simple s i n g l e words. Parents w i l l i n g l y accepted plans to keep the boy a t home when t r a i n i n g was a v a i l a b l e i n the community. He made l i t t l e p r o g r e s s ; however, parents r e p o r t e d home and s c h o o l circum-stances to be q u i t e s a t i s f a c t o r y . Johnnie was e l e v e n y e a r s o l d when h i s mother c a l l e d the - 55 -) i n s t i t u t i o n to ask t h a t admission be granted when p o s s i b l e . A baby s i s t e r was now seven months o l d . Johnnie had become q u i t e a behaviour problem. He s t i l l had a v e r y l i m i t e d v o cabulary but babbled c o n t i n u a l l y . He was h y p e r a c t i v e and becoming d e s t r u c t i v e . He would ru n away and become l o s t . He would damage parked auto-mobiles, t u r n on outdoor f a u c e t s when he found them, throw stones, and s p i t e x c e s s i v e l y . Other c h i l d r e n t r e a t e d him as a l o u t and played s a d i s t i c pranks on him. He was f e d d i r t , d i s r o b e d , dumped i n mud-puddles and g e n e r a l l y i l l t r e a t e d . I n s p i t e of these • • t h i n g s , p arents d e s c r i b e d him as p l a c i d and s a i d they would p r e f e r t o keep him a t home were i t not f o r the i n d i g n i t i e s s u f f e r e d by the boy. A month l a t e r , Johnnie's mother requested emergency ad-^ m i s s i o n f o r him. One o f her p a r e n t s , who l i v e d up the c o a s t , had become s e r i o u s l y i l l , and she f e l t compelled to v i s i t and render n u r s i n g c a r e . I n view o f the o v e r a l l circumstances, the i n s t i t u -t i o n granted admission to the boy. At the i n s t i t u t i o n , Johnnie was r e p o r t e d to be able to f e e d and dress h i m s e l f . He a l s o cared f o r h i s own t o i l e t though r e g u l a r l y was s u b j e c t to n i g h t t i m e e n u r e s i s . S e i z u r e s were now c o n t r o l l e d by m e d i c a t i o n . Johnnie was t r i e d i n s p e c i a l academic c l a s s e s f o r the f i r s t y e a r but i t was found t h a t he c o u l d make no p r o g r e s s . He was t r a n s f e r r e d to the s p e c i a l t r a i n i n g c l a s s where f o r the f i r s t s i x months, h i s classroom conduct was d i s t i n g u i s h e d by h y p e r a c t i -v i t y . He c r i e d e x c e s s i v e l y , was o v e r l y s e n s i t i v e and v e r y restless. However, he gradually settled down and began to parti-cipate. He showed more enjoyment i n various act i v i t i e s and began to learn to recognize colors and numbers, as well as how to do various practical things. Though he was able to say a few single words, even these were often incomprehensible. It i s f e l t that he has made some significant strides forward i n spite of the fact that the teacher now gives him a rating on the Social Competency Scale which i s considerably less than that awarded by his father. Psychological tests i n Apr i l , 1959, assigned an I. Q. score of 35, (Stanford-Binet - Porm L). At the same time, the Vineland 1 Social Maturity Scale was given. Retesting with the Vineland 2 Social Maturity Scale in A p r i l , 1962, i t was found that Johnnie shows marked improvement i n three areas - a b i l i t y to receive direc-tion and apply this i n self-help, a b i l i t y to occupy himself without supervision, and a b i l i t y i n socialization. It i s to be noted that though the parents maintained con-tact with Johnnie and have had him home to v i s i t , neither parent ever visited him i n his classroom, or showed inquisitiveness regar-ding the training he was receiving there. It i s noted too, that marital strain i n the home continually mounted, and that eventually, when Johnnie was fourteen years of age, the couple separated. Mrs. A. took the two g i r l s with her. Mr. A. has continued to have Johnnie v i s i t for a day once a month and also had him home last Psychological tests conducted at The Woodlands School. •2 Ibid. Christmastime (1961); for a week. On these occasions he claims that the boy i s no better, or no worse than he was before he entered the institution. Mr. A. i s strongly c r i t i c a l of the special class because Johnnie, who he claims learned how to print his name in his former school, can no longer do so. His conver-sation revealed that he obviously placed a great amount of impor-tance on academic achievement rather than on the practical things that the boy might learn to do. In spite of this, he says that the boy i s now able to do things around the house, such as washing dishes, sweeping the floor, making beds, and that Johnnie actually enjoys doing these things. Mr. A., now forty-four, attained Grade 7 education. He i s a hard worker, though has been unemployed on several occasions. His parents came from Sweden where they had a small farm, and sett-led on the British Columbia coast. There he and Mrs. A. grew up and married. They were at a loss to know what to do when Johnnie was born handicapped. However, they received some guidance from a nearby physician. Family strain gradually became pronounced. Johnnie's older sister became upset and jealous. Attempts were made to arrange his institutionalization. Finally the family moved near to the institution and made arrangements for Johnnie to attend a community school for the mentally retarded. There he made l i t t l e progress, but the family was able to carry on. When Johnnie was ten, a baby sister was born. His behaviour began to deteriorate and over a period of eight months, he became very hyperactive and destructive. Admission to the institution was arranged on an - 58 -emergency b a s i s . Yet f o r a l l t h i s , the f a t h e r has been able to observe no advance i n the boy's s o c i a l competency s i n c e s p e c i a l t r a i n i n g c l a s s e s began over two y e a r s ago. There are s e v e r a l p o s s i b l e e x p l a n a t i o n s f o r t h i s . One, of course, i s t h a t Johnnie may a c t u a l l y not have advanced beyond h i s f u n c t i o n i n g l e v e l of s o c i a l competency as of the time of h i s i n s t i t u t i o n a l i z a t i o n . However, up-to-date s o c i a l competency r a t i n g s suggest otherwise. I t i s more probable t h a t parents have expected too much o f the boy. He was able to l e a r n to p r i n t h i s name a f t e r a t t e n d i n g a community s c h o o l f o r r e t a r d a t e s f o r almost t h r e e y e a r s , but he a c t u a l l y made l i t t l e p r o g r e s s . Whether he knew what he was doing when he p r i n t e d h i s name i s another ques-t i o n . Perhaps the parents a t t a c h e d l i t t l e importance to simple s k i l l s and more to academic. Gross s u b j e c t i v i t y seems to be a p o s s i b i l i t y i n the f a t h e r ' s o b s e r v a t i o n of t h i s boy, p a r t i c u l a r l y when he admits t h a t Johnnie now does such t h i n g s as wash the d i s h e s and t h a t he c o u l d not do these t h i n g s b e f o r e . Another p o s s i b i l i t y , too, i s t h a t the m a r i t a l upset and s e p a r a t i o n of Johnnie's parents l e f t Mr. A. more d e f e n s i v e . He emphasized how the "good parent" should do t h i s , t h a t or the other t h i n g f o r h i s r e t a r d e d c h i l d . He allowed h i m s e l f to be c r i t i c a l of h i s o t h e r c h i l d r e n ' s f e e l i n g s about b r i n g i n g t h e i r f r i e n d s home to v i s i t w h i l e Johnnie was a l s o a t home. Otherwise, he d i d not permit h i m s e l f to show any f e e l i n g s t h a t were s u g g e s t i v e of r e j e c t i o n . Though Johnnie d i d not r e c e i v e a good progress r e p o r t from h i s former community c l a s s , perhaps he d i d make s t r i d e s ahead - 59 -as f a r as h i s parents were concerned, a t l e a s t i n t h e i r 'mind's eye'. V i s i o n of these s t r i d e s may have been so advanced as t o pre c l u d e the p o s s i b i l i t y of f u r t h e r improvement. I n any case, Mr. A.'s p r o j e c t e d p i c t u r e o f Johnnie i s one of a competent, r e s o u r c e f u l , v e r y a c c e p t a b l e boy who i s a b l e to perform a t a l e v e l s i g n i f i c a n t l y h i g h e r than t h a t observed i n day to day s p e c i a l c l a s s e s by h i s t e a c h e r . L i k e w i s e , Mr. A. presented a p i c t u r e o f an a l l a c c e p t i n g parent r a t i n g extremely h i g h on the a c c e p t a b i l i t y s c a l e . Case D. Tommy was born September 21st, 1952. H i s pare n t s l e a r n e d t h a t he was a mongoloid when he was f i v e months of age. He i s the youngest o f f o u r s i b l i n g s . One b r o t h e r , aged t h i r t e e n , i s normal w h i l e h i s t w i n s i s t e r s u f f e r s from hydrocephaly. H i s e l d e r b r o t h e r , aged seventeen, i s p h y s i c a l l y w e l l , but m e n t a l l y r e t a r d e d . Tommy's pa r e n t s were born i n R u s s i a . H i s f a t h e r , now aged f i f t y - f o u r , a c h i e v e d the e q u i v a l e n t o f h i g h s c h o o l s t a n d i n g i n R u s s i a . H i s mother, aged f o r t y - f o u r , came to Canada w i t h her parents as a l i t t l e c h i l d and achieved Grade 8 here. The couple were m a r r i e d i n 1944 and have l i v e d s i n c e then on h i s smal l farm i n the lower F r a s e r V a l l e y . Mr. D., who was brought up i n a Mennonite f a m i l y , helped care f o r the c h i l d r e n when he was not busy w i t h the farm work; y e t he d i d v e r y l i t t l e d i s c i p l i n i n g of the c h i l d r e n . H i s w i f e had worked hard on her p a r e n t s ' farm up to the time o f h e r marriage and had r e l a t i v e l y good h e a l t h . However, when Tommy was f i v e , - 60 -the care of three r e t a r d e d c h i l d r e n proved too much f o r h e r . Her h e a l t h began to break. The e l d e s t boy, Joseph, who had attended s c h o o l f o r f i v e y e a r s , had not been able to pass Grade 1. Parents tended to blame l a c k o f p r o g r e s s on the t e a c h e r s who, they claimed, l a c k e d p a t i e n c e and were too nervous and h i g h - s t r u n g to h e l p him. Joseph was d i f f i c u l t but h i s parents a b l y cared f o r him at home. Mary, Tommy's o n l y s i s t e r , was s u f f e r i n g more from a d e t e r i o r a t i n g h y d r o c e p h a l i c c o n d i t i o n . Brother Jim was a p p a r e n t l y normal. C o n d i t i o n s i n the home were most d i f f i c u l t . The house was extremely inadequate. S i x persons l i v e d i n t h r e e s m a l l and p o o r l y f u r n i s h e d rooms. Mrs. D.'s h e a l t h was b r e a k i n g under the heavy l o a d of r e s p o n s i b i l i t y and worry. Mr. D., though h e l p f u l , was not a b l e to d i s c i p l i n e the c h i l d r e n . Tommy had become a s e r i o u s behaviour problem. One room of the s m a l l house had been r e s e r v e d f o r him. Here he was kept caged; the parents were not otherwise a b l e to handle the s i t u a t i o n . He was completely depen-dent. H i s mother dressed, f e d and tended him a t t o i l e t . He was i n c o n t i n e n t of u r i n e . He was c a p r i c i o u s and d e s t r u c t i v e , and o f t e n threw o b j e c t s . He r e q u i r e d constant watching. Parents were most embarrassed by h i s conduct, p a r t i c u l a r l y by h i s t o i l e t h a b i t s and u n p r e d i c t a b l e mannerisms. Por i n s t a n c e , he l e a r n e d how to r e -move h i s c l o t h i n g . T h i s proved v e r y u p s e t t i n g to h i s parents i f neighbours or f r i e n d s v i s i t e d . E v e n t u a l l y the f a m i l y p h y s i c i a n requested s p e c i a l c o n s i d e r a t i o n f o r Tommy's admission to the i n s t i -t u t i o n because of the mother's poor h e a l t h and h i s concern f o r h e r . - 61 -Tommy was admitted when just over five years of age. According to his parents, Tommy has made quite s i g n i f i -cant gains i n his a b i l i t y to care for himself and i n maturity growth since his institutionalization. Noting the various tables which record change i n the boy, we see that Tommy's gain i s con-siderably less than some of the other children. However, he has moved forward to a recognizable degree. And the important thing i n regard to this study i s the pronounced change of attitude on the part of parents. Before admittance, they were unable to cope with his demands and were quite rejecting i n a number of ways. Though they were rated as the least accepting parents before and after ad-mission of the child, their increased acceptability was greater than any other parents. (See Table 8, p. 51). They now demon-strate this more positive attitude by having Tommy home for weekly v i s i t s at relatively short intervals. This couple make an interesting observation; they note that neighbours may not be withdrawn because of the retarded child. They found that some neighbours had f e l t "snubbed" because they were not given normal attention by the family and so gave up "calling" themselves. Parents and neighbours f i n a l l y got together, discussed this point, a gross misunderstanding was cleared up, and social relations were cordially restored. When Tommy now v i s i t s home, he eats nicely with the rest of the family, wants to help by sweeping the floor, wants to polish his own shoes, dresses and undresses himself, washes himself, tends his own t o i l e t , says "hello" to visitors, and i s well-mannered i n t h e i r presence. The g e n e r a l r e l i e f o f care r e s p o n s i b i l i t y o f t h i s c h i l d i s a v a r i a b l e we have not t r i e d to measure i n t h i s paper. Other p o i n t s we can suggest may be s i g n i f i c a n t . One i s t h a t the f a m i l y was unable to set l i m i t s f o r Tommy as a l i t t l e boy. They were o v e r p r o t e c t i v e , d i d not a l l o w the c h i l d any chance f o r accomplish-ment, and were completely uncomprehending of h i s behaviour r e a c -t i o n s . T r a i n i n g has g i v e n Tommy the o p p o r t u n i t y to accomplish t h i n g s and to b e g i n the pro c e s s o f e s t a b l i s h i n g h i s own i d e n t i t y . Thus, when he now r e t u r n s home f o r a v i s i t , he i s able to f i n d h i s p l a c e amongst the other f a m i l y members. Parents are l e s s embarrassed by him now. F r i e n d s may v i s i t without them becoming upset. The f a m i l y can take Tommy to church s c h o o l and though he does not understand, n e i t h e r does he make a s p e c t a c l e o f h i m s e l f . Seeing t h a t the boy i s a c t u a l l y able to l e a r n , and that when he i s a t home v i s i t i n g , he enjoys l i f e as he never d i d b e f o r e , parents are c o n s i d e r i n g the p o s s i b i l i t y o f e v e n t u a l l y having him home to l i v e w i t h them on the farm. He has l e a r n e d to i d e n t i f y o b j e c t s about the farm, the sounds, the animals and b i r d s . H i s enjoyment o f t h i s c a p a c i t y has g i v e n the parents new p l e a s u r e and cause f o r p r i d e . Where once the c h i l d seemed t o be a 'cr o s s ' which c o u l d not be borne i n a d d i t i o n to the r e s p o n s i b i l i t i e s a l r e a d y w e i g h t i n g too h e a v i l y upon the pa r e n t s , now Tommy i s a person to be enjoyed and g i v e n a p l a c e i n the f a m i l y equal to t h a t o f the other c h i l d r e n . Evaluation of Training Looking at the various scales, i t i s quite evident that each boy has made some progress. Several of them have made quite notable progress, at least as far as the parents who made the rating are concerned. Half of the boys were rerated by the teacher of the class and were given a score totalling an average of five points less per boy per area of study. (Tables 3 - 7, pp. 48 - 50). This does not include boy A. who the teacher rated an average of fourteen points less per area of study than did the boy's father. The general concensus on the part of the parents i s that their sons have progressed well; as a result, the boys are able to participate more i n the ac t i v i t i e s of the home and community. This i n turn has given parents objective cause for hope that the boys may actually get a good deal out of their lives through achievement at their own level of potentiality; i t i s hoped that they w i l l also get enjoyment because of their broadened knowledge and experience. In the institution i t s e l f , the boys are noticeably hap-pier and more content. They are now able to perform much of their own self-care requirements. They have improved relationships with one another. The more advanced boys look forward with pleasure to their daily training classes, a fact that has been cheering to several parents. It should be noted that the boy who made the most progress i n a comprehensive score of a l l areas of study, i s one whose mother has consistently visited the classroom as well as having the boy home regularly for v i s i t s . This might suggest that increased parental interest evidenced by classroom v i s i t s could - 64 -increase pupil motivation for learning. However, this i s another subject and would constitute a separate study for research. Positive and Negative Observations of Parents Teh interviews were conducted. These included four with couples (fathers and mothers together), five with mothers only, and one with a father only. A total of fourteen persons, nine mothers and five fathers, were interviewed. Item 1, Amount of Time Spent Playing With or Teaching  the Child. Pour mothers and two fathers said they feel that the child's training has enabled them to spend more time with him. It was explained that other demands, such as having to dress the child, are effectively lessened. Thus more time i s now available for social intercourse. Pive mothers feel that there has been no change; four of these had given optimum amounts of time before training, and one, a substantial amount. Three fathers claimed they continue to give the same substantial amount of time as they did before institutionalization. One father i s less inclined to spend time than his wife. Parents noted that another adult i n the home i s i n f l u -ential. They feel that a mother or father l e f t with f u l l respon-s i b i l i t y and without the assistance of another adult would have much less time available and so could not give as much to the child i n play and teaching. i See Table 8, p. 51. - 65 -I Item 2, Response to C h i l d ' s E x p r e s s i o n s o f A f f e c t i o n . Two mothers and t h r e e f a t h e r s f e e l they are now able to respond more e a s i l y and s i n c e r e l y to t h e i r c h i l d ' s e x p r e s s i o n of a f f e c t i o n . Seven mothers and one f a t h e r t h i n k t h e i r f e e l i n g s , which are v e r y a c c e p t i n g toward t h e i r c h i l d now, were the same before i n s t i t u t i o n a -l i z a t i o n . One f a t h e r f e e l s i t i s more d i f f i c u l t t o accept the c h i l d ' s demonstration of a f f e c t i o n s i n c e he has grown c o n s i d e r a b l y p h y s i c a l l y , and i t i s now l e s s becoming of a f a t h e r . One f a t h e r s t a t e d . i t i s harder f o r h i m s e l f than h i s w i f e , "men are l i k e t h a t . " I n one i n t e r v i e w , a mother s t a t e d t h a t her c h i l d (H) was angry a t her f o r s e v e r a l months a f t e r being i n s t i t u t i o n a l i z e d . She f e e l s t h a t classroom a c t i v i t i e s may have helped r e s t o r e h i s a b i l i t y t o show a f f e c t i o n . He sought to communicate classroom i d e a s to ^ her and perhaps was thus able to set a s i d e h i s b i t t e r n e s s . Item 3, P a r e n t a l I n i t i a t i o n of E x p r e s s i o n s of A f f e c t i o n . Pour mothers and two f a t h e r s f e e l they are now more i n c l i n e d to spontaneously extend exp r e s s i o n s of a f f e c t i o n to t h e i r c h i l d . P i v e mothers and three f a t h e r s f e e l t h a t they have a h i g h degree of s p o n t a n e i t y now and t h a t t h i s r e p r e s e n t s no change i n a t t i t u d e . One f a t h e r f e l t l e s s able to extend h i m s e l f to the c h i l d than h i s w i f e . Before the i n s t i t u t i o n a l i z a t i o n of t h e i r c h i l d , one couple was v e r y concerned over t h e i r l a c k of a b i l i t y to handle the c h i l d , and the p o s s i b i l i t y t h a t he would not develop a f f e c t i o n toward them. They f e e l , however, t h a t t r a i n i n g has so improved i t h e i r boy's behaviour (D) t h a t he now pays a t t e n t i o n to them. - 66 -They are more ab l e to g i v e a f f e c t i o n and he to r e t u r n i t , a f a c t which i s q u i t e a r e l i e f to these people. Item 4» Comparing Retardate to Normal C h i l d r e n . Most p a r e n t s f e e l unhappiness over the c h i l d ' s handicap as i t r e l a t e s to themselves (the p a r e n t s ) . S e v e r a l p o i n t e d out t h a t i t would be most d i f f i c u l t i f there were no normal s i b l i n g s i n the f a m i l y . T r a i n i n g seems to s e v e r a l to have helped i n c r e a s e the competence of the c h i l d so t h a t p arents can have more p r i d e i n him. Seven mothers and f o u r f a t h e r s f e e l t h i s way. Two mothers and one f a t h e r f e e l no d i f f e r e n t l y , and both mothers' claims are now g i v e n f u l l p o i n t s f o r t h e i r a t t i t u d e s . One couple commented t h a t they c o u l d now l e a v e the c h i l d at home w i t h an o l d e r s i b l i n g w h i l e they went out, and t h a t t h i s was because the boy was b e t t e r behaved. Another s a i d t h a t because o f b e t t e r behaviour, there i s not so much cause f o r worry. One couple was q u i t e d e f e n s i v e about t r a i n i n g / . They had t r i e d and had not succeeded to t e a c h the c h i l d t h i n g s he had l a t e r l e a r n e d i n s c h o o l . T h i s appears to have s t r u c k a t t h e i r a b i l i t y as p a r e n t s . However, i n s p i t e of f e e l i n g s here, they were abl e to observe progress w i t h some g r a t i t u d e . They p o i g n a n t l y ob-served t h a t parents who accept t h e i r c h i l d b e f o r e he i s i n s t i t u -t i o n a l i z e d are a b l e to see improvement, and t h a t those who do not might expect and demand more of t h e i r c h i l d a f t e r he has been t r a i n e d . Item 5, A t t i t u d e o f Parents to In-laws. Parents r e p o r t e d v e r y l i t t l e change r e g a r d i n g t h e i r f e e l i n g s toward these r e l a t i v e s . Only one mother and two f a t h e r s f e e l more secure i n the presence of " i n - l a w s " . Seven mothers and one f a t h e r r e p o r t e d f e e l i n g no d i s c o m f o r t now or p r i o r to the c h i l d ' s i n s t i t u t i o n a l i z a t i o n . One mother and two f a t h e r s are s t i l l somewhat uncomfortable i n the presence o f " i n - l a w s " . T h e i r f e e l i n g s have not changed. V a r i a t i o n o f acceptance on the p a r t of in- l a w s i s r e p o r -te d by couples and t h i s has a f f e c t e d the degree of comfort parents experience i n t h e i r presence. One mother r e p o r t e d t h a t her hus-band's parents were extremely understanding and h e l p f u l . Conse-quently t h e r e i s no s t r e s s when they v i s i t . On the other hand, her own parents s t i l l have t r o u b l e a c c e p t i n g the r e t a r d a t e ' s beha-v i o u r and as a r e s u l t tend to upset the household when they v i s i t . Item 6, A t t i t u d e o f Parents to F r i e n d s or Neighbours. S i x mothers and three f a t h e r s f e e l t h a t t h e i r r e l a t i o n s h i p s w i t h f r i e n d s and neighbours have improved. These parents f i n d t h a t t h e i r boy's behaviour, e s p e c i a l l y h i s manners, has improved a good d e a l . At the same time, i t was noted t h a t p u b l i c a t t i t u d e s have been changing because of g r e a t e r awareness o f the mental r e t a r d a t i o n problem. Three mothers and two f a t h e r s t h i n k they are very r e l a x e d and secure w i t h f r i e n d s and neighbours now, but t h a t t h i s does not r e p r e s e n t a change i n a t t i t u d e . They f e l t t h i s way bef o r e t h e i r boy was i n s t i t u t i o n a l i z e d . Item 7, A t t i t u d e o f Parents to S t r a n g e r s . Of the l a s t t h r e e items r a t e d , t h e r e was a more pronounced change observable i n t h i s one. Seven mothers and f o u r f a t h e r s noted p o s i t i v e change i n t h e i r f e e l i n g s . These persons f e e l more secure and l e s s r, 68 \ embarrassed i f strangers c a l l or are otherwise introduced while the retardate i s present. This i s again attributed to improved manners. However, several parents are i r r i t a t e d by the fact that their boy now uses 'choice 1 (swear) words - not only i n the pres-cence of other members of the family, friends and neighbours, but also without discrimination, i n the presence of strangers. It bothers parents more when the child swears i n front of strangers. There i s a tendency to blame the institution for this behaviour and apparently l i t t l e cognizance of the fact that, as normal c h i l -dren go through 'this stage*, so too, i t might be expected that retardates w i l l also 'give i t a whirl'. S t i l l , the predominant feeling i s that the child has 'more sense' after training and does not stand out so much i n a negative manner. ^ Item 8, Total Family Planning after Institutionalization of Retardate, Pour mothers and two fathers feel that parents would be more apt to wish the retarded child continue to be an i n ^ tegral part of the family, including having him home for regular v i s i t s , after the child has received training. Five mothers and two fathers said they wanted from the time of institutionalization to have their child always to be an important and accepted member of the family and that they feel no differently now. One father's feelings were unchanged and expressed less than optimum acceptance. This same person rated lower than his wife. With one accord, a l l those interviewed had d i f f i c u l t y seeing how any parent would institutionalize a child with the plan k to forget him. A l l , of course, had themselves arranged for their - 69 -c h i l d to v i s i t home. S e v e r a l f e e l t h a t parents should l o o k on the i n s t i t u t i o n as a b o a r d i n g s c h o o l experience f o r a boy. They note the c h i l d ' s need to p a r t i c i p a t e i n s o c i a l f u n c t i o n i n g w i t h others h i s own l e v e l . They observe how g l a d the c h i l d i s to v i s i t home and how, f o r the most p a r t , t h a t the c h i l d i s p l e a s e d to r e -t u r n to the s c h o o l makes i t e a s i e r f o r p a r e n t s . I t i s p o s s i b l e t h a t t h i s type of t h i n k i n g h e l p s f i l l a need of parents themselves, a need to see the c h i l d doing t h i n g s which r e f l e c t normal community behaviour. Item 9, P a r e n t a l Response to C h i l d I n i t i a t i n g Task Per- formance . R a t i n g s f o r t h i s item were h i g h e r than any of the o t h e r s . A l l nine mothers and f o u r f a t h e r s f e e l they have more pa-t i e n c e w i t h t h e i r c h i l d when he now attempts to perform t a s k s . Only one f a t h e r (A) says there i s no change i n h i s f e e l i n g , to which he gave top r a t i n g b efore i n s t i t u t i o n a l i z a t i o n . One couple s t a t e d t h a t they a r e - a b l e to observe some improvement i n t h e i r c h i l d on every v i s i t home. He now v i s i t s home f o r weekly p e r i o d s a t r e l a -t i v e l y s h o r t i n t e r v a l s . They d i d not have the knowledge or the p a t i e n c e to t r a i n t h e i r own c h i l d , and see the s c h o o l as a t r a i n i n g mecca. They t h i n k other parents w i l l be g r e a t l y helped when a t r a i n a b l e c h i l d a t tends such a c l a s s . I t was observed t h a t parents not so t i e d to the c h i l d , because he i s able to do t h i n g s f o r him-s e l f , are able to enjoy him more and a c t u a l l y are a l s o able to g i v e him more; "The s c h o o l knows how."' I t i s not uncommon f o r c h i l d r e n to be abandoned to the i n s t i t u t i o n . - 70 -Item 10, P a r e n t a l Response to C h i l d ' s Improved Task  Performance* S i x mothers and f o u r f a t h e r s f e e l t h a t t r a i n i n g of the c h i l d has r e s u l t e d i n them becoming more observant of the c h i l d . They are i n t r i g u e d by what the c h i l d has been able to a c -complish and now watch c a r e f u l l y f o r s i g n s of advancement. One p a r e n t says, "He i s not an o r d i n a r y c h i l d so we never l o s e i n t e r e s t i n what he can get." Three mothers and one f a t h e r f e e l no change i n t h e i r a t t i t u d e . These t h i n k they have always been v e r y obser-vant of t h e i r c h i l d ' s improving performance a b i l i t i e s . Item 11, P a r e n t a l Response to C h i l d ' s P a i l u r e i n Task  Performance. Seven mothers and f o u r f a t h e r s f e e l they are now more a c c e p t i n g of t h e i r c h i l d ' s f a i l u r e and more apt to encourage the c h i l d t o . t r y a g a i n i f a t a s k i s w i t h i n h i s l i m i t s . I t was mentioned t h a t parents are not apt to be so t i r e d as they were be f o r e (when they had f u l l care r e s p o n s i b i l i t y f o r the c h i l d ) , and t h a t they are not t i e d down so much. These persons f e e l they have more p a t i e n c e . Two mothers and one f a t h e r , who give themselves h i g h e s t r a t i n g f o r t h i s item, say t h e i r a t t i t u d e s have not changed. One f a t h e r , who r a t e d l e s s than h i s w i f e , s a i d t h a t women have g r e a t e r e x p e c t a t i o n s f o r r e t a r d e d c h i l d r e n than men, y e t t o l d w i t h no l i t t l e p r i d e how h i s son had l e a r n e d to r i d e a bicycle I Item 12, P a r e n t a l A t t i t u d e Toward Appearing w i t h Retarded  C h i l d i n P u b l i c P l a c e s . Seven mothers and f o u r f a t h e r s f e e l more at ease w i t h t h e i r c h i l d i n p u b l i c p l a c e s now t h a t he has r e c e i v e d t r a i n i n g . One couple f e e l s t h a t much depends on the appearance of the c h i l d . Another couple f e e l s t h e i r c h i l d now behaves b e t t e r - 71 -than most normal c h i l d r e n , and say they have much more conf i d e n c e i n the c h i l d . One mother and one f a t h e r say t h e i r a t t i t u d e , which they r e p o r t to be i n the top r a t i n g , has not changed. One mother says t h a t she had mixed f e e l i n g s before and s t i l l has them. I n f a c t , though t r a i n i n g o f the c h i l d has compensated i n t h a t he i s a b l e to behave b e t t e r i n p u b l i c , h i s mother says i t i s now more embarrassing to take him to p u b l i c p l a c e s . She a t t r i b u t e s t h i s to "not being accustomed to t a k i n g him out r e g u l a r l y as I d i d b e f o r e . " Perhaps i n her case she took the c h i l d out before i n s p i t e of h e r f e e l i n g s and now, h a v i n g been f r e e d from h i s t o t a l care r e s p o n s i b i -l i t y , she does not f e e l so o b l i g a t e d . F u r t h e r r e s e a r c h would alone answer t h i s q u e s t i o n . Item 13, A t t i t u d e of Neighbours to the C h i l d . Seven mothers and f o u r f a t h e r s f e e l t h a t neighbours are more p o s i t i v e i n t h e i r t h i n k i n g toward t h e i r r e t a r d e d c h i l d . One mother f e e l s neighbours r e c e i v e top r a t i n g f o r both p a s t and p r e s e n t . She says t h a t when she e x p l a i n e d the s i t u a t i o n to other p a r e n t s , and to the neighbourhood c h i l d r e n , sympathetic understanding and c o - o p e r a t i o n were forthcoming. She r e p o r t s t h a t the c h i l d r e n seemed to under-stand a f t e r they had been taken i n t o c o nfidence, gave up t h e i r l a u g h i n g and t e a s i n g , and took an a c t i v e i n t e r e s t i n the r e t a r d a t e ' s s c h o o l p r o g r e s s and community a c t i v i t y . Another person says t h a t e d u c a t i o n of the p u b l i c over the l a s t few years has probably p l a y e d an important p a r t . One mother and one f a t h e r say neighbours have always been somewhat a l o o f and t h a t the boy's t r a i n i n g has not changed t h e i r a t t i t u d e s . - 72 -Item 14, Attitude of Siblings to Playing with the  Retardate. Pour mothers and two fathers f e e l there has been p o s i -t i v e improvement i n the attitudes of normal s i b l i n g s . One con-firmed t h i s by saying, "He plays and f i g h t s just l i k e the others." Another pointed out that her c h i l d does not wish to play with other children. Pour mothers and two fathers gave t h e i r normal childre n top r a t i n g both before and a f t e r the c h i l d had received t r a i n i n g . Item 15, Attitude of Siblings to Bringing Friends Home  When Retardate i s There. Pour mothers and two fathers f e e l t h e i r normal c h i l d r e n are more accepting of t h e i r retarded brother now that he has received t r a i n i n g . One reported less acceptance and that as t h e i r normal childre n get older and into the teen-age bracket, they became more sensitive, p a r t i c u l a r l y i n the presence of t h e i r f r i e n d s . Two other families reported much shame f e l t by si b l i n g s before the c h i l d was trained, and that though they were somewhat r e l i e v e d afterward, parents s t i l l emphasize that i t i s d i f f i c u l t f o r normal childre n moving into t h e i r teens to have a generous attitude towards a retarded c h i l d . General Question, Attitude of Parents to Special Education  for the Trainable C h i l d . Only one parent f e l t that the spe c i a l class was of l i t t l e or no consequence i n the ch i l d ' s progress. This parent (A) reported very l i t t l e change i n the c h i l d before and a f t e r t r a i n i n g . At the same time, t h i s parent's r a t i n g i s i n the Por composite of s o c i a l competency and Parent Ac c e p t a b i l i t y Scales showing gains and losses a f t e r t r a i n i n g , see Table 9, p. 53. - 73 -high point category, thus precluding that gain would take place for any reason. This child was given a significantly lower rating (anaverage of 14 points per area rated) by his teacher. S t i l l , the -teacher i s sure that the child has improved a good deal. Like-wise, new psychological tests show gain in the child's function. This would suggest l i t t l e objectivity on the parent's part. Twelve of the other thirteen parents gave the training programme the highest rating possible and the other one, the second highest. Home V i s i t s Approximately 10$ more of trainable boys are v i s i t i n g home on any basis now than were at the beginning of the training 1 programme. Score indication would suggest that boys have become more acceptable and families are therefore more interested i n having the boy v i s i t , less anxious about possible negative social consequences. It appears then, that training may be a significant factor an the increased involvement of boys in home and community social intercourse. However, several parents were not aware that their child was attending special class. They a l l expected that some training was going on, but were not sure what. Attempts to discover progress of the child generally ended i n short discussions with the ward nurse when the child was picked up for the home v i s i t , or when returned from home to the institution. Only three of ten families interviewed had examined the special classroom f a c i l i t i e s or observed while class was i n session. From The Woodlands School CHAPTER IV WHAT DOES INSTITUTIONAL TRAINING OFFER This study has examined the effects of special training for boys who are i n the trainable category of mental retardation, and whether improved social competency has influenced the child's acceptability to his family. Each boy has shown improvement in his social functioning and several, pronounced improvement. It has been emphasized that there were too many variables involved to allow for firm assess-ment of the reasons for improvement. However, since improvement occurred coincident with special training i n the institution, i t would seem that training probably has played a significant part. Most of the children now admitted to The Woodlands School are admitted on an emergency basis. And this emergency refers not just to the condition of the child who may require medi-cal treatment, but also to the other members of the retarded child's family - who, i n many instances, have through the responsibility of caring for the child, become depleted of physical, mental, emotional and moral strength. When the child i s admitted to the institution, the release from the burden of his care at last provides the family an opportunity to gather i t s strength once again. Because of the pressing nature of demands prior to the child's admission and the great need for rest and recuperation immediately f o l l o w i n g , r e l e a s e from r e s p o n s i b i l i t y f o r the care of the c h i l d may seem a t f i r s t almost too good to be t r u e . And perhaps i t i s too good to be t r u e f o r many p a r e n t s . Being f r e e d from r e s p o n s i b i l i t y f o r the care of the c h i l d does not n e c e s s a r i l y s o l v e a l l t h e i r problems. I n some i n s t a n c e s , i t p r o v i d e s time to t h i n k about them and to worry about t h e i r p o s i t i o n as the p a r e n t s of t h i s c h i l d - the d e c i s i o n they have made r e g a r d i n g h i s i n s t i t u -t i o n a l i z a t i o n , what k i n d of c o n t i n u i n g r e l a t i o n s h i p there w i l l be, and whether or not they, the f a m i l y , can salvage unbroken p i e c e s o f f a m i l y l i f e and s o r t them out i n a way t h a t w i l l p r o v i d e some k i n d of hope and a s p i r a t i o n f o r the f u t u r e . Not a few f a m i l i e s have, f o r one reason or another, decided to f o r g e t t h e i r c h i l d com-p l e t e l y a f t e r he has been i n s t i t u t i o n a l i z e d . Others have maintained s u p e r f i c i a l c o n t a c t . S t i l l o t h e r s have t r i e d to keep c l o s e and i n -timate the r e l a t i o n s h i p between t h e i r r e t a r d e d c h i l d . There i s i n d i c a t i o n t h a t r e l e a s e from the r e s p o n s i b i l i t y o f c a r i n g f o r a c h i l d i n the home i s an extremely important f a c t o r i n f l u e n c i n g the a t t i t u d e s of p a r e n t s . However, parents a l s o i n d i -cate t h a t t h e i r c h i l d ha.s become more a c c e p t a b l e to them i n the home a f t e r he has r e c e i v e d s p e c i a l i z e d t r a i n i n g i n a d d i t i o n to b e i n g i n s t i t u t i o n a l i z e d . I n o t h e r words, the f a c t o r of t r a i n i n g may be an important element i n i n c r e a s i n g a c c e p t a b i l i t y of the c h i l d to the parents because the c h i l d ' s p o t e n t i a l i t i e s have been encouraged to an extent t h a t he i s a b l e to p a r t i c i p a t e i n f a m i l y and community s o c i a l i n t e r c o u r s e i n a more a c c e p t a b l e manner. The emphasis here i s t h a t the c h i l d i s more ac c e p t a b l e when he i s a t - 76 -home. The emphasis a f t e r i n s t i t u t i o n a l i z a t i o n only, i s t h a t the c h i l d i s more ac c e p t a b l e when he i s away from the home. Here i s an important i m p l i c a t i o n f o r f u t u r e s o c i a l work. There must be c o n s i d e r a t i o n of and p l a n n i n g f o r the need of c o n t i n u e d s o c i a l s e r v i c e s to p arents a f t e r a d e c i s i o n has been made to apply f o r i n s t i t u t i o n a l i z a t i o n of t h e i r c h i l d . And, i n the event t h a t i n s t i t u t i o n a l i z a t i o n i s necessary, s o c i a l s e r -v i c e s should be made a v a i l a b l e to f a m i l i e s on a r e g u l a r and con-t i n u i n g b a s i s f o l l o w i n g admission of the c h i l d . P arents Need More Help Judging from t h i s study, parents may a c t u a l l y f e e l more i n c l i n e d to i n c l u d e t h e i r r e t a r d e d c h i l d i n v a r i o u s f a m i l y a c t i v i -t i e s a f t e r he has r e c e i v e d t r a i n i n g i n the i n s t i t u t i o n . But how l o n g d i d i t take them to f i n d out t h i s f a c t ? How many parents who have had t h e i r c h i l d r e n i n s t i t u t i o n a l i z e d have considered the f a c t t h a t t r a i n i n g f o r t h e i r c h i l d may make i t p o s s i b l e f o r them to continue f a m i l y r e l a t i o n s h i p s i n a manner t h a t w i l l i n c l u d e the r e t a r d e d c h i l d ? Not one of the parents i n t e r v i e w e d i n t h i s study c o u l d see how any parent c o u l d p o s s i b l y abandon h i s c h i l d to the i n s t i t u t i o n . However, i t must be emphasized t h a t the sample f a m i -l i e s i n t e r v i e w e d had maintained a c o n t i n u i n g i n t e r e s t i n t h e i r c h i l d s i n c e h i s i n s t i t u t i o n a l i z a t i o n . Why they maintained t h i s c o n t a c t i s another q u e s t i o n , and perhaps a s u b j e c t f o r f u t u r e r e s e a r c h . The p o i n t i s , t h a t these parents found t h e i r c h i l d r e n more a c c e p t a b l e a f t e r t r a i n i n g . - 77 -Some s i g n i f i c a n t q uestions f o l l o w . Would these parents have progressed more q u i c k l y , and to a g r e a t e r extent o f a c c e p t a -b i l i t y , were they to have had caeework support and i n t e r p r e t a t i o n both b e f o r e and a f t e r the time of t h e i r c h i l d ' s i n s t i t u t i o n a l i z a -t i o n ? Would the parents who have abandoned t h e i r c h i l d r e n or who have been showing r e l a t i v e l y minor i n t e r e s t i n them, have been able t o and d e s i r e d to have c o n t a c t w i t h t h e i r c h i l d i n a manner which would have been rewarding both to themselves and the c h i l d ? I n o t h e r words, would f a m i l y i n t e r r e l a t i o n s h i p s o f a p o s i t i v e and i n c l u s i v e nature have been f o s t e r e d had i n t e r p r e t i v e and suppor-t i v e s e r v i c e s been a v a i l a b l e ? I t would appear t h a t an attempt to p r o v i d e such s e r v i c e s should be made, a t l e a s t on an experimen-t a l b a s i s . I n d i c a t i o n o f Heed f o r Extended Casework S e r v i c e s . I n the case of one parent i n c l u d e d i n t h i s study, a c c e p t a b i l i t y o f the c h i l d d i d not improve i n one p a r t i c u l a r area, that o f w i l l i n g -ness or d e s i r e to have the c h i l d accompany her i n p u b l i c p l a c e s . I n f a c t , she now f e e l s more embarrassed to have him accompany her. Why? The c h i l d h i m s e l f has shown c o n s i d e r a b l e improvement because o f h i s t r a i n i n g . A g e n e r a l assumption, because o f t h i s , might be th a t a parent would t h e r e f o r e be more ready to have her c h i l d a c -company her to p u b l i c p l a c e s . I s the answer to be found i n t h i s l a d y ' s own a t t i t u d e s or l i f e experience? Did she take the c h i l d w i t h her bef o r e because t h i s was e a s i e r than f a c i n g the g u i l t she would f e e l f o r denying the c h i l d i n the presence o f others? Has she r e s o l v e d t h i s g u i l t through the i n s t i t u t i o n a l i z a t i o n o f her - 78 -c h i l d and being r i d of the r e s p o n s i b i l i t i e s so e n t a i l e d ? Does the f a c t t h a t the c h i l d i s more capable now f r i g h t e n her, make her f e e l t h a t she may be expected to a g a i n reassume r e s p o n s i b i l i t y , s t a r t a l l over a g a i n i n the process of c a r i n g f o r her c h i l d ? There are o t h e r h y p o t h e t i c a l q u e s t i o n s t h a t could be asked. The i m p l i c a -t i o n i s t h a t t h i s woman and probably many l i k e her should have had the o p p o r t u n i t y , i f she wished, to d i s c u s s and to work out her f e e l i n g s , and to have r e c e i v e d guidance i n terms o f long-range p l a n n i n g both f o r her c h i l d , and f o r h e r s e l f and other members of the f a m i l y . Casework i n t e r p r e t a t i o n of behaviour probably c o u l d h e l p parents a d j u s t t h e i r responses. However, the c h i l d ' s p o t e n t i a l a b i l i t y f o r p o s i t i v e s o c i a l f u n c t i o n i n g i s o f t e n kept i n abeyance because parents are unable to g i v e c o n s i s t e n t l o v i n g s t i m u l a t i o n and t r a i n i n g . A l l p o r t s t a t e s t h a t " p r a i s e and r e c o g n i t i o n not 1 o n l y h e l p l e a r n i n g but appear to i n c r e a s e the c a p a c i t y f o r i t . " He a l s o says, "to maximize the c h i l d ' s i n t e l l i g e n c e , we must maxi-2 mize h i s ego." T h i s does not mean that the l e v e l of mental deve-lopment can be changed. However, i t does support a view t h a t v i r -t u a l l y a l l t r a i n a b l e c h i l d r e n , w i t h the p o s s i b l e e x c e p t i o n o f the s e r i o u s l y i l l , have the c a p a c i t y to u t i l i z e t h e i r a b i l i t i e s i n a manner more s a t i s f y i n g to themselves, t h e i r peers, t h e i r s i b l i n g s , t h e i r parents and o t h e r s . •j A l l p o r t , G. ¥., P e r s o n a l i t y and S o c i a l Encounter, S. J . R e g i n a l Saunders and Company L t d . , Toronto, I960, p. 83. 2 T Loc. c i t . - 7 9 -I n the study i t was brought out t h a t teenagers seemed to be extremely s e n s i t i v e to a handicapped member of the f a m i l y i n the home, p a r t i c u l a r l y when t h e i r community f r i e n d s are i n v o l -ved. The f a c t i s that teenagers are o f t e n s e n s i t i v e . They are growing p h y s i c a l l y and e m o t i o n a l l y . They are going through a d i f -f i c u l t p e r i o d i n t h e i r l i v e s when the establishment of t h e i r own i d e n t i t y , f e e l i n g s of s e l f - w o r t h , e v o l v i n g r o l e s , t h e i r p o s i t i o n i n r e g a r d to the expectancy of a d u l t f a m i l y members and the com-munity and c u l t u r a l v a l u e s , a l l weigh h e a v i l y upon them. I f p a rents are i n a p o s i t i o n to b e n e f i t from s o c i a l work casework s e r v i c e s , i n d i c a t i o n s are t h a t other f a m i l y members, perhaps p a r -t i c u l a r l y the teenagers, could a l s o be helped c o n s i d e r a b l y . Teen-agers w i l l be s t r u g g l i n g to r e s o l v e t h i n k i n g concerning the h a n d i -capped member of t h e i r f a m i l y , perhaps e s p e c i a l l y , t h i n k i n g about how h a ving a handicapped member o f the f a m i l y w i l l a f f e c t them, p a r t i c u l a r l y i n r e l a t i o n to t h e i r f r i e n d s and other community mem-be r s . S i b l i n g s are o f t e n caught i n and c o n t r i b u t e to the f a m i l y emotional chaos. I t i s q u i t e p o s s i b l e t h a t t h e i r own developmental needs have been n e g l e c t e d , t h a t because of the constant demands of the d e f e c t i v e c h i l d on parents, s i b l i n g s have been d e p r i v e d . O f t e n emotional d i s t u r b a n c e s accompanied by v a r i o u s symptomatic r e a c t i o n s w i l l occur. Parents may be aware o f what i s happening, f e e l i n -competent to a l t e r c i r c u m s t a n c e s . They may experience compounding g u i l t f o r n e g l e c t i n g t h e i r 'healthy' c h i l d r e n , and b i t t e r r e s e n t -ment t h a t these c h i l d r e n are h a v i n g t h e i r l i v e s r u i n e d d e s p i t e - 80 -desperate e f f o r t s to a l t e r the s i t u a t i o n . On the other hand, they may be unaware of the needs of these c h i l d r e n or f e e l t h a t they are compensated by t h e i r very n o r m a l i t y . The s i b l i n g who i s o l d e r may make a h e l p f u l c o n t r i b u t i o n towards f a m i l y care o f the r e t a r d a t e . However, he may be burdened w i t h too many r e s p o n s i b i l i t i e s . As an a d o l e s c e n t he may be s e l f -c o n s c i o u s and ambivalent. On the one hand he may be o v e r p r o t e c t i v e of the c h i l d ; on the oth e r , he may be d e f e n s i v e , as he moves amongst h i s peer group. B l o g e t t and W a r f i e l d f e e l t h a t s e r i o u s 1 c o n f l i c t s about marriage and r e p r o d u c t i o n can be caused. In c h i l -d r e n more n e a r l y the age of the r e t a r d a t e , r i v a l r y and j e a l o u s y i n v o l v i n g p a r e n t s , o t h e r s i b l i n g s and the d e f e c t i v e c h i l d , may lea v e marked i m p r i n t s on the p e r s o n a l i t i e s o f these youngsters. I n Case A., the parents s a i d t h a t they would have l i k e d t o have kept t h e i r boy a t home i f i t had not been f o r the d i f f i -c u l t circumstances to which the c h i l d was exposed. When we con-s i d e r t h a t the parents seemed to be h i g h l y s u b j e c t i v e and t h a t they q u i t e p o s s i b l y o v e r - r a t e d the boy's a b i l i t y , we would a s c e r t a i n t h a t such a statement may w e l l have been a form o f defense. How-ever, i f i t were not, and the parents were a c t u a l l y anxious t o have t h e i r boy remain a t home, i t would seem t h a t s e r v i c e s to h e l p them do t h i s should have been p r o v i d e d . I t may be t h a t they were m o t i -v a t e d more to have t h e i r c h i l d remain at home than to have the c h i l d B l o d g e t t , H a r r i e t E., and W a r f i e l d , Grace J . , Und er s tand i n g  M e n t a l l y Retarded C h i l d r e n , A p p l e t o n - C e n t u r y - C r o f t s , Inc., New York, 1959, p. 55. i n s t i t u t i o n a l i z e d . S o c i a l work s e r v i c e s c o u l d a s s i s t parents making s i m i l a r d e c i s i o n s , to s o r t out t h e i r f e e l i n g s and h e l p them to weigh the pros and cons of the v a r i o u s i n f l u e n c e s which have brought them to the p o i n t o f seemingly f i n d i n g i t necessary to have t h e i r c h i l d admitted to an i n s t i t u t i o n . I f these i n f l u -ences c e n t e r around t h e i r own a t t i t u d e s , perhaps casework may h e l p . I f they c e n t e r around the a t t i t u d e s of community members, perhaps s o c i a l work, i n t e r p r e t i v e s e r v i c e s and l i a i s o n between f a m i l y and community members c o u l d be of a s s i s t a n c e . I f d i f f i -c u l t i e s c e n t e r around adv i c e g i v e n by o t h e r p r o f e s s i o n a l members of a s o c i e t y , perhaps t h a t a d v i c e could be put i n p e r s p e c t i v e . The i m p l i c a t i o n i s t h a t the parents r e q u i r e d h e l p a t the t i ^ e i n -s t i t u t i o n a l i z a t i o n was being arranged, and t h a t had they had con-t i n u i n g h e l p p r i o r to t h i s time, circumstances may w e l l have been d i f f e r e n t . T h i s goes back to the time when parents have a h a n d i -capped c h i l d born to them. I n each of two f a m i l i e s i n t e r v i e w e d , there were th r e e r e t a r d e d c h i l d r e n . T h i s would i n d i c a t e the s t r o n g p o s s i b i l i t y of h e r e d i t y f a c t o r s b e i n g i n v o l v e d . I t would seem from comments pa-r e n t s make t h a t most q u e s t i o n t h e i r sense of s e l f - w o r t h when a handicapped c h i l d i s born to them. When more than one handicapped c h i l d i s born i n a f a m i l y , these f e e l i n g s may w e l l be very empha-s i z e d . S o c i a l work i n t e r p r e t a t i o n of c l i n i c a l f i n d i n g s and of what t h i s w i l l mean to the f a m i l y as a. whole, and t h e i r p l a n n i n g f o r the f u t u r e , would appear to be an important s e r v i c e . T h i s s e r v i c e should be made a v a i l a b l e not j u s t at the request of p a r e n t s , - 82 -but as p a r t of d i a g n o s t i c and t o t a l assessment s e r v i c e s to any parent w i t h a handicapped c h i l d . The S o c i a l Work L i a i s o n Role Between the Retardate's Family and  the Gommunity. E a r l i e r i t was mentioned t h a t s o c i a l stigma can add to the burden of p a r e n t s . Casework h e l p i n h a n d l i n g t h i s i s im-p o r t a n t , not o n l y on a p e r s o n a l but a l s o on a group and community l e v e l . P arents, o f t e n a l r e a d y o v e r l y s e n s i t i v e to p a i n c a u s i n g s t i m u l i , whose sense o f s e l f - w o r t h has been d e p r e c i a t e d , can h a r d l y be unaware of the c r i t i c a l , sometimes contemptuous expres-s i o n s of f e l l o w c i t i z e n s . On the o t h e r hand, judgmental r e l a t i v e s and f r i e n d s may have l i t t l e a p p r e c i a t i o n of the t o t a l p r e s s u r e exerted upon the f a m i l y , or of the near h e r o i c attempt i t has made to keep some order and balance. Parents may not have f e l t f r e e or a b l e to d i s c u s s t h e i r problems. Perhaps they would have f e l t b e t t e r had they been a b l e . The caseworker c o u l d a s s i s t them to l o o k a t the reasons f o r keeping to themselves, and perhaps open the way f o r s h a r i n g . Some of the parents i n t e r v i e w e d f e e l q u i t e s t r o n g l y about the a t t i t u d e s of neighbours. I n two i n s t a n c e s , parents found t h a t a f t e r e x p l a i n i n g the s i t u a t i o n to neighbours and neighbourhood c h i l d r e n , community circumstances improved a good d e a l . I t i s q u i t e p o s s i b l e t h a t community a t t i t u d e s would improve or change more i n some l o c a l i t i e s than i n o t h e r s . Perhaps we should not be o v e r l y o p t i m i s t i c about e n l i s t i n g the support o f the g e n e r a l - 83 -community. However, the f a c t t h a t i n c e r t a i n areas improvement has been n o t i c e a b l e suggests t h a t f a m i l i e s might v e r y w e l l bene-f i t by a systematic attempt to e n l i s t the understanding and sup-p o r t of neighbours and other s o c i a l acquaintances. The i m p l i c a -t i o n here i s t h a t the s o c i a l worker may a c t as l i a i s o n between f a m i l y and other persons and thereby h e l p f a c i l i t a t e improved community a t t i t u d e s . The stigma problem sometimes comes to a head when f r i e n d s and neighbours l e a r n t h a t the p arents of a r e t a r d e d c h i l d are c o n s i d e r i n g i n s t i t u t i o n a l i z a t i o n . They ( f r i e n d s , etc.) may i n t e r p r e t t h i s as o v e r t r e j e c t i o n of the c h i l d and symptomatic of a h e a r t l e s s r e f u s a l to accept r e s p o n s i b i l i t y . An experiment c o u l d be t r i e d c o n cerning the h a n d l i n g of t h i s problem. The aim would be to h e l p encourage the s h a r i n g o f n o n - c o n f i d e n t i a l i n f o r -mation between parents and f r i e n d s . T h i s might be done on a group d i s c u s s i o n b a s i s . D i s c u s s i o n c o u l d i n v o l v e the e x p l o r a t i o n o f the reasons behind c o n s i d e r a t i o n o f i n s t i t u t i o n a l i z a t i o n , what the r e -s u l t s might be, and so on. T h i s would be a h e l p f u l supplement to i n d i v i d u a l f a m i l y casework s e r v i c e . Through such a p r o c e s s , doubts may be d i s s i p a t e d and a genuine i n t e r e s t i n the problem of p arents w i t h m e n t a l l y r e t a r d e d c h i l d r e n aroused. The p arents could be supported i n t h a t t h e i r t r o u b l e s may be b e t t e r understood and t h e i r motives f o r c o n s i d e r i n g the i n s t i t u t i o n a l i z a t i o n o f t h e i r c h i l d defended. While r e c o g n i -z i n g the n a t u r a l i n t e r e s t of f r i e n d s and r e l a t i v e s , parents c o u l d , at the same time, promote more p o s i t i v e and continuous c o n t a c t w i t h - 84 -these people - people who might w e l l h e l p share t h e i r burden. Again, i f the p a r e n t s are members o f the l o c a l A s s o c i a t i o n f o r Retarded C h i l d r e n , i t may w e l l be t h a t those who have shared w i t h them i n a s p e c i a l group s e s s i o n c o u l d be r e c r u i t e d to h e l p i n community programmes. T h i s type of c o u n s e l need not be c o n f i n e d to a d u l t s . The peer group, and other c h i l d r e n i n the community may respond w e l l to an i n v i t a t i o n t h a t they be given' the o p p o r t u n i t y to l e a r n of some of the d i f f i c u l t i e s connected w i t h the care o f the r e t a r d e d . A h e l p f u l r e s o u r c e of p r o s p e c t i v e baby s i t t e r s may be found i n both groups - p r o v i d e d some b a s i c t r a i n i n g i n t o the care and h a n d l i n g of the c h i l d be g i v e n . The whole e f f e c t of t h i s programme co u l d be to encourage a 'conspiracy o f l o v e ' , a c r e a t i v e community f o r c e which would e f f e c t i v e l y h e l p d i s p e l l p r e j u d i c e , f e a r and c r u e l t y . The S o c i a l Work L i a i s o n Role Between the Retardate's Family and  the I n s t i t u t i o n I n t h i s study, three o f the parents i n t e r v i e w e d were not aware of the f a c t t h a t t h e i r boy was a t t e n d i n g a p a r t i c u l a r type o f t r a i n i n g c l a s s i n the i n s t i t u t i o n . They f e l t t h a t as the other c h i l d r e n , t h e i r boy would be r e c e i v i n g t r a i n i n g a t h i s own l e v e l but they had not been informed about a s p e c i f i c programme. Seve-r a l o f the p a r e n t s have not e x p l o r e d the type of t r a i n i n g being g i v e n t h e i r boy though they have made i n q u i r i e s r e g u l a r l y as to the g e n e r a l p r o g r e s s of t h e i r boy. Perhaps parents f e e l t h e r e i s l i t t l e s t a t u s as such f o r them to have t h e i r boy a t t e n d a s p e c i a l c l a s s i n a s c h o o l f o r r e t a r d e d c h i l d r e n . Perhaps they would not a n x i -o u s l y c l a i m to f r i e n d s , f a m i l y , neighbours, t h a t , "My c h i l d i s one of the top boys i n the s p e c i a l t r a i n i n g c l a s s f o r r e t a r d e d c h i l d r e n . " So i t may be t h a t the f a c t t h a t some have not s p e c i -f i c a l l y i n q u i r e d , or made obvious attempts to p a r t i c i p a t e i n classroom a c t i v i t i e s themselves by o b s e r v i n g , i s o f l e s s s i g n i f i -cance than t h a t they have l i m i t e d e x p e c t a t i o n s f o r t h e i r c h i l d . I n f o r m a t i o n suggests t h a t , because of t r a i n i n g , p a rents w i l l have more cause to be proud of t h e i r c h i l d , w i l l f i n d him more a c c e p t a b l e i n the home, and w i l l f i n d neighbours, f r i e n d s and r e l a t i v e s more a c c e p t i n g of him. T h e r e f o r e , parents should be d i r e c t l y informed of the i n s t i t u t i o n a l programme. They should a l s o have c l e a r l y i n d i c a t e d f o r them where and when they as parents might p a r t i c i p a t e by o b s e r v i n g the c h i l d i n a c t i o n , or by d i s c u s -s i n g h i s p r o g r e s s w i t h the t e a c h e r , s o c i a l workers and other s t a f f members. The s o c i a l worker c o u l d be an e f f e c t i v e l i a i s o n between the t r a i n i n g c l a s s and the f a m i l y . In the f i r s t i n s t a n c e , he would be a b l e to i n f o r m f a m i l i e s c o n c e r n i n g v a r i o u s a c t i v i t i e s engaged i n by t h e i r c h i l d and through d i s c u s s i o n of these a c t i v i -t i e s p r o v i d e parents the o p p o r t u n i t y f o r v e n t i l a t i o n of t h e i r gene-r a l concerns and thoughts r e s p e c t i v e to the c h i l d and other members of t h e i r f a m i l y . I n other words, the s e r v i c e c o u l d serve not only to f a c i l i t a t e g r e a t e r f a m i l y p a r t i c i p a t i o n i n the boy's w e l f a r e , but a l s o t o prepare the road f o r t h a t p a r t i c i p a t i o n by h e l p i n g parents s o r t out t h e i r f e e l i n g s . Highly-charged ambivalent f e e l i n g s - 86 -of the parents c o u l d be eased t o a c o n s i d e r a b l e degree. Per-s p e c t i v e i s o f t e n l o s t because of the p r e s s i n g c l o s e n e s s and acuteness o f problems. A f t e r the c h i l d has been admitted to the p r o v i n c i a l s e t t i n g , casework w i t h parents should continue f o r an i n d e f i n i t e p e r i o d o f time. I f adequate p r e p a r a t i o n has been made f o r the admission o f the c h i l d , p a rents w i l l have a l r e a d y been o r i e n t e d to the s e t t i n g and i n t r o d u c e d to members of the s t a f f most l i k e l y to be i n v o l v e d i n the ca r e , treatment and t r a i n i n g o f t h e i r c h i l d . But there w i l l be need f o r continued i n t e r p r e t a t i o n o f r o u t i n e a c t i v i t i e s and p a r t i c u l a r l y o f the s p e c i a l t r a i n i n g c l a s s . T h i s c o n t i n u i n g r e l a t i o n s h i p w i l l be important f o r both c h i l d and pa-r e n t . The c h i l d needs to m a i n t a i n a sense of bel o n g i n g to and being l o v e d by h i s f a m i l y . I f these a t t r i b u t e s are not e s t a b l i s h e d when the c h i l d i s admitted, then i t would be hoped t h a t they c o u l d be. Prearranged v i s i t s to the class-room c o u l d encourage both c h i l d and teacher, and h e l p the parent keep a b r e a s t of the c h i l d ' s growth. The parent who has observed the emotional c l i m a t e o f the s p e c i a l class-room, as w e l l as t e a c h i n g techniques, equipment and go a l s , may g a i n v a l u a b l e i n s i g h t . Parents and f a m i l y may be a b l e to f o l l o w the c h i l d ' s p r o g r e s s and gi v e him emotional support. I t w i l l be r e a s s u r i n g f o r them to see t h a t the c h i l d i s p h y s i c a l l y comfortable, i s ab l e to be f r i e n d l y w i t h o t h e r s , i s g a i n i n g c o n f i -dence, i s e x p e r i e n c i n g the s e c u r i t y o f success and knows t h a t he i s accepted and l i k e d . The parent w i l l see too, t h a t the c h i l d i s l e a r n i n g to get al o n g w i t h classmates and grownups, that l i f e has - 87 -r u l e s and r o u t i n e s , and t h a t there are many t h i n g s to f e e l good about. The caseworker's continued c o n t a c t w i t h the parent w i l l a l l o w f o r v e n t i l a t i o n of g u i l t f e e l i n g , both r e s u l t i n g from ' p u t t i n g him away' and from o b s e r v a t i o n t h a t i n the new s e t t i n g the c h i l d ' s improved behaviour and progress i n s o c i a l f u n c t i o n takes p l a c e so r e a d i l y . T h i s l a t t e r p o i n t can be d i s t u r b i n g and emphasize f e e l i n g s of p a r e n t a l inadequacy. Again, continued con-t a c t a l l o w s f o r e x p r e s s i o n of p a r e n t a l r e s p o n s i b i l i t y - a sense t h a t may be seen i n an e n t i r e l y new p e r s p e c t i v e once the c h i l d ' s p o t e n t i a l has been tapped, h i s emotional s t r e n g t h s grouped and d i r e c t e d , h i s behaviour more a c c e p t a b l e and even rewarding. En-couraged parents may t r y h a v i n g the c h i l d home f o r v i s i t s from time to time and may w e l l have some of t h e i r o r i g i n a l hopes f o r the c h i l d r e s t o r e d when they see him a c t i n a manner both p l e a s i n g to neighbours, themselves and h i m s e l f . A l s o , they may be encou-raged by the f a c t t h a t he has new v i s t a s opened, new p o s s i b i l i t i e s f o r e n j o y i n g l i f e , and t h a t he can a c t u a l l y make some, however sm a l l , c o n t r i b u t i o n t o h i s fellowmen. Goals and accomplishments should be r e p e a t e d l y presented to and d i s c u s s e d w i t h parents - not only to keep them informed but to e n l i s t t h e i r continued support, an i n v a l u a b l e a s s e t to the t e a c h e r . Parents would be compensated by knowing t h a t t h e i r c o n t r i b u t i o n i s an i n t e g r a l p a r t of the c h i l d ' s new l i f e . I n t u r n they c o u l d be encouraged by assurance t h a t the c h i l d i s b e ing met and accepted where he i s , as he i s . Casework should be a r e g u l a r s e r v i c e t o p a r e n t s , one t h a t - 88 -i s scheduled and not dependent upon s p o r a d i c p e r i o d s o f i n t e r e s t or s p e c i a l study. I t may be t h a t study o f the reasons why f a m i -l i e s are now a c t u a l l y p a r t i c i p a t i n g by m a i n t a i n i n g c l o s e c o n t a c t w i t h the c h i l d i n h i s c l a s s would be of v a l u e . Some of the parents i n t e r v i e w e d knew about the c l a s s , but d i d not v i s i t i t . S e r v i c e a t the i n s t i t u t i o n today i n c l u d e s , when p o s s i b l e , o r i e n t a t i o n o f pa-r e n t s to the v a r i o u s areas o f a c t i v i t y and t r a i n i n g throughout the s c h o o l a t the time o f or bef o r e the time o f the c h i l d ' s admission. I t may be t h a t because of the c h i l d ' s a c t u a l c o n d i t i o n , the whole f a m i l y m a t r i x and circumstance, parents j u s t have not been a b l e to p a r t i c i p a t e . I t may l i k e w i s e be t h a t p arents who do p a r t i c i p a t e do so out o f t h e i r own emotional need. We know who v i s i t s and who does not v i s i t . But we do not know the meaning of t h i s beha-v i o r . T h i s would i n d i c a t e t h a t there i s a need f o r s o c i a l work assessment of f a m i l y b e h a v i o r to a s c e r t a i n i t s meaning, to h e l p f a m i l i e s p l a n i n terms of t h e i r t h i n k i n g and circumstances, and to he l p f a m i l i e s a l t e r or rearrange circumstances seemingly too f o r -midable f o r them to f a c e , or perhaps f a c t s accepted as unchange-a b l e , which, i n f a c t , may be changed. T h i s p r e s e n t study has i n v o l v e d only parents who have had t h e i r c h i l d home f o r v i s i t s . There are a number of f a m i l i e s t h a t do not have t h e i r c h i l d v i s i t home a t a l l . We must ask why. Is i t because of t h e i r own c o n f l i c t i n g f e e l i n g s ? I s i t because they have not been encouraged? I s i t because they have not r e -c e i v e d r e p o r t s o f the c h i l d ' s p r o g r e s s ? I s i t because they have not had an o p p o r t u n i t y to d i s c u s s t h e i r problems of acceptance or - 89 -r e j e c t i o n of t h e i r c h i l d ' s handicap? Again, i n d i c a t i o n i s t h a t whether or not s e r v i c e s can now be made to parents who have l o s t c o n t a c t w i t h t h e i r c h i l d r e n , an a l l out e f f o r t should be made to f a c i l i t a t e continued c o n t a c t between parent, c h i l d and other f a -m i l y members when i n s t i t u t i o n a l i z a t i o n now takes p l a c e . The Casework Process A s o c i a l assessment of the t o t a l f a m i l y i s the f i r s t r e q u i s i t e i n the casework p r o c e s s . Many v a l u e s and r o l e s are badly t h r e a t e n e d when a d e f e c t i v e c h i l d i s b o m i n t o a f a m i l y . Yet where the t h r e a t i s most f e l t w i l l v a r y . The emotional m a t u r i t y of pa-r e n t s , t h e i r e ducation, type of f a t h e r ' s employment, f i n a n c i a l and s o c i a l s t a t u s , c u l t u r a l background, age, p h y s i c a l h e a l t h , extended f a m i l y and r e l a t i v e s , number, age, sex and i n t e r e s t s o f s i b l i n g s , the p h y s i c a l , mental and emotional development of the r e t a r d a t e , a t t i t u d e s o f neighbours and f r i e n d s and business a s s o c i a t e s , r e l i -g i o u s i n c l i n a t i o n s and p o l i t i c a l i n t e r e s t s a l l have a b e a r i n g on the k i n d s of problems experienced, a l l have a b e a r i n g on the way problems have been handled, how they may be handled i n the f u t u r e . I n making a s o c i a l assessment of the f a m i l y , i t w i l l be important to be e x p l i c i t c oncerning both p a r e n t s . Each are d i f -f e r e n t p e r s o n a l i t i e s . Each w i l l have somewhat d i f f e r e n t o u t l o o k s . Each w i l l have t h e i r own emphasis i n the i n t e r p r e t a t i o n of the prob-lem, g o a l s to be sought and home care methods to be f o l l o w e d . I t may be t h a t f e e l i n g s about the r e t a r d a t e are p r o j e c t e d to the - 90 -m a r i t a l p a r t n e r . "A profound disagreement between the p a r t n e r s about a c h i l d ... i f i t cannot be r e s o l v e d ... a c t s as a dangerous i n f e c t i o n i n the e n t i r e f a m i l y , o f t e n c u l m i n a t i n g i n a severe emo-1 t i o n a l c r i p p l i n g o f a l l members." Before casework s e r v i c e may adequately proceed, the c h i l d and h i s f a m i l y s o c i a l assessment w i l l need to be presented a t a m u l t i - d i s c i p l i n e , m e d i c a l l y o r i e n t e d d i a g n o s t i c c l i n i c . Pa-r e n t s may have never r e c e i v e d p r e c i s e knowledge about t h e i r c h i l d ' s d i s a b i l i t y and the p e r s o n a l and s o c i a l i m p l i c a t i o n s . I n f a c t , " d e f e n s i v e n e s s i n parents may have been b u i l t up because of a f o r -mer u n f o r t u n a t e c o n t a c t w i t h an e m o t i o n a l l y immature and i n s e c u r e 2 p r o f e s s i o n a l person." When a t o t a l d i a g n o s t i c p i c t u r e i s r e c e i v e d the caseworker w i l l convey the f i n d i n g s to the p a r e n t s . -Mrs. Max Murray, h e r s e l f the mother of a r e t a r d e d c h i l d , g i v e s an i n t e r e s t i n g p e r s p e c t i v e to the problem s i t u a t i o n when she d e s c r i b e s , from a layman's p o i n t o f view, deep seated needs of pa-r e n t s w i t h d e f e c t i v e c h i l d r e n . She says: A f t e r t a l k i n g to hundreds o f parents i t i s my f e e l i n g t h a t more r e a l damage has been brought about by the i n a b i l i t y to share t h e i r problem than by any other s i n g l e f a c t o r ... The g r e a t e s t s i n g l e need of parents o f m e n t a l l y r e t a r d e d c h i l d r e n i s c o n s t r u c t i v e p r o f e s s i o n a l c o u n s e l l i n g a t v a -r i o u s stages i n the c h i l d ' s l i f e which w i l l enable the parents to f i n d the answers to t h e i r own i n d i v i d u a l prob-lems t o a rea s o n a b l y s a t i s f a c t o r y degree. Mandelbaum, A r t h u r , and Wheeler, Mary, "The Meaning of a D e f e c t i v e C h i l d to P a r e n t s , " S o c i a l Casework, J o u r n a l o f , J u l y , I960, p. 329. 2 Murray, Mrs. Max, "Heeds o f Parents of M e n t a l l y Retarded C h i l d r e n , " American J o u r n a l o f Mental D e f i c i e n c y , V o l . 63, No. 6, May, 1959, p. 1082. 3 I b i d . , p. 1084. - 91 -As the interpreter of diagnostic findings, the social wor-ker w i l l need to "be aware of his own reactions and feelings to the totality of stress experienced by the family. Does he have under-lying guilt and frustration about having to interpret the condition of the child to the parents? Or does he feel angry that i t i s he who has to inform parents of limitations and handicaps? Being aware of his own feelings and at the same time confident in his professio-nal position and outlook, he w i l l be able to "individualize this un-derstanding". With honesty and integrity he shares his strength with the parents and helps them to accept, insofar as they are able, the findings of diagnostic c l i n i c . He can encourage by giving rea-son for hope based on a r e a l i s t i c prognosis of the child's potential for personal and social development. Further Resources. There are other resources that the so-c i a l worker should use whenever feasible. If parents are not mem-bers of the local Association for Retarded Children, the social wor-ker should introduce them to this group. To be able to share their problems with parents who themselves have retarded children, i s ex-tremely encouraging, helps bolster their sense of self-worth, i s a social outlet and makes available an avenue by which the parent can make his contribution to the general cause. Again, through consultation and cooperative service, Public Health Nurses may be engaged to supplement casework services by teaching and assisting in nursing and other care techniques. To the mother who i s overwhelmed by the care of her mentally retarded Kelman, H. R., "Some Problems i n Casework With Parents of Mentally Retarded Children," American Journal of Mental Deficiency, Vol. 61, No. 3, January, 1957, p. 596. - 92 -c h i l d , i n a d d i t i o n to other f a m i l y r e s p o n s i b i l i t i e s , the P u b l i c H e a l t h Nurse can be a most welcomed h e l p . A f t e r commitment of t h e i r c h i l d i t i s sometimes h e l p f u l f o r p a r e n t s to have the o p p o r t u n i t y f o r s e r v i c e i n the cause of mental r e t a r d a t i o n . Much o f t h e i r d a i l y time (and n i g h t l y ) p a r -t i c u l a r l y the mothers, may have been taken i n c a r i n g f o r t h e i r c h i l d . Freed o f t h i s r e s p o n s i b i l i t y i d l e time can emphasize se-p a r a t i o n from the c h i l d , and the f a c t t h a t s o c i a l c o n t a c t w i t h the community has been r e s t r i c t e d . These persons, many of whom have waited d e s p e r a t e l y f o r r e l i e f from r e s p o n s i b i l i t i e s o f c a r i n g f o r t h e i r c h i l d are v e r y much aware t h a t r e s o u r c e s are t e r r i b l y l i m i t e d . Often they are w i l l i n g to g i v e generously of t h e i r time to serve through t h e i r l o c a l A s s o c i a t i o n f o r Retarded C h i l d r e n . The s o c i a l worker can h e l p encourage these a c t i v i t i e s by p r o v i d i n g c o n s u l t a t i v e s e r v i c e s to the groups i n v o l v e d as w e l l as continued p e r s o n a l casework i n i n d i v i d u a l i n s t a n c e s . The Need f o r Extended S e r v i c e s There i s a need f o r more d e f i n i t e p o l i c y r e g a r d i n g who w i l l be r e s p o n s i b l e f o r s u p p l y i n g s o c i a l and d i a g n o s t i c s e r v i c e s to p a r e n t s . At p r e s e n t , parents must make a p p l i c a t i o n to have t h e i r c h i l d admitted to a p r o v i n c i a l i n s t i t u t i o n before i t s d i a g -n o s t i c , temporary admission or s o c i a l s e r v i c e s become p o s s i b l e r e s o u r c e s . But a l l parents should have the o p p o r t u n i t y to r e c e i v e c o u n s e l a t the time of, and on a continuous b a s i s a f t e r , the r e -tarded c h i l d i s born. Our s o c i e t y has not yet decided who w i l l - 93 -be r e s p o n s i b l e f o r t h i s s e r v i c e . I t i s c e r t a i n t h a t the i n s t i t u -t i o n s cannot p r o v i d e i t , simply because the demands f o r s e r v i c e are too g r e a t . I t would seem, t h e r e f o r e , t h a t p r o v i s i o n should be made e a s i l y a v a i l a b l e i n the l o c a l communities. Some proce-dure should be worked out to p r o v i d e f o r c o u n s e l l i n g s e r v i c e s co-i n c i d e n t w i t h the r e g i s t e r i n g of these handicapped c h i l d r e n . De-f i n i t i o n s of r e s p o n s i b i l i t y should be c l e a r l y i n d i c a t e d and approp-r i a t e community agencies appointed to c a r r y out these f u n c t i o n s . The f o c u s s i n g of the casework process upon support or m o d i f i c a t i o n of the ego of parents w i t h r e t a r d e d c h i l d r e n i s not enough. Nor w i l l e x t r a h e l p w i t h f r i e n d s , r e l a t i v e s , and n e i g h -bours s u f f i c e to a s s i s t them over t h e i r seemingly insurmountable problems. They a l s o need some guidance to h e l p them f a c e more s u c c e s s f u l l y the everyday chores of the l i v i n g s i t u a t i o n . Here two p o i n t s emerge. The caseworker should (a) be o r i e n t e d and i n d o c t r i n a t e d i n t o the methods and p r a c t i c e s of the t r a i n i n g c l a s s and be thoroughly f a m i l i a r and experienced i n ways and means o f t e a c h i n g and i n t e r a c t i n g w i t h m e n t a l l y r e t a r d e d c h i l -dren and (b) he should f a c i l i t a t e u t i l i z a t i o n of the t r a i n i n g c l a s s as a t r a i n i n g area f o r p a r e n t s , r e i n f o r c i n g l e a r n i n g by casework s e r v i c e and d i r e c t h e l p i n the home or community p l a y and t r a i n i n g c l a s s e s . Where t h i s i s not p o s s i b l e because of geographi-c a l d i s t a n c e , an expert teacher and s o c i a l worker should be a v a i l -a b l e on a t r a v e l l i n g team to spend necessary time i n c e n t r e s where r e s o u r c e s are not now a v a i l a b l e , h e l p set up the same, t r a i n t e a c h e r s , encourage p a r e n t s , and f a c i l i t a t e l i a i s o n w i t h the - 9 4 -c e n t r a l r e s o u r c e . Here the s o c i a l worker c o u l d p l a y an important l i a i s o n p a r t . B e t t e r informed parents would l e a d to r e - e n f o r c e -ment of classroom a c t i v i t i e s i n the home. As i t i s , though pa-r e n t s are g r a t e f u l f o r g e n e r a l improvement i n the c h i l d ' s beha-v i o r , they are somewhat at a l o s s as to how they can help, what they might expect from the c h i l d , and a c t u a l methods which might be used i n the home to encourage improved c h i l d b e havior. T h i s i s p a r t i c u l a r l y borne out by case example G. The mother o f t h i s boy has shown a g r e a t d e a l of i n t e r e s t i n h i s a c t i v i t i e s i n the schoolroom and has v i s i t e d the classroom on r e g u l a r i n t e r v a l s . T h i s boy has shown a s i g n i f i c a n t l y h i g h e r l e v e l of improvement i n a l l areas s t u d i e d than any of the other c h i l d r e n . T h i s may or may not i n d i c a t e t h a t c l o s e r l i a i s o n between teacher and f a m i l y would h e l p f a c i l i t a t e the c h i l d ' s l e a r n i n g . Par too o f t e n , f a m i l i e s become so upset t h a t i f severe and permanent damage i s to be avoided, emergency measures to grant r e l i e f must be arranged. A temporary admission program which i s o p e r a t i n g a t The Woodlands School can be used i n a l i m i t e d number of cases. T h i s s e r v i c e has been a b l e to give to some parents the o p p o r t u n i t y f o r a h o l i d a y , a much needed r e s t a f t e r the demanding care r e s p o n s i b i l i t i e s which they have borne over many months. I t would seem reasonable to propose t h a t steps be now taken to permit as many pa r e n t s as wish to have the o p p o r t u n i t y to r e c e i v e such h e l p . T h i s type of s e r v i c e should be over and above temporary admissions granted f o r d i a g n o s t i c purposes. I t would mean, of course, an e x t e n s i o n o f r e s i d e n t i a l f a c i l i t i e s , p r e f e r a b l y i n - 9 5 -d e c e n t r a l i z e d areas of the p r o v i n c e . P o s t e r home programmes, sometimes p r o v i d e r e l i e f f o r p a r e n t s when there i s no other h e l p a v a i l a b l e . T h i s s e r v i c e may a l s o be g r a d u a l l y more e x t e n s i v e l y used to r e i n t r o d u c e r e t a r d a t e s now r e s i d i n g i n i n s t i t u t i o n s to the community. However, to make such programmes r e l i a b l e , extended s u p e r v i s i o n s e r v i c e s are r e -q u i r e d . Another resource not as y e t used e x t e n s i v e l y enough, i s the t r a i n e d homemaker. The homemaker could be used e f f e c t i v e l y to a s s i s t the mother meet not only the r e t a r d a t e " s needs, which o f t e n take a d i s p r o p o r t i o n a t e amount of her time, but the needs of the other c h i l d r e n . I f the homemaker i s c a r e f u l l y s e l e c t e d and t r a i n e d so t h a t she i s able to withstand the demands and c r i t i c i s m s o f t i r e d and a n x i e t y - r i d d e n p a r e n t s , she may w e l l not only make a s i g n i f i c a n t c o n t r i b u t i o n toward the h a n d l i n g of house-h o l d t a s k s , but a l s o towards e a s i n g f a m i l y t e n s i o n s . Experience and s k i l l i n working w i t h a s o c i a l worker, i n c l u d i n g an a b i l i t y to accept and use i n t e r p r e t a t i o n , can make her a major defence a g a i n s t home breakdown. The aim, o f course, should be to use a l l r e s o u r c e s i n a p r e v e n t a t i v e r a t h e r than stop-gap manner. As s e r v i c e s to the pa-r e n t s of mental r e t a r d a t e s i n c r e a s e , more and more emphasis w i l l need to be p l a c e d on e a r l y p l a n n i n g and p r e p a r a t i o n of the parents f o r the time when, as w i l l probably be the case w i t h most modera-t e l y r e t a r d e d c h i l d r e n , i n s t i t u t i o n a l i z a t i o n w i l l be r e q u i r e d . P arents w i l l need the o p p o r t u n i t y to v e n t i l a t e t h e i r f e e l i n g s and h e l p t o see the needs of a l l members of the f a m i l y i n c l e a r - 96 -p e r s p e c t i v e . A s s i s t a n c e i n a c c e p t i n g not only i n e v i t a b i l i t y of i n s t i t u t i o n a l i z a t i o n but a l s o o f the advantages and p o s s i b i l i t i e s i n v o l v e d w i l l need to be g i v e n . P o s s i b l e Research P r o j e c t s A number o f r e s e a r c h questions could be f o l l o w e d through w i t h p r o f i t f o r a l l concerned. Casework S e r v i c e s . T h i s study has emphasized the need f o r extended casework s e r v i c e s . Some may doubt the value o f t h i s t o p a rents o f r e t a r d e d c h i l d r e n . As mentioned p r e v i o u s l y , s e r v i c e s are now o f t e n s u p p l i e d only on an emergency b a s i s and when attempts to b o l s t e r f a m i l y a b i l i t i e s t o cope w i t h t h e i r problems are f r a u g h t w i t h f a i l u r e . I t i s suggested t h a t an experimental group o f fa m i -l i e s be s e l e c t e d f o r study on the b a s i s that they have a new born r e t a r d e d c h i l d . Continued casework s e r v i c e s c o u l d be s u p p l i e d to these f a m i l i e s f o r the f i r s t s i x t o e i g h t y e a r s . Family assessment at the end of t h i s p e r i o d c o u l d be compared to s i m i l a r f a m i l i e s who have not r e c e i v e d r e g u l a r casework h e l p . Family P a r t i c i p a t i o n i n T r a i n i n g Programmes f o r the  Moderately Retarded. I n the study i t was observed t h a t o n l y three of t e n f a m i l i e s have a c t u a l l y v i s i t e d the s p e c i a l classroom o f t h e i r r e t a r d e d c h i l d . The unanswered q u e s t i o n i s , "Why?" I t was a l s o observed t h a t one boy i n the sample group progressed almost twice as much as oth e r s , and t h a t t h i s boy's mother r e g u l a r l y v i s i t s the classroom. A second unanswered q u e s t i o n thus a r i s e s : "What are the e f f e c t s o f p a r e n t a l p a r t i c i p a t i o n i n the c h i l d ' s s p e c i a l - 97 -classroom a c t i v i t i e s on h i s o v e r a l l p r o g r e s s ? " The S p e c i a l T r a i n i n g C l a s s . Judging from t h i s study, a more e x t e n s i v e study u s i n g c o n t r o l and experimental groups of moderately r e t a r d e d c h i l d r e n , should be conducted to determine i n a s u b s t a n t i a t e d manner the e f f e c t s o f t h i s p a r t i c u l a r type of t r a i n i n g on the c h i l d ' s s o c i a l competence, and whether t h i s i n t u r n i n f l u e n c e s p a r e n t a l a c c e p t a b i l i t y . The Challenge S p e c i f i c r e s e a r c h p r o j e c t s should l e a d to the p r o v i s i o n of s p e c i f i c s e r v i c e s . The unmet s p e c i a l and common human needs of mental d e f e c t i v e s and t h e i r f a m i l i e s c h a l l e n g e t h o u g h t f u l people. T h i s i s s u e should c l a i m precedence f o r extended s o c i a l s e r v i c e s over many community problems because o f the e x c r u c i a t i n g mental and p h y s i c a l s u f f e r i n g o f the human beings i n v o l v e d . I t has been estimated t h a t about three percent o f the p o p u l a t i o n i s m e n t a l l y r e t a r d e d . Many more w i l l f i t i n t o the c a t e -gory o f ' b o r d e r l i n e ' o r ' d u l l normal'. The m u l t i p l y i n g care demands and the e r r a t i c behaviour of r e t a r d a t e s cause s t r e s s which too o f t e n becomes unbearable to parents and r e s u l t s i n o v e r a l l f a m i l y emotio-n a l and p h y s i c a l d e t e r i o r a t i o n . Mothers and f a t h e r s become ener-vated, exasperated. Formerly c o n t r o l l e d areas o f m a r i t a l d i s a g r e e -ment or i n c o m p a t i b i l i t y break down. Normal s i b l i n g s are caught i n a mesh between the parents and the r e t a r d a t e (or r e t a r d a t e s ) , s u f -f e r e m o t i o n a l l y and consequently i n a l l t h e i r s o c i a l r e l a t i o n s h i p s . The r e t a r d a t e , h a v i n g l e s s and l e s s o f h i s emotional need s a t i s f i e d - 98 -reacts by behaving i n a more and more negative manner. A r e l a t i -vely normal family exposed without adequate guidance to the care of a retardate may become a multi-problem family. There i s l i t t l e resource for help. Social services are peripheral. Institutionalization i s possible for emergency cases only, cases when home care i s completely out of hand. And in many instances, i n spite of emergency conditions, admission cannot be granted. School opportunities for the educable retar-date are increasing, but resources for the trainable are negli-gible. Day care centers for the more severely retarded are prac-t i c a l l y non-existent. Although the Association for Retarded Children of Br i t i s h Columbia i s active and doing a credible public relations job i n communities, there i s much need for community education. Professional persons, including physicians, nurses, teachers and clergy on the whole are poorly equipped to give under-standing guidance. It has been shown by this and other studies that something can be done for retarded children and their families. Inroads are now being made. It i s up "to those interested to interest others that forces may continue to be joined together i n greater efforts to help a large and needy segment of our population. - 99 -APPENDIX "A" SAMPLE OP LETTER TO PARENTS Vancouver, B. C., March, 1962. Mr. and Mrs. John Doe Dear Mr. and Mrs. Doe: As a student of the University of British Columbia, on leave of absence from the Social Service Department of The Woodlands School, I am examining the self - help and social progress of several children i n residence at The Woodlands School. Each child's family i s being asked to help by giving i t s impression. I hope to include your son i n this study so would very much appreciate your participation. A l l names w i l l be kept anonymous. Within a few days I w i l l telephone to ask i f I may v i s i t you i n your home. If you approve we w i l l arrange this to suit your convenience. About two hours time w i l l be involved. Many thanks for your favourable consideration of this request. Yours sincerely, - 100 -APPENDIX "B"  SOCIAL COMPETENCY SCALE (Retarded Children) I. Self-Help l a . Personal Undressing A. Cannot undress s e l f . B. Takes o f f most clothing but cannot unbutton or unzip. C. Takes o f f most clothing and can unbutton and unzip. D. Completely undresses s e l f . Removing Outer Clothing A. Cannot take o f f outer clothing. B. Can take o f f outer clothing such as coats and jackets. C. Can take o f f outer clot h i n g such as s h i r t s , pull-over sweaters, blouses, shoes, etc. D. Can remove a l l outer clothing, including undoing back buttons, b e l t s , etc. Dressing A. Cannot put on any clothing, B. Usually someone else must p a r t l y redo and complete the job (e.g., button c o r r e c t l y , put shoes on proper f e e t ) . C. Adult must check job and frequently adjust clothing. D. Job must be checked by someone else and necessary adjust-ments made by the c h i l d . E. Dresses s e l f adequately without having to be checked. Putting on Shoes A. Cannot put on shoes. B. Can put on shoes and p u l l laces t i g h t . C. Can put on shoes and make f i r s t part of the knot. D. Can put on shoes and t i e bow. - 101 -5. Care of Shoes A. Cannot wipe shoes. B. Can wipe shoes but cannot brush or polish. C. Can wipe and brush shoes but cannot polish. D. Can clean, brush and polish shoes. 6. Washing (hands and Pace) A. Although the child goes through the motions of washing hands and face, they must be redone by someone else. B. After washing hands and face they must be partially redone by someone else. C. Usually washes hands and face so that they do not need redoing, but child needs to be checked each time. D. Can wash hands and face without having to be checked. 7. Care of Fingernails A. Cannot clean or f i l e fingernails. B. Can clean nails with better hand but needs help with other hand. C. Can clean nails on both hands. D. Can clean and f i l e nails on both hands. 8. Combing or Brushing Hair A. Will not attempt to comb or brush hair. B. Combs or brushes hair but i t must be redone by someone else. C. Combs or brushes hair so i t does not need redoing but needs to be rechecked each time. D. Combs or brushes hair without help or having to be checked. 9. Brushing Teeth A. Cannot hold toothbrush. B. Can hold toothbrush but cannot brush teeth. C. Can hold brush, makes brushing motions, but does not brush properly. Cannot apply paste. D. Can hold brush, apply paste and get to mouth, but must be aided with actual brushing. - 102 -E. Can brush teeth unaided. 10. Blowing Nose A. Cannot blow nose. B. Can blow nose but usually needs wiping. C. Can blow nose but sometimes needs wiping. D. Can blow nose, including wiping.. Ib. Things 11. Eating A. Cannot feed self. B. Can hold utensils but can use only spoon i n feeding self. C. Successfully uses a spoon but sometimes s p i l l s with a fork. D. Feeds self with a fork and spoon without s p i l l i n g . E. Can use spoon and fork and cut with knife in eating. 12. Use of Knife A. Cannot hold knife. B. Can hold knife but cannot use. C. Can spread butter or jam with knife. D. Can cut soft food such as sausage, hamburger patties, french toast. E. Can cut up meat i f trimmed and removed from bone. 13. Serving Food A. Cannot carry food without s p i l l i n g . B. Can carry only solid foods without s p i l l i n g . C. Can carry semi-solid foods without s p i l l i n g . D. Can carry a pitcher or glass of liquid without s p i l l i n g . E. Can carry and pour liquids without s p i l l i n g (e.g., milk, juice, coffee). - 103 -14. Passing Pood A. Cannot pass food. B. Can pass bowls with solid food only. C. Can pass plates with solid food only. D. Can pass bowls with liquid or semi-liquid food. E. Can pass a l l items, including platters and trays with food on them. 15. Clearing Table A. Cannot clear table of unbreakable dishes. B. Can clear table of unbreakable dishes and silverware but cannot scrape dishes and stack. C. Can clear table of breakable dishes, glassware and si l v e r -ware, but cannot scrape dishes and stack. D. Can clear table, scrape and stack breakable dishes for washing. 16. Cleaning Up (Liquids) A. When cleaning up spilled liquids he smears over larger area, making a bigger mess. B. Blots up some liquid, but job must be completed by someone else. C. Blots up liquid but area requires finishing touches by someone else. D. Cleans up liquid and does not require someone to f i n i s h job. 17. Cleaning Dishes A. Cannot stack or scrape dishes. B. Can stack dishes but cannot scrape. C. Can stack and scrape but cannot wash dishes. D. Can wash and dry dishes. 18. Opening Door A. Cannot open door. B. Cannot open door requiring turning knob, but can push door open. - 104 -C. Can open door when knob turning i s required. D. Can open or lock door with key. 19. Sweeping A. Cannot sweep floor. B. Can sweep floor where there are no obstructions: unable to pick up dir t i n dustpan. C. Can sweep under desks or tables but cannot pick up dir t i n dustpan. D. Can sweep under desks or tables and can pick up di r t i n dustpan. 20. Making Bed A. Cannot make or undo bed. B. Can undo but cannot make bed. C. Can spread sheets and blankets on bed, but cannot tuck or put pillow i n case. D. Can completely make bed, including tucking and putting pillow i n case. 21. Folding Articles A. Cannot fold any laundry items. B. Can fold washcloths, towels and pillow cases with help. C. Can fold washcloths, towels and pillow cases without help. D. Can fold washcloths, towels and pillow cases without help, and sheets, blankets and bedspreads with help. E. Can fold a l l of above items without help. - 105 -II. Growth and Maturity I l a . Initiative Responsibility Washing Hands and Face A. Does not wash hands and face without being told. B. Sometimes washes hands and face without being told. C. Usually washes hands and face without being told. D. Nearly always washes hands and face without being told. Brushing Teeth A. Brushes teeth only when directed to do so. B. Sometimes brushes teeth without having to be told. C. Usually brushes teeth without having to be told. D. Nearly always brushes teeth without having to be told. Hanging Up Olothes A. Does not hang up clothes without being told. B. Sometimes hangs up clothes without being told. C. Usually hangs up clothes without being told. D. Nearly always hangs up clothes without being told. Toileting A. Does not wipe self. B. Sometimes wipes self. C. Usually wipes self. D. Nearly always wipes self. Table Setting A. Does not place silver, plates, cups, etc. on table. B. Simply places silver, plates, cups, etc. on table. C. Simply places items around table, not necessarily where they belong. D. Places plates, glasses, and utensils i n positions he has learned. E. Places a l l eating utensils, napkins, salt, pepper, sugar, etc. i n positions he has learned. - 106 -6. Cleaning Up Mess A. Does not take i n i t i a t i v e i n cleaning up own mess. B. Sometimes takes i n i t i a t i v e i n cleaning up own mess. C. Frequently takes i n i t i a t i v e i n cleaning up own mess. D. Nearly always takes i n i t i a t i v e i n cleaning up own mess. 7. Playing With Others A. Does not i n i t i a t e play with others. B. Occasionally ini t i a t e s play with others. C. Frequently i n i t i a t e s play with others. D. Nearly always in i t i a t e s play with others. 8. Initiating Tasks When given the responsibility for a task (e.g.: table setting, washing dishes, cleaning room), he: A. Does not i n i t i a t e task. B. Seldom in i t i a t e s task. C. Sometimes in i t i a t e s task. D. Usually i n i t i a t e s task. E. Nearly always ini t i a t e s task. 9. Offering Assistance A. Does not offer assistance to others. B. Sometimes offers assistance to others. C. Frequently offers assistance to others. D. Nearly always offers assistance to others. l i b . Social S k i l l s 1. Telling Time A. Cannot t e l l time... B. Can t e l l time to nearest hour. C. Can t e l l time to nearest •§ hour. D. Can t e l l time to nearest quarter hour. E. Can t e l l time to nearest five minutes. - 107 -2. Sharing When other children wish to share his favorite toy, he: A. Watches passively or cries. B. Protests. C. Shares i f both play together with the toy, but otherwise does not share. D. Shares, sometimes giving permission for others to play separately with the toy. E. Shares, frequently giving permission for others to play separately with the toy. 3. Playing With Others A. Usually plays by self. B. Plays with others but limits play to one or two children. C. Occasionally plays with a larger group (three or more children). D. Usually plays with a larger group (three or more children). 4. Pare of Self A. Adult must be with or near child at a l l times. B. Child can be l e f t alone i n his own room with adult i n the house. C. Child can be l e f t i n the house but adult must be close by (e.g.: i n the yard). D. Child can be l e f t alone i n the house while adult v i s i t s neighbor or goes to the store (short period, 20 - 30 minutes). 5. Telephone A. Cannot answer telephone. B. Answers telephone, but unable to take message and/or c a l l appropriate person. C. Answers telephone, calls appropriate person. Cannot take message. D. Answers telephone, calls appropriate person and takes message. - 108 -6. Going on Errands A. Cannot be sent on errands to other people. B. Can be sent on errands with note to other people. C. Can be sent on errands without note i f only one object i s desired. D. Can be sent on errands without note i f not more than two objects are desired. 7. Traffic Signs A. Doesn't understand any t r a f f i c signals or signs. B. Understands a few t r a f f i c signs which do not require reading. C. Understands most t r a f f i c signs which do not require reading. D. Understands a few t r a f f i c signs which require reading. E. Understands many t r a f f i c signs which require reading. 8. Answering Door A. When door b e l l rings or there i s a knock, child does not answer door. B. Answers door b e l l or knock, does not take message, does not c a l l appropriate person. C. Answers door and calls appropriate person, but does not take messages. D. Answers door, calls appropriate person, and, when required, relays simple message such as, "Mr. A was here." 9. Behavior i n Public A. Cannot be taken to public places because he cries, becomes restless, or frightened, etc. B. Can be taken to public places but must be held by the hand or given constant reassurance. C. Can be taken to public places but sometimes requires reassurance. D. Can be taken to public places and seldom, i f ever, requires reassurance. - 109 -10. Attending Tasks A. Pays attention to task i f time does not exceed five minutes. B. Pays attention to task i f time does not exceed ten minutes. C. Pays attention to task i f time does not exceed 15 minutes. D. Pays attention to task i f time does not exceed 20 minutes. E. Pays attention to task even i f time exceeds 20 minutes. l i e . Communication 1. Delivering Messages A. Cannot deliver messages by gesture or other means. B. Can deliver a simple message by gesture only (one thought or action). C. Can deliver a simple message verbally. D. Can deliver a more complex message verbally (more than one thought or action). 2. Answering Questions When asked a question, he: A. Does not respond. B. Responds by nodding, pointing, or other gesture. C. Responds by combination of gesture and speech, but oral response i s limited (e.g.: yes, no, etc.). D. Verbally answers question with complete sentence. 3. Relating Objects to Action A. Cannot name objects i n pictures or story books. B. Canname objects and people i n pictures but cannot indicate actions. C. Can relate object to action but unable to connect actions into a story. D. Can connect actions in a picture to t e l l a story. - 110 -4. Use of Language A. Says no words - gestures only. B. Says a few specific words (e.g.: water, mother, father). C. Speaks i n complete sentences (e.g.: "I want a drink," "I want the toy," etc.). D. Speaks i n more complex sentences, connecting a number of actions or statements. 5. Spontaneous Speech A. Rarely speaks spontaneously i n group situation, even when question i s directed to him. B. Responds i n group situation only i f question or command i s directed to him. C. Sometimes speaks spontaneously i n a group situation. D. Usually speaks spontaneously i n a group situation. 6. Following Instructions A. Cannot follow familiar instructions. B. Can carry out one familiar instruction. C. Can follow new instructions given one at a time, as well as familiar ones. D. Can follow several new instructions given at the same time, as well as familiar ones. 7. Speaking to Adults A. Does not speak to adult friends or adult v i s i t o r s . B. Speaks only to close friends of family. C. Speaks to adult visitors i f he has met them before. D. Speaks to most adult visi t o r s , even i f he has not met them before. 8. Going Places When he wishes to go someplace: A. Indicates by gesture only. B. Indicates by using simple words (e.g.: "zoo", "store"). - I l l -0. Indicates "by using short phrases (e.g.: "go store," "go zoo"). D. Indicates by using complete sentences. 9 . Playing With Others A. Does not ask to play with other children. B. Indicates by gesture h i s desire to play with other c h i l d r e n but does not name people or a c t i v i t y . C. States h i s desire to play with other children but does not name people or a c t i v i t y (e.g.: "I want to pl a y " ) . D. States h i s desire to play with others, naming people and/or a c t i v i t y (e.g.: "I want to play b a l l with John," or "I want to jump rope with Mary"). 10. Communicating Unhappiness When unhappy, he* A. Cries or runs away without explaining reason f o r h i s unhappiness. B. Kicks or screams at offending object. C. Seeks help by crying and searching out an adult, but i s unable to explain h i s unhappiness. D. Expresses h i s f e e l i n g and the cause of h i s unhappiness. 11. Answering Door A. Does not gesture or speak, just stands there. B. Indicates that someone i s at door by gesture only. C. Indicates that someone i s at door by gesture and li m i t e d speech, (e.g.: "Man here"). D. Indicates that someone i s at door by using complete sentence. - 112 -APPENDIX "0" PARENT ACCEPTABILITY SCALE 1. How much time might the parents spend playing with or teaching  t h e i r child? A. None. Could not tolerate the simple l e v e l of the child' s a c t i v i t y and would be too occupied with more important things. B. Very l i t t l e time. Only when urged by the other parent or to escape the continual requests of the c h i l d . C. A f a i r amount of time. L i t t l e desire, but would play with or teach the c h i l d out of a sense of duty. D. Quite a l o t . Would enjoy playing with or teaching the c h i l d and make time a v a i l a b l e . 2. When the c h i l d hugs or kisses h i s parents they mightt A. Be repulsed and unable to return a show of a f f e c t i o n . B. On very rare occasions return the hugs or ki s s e s . C. Quite often accept the c h i l d ' s a f f e c t i o n and return i t i f others are not present. D. Warmly accept and on most occasions return the hugs or kis s e s . 3. Would parents hug or k i s s t h e i r c h i l d before he did t h i s to  them? A. Never. Would be too d i f f i c u l t . B. On very rare occasions to a s l i g h t degree. C. Sometimes when others not around. D. Often. Would f e e l l i k e hugging or k i s s i n g the c h i l d , so do i t . 4. When parents compare t h e i r c h i l d to normal children, they may  f e e l : A. B i t t e r , the victims of i n j u s t i c e . B. Very hurt, can expect l i t t l e but pain and sorrow from t h e i r c h i l d . C. Mixed f e e l i n g s . Sometimes enjoy t h e i r c h i l d but have d i f f i c u l t y f e e l i n g any sense of pride as parents. D. Quite happy. Would be affected more by what the c h i l d can do than by what he cannot do. - 113 -5. When "in-laws" v i s i t , parents would f e e l : A. Extremely apologetic, unworthy and ashamed. B. Very apologetic, unworthy and ashamed. C. Somewhat apologetic and ashamed. D. Relaxed. Accepting of parenthood without apology or need for apology. 6. When friends or neighbours c a l l at their home, parents may: A. Be extremely ashamed and make sure the child i s confined to another part of the house. B. Be very ashamed and attempt to direct attention av/ay from the child. C. Be somewhat ashamed. Would introduce the child and apologize for him. D. Acknowledge and introduce the child without any sense of shame. 7« I f strangers v i s i t their home, the parents may well be: A. Extremely embarrassed and make sure the child i s confined to another part of the house. B. Very embarrassed and try to direct attention away from the child. C. Somewhat embarrassed and when introducing the child, apologize for him. D. Relaxed and introduce the child without any sense of embarra s sm ent. 8. After a child i s admitted to an institution (permanently), what might parents think best both for the child and for the  rest of his family? A. To forget about the child. B. To occasionally send gifts but never have any personal contact with the child. C. To often send g i f t s , occasionally speak to staff members about the child's progress and sometimes v i s i t the child i n the institution. D. Send gifts at appropriate times. Often speak to and closely cooperate with those who care for the child. Have regular v i s i t s with the child both i n the institution and at home. - 114 -9. What might parents be expected to do when their child attempts To do something for himself7 A. Stop him because he only makes things worse. B. Allow a few extremely simple things. However, watch closely and prevent from trying more. C. Allow some reasonably demanding things, watching and instructing the child at a l l times. D. Encourage the child to do what he can by himself, being ready to help i f there i s a request. 10. I f the child shows improvement i n a b i l i t y to do things or i n  'Behaviour, the parents might! A. Expect no change and so ignore the child*s self-endeavours. B. On rare occasions be able to see change and give the child praise. C. Notice very obvious change and praise the child. D. Watch for and often see the slightest change and give immediate praise on each occasion. 11. When the child f a i l s to accomplish a task, his parent may: A. Have no patience or tolerance for failure, so stop the child from again attempting the task. B. Have very l i t t l e patience and warn the child not to try again. C. Be somewhat patient and sometimes encourage the child to try again i f the task i s within his limits. D. Help the child accept his failure without undue feelings of i n f e r i o r i t y and definitely encourage the child to try again i f the task i s within his limits. 12. Would parents consider taking their child to public places  such as supermarkets? A. Never. Amongst other things i t would be too embarrassing. B. Only on exceptional occasions. The slightest interest expressed by others would be very embarrassing. C. Once i n a while. It would be somewhat embarrassing. D. Often. It would not l i k e l y be embarrassing. - 115 -15. When neighbours meet the child on the street, they may: A. Treat him as being repulsive and completely avoid except to command child to stay off their premises. B. Be very cautious and view the child as a threat to person, property and the general well being of the community. C. Somewhat aloof. Talk to the child i n passing, but not encourage further contact. D. Accept him with warmth. Talk to i n a friendly way and sometimes invite him to v i s i t their home. 14. What might the brothers or sisters do i f the child wants to  play with them and their friends? A. Refuse to allow to join the group or to watch acti v i t i e s from close by. B. Not l e t the child participate i n any of the group's act i v i t i e s but allow to watch from the side-lines. C. Begrudgingly accept the child and allow minor participation. D. Accept into their group and encourage participation whenever he i s able. 15. How do you think brothers or sisters would feel about bringing  their friends home? A. Too ashamed to bring their friends home. B. Very ashamed though would bring friends home on rare occasions. Would avoid questions about the child. 0. Somewhat ashamed though would often bring their friends home. Would give non-specific answers to questions about the child. D. Quite relaxed, would easily accept the child i n the presence of their friends and acknowledge questions about his handicap with specific answers. - 1 1 6 -A general question f o r i n c l u s i o n a f t e r the A c c e p t a b i l i t y  Scale has been completed: How might parents rate the value of special education f o r the trainable child? A. As of l i t t l e consequence. B. I t helps entertain the c h i l d but does not a s s i s t him to grow up. C. I t helps the c h i l d be more independent (do cer t a i n things f o r himself), but i t does not a f f e c t the way he gets along with others. D. I t d e f i n i t e l y helps him to do more things f o r himself and prepares the c h i l d f o r more acceptable s o c i a l p a r t i c i p a t i o n . Family information AGE SEX —( EDUCATION _ j TYPE OP EMPLOYMENT ANNUAL INCOME MOTHER FATHER : - 117 -APPENDIX "D"  CATALOGUE OF CLASSROOM ACTIVITIES  "PLAY TO LEARN" A. Prayer Each class begins i t s session with prayer - the teacher leads, the group repeats after him to their a b i l i t y : "Dear God, please help me to play with a l l my friends i n a happy way. Amen." B. Roll Call Each child stands when his name i s called -If he speaks, he says, "Here, Sir." If he does not speak, he raises his right arm. C. Dramatic Play Activities 1. Trips. "Let's go to the farm" or "Let's go to the zoo" or "Let's go for a holiday" - on train, ship or airplane. a) Equipment: i . Regular bus stop sign. i i . Umbrella, golf clubs, tennis rackets, etc. i i i . Bus driver's seat, steering wheel, fee box, and change plate, bus driver's cap, lunch box. i v . 35 mm slide projector and daylight screen, slides of general countryside, farm, sights at the farm. v. Tape recorder and tape containing sounds of bus' engine starting and running, travelogue music, sounds at the farm including trains, aeroplanes, cars, tractors, farm animals, and so on. v i . Large colour picture of farm - farm buildings, animals, machinery, background with cars, train, aeroplane, etc. - 118 -b) Action: i . One child occupies bus driver's seat. He w i l l conduct the tour. i i . Children line up at bus stop. They carry umbrella, golf clubs, etc., as adults i n community carry parcels. i i i . They enter bus i n single f i l e . Bus driver says, "Good morning - put money i n box". Child answers, "Good morning", puts money in box. Child takes his seat. i v . Tape recorder i s turned on. Children hear sound of bus engine starting and driver "drives" off turning steering wheel. v. Room lights are dimmed. Projector i s turned on. As each picture i s shown, tour conductor says, "This i s a road, lake, train, airplane, dog, horse, etc." and after each statement the whole class repeats, shouting "road", "lake", "train", and so on. v i . At different stops a new driver comes on duty (as i n real l i f e ) and over a period of several days, each child has a chance to conduct the tour. v i i . The teacher gives instructions: "Show me a big horse, a l i t t l e horse, a flower (telling colour), parts of an ob-ject" - e.g. as doors, windows, roof are part of a house, and so on. v i i i . After the trip i s a review. The lights are turned on. A large picture of farm i s located at front. The tape recorder i s turned to various sounds and different c h i l -dren are asked to point out from a l l the objects the animal or other objects making the sound. ix. A similar process i s followed when the class " v i s i t s " the zoo, park, holiday trips and so on. x. When possible, actual outdoor v i s i t s to these places are made. c) ,Aims: To duplicate real l i f e community experiences as closely as possible and thereby to f a c i l i t a t e , respect for pro-perty; polite manners; routine expected behaviour; speech practice and memorization of new words; sounds and con-necting these; learning colours; learning objects and animals; learning concepts as big, small; counting, and so on. Each boy gets recognition as a person and for - 119 -accomplishment, both from s c h o o l teacher and f e l l o w c l a s s members. Along w i t h t h i s i s the t h r i l l of p a r -t i c i p a t i n g i n group dramatic p l a y , and so the l e s s o n t h a t l i f e can have enjoyment. 2. D e l i v e r i n g L e t t e r s . a) Equipment: i . Postman's h a t . i i . C a r r y i n g bag. i i i . L e t t e r s w i t h p i c t u r e s o f members o f c l a s s a t t a c h e d . b) A c t i o n : i . A boy w i t h postman's hat, and c a r r y i n g postman's bag c o n t a i n i n g l e t t e r s stands o u t s i d e of the room and knocks. He i s t o l d to e n t e r . He says, "Good morning". C l a s s answers, "Good morning, S i r " . i i . The postman l o o k s a t the p i c t u r e . I f he can speak, he c a l l s the boy's name, saying, "Mr. Brown," e t c . , and d e l i v e r s l e t t e r . I f he cannot speak, he j u s t d e l i v e r s l e t t e r . Each boy r e c e i v i n g says, "Thank you, S i r . " c) Aims: Here the boys l e a r n to r e c o g n i z e others and s e l f by p i c t u r e s . A l s o , they p r a c t i c e e t i q u e t t e , l e a r n i n g to say MISTER when speaking to a man. 3. M a i l i n g L e t t e r s . a) Equipment: i . A c t u a l m a i l box. i i . L e t t e r s . b) A c t i o n : i . The m a i l box i s moved to d i f f e r e n t p a r t s of the room on d i f f e r e n t days. The boys f i n d and post l e t t e r s . The t e a c h e r o f t e n takes c l a s s to post i n s t i t u t i o n a l l e t t e r s . i i . The boys, when s u p e r v i s e d , p i c k up l e t t e r s a t the c e n t r a l o f f i c e and put them i n the r e g u l a r m a i l box. On t h i s t r i p , they p r a c t i c e e t i q u e t t e by s a y i n g , "Good morning", (good a f t e r n o o n ) , " s i r " (madam), "thank you", e t c . , a t a p p r o p r i a t e times. - 120 -c) Aims: To f a m i l i a r i z e boys w i t h l e t t e r m a i l i n g procedure. Boys a l s o a s s o c i a t e i d e a s from o t h e r games to r e i n f o r c e l e a r n i n g • 3. Grocery S t o r e . a) Equipment: i . Shelves w i t h r e a l can goods, f r u i t s , v e g e t a b l e s , c l o t h i n g a r t i c l e s , e t c . i i . Signs i n c l u d i n g p o s t e r s , d e c o r a t i o n f l a g s , e t c . i i i . Push c a r t . i v . Telephone. v. Grocer's apron and h a t . b) A c t i o n : i . A boy i s sent t o s t o r e to be s t o r e keeper. He i s dressed i n white. Another boy shops. i i . Another boy pushes c a r t . I f he bumps any person, he must say, "Excuse me, p l e a s e " . i i i . When the boy gets to s t o r e , the teacher remembers another a r t i c l e and i n s t r u c t s a t h i r d boy to phone a message. T h i s boy goes t o a r e g u l a r phone booth, which i s l o c a t e d i n the classroom, t u r n s handle ( o l d f a s h i o n e d type o f r i n g e r ) p i c k s up phone, says " h e l l o " and g i v e s i n s t r u c -t i o n s to the s t o r e keeper - "bag of oranges", "bar of soap", e t c . , says "thank you" and "goodbye", and puts phone back i n p l a c e . c) Aims: T h i s teaches use of telephone and r i g h t language. The s t o r e keeper s e l e c t s the a r t i c l e s by r e c o g n i z i n g them, or i f canned goods, by the p i c t u r e s on the cans. The shopper c o l l e c t s the goods, pays f o r them and r e t u r n s . Many words are l e a r n e d , the c o l o u r s of o b j e c t s , s i z e concepts and shape concepts. A l s o , signs are r e c o g n i z e d -p a r t i c u l a r l y SALE and i t s meaning;. Manners and e t i q u e t t e f o r p u b l i c p l a c e s are f a c i l i t a t e d . - 121 -4. Milk-Man. a) Equipment: i . Milk-Man's h a t . i i . Milk-Man's c a r r i e r , i i i . Cartons and b o t t l e s of m i l k , i v . C oins. b) A c t i o n : Boy d e l i v e r s m i l k as i n s t r u c t e d and r e c e i v e s payment. c) Aims: The boys l e a r n new shapes, s i z e s , and the words - m i l k and cream, b i g , s m a l l c a r t o n , b o t t l e and so on. Good manners are p r a c t i c e d . 5. Fireman. a) Equipment: i . B e l l . i i . 2 Fireman's helmets, i i i . 2 Fireman's c o a t s , i v . l e n g t h of f i r e hose and n o z z l e . v. W a l l c o n n e c t i o n , v i . Wrench. b) A c t i o n : i . Two boys are appointed f i r e m e n . F i r e b e l l i s rung. i i . Boys q u i c k l y put on fireman's d r e s s , r o l l out hose, a t t a c h i t to w a l l p i e c e , and stand 'spraying' the f i r e w i t h water. The boys v i s i t a c t u a l community f i r e h a l l t o see r e a l f iremen, t r u c k s and t h e i r equipment. c) Aims: The game i s designed to i n c r e a s e speed of d r e s s i n g and d e x t e r i t y . A l s o the boys l e a r n to be a l e r t to the danger of f i r e , r e c o g n i z e the meaning o f the f i r e b e l l , and the urgency r e q u i r e d i n f i g h t i n g and f o r escaping from f i r e s . - 122 -6. L e t ' s Go F i s h i n g . a) Equipment: i . A c t u a l f i s h i n g p o l e s equipped w i t h r e e l s and magnetic 'hooks'. i i . Straw h a t s . i i i . Paper f i s h i n g pond. i v . M e t a l ' f i s h ' . b) A c t i o n : i . A paper pond i s l a y e d out on classroom f l o o r . i i . The "fishermen" put on f i s h i n g hats (to p r o t e c t from sun), use f i s h i n g p o l e and 'hooks' o b j e c t s which are i n the pond. i i i . The teacher t e l l s which o b j e c t to f i s h . c) Aims: To i n t e r e s t boys i n f i s h i n g as a sp o r t ( s e v e r a l have gone to f i s h w i t h t e a c h e r i n nearby w a t e r s ) . Game a l s o teaches hand-eye c o o r d i n a t i o n . 7. L e t ' s Go Camping. a) Equipment: i . S a f e t y helmets, i i . Saw. i i i . Sawhorse. i v . Branch wood. b) A c t i o n : i . Teacher says, " L e t ' s go camping" - " L e t ' s go saw wood." i i . Two boys put on s a f e t y helmets, arrange branch wood i n sawing p o s i t i o n on sawhorse and tog e t h e r saw wood. I n the summer, some boys a c t u a l l y go camping. c) Aims: To h e l p boys r e c a l l a c t u a l camping experience and to a s s o c i a t e t a s k s w i t h t h a t experience. A l s o , they l e a r n to take s a f e t y p r e c a u t i o n s . - 123 -8. Buying Newspaper. a) Equipment: i . Newspaper honour "boxes which r e p r e s e n t two l o c a l d a i l y newspapers. i i . Newspapers i n each box. i i i . C oins. b) A c t i o n : i . A boy i s g i v e n i n s t r u c t i o n to buy a Sun (or P r o v i n c e ) newspaper. i i . He goes to the newspaper honour box (which he d i s t i n -g uishes from other newspaper honour box by i t s c o l o u r ) , p l a c e s c o i n i n proper s l o t , removes newspaper from box and r e t u r n s to the t e a c h e r . c) Aims: The boys l e a r n they must not take a paper before p u t t i n g c o i n i n box. They a l s o l e a r n how to perform the errand of g e t t i n g a newspaper - i . e . , to c a r r y out errand i n s t r u c t i o n s . 9. A s s o c i a t i o n of Ideas - E r r a n d s . a) Equipment: The v a r i o u s areas and equipment of the s p e c i a l classroom. b) A c t i o n : A boy i s i n s t r u c t e d by the t e a c h e r to do s e v e r a l t h i n g s i n sequence, e.g., "a^ Go to the s t o r e , b) buy a b i g bag of oranges; but c) b e f o r e you go, d) m a i l t h i s l e t t e r , e) a f t e r you go to the s t o r e , f ) buy a "Sun" newspaper." c) Aims: Boys l e a r n i d e a s " b e f o r e " and " a f t e r " and to remember sequence of words and a c t i v i t y . He p r a c t i c e s speaking, p o l i t e manners, e t c . 10. T r a f f i c L i g h t S t r e e t C r o s s i n g . a) Equipment: i . A c t u a l t r a f f i c l i g h t w i t h s w i t c h operated l i g h t s , i i . S t r e e t c r o s s walk p a i n t e d on f l o o r about 20* l o n g . - 124 -b) A c t i o n : i . Song i s sung - " H i p p i t y hop, h i p p i t y hop, green says gi re d says stop".-i i . Boys stand and wait when r e d l i g h t i s on. They c r o s s a t green s i g n a l . i i i . I n s t r u c t i o n s are g i v e n by the te a c h e r t o : "Take l o n g s t e p s " ; "Take s h o r t s t e p s " ; "Take r u n n i n g s t e p s " ; "Go f a s t " ; "Go slow"; "Walk on t i p - t o e " . i v . C r o s s i n g a t a r e g u l a r pace i s p r a c t i c e d a t a r e g u l a r community i n t e r s e c t i o n . c) Aims: The t r a f f i c l i g h t game teaches not only how to cr o s s a s t r e e t s a f e l y , but a l s o s e v e r a l words and s i x i d e a s . These i d e a s and words may be used i n other c l a s s and community a c t i v i t i e s . 11. Steps. a) Equipment: Wooden p l a t f o r m w i t h steps and r a i l s on e i t h e r s i d e . There are no s t a i r s i n the i n s t i t u t i o n . b) A c t i o n : The boys ascend and descend steps, sometimes c a r r y i n g o b j e c t s . c) Aims: They l e a r n the meaning of the words " u p - s t a i r s " , "down-s t a i r s " . They improve t h e i r balance-by c a r r y i n g s m a l l o b j e c t s (such as t r a y s ) . 12. Competition. a) Equipment: Large box of a s s o r t e d men's and women's shoes. b) A c t i o n : i . The boys are asked to s o r t ; b i g - s m a l l , and v a r i o u s c o l o u r s of men's and women's shoes. i i . The teacher t r i e s to put shoe i n a box - i f i t i s too b i g , the boys say so - i f i t f i t s , they say so. - 125 -i i i . The teacher tries to put on shoe. If i t i s too big, too small, or for a woman, the boys t e l l him. c) Aims: The game teaches the boys to recognize the concepts of size and purpose, as well as giving practice i n action which improves dexterity. 13. Competition. a) Equipment: Wooden shapes (square, c i r c l e , triangle,. % c i r c l e , star)' are mounted ver t i c a l l y on table. Each shape i s painted several different colours. Each shape has several bolts and nuts of various sizes attached to the back. b) Action: i . Each boy i s instructed to stand in front of a shape. i i . He t e l l s or points to different colours, depending on whether he can speak. i i i . There i s competition between boys to undo the bolts and to replace them. c) Aims: Boys learn shapes, sizes, new words, to increase manual dexterity and practice the selection of colours. 14. Manipulation of Window Blinds. a) Equipment: Classroom window blinds. b) Action: Two boys participate. One gives instructions, "Open blind, please", the other follows instructions. c) Aims: To acquaint boys with a common household task, to help boys learn how to communicate ideas i n a clear, yet polite way, and to provide practice i n manual dexterity. - 126 -15. Music. a) Equipment: i . Record player and records, i i . A set of chimes, i i i . Other rhythm-band equipment. b) Action: i . A few simple songs are repeated often. i i . Boys 'sing along', keep time with their feet, hands and band equipment. i i i . When the chimes are used, each boy has a number. The teacher calls a number, a boy strikes "his" chime. A favourite tune i s "The Bells of St. Mary's." c) Aims: To teach rhythm, and encourage musical enjoyment. 16. Telling Time. a) 'i Equipment: i . A large clock face with times designated by .numerals and colours. i i . A small clock face for each boy. i i i . A small clock equipped with a b e l l . b) Action: i . One boy sets the time on the large clock face as instructed by the teacher. i i . Each other boy also sets his own smaller clock face. i i i . Besides speaking the time after i t has been set, the boy t e l l s the colour. i v . After this, the b e l l on the small clock i s rung. The boys count the number of rings. c) Aims: To teach how to recognize the time at the f u l l hour. Boys also practice speaking, counting, and te l l i n g colours. - 127 -P a r a l l e l or A s s o c i a t e d Objecta C h i l d r e n are g i v e n one thought, i d e a , and a s s o c i a t e i t w i t h two or th r e e a c t i v i t i e s . 1. What game i s t h i s ? The teacher makes the b a t t i n g movement of a ping-pong p l a y e r . The c l a e s r e c o g n i z e s movement. One boy s e l e c t s a ping-pong bat from other equipment. Teacher asks, "Where i s ping-pong b a l l ? " A boy s e l e c t s i t . The boy i s t o l d to put the b a l l i n a l a r g e c l o t h bag. By the same process a g o l f - b a l l , a s o f t - b a l l , a t e n n i s - b a l l , a hockey-puck are p l a c e d i n the bag. A boy i s then asked to "put hand i n bag, get g o l f b a l l " , and so on. Ideas are a s s o c i a t e d and the sense of f e e l i n g i s p r a c t i c e d . 2. What i s m i s s i n g ? S e v e r a l common o b j e c t s , as p i p e , f o r k , b e l l , comb, are p l a c e d on a t a b l e t o g e t h e r . A boy i s asked to remember them. He i s sent to another p a r t of the room w h i l e the . t e a c h e r removes one o b j e c t . He i s c a l l e d back and asked, "What i s m i s s i n g ? " He t r i e s to r e c a l l . Ideas are a s s o c i a t e d and the sense o f memory i s f a c i l i t a t e d . 3. What i s h i s name? A boy i s b l i n d f o l d e d and turned about 2 or 3 times. Another boy from the.group i s i n s t r u c t e d to say to him, "Good morning, S i r " . He must guess the boy's name. The sense o f sound i s i a c i l i t a t e d . - 128 -4. What i s i t ? A boy i s blindfolded. He guesses objects by smelling them - soap, orange, apple, etc. The sense of smell i s f a c i l i t a t e d . 5. Where does i t go? Competition i s arranged between 2 boys. They f i t d i f -ferent sized - different coloured cylinders together. They also place knives, forks and spoons in the proper places i n a drawer container. This teaches speed, and seeing size and shape concepts. 6. Learning to Count. (a) Numerals: There are numerals 1 - 20 on separate pieces that may be hung on a wall. A boy uses pointer and counts. (b) Counting-board: A counting-board contains different numbers of real objects, such as cups, oranges, cans, etc. Each item i n a row i s exactly the same. A boy i s asked to switch numeral values to the row opposite the right number. For example, i f there are nine cups, the boy counts nine, finds numeral 9 and places i t beside the 'cup row'. (c) Bouncing the ball? i . The teacher bounces the b a l l . The group t e l l s how many times he bounces i t . - 129 -i i . A boy bounces the b a l l . The group t e l l s how many times he bounces i t . i i i . A boy bounces the b a l l and the same boy counts how many times he bounces i t . (d) R o l l i n g the d i c e : l a r g e c o l o u r e d d i c e are r o l l e d . A boy counts the dots turned up. (e) Weight s c a l e : Objects weighing from 1 to 25 l b s . are p l a c e d on s c a l e . A boy reads the weight. ( f ) Coloured c l o t h s e t s : Coloured c l o t h s e t s w i t h buttons and b u t t o n h o l e s . Boys match c o l o u r s and b u t t o n p i e c e s t o g e t h e r . They count the number of buttons, t e l l the c o l o u r s , p r a c t i c e b u t t o n i n g . 7. Signs. At v a r i o u s c l a s s a c t i v i t i e s , s i g n s are used. These apply to d i f f e r e n t a c t i v i t i e s and are used to i n c r e a s e c h i l d ' s g e n e r a l knowledge and a l e r t n e s s . Signs a r e : "Men", "Women", "Stop", "Out of Order", "Bus Stop", " S a l e " . 8. Speech (Phonetic l e s s o n ) . The boys are taught to d i s t i n g u i s h between and say c l o s e l y r e l a t e d sounds: B a l l - b e l l ; window - elbow -y e l l o w ; door - f l o o r ; head - r e d ; h a i r - c h a i r , and so on. 9. Drawing and C o l o u r i n g . The boys j o i n numbers i n sequence w i t h a p e n c i l to get - 130 -a p i c t u r e . They c o l o u r the p i c t u r e s . These p i c t u r e s are o f other o b j e c t s i n the c l a s s room - as t r a f f i c l i g h t , f i s h , b i r d , e t c . 10. Pare of P e t s . Budgie b i r d i s f e d and watered, and the cage i s cleaned d a i l y by the boys. Prom time to time, other l i v e animals and b i r d s are shown t o the c h i l d r e n ; i . e . , chickens and r a b b i t s a t E a s t e r time. 11. Care o f P l a n t s . The boys water the p l a n t s d a i l y . 12. Care o f Grass. During warm Summer weather, the boys are taught the care of g r a s s - ( c u t t i n g and r a k i n g ) . - 131 APPENDIX "E" BIBLIOGRAPHY Allport, G. W., Personality and Social Encounter, S. J. Reginal Saunders and Company Ltd., Toronto, I960. Blodgett, Harriet E., "Report of a Research Study at the Sheltering Arms, Minneapolis, Minnesota", First Winfield Institute: Research i n the Management of the Mentally- Retarded Child. Winfield State Training School. Winfield. Kansas, October, 1956. Blodgett, Harriet E., and Warfield, Grace J., Understanding Mentally Retarded Children, Appleton-Century-Crofts, Inc., New York, 1959. Bowlby, J., Maternal Care and Mental Health, World Health Organization, Geneva, 1952. Cain, Leo P., and Levine, Samuel, A Study of the Effects of  Community and Institutional School Classes for Trainable  Mentally Retarded Children, U. S. Office of Health, Education and Welfare, Contract NO SAE 8257, June, 1961. First Annual Convention, Canadian Association for Retarded Children, Calgary, Alberta, September 17 - 19, 1958. Herber, Rick, "A Manual on Terminology and Classification In Mental Retardation", a monograph supplement to the American  Journal of Mental Deficiency. September, 1959. Kelman, H. R., "Some Problems i n Casework With Parents of Mentally Retarded Children", American Journal of Mental Deficiency, Vol. 61, no. 3, January, 1957. Laycock, Samuel R., Mental Hygiene i n the School, The Copp Clark Publishing Co. Limited, Toronto, I960. Levinson, Abraham, and Bigler, John A., Mental Retardation i n  Infants and Children. The Year Book Publishers, Inc., Chicago, I960. Mandelbaum, Arthur, and Wheeler, Mary, "The Meaning of a Defective Child to Parents", Social Casework, Journal of, July, I960. Masland, L., Sarason S., Gladwin, T., Mental Subnormality, Basic Books, Inc., New York, 1958. Masterman, Louis E., Attitudes Toward Children of Subnormal Intelligence, Publication No 133, Community Studies, Inc., Kansas City, Missouri, and The State Division of Health of Missouri, Jefferson City, Missouri, June, 1961. - 132 -BIBLIOGRAPHY (continued) Murray, Mrs. Max, "Needs of Parents of Mentally Retarded Children", American Journal of Mental Deficiency, Vol. 63, no. 6, May, Noyes, Arthur P., and Kolb, Lawrence C , Modern C l i n i c a l Psychiatry, W. B. Saunders Company, Philadelphia and London, I960. Queen, Alfred S., Social Work i n The Light of History, J. B. Lippincott Co., Philadelphia, 1921. Stanley, J. C , Brief to the Royal Commission on Health Services, Saint John, New Brunswick, 1959. Tredgold, R. P., and Soddy, K., A Text-book of Mental Deficiency, The Williams & Wilkins Company, Baltimore, 1956 (ninth edition). Winthrop, Henry, and Taylor, Howard, "An Inquiry Concerning the Prevalence of Popular Misconceptions Relating to Mental Retardation", American Journal of Mental Deficiency, Vol. 62, no. 2, (19575 -Zaleski, W. A., "Some Advantages and Disadvantages of Institutiona-liz a t i o n " , The Fourth Conference on Mental Retardation, Canadian Association for Retarded Children, Vancouver, September 26 - 28, 1961. Special Canada, Dominion Bureau of Statistics, Census Division, Census of  Canada. 1956. Vol. 1, part 9. Canada, Dominion Bureau of Statistics, Census (Demography) Division, Population Section, Census of Canada, 1961, Advance Report, NO API, March 16, 19^2~. Spitz, Rene and Wolf, Katherine A., "Grief - A Period i n Infancy", (film), 3 reels, 35 minutes. Silent. Rene Spitz, 1150 F i f t h Avenue, New York 28. 

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