666
Letters to the Editor
for social-communication disorder. These were clinic-based samples, so we are not able to evaluate the frequency or pattern of families with children affected in milder ways that did not come to our attention at the clinics. The results here, if replicated, suggest that there may be other as yet unidentified factors such as maternal immunoreactions (Gualtieri & Hicks, 1985) associated in some way with birth order that may influence cognitive level within autism and pervasive developmental disorder, at least in multiplex families. The purpose of this letter is to encourage other investigators to review their data in order to consider this possibility.
Catherine Lord Greensboro and High Point TEACCH Center
REFERENCES Folstein, S. E., & Rutter, M. (1988). Familial aggregation and genetic implications. Journal of Autism and Developmental Disorders, 18, 3-30. GiUberg, C., & Gillberg, I. C. (1983). Infantile autism: A total population study of reduced optimality in the pre-, peri-, and neonatal periods. Journal of Autism and Developmental Disorders, 13, 153-166. Gualtieri, T., & Hicks, R. E. (1985). Immunoreactive theory of selective male affliction. Behavioral and Brah7 Sciences, 3, 427-477. Jones, M. B., & Szatmari, P. (1988). Stoppage rules and genetic studies of autism. Journal of Autism and Developmental Disorders, 18, 31-40. Le Couteur, A., Rutter, M., Lord, C., Rios, P., Robertson, S., Holdgrafer, M., & McLennan, J. D. (1989). Autism Diagnostic Interview: A semistructured interview for parents and caregivers of autistic persons. Journal of Autism and Developmental Disorders, 19, 363-387. Szatmari, P., & Jones, M. B. (1991). IQ and the genetics of autism. Journal of Child Psychology and Psychiatry, 39, 897-908.
N O R M A L I Z A T I O N - STILL RELEVANT TODAY 1 In a recent issue of the Journal of Aut&m and Developmental Disorders, Mesibov (1990) provides a provocative and timely essay questioning the relevance of normalization for practitioners today. His primary thesis is that although normalization was "an important rallying point for the muchneeded deinstitutionalization movement of the 1960s, the greater complexity of today's issues and choices has made this principle more of a detriment than an advantage" (p. 388). While we appreciate Mesibov's critical analysis of normalization, we are not convinced that it is time to abandon this important, yet sometimes 1The authors thank Jennifer York and K. Charlie Lakin tbr comments on earlier versions of this manuscript.
Letters to the Editor
667
misunderstood, principle. To the contrary, our position is that normalization continues to be extremely useful when it is applied correctly and is used in concert with other "guiding philosophies," particularly those associated with the concepts of "individualization" and "self determination." We feel that Mesibov fails to consider normalization in light of the basic limitations which are inherent to all broad service philosophies, thus overlooking the benefits that have been derived from its application. Before we address the issues where we question Mesibov's conclusions or interpretation of normalization, we comment on issues raised by Mesibov which we feel either identify legitimate limitations of the principle or provide examples of situations where normalization has been misapplied. Mesibov offers a valid criticism of the manner in which advocacy for normalization has evolved during the past quarter century. He has observed individuals who promote the philosophy with such evangelical zeal that they become overly emotional and personal in their advocacy efforts. This "creates a most undesirable climate where thoughtful discussion and muchneeded experimentation are discouraged and stifled" (p. 385). We have observed such behavior as well and share Mesibov's conviction that the open exchange of ideas and opinions is critical to the evolution of services and supports which truly afford people with disabilities opportunities to enjoy an optimal quality of life. Although Mesibov focused upon personal attacks that he and others have received in response to previous articles written on normalization, we are more concerned when such actions occur at the local service level. Recently, a rehabilitation supervisor reported that he was referred to as a "segregationist" by an advocate in response to his suggestion that a consumer pursue a period of training at a sheltered workshop (this was after the consumer had been dismissed from two previous community work sites for grossly inappropriate behavior). The accusation transformed a collaborative planning meeting into a tension-filled, confrontational standoff. A more constructive response would have been to consider the relative merits of the supervisor's suggestion along with alternative recommendations. On this point we agree fully with Mesibov: Normalization is a philosophy to guide service delivery--it is not a religion that demands an indiscriminate allegiance. Normalization should not be used as a means to capture the moral high ground in order to summarily dismiss service alternatives that are not completely consistent with the philosophy. Mesibov correctly indicates that the application of normalization has encouraged the integration of people with autism and other disabilities into the largely nondisabled society and has subsequently discouraged congregate "disabled only" options. However, he further contends that by discouraging the grouping of people with disabilities "normalization advocates
668
Letters to the Editor
are restricting developmentally handicapped people from some of their potentially most satisfying relationships" (p. 384). We are not aware of any communities where there is a surplus of integrated options and a lack of "disabled only" options. Thus, the chance of people with developmental disabilities never having contact with one another is unlikely to occur. It is our belief that the "real" issue is not how much time people with disabilities spend with others who may or may not have disabilities, but rather whether they have the option to choose the people with whom they socialize. Based upon the normalization principle, this choice should rest with each i n d i v i d u a l - not with a staff member, agency, and so forth. Because the power to select one's friends and control the nature of one's relationships is one of the most valued rights enjoyed by members of our culture, vesting the power of choice with individuals with disabilities is completely consistent with normalization. Contrary to Mesibov's implication, normalization remains relevant to practitioners regardless of whether they serve consumers who desire to cultivate relationships within their disability group or expand their range of relationships beyond their group. Throughout the article, Mesibov's major concern seems to be his belief that normalization has overshadowed the importance of tailoring services to the unique needs of individuals. He repeatedly suggests that service providers have become preoccupied with utilizing approaches consistent with normalization to the detriment of individuals whose needs are not best met by such approaches. In one example, a classroom program that included children with autism is discussed. Mesibov indicates that the overriding goal of this program was to increase the amount of time the children with autism spent in activities with children without disabilities. Apparently, little attention was paid to the educational progress (i.e., measurable achievement) of the children. We concur wholeheartedly that inclusive education programs must be designed to meet the academic and developmental needs of students with autism, not just the social needs. We also agree that s o m e children with autism may have certain needs that are not likely to be best addressed in a typical classroom setting. As Brown et al. (1991) pointed out, being included as a member of a regular education classroom does not mean being confined to the regular classroom setting for the entire school day. We believe strongly the needs of an individual should never be sacrificed for adherence to an ideology. Having said this, we believe it is our lack of knowledge about h o w to meet a student's needs in an integrated setting that is the biggest barrier to the full inclusion of children with autism. However, the fact that many educators are striving to develop, adapt, and evaluate strategies to facilitate
Letters to the Editor
669
inclusion is a sign that the educational methodology for these students is in a healthy stage of growth. One of the great contributions of normalization has been the manner by which it has consistently challenged educators, as well as other service providers, to evaluate and improve their practices. Mesibov provides other legitimate examples of misguided and ineffective application of the normalization principle throughout his essay. However, when a philosophy is either misconstrued or misapplied, the problem rests with the misapplication not with the concept u thus, the solution is to improve practice not reject a useful principle. Unfortunately, instead of advocating for improved training, monitoring procedures, or other possible solutions to rectify these problems and ensure that normalization is implemented effectively, Mesibov advocates disregarding the principle altogether. To dismiss the relevance of normalization because it has been misapplied by certain practitioners wo~ld be a classic example of "throwing the baby out with the bath water." Another of Mesibov's recurrent themes is the suggestion that normalization has created unattainable and undesirable goals for people with autism and other developmental disabilities. He points out that expecting an individual with severe organic problems to live a "normal" life is unfair and unwise. He also writes that normalization "yields a narrow concept of what is normal to determine the appropriateness of living environments" (p. 381) and implies that the living options available to individuals with disabilities are being restricted by the application of normalization. Our interpretation of normalization is fundamentally different from Mesibov's in regard to these issues in at least two ways. First, in suggesting that normalization has created unattainable goals for individuals with disabilities, Mesibov reinforces a common misconception that normalization involves an attempt to make a person with a disability "normal." In actuality, the focus of this principle is on normalizing experiences and environments, not people (Wolfensberger, 1980). The normalization principle is based on the premise that persons with disabilities, including persons with autism, are full and equal members of society who are entitled to the same rights, dignity, and respect as others. However, this does not mean that the special needs of people with disabilities should be denied or ignored. Second, normalization does not require ~iving where most people tire. hut it does require residing in an environment that most people in one's respective community value. Wolfensberger (1980) indicated that "normalization does not simply call for the option that is chosen by the single largest group of people . . . it calls for options that either fall within the statistical normative range, o r . . . within the supranormative valued end of the continuum of culturally valued options" (p. 92). Therefore, in applying the nor-
670
Letters to the Editor
malization principle, widespread deviation in living arrangements and settings based solely upon labels must be avoided. However, the application of normalization does not discourage the adaptation of living environments to meet individual needs. For example, while certain individuals with autism may require household environments that are less visually and auditorily stimulating than typical settings, their residences should not be inferior or unnecessarily deviate from the residences of others in the community. In this same vein, participation in community life by persons with autism and other disabilities should not be arbitrarily restricted. Predisposed notions about the capabilities of persons with disabilities, and specifically persons with autism, have prohibited many individuals from opportunities to learn and practice skills in normalized (i.e., culturally valued) settings. Our major objection to Mesibov's essay is his significant underestimation of the range of benefits that have been derived from the application of the normalization principle. During the past quarter century normalization has inspired and guided the transformation of the service delivery system from primarily a custodial orientation, which emphasized the need for specialized care, to an ecological and training orientation where the need to adapt the environment and develop the talents of the individual are emphasized. By encouraging services and supports that foster independence, personal growth, and participation in the community, normalization has consistently promoted the notion that people with autism and other developmental disabilities are capable of living full lives as contributing members of society as opposed to simply being objects of compassion. Recent innovations which were at least partially justified on the basis of their compatibility with normalization include, but are not limited to, supported employment, inclusive schooling, integrated recreation programs, and consumer-controlled housing. In light of the progress that has resulted from the application of normalization, Mesibov's assertion that normalization discourages innovation and diversity appears especially questionable. Although space does not permit us to review the professional literature in defense of normalization, there is clearly an abundance of empirical support. In an excellent review of research concerning the manner by which persons with developmental disabilities acquire and generalize skills across environments, Liberty (1985) indicated the importance of the learning setting. Skills are far more likely to be acquired and generalized when they are taught in community settings due to the natural reinforcement such settings afford. Wolfensberger (1972) perceived the association between individual growth and environmental context when he originally defined normalization as the "utilization of means which are as culturally normative
Letters to the Editor
671
as possible in order to established and/or maintain personal behaviors and characteristics which are as culturally normative as possible" (p. 28). There is ample evidence to support the assertion that normalization has resulted in beneficial practices for individuals with severe disabilities, regardless of age. For example, Larson and Lakin (1989) reviewed 18 different studies concerning people with severe disabilities who moved out of institutions into community residences. They report that "all of the studies that examined overall adaptive behavior found increases associated with movement from institutions to small community living arrangements" (p. 329). At the other end of the age continuum, Odom and McEvoy (1988) reviewed a host of early childhood studies which have demonstrated the positive effects of early integration for both children with and without disabilities. Mesibov believes that problems associated with normalization outweigh its usefulness and new guiding principles are needed. In our view, eliminating the sorts of service delivery incompetence described by Mesibov can only be achieved through improved public and organizational policies that result in better training and development of staff, increased collaborative planning among all stakeholders, and more effective program design and monitoring. Mesibov provides much food for thought. Clearly, normalization, like all other approaches to the provision of services and support to people with autism and other developmental disabilities, has certain limitations and does not provide a definitive answer to all of the challenges which practitioners face. In addition, Mesibov is correct in asserting that overzealous adherence to certain aspects of normalization invites tunnel vision and poor decision making. However, we believe that there are far more situations where the principle has been applied skillfully than where it has been misapplied. One must only look at the thousands of individuals who are living in neighborhood homes, working on community jobs, learning in regular schools, and experiencing the dignity that comes with a sense of belonging to the larger culture to conclude that normalization has upgraded service delivery in a manner unequaled by any other approach. Normalization is a humanistically compelling and parsimonious concept which has created a shared vision of what life could and should be like for citizens with autism and other developmental disabilities. This vision continues to challenge service providers to focus their energies toward the promotion of a valued life-style for people with disabilities. Thus, we believe that normalization remains a relevant and important guiding principle for the 1990s.
James R. Thompson 2 and Mary A. McEvoy
672
Letters to the Editor
University of Minnesota REFERENCES Brown, L., Schwarz, P., Udvari-Solner, A., Kampschroer, E. F., Johnson, & Gruenewald, L. (1991). How much time should students with severe intellectual disabilities spend in regular education classrooms and elsewhere? Journal of the Association for Persons with Severe Handicaps, 16, 39-47. Larson, S. A., & l.akin, IC C. (1989). Deinstitutionalization of persons with mental retardation: Behavioral outcomes. Journal of the Association for Persons with Severe Handicaps 14, 324-332. Liberty, K. A. (1985). Enhancing instruction for maintenance, generalization, and adaptation. In K. C. Lakin & R. H. Bruininks (Eds.), Strategies for ach&ving community integration of developmentally disabled citizens (pp. 29-72). Baltimore: Brookes. Mesibov, G. B. (1990). Normalization and its relevance today. Journal of Autism and Developmental Disorders, 20, 379-390. Odom, S., & McEvoy, M. (1988). Integration of young children with handicaps and normally developing children. In S. Odom & M. Karnes (Eds.), Early intelvention for infants and childJen with handicaps (pp. 241-267). Baltimore: Brookes. Wolfensberger, W. (1980). The definition of normalization. In R. Flynn & K. Nitsch (Eds.), Normalization, social h~tegration, and community services (pp. 71-116). Baltimore: University Park Press. Wolfensberger, W. (1972). The principle of normalization in human services. Toronto: National Institute on Mental Retardation.
RESPONSE TO THOMPSON AND McEVOY
First, I would like to compliment the authors on their constructive response to my article. Although they clearly disagree with my ideas, they should be commended for presenting their position positively and professionally. If other advocates of normalization could be as thoughtful and constructive as these authors, then we might one day sort out these complex issues and better understand what is really in the best interest of the clients and families we serve. Although there are several areas of disagreement between our positions, a crucial one is where responsibility rests for misapplications of the theory of normalization. The authors and I agree that proponents of the normalization principle advocate for normalized experiences, rather than normal behavior. The interpretation by many professionals that we should try to make our clients as normal as possible is a misapplication of the theory. Thompson and McEvoy argue that when a philosophy is either misconstrued or misapplied, the problem rests with the misapplication, not the concept. Although I generally agree with their statement, I think that there 2Address all correspondence to James R. Thompson, Institute on Community Integration, 6 Pattee Hall, University of Minnesota, Minneapolis, MN 55455.
Letters to the Editor
673
are some philosophies, and normalization is one of them, that are more likely to be misinterpreted and misapplied. A human service philosophy focusing on meeting individual needs and maximizing individual potentials is more likely, in my opinion, to encourage appropriate programmatic strategies than is a philosophy advancing the concept of "normalcy."
Gary B. Mesibov The University of North Carolina at Chapel Hill
Letters to the Editor
for social-communication disorder. These were clinic-based samples, so we are not able to evaluate the frequency or pattern of families with children affected in milder ways that did not come to our attention at the clinics. The results here, if replicated, suggest that there may be other as yet unidentified factors such as maternal immunoreactions (Gualtieri & Hicks, 1985) associated in some way with birth order that may influence cognitive level within autism and pervasive developmental disorder, at least in multiplex families. The purpose of this letter is to encourage other investigators to review their data in order to consider this possibility.
Catherine Lord Greensboro and High Point TEACCH Center
REFERENCES Folstein, S. E., & Rutter, M. (1988). Familial aggregation and genetic implications. Journal of Autism and Developmental Disorders, 18, 3-30. GiUberg, C., & Gillberg, I. C. (1983). Infantile autism: A total population study of reduced optimality in the pre-, peri-, and neonatal periods. Journal of Autism and Developmental Disorders, 13, 153-166. Gualtieri, T., & Hicks, R. E. (1985). Immunoreactive theory of selective male affliction. Behavioral and Brah7 Sciences, 3, 427-477. Jones, M. B., & Szatmari, P. (1988). Stoppage rules and genetic studies of autism. Journal of Autism and Developmental Disorders, 18, 31-40. Le Couteur, A., Rutter, M., Lord, C., Rios, P., Robertson, S., Holdgrafer, M., & McLennan, J. D. (1989). Autism Diagnostic Interview: A semistructured interview for parents and caregivers of autistic persons. Journal of Autism and Developmental Disorders, 19, 363-387. Szatmari, P., & Jones, M. B. (1991). IQ and the genetics of autism. Journal of Child Psychology and Psychiatry, 39, 897-908.
N O R M A L I Z A T I O N - STILL RELEVANT TODAY 1 In a recent issue of the Journal of Aut&m and Developmental Disorders, Mesibov (1990) provides a provocative and timely essay questioning the relevance of normalization for practitioners today. His primary thesis is that although normalization was "an important rallying point for the muchneeded deinstitutionalization movement of the 1960s, the greater complexity of today's issues and choices has made this principle more of a detriment than an advantage" (p. 388). While we appreciate Mesibov's critical analysis of normalization, we are not convinced that it is time to abandon this important, yet sometimes 1The authors thank Jennifer York and K. Charlie Lakin tbr comments on earlier versions of this manuscript.
Letters to the Editor
667
misunderstood, principle. To the contrary, our position is that normalization continues to be extremely useful when it is applied correctly and is used in concert with other "guiding philosophies," particularly those associated with the concepts of "individualization" and "self determination." We feel that Mesibov fails to consider normalization in light of the basic limitations which are inherent to all broad service philosophies, thus overlooking the benefits that have been derived from its application. Before we address the issues where we question Mesibov's conclusions or interpretation of normalization, we comment on issues raised by Mesibov which we feel either identify legitimate limitations of the principle or provide examples of situations where normalization has been misapplied. Mesibov offers a valid criticism of the manner in which advocacy for normalization has evolved during the past quarter century. He has observed individuals who promote the philosophy with such evangelical zeal that they become overly emotional and personal in their advocacy efforts. This "creates a most undesirable climate where thoughtful discussion and muchneeded experimentation are discouraged and stifled" (p. 385). We have observed such behavior as well and share Mesibov's conviction that the open exchange of ideas and opinions is critical to the evolution of services and supports which truly afford people with disabilities opportunities to enjoy an optimal quality of life. Although Mesibov focused upon personal attacks that he and others have received in response to previous articles written on normalization, we are more concerned when such actions occur at the local service level. Recently, a rehabilitation supervisor reported that he was referred to as a "segregationist" by an advocate in response to his suggestion that a consumer pursue a period of training at a sheltered workshop (this was after the consumer had been dismissed from two previous community work sites for grossly inappropriate behavior). The accusation transformed a collaborative planning meeting into a tension-filled, confrontational standoff. A more constructive response would have been to consider the relative merits of the supervisor's suggestion along with alternative recommendations. On this point we agree fully with Mesibov: Normalization is a philosophy to guide service delivery--it is not a religion that demands an indiscriminate allegiance. Normalization should not be used as a means to capture the moral high ground in order to summarily dismiss service alternatives that are not completely consistent with the philosophy. Mesibov correctly indicates that the application of normalization has encouraged the integration of people with autism and other disabilities into the largely nondisabled society and has subsequently discouraged congregate "disabled only" options. However, he further contends that by discouraging the grouping of people with disabilities "normalization advocates
668
Letters to the Editor
are restricting developmentally handicapped people from some of their potentially most satisfying relationships" (p. 384). We are not aware of any communities where there is a surplus of integrated options and a lack of "disabled only" options. Thus, the chance of people with developmental disabilities never having contact with one another is unlikely to occur. It is our belief that the "real" issue is not how much time people with disabilities spend with others who may or may not have disabilities, but rather whether they have the option to choose the people with whom they socialize. Based upon the normalization principle, this choice should rest with each i n d i v i d u a l - not with a staff member, agency, and so forth. Because the power to select one's friends and control the nature of one's relationships is one of the most valued rights enjoyed by members of our culture, vesting the power of choice with individuals with disabilities is completely consistent with normalization. Contrary to Mesibov's implication, normalization remains relevant to practitioners regardless of whether they serve consumers who desire to cultivate relationships within their disability group or expand their range of relationships beyond their group. Throughout the article, Mesibov's major concern seems to be his belief that normalization has overshadowed the importance of tailoring services to the unique needs of individuals. He repeatedly suggests that service providers have become preoccupied with utilizing approaches consistent with normalization to the detriment of individuals whose needs are not best met by such approaches. In one example, a classroom program that included children with autism is discussed. Mesibov indicates that the overriding goal of this program was to increase the amount of time the children with autism spent in activities with children without disabilities. Apparently, little attention was paid to the educational progress (i.e., measurable achievement) of the children. We concur wholeheartedly that inclusive education programs must be designed to meet the academic and developmental needs of students with autism, not just the social needs. We also agree that s o m e children with autism may have certain needs that are not likely to be best addressed in a typical classroom setting. As Brown et al. (1991) pointed out, being included as a member of a regular education classroom does not mean being confined to the regular classroom setting for the entire school day. We believe strongly the needs of an individual should never be sacrificed for adherence to an ideology. Having said this, we believe it is our lack of knowledge about h o w to meet a student's needs in an integrated setting that is the biggest barrier to the full inclusion of children with autism. However, the fact that many educators are striving to develop, adapt, and evaluate strategies to facilitate
Letters to the Editor
669
inclusion is a sign that the educational methodology for these students is in a healthy stage of growth. One of the great contributions of normalization has been the manner by which it has consistently challenged educators, as well as other service providers, to evaluate and improve their practices. Mesibov provides other legitimate examples of misguided and ineffective application of the normalization principle throughout his essay. However, when a philosophy is either misconstrued or misapplied, the problem rests with the misapplication not with the concept u thus, the solution is to improve practice not reject a useful principle. Unfortunately, instead of advocating for improved training, monitoring procedures, or other possible solutions to rectify these problems and ensure that normalization is implemented effectively, Mesibov advocates disregarding the principle altogether. To dismiss the relevance of normalization because it has been misapplied by certain practitioners wo~ld be a classic example of "throwing the baby out with the bath water." Another of Mesibov's recurrent themes is the suggestion that normalization has created unattainable and undesirable goals for people with autism and other developmental disabilities. He points out that expecting an individual with severe organic problems to live a "normal" life is unfair and unwise. He also writes that normalization "yields a narrow concept of what is normal to determine the appropriateness of living environments" (p. 381) and implies that the living options available to individuals with disabilities are being restricted by the application of normalization. Our interpretation of normalization is fundamentally different from Mesibov's in regard to these issues in at least two ways. First, in suggesting that normalization has created unattainable goals for individuals with disabilities, Mesibov reinforces a common misconception that normalization involves an attempt to make a person with a disability "normal." In actuality, the focus of this principle is on normalizing experiences and environments, not people (Wolfensberger, 1980). The normalization principle is based on the premise that persons with disabilities, including persons with autism, are full and equal members of society who are entitled to the same rights, dignity, and respect as others. However, this does not mean that the special needs of people with disabilities should be denied or ignored. Second, normalization does not require ~iving where most people tire. hut it does require residing in an environment that most people in one's respective community value. Wolfensberger (1980) indicated that "normalization does not simply call for the option that is chosen by the single largest group of people . . . it calls for options that either fall within the statistical normative range, o r . . . within the supranormative valued end of the continuum of culturally valued options" (p. 92). Therefore, in applying the nor-
670
Letters to the Editor
malization principle, widespread deviation in living arrangements and settings based solely upon labels must be avoided. However, the application of normalization does not discourage the adaptation of living environments to meet individual needs. For example, while certain individuals with autism may require household environments that are less visually and auditorily stimulating than typical settings, their residences should not be inferior or unnecessarily deviate from the residences of others in the community. In this same vein, participation in community life by persons with autism and other disabilities should not be arbitrarily restricted. Predisposed notions about the capabilities of persons with disabilities, and specifically persons with autism, have prohibited many individuals from opportunities to learn and practice skills in normalized (i.e., culturally valued) settings. Our major objection to Mesibov's essay is his significant underestimation of the range of benefits that have been derived from the application of the normalization principle. During the past quarter century normalization has inspired and guided the transformation of the service delivery system from primarily a custodial orientation, which emphasized the need for specialized care, to an ecological and training orientation where the need to adapt the environment and develop the talents of the individual are emphasized. By encouraging services and supports that foster independence, personal growth, and participation in the community, normalization has consistently promoted the notion that people with autism and other developmental disabilities are capable of living full lives as contributing members of society as opposed to simply being objects of compassion. Recent innovations which were at least partially justified on the basis of their compatibility with normalization include, but are not limited to, supported employment, inclusive schooling, integrated recreation programs, and consumer-controlled housing. In light of the progress that has resulted from the application of normalization, Mesibov's assertion that normalization discourages innovation and diversity appears especially questionable. Although space does not permit us to review the professional literature in defense of normalization, there is clearly an abundance of empirical support. In an excellent review of research concerning the manner by which persons with developmental disabilities acquire and generalize skills across environments, Liberty (1985) indicated the importance of the learning setting. Skills are far more likely to be acquired and generalized when they are taught in community settings due to the natural reinforcement such settings afford. Wolfensberger (1972) perceived the association between individual growth and environmental context when he originally defined normalization as the "utilization of means which are as culturally normative
Letters to the Editor
671
as possible in order to established and/or maintain personal behaviors and characteristics which are as culturally normative as possible" (p. 28). There is ample evidence to support the assertion that normalization has resulted in beneficial practices for individuals with severe disabilities, regardless of age. For example, Larson and Lakin (1989) reviewed 18 different studies concerning people with severe disabilities who moved out of institutions into community residences. They report that "all of the studies that examined overall adaptive behavior found increases associated with movement from institutions to small community living arrangements" (p. 329). At the other end of the age continuum, Odom and McEvoy (1988) reviewed a host of early childhood studies which have demonstrated the positive effects of early integration for both children with and without disabilities. Mesibov believes that problems associated with normalization outweigh its usefulness and new guiding principles are needed. In our view, eliminating the sorts of service delivery incompetence described by Mesibov can only be achieved through improved public and organizational policies that result in better training and development of staff, increased collaborative planning among all stakeholders, and more effective program design and monitoring. Mesibov provides much food for thought. Clearly, normalization, like all other approaches to the provision of services and support to people with autism and other developmental disabilities, has certain limitations and does not provide a definitive answer to all of the challenges which practitioners face. In addition, Mesibov is correct in asserting that overzealous adherence to certain aspects of normalization invites tunnel vision and poor decision making. However, we believe that there are far more situations where the principle has been applied skillfully than where it has been misapplied. One must only look at the thousands of individuals who are living in neighborhood homes, working on community jobs, learning in regular schools, and experiencing the dignity that comes with a sense of belonging to the larger culture to conclude that normalization has upgraded service delivery in a manner unequaled by any other approach. Normalization is a humanistically compelling and parsimonious concept which has created a shared vision of what life could and should be like for citizens with autism and other developmental disabilities. This vision continues to challenge service providers to focus their energies toward the promotion of a valued life-style for people with disabilities. Thus, we believe that normalization remains a relevant and important guiding principle for the 1990s.
James R. Thompson 2 and Mary A. McEvoy
672
Letters to the Editor
University of Minnesota REFERENCES Brown, L., Schwarz, P., Udvari-Solner, A., Kampschroer, E. F., Johnson, & Gruenewald, L. (1991). How much time should students with severe intellectual disabilities spend in regular education classrooms and elsewhere? Journal of the Association for Persons with Severe Handicaps, 16, 39-47. Larson, S. A., & l.akin, IC C. (1989). Deinstitutionalization of persons with mental retardation: Behavioral outcomes. Journal of the Association for Persons with Severe Handicaps 14, 324-332. Liberty, K. A. (1985). Enhancing instruction for maintenance, generalization, and adaptation. In K. C. Lakin & R. H. Bruininks (Eds.), Strategies for ach&ving community integration of developmentally disabled citizens (pp. 29-72). Baltimore: Brookes. Mesibov, G. B. (1990). Normalization and its relevance today. Journal of Autism and Developmental Disorders, 20, 379-390. Odom, S., & McEvoy, M. (1988). Integration of young children with handicaps and normally developing children. In S. Odom & M. Karnes (Eds.), Early intelvention for infants and childJen with handicaps (pp. 241-267). Baltimore: Brookes. Wolfensberger, W. (1980). The definition of normalization. In R. Flynn & K. Nitsch (Eds.), Normalization, social h~tegration, and community services (pp. 71-116). Baltimore: University Park Press. Wolfensberger, W. (1972). The principle of normalization in human services. Toronto: National Institute on Mental Retardation.
RESPONSE TO THOMPSON AND McEVOY
First, I would like to compliment the authors on their constructive response to my article. Although they clearly disagree with my ideas, they should be commended for presenting their position positively and professionally. If other advocates of normalization could be as thoughtful and constructive as these authors, then we might one day sort out these complex issues and better understand what is really in the best interest of the clients and families we serve. Although there are several areas of disagreement between our positions, a crucial one is where responsibility rests for misapplications of the theory of normalization. The authors and I agree that proponents of the normalization principle advocate for normalized experiences, rather than normal behavior. The interpretation by many professionals that we should try to make our clients as normal as possible is a misapplication of the theory. Thompson and McEvoy argue that when a philosophy is either misconstrued or misapplied, the problem rests with the misapplication, not the concept. Although I generally agree with their statement, I think that there 2Address all correspondence to James R. Thompson, Institute on Community Integration, 6 Pattee Hall, University of Minnesota, Minneapolis, MN 55455.
Letters to the Editor
673
are some philosophies, and normalization is one of them, that are more likely to be misinterpreted and misapplied. A human service philosophy focusing on meeting individual needs and maximizing individual potentials is more likely, in my opinion, to encourage appropriate programmatic strategies than is a philosophy advancing the concept of "normalcy."
Gary B. Mesibov The University of North Carolina at Chapel Hill
