RESEARCH NOTES Br. J. educ. Psycliol., 45, 307-311, 1975
PRE-SCHOOL MENTALLY HANDICAPPED CHILDREN
BY R. McCONKEY AND DOROTHY M. JEFFREE (Hester Adrian Research Centre, University of Manchester) SUMMARY. Information was collected on 150 mentally handicapped children who were under 5. Many of the children had additional handicaps and all showed marked retardation in their physical, social, play and language development. The majority of parents expressed a willingness to take part in a parental involvement project. Their main concerns were with the child’s speech and language development and in coping with management problems. The implications of these findings for services provided for these parents and children is discussed. INTRODUCTION Although there have been many surveys involving the mentally handicapped and their families, these have tended to concentrate on school-age children or adults, and have been primarily concerned with the family and home situation (e.g., Tizard and Grad, 1961 ; Kushlick and Cox, 1970). Consequently there is very little information on the characteristics of the ‘pre-school’ mentally handicapped child, under 5 years old. Yet this information is very necessary for the planning of services to help these children and their parents. Already some authorities are taking children into ESNS schools prior to their fifth birthday and there is also an increasing interest in involving parents in helping their child’s development during the early, formative years of life (Mittler, 1974). As the development of parental involvement schemes is of particular concern to us, we decided to carry out a survey which concentrated on the characteristics of the pre-school child, with the secondary aim of establishing the parent’s willingness to take part in an involvement project. METHOD The Education Departments of the 10 authorities in the Greater Manchester Council were asked to supply the names of all children within their area who were officially classified as ESNS and who would be under 5 on October Ist, 1974. We were given 178 names which produces an incidence rate of 0.77 per 1,OOO. This is lower than the figure of 0.91 reported for Salford in 1961, but higher than that for Wessex (0.53-Kushlick and Cox, 1970). On the advice of the authority, six of the parents were not followed up because of unusual circumstances affecting the child. A further two parents were excluded as they subsequently moved out of the GMC area. An introductory letter describing the project was then sent to 170 parents. Fourteen parents did not reply to this letter (even though a pre-paid card was enclosed) and one parent indicated she did not want to take part in the project. A further five parents expressed an initial interest in the project but they did not reply to further correspondence. The remaining 150 parents either were visited by a member of the project team (141) or completed the questionnaire by post (9) (87 per cent response). RESULTS Children’s Characteristics. The ages of the children ranged from 19 to 60 months, 50 per cent were 4 years old ; 34 per cent were 3 years old and 16 per cent were 2 years or less. If one assumes that the number of children born in any one year is relatively constant, then these figures suggest that chddren are not officially classified as ESNS until their third birthday or later. (This makes it difficult to calculate accurate rates in the age range
307
Research Notes 0-4 and to assess demand for services). As usual, boys outnumbered the girls ; 63 per cent and 37 per cent, respectively. Aetiology : This was unknown in 28 per cent of the cases. The principal aetiologies reported are given in Table 1 along with their frequency of occurrence.
TABLE 1 FREQUENCYOF OCCURRENCE OF Amomm,
Down’sSyndrome ........ Cerebral Palsy ............ Unspecified Brain Damage . . Birth Iqjury ..............
Additional Handicaps : 13 per cent of the children were presently experiencing epileptic fits (9 per cent were having grand-mal fits), but in all 20 per cent of the children were on medications to control epileptic fits. 27 per cent of the children had some form of physical handicap. In 11 per cent of the children this was a deformity or malfunctioning of the legs and in a further 10 per cent both the arms and legs were affected. 33 per cent of the children were reported as having difficulty in seeing. This ranged from short-sightedness to total blindness (although precise indications of loss of vision were rarely known). 9 per cent of the children had a squint. With the vast majority of children hearing tests of some description had been carried out and 9 per cent were reported as having difficulty in hearing, but the extent of hearing loss was often unknown. Stages of development : In order to provide a framework for describing the child’s abilities (and disabilities) we prepared development charts covering five main areas of development ; the development of physical skills, eye-hand skills, social skills, language and play. The items included in the charts covered the skills which children normally acquire during their first five years of life, although they concentrated mainly on the fist two years. Certain ‘ target ’ skills were emphasised in the charts (e.g., ‘ walks confidently ’ ; ‘feeds self with a spoon’) but the skills which precede these in development were also listed. Hence, we could ascertain from the parents whether the children had attained the target skills or, if not, the level of development they had reached. (Copies of the charts are available from the authors.) In order to summarise the results, only some of the skills within each area of development will be reported. The majority of the skills listed are normally attained by children at 24 months or, in a few cases, marked with an asterisk in the table, at 36 months.
In Table 2 the skills are given in developmental order with the most advanced skill first and the earliest skills last. In order to emphasise the children’s retarded development, we have shown the percentage of children not capable of each skill. (The percentage of children who have attained the skills can, of course, be calculated by subtracting from 100.) The results are presented separately for the Cyear-olds and those who were aged 3 or under, so as to reflect the on-going development of the children. (There were 75 children in each grouping). School Placement : 65 per cent of the Cyear-olds and 48 per cent of the younger children were attending an ESNS school, while a further 17 per cent and 16 per cent, respectively, went to a day-care nursery, a nursery school on a part-time basis or a local playgroup. 18 per cent of the 4-year-olds and 36 per cent of the younger children were at home all day.
Research Notes
309
TABLE 2 PERCENTAGE OF CHILDREN NOT CAPABLE OF EACHSKILL. PERCENTAGE CHILDREN NOTCAPABLE 3 years 4 years and under
SKlLLS
1
.
PHYSICAL SKILLS (a) Mobility Goes up and down stairs in an upright position ............ Gets up and down stairs but not upright .................. Walksconfidently .................................... Can get up off the floor unaided and stand ................ Walks with help from an adult .......................... Can get around room by crawling or some other means . . Sits alone on the floor .................................. Holds head steady when sitting on your knee .............. (b) Eye-Hand Skills *Draws a man on request showing legs and head .......... Can scribble in circles and straight lines .................. Will use a pencil to scribble a little ........................ Picks up small objects (e.g., small pieces of string between fingers and tip of thumb) ................................ Reaches out and picks up small objects straightaway ........ Watches or follows a dangling toy moved in front of face ....
. .
2 . SOCIALSKILLS (a) Feeding Feeds self with SDOOD. . . only . occasional sDillinn ~- .............. Manages a cup well .................................... Feeds self with fingers .................................. Takes solids well ...................................... (h) Toileting *Toilet-trained with infrequent accidents .................. Bowel control complete ................................ Will use potty (or toilet) when put on it .................... Shows some regularity of bladder and bowel motions ...... (c) Dressing *Removes and puts on simple articles of clothing, e.g., vests and pants ............................................ Helps actively to dress and undress (e.g., pulls pants down) . Can take shoes and socks off ............................ Co-operates in dressing-holds out arm or foot ............
.
3 . PLAY Engages in make-believe play. e.g., putting doll to bed .......... Will join in play with one other person-; chasing or kicking a ball Will hug or kiss a doll or teddy bear .......................... Co-operates in games of clap hands and pat.a-cake .............. Enjoys peek-a-boo ........................................
4
.
LANGUAGE SKILLS (a) Spoken Language Put two words together. e.g., milk gone. bye-bye shoe ...... Uses 20 clear words .................................... Talk is mostly jargon with some words clear ................ Uses 4 to 5 clear words .................................. Babbles constantly with one clear word .................... Has two or more soundswhich he repeats .................. ( b ) Imitation of Language Imitates one word ...................................... Imitates playful sounds-smacking lips .................... Imitates own sounds. ba.ba. ma-ma Makes noises when talked to
...................... ............................
80
61 51 39 29 24 23 9
60
40
28
15 11 7 5 3
99 60 42
96 43 24
39 22 5
20 7 3
64 45 37 13
41 27 16 8
92 69 45
68 54 37 31
71 ._
64 _.
44
52 35 23
32 24
17
70 42 43 27 12
53 35 39 23 12
85 77 50
32 27 12
60 55 41 36 27 9
60 40 32 20
48 32 23 22
Research Notes
3 10 TABLE 2--continued.
PERCENTAGE CHILDREN NOT CAPABLE 3 years 4 years and under
SKILLS
4. LANGUAGE Smu-continued. (c) Understandingof Lmguage Identifies at least seven pictures of common objects. . . . . . . . . . Points to familiar person or toys on request. ............... Will obey simple request. e.g., give ball to mummy. . . . . . . . . . Comprehends simple commands if you use gestures, e.g.. wave bye-bye .......................................... Responds to own name ................................
72 51
41
49
29
23
17 II
53
8
f i e Family. 97 per cent of the children were living with their parents, 1 per cent were with a relative and 2 per cent were with foster parents. 9 per cent of the children were the only child in the family ; 22 per cent were the first-born in the family and 52 per cent the last born. 17 per cent had one sibling still living at home, 31 per cent had two siblings ; 11 per cent had three siblings and 16 per cent had four or more siblings at home. An estimate was made of the mother's age : 6 per cent were rated under 25 ; 43 per cent as between 25 and 35 ; and 51 per cent as over 35 years. Parents' concerns : The parents were asked if they had had any particular problem with their child or if there was anything that concerned them now on which they would like guidance or help. 18 per cent of parents said that they had no problems or concerns. Of the remaining parents, 39 per cent mentioned one area of concern ; 27 per cent two areas of concern and 16 per cent three or more areas of concern. A wide diversity of problems and concerns were expressed by the parents but for convenience we have grouped them into four areas and given examples of specific concerns mentioned. This is given separately for the two age groups of children as the type of problem varied with the age of the child. Parents with a younger child were more concerned about physical skills than parents of 4-year-olds, who were much more concerned with management problems. However, speech (and/or language) was the biggest single concern of all parents (seeTable 3). TABLE 3 TEEPERCENTAGE OF PARENTS REPORTING EACHAREAOF CONCERN. Area of Concern
Percentage of Parents
Specific Examples
3Yand under Physical Skills . . . . . . . . . . Social Skills ............ Communication . . . . . . . . Management Problem
....
Walking Sitting Toilet training Feeding self Speech
language Screaming Temper Tantrums Defiance Aggression to others
24
I I
I I
'
I
I
4-
I
I!
15
I
j 27 41 25
25
I
1
41
I
48
I
I
The Involvement Project : 42 per cent of the parents were willing to come regularly
to the University to take part in the project while a further 18 per cent wanted to keep
in touch through booklets and similar means. 40 per cent of the parents did not contact us again.
Research Notes
31 1
DISCUSSION The main aim of the survey was to obtain information about the characteristics of pre-school mentally handicapped children with the secondary aim of establishing parents’ willingness to take part in an involvement project. Although we realise that the latter finding could have limited generalisation, especially as the parent’s willingness may well vary according to the nature of the project proposed, it was encouraging to find that the majority of parents were willing to be involved in a project based at the university which could involve them in a great deal of travelling. Undoubtedly, this willingness is a reflection of the parent’s concern about their child‘s development. Interestingly, their major concerns were not with ‘ practical ’ issues such as toileting and feeding, where perhaps parents felt they could cope, but rather it was with speech and language or dealing with management problems. These are topics on which parents seldom receive guidance. In many ways the children in this sample were multiply handicapped rather than inentally handicapped. They weie retarded in all aspects of development ; physical skills, social skills, language and play. Only a minority of children had attained the skills which a normal child usually develops by age two years. Furthermore, many of the children had additional handicaps such as epilepsy or visual and hearing defects. The majority of these children require specialist help and attention if their development is to be advanced. Yet there can never be sufficient professional resources available to give the sustained, one-to-one contact over prolonged periods of time that is necessary to further the development of handicapped children. It would seem logical, therefore, to give the parents more expertise, making them more effective in furthering their child’s development.. They are already the primary influence on their child’s development especially during the early formative years and provide the iiecessary contact with the child that no professional could emulate. This would lead to a more active co-operation between parents and professionals. The survey findings also have implications for the education which is provided for these children. Already the majority of children in this survey were attending an ESNS school and the proportion will undoubtedly increase. As many local authorities and teachers have recognised, the content and method of‘ nursery education ’ provided in ESNS schools has to be different from that provided for normal children. Its curriculum has to cover such basic skills as walking, self-feeding and toilet training. It would also be insufficient simply to provide the children with the opportunity to play, or with an enriched language environment, when the children lack the necessary skills to make use of the opportunity. Often these children need to be taught to play or given specific help in acquiring language skills, albeit within the context of an enriched environment. Perhaps the most urgent need at present is the development of teaching schemes which teachers and parents can use to further the child’s development (see Jeffree and McConkey, 1974). By itself, obtaining information about the needs of parents and children is a small step : meeting these needs is the major challenge. AcKNowLEmMEms-We would like to thank Susan McTear and Simon Hewson for all their help in carrying out this survey. This resaich was financed by a DHSS/DES grant (ref. J/C 370/61) held by the authors. REFERENCES JEFFREE, D. M., and MCCONKEY, R. (1974). Extending language through play. Special
Education : ForwardTrendr, 1, 3 , 13-16. KUSHLICK, A.. and Cox, G. R. (1970). Planning Services for the Subnormal in Wessex. Department of Health and Social Security, Statistical Report, Series No. 8. HMSO. MITTLER, P. (1974). Parental involvement in the education of the handicapped. Teaching and Training, 12,7484. RZARD, J., and GRAD, J. C . (1961). The Mentally HandicappedandTheir Families. London :
Oxford University Press.
(Manuscriptreceived 10th February, 1975)
PRE-SCHOOL MENTALLY HANDICAPPED CHILDREN
BY R. McCONKEY AND DOROTHY M. JEFFREE (Hester Adrian Research Centre, University of Manchester) SUMMARY. Information was collected on 150 mentally handicapped children who were under 5. Many of the children had additional handicaps and all showed marked retardation in their physical, social, play and language development. The majority of parents expressed a willingness to take part in a parental involvement project. Their main concerns were with the child’s speech and language development and in coping with management problems. The implications of these findings for services provided for these parents and children is discussed. INTRODUCTION Although there have been many surveys involving the mentally handicapped and their families, these have tended to concentrate on school-age children or adults, and have been primarily concerned with the family and home situation (e.g., Tizard and Grad, 1961 ; Kushlick and Cox, 1970). Consequently there is very little information on the characteristics of the ‘pre-school’ mentally handicapped child, under 5 years old. Yet this information is very necessary for the planning of services to help these children and their parents. Already some authorities are taking children into ESNS schools prior to their fifth birthday and there is also an increasing interest in involving parents in helping their child’s development during the early, formative years of life (Mittler, 1974). As the development of parental involvement schemes is of particular concern to us, we decided to carry out a survey which concentrated on the characteristics of the pre-school child, with the secondary aim of establishing the parent’s willingness to take part in an involvement project. METHOD The Education Departments of the 10 authorities in the Greater Manchester Council were asked to supply the names of all children within their area who were officially classified as ESNS and who would be under 5 on October Ist, 1974. We were given 178 names which produces an incidence rate of 0.77 per 1,OOO. This is lower than the figure of 0.91 reported for Salford in 1961, but higher than that for Wessex (0.53-Kushlick and Cox, 1970). On the advice of the authority, six of the parents were not followed up because of unusual circumstances affecting the child. A further two parents were excluded as they subsequently moved out of the GMC area. An introductory letter describing the project was then sent to 170 parents. Fourteen parents did not reply to this letter (even though a pre-paid card was enclosed) and one parent indicated she did not want to take part in the project. A further five parents expressed an initial interest in the project but they did not reply to further correspondence. The remaining 150 parents either were visited by a member of the project team (141) or completed the questionnaire by post (9) (87 per cent response). RESULTS Children’s Characteristics. The ages of the children ranged from 19 to 60 months, 50 per cent were 4 years old ; 34 per cent were 3 years old and 16 per cent were 2 years or less. If one assumes that the number of children born in any one year is relatively constant, then these figures suggest that chddren are not officially classified as ESNS until their third birthday or later. (This makes it difficult to calculate accurate rates in the age range
307
Research Notes 0-4 and to assess demand for services). As usual, boys outnumbered the girls ; 63 per cent and 37 per cent, respectively. Aetiology : This was unknown in 28 per cent of the cases. The principal aetiologies reported are given in Table 1 along with their frequency of occurrence.
TABLE 1 FREQUENCYOF OCCURRENCE OF Amomm,
Down’sSyndrome ........ Cerebral Palsy ............ Unspecified Brain Damage . . Birth Iqjury ..............
Additional Handicaps : 13 per cent of the children were presently experiencing epileptic fits (9 per cent were having grand-mal fits), but in all 20 per cent of the children were on medications to control epileptic fits. 27 per cent of the children had some form of physical handicap. In 11 per cent of the children this was a deformity or malfunctioning of the legs and in a further 10 per cent both the arms and legs were affected. 33 per cent of the children were reported as having difficulty in seeing. This ranged from short-sightedness to total blindness (although precise indications of loss of vision were rarely known). 9 per cent of the children had a squint. With the vast majority of children hearing tests of some description had been carried out and 9 per cent were reported as having difficulty in hearing, but the extent of hearing loss was often unknown. Stages of development : In order to provide a framework for describing the child’s abilities (and disabilities) we prepared development charts covering five main areas of development ; the development of physical skills, eye-hand skills, social skills, language and play. The items included in the charts covered the skills which children normally acquire during their first five years of life, although they concentrated mainly on the fist two years. Certain ‘ target ’ skills were emphasised in the charts (e.g., ‘ walks confidently ’ ; ‘feeds self with a spoon’) but the skills which precede these in development were also listed. Hence, we could ascertain from the parents whether the children had attained the target skills or, if not, the level of development they had reached. (Copies of the charts are available from the authors.) In order to summarise the results, only some of the skills within each area of development will be reported. The majority of the skills listed are normally attained by children at 24 months or, in a few cases, marked with an asterisk in the table, at 36 months.
In Table 2 the skills are given in developmental order with the most advanced skill first and the earliest skills last. In order to emphasise the children’s retarded development, we have shown the percentage of children not capable of each skill. (The percentage of children who have attained the skills can, of course, be calculated by subtracting from 100.) The results are presented separately for the Cyear-olds and those who were aged 3 or under, so as to reflect the on-going development of the children. (There were 75 children in each grouping). School Placement : 65 per cent of the Cyear-olds and 48 per cent of the younger children were attending an ESNS school, while a further 17 per cent and 16 per cent, respectively, went to a day-care nursery, a nursery school on a part-time basis or a local playgroup. 18 per cent of the 4-year-olds and 36 per cent of the younger children were at home all day.
Research Notes
309
TABLE 2 PERCENTAGE OF CHILDREN NOT CAPABLE OF EACHSKILL. PERCENTAGE CHILDREN NOTCAPABLE 3 years 4 years and under
SKlLLS
1
.
PHYSICAL SKILLS (a) Mobility Goes up and down stairs in an upright position ............ Gets up and down stairs but not upright .................. Walksconfidently .................................... Can get up off the floor unaided and stand ................ Walks with help from an adult .......................... Can get around room by crawling or some other means . . Sits alone on the floor .................................. Holds head steady when sitting on your knee .............. (b) Eye-Hand Skills *Draws a man on request showing legs and head .......... Can scribble in circles and straight lines .................. Will use a pencil to scribble a little ........................ Picks up small objects (e.g., small pieces of string between fingers and tip of thumb) ................................ Reaches out and picks up small objects straightaway ........ Watches or follows a dangling toy moved in front of face ....
. .
2 . SOCIALSKILLS (a) Feeding Feeds self with SDOOD. . . only . occasional sDillinn ~- .............. Manages a cup well .................................... Feeds self with fingers .................................. Takes solids well ...................................... (h) Toileting *Toilet-trained with infrequent accidents .................. Bowel control complete ................................ Will use potty (or toilet) when put on it .................... Shows some regularity of bladder and bowel motions ...... (c) Dressing *Removes and puts on simple articles of clothing, e.g., vests and pants ............................................ Helps actively to dress and undress (e.g., pulls pants down) . Can take shoes and socks off ............................ Co-operates in dressing-holds out arm or foot ............
.
3 . PLAY Engages in make-believe play. e.g., putting doll to bed .......... Will join in play with one other person-; chasing or kicking a ball Will hug or kiss a doll or teddy bear .......................... Co-operates in games of clap hands and pat.a-cake .............. Enjoys peek-a-boo ........................................
4
.
LANGUAGE SKILLS (a) Spoken Language Put two words together. e.g., milk gone. bye-bye shoe ...... Uses 20 clear words .................................... Talk is mostly jargon with some words clear ................ Uses 4 to 5 clear words .................................. Babbles constantly with one clear word .................... Has two or more soundswhich he repeats .................. ( b ) Imitation of Language Imitates one word ...................................... Imitates playful sounds-smacking lips .................... Imitates own sounds. ba.ba. ma-ma Makes noises when talked to
...................... ............................
80
61 51 39 29 24 23 9
60
40
28
15 11 7 5 3
99 60 42
96 43 24
39 22 5
20 7 3
64 45 37 13
41 27 16 8
92 69 45
68 54 37 31
71 ._
64 _.
44
52 35 23
32 24
17
70 42 43 27 12
53 35 39 23 12
85 77 50
32 27 12
60 55 41 36 27 9
60 40 32 20
48 32 23 22
Research Notes
3 10 TABLE 2--continued.
PERCENTAGE CHILDREN NOT CAPABLE 3 years 4 years and under
SKILLS
4. LANGUAGE Smu-continued. (c) Understandingof Lmguage Identifies at least seven pictures of common objects. . . . . . . . . . Points to familiar person or toys on request. ............... Will obey simple request. e.g., give ball to mummy. . . . . . . . . . Comprehends simple commands if you use gestures, e.g.. wave bye-bye .......................................... Responds to own name ................................
72 51
41
49
29
23
17 II
53
8
f i e Family. 97 per cent of the children were living with their parents, 1 per cent were with a relative and 2 per cent were with foster parents. 9 per cent of the children were the only child in the family ; 22 per cent were the first-born in the family and 52 per cent the last born. 17 per cent had one sibling still living at home, 31 per cent had two siblings ; 11 per cent had three siblings and 16 per cent had four or more siblings at home. An estimate was made of the mother's age : 6 per cent were rated under 25 ; 43 per cent as between 25 and 35 ; and 51 per cent as over 35 years. Parents' concerns : The parents were asked if they had had any particular problem with their child or if there was anything that concerned them now on which they would like guidance or help. 18 per cent of parents said that they had no problems or concerns. Of the remaining parents, 39 per cent mentioned one area of concern ; 27 per cent two areas of concern and 16 per cent three or more areas of concern. A wide diversity of problems and concerns were expressed by the parents but for convenience we have grouped them into four areas and given examples of specific concerns mentioned. This is given separately for the two age groups of children as the type of problem varied with the age of the child. Parents with a younger child were more concerned about physical skills than parents of 4-year-olds, who were much more concerned with management problems. However, speech (and/or language) was the biggest single concern of all parents (seeTable 3). TABLE 3 TEEPERCENTAGE OF PARENTS REPORTING EACHAREAOF CONCERN. Area of Concern
Percentage of Parents
Specific Examples
3Yand under Physical Skills . . . . . . . . . . Social Skills ............ Communication . . . . . . . . Management Problem
....
Walking Sitting Toilet training Feeding self Speech
language Screaming Temper Tantrums Defiance Aggression to others
24
I I
I I
'
I
I
4-
I
I!
15
I
j 27 41 25
25
I
1
41
I
48
I
I
The Involvement Project : 42 per cent of the parents were willing to come regularly
to the University to take part in the project while a further 18 per cent wanted to keep
in touch through booklets and similar means. 40 per cent of the parents did not contact us again.
Research Notes
31 1
DISCUSSION The main aim of the survey was to obtain information about the characteristics of pre-school mentally handicapped children with the secondary aim of establishing parents’ willingness to take part in an involvement project. Although we realise that the latter finding could have limited generalisation, especially as the parent’s willingness may well vary according to the nature of the project proposed, it was encouraging to find that the majority of parents were willing to be involved in a project based at the university which could involve them in a great deal of travelling. Undoubtedly, this willingness is a reflection of the parent’s concern about their child‘s development. Interestingly, their major concerns were not with ‘ practical ’ issues such as toileting and feeding, where perhaps parents felt they could cope, but rather it was with speech and language or dealing with management problems. These are topics on which parents seldom receive guidance. In many ways the children in this sample were multiply handicapped rather than inentally handicapped. They weie retarded in all aspects of development ; physical skills, social skills, language and play. Only a minority of children had attained the skills which a normal child usually develops by age two years. Furthermore, many of the children had additional handicaps such as epilepsy or visual and hearing defects. The majority of these children require specialist help and attention if their development is to be advanced. Yet there can never be sufficient professional resources available to give the sustained, one-to-one contact over prolonged periods of time that is necessary to further the development of handicapped children. It would seem logical, therefore, to give the parents more expertise, making them more effective in furthering their child’s development.. They are already the primary influence on their child’s development especially during the early formative years and provide the iiecessary contact with the child that no professional could emulate. This would lead to a more active co-operation between parents and professionals. The survey findings also have implications for the education which is provided for these children. Already the majority of children in this survey were attending an ESNS school and the proportion will undoubtedly increase. As many local authorities and teachers have recognised, the content and method of‘ nursery education ’ provided in ESNS schools has to be different from that provided for normal children. Its curriculum has to cover such basic skills as walking, self-feeding and toilet training. It would also be insufficient simply to provide the children with the opportunity to play, or with an enriched language environment, when the children lack the necessary skills to make use of the opportunity. Often these children need to be taught to play or given specific help in acquiring language skills, albeit within the context of an enriched environment. Perhaps the most urgent need at present is the development of teaching schemes which teachers and parents can use to further the child’s development (see Jeffree and McConkey, 1974). By itself, obtaining information about the needs of parents and children is a small step : meeting these needs is the major challenge. AcKNowLEmMEms-We would like to thank Susan McTear and Simon Hewson for all their help in carrying out this survey. This resaich was financed by a DHSS/DES grant (ref. J/C 370/61) held by the authors. REFERENCES JEFFREE, D. M., and MCCONKEY, R. (1974). Extending language through play. Special
Education : ForwardTrendr, 1, 3 , 13-16. KUSHLICK, A.. and Cox, G. R. (1970). Planning Services for the Subnormal in Wessex. Department of Health and Social Security, Statistical Report, Series No. 8. HMSO. MITTLER, P. (1974). Parental involvement in the education of the handicapped. Teaching and Training, 12,7484. RZARD, J., and GRAD, J. C . (1961). The Mentally HandicappedandTheir Families. London :
Oxford University Press.
(Manuscriptreceived 10th February, 1975)
