Can Iq Be Cultured? - Learning/intellectual Disability (mental Handicap)

Can IQ be Cultured? Learning/Intellectual Disability (Mental Handicap) Alan Challoner MA MChS Research in this area has been going on for many years and thus the description of the disability has changed with time. In order to avoid confusion and so as to steer clear of using descriptions that were not used by the authors cited, I have kept the old descriptions except where it has been possible to use a later one. In those cases it seems sensible to use the current one — intellectual disability. The term general learning disability has now been recommended in the UK to replace terms such as mental handicap or mental retardation but it is referred to increasingly as intellectual disability. A child with a general intellectual disability finds it more difficult to learn, understand and do things compared to other children of the same age. The degree of disability can vary greatly. General learning disability must be differentiated from specific learning difficulty (e.g. dyslexia) which means that the person has one difficulty such as in reading, writing or understanding, but has no problem with learning in other areas. CLASSIFICATION

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Mild learning disability: IQ 50-70, approximately 85% of cases; most can lead normal lives except may need assistance in handling difficult situations.

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Moderate: IQ 35-49, approximately 10% cases; use simple language when talking but understand speech better. Patient can generally attend to the basic tasks of life after training but more complex activities such as using money usually require support within a special residential environment.

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Severe: IQ 20-34, approximately 3-4% cases: many able to look after themselves with careful supervision.

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Profound: IQ less than 20, approximately 1-2% cases: development level of one year old baby across a range of parameters and so require intensive help and supervision in all activities.

EPIDEMIOLOGY

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Learning disability is common, affecting 1-2.5% of the general population in the Western world. 1 .

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The number of people with intellectual disabilities increased by 53% over the 35 year period from 1960 to 1995 (as a result of improved socioeconomic conditions, intensive neonatal care and increasing survival). 2

Psychometric tests which produce an intelligence quotient (IQ) are constructed such that, theoretically, the population mean IQ is 100, with a standard deviation of 15 1

Gillberg C, Soderstrom H; Learning disability. Lancet. 2003 Sep 6;362(9386):811-21.

2

Cooper SA, Melville C, Morrison J; People with intellectual disabilities. BMJ. 2004 Aug 21;329(7463):414-5.

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(Weschler, 1992). The expected population mean of both verbal (VIQ) and performance (PIQ) sub-tests is also 100, hence the expected discrepancy between sub-tests in a large enough, normal, population is zero. Whereas an individual discrepancy of 9 ( p < 0.05 ) to 12 ( p < 0.01 ) is statistically significant, an individual discrepancy is not usually considered clinically significant unless it is greater than 15 (Weschler, 1981; Kaufman, 1990). In putting dividing lines between the levels of learning disability at a notional level of IQ 50, it should be stressed that this is essentially an administrative guidance tool. Throughout the whole range of intellectual ability many intellectually disabled people will have 'islets' of substantial ability, but other areas may well be very low. The groupings therefore will be seen as artificial, and because in reality those who care for such persons will make assessments at an individual level, there may be good cause to phase out the system of IQ assessments as a means of labelling people. If such assessments have a place they ought to be used as a means of gaining a better understanding of the individuals' needs in terms of an educational curriculum and social welfare. It is accepted now, as described by Howells 3 that environmental problems can slow the development of the young child, and premature birth, difficult delivery and low Apgar scores compound the problem. Similarly a child who is deprived of learning opportunities will not develop to its full potential. Inadequate parenting resulting from separation from the mother, either physically or emotionally, may also give rise to handicap. Clarke and Clarke (1987) undertook a selective review of research on mental handicap, which looked at the period 1957-1987.4 From this it became evident that although many types of severe mental handicap were decreasing in prevalence, Down's syndrome was increasing enough to make overall numbers of cases stable. Some further research from Sweden indicated a reduction in the number of cases of mild mental handicap which was seen as a reflection of the genuine secular trend for higher intelligence arising from a highly developed social environment and a social welfare state which was effective in tackling social disadvantage. Clarke & Clarke [idem] mention work done by Richardson & Koller (1985) from which it was possible to establish both the true and the administrative prevalence of psychometric retardation in childhood. Epidemiology can be a powerful tool in this field, and according to Clarke & Clarke, Fryers (1984)5 gives an excellent account of the complex dynamics of prevalence, involving among other factors, incidence, mortality and migration. It is accepted, sociologically, that poverty and its sequelae create a greater prevalence of handicap in its midst than does affluence. Therefore prime consideration should be given to research and practice that affects the early experiences of handicapped infants, so that as much progress as possible can be made towards developing their social and intellectual competence. If we accept intellectual disability as a reason to delay or omit the development of these competencies, then we deny the needs of those children, and thereby exacerbate the conditions which will set them apart from others.

3

Howells, Gwyn. 'The child with mental handicap'. In Howells, G. (ed) Primary care for people with a mental handicap. RCGP, Nov. 1990.

4

Clarke, A. D. B. and Clarke, A. M. 'Research on Mental Handicap, 1957-1987: a selective review'. Journal of Mental Def. Research, 1987, Vol. 31, pps.317-328.

5

Fryers, T. The Epidemiology of Severe Intellectual Impairment. 1984; Academic Press, London.

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In recent years anthropolological concepts have been used to study the links between poverty, ethnology, families and intellectual disability, as well as the nature of intelligence and adaptation. Societies have developed accepted norms of appearance and behaviour, and beyond these, individual cultural societies will accept or reject divergences according to the tolerances that they perceive as normal. Within these there will be sub-cultures which will develop their own levels of appearance and behaviour (peer group approximation). There is a need to focus on the meaning of culture and how it relates to the sense in which it is used here. It hardly needs to be emphasized how much human behaviour is affected by different cultural backgrounds. Culture is not passed on directly through the genes, it has to be acquired by experience through contact and communication. It is however partly to do with inherited instincts, and partly with the development of a social identity. Generally this allows people from a variety of backgrounds to do things together. These are consolidated into millions of tasks and transactions which fall into practical patterns and spontaneous ritualizations which can be shared by all who are able to fit into the pattern. However where a cultural development has been interfered with, and an individual has been brought up in special circumstances, then the mould is broken and a person who is 'different' emerges. This is most marked in people who have been institutionalized (particularly if from an early age), but also in those who have been otherwise segregated, and over-protected. Thus they are often seen to exhibit behaviour which marks them out as being of a 'cultural divergence'. This then brings about a certain ambiguity; for those who are affected by this cultural divergence live in a handicapped world, whilst those who are endowed with a normal existence have their experience in another. Their lives; as family, carers, nurses, etc., are part of the more general and accepted social culture. Whilst those who suffer this cultural divergence are segregated, by whatever means, they are not faced with the problems of this cultural conflict. When they are placed elsewhere for purposes of rehabilitation, or naturally move into the world outside of their family, then they face varying degrees of difficulty, as do the more normal people who are then around them, because of the differences which are exhibited. This cultural ambiguity is not necessarily completory, but its transition to a more acceptable state depends upon the divergent cultures adapting each to the other, and if possible for them to reach an acceptable coalescence. Edgerton 6 reminds us that: "...the heterogeneous nature of the population officially designated 'mentally retarded' is seldom fully comprehended. Every conceivable kind and degree of cognitive impairment occurs amongst these people. Some mentally retarded persons are so profoundly retarded that they have no speech, no testable IQ, and must live vegetative lives under medical supervision; others are so mildly retarded that they appear to have normal intelligence until they are required to read or to perform mathematical calculations." [op cit, p.28]

He argues that it is no longer disputed in social science that the IQ test performance is largely a function of cultural experience; and that poor adaptive behaviour is based on cultural judgement and sub-cultural values. He believes that when these judgements and values are applied to any but the most severely retarded people, they are as purely cultural as any diagnostic criterion could be. Carl Bereiter7 relates how the intelligence test was originated by Alfred Binet, who had been asked by the French education authorities to devise a system for identifying children who were considered inappropriate for regular education facilities in French schools. He goes on to suggest 6

Edgerton, Robert, B. 'Anthropology and Mental Retardation: Research Approaches and Opportunities'. Culture, Medicine and Psychiatry. 1984. 8: p.28.

7

Bereiter, Carl. Genetics and Educability. In Block, NJ; and Dworkin, G. (Eds.) The IQ Controversy. Pantheon, New York, 1976. [p. 383]

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that if a different system had been established we might now have a different concept of intelligence. The relationship between socio-cultural mental handicap (i.e. where their is no organic cause) and poverty has been made clear by, amongst others, Hurley8. Also Ramey et al 9 have shown that it is possible to identify children who will need special educational services (in USA) before or during grade school, solely by information available on birth certificates, mother's race and education, the month pre-natal care began, survival of other siblings, and the child's legitimacy. Children most at risk were male, black, and born illegitimately to mothers of little formal education. Of course there are many other factors that may be involved, such as: birth injuries, maternal infections, toxins, poor nutrition, injury and disease. Some of these may also occur to children born of mothers who are in a higher cultural or social class, but Tarjan10 has estimated that a child born in the urban areas of the USA is fifteen times more likely to be diagnosed mentally retarded than is a child born to middle-class suburban parents. It is known that mothers of handicapped pre-school children show significantly more psychiatric morbidity than mothers of healthy pre-school children11. Success or failure in establishing the child in society may depend more on the relationships between the child and its parents than on any other factor.[Howells 1990, op cit] The early responses of the normal infant, help to 'release' appropriate responses from the mother. By such abilities as sucking, rooting, grasping, turning his head when his cheek is stroked, by eye to eye contact and a social smile he is able to teach his mother how to respond to his needs. Not only may a handicapped child be unable to do this but his very existence may produce in the mother feelings of grief, shame, disgust, rage and disbelief. These feelings may, if not understood and dealt with, lead to long-term rejection of the child and further decrease the ability of the mother to meet his needs. Tinbergen12 tells us: "Shortly after the Second World War, Bowlby (1951, 1969) traced back certain disturbances of social behaviour to disruptions of the early phases of affiliation, of bonding between mother and child. Bowlby saw straightforward deprivation of the presence of the mother during longer or shorter periods as the primary cause of a failure in children; first to form personal bonds with the mother, and subsequently of social bonding of any kind. He argued that socialization comes about by a widening of the circle of friends which is only possible if the first personal bond is successfully established."

Research has shown13 that the communicative competence of adults with a mental handicap and who were living in hospital was less than that of those who lived in community settings. Van Der Gaag points to various research projects that have taken place and which, firstly have underlined that adults with a mental handicap can no 8

Hurley, R L. Poverty and Mental Retardation: A causal relationship. Vintage Press, New York, 1969.

9

Ramey, C T; Stedman, D J; Borders-Patterson, A; Mengel, W. 'Predicting school failure from information available at birth'. Am. Jnl. Ment. Def. 1978, 82: 525-534

10

Tarjan, G. 'Some thoughts on socio-cultural retardation'. In Haywood, H C (ed.) SocialCultural Aspects of Mental Retardation. Appleton-Century Crofts, New York, 1970, pps. 745-758

11

Romans-Clarkson, S; Clarkson, E; Dittmer, I D; et al. Impact of a handicapped child on mental health of parents. British Medical Journal, 1986, 293: 1395-1397.

12

Tinbergen, N; Functional ethology and the human sciences. In Halsey, A H. (Ed.) Heredity & Environment. Methuen, 1977; [pps.79-80]

13

Van Der Gaag, A, D. The view from Walter's window: social environment and the communicative competence of adults with a mental handicap. Jnl. Ment. Def. Res. 1989; 33: 221-227.

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longer be seen as 'children who have never grown up', and secondly, show that the science of language in context, or pragmatics, has brought together experts from differing disciplines, who have drawn attention to the communicative competence of adults with a mental handicap. Price Williams & Sabsay14 have divided 'communicative competence' into two parts; pragmatic and linguistic. They have defined pragmatic competence as the ability to use language; and linguistic competence as the ability to produce and interpret syntactically and phonologically, well-formed sentences. It was further suggested by them that the latter had received far more attention than the former. As a consequence of this there has been an oversimplification of the 'communicative competence' of adults. This view is confirmed by Calculator and Bedrosian15, who are critical of the use of 'child standard tests' with adults because they concentrate on linguistic comparisons which reveal nothing about pragmatic competence. Bedrosian and Prutting16 found that the adults in their study could take part in a conversation and utilize the same types of controversial controls and constraints as adults who had no mental handicaps, despite the apparent differences in linguistic competence. Studies of this sort indicate that adults with a mental handicap are more able to give information than their formal linguistic abilities would suggest. [Van Der Gaag, op cit] Guyette17 describes the 'communication environment', by which is meant the actual demands that are placed on the individual and the opportunities they are given to communicate. This communication environment is created by those who are involved in caring for the individual person. If they do not establish an adequate communication environment then the appropriateness of that environment will be reduced. The degree to which this environment is established will inevitably affect the communicative competence of the individual person. Patients on wards in hospitals for the mentally handicapped, and others who were segregated into groups of a similar disability, did not have the same opportunities to develop communicative competence. Other studies show how the expectations of non-handicapped individuals can have an important influence on the communication skills that the handicapped person actually uses. This point is well illustrated in the novel by Cook 18; 'Walter was aware that he should be doing something, but did not know what, and rather than do something wrong...he thought it wiser to do nothing'. [p.165] It would seem therefore that this communication environment is related to the communicative competence of adults with a intellectual disability. Van Der Gaag [op cit] shows, by comparing two similar groups that were differentiated only by their living environment, that those who lived in the community achieved higher scores on pragmatic competence, than did those who resided in hospital. These findings were not precise or clear cut, and he reports some overlapping between the two groups which led him to believe that there were also other environmental factors which will influence the person's communicative response, e.g. learning, health, and emotional environments. He believes that the differences were partly related to the levels of linguistic competence, and that this together with the communication environment will affect 14

Price Williams, D; & Sabsay, S. Communicative competence among severely retarded persons. Semiotica; 1979, 26: 35-63.

15

Calculator, S N; & Bedrosian, J L. Communication Assessment and Intervention for Adults with Mental Retardation. 1988; Taylor & Francis, London.

16

Bedrosian, J L; & Prutting, C A. Communicative performance of mentally retarded adults in four conversational settings. Jnl. Speech Hearing Res. 1976; 21: 79-95.

17

Guyette, T W. 'A discussion of the use of the environmental approach to developing communication intervention programmes with the mentally retarded'. 1978, unpublished ms: Univ. Kansas.

18

Cook, D. Walter. 1978; Penguin Books, London.

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pragmatic competence. It is vital therefore that there should be the provision of appropriate settings of demand, expectation and opportunity for each individual. Often the lack of appropriate levels of this demand in the hospital setting was a variable factor in the limitation of attainment of language skills. That said, the problem with poor communication environment is not restricted to those who are severely intellectually disabled, nor to those who were in mental handicap hospitals. Most of the one million people who are assessed as being moderately intellectually disabled, will be resident in the community, never having been in hospital, and probably not having spent very much time outside the immediate family circle. Indeed their very handicap might well be centred on lack of communication. Learning is a continuous experience, and with very young children this will usually be on an entirely informal basis. Right from the moment of birth, the more fortunate children will be parented in an atmosphere of communication. Both mother and father will spend time talking to their infant, and even if at that stage it does not understand the words, it will slowly be absorbing the sounds, the tone of voice and the associated expressions on the face of the speaker. 'Communication' from the Latin communicare is closely related to communitas, which means not only community, but also fellowship and justice in men's dealings with one another. Society is based on the possibility of people working together for common ends, in a word, co-operation. Without proper communication, co-operation may well be reduced. Equally, without proper communication between parents, siblings and the new infant, there will be a lack of learning, an absence of shared knowledge, information and experience. This will in turn lead to a deficient personality; for delays in learning may never subsequently be made up, and this will reduce the quality of personhood in the individual. Where this has happened, consideration needs to be given to the realisation of some equality by artificial means. It is unlikely that help will be at hand in the family in which this situation has developed. Therefore some form of personal advocacy will be necessary to assist the handicapped person forward, and to allow that person to take an appropriate place in society without the developmental deficiencies reducing the quality of life below an acceptable level. This should be judged by the individual, if possible; or by those closest to that person, again if possible and appropriate. Failing those possibilities then it will need to be assessed by society at large, though this will probably be undertaken by those who have a statutory responsibility for that person if there is no one closer. To the extent that good communication skills are not allowed to develop, then there will also be enormous cultural divergencies between the handicapped person and his fellows. This will contribute markedly to the subsequent ambiguity and how that person fits into his local community, and his acceptance by it. These views may not be shared by the romantic nativists however.19 Their assertion that the infant is born with unspoken wisdom, an awareness and feelings which just simply need to be allowed to grow, may have to be questioned. Others who believe infants are endowed with problem-solving tendencies and rational awareness, have to vie with those who believe that infants have nothing but reflex powers of integration. The most recent research however has determined that children: 19

Note: Chomsky's arguments that natural human languages are based on a common 'deep structure', which is inherited, is at variance with Piaget who subscribes to 'a model of development through active adaptation' which underlines the importance of the person's actual life experiences.

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"...refine their reactions to particular events and formulate specialized skills within a coherent general ability to perceive...and are born with several complementary forms of knowing, and they use these to develop experience of the particular world they are in, assisted by communicating." 20

The epigenesis of identity has an importance for everyone, the intellectually disabled person included. In a particularly telling chapter of his book on Identity, Erikson 21 presents human growth from the point of view of the conflicts, inner and outer, which the vital (healthy) personality weathers. In speaking of this 'vital' personality he refers to the criteria presented by Marie Jahoda 22, according to which a healthy personality actively masters his environment, shows a certain unity of personality, and is able to perceive the world and himself correctly. In considering that all of these criteria are relative to a child's cognitive and social development, we may look upon childhood, by definition, as having an initial absence of such criteria, and of developing them in complex steps of increasing differentiation. This epigenetic principle is derived from the growth of organisms in utero. It states that the growth of living organisms follows a pattern or plan. As this plan proceeds and unfolds there arises individual parts which eventually will form the functioning whole. The ascendance of these parts also has a critical phase where there is a particular danger of defect. In addition to these, and following birth, the baby enters the system of his society and will proceed to develop his capacity to meet the opportunities of his culture. How well he succeeds in this will depend upon any genetic defect, damage that was sustained in utero or subsequent to birth; or to the effects of his environment and the nature of parental influences. There will be inner conflicts to be met and these idiosyncratic developments will determine how and in what manner the individual becomes a distinct personality. Epigenesis is governed by 'the proper rate and the proper sequence', but nevertheless varies from culture to culture. The child who is healthy, in Erikson's sense, and who is given appropriate guidance can be 'trusted' to obey the inner laws of development. These laws ensure a series of 'potentialities for significant interaction' with those who will parent him and the society which responds to him. So we have the force from within and the interaction from without, and these two will allow for the development of personality over a period of time. This time may often be contained mainly within the first seven years of life; or it may extend further in certain circumstances. What is worth considering is how these forces and interactions vary. Not only in normal, healthy children but in those who are handicapped or who have a potential for becoming handicapped. Erikson [op cit] writes of a paradox in which the child, having instinctual energy (the genetic endowment of developmental potential), is also vulnerable; and whilst this vulnerability is always present in some respects, the child is also completely oblivious and insensitive in others, and yet remains unbelievably persistent in the same respects in which he is vulnerable. If the child is to grow up 'normal' the family must reorient itself to accommodate his presence and they must grow together as a group. 'A family can bring up a baby only by being brought up by him. His growth consists of a series of challenges to them to serve his newly developing potentialities for social interaction.' [p.96]

20

Trevarthen, Colwyn. In Oxford Companion to the Mind. R L Gregory (ed), OUP, 1987. [p.363]

21

Erikson, E H. Identity; Youth and Crisis. 1974; Faber, 91-144.

22

Jahoda, Marie. 'Towards a Social Psychology of Mental Health; Symposium on the Healthy Personality', supplement II; Problems of Infancy and Childhood, Transaction of Fourth Conference, March 1950, MJE Benn (ed.), New York: Josiah Macy Fndtn. 1950.

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If however the baby's instinctive responsiveness is damaged in some way, or if his parental or societal environment is deficient, then this situation has the possibility of creating a damaged personality, which in itself may be the basis of a handicap, or at least contribute to causing the handicap to be visible because the child becomes socially unacceptable due to the differences from the norm that are exhibited by him. To pursue this development of identity I mention here the important division between the two basic types of intellectual disability. They are the genetic and the brain damaged who although distinct are usually severely handicapped; and the mildly handicapped who are in this state, largely, because of environmental factors that gain influence from familial low intelligence, poor maternal pre-conceptual care, and a lack of nurturing associated with a progressive lack of basic 'trust' [Erikson, op cit, p.102] or 'confidence' [Benedek, vide Erikson op cit, p.102]. According to Erikson, these latter, at a level of infantile experience, do not seem to depend on quantities of food or demonstrations of love, but rather on the quality of the maternal relationship. Erikson explains this as follows: "Parents must not only have certain ways of guiding by prohibition and permission, they must also be able to represent to the child a deep, almost somatic (heartfelt) conviction that there is a meaning in what they are doing. In this sense a(ny) traditional system of child care can be said to be a factor making for trust, even where certain items of that tradition, taken singly, may seem arbitrary or unnecessarily cruel - or lenient. Here much depends on whether such items are inflicted on the child by the parent in the firm traditional belief that this is the only way to do things or whether the parent misuses his administration of the baby and the child in order to work off anger, alleviate fear, or win an argument, either with the child himself or with somebody else..." [op cit, p.103]

In differentiating between these two divisions of intellectual disability, there will be, on the part of the severely handicapped person, a delay in reaching the goals of identity (some of which might never be reached); and on the part of the mildly handicapped a more natural progression, but one that is warped by deprivation of one sort or another. The landmarks in the formation of identity from birth, as outlined by Erikson [ibid], apart from aspects of physical growth, are: 1.

The expanding libidinal needs of the developing being and, with them, new possibilities of satisfaction, of frustration, and of sublimation.

2.

The widening social radius, i.e. the number and kinds of people to whom he can respond meaningfully on the basis of his ever more highly differentiated capacities.

3.

The developmental crisis evoked by the necessity to manage new encounters within a given time allowance.

4.

5. A new sense of estrangement awakened along with the awareness of new dependences and new familiarities (e.g., in early infancy, the sense of abandonment).

5.

A specifically new psycho-social strength (here a favourable ratio of trust over mistrust) which is a foundation for all future strengths. [pps.104-105]

He considers that the earliest and most undifferentiated 'sense of identity' arises out of the encounter of maternal person and small infant, an encounter which is one of mutual trustworthiness and mutual recognition. This, he says, is in all its infantile simplicity, the first experience of what later reoccurrences in love and admiration and can be called a sense of 'hallowed presence', the need for which remains basic in man. Its absence or impairment can dangerously limit the capacity to feel identical, when adolescent growth makes it incumbent on the person to abandon his childhood and to trust adulthood and, with it, the search for self-chosen loves and incentives.

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Deprivation of the maternal 'goodwill' in any or all of the above aspects will so compound the basic deficits of the infant that the degree of handicap can be intensified. This not only sets the child apart from his family, causing in some cases infantile depression and subsequent withdrawal, but begins the process of accentuating the difference that handicap imparts, and draws a greater gap between the individual and the society of which that person is part. Lomasky writes:

23

makes some interesting comments on the upbringing of children when he

"One who is thoroughly servile is not a project pursuer...For if the enterprise is such a total failure that the child is left attitudeless and valueless, and thus can only be moved to action by the projects of others, then the child has been severely harmed." [p.185]

If the environment is changed there is evidence that the force of such change can be beneficial as has been indicated in studies in France where children from deprived backgrounds, who were fostered or adopted at four to six years of age, and who had an initial IQ of 77, subsequently some five to 12 years later, were recorded as having IQs of over 100 in a quarter of the cases. 24 It is worth pointing out, in connection with persons who are mildly intellectually disabled - and for whom it might be said that they had spent some of their developing years in a deprived (in any sense) environment, that when it has been possible to improve their environment, there has often been a substantial improvement in IQ. In these circumstances it might also be said by some observers that variation in teaching methods might also have some effect on ability to comprehend, and therefore on IQ. My main concern here is not to denigrate families, teachers or society in general, but to look at possibilities whereby any person who has learning difficulties can be monitored, assessed and offered whatever services are required, to improve his chances of an increased potential in both educational and social skills. However where mild intellectual disability is exhibited by a person who suffers from no obvious environmental inadequacies, then there may be other factors that need attention. These may include a change in teaching methods, psychological assessment, and a check on any health problems. Intelligence skills are epigenetic, that is they are not innate, but develop in the course of time. Experience and developing cognitive abilities accrete, but are also affected by genetic factors, and the influence of adaptability to the environmental circumstances. Culture therefore plays an important part in the development (or lack of development) of intelligence. Separation from normal cultural standards may well influence the abilities of individuals to relate to others in that culture, and may therefore interfere with the epigenesis of intelligence. To complete even a small picture of these circumstances it is necessary to show the possibility expressed by such as Carl Bereiter who says: "...culture may not only influence the phenotypic expression of inherited traits but may also, through selection pressures, influence the distribution of genes within cultural groups, and that cultural differences may represent not only adaptations to environmental conditions but also to distributional genetic differences between groups, with the result that culture and heredity are intimately interconnected." [op cit, p.404] 23

Lomasky, Loren E. Persons, Rights and the Moral Community. OUP, New York, 1987.

24

Duyme, M. & Dunmaret, A. 'La Reversabilité de la Débilité Légère: une thérapeutique sans Thérapeute'. 1986, CNAMS-INSERM, Vol. 144, pp 553-62. [For a summary in English, see Clarke A M.; Clarke, A.D.B.; & Berg, J.M. (eds.) Mental Deficiency: the changing outlook. 1985, Methuen, London. pps.458-9.]

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He suggests (ibid) that findings on child-rearing antecedents of behaviour must be regarded as ambiguous, and that causal hypotheses must be more fully tested in order to ascertain if they have any credibility. In practice, at the coal-face so to speak, teachers are dealing with practical issues and these in the main are to do with environmental matters and teaching methods in the context of individuals. Thus efforts to improve situations for each child should concentrate in these areas rather than be overly concerned with genetic inheritance. Bereiter is concerned that the education of children is based on abilities to use abstract thought and verbal cognition. [ibid, p.385] Those who are unable to grasp these concepts are measured as failures by the IQ system, which is then seen as a selffulfilling prophecy. Those children who are unable to make progress in this type of an education system, and whose difficulties are categorized as being brought about by developmental delays or impairments, should not be considered uneducable (albeit that some classes may be unproductive of progress). Steps should be taken to establish what areas of learning are possible for these children, and under what circumstances. These should then be part of the curriculum for them, and this teaching should be located alongside that given to others in normal schools, if integrated classes are not possible. Education has a social content as well as an intellectual one. It is important that this is not denied to intellectually disabled children by using their lack of normal abilities as a reason to segregate them. Bereiter's approach has been, 'a matter of trying to locate the underlying sources of difficulty in grasping various concepts and operations, and then trying to devise ways to overcome them.' [ibid, p.386] He believes that educational systems should not place 'unnecessary thinking difficulties into the path of learning', which he sees as discriminatory. [ibid, p.388] However he does see the problems of this approach, and wonders if the lack of deep understanding may limit their ability to apply knowledge in new situations, which might damage their self-confidence. This is a challenge for those who are charged with the education and support of persons with an intellectual disability. Having established a policy of community care, it is the duty of all concerned to allow progress towards integration, which in turn demands appropriate support in areas of actual or potential fallibility. It is of course speculative to consider how changed circumstances and environmental conditions would affect the development of an individual. Some circumstances, however, are self-evidently the cause of low achievement, and it is important that these are at least discovered at an early stage, before the lack of intellectual development brings about potential (further) deprivation and possibly handicap. One such case that I came across personally some years ago related to a young boy from Hong Kong, who had followed his father to the UK with the rest of his family. He arrived here at about the age of five, not being able to speak English, not having an understanding of the British culture, and almost immediately was placed in a normal English-speaking school. Not surprisingly he soon became educationally 'lost'. Eventually, at about the age of 17 he arrived at an education centre for mentally handicapped young adults, and it soon became obvious to us that his lack of educational development was entirely due to his cultural difficulties which were compounded by his inadequacies in local language. It took several years for him to do the necessary catching up that allowed him to take his place in normal society.

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REFERENCES Bowlby, J. The nature of the child’s tie to his mother. Internat. Jnl. Psychoanal. 39; [pp., 350-373], 1951. Bowlby, J. Attachment and Loss. (Vol. 1); Attachment. Hogarth Press, 1969. Richardson, S.A; Koller, H.; Katz, M. Relationship of upbringing to later behaviour disturbance of mildly mentally retarded young people. Am. J. Ment. Def.; 90: [pp., 1-8.];1985.

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