Stephen A. Richardson

Epilepsy in Children with Mental Retardation: A Cohort Study

Summary: The cumulative risk of seizures and epilepsy was investigated in a prospectively identified cohort of 221 children with mental retardation (MR) born between 1951 and 1955 in Aberdeen, Scotland. By age 22 years, 33 (15%) had epilepsy. An additional 16 (7%) had had at least one seizure, but did not meet the criteria for epilepsy. The cumulative risk of epilepsy was 9, 11, 13, and 15% at 5, 10, 15, and 22 years, respectively. In children with MR and no associated disabilities, the cumulative risk of epilepsy was only 2.6, 3.2, 3.9, and 5.2% at 5, 10, 15, and 22 years. In children with MR and cerebral palsy (CP), the cumulative risk was 28, 31, and 38% at 5, 10, and 22 years. Children with a postnatal injury associated with MR had a cumulative risk of epilepsy of 53, 66, and 66% at 5, 10, and 15 years after the injury. By age 22 years, 39% had achieved 5‐year seizure‐free remission, including 56% of children with MR without associated disability, 47% of children with MR and CP, and 11% of children with a postnatal injury. We conclude that, in the absence of associated disability or postnatal injury, the risk of epilepsy in the retarded population is low. Epilepsy in this population also will frequently enter remission in later life.

Handicap, appearance and stigma☆

Abstract Values toward various types of physical appearance and handicap were studied using 21 pictures of a child in which everything was held constant except the forms of appearance and handicaps. Values were obtained through use of a preference ranking method. Subjects were 10–11 year old boys and girls living in London. From most to least liked, the general order of preference was a non handicapped white child, a non handicapped black child, facial disfigurement, use of wheelchair, crutches and leg braces, obesity and amputations. Use of prostheses with amputations increased their liking. Several sex differences in values were found.

Twenty-two years : causes and consequences of mental retardation

Preface Part I. Background A Research Opportunity Issues and Concepts Previous Research Setting, Design, and Methods Part II. Epidemiology Prevalence Clues to Etiology Part III. Individual Characteristics Stability and Change in IQ Behavior Disturbance Epilepsy Verbal Communication Patterns of Disability Appearance Self-Esteem Part IV. Histories Upbringing and Family Histories Paths through Mental Retardation Services Job Histories Activities outside Working Hours Fitting the Pieces Together Conclusion: Relevance of Research Findings for Today References Index

The Social Status of Handicapped and Nonhandicapped Boys in a Camp Setting

1This research was supported in part by Grant No. 14508 from the National Institutes of Mental Health and by grants from the Foundation for Child Development and The Easter Seal Research Foundation. Many studies of physically handicapped children suggest that they are disadvantaged in developing social relationships with peers. The evidence supporting this generalization comes from experimental studies of interpersonal relations, sociometric investigations and personal reports from disabled persons. Experimental studies have shown that the behavior of a

Seizures and epilepsy in a mentally retarded population over the first 22 years of life.

Abstract The paper examines seizure histories in a 5-year cohort, age 22, who had been classified as mentally retarded during the school years in a British city. Results are examined in relation to matched comparisons, a borderline mentally retarded group, and other studies. Twenty-seven percent of the mentally retarded experienced one or more seizures. Equivalent figures for the borderline and comparison groups are 11% and 4% respectively. Within the mentally retarded population, the more severely mentally retarded more often had seizures, had them earlier and over a longer time span than the mildly retarded. Seizures are described on a year-by-year basis using both longitudinal and cross-sectional views. Prevalence studies of epilepsy in mentally retarded populations are reviewed, and problems of definition and method are discussed.

The Influence of Severe Malnutrition in Infancy on the Intelligence of Children at School Age: An Ecological Perspective

The rationale for including a chapter on malnutrition in a book dealing with brain dysfunction is that severe malnutrition in infancy may cause central nervous system damage which leads to permanent intellectual impairment The insertion of the word “may” in the preceding sentence is necessary because widely different interpretations have been made of the results of malnutrition studies. Two summaries by reviewers illustrate these differences.

Physical growth of Jamaican school children who were severely malnourished before 2 years of age

A study is reported of physical growth of Jamaican schoolboys who had been admitted to hospital with severe malnutrition during infancy (index cases). Height, weight and head circumference of the index cases was compared with that of male siblings close in age (siblings), with unrelated classmates or neighbours matched for sex and age (comparisons) and with Jamaican or US growth standards. Index boys were significantly smaller in height and head circumference than comparisons and significantly smaller than sibs only in head circumference. Sibs were intermediate in stature to the index and comparison boys. When the boys were divided into three age groups there was evidence of complete catch-up in height and weight after 7 years of age, but catch-up was incomplete for head circumference in the oldest group. No significant differences in stature at follow-up of the index boys were found in relation to age when admitted to hospital.

Issues in the definition of mental retardation and the representativeness of studies.

The lack of a clear definition of mental retardation in many studies and the lack of a description of the methods used in selecting subjects make it difficult to determine to whom the results apply. A review of prevalence studies of MR in childhood shows that over the past 30 years there has been a trend of decreasing rates. Reasons are suggested to explain these falling prevalence rates. Adult prevalence rates were lower than childhood rates and reasons are suggested for this drop. Factors needing consideration in future studies are suggested.

The contributions of differing degrees of acute and chronic malnutrition to the intellectual development of Jamaican boys

The purpose of this paper is to determine whether differing degrees and types of malnutrition cause differing degrees of mental impairment. Subjects were 59 Jamaican boys hospitalized for malnutrition in infancy and whose intelligence was assessed at school age. The measure used for degree of chronic malnutrition was height for age and for acute malnutrition weight for height. The measure of intelligence was the I.Q. (WISC). Because the social environment in which a child lives influences his intellectual development, a measure of social background was used as an independent variable in addition to the nutrition measures. Social background showed a significant effect on I.Q. but neither measure of nutrition was significant. A further analysis using comparisons who had not been hospitalized for malnutrition suggests that malnutrition may contribute to mental impairment, through a threshold effect rather than acting as a continuous variable where increasing degrees of malnutrition cause increasing degrees of mental impairment.

Career paths through mental retardation services: an epidemiological perspective.

Children born during a five year period, resident in a British city, and administratively defined as mentally retarded were followed up at age 22. Age specific prevalence rates ranged from 2.5/1000 at age 5 to 14.7/1000 at age 11. The various mental retardation services for children and adults are described and the frequencies with which different paths through services were followed are given. Almost three-quarters of those who had been at a school for educable, mentally retarded children received no services in the young adult period. The distributions of various associated disabilities among those receiving different services after leaving school are given. These illustrate the multiple problems presented by those who continue to require services in adulthood. The epidemiologic data presented provide a basis for estimating service needs.