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[ATTACHED] Dr. Harold Stevenson

[ATTACHED] FOR RELEASE A.M. PAPERS

TUESDAY, OCTOBER 16, 1962

NOTICE: There should be no premature release of this report, nor should its contents be paraphrased, alluded to or hinted at in earlier stories.

Pierre Salinger

Press Secretary to the President

A Proposed Program for

National Action to Combat

Mental Retardation

The President’s Panel on Mental Retardation

October 1962

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THE PRESIDENT’S PANEL ON MENTAL RETARDATION

WASHINGTON 25, D.C.

October 16, 1962

Dear Mr. President:

I have the honor to submit herewith the Report of the President’s Panel on Mental Retardation. The panel was appointed by you on October 17, 1961, with the mandate to prepare on or before December 31, 1962, a “National Plan to Combat Mental Retardation.” We have devoted the intervening months to carrying out this assignment and have prepared for your consideration recommendations concerning research and manpower, treatment and care, education and preparation for employment, legal protection and development of federal, state and local programs.

The Panel gratefully acknowledges the cooperation of government officials and literally thousands of persons in every state who have responded enthusiastically to your leadership in bringing the needs of the retarded to the attention of the country. Members of the Panel appreciate the opportunity afforded them to be of service in this undertaking.

Respectfully yours,

[SIGNED] Leonard W. Mayo

Chairman

The President

The White House

Washington 25, D.C.

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PANEL MEMBERS

Mayo, Leonard W., S. Sc. D., (Chr.)

Tarjan, George, M.D., (V. Chr.)

Bazelon, David L., B.S.L.

Behrmann, Elmer H., Ed. D. (Msgr.)

Boggs, Elizabeth M., Ph.D.

Cooke, Robert E., M.D.

Cottrell, Leonard S., Jr., Ph. D.

Davens, Edward, M.D.

Dunn, Lloyd M., Ph. D.

Hellman, Louis M., M.D.

Hilleboe, Herman E., M.D.

Hobbs, Nicholas, Ph. D.

Hurder, William P., Ph. D., M.D.

Kety, Seymour S., M.D.

Lederberg, Joshua, Ph. D.

Lourie, Reginald S., M.D.

Lowry, Oliver H., Ph. D.

Magoun, Horace W., Ph. D.

Mase, Darrel J., Ph. D.

Power, F. Ray

Ritter, Anne M., Ph. D.

Stanley, Wendell M., Ph. D.

Stevenson, Harold W., Ph. D.

Tudor, Wallace W.

Viscardi, Henry, Jr., LL.D.

Willenberg, Ernest P., Ed. D.

Wright, Irene A.

CONSULTANT TO THE PANEL

Mrs. R. Sargent Shriver, Jr.

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PRESIDENT’S PANEL ON MENTAL RETARDATION

Leonard W. Mayo, S. Sc.D. (Hon.), Chairman

George Tarjan, M D., Vice-Chairman

David L. Bazelon, B S.L.

Elmer H. Behrmann, Ed. D (Msgr.)

Elizabeth M. Boggs, Ph. D.

Robert E. Cooke, M D.

Leonard S. Cottrell, Jr., Ph.D.

Edward Davens, M.D.

Lloyd M. Dunn, Ph.D.

Louis M. Hellman, M.D.

Herman E. Hilleboe, M.D.

Nicholas Hobbs, Ph.D.

William P. Hurder, Ph.D., M.D.

Seymour S. Kety, M.D.

Joshua Lederberg, Ph.D.

Reginal S. Lourie, M.D.

Oliver H. Lowry, Ph.D

Horace W Magoun, Ph.D.

Darre; J. Mase, Ph.D.

F. Ray Power

Anne M. Ritter, Ph.D.

Wendell M. Stanley, Ph.D.

Harold W. Stevenson, Ph.D.

Wallace W. Tudor

Henry Viscardi, Jr. LL.D.

Ernest P. Willenberg, Ed.D.

Irene A. Wright

Consultant to the Panel: Mrs. R. Sargent Shriver, Jr.

Staff Members

Rick Heber, Ph.D.

William I. Gardner, Ph.D.

Bertram S. Brown, M.D.

Betty J. Willis, M.B.A.

C. Anne Gibson, B.S.

Nancy B. Simpson, B.A.

Office Staff

Jean E. Bullion

Rita E. Dolan

Ruth G. Gray

Isadora W. Moore

Patricia A. Seldon

Keith M. Taylor

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TABLE OF CONTENTS

LETTER OF TRANSMITTAL

SECTION I. INTRODUCTION [PAGE] 1

SECTION II. RESEARCH [PAGE] 25

Federal Leadership in Research [PAGE] 29

Expansion of Research [PAGE] 31

Increased Statistical Information [PAGE] 39

Research on Learning Processes and Education [PAGE] 42

Scientific Communication [PAGE] 47

Manpower and Training [PAGE] 54

SECTION III. PREVENTION [PAGE] 65

Biological and Medical Preventive Measures [PAGE] 66

Preventive Measures to Correct Adverse Environmental Conditions [PAGE] 86

SECTION IV. CLINICAL AND SOCIAL SERVICES [PAGE] 103

A comprehensive Program for the Retarded “Continuum of Care” [PAGE] 104

Detection, Evaluation and Medical Care [PAGE] 109

Role of the Family [PAGE] 125

Cooperative Planning for the Mentally Retarded Child and Adult [PAGE] 129

Recreational Opportunities [PAGE] 136

Religion [PAGE] 139

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TABLE OF CONTENTS (Continued)

SECTION V. EDUCATION, VOCATIONAL REHABILITATION AND TRAINING [PAGE] 143

Education [PAGE] 144

Employment [PAGE] 166

Vocational Rehabilitation and Training [PAGE] 170

SECTION VI. RESIDENTIAL CARE [PAGE] 188

The Role of Residential Care [PAGE] 192

The Pattern of the Future [PAGE] 200

SECTION VII. THE LAW AND THE MENTALLY RETARDED [PAGE] 214

SECTION VIII. ORGANIZATION OF SERVICES—PLANNING AND COORDINATION [PAGE] 227

The Role of Coordination [PAGE] 227

Organization of State Services to the Mentally Retarded [PAGE] 231

Organization of Local and Area Services [PAGE] 234

The Federal Role in Comprehensive Planning for the Retarded [PAGE] 250

SECTION IX. PUBLIC AWARENESS [PAGE] 275

APPENDIX A. Statement by the President Regarding the Need for a National Plan in Mental Retardation, October 11, 1961 [PAGE] 287

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SECTION I

INTRODUCTION

The mentally retarded are children and adults who, as a result of inadequately developed intelligence, are significantly impaired in their ability to learn and to adapt to the demands of society. An estimated 3 percent of the population, or 5.4 million children and adults in the United States are afflicted, some severely, most only mildly. Assuming this rate of prevalence, an estimated 126,000 babies born each year will be regarded as mentally retarded at some time in their lives.

Significance of the Problem

Mental retardation ranks as a major national health, social, and economic problem:

  • It afflicts twice as many individuals as blindness, polio, cerebral palsy, and rheumatic heart disease, combined; only 4 significant disabling conditions—mental illness, cardiac disease, arthritis, and cancer—have a higher prevalence, but they tend to come late in life while mental retardation comes early.
  • About 400,000 of the persons affected are so retarded that they require constant care or supervision, or are severely

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limited in their ability to care for themselves and to engage in productive work; the remaining 5 million are individuals with mild disabilities.

  • Over 200,000 adults and children, largely from the severely and profound mental retarded groups, are cared for in residential institutions, mostly at public expense. States and localities spend $300 million a year in capital and operating expenses for their care. In addition they spend perhaps $250 million for special education, welfare, rehabilitation, and other benefits and services for retarded individuals outside of public institutions. In the current fiscal year, the Federal Government will obligate an estimated $178 million for the mentally retarded, about four-fifths for income maintenance payments and the rest for research, training and for special services. Federal funds for this group have increased by about 75percent in 5 years.
  • The Nation is denied several billion dollars of economic output because of the under-achievement, under-production and/or the complete incapability of the mentally retarded.
  • The untold human anguish and loss of happiness and well being which results from mental l retardation blights the families in the United States. An estimated 15 to 20 million people live in families in which there is a mentally retarded individual. Economic costs cannot compare with the misery and frustration and realization that one’s

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child will be incapable of living a normal life or fully contributing to the well being of himself and to society in later life.

The Impact of Mental Retardation on the Public

Mental retardation does not respect station in life or geography. It may strike the children of the rich or of the poor, in any part of the country. Yet there are extremely striking variations in its incidence by socio-economic groups and by geographic areas, which often mirror such differences. From the mounting body of research information on mental retardation, the following points stand out:

  • The more severe cases of mental retardation are likely to be associated with organic defects. However, in mild retardation, which affects the great bulk of the cases, specific physical or neurological defects are usually not diagnosable with present biomedical techniques.
  • The occurrence of severely retarded children tends to be spread more evenly throughout the population regardless of the socio-economic class of the family. The prevalence of children who are mildly retarded is heavily concentrated among the parents with poor education and low incomes.
  • Selective Service statistics reveal an extremely wide variation geographically in the prevalence of mental retardation. During World War II 716,000 or 4 percent, of the persons examined were rejected on grounds of mental deficiency. The percentage rejected for this cause ranged from only one-half

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of 1 percent in some States to nearly 14 percent in others. Regional rejection rates ranged from 1 percent in the Far West to nearly 10 percent in the Southeast. Nationwide, 7 individuals are rejected for mental retardation for every 10 turned down for mental disease.

  • The Selective Service statistics also show a much heavier prevalence of mental retardation among non-whites than in the rest of the population. Draft rejection rates because of mental deficiency were 6 times as high for non-whites as they were for whites. Of the total rejections of 716,000 for mental deficiency, 325,000 were non-whites. In both categories there were substantial regional variation [sic] in the rejection rates. Among the whites, the rejections in the Southwest were 6 times as high for this cause as in the Far West. Among non-whites rejections in the Southwest were 4 times as high as in the Northwest. However, in every region the rejection rate for non-whites was at least 3 times as high as that for whites; but the highest regional rejection rates for whites exceeded the lowest regional rejection rates for non-whites. Modern science has indicated that such variations are due to lack of opportunity rather than heredity or mental endowment.
  • Data from a representative nationwide statistical sample on the basis of which the Stanford-Binet intelligence tests were standardized in 1937 confirm the geographic variations in

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intelligence. In addition, they highlight a significant variation in intelligence according to the socio-economic level of the families. For example, children of fathers who were day laborers had a mean IQ of 93.6 while children of professionally employed fathers had an average IQ of 116.2. The inverse relationship in the intermediate ranges of vocations in these tests between degrees of economic and social well being and the rated intelligence confirmed this correlation.

  • Strikingly high concentrations of mental deficiency in specific sections of metropolitan communities also point to a strong correlation between economic status and intellectual development. A 1952 study in Chicago, for instance, showed that 65 percent of the pupils in special classes for the retarded came from 11 slum-ridden areas out of the 75 comprising the metropolitan community. In these 11 communities, the rate of referral for mental retardation among school-age children ranged from 10 to 30 percent. However, children too severely mentally retarded for school and severely retarded children were fairly evenly distributed throughout the entire city.
  • Prevalence of mental retardation tends to be heavily associated with lack of prenatal care, prematurity, and high infant death rates. Women who do not have prenatal care are approximately 3 times as likely to give birth to premature babies as are women who receive adequate prenatal care, and very small

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premature babies are about 10 times more likely to be mentally retarded than are children of normal births. The study in Chicago showed that infant mortality rates during the second through the twelfth month of life were 3 times the rates in the best socio-economic areas. In the United States as a whole in 1960, infant mortality averaged 26 per 1,000 live births but the State with the poorest record had a rate of 41.6, twice the rate of 19.6 in the State with the lowest rate.

The Nature, the Causes, and the Effects of Mental Retardation

The term mental retardation is a simple designation for a group of complex phenomena stemming from many different causes, but all having the common characteristic of inadequately developed intelligence. Many synonyms for the term mental retardation have been used in the past and are still in use at the present. They include amentia, feeble-mindedness, mental deficiency, mental subnormality, imbecility and moronity.

Because mental retardation is a relative concept depending on the prevailing educational and cultural standards, there is no completely satisfactory measure for mental retardation. Current scientific usage favors groupings based on the intelligence quotient (IQ.) and adaptive behavior of the person. Four groups are commonly used—profound, severe, moderate, and mild. They range from the

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absent to that where the degree of impairment is minimal and the difference from normality almost indistinct.

Utilizing the 4 categories based on intelligence quotient, those individuals who are considered profoundly retarded (IQ usually below 20) and those designated as severely retarded (IQ from about 20 to 35) need constant care or supervision throughout their lives if they are to survive. In these groups are the anencephalics, human beings without cerebral cortexes, and the more seriously impaired Mongoloids. There are an estimated 60,000 to 90,000 persons, mostly children and adolescents, who are profoundly or severely retarded. It is estimated that 1 child out of every 1,000 born, or somewhat over 4,000 births a year, falls in these 2 groups.

The moderately retarded persons (IQ usually 35 to 50), of whom 300,000 to 350,000 individuals are so classified, are capable of developing self-protection skills and mastering limited skills for semiproductive [sic] effort so they can contribute partially to their self-support if given an adequately protected environment. An estimated 3 children per 1,000 births will become moderately retarded, unlikely to progress beyond a mental age of 7 years even in adulthood.

Finally, the mildly retarded (IQ usually 50 to 80), comprising the largest group of approximately 5 million retarded persons, are usually not distinguishable from normal individuals until school age when they are often identified by an inability to learn school subjects. Without special attention, they often become the

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problem members of our society, capable only of a marginal productive role. They are the workers who are the most frequently displaced by the economic adjustments in our competitive society. However, given timely supervision, guidance, and training early enough in life, they will often be capable of complete assimilation into our society. Minimally retarded persons are more nearly comparable to the non-retarded than they are to the most profoundly retarded. It is estimated that about 26 out of every 1,000 children born will be mildly retarded at some time in their lives.

The manifestation of mental retardation varies significantly among different age groups and also among different types of retardation. Only a small proportion of infants is identified as mentally retarded, because gross defects are apparent and intellectual deficits which may show up later in life are not yet obvious. Many of the causative physical and environmental factors have not as yet had a chance to adversely affect the infant. By far the heaviest prevalence comes during the school age when more exacting as yet had a chance to adversely affect the infant. [sic REPEATS]

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