Nietern, S. HELPING THE RETARDED CHILD New York: Grossett & Dunlap, 1975, 289 pp.
Until quite recently the child with mental retardation was often closeted at home or institutionalized and put out of contact with the community. The condition was seen as a fixed level of deficit without possibilities for change or future development, regardless of etiology. And generally, depending on the level of professional experience or sophistication, it was considered a discrete disability not related to or confused with other developmental deficits. Much has happened to change these views. Increasing numbers of affected surviving children, the total inadequacy of institutional care, encouraging results of new special-education programs, and community awareness of responsibility for maintaining the child at home have all increasingly come into play to change the outlook.
Yet even among professionals there is much misunderstanding about the condition, particularly in relation to pathophysiology. In a period when we are confronted with a multitude of developmental defects that need to be better codified and interrelated, we have not yet had a text to guide us through the maze of such disorders and specifically to refine the concept of retardation.
Fortunately, Dr. Nietern has changed this situation and brought a warm, balanced approach to the field of retardation. Mind you, he speaks not of mental retardation but of retardation alone as a variant of normal human development - one of several possible developmental pathways a child may take, owing either to a specific known cause or to an anomaly of uncertain orgin- We are also introduced to the concept of an associated impulse disorder, so often seen in retardation and a basis for much behavior disturbance.
Dr. Nietern takes us carefully through normal growth periods from the newborn to senescence, describing in great detail normal physical and psychosocial development, and contrasts this with the retarded individual of comparable age. By this device we gain an appreciation of retardation as a developmental process with features often enabling recognition at an early infani stage in the more severely affected. Similarly, characteristics and needs of the retarded within each group provide insights into the changing nature of the condition.
Remediation is the name of the game as early as definite diagnosis can be made, and Dr. Nietern is quite specific about techniques of working with these children in such areas, for example, as infant feeding, toilet training, school needs and problems, and sex education. Considerable attention is also given to prevention. Genetic counseling for new parents is stressed. Recent data on infections and nutritional factors of pregnancy are discussed. An extensive glossary of retardation syndromes is included, coded by etiology and generally expected degree of severity.
This is a work with which all pediatricians should be thoroughly familiar. It provides the kind of learned overview that will enable practitioners to appreciate the developmental process of the retarded child and how it affects the family and community. And in the last analysis it is within the family and community that care for most such children should take place. The pediatrician has a primary role in guiding this process and would do well to acquaint himself with this major contribution by Dr. Nietern.