Monographs of the American Association on Mental Deficiency (1982)最新文献

Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE) are preventable forms of mental retardation and developmental disability caused by heavy prenatal alcohol exposure. Our best evidence of the overall prevalence of FAS is around 1 in 750 live births, but this figure will vary according to the drinking habits of the community and the diagnostic skills and interests of local physicians. It is likely that many infants are born with FAS or FAE, are never recognized as such, and are never properly diagnosed or evaluated. Other diagnoses that are sometimes confused with FAS include Noonan syndrome and William syndrome. More often, children with milder FAS or FAE go unrecognized. Careful evaluation of possible maternal alcohol abuse during pregnancy can be an important factor in differential diagnosis and proper case management. Alcohol is a teratogenic drug that can produce a wide variety of deficits from prenatal exposure, depending on the dose, timing, and conditions of exposure, as well as on individual differences in sensitivity on the part of the mother and the child. Not all children who are exposed are affected. Perhaps 30-40% of the children of chronic alcoholic mothers who were drinking during pregnancy will have FAS. These children are at high risk for mental retardation or developmental disability. Even within this group, however, there can be large individual differences in eventual outcome. Prognosis involves an interaction between the extent of the damage and the stability and structure of the environment. Children whose mothers were abusing alcohol during pregnancy can be at risk for various learning and attentional problems even without FAS, but in the absence of morphologic effects, the diagnostic and prognostic picture is less clear. Systematic efforts toward both prevention and intervention can assure that each child develops to his or her own best potential.

The IMRT draws from a diverse array of sources to present a possible etiology for many cases of neurodevelopmental impairment. It is concerned with the problems of selective male affliction, maternal insufficiency, the structure of sex differences, and negative parity effects on intellectual development. The strongest appeal of the theory lies neither in its internal consistency nor in its success in bringing together obscure and seemingly unrelated findings, but rather in its ability to engender testable hypotheses. Many of these are affirmed in the literature or by preliminary investigations derived from existing data. The theory suggests two interesting routes for further investigation, the antecedent brother effect and the study of immunoreactive subgroups. It is strongly suggested that studies of parity effects, pre- and perinatal complications, maternal insufficiency, and family genetic background relative to intellectual development take into consideration the sex of the proband and of antecedent siblings and the family proclivity to autoimmune and to allergic disorders. If the theory were supported by research along the lines suggested above, hypotheses concerning specific immunologic mechanisms might be developed. Such research might yield strategies for the prevention of some of the neurodevelopmental disorders of childhood.

A model state plan for prevention coordinates human, economic, and social resources in a thoughtful process of identification of causes and prevention of mental retardation and a systematic application of that knowledge through a variety of approaches. Systems approaches suggest that "everything is connected to everything else." In this connection, a program, by definition, should be a planned effort to approach various aspects of an identified major problem by means of a series of interrelated projects; a single, isolated, one-shot project is not a program. This definition of program connotes a sustained commitment consistent with planned social change in order to modify institutions to make them more responsive to community need (Goldston, 1977). A sustained commitment is the cornerstone of a model state plan for prevention. The meshing of effort and services demanded of comprehensive prevention planning requires the support of both the executive and legislative branches of government.