Challenged Child

Based on lecture by Nina Bass, M.D.

Developmental Challenge = anything that throws a child off his or her developmental track

History: in Victorian era, developmentally challenged children were viewed as inferior, even demons. In the 1950's, the Kennedy movement began (after Joe Kennedy had a child who was mentally retarded and received a lobotomy).

Today, involuntary sterilization and infanticide persist, particularly in developing countries.


Mental Retardation see also

        The Mental Retardation cutoffs, per DSM-IV:

       Mental Retardation          IQ               Equivalent
       Mild                              50-55 - 70        6th grade
       Moderate                     35-40 - 50-55   1st grade
       Severe                          20-25 - 35-40   Requires constant supervision
       Profound                       below 20-25     Requires constant care

Mental Retardation Definition:

Unspecified MR and Borderline MR (75-80 IQ) are two additional categories.

Standardized Measures of Intelligence

Stanford Binet

WISC (Wechsler) - reported on a normal (bell) curve; used for older children (8 or above).

WIPPSI (Wechsler Preschool) - developed as a screening tool for normal v. abnormal child; was intended to be very simple; given at 4 y/o, but many children blossom thereafter; can stigmatize a child (used heavily by educational system).

Recommendation: retest at 8 with the WISC.

Peabody Picture Vocabulary

Adaptive and Developmental Measures

Vineland Social Maturity Scale (Adaptive Behavior Scale) - would be excellent tool to determine a child's ability to enter a school environment, but not commonly used

Coordinated psychomotor skills


ADLS (self help/independence)

Social skills

Accommodation to environment

Vocational mastery

Denver Developmental Screening Test - used commonly by pediatricians; excellent test; series of tasks, e.g., stacking cubes, that tests development

Bailey Infant Scale

Hearing Impairment




Visual Impairment

Varies from visual impairment to social blindness to virtual blindness to total blindness.


Ritvo definition of autism:


Pervasive Developmental Delays

Learning Disabilities

Cerebral Palsy



Multiple Handicapping Conditions

Development of Milestones

Mental retardation: orderly, but delayed; don't tend to lose milestones once achieved.

Autism: erratic, may regress and lose prior milestones, maybe out of order.

Cerebral Palsy or Sensory Deficits: Isolated delays or omission - early and "soft" neurological signs important in diagnosis eg poor bonding, feeding, irritability


Coexisting Psychiatric Disorders occur in 30% of patients with developmental delays.


Behavioral Treatment

Mainstreaming: putting developmentally impaired children into classrooms with those who aren't; controversial.

Early Intervention: good if before kindergarten.


Head Start: government program aimed at poor children

Key Legislation:

1935 - Title V of the Social Security Act

1975 - PL 94-142: controversial law that mandates children must be educated in the least restrictive environment, and school must pick up the tab for any attendant medical expenses, e.g., respirators in the classroom.

1991 - Americans With Disabilities Act

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