DEVELOPMENTAL hlEDICINE A N D CHILD NEUROLOGY.
1978, 20
those responsible for the training of physiotherapists and by the council of the Chartered Society of Physiotherapists. The questions they must ask themselves are: (1) Does the training syllabus include enough training in the assessment of disability and in planning correction and treatment ? (2) With the new career structure (Halsbury) now over its teething problems, is it not recognised that specialisation is acceptable ? (3) Is there sufficient knowledge among members of the medical profession about the r6le of the physiotherapist? (4) Are physiotherapists now, as a profession, mature enough to accept the responsibilities which the change in the code of ethics would place upon them ? When the answer to these (and other) questions is 'yes', then we may be able to go along \\ith our Australian colleagues. I f the answer to even one of these questions is 'no', then we still have a great deal of professional heart-searching to do. JEAN BIDDLE Medical Advisory Unit, Martindale Road, Hounslow TW4 7HE. REFERENCES I . Galley, P. ( 1977) 'Physiotherapy as first contact practitioners.' Physiotherapj. 63,246-248. 2. Whitehouse, J . (1977) 'Advance Australia Fair.' Physiotherapy, 63, 245. (Editorial.) 3 . Department of Health and Social Security (1977) Health Service Developtitent: Relationship Between the Medicaland Retnedial Professions. London: H.M.S.O.
SPEECH AND LANGUAGE DEVELOPMENT OF CHILDREN WlTH DOWN'S SYNDROME THElanguage development of the child with Down's syndrome often seems disappointing. Just as the over-all developmental quotient of these children is relatively high in the first year' but fails to maintain its promise in the second and third years, so it is often only at the end of the 'babbling' stage that their communication falls behind2. Their language development is very variable-the appearance of the first words ranging from I2 months to six years. The average age at which these children start to use words is 30 months, and most can use phrases by five years3. LENNEBERG and colleagues4 made a three-year study of 61 Down's syndrome patients aged from three to 22 years, who were living at home. They found that it was not IQ which best predicted language development, but chronological age and the passing of particular motor milestones. On verbal imitation tests, these children performed like younger normal children. LENNEBERGconcluded that they were slower in maturational development and thus slower in acquiring language; they were arrested at a primitive but normal stage of language development, and did not show deviant language behaviour. I t is often said about mental retardation that the developmental processes are the same as in normal children but that they proceed at a slower rate. Broadly speaking, the language of a child with Down's syndrome follows the same developmental pattern as for normal children. During the first year the vocalisations of Down's and normal infants do not dieer, and in early childhood the grammar of the Down's child is very general and nonspecific: i.e. they develop language functions in the same sequence as ordinary children, although there is an increasing lag in achieving major developmental landmarks. A Down's child at 2+ years is unlikely to understand passive or negative sentences or negative/passive 106
ANNOTATIONS
questions; or at three years to understand the passive construction and negativelpassive sentence; or at five years the negativelpassive sentence or negative/passive questions5. The language abilities of these children do differ in some respects from those of other retarded groups. Institutionalisation has a greater effect on their language development than on that of the other groups6. KIRKand KIRK’, using the Illinois Test of Psycholinguisfic Abilities (ITPA), claimed to have established a distinctive ‘Down language profile’, in which these children’s expression of ideas in terms of gestures (motor encoding) was superior to their verbal description of objects (vocal encoding). However, tests such as this are rather unsatisfactory, being designed for standardised, normal populations. EVANS*, in a study of 101 people with Down’s syndrome aged between eight and 31 years, used a battery of language tests (including the heavily criticised ITPA),and looked particularly for age effects and a Down’s syndrome language profile. A factor analysis revealed a General Verbal Factor (highly loaded on intelligence), a Disfluent Speech Factor (loaded on intelligibility) and a Structure of Speech Factor (a grammar factor). Numerous studiesghave shown that intelligence correlates highly with vocabulary scores, but only moderately with the development of grammar (which has, like ‘babbling’, an innate component). O’CONNOR and HERMELIN’O emphasised this point-the failure of the severely handicapped to develop adequate speech was not so much because they were unable to understand grammar, but rather that they did not know many words. Commenting on the Disfluent Speech Factor, EVANSconsidered that intelligibility in the group studied depended on whether interjections and repetition of words, or repetitions of parts of words (a form of stuttering), were the cause of the disfluency. In the latter case, intelligibility was low and speech therapy was especially indicated. It is noteworthy that males with Down’s syndrome are more likely to stutter than are females. DODD”compared the phonological rules of Down’s and normal children and found that the Down’s children used the same 23 phonological rules as normal children, but did so inconsistently. Many of their errors could not be accounted for by any phonological rules, e.g. repetition of one syllable of a word-‘meta meta mato’ for tomato; or squashing of words so that only vowels were uttered-‘e e’ for elephant; and deletion of consonant clusters. Other severely retarded children who did not have Down’s syndrome performed like age-matched children, following the rules. Such errors in Down’s children cannot be explained by lack of ability to form these sounds-they imitate well. Their poor performance may be due to a failure of long-term psychomotor programmes. These children have an abnormally small cerebellum, which is particularly important in motor performance and learning12, and their disfluency may be a direct result of this anatomical abnormality. Anatomical differences largely explain the typical weak, hoarse, low-pitched voice evident from early infancy. LINDet all3 confirmed by means of spectographic cry analysis that the pitch was lower than average, but not strikingly so (mean minimum pitch 270Hz, compared with normal 390Hz). The melody of the Down’s cry was similar to that of the cri-duchat syndrome; both cries were longer than normal pain cries, and were ‘tense’, with a stuttering characteristic. Taken together, these features constituted a Down’s voice profile which differed from normal pain cries, and staff could be easily trained to recognise the Down’s syndrome cry. The upper articulatory aperture of these infants is very tight, which gives a special fricative quality, and the narrow opening of the lips when crying contrasts with the usual wide ‘bawling’shape of the normal infant’s mouth. made Protrusion of the tongue does not seem to be due to its enlargement. ARDRAN et a radiographic examination of the tongues of eight children with Down’s syndrome. In
107
DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY.
1978, 20
relation to the mouth cavity, no tongue was enlarged, However, all eight had enlarged adenoids and tonsils, or evidence of such, and over-biting of the mandible, suggesting that the gaping mouth and protruding tongue were related to the need to provide an airway, and that removal of obstructions such as adenoids, pharyngeal tonsils and lingual tonsil would help many to close their lips, favour jaw development and also improve the voice. Conductive, mixed and sensorineural hearing-loss are more common in Down’s syndrome, and early detection of exudative otitis media may result in better communicationlj. While maturational and intellectual factors cannot be manipulated, the environment can be. Down’s syndrome speech continues to improve after 12 years of age, the end of the socalled ‘critical language learning period’. Young adults with Down’s syndrome (over 16 years) generally have better verbal ability than those between eight and 16 years. Those in the older age-group are more likely to be in an environment of good speech models, whereas the mother of a Down‘s syndrome child may provide a less complex and more controlling type of speech than does the mother of a normal child. This is more likely to be a response to the low level of expressive speech of a Down’s child, rather than to maternal inhibition caused by the knowledge that the child has Down’s syndrome16. Early intervention may reduce the comparative deterioration in language of these children in the second and third years. Instructional manuals, parent workshops and the Portage Project’’ in the home help the mother to realise that language is not merely ‘parts of speech’, but is the way a child learns to map his world, and that she must provide and demand the world and language of relationships (as distinct from labels and baby songs). The child should be introduced into a nursery which requires him to use speech regularly. Even the most severely retarded Down’s child can communicate to some extent, enjoys communicating, and can be an asset in a nursery. W. I. FRASER Lynebank Hospital, Halbeath Road, Dunfermline, Fife. REFERENCES I . Melyn. M. A., Whyte, D. T. (1973) ‘Mental and developmental milestones of non-institutionalised Down‘s syndrome children.‘ Pediatrics, 52,542-545. 2. Dodd, B. (1972) ’Comparison of babbling patterns in normal and Down’s syndrome infants.’Jorirnal of Mental Deficiency Research, 16, 3540. 3 . Strazzulla, M. (1953) ‘Speech problems of a mongoloid child.‘ Qiiarterly Review ofPediafrics, 8,268-273. 4. Lenneberg, E. H., Nichols, I. A., Rosenberger, E. F. (1964) ’Primitive stages of language development.’ Association for Research in Nervous ond Mental Disease, Research Piiblication 42,119-1 37. 5 . Lackner. J . R. (1968) ‘A developmental study of language behaviour in retarded children.’ Neuropsycho/oEia, 6,301-320. 6. Lyle, J . G. (1960) ‘The effect of an institution environment upon the verbal development of imbecile children.‘ Journal o / Mental Deficiencj. Research, 4, 1-1 3. 7. Kirk, S. A., Kirk, W. D. (1971 ) P.q.cho/itigiiistic Leorning Disabilities: Diugnosis and Remedia/ion. Illinois: University of Illinois Press. 8. Evans. D. (1977) ’The development of language in mongols: a correlative study.’ fournu/ of Meniril Deficiency Research, 21, 103-1 17. 9. Spreen. 0. (1965) ‘Language functions in mental retardation. A review. I. Langauge development: types of retardation and intelligence level.‘ Aniericriti foii,na/ofMenral Dejciency, 69,482-494. 10. O’Connor, N., Herrnelin, B. (1963) Speech and T/ioi/gh/in Se\,ere Sitbnornroliry. Oxford: Pergamon. I I . Dodd, B. (1974) Cited by Cromer, R. S. in Scheefelhuch, R. L., Lloyd, D. (Eds.) Language Perspectives: .4cqrtisirion, Rerardatiorr and In;ertwitioti. London : Macrnillan. p.25 I . 12. Cronie. L. C.. Stern, J. (1967) The Purhology of Menrtil Retcirdurion. London: Churchill. 13. Lind. J., Vuorenkoski, V.. Rosberg. C., Partanen. T. J., Wasz-Hockert, O., (1970) ‘Spectrographic analyses of vocal responses to pain stimuli in infants with Down‘s syndrome.’ Developnental Medicine ond Clii/d Neiirolog).. 12, 478-486. 14. Adran. G. M., Harker. P., Kenip, P. T. (1972) ’Tongue bize i n Down’s syndrome.’ Jolonril 0 1 j Metlrcrl Ocfic.ierrcy Resenrch, 16, 160- 166.
108
ANNOTATIONS
15. Brooks, D. N., Woolley, H. (1972) ‘Hearing loss and middle ear disorders of patients with Down’s syndrome.’Journalof Mental Deficiency Research, 16,21-29. 16. Ronda], J. A. (1977) ‘Maternal speech in normal and Down’s syndrome children.’ in Mittler, P. A. (Ed.) Research to Practice in Mental Retardation-Education and Training.London: I.A.S.S.M.D. 17. Shearer, M. S., Shearer, D. E. (1972) ‘The Portage Project: a model for early childhood education.’ Exceptional Children, 36, 217-219.
Notices Meeting on the Primary Prevention of Cerebral Palsy Aosta, Italy, 26tli-28tli May 1978 THEInternational Cerebral Palsy Society is organising a meeting to discuss both the implementation of known methods of primary prevention of cerebral palsy and possible ways forward for the future. With present knowledge, at least 40 to 50 per cent of cases of cerebral palsy could be prevented, and some of the most distinguished people in this field of prevention will be speaking at the meeting. Languages: English, French and Italian. Further information from Mrs. Anita Loring, International Cerebral Palsy Society, 5A Netherhall Gardens, London NW3 5RN.Telephone 01-794 9761.
10th Annual Meeting on Birth Defects San Francisco, 12th-14th June 1978 THEUniversity of California, San Francisco, and the National Foundation-March of Dimes are sponsoring the 1978 Birth Defects Conference in San Francisco from 12th to 14th June 1978. Further information from Bryan D. Hall, M.D., M648-Department of Pediatrics, University of California, San Francisco, California 94143.
Annual Meeting European Brain and Behaviour Society London, 6th-8tli July 1978 THEEuropean Brain and Behaviour Society will hold its 1978 Annual meeting in London between 6th and 8th July 1978. The Society was formed in 1969 with two principal objectives in mind : to provide an interdisciplinary forum for all the sciences concerned with the twin interests of brain function and behaviour; and that the Society should be a European as opposed to a national organization. Each year the Society organizes a workshop on a selected topic, as well as an Annual General Meeting. On these occasions papers are presented on anatomy, medicine, pharmacology, psychology and zoology. A recent trend has been to give increased recognition to applied fields such as developmental neuropsychology. Further information from Professor Ian Steele-Russell, MRC Unit on Neural Mechanisms of Behaviour, 3 Malet Place, London WClE 7JG. 109
1978, 20
those responsible for the training of physiotherapists and by the council of the Chartered Society of Physiotherapists. The questions they must ask themselves are: (1) Does the training syllabus include enough training in the assessment of disability and in planning correction and treatment ? (2) With the new career structure (Halsbury) now over its teething problems, is it not recognised that specialisation is acceptable ? (3) Is there sufficient knowledge among members of the medical profession about the r6le of the physiotherapist? (4) Are physiotherapists now, as a profession, mature enough to accept the responsibilities which the change in the code of ethics would place upon them ? When the answer to these (and other) questions is 'yes', then we may be able to go along \\ith our Australian colleagues. I f the answer to even one of these questions is 'no', then we still have a great deal of professional heart-searching to do. JEAN BIDDLE Medical Advisory Unit, Martindale Road, Hounslow TW4 7HE. REFERENCES I . Galley, P. ( 1977) 'Physiotherapy as first contact practitioners.' Physiotherapj. 63,246-248. 2. Whitehouse, J . (1977) 'Advance Australia Fair.' Physiotherapy, 63, 245. (Editorial.) 3 . Department of Health and Social Security (1977) Health Service Developtitent: Relationship Between the Medicaland Retnedial Professions. London: H.M.S.O.
SPEECH AND LANGUAGE DEVELOPMENT OF CHILDREN WlTH DOWN'S SYNDROME THElanguage development of the child with Down's syndrome often seems disappointing. Just as the over-all developmental quotient of these children is relatively high in the first year' but fails to maintain its promise in the second and third years, so it is often only at the end of the 'babbling' stage that their communication falls behind2. Their language development is very variable-the appearance of the first words ranging from I2 months to six years. The average age at which these children start to use words is 30 months, and most can use phrases by five years3. LENNEBERG and colleagues4 made a three-year study of 61 Down's syndrome patients aged from three to 22 years, who were living at home. They found that it was not IQ which best predicted language development, but chronological age and the passing of particular motor milestones. On verbal imitation tests, these children performed like younger normal children. LENNEBERGconcluded that they were slower in maturational development and thus slower in acquiring language; they were arrested at a primitive but normal stage of language development, and did not show deviant language behaviour. I t is often said about mental retardation that the developmental processes are the same as in normal children but that they proceed at a slower rate. Broadly speaking, the language of a child with Down's syndrome follows the same developmental pattern as for normal children. During the first year the vocalisations of Down's and normal infants do not dieer, and in early childhood the grammar of the Down's child is very general and nonspecific: i.e. they develop language functions in the same sequence as ordinary children, although there is an increasing lag in achieving major developmental landmarks. A Down's child at 2+ years is unlikely to understand passive or negative sentences or negative/passive 106
ANNOTATIONS
questions; or at three years to understand the passive construction and negativelpassive sentence; or at five years the negativelpassive sentence or negative/passive questions5. The language abilities of these children do differ in some respects from those of other retarded groups. Institutionalisation has a greater effect on their language development than on that of the other groups6. KIRKand KIRK’, using the Illinois Test of Psycholinguisfic Abilities (ITPA), claimed to have established a distinctive ‘Down language profile’, in which these children’s expression of ideas in terms of gestures (motor encoding) was superior to their verbal description of objects (vocal encoding). However, tests such as this are rather unsatisfactory, being designed for standardised, normal populations. EVANS*, in a study of 101 people with Down’s syndrome aged between eight and 31 years, used a battery of language tests (including the heavily criticised ITPA),and looked particularly for age effects and a Down’s syndrome language profile. A factor analysis revealed a General Verbal Factor (highly loaded on intelligence), a Disfluent Speech Factor (loaded on intelligibility) and a Structure of Speech Factor (a grammar factor). Numerous studiesghave shown that intelligence correlates highly with vocabulary scores, but only moderately with the development of grammar (which has, like ‘babbling’, an innate component). O’CONNOR and HERMELIN’O emphasised this point-the failure of the severely handicapped to develop adequate speech was not so much because they were unable to understand grammar, but rather that they did not know many words. Commenting on the Disfluent Speech Factor, EVANSconsidered that intelligibility in the group studied depended on whether interjections and repetition of words, or repetitions of parts of words (a form of stuttering), were the cause of the disfluency. In the latter case, intelligibility was low and speech therapy was especially indicated. It is noteworthy that males with Down’s syndrome are more likely to stutter than are females. DODD”compared the phonological rules of Down’s and normal children and found that the Down’s children used the same 23 phonological rules as normal children, but did so inconsistently. Many of their errors could not be accounted for by any phonological rules, e.g. repetition of one syllable of a word-‘meta meta mato’ for tomato; or squashing of words so that only vowels were uttered-‘e e’ for elephant; and deletion of consonant clusters. Other severely retarded children who did not have Down’s syndrome performed like age-matched children, following the rules. Such errors in Down’s children cannot be explained by lack of ability to form these sounds-they imitate well. Their poor performance may be due to a failure of long-term psychomotor programmes. These children have an abnormally small cerebellum, which is particularly important in motor performance and learning12, and their disfluency may be a direct result of this anatomical abnormality. Anatomical differences largely explain the typical weak, hoarse, low-pitched voice evident from early infancy. LINDet all3 confirmed by means of spectographic cry analysis that the pitch was lower than average, but not strikingly so (mean minimum pitch 270Hz, compared with normal 390Hz). The melody of the Down’s cry was similar to that of the cri-duchat syndrome; both cries were longer than normal pain cries, and were ‘tense’, with a stuttering characteristic. Taken together, these features constituted a Down’s voice profile which differed from normal pain cries, and staff could be easily trained to recognise the Down’s syndrome cry. The upper articulatory aperture of these infants is very tight, which gives a special fricative quality, and the narrow opening of the lips when crying contrasts with the usual wide ‘bawling’shape of the normal infant’s mouth. made Protrusion of the tongue does not seem to be due to its enlargement. ARDRAN et a radiographic examination of the tongues of eight children with Down’s syndrome. In
107
DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY.
1978, 20
relation to the mouth cavity, no tongue was enlarged, However, all eight had enlarged adenoids and tonsils, or evidence of such, and over-biting of the mandible, suggesting that the gaping mouth and protruding tongue were related to the need to provide an airway, and that removal of obstructions such as adenoids, pharyngeal tonsils and lingual tonsil would help many to close their lips, favour jaw development and also improve the voice. Conductive, mixed and sensorineural hearing-loss are more common in Down’s syndrome, and early detection of exudative otitis media may result in better communicationlj. While maturational and intellectual factors cannot be manipulated, the environment can be. Down’s syndrome speech continues to improve after 12 years of age, the end of the socalled ‘critical language learning period’. Young adults with Down’s syndrome (over 16 years) generally have better verbal ability than those between eight and 16 years. Those in the older age-group are more likely to be in an environment of good speech models, whereas the mother of a Down‘s syndrome child may provide a less complex and more controlling type of speech than does the mother of a normal child. This is more likely to be a response to the low level of expressive speech of a Down’s child, rather than to maternal inhibition caused by the knowledge that the child has Down’s syndrome16. Early intervention may reduce the comparative deterioration in language of these children in the second and third years. Instructional manuals, parent workshops and the Portage Project’’ in the home help the mother to realise that language is not merely ‘parts of speech’, but is the way a child learns to map his world, and that she must provide and demand the world and language of relationships (as distinct from labels and baby songs). The child should be introduced into a nursery which requires him to use speech regularly. Even the most severely retarded Down’s child can communicate to some extent, enjoys communicating, and can be an asset in a nursery. W. I. FRASER Lynebank Hospital, Halbeath Road, Dunfermline, Fife. REFERENCES I . Melyn. M. A., Whyte, D. T. (1973) ‘Mental and developmental milestones of non-institutionalised Down‘s syndrome children.‘ Pediatrics, 52,542-545. 2. Dodd, B. (1972) ’Comparison of babbling patterns in normal and Down’s syndrome infants.’Jorirnal of Mental Deficiency Research, 16, 3540. 3 . Strazzulla, M. (1953) ‘Speech problems of a mongoloid child.‘ Qiiarterly Review ofPediafrics, 8,268-273. 4. Lenneberg, E. H., Nichols, I. A., Rosenberger, E. F. (1964) ’Primitive stages of language development.’ Association for Research in Nervous ond Mental Disease, Research Piiblication 42,119-1 37. 5 . Lackner. J . R. (1968) ‘A developmental study of language behaviour in retarded children.’ Neuropsycho/oEia, 6,301-320. 6. Lyle, J . G. (1960) ‘The effect of an institution environment upon the verbal development of imbecile children.‘ Journal o / Mental Deficiencj. Research, 4, 1-1 3. 7. Kirk, S. A., Kirk, W. D. (1971 ) P.q.cho/itigiiistic Leorning Disabilities: Diugnosis and Remedia/ion. Illinois: University of Illinois Press. 8. Evans. D. (1977) ’The development of language in mongols: a correlative study.’ fournu/ of Meniril Deficiency Research, 21, 103-1 17. 9. Spreen. 0. (1965) ‘Language functions in mental retardation. A review. I. Langauge development: types of retardation and intelligence level.‘ Aniericriti foii,na/ofMenral Dejciency, 69,482-494. 10. O’Connor, N., Herrnelin, B. (1963) Speech and T/ioi/gh/in Se\,ere Sitbnornroliry. Oxford: Pergamon. I I . Dodd, B. (1974) Cited by Cromer, R. S. in Scheefelhuch, R. L., Lloyd, D. (Eds.) Language Perspectives: .4cqrtisirion, Rerardatiorr and In;ertwitioti. London : Macrnillan. p.25 I . 12. Cronie. L. C.. Stern, J. (1967) The Purhology of Menrtil Retcirdurion. London: Churchill. 13. Lind. J., Vuorenkoski, V.. Rosberg. C., Partanen. T. J., Wasz-Hockert, O., (1970) ‘Spectrographic analyses of vocal responses to pain stimuli in infants with Down‘s syndrome.’ Developnental Medicine ond Clii/d Neiirolog).. 12, 478-486. 14. Adran. G. M., Harker. P., Kenip, P. T. (1972) ’Tongue bize i n Down’s syndrome.’ Jolonril 0 1 j Metlrcrl Ocfic.ierrcy Resenrch, 16, 160- 166.
108
ANNOTATIONS
15. Brooks, D. N., Woolley, H. (1972) ‘Hearing loss and middle ear disorders of patients with Down’s syndrome.’Journalof Mental Deficiency Research, 16,21-29. 16. Ronda], J. A. (1977) ‘Maternal speech in normal and Down’s syndrome children.’ in Mittler, P. A. (Ed.) Research to Practice in Mental Retardation-Education and Training.London: I.A.S.S.M.D. 17. Shearer, M. S., Shearer, D. E. (1972) ‘The Portage Project: a model for early childhood education.’ Exceptional Children, 36, 217-219.
Notices Meeting on the Primary Prevention of Cerebral Palsy Aosta, Italy, 26tli-28tli May 1978 THEInternational Cerebral Palsy Society is organising a meeting to discuss both the implementation of known methods of primary prevention of cerebral palsy and possible ways forward for the future. With present knowledge, at least 40 to 50 per cent of cases of cerebral palsy could be prevented, and some of the most distinguished people in this field of prevention will be speaking at the meeting. Languages: English, French and Italian. Further information from Mrs. Anita Loring, International Cerebral Palsy Society, 5A Netherhall Gardens, London NW3 5RN.Telephone 01-794 9761.
10th Annual Meeting on Birth Defects San Francisco, 12th-14th June 1978 THEUniversity of California, San Francisco, and the National Foundation-March of Dimes are sponsoring the 1978 Birth Defects Conference in San Francisco from 12th to 14th June 1978. Further information from Bryan D. Hall, M.D., M648-Department of Pediatrics, University of California, San Francisco, California 94143.
Annual Meeting European Brain and Behaviour Society London, 6th-8tli July 1978 THEEuropean Brain and Behaviour Society will hold its 1978 Annual meeting in London between 6th and 8th July 1978. The Society was formed in 1969 with two principal objectives in mind : to provide an interdisciplinary forum for all the sciences concerned with the twin interests of brain function and behaviour; and that the Society should be a European as opposed to a national organization. Each year the Society organizes a workshop on a selected topic, as well as an Annual General Meeting. On these occasions papers are presented on anatomy, medicine, pharmacology, psychology and zoology. A recent trend has been to give increased recognition to applied fields such as developmental neuropsychology. Further information from Professor Ian Steele-Russell, MRC Unit on Neural Mechanisms of Behaviour, 3 Malet Place, London WClE 7JG. 109
