DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY.

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22. Ellis, E. (1967) ‘Historical aspects of the physical treatment of developmental disorders.’ In The Physical :Managenrent of Dei~elopnientalDisorders. Clinics in Developnien fa1 Medicine No. 26. London S.I.M.P. with Heinemann Medical. Ch. 4, p. 24. 23. Lansdown. R. (1976) ‘Children with s-x l l i n a- difficulties.’ Child: Care. Health and Development,. 2,. 353-364. 24. Arnhem, D. D., Sinclair, MI. A. (1975) The Cliitnsy Child. A Program of Motor Therapy. St. Louis: C. V. Mosby. 25. Holle, B. (1976) Motor Developnrent in Children: Nonnal and Retarded. Oxford: Blackwell. 26. Frostig, M. (1969) Move, Grow, Learn. Chicago: Follett. 27. Valett. R.E. ( 1 967) The Retnediation uJLearning Difficulties. A Handbook of Psychoeducational Problems. Palo Alto, Calif. : Fearon Press. 28. Grimley, A. M. D., McKinlay, I. A. (1977) The C/uni.sy Child. Association of Paediatric Chartered Physiotherapists. 29. Gearheart, B. R.(1973) Learning Disabilities: Ediicrrtional Strategies. St. Louis: C. V. Mosby. 30. Kephart. N. C . (1971) The Slow Learner in the Clussrooni, 2nd Edn. Columbus, Ohio: Merrill. 31. Tansley, A. E. (1967) Reading and Remedial Reading. London: Routledge and Kegan Paul. 32. Brennan. W. K. (1974) Shuping the Education of Slow Learners. London: Routledge and Kegan Paul. 33. Great Britain: Department of Education and Science (1972) Movement Physical Ediication in the Priniary Years. London: H.M.S.O. 34. Francis-Williams, J. (1 974) Children with Specific Learning Dificiilties, 2nd. Edn. Oxford: Pergamon. 35. Boston Children’s Medical Centre and Gregg, E. M. (1969) What To Do When There’s Nothing To Do. London : Hutchinson. 36. Stott, D. H. (1977) ’A strategy for remedial handwriting.’ Special Education, 4 (3), 20-22. 37. Jarman, C. (1977) ’A helping hand for slow learners.’ Special €dimtion, 4 (4), 11-13. 38. Mesker. P. (1972) De Menselijke Hand. Nijmegen: Dekker & Van de Vegt. 39. Bentley, W. G. (1970) Learning to Move und M ~ v i t i gto Learn. New York: Citation Press.

THE LEARNING-DISABLED CHILD: EARLY DETECTION AND PREVENTION IN recent years educational psychologists have cast serious doubt on the value of conventional tests for children, especially those resulting in an IQ. The quotient so produced is seen as psychometrically unreliable and educationally irrelevant. Instead there has been a shift from ‘problem children’ to ‘problem situations”. This shift can be seen exemplified in discussions on the backward reader. Surveys have not shown remedial work to be of any and there is a disillusionment with the medical model of diagnosis when applied to children’s learning problems. The concept of diagnostic teaching, as opposed to diagnostic testing, was put forward by STRANG in 1964*, when she advocated bringing traditional diagnostic insights into the classroom. A further step was taken by CLAY^ when she published her work based on the weekly observation of five-year-old children learning to read. Last year, NEWCOMER^ also argued powerfully against the conventional diagnosticremedial model. She saw this as being based on five premises, all of which are false: (1) children with mild reading problems are deviant; (2) their defects are discrete; (3) underlying problems can be isolated; (4) present instruments are adequate to detect them; (5) remediation can be provided in isolation from everything else. A diagnostic session using the WISC and Frostig-type tests, followed by remedial reading lessons should, she claimed, be seen as irrelevant for most children. She carefully qualifies her condemnations: she is not writing about all children. She went on to recommend that conventional practice be replaced by classroom observation by a teacher-consultant, who must be able to carry out remedial work on the spot. CLAY 7. commenting on NEWCOMER’S proposed scheme, takes up many points made at

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greater length in her own earlier book5. In particular, she advocates very early detection of reading difficulties, using careful observation of children’s day-to-day behaviour. Observations that she had found helpful fall under three main headings : (1) Language development : often children have only a limited range of syntactic forms at their command, or they may have mature speech which is too fast for their visual perception to keep up with. (2) Directional behaviour : children frequently waver for several months before they establish a consistent directional approach to print. (3) Co-ordination: some children find it difficult to match words and spaces in print to words and phrases in speech. All these difficulties, alone or in combination, interacting with emotional disturbance which may be primary or secondary, lead to cognitive confusion during the first year in school which, she claims, has a long-lasting effect. CLAYhas published a booklet for teachers* on ways of detecting early difficulties, and her main work5 deals at length with ways in which the classroom teacher may monitor progress and modify everyday teaching in order to overcome problems before they become firmly set. If her approach were to be generally adopted (she works in New Zealand), the implications would be considerable. A great weight of responsibility would be put on the reception class teacher during the child’s first school year, who could no longer assume that a remedial net would catch her failures. The idea of prevention rather than cure, given that a number of our ‘cures’ are questionable, is long overdue. It has been claimed in Swedengthat an approach similar to that advocated by CLAYprevented more than 80 per cent of the children identified as potential cases of reading disability at the beginning of the first grade from becoming so. Department of Psychological Medicine, RICHARD LANSDOWN The Hospital for Sick Children, Great Ormond Street, London WClN 3JH. REFERENCES 1 . Loxley, D., Harrison, B. (1978) ‘The Sheffield Psychological Service.’ Journal of the Association of Educational Psychologists, 4, 20-24. 2. Carroll, H. C. M. (1972) ‘The remedial teaching of reading: an evaluation.’ Remedial Education, 7(1), 10-15. 3. Yule, W. (1976) ‘Issues and problems in remedial education.’ Developmental Medicine and Child Neurology, 18,675-682. 4. Strang, R. (1964) Diagnostic Teaching of Reading. New York: McGraw-Hill. 5. Clay, M. M. (1972) Reading: the Patterning of Complex Behaviour. London: Heinemann Educational

Books. 6. Newcomer, P. L. (1977) ‘Special education services for the mildly handicapped. Beyond a diagnostic and remedial model,’ Journal of Special Education, 11, 153-165. 7. Clay, M. M. (1977) ‘An emphasis on prevention.’Journalof SpecialEducation, 11, 183-188. 8. Clay, M. M. (1972) The Early Detection of Reading Difficulties: a Diagnostic Survey. London: Heinemann Educational Books. 9. Malrnquist, E. (1973) ‘Perspectives on reading research.’ In Karlin, R. (Ed.) Reading For All. Newark, Delaware : International Reading Association.

INFANTILE NEUROAXONAL DYSTROPHY AND RELATED DISORDERS DEGENERATIVE diseases of the central nervous system in childhood are a depressing subject because so often no treatment is available. If advances are to be made, it is essential that clinicopathological entities be identified; only then will there be an opportunity to study F

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The learning-disabled child: early detection and prevention.

DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY. 1978, 20 22. Ellis, E. (1967) ‘Historical aspects of the physical treatment of developmental disorders.’...
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