Psychological medicine. Mental handicap and syndromes of brain damage in children.

Mental handicap is not a single syndrome comprising lack of intellectual capacity sufficient to require the use of special educational and health service facilities. A too simple approach to it prevents the utilization of the appropriate services for a particular child. This-article is primarily about treatment, but it is -important to have some knowledge of the different categories of mental handicap. Basically there are two categories of mental handicapsubcultural handicap and pathological handicap. Subcultural handicap is a condition of mild handicap (I.Q. 50-70) in which poor genetic endowment (for example, from parents of modest intelligence) is compounded with social and educational disadvantages. These children are apt to come from large families, usually in slum areas of substandard housing, with the father in an unskilled manual job or, more commonly, out of work. Often two or three children in the same sibship are ascertained as mentally handicapped and recommended for special education. This category (subcultural handicap) is certainly the commonest syndrome in mental handicap. Some authorities consider it accounts for 75% of all cases. The pathological group includes genetic unifactorial disorders such as phenylketonuria (recessive) and epiloia (dominant), chromosomal disorders such as Down's syndrome (mongolism), spastic syndromes such as cerebral diplegia or hemiplegia, brain damage from trauma or encephalitis with resulting epilepsy and mental handicap, and many other syndromes such as spina bifida which may result in mental handicap. In addition there are a group of children variously described