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This very sensible suggestion is by no means obviated by another recommendation that has been made by many parent associations in various countries, but recently has been echoed by a few professional persons and indeed in a very few places been put into practice -- that the parents be given an opportunity to participate in the assessment process and in particular in the assessment conference, unless some unusual circumstances speak against that.

Furthermore, because experience has brought out very clearly that an initial assessment cannot possibly predict with accuracy the child's development, periodic reassessment with participation from the parents, but perhaps with a more limited professional staffing, is of the essence. What needs to be stressed is that in distinction to the term "diagnosis," the term "assessment" should be understood to include a statement of the child's needs and ways of meeting them, and each time, we agree with Ann Jones, the parents should get a written summary.

The process of assessment is usefully supplemented by parent education of the type so successfully demonstrated by the staff of the Hester Adrian Centre at the University of Manchester. Parents of a severely handicapped child come face to face with new words like mental handicap and mental subnormality, new facilities like day center or special care center, new procedures like speech stimulation or motor development; experience has shown they can learn best about these things if they are being discussed in a group, although we must of course make allowance for the occasional parent for whom participation in a group is either undesirable or inappropriate. Much is gained when parents have a better understanding not just of their handicapped child's special needs, but to what extent that child is more like than unlike other children.

Parent education in groups is usually organized for a limited number of meetings. It is, as the name says, an educational process, and needs to be clearly differentiated from parent counseling, which may take place either individually or also in groups. Parent education conveys broad information; parent counseling deals with specific problem situations the parent is encountering with the management of the child, in the relationship with neighbors, in the use of community facilities.

The essence of early intervention, of course, lies in making available to parents not only advice and counsel but detailed technical instruction or perhaps specific equipment that will help them in taking care of their children and furthering their growth and development. From our own experience with many parents, we know, for instance, that feeding such a child may pose great problems, taking hours of the mother's time and causing her great anxiety. Yet there are simple ways of helping the mother to teach her child to suck, to swallow, to use a spoon, and they can easily be demonstrated. I had hoped to show you as one example a brief teaching film on such a subject, but technical problems made this not possible.

Many mothers urgently need not only to understand the nutritional requirements of their child but ways to meet them, need to understand not only the sequence from soft to solid food but how to achieve this, need to understand the significance of proper food and proper chewing, not just for dentition but for the beginnings of language development. Parents struggle needlessly with feeding problems when a special spoon, a special cup, or some other procedure may speed up the training, not only saving the parent time but helping child and parent to move on to the next developmental stage. Add to this effective help with sleep problems and toilet training, and the improvement in the domestic scene and the child's greater readiness for a first group experience will be advanced beyond measure.

That the first three years of life are the most significant development learning period in a child's life is common knowledge, yet traditionally we have thought of education as a business of schools. But education does of course begin at home, and the role of the parent as a teacher in child development is of particular significance with the handicapped child. For instance, a baby with Down's syndrome needs a maximum of stimulation, through early sensory training and in motor development. Short teaching films are available to show a mother how to help her baby with Down's syndrome to learn to raise his or her head, or to roll over. There is the matter of speech stimulation and development, and the all important need for parents to understand that the severely mentally handicapped child will need help in developing a concept of self. Managing such a child may require home help, and Britain has not only pioneered in providing home helpers but now also is providing an attendance allowance in consideration of the extra expenses which accrue to families with this kind of problem.

Multiply handicapped children have need for medical intervention, and our contacts with parents indicate this still today presents an uneven picture, particularly in terms of orthopedic and other needed surgery, eye glasses, and hearing aids, where help is often not offered, and if requested, refused. There is little recognition by many physicians even today that many of these children need special attention for problems which are well within reach of remedial medical steps.