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All of these factors become more complicated when the mentally retarded child is not an only child and the parents' relationship to the siblings must reflect on their planning for this retarded child.

We need experimentation in research in the area of the education and training of the mentally retarded. It is increasingly recognized that level of intellectual ability is but one of many factors affecting the quality of ultimate social and economic functioning. Secondary characteristics in the form of behavior and attitudes are as important in reference to the ultimate adjustment of the mentally retarded as they are in reference to the adjustment of the intellectually normal.

There is a need for expansion of research dealing with the effects of early childhood and preschool programs upon the later adjustment of the retarded. There is a need for experimentation in the area of curriculum development and teaching materials. Comparative studies of the effectiveness of a variety of curricula and materials are sorely needed.

In reference to the primary characteristic of intellectual development, the results of research point to increasing consideration of intelligence, not as a single unitary process, but rather one which is composed of many factors. There is a need for the development of new diagnostic instruments which will more effectively identify those factors as a basis for the development of specific instructional materials and methods designed to facilitate specific training in intellectual functions.

In the area of residential care there is need for a multitude of closely controlled studies to evaluate the effectiveness of present systems and of "improved" experimental services. Proposals have also been made for the use of institutions on the basis of intensive but temporary training periods facilitating the return of the child to his family whenever feasible.

Some excellent studies have recently been published showing how, in our state hospitals for the mentally ill, the inflexibility of the present power structure effectively interferes with the main purpose of these state hospitals, namely to cure the patient. Similar studies need to be undertaken in institutions for the mentally retarded to provide guidance for future developments in residential care.

One of the most significant studies undertaken in recent years is Dr. Gerhart Saenger's "The Adjustment of Severely Retarded Adults in the Community". Furthermore, intensive studies are needed with particular reference also to the social, economic, psychological, and cultural factors in causation.

Prevention

As we plan ahead for the next decade a new concept must be introduced which 10 years ago would hardly have been listed in the framework of a paper on mental retardation -- prevention.

By control of biochemical (metabolic) disorders, by surgical intervention, by improved techniques of delivery, and by eliminating damaging conditions during pregnancy medical science is slowly but steadily moving ahead on programs directed at preventing a condition that formerly were characterized by hopelessness. Mental retardation has thus become a promising new field for public health action.

To be sure the conditions in which preventive measures can now be taken represent only a very small numerical fraction of the mentally retarded. But as Dr. Richard Masland puts it succinctly in his summary of his study "The Prevention of Mental Subnormaljlty": "One cannot escape the conclusion that progress in the program for the prevention of mental retardation will take place by small advances along a broad front."