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Mental Retardation and Developmental
Disabilities Volume 13
A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher. Inquiries about earlier volumes of this series, published by Brunner/Mazel, New York, may be directed to the Editor.
Mental Retardation d Developmental
Disabilities Volume 13
Editbd by
Joseph Wortis. M.D. State University of New YorL <It Stony Brook
Stony Brook, New York
ENUM PRESS • NEW YORK AND LONDON
ISBN-13: 978-1-4684-4612-8 e-ISBN-13: 978-1-4684-4610-4 001: 10.1007/978-1-4684-4610-4
Library of Congress Card No. 73-647002
©1984 Plenum Press. New York Softcover reprint of the hardcover 1 st edition 1984
A Division of Plenum Publishing Corporation 233 Spring Street. New York. N.Y. 10013
All rights reserved
No part of this book may be reproduced. stored in a retrieval system. or transmitted. in any form or by any means. electronic. mechanical. photocopying. microfilming.
recording. or otherwise. without written permission from the Publisher
Contributors
BASKIN, BARBARA H., Ed.D.-Director, Office of Special Education, State University of New York at Stony Brook, Stony Brook, New York 11794
BERKSON, GERSHON, Ph.D.-Professor, Department of Psychology, University of Illinois at Chicago, Chicago, Illinois 60680
COLEMAN, MARY, M.D.-Director, Children's Brain Research Clinic, and Georgetown University School of Medicine, Washington, D.C. 20008
FRIEDE, REINHARD L., M.D.-Professor, Department of Neuropathology, University of Gottingen, D-3400 Gottingen, Federal Republic of Germany
HARRIS, KAREN H., M.A.-Professor, Department of Curriculum and Instruction, University of New Orleans, New Orleans, Louisiana 70148
HILL, A. LEWIS, Ph.D.-Research Scientist, Institute for Basic Research in Mental Retardation, Staten Island, New York 10314
KIRMAN, BRIAN H., M.D.-Consultant Psychiatrist, Bodey's Park Hospital, Chertsey, Surrey KT16 OQA, England
KOLODNY, EDWIN H., M.D.-Associate Director, Eunice Kennedy Shriver Center for Mental Retardation, Waltham, Massachusetts 02254
LANDESMAN-DWYER, SHARON, Ph.D.-Associate Professor, Department of Psychiatry and Behavioral Sciences and Child Development and Mental Retardation Center, University of Washington, Seattle, Washington 98195
v
VI CONTRIBUTORS
MENNINGER, HEATHER S., M.H.S.M.-Transportation Project Director, California Department of Developmental Services, Planning and Evaluation Division, Sacramento, California 95814
RIMLAND, BERNARD, Ph.D.-Director, Institute for Child Behavior Research, San Diego, California 92116
WOLFF, SULA, M.D.-Consultant Psychiatrist, Department of Child and Family Psychiatry, Royal Hospital for Sick Children, Edinburgh EH9 1 LL, Scotland
Contents
INTRODUCTION: QUALITY OF LIFE. joseph Wortis . .................. xvii
CLINICAL ASPECTS. Brian H. Kirman. . . . . . . .. . . . . . .. . .. . .. . . .. . . . . 1
PERINATAL CEREBRAL DAMAGE. Reinhard L. Friede. . . . .. . .. . . . .. . .. 21
EARLY DIAGNOSIS. Mary Coleman. . . . . .. . . . . . . .. . . . . . . .. . . .. . . . . .. 47
LYSOSOMAL STORAGE DISEASES. Edwin H. Kolodny. . . . . . . . . .. . . . . . .. 59
SCHIZOID PERSONALITY. Sula Wolff.. . . . . . . .. . . . . . . . . . . . . ... . .. . .. 81
MENTAL RETARDATION IN JUVENILE FICTION. Barbara H. Baskin and Karen H. Harris. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 105
FRIENDSHIPS AND SOCIAL BEHAVIOR. Sharon Landesman-Dwyer and Gershon Berkson . ................................................ 129
IDIOT SAVANTS. Bernard Rimland and A. Lewis Hill . ................ 155
Vll
Vlll CONTENTS
TRANSPORTATION. Heather S. Menninger . ......................... 171
CUMULATIVE INDEX, Volumes 11-13 ............................. 207
Previous Volumes in This Series
VOLUME 1-1970
DEVELOPMENTAL PSYCHOLOGY. ZELDA S. KLAPPER
COMPARATIVE PSYCHOLOGY. GERALD TURKEWITZ AND HERBERT G.
BIRCH
CONDITIONING AND LEARNING. EUGENE A. SERSEN
CLINICAL ASPECTS. BRIAN H. KIRMAN
DOWN'S SYNDROME. BRIAN H. KIRMAN
NEUROLOGY. KYTjA VOELLER
NEUROPATHOLOGY. GEORGE A. JERVIS
NEUROPHYSIOLOGY. ROBERT J. ELLINGSON
METABOLISM. SELMA E. SNYDERMAN
EPIDEMIOLOGY. REMA LAPOUSE AND MARTIN WEITZNER
COMMUNITY ORGANIZATION: FOREIGN COUNTRIES. GUNNAR DYBWAD
AND ROSEMARY F. DYBWAD
COMMUNITY ORGANIZATION: U.S.A. LEOPOLD LIPPMAN
LEGAL ASPECTS. AUGUSTUS M. JACOBS
POVERTY AND RETARDATION: SOCIAL ASPECTS. HELEN WORTIS
POVERTY AND RETARDATION: BIOSOCIAL FACTORS. JOSEPH WORTIS
COMPLICATIONS OF PREGNANCY AND DELIVERY. CECIL M. DRILLIEN
TERMINOLOGY AND CLASSIFICATION. CHRISTOPHER SANDERS
CHRONICLE. ELIZABETH M. BOGGS
CALENDAR. IDA AXELROD
lX
x PREVIOUS VOLUMES IN THIS SERIES
VOLUME 2-1970
INTRODUCTION: WHAT IS MENTAL RETARDATION? JOSEPH WORTIS
CLINICAL ASPECTS. BRIAN H. KIRMAN
PHENYLKETONURIA AND PHENYLALANINEMIA. L. 1. WOOLF
DERMATOGLYPHICS. G. F. SMITH AND JOAN SCHINDELER
NEUROLOGY. KYTjA VOELLER
NUTRITION. ZENA A. STEIN AND HANNAH KASSAB
PEDAGOGY. H.C.GUNZBURG
READING DISABILITY. LILLIE POPE AND ABRAHAM HAKLAY
ARCHITECTURE. ARNOLD G. GANGNES
GENETICS. ARNOLD R. KAPLAN
SOCIAL WORK. RUDOLF P. HORMUTH
PARENT ORGANIZATIONS. PHILLIP Roos
CHRONICLE. ELIZABETH M. BOGGS
CALENDAR. BRIAN M. MCCANN
VOLUME 3-1971
CLINICAL ASPECTS. BRIAN H. KIRMAN
GUARDIANSHIP. KNUTE MARTIN
NEUROPATHOLOGY. GEORGE A. JERVIS
METABOLISM. SELMA E. SNYDERMAN
DENTISTRY. HAROLD DINER
RESIDENTIAL SERVICE. ELSIE D. HELSEL
FEDERAL LEGISLATION: 1955-1965. ELIZABETH M. BOGGS
OPERANT CONDITIONING. JAMES D. BLOCK
RECENT FRENCH LITERATURE. PSYCHOEDUCATIONAL ASPECTS.
ELEONORA jEDRYSEK
PEDIATRICS. CARL DRAYER AND GILDA GUZMAN-NEUHAUS
PSYCHIATRY. MICHAEL L. RUTTER
PREVENTION. JOSEPH WORTIS
CALENDAR 1971. ANGELA WILSON AND BARBARA SCHER
CHRONICLE 1970. ELIZABETH M. BOGGS
VOLUME 4-1972
INTRODUCTION AND ANNOUNCEMENT
CLINICAL ASPECTS. BRIAN H. KIRMAN
PARENT COUNSELING. HELEN WORTIS
PARENTS AS TEACHERS OF THEIR OWN CHILDREN. NANETTE L. DOERNBERG
PREVIOUS VOLUMES IN THIS SERIES
SOME RECENT TRENDS: A PARENT'S VIEW. JOSEPH T. WEINGOLD
GENETICS. ARNOLD R. KAPLAN
PSYCHOPHARMACOLOGY. JOHN S. WERRY AND ROBERT L. SPRAGUE
NEUROLOGY. KYTJA VOELLER
NEUROPHYSIOLOGY. ROBERT J. ELLINGSON
AUDIOLOGY. LYLE L. LLOYD AND E. J. MOORE, JR.
FEDERAL LEGISLATION (CONCLUSION). ELIZABETH M. BOGGS
RECENT ITALIAN LITERATURE. GEORGE R. JERVIS
CHRONICLE. GEORGE SOLOY ANIS
CALENDAR. GEORGE SOLOY ANIS
VOLUME 5-1973
INTRODUCTION: THE ROLE OF EDUCATION IN MENTAL RETARDATION
WORK. JOSEPH WORTIS
CLINICAL ASPECTS. BRIAN H. KIRMAN
PSYCHOMETRICS. C. E. MEYERS
BEHAVIOR. GERSHON BERKSON
NURSING. KATHRYN E. BARNARD
CEREBRAL PALSY. GABRIELLA E. MOLNAR AND LAWRENCE T. TAFT
CONGENITAL MALFORMATIONS: MICROCEPHALY. JOSEF WARKANY AND
PETER ST. J. DIGNAN
COMMUNITY SERVICE MODELS: Two FOREIGN SYSTEMS.
WEST GERMANY. TOM MUTTERS
NEW ZEALAND. R. G. MATHEWS
J APANESE LITERATURE AND DEVELOPMENTS. AKIHIKO TAKAHASHI
RECENT ADVANCES IN SOVIET DEFECTOLOGY. T. A. VLASOVA
CHRONICLE. GEORGE SOLOYANIS AND SUSAN YODER
CALENDAR. GEORGE SOLOYANIS AND SUSAN YODER
VOLUME 6-1974
Xl
INTRODUCTION: NATIONAL PRIORITIES AND THE HANDICAPPED. JOSEPH
WORTIS
CLINICAL ASPECTS. BRIAN H. KIRMAN
GENETICS AND INTELLIGENCE. V. ELVING ANDERSON
CONGENITAL MALFORMATIONS: HYDROCEPHALY. PETER ST. J. DIGNAN
AND JOSEPH W ARKANY
DEVELOPMENTAL BIOCHEMISTRY. W. A. HIMWICH AND H. C. ARGAWAL
U.S. FEDERAL FUNDS: A POLICY STUDY. DAVID L. BRADDOCK
SOCIOLOGY. BERNARD FARBER
EDUCATION. JAMES J. GALLAGHER
XlI PREVIOUS VOLUMES IN THIS SERIES
SEXUAL BEHAVIOR. JUDY E. HALL
PHYSICAL EDUCATION AND SPORT. FRANK J. HAYDEN
EMPLOYMENT. BERNARD POSNER
LANGUAGE. RICHARD L. SCHIEFELBUSCH
THE VOLUNTARY ASSOCIATION ON THE INTERNATIONAL SCENE.
ROSEMARY F. DYBWAD
CHRONICLE: 1972-1973. GEORGE SOLOYANIS AND SUSAN YODER
CALENDAR: 1974. GEORGE SOLOYANIS AND SUSAN YODER
VOLUME 7-1975
INTRODUCTION: THE DRIFT OF EVENTS. JOSEPH WORTIS
CLINICAL ASPECTS. BRIAN H. KIRMAN
DEVELOPMENTAL NEUROPHYSIOLOGY. GUENTER H. ROSE AND PETER E. TANGUAY
METABOLISM. SELMA E. SNYDERMAN
EPILEPSY. JOHN A. CORBETT, RUTH HARRIS, AND ROGER G. ROBINSON
CONGENITAL MALFORMATIONS: THE GENERAL PROBLEM. KENNETH L. JONES
CONGENITAL MALFORMATIONS: HYDRANENCEPHALY. JOSEF WARKANY
AND PETER ST. J. DIGNAN
EARLY STIMULATION. BETTYE M. CALDWELL, ROBERT H. BRADLEY, AND
RICHARD ELARDO
PUBLIC SCHOOLS. RONALD WIEGERINK AND RUNE J. SIMEONSSON
COMPUTERS IN EDUCATION . LAWRENCE M. STOLUROW
VOCATIONAL TRAINING. MARC W. GOLD
NORMALIZATION. HELEN R. ZIPPERLEN
SELF-HELP. ALFRED H. KATZ
PERSONNEL TRAINING. DONALD E. ZARFAS, BERNICE I. LOVERING, AND
HAROLD j. ROBBINS
SWEDEN: SERVICES AND DEVELOPMENTS. KARL GRUNEWALD
CHRONICLE: 1973-1974. GEORGE SOLOYANIS AND SUSAN YODER
CALENDAR: 1975. GEORGE SOLOYANIS AND SUSAN YODER
VOLUME 8-1976
INTRODUCTION: THE HISTORY OF INTELLIGENCE. JOSEPH WORTIS
THE RIGHT TO TREATMENT. MARSHALL J. COHEN
CLINICAL ASPECTS. BRIAN H. KIRMAN
GENETICS AND GENETIC COUNSELING. JOSEPH M. BERG
HEREDITARY DISEASE: SCREENING AND DETECTION. R. G. CHITHAM, D.
j.T. STARR,ANDj.STERN
PREVIOUS VOLUMES IN THIS SERIES Xlll
OPHTHALMOLOGY. JAMES L. KENNERLEY BANKES
INFECTIONS IN RESIDENTIAL INSTITUTIONS. MEIR YOELI AND GEORGE
P. SCHEINESSON
CONGENITAL MALFORMATIONS: MEGALENCEPHALY. JACK H.
RUBINSTEIN AND JOSEF WARKANY
GERIATRICS. SARA FINN KRIGER
HEALTH AND LONGEVITY. B. W. RICHARDS
PERSONALITY: ONE VIEW. MANNY STERNLICHT
PERSONALITY: ANOTHER VIEW. MORTIMER GARRISON, JR!
LEARNING. L. BEERMANN
CURRICULUM DEVELOPMENT. EDWARD L. MEYEN AND R. DONALD
HORNER
RECENT FRENCH LITERATURE. GABRIEL V. LAURY
CHRONICLE: 1974-1975. DIANA MORRISON-SMITH
CALENDAR: 1976. DIANA MORRISON-SMITH
VOLUME 9-1977
INTRODUCTION: THE ROLE OF PSYCHIATRY IN MENTAL RETARDATION
SERVICES. JOSEPH WORTIS
WILLOWBROOK. CHRISTOPHER A. HANSEN
WILLOWBROOK: A VIEW FROM THE Top. FREDERIC GRUNBERG
CLINICAL ASPECTS. BRIAN H. KIRMAN
INFECTIOUS DISEASES IN ETIOLOGY. MEIR YOELI, GEORGE P.
SCHEINESSON, AND BRUCE J. HARGREAVES
CONGENITAL MALFORMATIONS: THE CORPUS CALLOSUM. PETER ST. J. DIGNAN AND JOSEF WARKANY
PHYSICAL AND OCCUPATIONAL THERAPY. BILLIE LEVINE AND ANN
BIRCH
BEHAVIOR ANALYSIS. BEATRICE H. BARRETT
COGNITIVE DEVELOPMENT AND SOCIAL CLASS. BEVERLY BIRNS AND
WAGNER BRIDGER
ADMINISTRATION: PUBLIC AGENCIES. ROBERT M. GETTINGS
PEOPLE FIRST: A SELF-HELP ORGANIZATION OF THE RETARDED.
VALERIE SCHAAF, TERRY HOOTEN, TERRY SCHWARTZ, CHUCK
YOUNG, JEAN KERRON, AND DENNIS HEATH
INCOME MAINTENANCE: FEDERAL INCOME RESOURCES FOR PERSONS
WITH LONG-TERM DISABILITIES ORIGINATING IN CHILDHOOD.
ELIZABETH M. BOGGS
CHINESE-AMERICANS: ANOTHER MINORITY. AGNES LIN BURGER
LATIN-AMERICA: RECENT DEVELOPMENTS. MILENA SARDI DE SELLE AND
ALBERTO ABADI
CHRONICLE
XIV PREVIOUS VOLUMES IN THIS SERIES
VOLUME 10-1978
INTRODUCTION: How SPECIAL ARE SPECIAL SERVICES? JOSEPH WORTIS
THE RIGHT TO EDUCATION. LYNDA KATZ-GARRIS
CLINICAL ASPECTS. BRIAN H. KIRMAN
GROWTH AND MATURATION. ALAN T. RUNDLE AND P. E. SYLVESTER
THE AUTISTIC SYNDROMES. MARY COLEMAN
CONGENITAL MALFORMATIONS: LISSENCEPHALY, AGYRIA, AND
PACHYGYRIA. PETER ST. J. DIGNAN AND JOSEPH WARKANY
DRUGS FOR BEHAVIOR MANAGEMENT, WITH COMMENT ON SOME LEGAL
ASPECTS. ROBERT L. SPRAGUE AND GLADYS B. BAXLEY
SOCIAL COMPETENCE. RUNE j. SIMEONSSON
CRIMINAL JUSTICE. DOUGLAS P. BIKLEN AND SANDRA MLINARCIK
PUBLIC ASSISTANCE IN HISTORICAL PERSPECTIVE. MARK E. LITVIN AND
PHILIP L. BROWNING
A TAXONOMY OF FEDERAL PROGRAMS AFFECTING DEVELOPMENTAL
DISABILITIES. ELIZABETH M. BOGGS
SERVICES IN THE UNITED KINGDOM. G. B. SIMON
VOLUME 11-1980
INTRODUCTION: DYSLEXIA, LEARNING DISABILITY, BRAIN DAMAGE,
ORGANICITY, AND OTHER NON-ENTITIES. JOSEPH WORTIS
CLINICAL ASPECTS. BRIAN H. KIRMAN
EPIDEMIOLOGY. HOLGER HANSEN, LILLIAN BELMONT, AND ZEN A STEIN
DE INSTITUTIONALIZATION AND COMMUNITY SERVICES. ROBERT H.
BRUININKS, MARTHA L. THURLOW, S. KENNETH THURMAN, AND
JOSEPH S. FIORELLI
CONGENITAL MALFORMATIONS: HYPERTELORISM. JACK H. RUBINSTEIN
CONGENITAL MALFORMATIONS: ARHINENCEPHALY. JACK H.
RUBINSTEIN
THE CHROMOSOME SYNDROMES. CAROLYN TRUNCA
DEVELOPMENTS IN SOUTHEAST ASIA. G. G. PRABHU
THE LESS DEVELOPED WORLD: SOUTHEAST ASIA AS PARADIGM. ZENA
STEIN AND MERVYN SUSSER
VOLUME 12-1981
INTRODUCTION: QUESTIONABLE PRACTICES. JOSEPH WORTIS
SOME CURRENT TRENDS. BRIAN H. KIRMAN
COURT DECISIONS: THE IMPACT OF LITIGATION. BARBARA KENEFICK
PREVIOUS VOLUMES IN THIS SERIES
CONGENITAL MALFORMATIONS: CRANIUM BIFIDUM/ENCEPHALOCELE.
JACK H. RUBINSTEIN
METABOLISM. SELMA E. SNYDERMAN
COMMUNITY RESIDENCES: THE STAFFING. WILLIAM T. MCCORD
FERAL CHILDREN. SUSAN CURTISS
xv
Introduction: Quality of Life
JOSEPH WORTIS
The phrase "quality of life" came into circulation years ago in connection with dying patients whose lives were being sustained with respirators, intravenous feeding, morphine, or heroic surgery, all in the name of humanity, when the quality of their life no longer justified the effort. Over a century ago the British poet Arthur Clough wrote:
Thou shalt not kill, nor need'st thou strive Officiously to keep alive.
As often happens, a recent series of publicized cases created popular and official concern, and a right-to-die movement was initiated that led to permissive legislation in a number of states that allowed the suspension of life-sustaining measures in the case of moribund individuals whose quality of life made survival a burden.
The same principle was then invoked in a number of cases of newborn infants who were so hopelessly maimed and handicapped that their lives could only be a burden to themselves and others. Here however it was no longer a mature and responsible individual who could choose to die, but the parents of a helpless child who would make the decision. This complicated the ethical and legal dilemma, created serious proble.ms of definition and limits, and raised the threat oflegalized infanticide. In an effort to stop this kind of permissive infanticide, a federal law was then enacted forbidding the practice, but the law was nullified in court.
In the Indiana Baby Doe case findings, Judge Gesell declared that a XVll
XVlll JOSEPH WORTIS
peremptory generic ruling by a federal law that any and every severely and multiply handicapped child must be permitted to survive should not be permitted to interdict a decision jointly made by parents, their physician, the hospital, and the local court. Without detailing the specific merits of the case, it would appear that the concurrence of all these elements would be sufficient safeguard that justice had prevailed.
Our code oflaw, generally speaking, can be regarded as the expression of widely accepted ethical norms or value systems, and it becomes difficult to enforce laws-as we learned during the years of Prohibition-that conflict with popular beliefs. It is thus not surprising for example that even where suicide and murder are prohibited by law, mercy-killings, suicide, and euthanasia have generally been condoned and exonerated in our courts when circumstances have justified them. No matter what complex legal formula is applied, and no matter what commissions on ethics are created, it is hard to imagine a formalized legal sanction to murder (even when we wage war or inflict capital punishment) that is not liable to abuse. Nevertheless extralegal acts will continue to take place, as they always have in the past, at the peril of the perpetrators, who may have to defend their action ex post facto in court.
But nowadays we hear discussions of the quality of life in other connections, often in relation to services to the handicapped. Standards of care, now required by court rulings, not only demand proper food, shelter, clothing, and medical attention, but an overall quality of life that provides dignity, pleasure, and maximum freedom for the individual. In the recent period, in the face of economic decline, rampant inflation, and budgetary cutbacks, this has been increasingly difficult to achieve, and the courts have proven to be impotent when legislatures refuse to appropriate enough money to satisfy these needs.
Can we maintain a reasonable quality of care for the handicapped when the quality oflife for most of our population is declining? A few facts, gleaned mostly from the pages of The New York Times, give us the answer. Real income, measured in constant dollars, has decreased over 10% in the past twelve years. Thousands of small farmers have gone bankrupt. In 1981 the official threshold of poverty set by our government was an income of $9287 a year for a family of four. In that year the number of Americans thus classified as poor had risen to involve 14% of the population, the highest rate since 1967. In our black population it was 34.2%. All superficial impressions to the contrary, there is widespread hunger and malnutrition in the U.S:A., greatly exacerbated these past few years. Back in 1972 Public Law 92-433 authorized an initial program with a very modest $20,000,000 to provide food supplements to poor and hungry pregnant
INTRODUCTION: QUALITY OF LIFE XlX
women and their children to age four (known as WIC, the Women's Infants' and Children's Program), but the program has been consistently obstructed and stifled since then. Our Department of Agriculture has conservatively estimated that 9,600,000 women and children are eligible for, and need, food that WIC provides, but as of 1980 only 1,800,000 were receiving those benefits. President Reagan proposed to cut this case load by 30%.
The year 1980 brought the first decrease in life expectancy since 1967 in this country. Death rates for young people aged 15-24 have been steadily rising since 1976, mostly because of accidents and violence. Homicide is the cause of 39% of the deaths of young black males, while suicide rates have increased for everybody in this age group. Official unemployment is over 10%, not counting the partially and minimally employed, the demoralized, and the new unemployed additions to our labor force.
Our government has been drastically reducing all programs for the weak and disabled. Government's commitment to the social welfare state was supported to varying degrees by all previous Democratic and Republican presidents and remained on course until the arrival of President Reagan. Through various devices Congress has already approved cuts in Medicare and Medicaid of $25,000,000,000 between 1983 and 1987. One of the cruelist dispensations of our administration was the ruling that would reduce by 60% the Medicare benefits to the terminally ill. Through the evasive and obfuscating device of block grants to the states, human service programs are to be cut by 25%, and maternal and child care programs by 13%. Congress, to its credit, refused to submerge the funds for developmental disabilities into these truncated block grants, and specifically authorized $61,000,000 for this purpose. When the administration tried to slash support for the training of health professionals, it was forced to include $120,000,000 for that purpose in its fiscal 1984 budget.
Benefits under Title XX have been drastically reduced in the Reagan budget by $1,000,000,000, or one third of its total. Supplemental Security Income was curtailed in several ways to cut its current role of 4,000,000 people: over 250,000 people were dropped last year, and hundreds of thousands are threatened. On appeal many decisions were reversed, and more humane practices have been promised, but the cuts go on.
Because of these developments, aggravated by cutbacks in rent subsidies and other services, many disabled persons are without adequate services: their day care, work activity, sheltered workshops, counseling services, and transportation, all formerly funded through Title XX, are no longer available, and community life itself is often no longer possible.
One could go on, and tell of the failure of our educational system, the
xx JOSEPH WORTIS
rampant increase in crime, and the general decline in morale, but this is enough to describe the trend. Meanwhile, our expenditures for the dangerous and threatening nuclear arms race are enormous and appalling. If the Reagan administration has its way, it will amount to $214,800,000,000 in 1983, a 6 to lO% increase in 1984, and so on up to $370,000,000,000 by 1986. In these budgetary projections, if Social Security payments (which are self-funded) are excluded, nearly two thirds, or 63%, of all federal expenditures would go to the military. Only 24% is left to the states and localities, largely for human service programs, and the remaining 13% to government operations. In a recent subcommittee hearing of the Ways and Means Committee of the House of Representatives, our National Association for Retarded Citizens joined with other interested groups to declare:
We believe it is time to relieve the poor, disabled and elderly of their role as victims in the fight for national security and a balanced budget. How can they continue to care that their country is safe if they are not themselves safe from their own country?