Special Article

How we deal with cognitive challenges

In 2006, Warren offered to donate his time to put together for the Miriam Foundation's Exceptional Family magazine website an historical perspective on the evolution of treatment for Canadians dealing with cognitive challenges. During the course of his research, Warren discovered that the histories of such treatments in Canada and the United States were intertwined. Researching cognitive challenges broadened into a study of how mental illness was treated in both countries because prior to, and for most of, the 20th century doctors and health officials categorized all cognitive disorders as a mental illness. We now know better, which is why treatment options have improved dramatically over the last few decades for cognitive conditions such as attention deficit disorder, dyslexia, dyscalculia (difficulty with math) and autism. In 2010, the Miriam Foundation redid its website for Exceptional Family magazine. Unfortunately, Warren's essay was dropped from the new site. So we have reproduced it here in its entirety as a service for people interested in learning the evolution of treatments for North Americans facing cognitive challenges.

The Stereotype

Dating back to our childhood, many of us remember the 19th century nursery rhyme, Simple Simon, about a naïve, penniless youth who tries unsuccessfully to convince a merchant "pieman" to give him a piece of pie — "let me taste your ware" — without paying for it.

Says the pieman to Simple Simon,
"Show me first your penny."
Says Simple Simon to the pieman,
"Indeed I have not any."

The Three Stooges: Seemingly simple, but not always.

As a result of this popular rhyme, the term Simple Simon has evolved into a cultural synonym for a foolish fellow, a simpleton, perhaps even someone with below average intelligence.

Despite the less than flattering image conjured up by such interpretations, entrepreneurs in the Western World have seized upon the name Simple Simon as a marketing tool to sell everything from pies and pizzas to computer technology and real estate.

Interestingly, The Three Stooges, those slapstick comedians of the 1930s, 40s and 50s whose short films are still in syndication for young (and old) audiences of today, turned the cultural paradigm of Simple Simon on its head by doing a short film in which they made Simple Simon the wise one and the pieman his foil with the following dialogue which precipitates a pie fight:

Said de pieman to Simple Simon,
“Foist let me see yah penny.”
Said Simple Simon to de pieman,
“Nah! Ya don’t get any!”

This multi-faceted interpretation that can be applied to a Simple Simon began to take root among health care professionals in the early 1970s who began to take a fresh look at children and adults with cognitive disabilities, individuals whom we might have dismissed in earlier years as Simple Simons.

Instead of looking at what they could not do, medical professionals, educators and social workers began to consider what the potential of such individuals could be if they were given the proper training and support mechanisms to integrate into their communities.

Organizations to help such individuals began to pop up across North America. They discovered that working with young children holds the greatest potential because experience has shown that initiating treatment at a young age increases the possibility that the child in question will be able to take his or her rightful place as a productive and well-adjusted member of society.

O Canada!

On an individual level, Canadian parents of 181,000 children with cognitive and/or physical challenges know first-hand the kind of patience and perseverance that is required day-to-day to secure access to the best community resources for their exceptional children.

In some ways, Canada has surpassed the U.S. in its treatment of exceptional children.

Of the 181,000 such children, Statistics Canada reports that 57.4 percent experience a mild to moderate disability, while 42.6 percent have a severe or very severe disability. In Quebec, the disability rate for children between the ages of 5 and 14 is almost double the national average.

Those statistics were culled from the Stats Can Participation and Activity Limitation Survey, as revealed by Exceptional Family Editor Aviva Engel in the inaugural issue of that magazine in the fall of 2005.

What many readers might not be aware of is the sad history of how children with disabilities were treated in ancient civilizations and the hundreds of years of heartbreak and cruelty that preceded the more enlightened attitude of the last three decades in the Western World.

When we speak of disabilities, we are speaking of cognitive as well as physical ones. The two can go hand-in-hand and may, in fact, have a causal relationship.

Canada and the U.S. have traveled a common road in this treatment area due to a shared European heritage and as a result of close bonds forged since the late 19th century between mental health advocates in both countries.

But it might surprise you to learn that in some ways Canada has been ahead of the U.S. in treating exceptional children, partially due to our national health insurance program, known as medicare, which has been in effect since 1966 and includes taxpayer-funded mental health care for all members of the population.

As of 2011 the U.S. was in the process of amending its public health care coverage, but most Americans have grown up in a system where both physical and mental health care were paid for by patients, the more wealthy of whom had insurance coverage paid either by themselves or in combination with their employer under group health plans.

In the sub-section Historical Perspective, we've made a serious effort to trace some of the major developments worldwide in health care for the disabled going back centuries with a view to bringing you up to the present in Canada. The section is intended to put into a worldwide context the evolution of present-day treatments available to exceptional children in Canada. In the subsequent sub-section, Can-Am Do, we explore the great strides Canada and the U.S. began to make in the fields of mental health care through joint and individual efforts in the 19th and early 20th centuries.

At this point, we should differentiate between cognitive disabilities and the more encompassing "mental health issues." A person with a cognitive disability has greater difficulty with one or more types of mental tasks than the average person. Most cognitive disabilities have some sort of basis in biology or brain chemistry which is often determined by genetics.

Among frequently reported cognitive problems:

• Concentration and attention

• Perception

• Planning and organizing

• Written and oral communication

• Short and long-term memory

• Judgment

• Sequencing

• Orientation

Some of the most common cognitive disabilities among children are dyslexia, Attention Deficit Hyperactivity Disorder, autism and Down's syndrome. Sometimes such cognitive disabilities are accompanied by physical symptoms such as a lack of coordination.

That said, it is only in recent decades that health-care professionals have begun to distinguish cognitive disabilities from the more serious "clinical" mental illnesses that require treatment by psychotherapy, psychotropic drugs or other similar methods.

So when you read the history of disability treatments in the sub-links which follow you will find allusions to many physical and mental health problems, including what we nowadays refer to as "cognitive" challenges, because such health-care issues were all lumped together until recent decades.

You will also find references to treatments for both children and adults because, once again, for most of human history children were considered to be small versions of adults in discussions concerning disabilities.

Historical Perspective

Most ancient civilizations, including the Egyptians, Greeks and Romans, practiced a heart-wrenching custom which involved exposing new-born children of poor families to the elements — laying them on the ground outside — in the hope that wealthier individuals who could afford to educate them would adopt the infants before they perished due to exposure.

Hippocrates was the first physician to state that cognitive problems have a physiological, natural basis.

However, the inhabitants of Laconia, a Greek province in the southern Peloponnes whose capital was Sparta, had an even more barbaric version of that custom, whereby "weakly or deformed" children were "cast into a deep cavern in the earth, near the mountain Taygetus, as thinking it neither for the good of the children themselves or for the public interest that defective children should be brought up." — Encyclopaedia Britannica, 3rd edition, 1788-1797.

It was not until 460 BC that Hippocrates, whose Oath of Medical Ethics is still followed by doctors, became the first physician to challenge the ancient belief that mental illness was caused by supernatural causes. Hippocrates said that cognitive problems had a physiological, natural basis.

Hippocrates held that the body must be treated as a whole and not just as a series of parts, a precursor to the holistic medical movement of today. He believed that the natural healing abilities within each one of us is the greatest force in getting well.

Unfortunately, the advent of the Middle Ages starting in the 5th century AD buried such enlightened theories under the dark shadows of demonology and witchcraft.

Such archaic theories were disputed by two of the most prominent physicians of the Renaissance Period (1300-1600) — the German-born Paracelsus (1493-1541) and the Dutchman Johann Weyer (1515-1588), considered a pioneer in the field of psychiatry. Complicating matters was the fact that although Weyer did believe in the existence of witches, he thought they should be treated by priests and physicians — not prosecuted — because they posed no danger to anyone but themselves and certainly were not responsible for mental illness.

Philippe Pinel favored a more humane approach to mental problems.

It was not until 200 years later — the beginning of the Industrial Revolution —that Philippe Pinel (1745-1826), director of two Paris institutions for patients with mental illness, took it a step further and spoke out in favor of a more humane approach.

Pinel, after whom the The Philippe Pinel Institute in Montreal is named, began taking a personal interest in the treatment of patients with mental problems after a friend of his went mad and ran into the countryside where he was eaten by wolves in 1785. Although he is properly considered one of the founders of psychiatry, Pinel's contemporaries regarded him as a master of internal medicine.

Pinel discarded the long-popular equation of mental illness with demoniacal possession, regarding mental illness as the result of excessive exposure to social and psychological stresses, and in some measure, of heredity and physiological damage.

He did away with such treatments as bleeding, purging and blistering, instead favoring a therapy that included close and friendly contact with the patient, discussion of personal difficulties and a program of purposeful activities.

Many important thinkers of the pre-French Revolution era in France, including Jean-Jacques Rousseau, Voltaire and Denis Diderot, were known as "Encyclopedists" and were concerned about the welfare of oppressed people, including those with intellectual disabilities.

At about the same time in England, the Society of Friends (Quakers) supported the work of William Tuke (1732-1822), a wealthy tea and coffee merchant who established in 1796 the York Retreat for the humane care of people with mental illness, the first of its kind in England.

Tuke pioneered new treatment methods for such people, including their release from chains and the implementation of therapeutic programs of occupational tasks whereby patients were expected to perform manual labor.

Both of these initiatives — English and French — of the 19th century were light years ahead of most European standards.

It was not until the mid-19th century that child protection laws came into force.

In describing mental health abuses of past centuries, we should reiterate that no distinction was made between adult and child because there were no child protection laws with enforcement mechanisms at that time. In essence, children were treated as smaller versions of adults with brutal and tragic consequences.

In fact, one of the horrors of the Industrial Revolution was that even able-bodied children were forced to toil long hours in factories — 12 hours a day, six days a week — under horrific working conditions.

In fact, one of the horrors of the Industrial Revolution was that even able-bodied children were forced to toil long hours in factories — 12 hours a day, six days a week —under horrific working conditions.

It was only in 1833 that the Parliament of Britain, where the Industrial Revolution began, passed its first Factory Act, which established a minimum working age of 9. But is was not until a third and final Factory Act was passed in 1853 that children under age 18 had their workday reduced to a maximum of 10 hours.

The able-bodied children who could work were lucky, compared with those children who had cognitive disabilities. In most metropolitan cities of 19th century Europe, those who had intellectual disabilities — adults and children — were considered to be insane and were, "if at all troublesome, confined to jails, where they were chained in the lowest dungeons or made the butts and menials of the most debased criminals," according to the 8th edition of Encyclopaedia Britannica (1852-1860). "Even in the public asylums…the inmates were generally confined in low and damp cellars, sometimes isolated in cages or chained to the floor or wall…The medial treatment consisted, perhaps, in an annual bleeding and a few emetics while the lash was systematically used…."

In its 8th edition (1852-1860), the Encyclopeadia Britannica noted that those suffering from psychiatric or cognitive illnesses were considered so unimportant in the 19th century that no medical schools in Britain had any curriculum dealing with mental illness.

Can-Am Do

The treatment of people with mental illness in both New France and British North America in the 18th and 19th centuries was primarily a family responsibility, but patients who could not be cared for at home found themselves placed in jails and poorhouses under deplorable conditions, similar to those in European institutions. They were often caged or kept in barred rooms.

Maine-born schoolteacher Dorothea Dix crusaded for mental health reforms in the U.S. and Canada.

"The mentally ill (in Canada)…were thought to be morally unfit and were treated essentially as sinners," according to The Canadian Encyclopedia, Volume 2. They could expect "overcrowding, poor sanitary conditions, inadequate food and heating, and no intervention or treatment."

But starting in the mid-19th century, the history of mental health reform in Canada and the U.S. was led by both Canadians and Americans who collaborated in efforts to bring improved conditions to patients in both countries.

Dorothea L. Dix (1802-1887) was a Maine-born schoolteacher who changed the way Canada and the U.S. cared for those who were mentally ill and poor. She wrote, lectured and informed the public and legislators in all the states east of the Mississippi River about the deplorable conditions in mental institutions whose inmates were treated more like criminals than patients.

In her biography of Dix, author Jenn Bumb writes that "in all she played a major role in founding 32 mental hospitals, 15 schools for the feeble-minded, a school for the blind and numerous training facilities for nurses."

According to Bumb, Dix became an advocate for mentally ill patients in March 1841 when, at the age of 39, she visited the East Cambridge Jail in the Boston area to teach a Sunday School class for women inmates. "Within the confines of this jail she observed prostitutes, drunks, criminals, retarded individuals and the mentally ill were all housed together in unheated, unfurnished and foul-smelling quarters."

She successfully lobbied the Massachussetts legislature to support and fund care for mentally ill patients at Worcester State Hospital.

At that time, the only asylums in Canada was one built in Saint John, N.B. in 1835 and another one started in an abandoned jail in Toronto in 1841.

American Clifford Beers was the founder of the mental health movement in North America.

Among the successes of Dix in Canada was the establishment of a mental hospital in St. John's, Nfld. in 1885 and the building of a mental hospital for patients in Nova Scotia as a result of her successful lobbying of the legislature in that province.

Clifford W. Beers (1876-1943) was another American who had a large cross-border influence as founder of the mental health movement in North America.

At the age of 18 while a sophomore at Yale University, Beers suffered from a severe mental depression and subsequently spent two years in private and state hospitals in Connecticut where he became aware of the appalling treatment and physical abuse suffered by patients.

Upon recovery, he wrote a book about his experiences, A Mind That Found Itself which was published in 1908, the year Beers founded the National Committee for Mental Hygiene which fought to improve care for people in mental hospitals in the U.S. and tried to correct the misimpression that one cannot recover from mental illness.

The honest yet balanced views expressed in his autobiography had a major impact on the public and were instrumental in his developing a national, and ultimately an international, movement.

Ten years later, in 1918, Beers, an engineer by training, hooked up with Dr. Clarence Hincks of St. Marys, Ont. to organize the Canadian National Committee for Mental Hygiene, which later became the Canadian Mental Health Association. In 1920, Beers and Hincks organized the International Committee for Mental Hygiene, which in 1948 became the World Federation for Mental Health with headquarters in London, England. The two men collaborated to plan the first International Congress on Mental Hygiene held in Washington in 1930.

Hincks (1885-1964), the only child of a school teacher and a Methodist minister, had an interest in mental health due to a life-long battle with manic depression.

As a young doctor in Toronto, Hincks took a special interest in school children who were having trouble keeping up with their assignments. He was deeply troubled that many of them had been assigned the pejorative labels of "feeble-minded" and "idiot" by school authorities who wanted them confined to asylums. Hincks believed that many of these children could be helped with the proper support and tutoring.

Dr. Clarence Hincks, a Canadian, worked with American Clifford Beers to found what would become the Canadian Mental Health Association.

How gratified would Hincks be to know that 42 years after his death, Exceptional Family magazine published a feature story in its summer 2006 issue about programs to enhance the intelligence and capabilities of exceptional children. The article, written by Editor Aviva Engel, is based on an interview with Prof. Reuven Feuerstein, an internationally renowned expert on Structural Cognitive Modifiabilty and the Mediated Learning Experience.

The article quotes the Jerusalem-based Prof. Feuerstein as saying: "When you define a child as 'learning-disabled' once, he will be learning disabled forever."

But in the early years of the 20th century, Hincks was one of the first physicians in Canada to recognize the value of prevention and of treating those with mental illness before they were incapacitated. His work led to the development of child-guidance clinics for the early detection and prevention of mental illness.

Academic interest in childhood cognitive development began in earnest at about that time and Hincks persuaded benefactors to fund the St. George's School for Child Study at the University of Toronto and the McGill University Nursery School and Child Laboratory in Montreal in 1925.

Hincks had a profound influence on Samuel Laycock (1882-1971), a Western Canadian psychologist who became professor of educational psychology in 1927 at the University of Saskatchewan and director of education for the Mental Hygiene Committee in 1929.

There were other notable Canadians who lobbied for more enlightened treatment of disabilities in the 19th century.

Dr. Richard Bucke, who was appointed superintendent of the Asylum for the Insane in Hamilton in 1876 and a year later of the asylum in London, Ont., believed that mental illness was a "failure of the biological process by which mankind adapts to change."

The Canadian Encyclopedia (Vol. 2) describes Bucke's accomplishments in the following terms:

In his attempts to reform the crude treatment of mentally ill patients, he abandoned the practice of pacifying the inmates with alcohol, ceased to restrain the patients, opened an infirmary to treat physical ills, and inaugurated regular cultural and sports events in which patients were encouraged to participate.

Another 19th century reformer was Dr. Charles K. Clarke, who as superintendent of the asylum at Kingston, Ont. changed it from a jail to a hospital by 1887 and instructed the nurses and attendants about the proper care of patients with mental illness, which included disposing of all physical restraints.

Modern Horrors

Paradoxically, Dr. Charles K. Clarke, lauded in our previous sub-link as a champion of the rights of Canadian mental health patients, was also an advocate of eugenics, one of the most intolerant and dangerous trends to sweep the globe in the late 19th and early 20th centuries.

"Eugenics," which in Greek means "well-born," was a term coined in 1883 by Francis Galton, Charles Darwin's cousin, to describe the process of influencing the physical or mental qualities of future generations through sterilization, marriage laws and segregation of the handicapped. One of its promoters was author Aldous Huxley, who summarized some of these ideas in Brave New World.

Eugenics was a government policy in Germany dating back to the early 20th century and was openly taught and practiced in medical establishments in that country. Between 1933 and 1945, the Nazis carried out such policies with great zeal as executed by their SS against minority groups.

Emily Murphy, an Edmonton-based social activist and author, favored eugenics even though she considered herself a defender of women's and children's rights.

Paradoxically, Dr. Charles K. Clarke, lauded in our previous sub-link as a champion of the rights of Canadian mental health patients, was also an advocate of eugenics, one of the most intolerant and dangerous trends to sweep the globe in the late 19th and early 20th centuries.

"Eugenics," which in Greek means "well-born," was a term coined in 1883 by Francis Galton, Charles Darwin's cousin, to describe the process of influencing the physical or mental qualities of future generations through sterilization, marriage laws and segregation of the handicapped. One of its promoters was author Aldous Huxley, who summarized some of these ideas in Brave New World.

Eugenics was a government policy in Germany dating back to the early 20th century and was openly taught and practiced in medical establishments in that country. Between 1933 and 1945, the Nazis carried out such policies with great zeal as executed by their SS against minority groups.

Martin Pernick’s 1996 book, The Black Stork, describes the Baby Bollinger case of 1915 and the efforts of Dr. Harry Haiselden to institute the medical practice of euthanizing children with disabilities.

The Kennedy Institute of Ethics at Georgetown University published a paper on the Bollinger case which reads in part:

In 1915, just before Thanksgiving, a baby was born without a neck, with only one ear, with a misshapen chest and misshapen shoulders, and with serious internal malformations. The doctor who delivered the baby at Chicago's German-American Hospital called in Dr. Harry Haiselden, a surgeon, to examine the baby. Haiselden concluded that this "defective" baby's life would not be worth saving. He convinced the parents, Anna and Allen Bollinger, to let their son die rather than embark on a series of operations to repair some of the baby's physical deformities….

Baby Bollinger was one of a number of babies whose deaths were "managed" by Haiselden. At first, Haiselden would let deformed babies die, but as time went on he would abet the process by injecting the babies with narcotics. He did not hide his role in these deaths. In fact, he wrote newspaper articles about the babies, gave lectures, brought reporters to the hospital to have a look at the dying newborns, and eventually wrote a film script for a full length silent film called The Black Stork in which he publicized and glamorized his role in the deaths of the babies. No actor was hired to portray Haiselden; he chose to portray himself.

Even though she was a deaf blind woman who was a role model for millions, Helen Keller supported euthanasia of babies with severe disabilities.

Ironically, among his supporters, Haiselden counted Helen Keller (1880-1968), the deaf blind woman who was a role model for millions of people and whose remarkable life story was well known from books and the 1962 movie The Miracle Worker. Although she was a strong advocate for the handicapped, Keller's position was that "a human life is sacred only when it may be of some use to itself and to the world."

Haiselden got into a certain amount of trouble for what he did, but he got into more trouble for bragging about it and broadcasting his activities. Eventually, he was ousted from the Chicago Medical Society.

As one can glean from reading its history, the euthanasia movement in the United States, which lasted until the 1970s, was not a lunatic fringe movement. It was well publicized in newspapers and media, and strongly promoted by professionals.

This can be better appreciated when one considers that during the Second World War, the American Psychiatric Association published a lead editorial in their journal that endorsed the legal euthanasia of children who were mentally retarded and the provision of psychotherapy to parents to relieve them of their guilt.

These attitudes in medicine and other scientific disciplines strongly influenced the treatment of persons with these conditions in America throughout the 20th century and transformed the nature of institutional care.

In New York state, some of the first American institutions that had been built to train, rehabilitate and release persons became places where they went to live forever with little hope of ever being released into the community.

The 1975 Academy-awarding winning film, One Flew Over the Cuckoo's Nest, captured the authoritarian, dehumanizing environment of a typical American mental hospital of the 20th century. Jack Nicholson plays the role of rebel inmate McMurphy — a flamboyant, wise guy anti-hero who challenges institutional authority and status-quo attitudes. Expressing his basic human rights and impulses, the protagonist protests against heavy-handed rules about watching the World Series, and illegally stages both a fishing trip and a drinking party in the ward — leading to his own paralyzing lobotomy at the hands of hospital medical personnel.

Due to this attitude of hopeless as it pertained to people with disabilities, more and more children in the U.S. were committed to institutes so that by 1943, 32 percent of beds in N.Y. state "institutions," "schools" and "colonies" — as they were originally called — were filled by children aged 5 to 10.

Almost every U.S. state had laws, (some staying on the books as late as the early 90s), which either prohibited or strongly discouraged people with disabilities from being a part of public life. In the article A Little History Worth Knowing, Timothy Cook cites examples of language found in state laws pertaining to such people.

Modern Era

The attitude of Canadians towards mental health changed during the Second World War after medical examinations revealed that thousands of the apparently healthy 1.1 million members of the Canadian military suffered from some form of mental problems.

Thousands of Canadian soldiers in WW II suffered psychological problems.

This finding stimulated research into preventive measures and methods of treatment, according to The Canadian Encyclopedia, and "led to a better understanding of the emotional needs of children and of the role of stress in causing mental disorders."

"Indeed, it is commonly held today that symptoms of much mental illness are a response to everyday or unusual stresses and are probably transitory."

Starting in the early 1970s, when Miriam Foundation — the financial and moral backer of Exceptional Family magazine — opened its doors in west-end Montreal, Canadian and U.S. practitioners in the field began evaluating psychotherapeutic, behavioral and biochemical interventions for mental health problems in support of what has become known as the Independent Living Movement.

Health-care professionals in both countries began to see the advantages of treating cognitive disabilities on an out-patient basis, with a view to allowing individuals with challenges to live at home and to integrate into their educational environment and into their work-place communities.

Kathy Martinez, International Director of the World Institute on Disability based in Oakland, California, wrote an on-line treatise in 2003 on the evolution of the Independent Living Movement in the U.S. and Canada.

Martinez says that Canada followed Sweden in the early 1970s as one of the first countries in the world to "de-institutionalize" people with developmental disabilities, recognizing that such individuals would fare better if integrated into their home communities.

This movement, Martinez says, was led by service providers and parents of people with developmental disabilities and was based on the principle of "normalization" developed by Bengt Nirje of Sweden and Wolf Wolfensberger, a German sociologist working for the Canadian National Institute on Mental Retardation in Toronto.

Wolfensberger's theory was that people with developmental disabilities should live in the most "normal" setting possible if they were expected to behave "normally." Dr. G. Allan Roeher, Ph.D., then director of the Canadian National Institute on Mental Retardation, was also considered an innovator and brought international consultants to Canada to help develop more humane social services. This de-institutionalization movement, which was the precursor to the Independent Living Movement, was a significant contribution from Canada, Martinez wrote.

An Independent Living Movement centre located in Kingston, Ontario.

"It appears to have been the first international movement focused on supporting the group considered the most severely disabled," she went on to say. "It was radical for the times, suggesting that people with cognitive disabilities could be better served outside institutions. In many ways, this was the first movement that acknowledged their humanity and served as a precursor to the renowned international organization, People First, which was also founded in Canada."

According to a paper by Victor R. Willi on Independent Living (IL) in Canada, the IL movement, with its philosophy, principles and attitude, was introduced into Canada by Gerben deJong at the Coalition of Provincial Organizations of the Handicapped (COPOH) national conference in Vancouver in 1980.

Willi states that: "IL evolved as a social movement or struggle for civil liberties by persons with a disability using self-help tactics. The idea of one disabled person helping another was revolutionary since it is not unusual, even today, for persons with a disability to avoid each other. Independent Living is really about interdependence, not living in isolation."

Willi estimated that there were 25 thriving Independent Living Resource Centers across Canada, from Newfoundland-Labrador to Vancouver Island as of about 2003. In addition, there are number of new centers with pending membership applications with the Canadian Association of Independent Living Centers, which was formed in 1985.

At the same time that the Independent Living Movement started to evolve into the mantra of the 1970s and onward, professionals in the field also began to be understood that the earlier in life that an intervention began, the greater the chance that an exceptional child could, with the proper support infrastructure, lead close to a normal life as an adult.

IQ tests were no longer the sole basis for judging developmental disabilities. A diagnosis of cognitive disability was now made only if an individual had an intellectual functioning level well below average, as well as significant limitations in two or more adaptive skill areas.

Adaptive skills refer to skills needed for daily life, including the ability to produce and understand language (communication); home-living skills; use of community resources; health, safety, leisure, self-care and social skills; self-direction; functional academic skills (reading, writing and arithmetic); and job-related skills.

What parents should be aware of is that many of the thousands of Canadian children diagnosed as having mild cognitive impairments can become fairly self-sufficient and, in some cases, live independently with community and social support provided by institutions.

Looking Ahead

We started The Stereotype segment of this article with an allusion to Simple Simon as an allegorical reference to the issue of care for exceptional children. Now just over 5,000 words later, after tracing the history of care for the disabled up to the present time in Canada, we think you'll likely share our conclusion that there is nothing "simple" about the matter.

The truth is that like most causes and issues throughout history, there are shades of gray, nuances and outright contradictions. How else to explain what we would consider, in looking back, the absurd ironies of 19th and 20th century social reformers in Canada opting for the deleterious sophistry of a pseudo-science such as eugenics which the Nazis later used to destroy those unfortunate souls who did not live up to their Aryan standards of beauty and brains?

Eunice Kennedy Shriver overlooks Chicago's Soldier Field in 1968, site of the first Special Olympics.

Yet even amid the contradictions, we find progress. For example, it is well known that the patriarch of the Kennedy clan, Joseph Kennedy, was an admirer of Adolf Hitler when Kennedy served as the American ambassador to the Court of St. James in London prior to the Second World War.

It was the same Kennedy who opted to have his mildly retarded daughter, Rosemary, undergo a prefrontal lobotomy at age 23 leaving her incapacitated in an institute for the rest of her life. Prior to her prefrontal lobotomy in 1941, Rosemary's diary entries revealed a life filled with outings to the opera, tea dances, dress fittings and other social interests. She died on Jan. 7, 2005. According to the Wikipedia on-line encyclopedia, Rosemary's problem may have been a misdiagnosed case of "agitated depression."

Yet this same Kennedy family, which had been so ashamed of Rosemary that it hid her away from public view, was instrumental through its organizational and financial support of launching an international version of the Special Olympics for mentally handicapped individuals founded by Dr. Frank Hayden of London, Ont. More than 1,000 cognitively challenged athletes from 26 states and Canada took part in the first such international Special Olympics in July 1968 at Chicago's Soldier Field, competing in track and field, floor hockey and aquatics.

The Special Olympics concept was the brainchild of Hayden, who had done research which indicated that cognitively challenged individuals were capable of fitness levels previously thought unattainable. His work came to the attention of Eunice Kennedy Shriver, the sister of Rosemary and of the late President John Kennedy, and the Kennedy Foundation in Washington, D.C.

The 2007 Special Olympics World Summer Games were to be held in Shanghai, China, with more than 1.5 million athletes from 160 countries around the world vying to make their respective squads.

Once again, this last anecdote illustrates the fact that when looked at over a continuum of centuries, we can appreciate that treatment norms and expectations have changed tremendously as people with disabilities have been given the opportunities and support to take their rightful places as productive, successful members of our communities.

Members of our society with disabilities are considered to be among our most vulnerable citizens, but through treatment and perseverance many have evolved into productive, successful, well-adjusted individuals.

The truth is that exceptional children are among our most resilient and treasured resources because they teach us that the pure of heart and spirit can overcome the most daunting of physical and cognitive challenges if we'll just accept them for who they are, rather than for what they cannot do. In the final analysis, that is the spirit of the human journey.