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One important point needs to be made here. It is often felt that we should not push such individuals of extremely low capacity into work and some authors have implied that this is a cruel and unethical procedure. Yet actually so far all the indications seem to point to work performance as the factor which stimulates these extremely retarded individuals sufficiently so they can participate in some group programs and enjoy group recreation and other pursuits.

At the same time, I want to reemphasize that this young man whose story I told in detail remained for years in a program that was not appropriate for his age and that, consequently, did not put before him the kind of increasing demands which should have been made upon him. This infantilizing of the severely and profoundly retarded is something one can observe in all too many countries and is a practice that urgently needs correction.

May I make an explanatory comment here -- I purposely have chosen cases from the lower levels of mental retardation because it seems to me we have, at this time, more to communicate from the lower to the upper levels than from the upper to the lower levels. But, certainly, I am aware that quantitatively the weight of our work must rest with the vastly larger group of the less severely retarded.

May I now bring my presentation to a close with a series of points that might serve to stimulate discussion and counter argumentation.

It seems obvious that we have been far too much influenced by prejudicial generalizations as to the expected learning capacity of mentally retarded persons in general and have let these generalizations stand in the way of needed efforts to assist each of these individuals toward his highest possible level of life fulfillment at home, at work and at play.

One of the most significant areas of recent exploration in this field deals with the development of the self concept in the mentally retarded, regardless of the degree of their handicap. I am sure you are acquainted with Dr. Henry Cobb's writing on this subject -- Let me call to your attention the excellent new book by Robert B. Edgerton "The Cloak of Competence -- Stigma in the Lives of the Mentally Retarded". It is of greatest importance to rehabilitation workers. Studies are needed to probe how the retarded sees himself among his contemporaries, whether less or more severely handicapped or non-handicapped; how he sees us and others who teach him or work with him and, last but not least, how this relates to how we see him. What does it mean to a retarded adolescent to be treated in school like a little child, singing nursery rhymes and playing silly games while after school hours he joins the rough life of the city streets which would frighten and horrify his teachers.

Studies are needed to show the problems arising from the different kinds of worlds confronting the retarded -- the world of home, the world of school, the world of the street and community, the world of work and their respective levels of language, feeling-tone, expectations.

Development of criteria and factors contributing to an adequate quantitative assessment of capacity for and performance in adaptive behavior must not just be an urgent concern of research centers but must be underpinned by day-to-day practical testing of existing and yet to be developed assessment scales to provide as soon as possible an operational basis for the presently accepted definition of mental retardation.

Developmentally appropriate activities must be provided in all areas of life for the mentally retarded and, of course, there must be added here the whole continuum of services which has been amply demonstrated as needed in support of the mentally retarded and his family.

May I now close with one more point: As of January 1, 1968, the Eighth Revision of the International Classification of Diseases will go into effect following its adoption by the WHO'S World Health Assembly. It includes a classification scheme of mental retardation which is essentially based on the one proposed by AAMD in 1959. Thus the designations -- mild, moderate, severe and profound mental retardation and their equivalents in the world's many languages provide for us a vastly improved tool for international communication. (WHO'S 1953 scheme was only a committee's proposal and not a result of proceedings before the World Health Assembly.)

In the light of the discussion here this morning, I hope that you are convinced of the increased usefulness of a four part classification scheme as compared with the old three part scheme, particularly since it is more discriminative in the area where we have made most progress -- that of the lower levels.

So -- could I plead that during this Institute we use this classification scheme and may I further urge that you do your part from the vantage point of your work to the end that the four levels of mild, moderate, severe and profound mental retardation will be better identified and provided with the missing evaluative links as far as that most elusive of factors is concerned -- adaptive behavior.