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One hundred and twenty-nine children in the 8- to 12-year-old age group in Cardiff were ascertained to have mild mental deficiency. Detailed obstetric data were obtained which indicated that nearly 69% of the children were associated with adverse obstetric factors. Fifty-five per cent had the combined pathogenetic risk factors of pre-, peri- and neonatal adversities. Forty-two per cent of the cases had non-optimal perinatal factors and 45% were considered to have prenatal causation. There were four children with chromosomal anomalies. The various adverse obstetric influences are discussed separately.

A comprehensive review of recent advances in mental handicap would warrant several topic-specific year books. There are 91 regular scientific periodicals concerning mental handicap (Beh-Pajooh, 1990). The reader is referred to Clarke and Clarke (1987) for a selective review of research in mental handicap; O'Connor (1987) for a recent review of cognitive psychology and mental handicap; Corbett (1987) on development and dementia; Stern (1987) on biochemical progress in mental handicap; Fryers (1987) on epidemiological issues, and U.K. research in mental handicap (Griffin, 1989). We shall confine this paper to recent developments in understanding and management of Challenging Behaviours in the mentally handicapped child and adolescent, drawing selectively also from overlapping literature on Autism

The admission and discharge records of a hospital for the mentally handicapped over two seven year time periods were compared. The total number of admissions and short term care admissions had risen dramatically, whereas long term care admissions had declined. The largest number of admissions was in the 15–24 age group. The case records of 293 mentally handicapped persons admitted to the hospital over 10 years indicated that the majority were from socio-economically disadvantaged families. Family resources were inadequate and there was a preponderance of behavioural and medical problems among those admitted. The study identifies families seeking the services of a mental handicap hospital, and highlights the adverse circumstances of this population.

Sixty-seven neuroleptic medicated mentally handicapped subjects in a hospital were rated on two occasions for abnormal involuntary movements on three scales: Abnormal Involuntary Movements (AIMS), Rockland and Parkinsonism scales, with 6 months between each assessment. Inter-rater and test-retest reliabilities were high. The data from the second assessment was analyzed. Prevalence of tardive dyskinesia (TD) was 21% on AIMS, 42% on the Rockland scale; 60% had parkinsonism. Multiple stepwise regression analysis revealed that age, sex, current neuroleptic and anticholinergic dose, antiepileptic medication, psychosis, cumulative anticholinergic dose were not significant predictors of TD as determined by AIMS. Parkinsonism and cumulative neuroleptic dose were significant predictors of and correlated positively with AIMS score. TD subjects formed 35% of the parkinsonian group. Overt brain damage was not a significant predictor of AIMS score and the difference between the neuroleptic medicated and neuroleptic free group on AIMS scores was highly significant.