Spina bifida children in ordinary schools: handicap, attainment and behaviour.

Virtually all survivors of a selective surgical treatment policy were reassessed. This paper describes the status of 43 of the 74 in ordinary schools. The small number placed in special units often had very low or deviant scores on all measures. Those fully integrated had scores insignificantly different from the controls on reading, spelling and mathematics, but had weaknesses of tests of hand function. The majority of fully integrated pupils were free from behaviour problems. The extent of physical handicap encountered among pupils in the ordinary school is described.

Family reactions to surgical correction for kyphoscoliosis in spina bifida children: a preliminary report.

The families of 11 children who had been operated for the correction of kyphosis and scoliosis not less than 12 months previously were visited. The anxieties and expectations of patients and parents were investigated and the results compared with a similar investigation in the schools of the children.

Marital stability following the birth of a child with spina bifida.

The matrimonial stability of 142 families where a child with neural tube malformation (mostly spina bifida) was born between 1964 and 1966, including 56 families with a surviving spina bifida child, was examined in January 1976. The divorce rate for families with a surviving child was found to be nine times higher than that for the local population and three times higher than for families experiencing bereavement of their spina bifida child. Marriages which followed a pre-nuptial conception resulting in a spina bifida child were particularly vulnerable and had a divorce or separation risk of 50 per cent. All the divorced fathers had remarried, but only one of the mothers. It is concluded that a handicapped child adds greatly to the strain on a marriage, especially when this has not been cemented before the arrival of a child. This strain is diminished by the child's early death.

The effects of admission to hospital and surgery on children with spina bifida.

Up to the age of nine years, 43 actively-treated cases of myelomeningocele had had an average stay of 28 weeks in hospital, one-fifth having spent between one and two years in hospital, and each child having had an average of six operations. After the age of two years there was a tendency to withhold surgery in more hopeless cases. The number of hospital admissions and surgical procedures declined appreciably after the children's admission to school. Girls spent longer periods in hospital than boys. Children with IQs of less than 80 spent twice as long in hospital compared with intellectually competitive children, probably because of the greater frequency of hydrocephalus and other physical handicaps. Admission to hospital in itself seemed to have little effect on intellectual status. Parents' comments showed that hospital admission held few fears for their children, except when orthopaedic procedures were involved. It is concluded that because of their familiarity with hospital, the emotional hazards associated with frequent admission to hospital seems to have little effect upon the behaviour of these children.

The reliability of prediction of outcome in spina bifida.

The clinical findings in 85 neonates with spina bifida were given to two neurosurgeons and two paediatricians, who were asked to predict from them the length of survival and quality of survival with regard to intellect, locomotion and continence, without their knowing the actual outcome. All four clinicians correctly predicted the survival of infants with meningocele, closed myelocele and encephalocele. The paediatricians correctly predicted the survival of all infants with open myelocele who actually survived, but also included some who had died. The surgeons correctly predicted the deaths of all those with open myelocele who actually died, but expected a considerable number to die who in fact survived. All four clinicians were similar in their predictions of intellect: they underestimated the outcome in patients with successfully shunted hydrocephalus, they overestimated the intellect in patients who had developed intracranial infection and shunt blockage, and they largely underestimated the outcome in the patients who did not require shunts. They made correct predictions for limb and sphincter function in nearly all the survivors. This investigation underlines the problem of selection for treatment caused by the inability to predict the complications of hydrocephalus and infection. Reasons for the differences between the expectations of the paediatricians and surgeons, and the implications of the results of this study for selection for surgery are discussed. It is suggested that limb paralysis and incontinence ought not to be considered as factors excluding infants from treatment.