Towards an understanding of profound mental handicap

Abstract

A brief introduction to profound mental handicap (PMH) is given. Problems in identifying the population to be studied are described, and detailed criteria, based upon behavioural characteristics, are proposed. A comprehensive survey of research literature relevant to people with profound mental handicap is presented, and inadequacies discussed. Frameworks within which to place the behaviour of the profoundly mentally handicapped are also discussed, and a modified developmental framework is suggested. An argument is made for the usefulness of conducting research which is informed by mother-infant studies and which examines the naturally occurring behaviour of the profoundly mentally handicapped, paying particular attention to communicative and emotional characteristics.The behaviour of a representative sample of 66 people with profound handicap, living at home or in one of three institutions, is investigated using micro-analysis of filmed sessions between carer and subject, and information gathered from two oral questionnaires administered to carers. A reliable profile of the behavioural characteristics of this sample of people with profound handicap is therefore obtained.Important findings include: a high level of awareness and engagement to the carer indicating a general responsiveness amongst people with profound handicap to aspects of the environment, and the ability to communicate with other people; evidence of a wide variety of social and emotional behaviours, in particular a discriminating sense of humour; evidence of spontaneous learning; and the presence of a 'responsiveness' factor underlying the behaviour of people with profound handicap, and dividing the subjects into distinct subgroups.The implications of these findings for the day-to-day care of people with profound handicap, and for an improved understanding of the nature of profound mental handicap are discussed.