Dear Ann Landers,
y wife and I never had the opportunity to be around children till we had our own. What should we do about childhood nudity in the home? We have a girl, 10, and two boys, 8 and 6. They love to run around naked. Now and then they ask if they can bathe together. My wife and I believe this is inno-cent childhood behavior that will pass in time. But how long should we allow it to continue? Please advise. -PARENTS WHO NEED GUIDANCE

DEAR PARENTS,
If the kids were all the same sex, it wouldn't make any difference, but nudity among brothers and sisters should not be allowed after five years of age. (Coeducational bath-ing should be stopped, also.) In most instances, nothing need be said-especially to girls. They usually develop a sense of modesty a few years before bodily changes occur. A girl of 10 who is still romping around nude with her brothers should be told her baby days of running around naked are over. If you catch the kids "playing doc-tor," don't take the roof off the house. Simply explain that their bodies are private and no one should be allowed to fool around with private parts. In recent times there has been an increase of interest in the problems of mi-nority groups. One group that has been grossly neglected is the children of the super-rich. The super-rich are defined as those with personal fortunes of many millions. These individuals are not ordinarily thought to be in need, but they are deprived in a very real sense and little has been written about them. THE PATIENTS Children of the super-rich usually come for psychiatric treatment out of whim, boredom, a desire to do the "in" thing, or because of behavior consid-ered bizarre or "too far out." They often lack motivation of anxiety, and do not seem to suffer greatly. They may be single or married, in school or out, but all have one or more of the following symptoms: chronic mild depres-sion, emptiness, boredom, superficiality, low self-awareness, lack of empathy, intense pursuit of pleasure and excitement, the belief that they can only be happy with people like themselves. They also show very little interest in work, goals, or ideals, and a belief that buying or spending or travel will solve any and all problems. They are generally not the children of hard-working parents who "have made it" in the new country, but the grandchildren of that group. The parents of the patient group are usually closer to their parents in values and ideals, having seen poverty or struggle and work-ethic attitudes. They too may have struggled hard, although their goals were power or fame, as well as amassing more wealth. They often suffer from typical neurotic conflicts, such as depression, phobias, compulsions, and the like. Even though they might not have seen a great deal of their parents, there was a strong bond and identifi-cation with parental values. The children of the latter group, the third generation, were usually raised by servants, tended to see little of their parents, had fewer and less-clear role models with which to identify and were keenly aware that money was plenti-ful. In general, the parents were busy, socially active, traveled a great deal, and left the child-rearing to servants. Not only did the children have unlimited freedom, but relatively few close friends. Most of their relationships were superficial, with individuals who came from the same type of background. Society is replete with figures that contradict the above description. As an example, the five Rockefeller children all have been hard-working and pro-ductive in government, banking and philanthropy. To say they have no prob-lems would be incorrect, but to say they are like the patients above would be untrue. They have ethics, morals, values, ideals and intense commitments to goals. Most other children of the super-rich have not been so fortunate. The patients to whom I refer have severe emotional problems, and scant awareness of themselves and others. They cannot tolerate frustration and are unconsciously so overwhelmed by anxiety, rage, shame or guilt that they op-erate with every possible defense. In addition, we see chronic failures, per-sonal attachments with great ambivalence, absent, perverse or compulsive sexuality. With the majority of these patients, the villain is not money, but the paren-tal relationship. The children are truly underprivileged. What the family has gained in money it has lost in feeling, and at times even common sense. Some of the most simple sensible child-rearing practices are beyond the parents' imagination. The patients show evidence of the typical narcissistic character: easy frus-tration, self-centeredness, shallowness, rage, vindictiveness, lack of shame or embarrassment, low empathy, little tenderness and, of course, difficulty in es-tablishing an honest relationship with a therapist. Before therapy, the parents do not seem to understand the deficiencies in their children. As one father said to me (his daughter at thirty had not one single friend or activity), "Thank God, she's not a lesbian." That was his only concern. Certain qualities of the parents often become clear. They may be jaded, see the world as corrupt, with money as power, and job or outside interests as unimportant. Even when the parents are* hard workers, they do not expect a similar work-ethic in their children. Always the focus is on what one has, not on what one does or how he does it. The exceptions occur in those families where creativity or hard work is an independent tradition. Often the parents are "unavoidably" absent. More often they are disin-terested in their children, self-absorbed, immature and tend to repeat patterns of their own childhood experiences, including frequent absences and shifting parent-substitutes. The manner in which they use money as a weapon or a token of love creates further distortions. The similarity between the children of the super-rich and the children of the poor is startling. The poor suffer from discrimination as well as inade-quate parenting or despised models for adult behavior. Their parents are often absent, depressed, action-oriented, angry and antisocial. They tend to feel frustration, hopelessness, boredom, cluster in groups of "like" people, have little tolerance for frustration, low empathy and have a poor sense of "self." There is a greater tendency towards antisocial activity, but otherwise the similarities are far greater than the differences. A supportive doctor-patient relationship, if it can be developed, has con-siderably more to offer than psychoanalysis. Ego-strengthening and models of behavior and values may be provided. A strong identification with the thera-pist or a substitute parent may be fostered. There is a latent hunger for feel-ings and ideals so that a desire to become a member of a meaningful group may appear. This may reveal itself in the form of a radical group, a religion, a political belief, an interest in power or philanthropy, and sometimes a strong interest in business and making money. Signs of progress are many, but the most important are increase in self-esteem, humor, empathy, less narcissistic object-choices, more compassion, the development of true inter-ests leading to activities that are maintained over time, lessened impulsivity and more introspection. Interest in children, animals, sexuality or marriage are all signs of development. The latent hunger for relief from boredom and depression may be satisfied by belonging to groups that provide a useful service, a shared belief or a common interest. These groups develop and enhance a capacity for trust, self-esteem, self-discipline and, above all, the capacity to endure frustrations, separations and loneliness. Cardinal signs of improvement are: increased involvement with others, the appearance of a sense of humor, the capacity for sympathy and empathy, and a realistic perspective of one's life, past, present and future. With hard work, gains are available and significant. credit: Roy R. Grinker, Jr., M.D., Attending Physician, Michael Reese Hospi- tal, Chicago; Training and Supervising Analyst, Chicago Institute for Psycho-analysis. Children Who Won't Eat No well child ever starved to death in the United States when adequate supplies of food were available and his parents were reasonably intelligent. Very few normal and well children between the ages of one and five are going to eat three square meals a day. One full meal a day is the limit for most, with considerable dawdling and picking over the other two meals. In this age range, growth and development continue at a slow pace, with a total weight gain of four or five pounds a year. This is reason enough for a child's finicky appetite and "not eating enough to keep a bird alive." Usually, he will eat enough snacks tliroughout the day to compensate in calories for the incomplete and poor meals. Concern about a "balanced diet" and forcing, cajoling, begging or bribing a child to eat a helping of vegetables, fruits and meats accomplishes very lit-tle. It even produces harm, in that it conditions the child early against certain foods and may give him a sense of satisfaction from the increased attention he is receiving. Children are creatures of habit. They resist the new and unusual. Most small children prefer the same old things rather than accepting or even tast-ing new and unfamiliar food. They also are "streak eaters," preferring and eating the same foods for weeks on end and then suddenly refusing to touch the favorite food. Mealtime should be a happy time for the child and parents. The following simple do's and don'ts will be helpful in achieving this goal: A quart of milk a day is great for the milk industry but not necessarily so for your child. One pint of milk a day-about six ounces at each meal-is sufficient. Too much milk fills the stomach, dulls the appetite, and leaves little room for other important foods. Serve small, attractive portions, emphasizing meat, eggs and cheese. Don't expect him to eat all of each food served. Serve raw vegetables; many children prefer them to cooked vegeta-bles. Don't allow him to refuse what had been placed before him and then expect something different prepared for him alone, such as a bowl of fruit or cereal to sustain him through the night or until the next meal. Thirty minutes is time enough; end the meal bravely and without emotion. Don't use dessert as a bribe or reward for eating. If a dessert is part of his planned meal, don't insist that he clean up his plate or eat his other foods first. Vitamin supplements do not take the place of food. credit: Dr. Jay Arena, Chief of Pediatrics, Duke University Medical Schools, Durham, North Carolina. Illegitimate Children {TheirRights), Approximately 10 percent of all newborn children in the United States today are born out of wedlock. Because the number has grown to such great pro-portions in the last decade, there have been many changes in the law of ille-gitimacy. Numerous court cases have been brought into this area of the law and be-cause of recent legal decisions the illegitimate child and the legitimate child now share legal equality. An illegitimate child has the right to support from his father. The father's liability to an illegitimate child is no different from the father's obligations to a legitimate child. The father of an illegitimate child cannot be denied visitation rights. Court decisions have on occasion given custody to such fathers and permitted them to adopt their illegitimate children. An illegitimate child has been held entitled to collect Workmen's Compen-sation benefits related to his father and an illegitimate child has also been held entitled to recover for his father's wrongful death. One case granted Social Security benefits to an illegitimate child whose fa-ther had conceded paternity. The Supreme Court has held that illegitimate children can inherit from a father who has left an estate but no will. The latest cases decided by the courts are noteworthy for their humani-tarian aspects. The rationale behind the humane thrust of the law is best summed up by the following quote from a 1972 case: The status of illegitimacy has expressed through the ages society's condemnation of irresponsible liaisons beyond the bonds of marriage. But visiting this condem-nation on the head of the infant is illogical and unjust. Moreover, imposing disabilities on the illegitimate child is contrary to the basic concept of our sys-tem that legal burdens should bear some relationships to individual responsibility or wrongdoing. Obviously, no child is responsible for his birth and penalizing the illegitimate child is an ineffectual-as well as an unjust-way of deterring the parent. credit: liana Diamond Rovner, attorney, Assistant Deputy to Governor James R. Thompson of Illinois. Mean Little Kids We have all seen cartoons portraying the theme of the pecking order for ex-pressing anger. In the barnyard the strongest chicken pecks the next strongest and on down the line to the weakest chicken, who has no one to peck. Similarly, the father who is angry at the boss comes home and yells at mother who screams at daughter who hits her brother who bites the baby who kicks the cat. The difference between chickens and humans is that older and bigger hu-mans fool themselves into believing that the target of the hit (whether verbal or physical) provoked it. Little kids do not have that skill. When we see children hitting or biting others or torturing animals we often think they do it for no reason at all. Ag-gressive acts for which adults cannot see a reason arouse fear. This fear is often stated as: "If I cannot control him when he's little, how will I control him when he's big?" From this fear comes inappropriate punishment that not only fails to get rid of the problem but often perpetuates it. Biting the child who bites another in no way conveys the message, "You're not allowed to bite." Almost everybody feels and acts like a baby at times. For example, when we are sick. A biting child tells us that he feels very babyish. It is a sign that he has not passed babyhood in his image of himself or that he has regressed to feeling like a baby. Parents feel frightened because it has gone on too long and efforts to stop it have failed. With a tone of helplessness parents say: "We've tried everything from punishing to being extra nice." They often feel guilty because, while their heads tell them the child has no reason for acting so mean, they feel uneasy about it. "Tell us what we're doing wrong," they say. Even though the reasons for biting and hitting people or hurting his pets are not apparent, we can be sure reasons do indeed exist. These are the ingredients of the problem: The child feels frustrated and angry. He cannot verbalize his feelings. He is impulsive, that is, he acts quickly on a feeling. He has not learned more socially acceptable ways to discharge his feel-ings or to get rid of the causes. When we understand this we are on our way to helping the mean little kid change into the wonderful little human that he really is. How can a much loved child feel so frustrated and angry? One of the most observable causes is a sudden change of expectation. For example: A new baby arrives. Suddenly he is supposed to give up his position as center of at-traction and be the "big brother." Or there may be sickness in the family, or lack of sufficient help for the mother to cope with all the demands in her life. The child is expected to understand and be good. This does not mean that parents must cater to the demands of the child. They should think about whether their expectations have jumped from little to much. The child could feel rejected, not because it is so, but because he perceives that brother or sister is more in favor. The possibilities are too numerous to itemize, but you should ask yourself whether it might be hard to be this particular child in this particular family at this particular time. There are many reasons why a child cannot express how he feels in words. One is obvious. He has not yet learned to talk. Another-he feels it isn't safe to speak. Still another-he feels he would be "bad" if he made his parents feel guilty. The young child does not know how to use himself well, that is, his eyes, ears, hands, feet and powers of speech. Often, we expect children to go from not knowing how to do something to knowing how, without helping them learn to do it; moreover, we do not provide models to imitate, or tools to practice with. We expect them to get along well with others but offer few op-portunities to practice doing just that. Start with recruiting help for the mother, who really should not have to shoulder all the work of raising a child. Fathers can help a lot. The littlest children can use a pounding toy and graduate to hammers and other tools for fixing and making. Parents can take children to where other children are playing to watch and participate. All kinds of games with balls help relieve frustration because they allow for throwing, kicking and hitting. Expose your child to many kinds of experiences-the greater the variety the greater is the possibility that one of them is going to strike him as his thing. For example: Grampa playing chess; the naturalist in the local park teaching about flowers and trees and birds; kids playing baseball, football, tennis or cheerleading; a cousin making music on a piano or a wind instru-ment; men working on the streets; and women doing needlework. They all plant seeds of future careers and hobbies. Turn off the TV and become an active, interacting, and socializing family. It is a good bet then that your destructive, mean little kid will turn into a con-structive likable kid. The famous deaf, blind Helen Keller was a mean little kid. Anne Sullivan helped her to great achievement through first teaching her to use her hands well. Knowing how to do opens acceptable channels for discharging aggressive feelings. If the problem continues, don't be reluctant to seek professional help. Sometimes when our own emotions are caught up in a problem we cannot see it clearly. You don't have to wait until you feel desperate. A little help early can save a lot of time and expense later. It may be distressing to discover that a child may be acting out the anger that one or both of his parents have bottled up. You have probably read the saying "Tall oaks from little acorns grow." Did you know that it comes from a poem called "Lines Spoken by a Boy of Seven Years," written by David Everett in 1791? The middle of it goes like this: Large streams from little fountains flow: Tall oaks from little acorns grow: And though I now am small and young, Of judgement weak and feeble tongue, Yet all great learned men, like me, Once learned to read their ABC. The poet wrote these words with a deep sense of understanding of the feel-ings of children and what they want adults to know about them. The hitting, biting little kid is saying by his actions, "I am having trouble learning the A B C of loving and being loved. I need a helping hand, not a heavy one." Don't be reassured by people who say "he'll grow out of it." Fulfilling a wonderful potential is too important to count on that. credit: Marita D. Kenna, M.D., child psychiatrist, Assistant Professor, Univer-sity of Pittsburgh. HOW SAD NOT TO HAVE ANY CHILDREN DEAR ANN: Now that so much has been said about your survey that re-vealed 70 per cent of America's cou-ples would not have had children if they had it to do over again-please rerun that great column, "Musing Of A Good Father On A Bad Day." BALTIMORE FAN DEAR FAN: I thought you'd never ask! Here it is: There's nothing sadder than the childless couple. It breaks your heart to see them stretched out relaxing around swim-ming pools in Florida and California, sun-tanned and miserable on the decks of boats, trotting off to Europe like lonesome fools-with more money to spend, time to enjoy themselves and nothing to worry about. Childless couples become so selfish and wrapped up in their own concerns, you feel sorry for them. They don't fight over the kid's discipline. They miss all the fun of "doing without" for the child's sake. They go along and do as they darn well please. It's a pathetic sight. Everyone should have children. No one should be allowed to escape the wonderful experiences attached to each stage in the development of the young. The happy memories of those early years-saturated mattresses, waiting for sitters who don't show, midnight asthma attacks-rushing to the emergency room of the hospital to get the kid's head stitched up. Then comes the payoff-when the child grows from a little acorn into a real nut. What can equal the warm smile of a small lad with the sun glit-tering on $1,500 worth of braces- ruined by peanut brittle-or the frol-icking, carefree voices of 20 hysterical savages running amok at a birthday party? How sad not to have children to brighten your cocktail parties-mas-saging potato chips into the rug, wres-tling the guests for the olives in their martinis. How empty is the home without challenging problems that make for a well-rounded life-and an early break-down. The end-of-day report from mother, related like strategically placed blows to the temple. The tender, thoughtful discussions when the report card reveals that your senior son is a moron. Children are worth every moment of anxiety, every sacrifice. You know it the first time you take your son hunting. He didn't mean to shoot you in the leg. Remember how he cried? How sorry he was? So disappointed you weren't a deer. Those are the memories a man treasures. Think back to that night of romantic adventure, when your budding, beauti-ful daughter eloped with the village idiot. What childless couple ever shares in such a wonderful growing experi-ence? Could a woman without children equal the strength and heroism of your wife when she tried to fling herself out of the bedroom window? Only a father could have the courage to stand by- ready to jump after her. The childless couple lives in a vac-uum. They try to fill their lonely lives with dinner dates, the theater, golf, tennis, swimming, civic affairs, and va-cation trips all over the world. They contribute nothing to humanity. The emptiness of life without chil-dren is indescribable. But the childless couple is too comfortable to know it. Just look at them and see what the years have done. He looks boyish, unlined and rested. She is slim, well- groomed and youthful. It isn't natural. If they had kids, they'd look like the rest of us-tired, gray, wrinkled and haggard. In other words, normal. The Terminally 111 Child Parents and children are faced with great tragedy when a terminal illness is diagnosed. They must deal with two traumas. First the shock at the time of diagnosis and second the shock at the time of death. As opposed to a sudden death such as an accident, murder or drowning, a terminal illness can give a family only one positive thing: the opportunity to do things correctly. Parents can help the child deal with the medical aspects of the illness, care for the child and, most important, show their love. Parents grieve differently because they are battling a foreign invader and each must handle it in his own way. When a child dies suddenly, it is difficult to forgive one's self for harsh words spoken, or punishment, perhaps too harsh, given in the past. There may be some guilt, too, about words of praise, or love not verbalized. When feasible, even ill children should have chores and responsibilities and the knowledge that they must not use their illness to take unfair advantage of others. There is security in discipline for all youngsters, sick or well. Strong and honest medical backup at such a time can be the difference be-tween falling off or hanging on. Parents and children have a right to expect a show of concern, and understandable explanations from a doctor. If a family turns to religious leaders for help, clergy should understand the dynamics of a family unit that is threatened-the fears, the neglect of other children. Because there is time, with guidance from trained personnel, the problems of coping with a terminally ill child should be handled as a total family. Sisters and brothers should be included in helping to feed the sick child and spend time with him. This will benefit not only the sick child but also the brothers and sisters, who later will have feelings of having helped. There is a growing move toward honesty with children about their terminal illness. Many parents are beginning to feel the need to answer frankly when asked questions by the dying child. When possible, straight answers can help the youngster talk openly about his or her own fears and thoughts. Although not every family can be completely honest at this time, more and more psychiatrists and social workers trained in grief therapy are advising parents to do so. They believe even young children suspect, through nonver-bal communication, when something is being hidden from them. Secre-tiveness tends to make the child extremely apprehensive and insecure. The unknown can be frightening. Although it may be difficult to face, try to un-derstand the value of these words: "and the truth can set you free." credit: Harriet Sarnoff Schiff, author of The Bereaved Parent, New York, New York: Crown Publishers. Unmotivated Children Lack of motivation occurs among school children with frequency in our soci-ety, and a variety of forces produces this lack. Motivation seems to require at least two ingredients: (1) the desire within the child to achieve and (2) the expectation by the child that he can and will succeed. The unmotivated do not meet these requirements. All learning is motivated and there are essentially two methods of partici-pating in this process. In one, the learning takes place for someone else (such as parents or teachers), or for honors or rewards, and is called extrinsic learning. Intrinsic learning, on the other hand, is done for oneself, is inner motivated, gives pleasure, and may take place in any setting at any time. When life is going well in a loving and accepting atmosphere, both the actual process of learning and the accomplishment of having done a good job brings pleasure. However, when the child becomes unmotivated, his ability to learn becomes impaired. Superimposed on the child's motivation are the expectations of society, the school, the child's family, and the child's teacher or teachers. Today, whether it is in the best interests of the children or not, it is expected that all children will complete their high school education and that one third to one half of them will go on for further education beyond high school, in vocational schools, junior colleges or colleges. In the past the less academically motivated students often planned appren-ticeships with their father, relatives or others with skills which the adolescents needed or wanted. This apprenticeship often occurred between the eighth and tenth grades and offered an easy transition from school to craft or trade. The academic skills that had already been acquired were sufficient for them to go successfully through life. In today's higher technical society, the jobs that require little or no training or skills are being done more and more by machines. This eliminates work formerly done by people with little academic training. Since many of these jobs which demand little training no longer exist, schools take the former ap-prentice population and force it towards higher academic attainments, whether the individuals have an aptitude for higher learning or not. When a child who is unmotivated for learning is evaluated, one must be aware of what is going on within the child, within the family, within the school environment and within his society. Such scrutiny usually requires a team of specialists in all these areas in order to determine whether the prob-lem lies within the child, the family, the school or parts of all three. Beyond these factors, within the child's body itself there may lie constitutional defects that lead secondarily to emotional problems, including lack of academic mo-tivation. Some organic factors which may reduce motivation will be briefly men-tioned since they must be ruled out. Mental retardation may be caused by birth injury, prematurity, con-vulsions, infections, malnutrition (both in the child after birth and also dur-ing pregnancy when the child is developing), biochemical or endocrine disor-ders such as hypothyroidism, viruses such as "German" measles and hepatitis in the mother during pregnancy, and various blood incompatibilities between the blood factors of the father and the mother. Visual problems or deafness may cause the child to appear unmo-tivated when in fact he cannot see or hear properly, and therefore gives up the attempt to keep up with his classmates. Specific degenerative diseases which show up after infancy or in child-hood, such as Tay-Sachs disease or Friedreich's ataxia or endocrinological disorders such as hypothyroidism, may hinder a child's academic progress. Chronic fatigue may affect the child. If he has been deprived of sleep for long periods of time, he may become apathetic in the classroom. Poor nutrition: too little or the wrong kind of food can affect learning. The unmotivated student in whom organic causes have been eliminated and who has, or appears to have, a learning problem will demonstrate (1) a decrease in ability to acquire knowledge (broadly defined as learning skills) or (2) a decrease in ability to impart or demonstrate this knowledge. Eventu-ally he develops negative feelings about school, about learning, and about himself. He often reaches a point where he either does not want to learn, or in some cases actively tries not to learn. Usually an unmotivated child comes to the attention of the school or par-ents when he is more than an academic year behind where he should be for his intelligence level. He may be considered a slow learner, or underachiever. In a conference about the child a teacher may say, "Well, he is bright enough, but he just doesn't try." It is frequently at this point that the school psychologist, school principal, child's parents or a school evaluation team is consulted and the child's skills, abilities and problems are assessed. Such an assessment may lead to consultation with a pediatrician, psychiatrist, or neurologist. What are some of the symptoms or signs of poor motivation? Short attention span. Hyperactivity or sometimes underactivity. Failure to finish tasks or assignments. Negative behavior such as tantrums, teasing, bullying, or distracting other children in the classroom. Developmental lag in which the child appears to be emotionally less ma-ture than his peers. Unwillingness to become involved because past involvement has re-sulted in failure. Feelings of being picked on by teachers and peers. School attendance problems such as "sickness" or truancy. In looking for the causes of these signs and symptoms, there are four major psychosocial areas to explore for problems that may be affecting the child's motivation: What is going on within the family which is not directly related to the child or child's learning? Is there severe marital discord, overly large family size, overcrowding, psychiatric disorders of other family members, or pov-erty? What are the family's spoken or unspoken attitudes towards learning? Disapproving facial expressions, a shrug of the shoulders, walking away from the child and his problems cut the props out from under any child struggling with school. A family that openly says, "School won't help you in life," deals mo-tivation a severe blow. Pressures to have the child achieve at a level which is too high for that particular child can be exhausting. One often hears parents say their child is going to learn all the things in school that they didn't. This then be-comes a struggle between parents and child with the parent saying to the child, "Study harder, get higher marks, do better or else." External familial pressure of this kind can leave the child feeling that his chance of success is so small he simply gives up. Children who view their parents as "super-successful" sometimes give up rather than try to equal that success. The fear of failing or suffering from comparison is so great they retreat from the challenge. Parents who are achievers should make a strong effort to let their child know he is loved, re-spected and is "okay." Sometimes the child does not have aptitudes in the areas of parental competence but he does have talents or competence in other areas which are not understood or given encouragement by his parents. He may be seen therefore by his parents (or by himself) as "dumb"! The family may be impatient with the child because he may learn more slowly, or in ways different from the ways in which they learned. This can turn off his motivation. What are the child's expectations of, or attitudes towards himself? There may be an expectation of failure, since there have been multi-ple failures in the past. Often a child fears success. This is manifested as a fear of competi-tion and responsibility, or a fear that he cannot master a skill. There may be a desire to rebel and show his parents "who is the boss" by getting whatever darned marks he pleases. The child may find that he can get attention (however negative) by refusal to involve himself in school activities or by misbehavior in school. A child may not want to show that he is smarter or more competent than his peers because he may be teased by them. Therefore he will take on the attitudes of his peers who regard academics as "square." What about the teacher or teaching process? The teacher must have knowledge and be able to impart knowledge. The teacher must realize that there are different speeds of learning and ways to learn, and should try to tailor his teaching to the child who is a little slow. Children usually want to identify with a teacher whom they like and who likes them. Two special categories of the learning child must not be overlooked: (1) learning disabilities, and (2) giftedness. Both categories may produce the same picture of low motivation. Children with specific learning disabilities, which are popularly called by various names such as dyslexia or minimal brain damage, show difficulties in school, usually in the areas of reading, writing and spelling. They also manifest dysfunctions in the area of motor activity and co-ordination, atten-tion and perceptual functions, interpersonal relationships, impulse control and emotional control. Boys more frequently than girls (4:1) are learning-disabled and are often not recognized until entering school. At this point they are often seen by their teachers as problem children because of their short attention span, inability to sit still and inability to easily follow directions. They are easily distracted by noise and visual stimuli and frequently have trouble stopping one school activity and switching to another. Letter and number reversals, mirror-read-ing or mirror-writing, lasts long after the other children in the classroom have established reading and writing patterns which have a firm left to right flow. Some children seem to have behavioral difficulties, others seem to have trou-ble comprehending something that is quite simple. Some gifted children appear unmotivated because they are academically unchallenged in settings where their special needs are unmet. Contrary to the belief that "smart kids can take care of themselves," it has been shown that there are over two million children in the elementary and high schools in this country whose needs are not being met and that many of them are high school dropouts for this reason. These children are especially unrecognized in the inner city and rural populations and comprise up to 15 percent of their school population. Programs which are designed for the average student will cause frustration, boredom and sometimes failure for the gifted and talented. It is important that these children be identified and their academic needs met, as they are our future scientists, scholars, philosophers and statesmen. What can be done to help the unmotivated psychosocial, learning-disabled and gifted children? A warm, accepting school environment may be pro-vided which gives direction, realistic and specific goals for the particular child. Simultaneous changes at home can provide the same modifications, along with love and recognition of the child for what he is and what he believes in. This may or may not include psychotherapy for the child and his family. The goals should be meaningful for each unmotivated child and should be tailored to his specific needs-his interests, his rate of learning, his strengths and weaknesses. Co-operation between the parents and the school is vital for a child's development. As he has a chance to experience success he then will attempt things that he previously was unwilling or unable to do, which then improves his self-esteem. Such things as prescriptive teaching, remedial edu-cation, one-to-one tutoring, participation in after-school activities such as scouting, or summer programs such as Outward Bound stimulate happy moti-vation. The feedback to the particular child is a continuous sense of his abil-ity to meet first the short-term goals and later the longer-term goals. This has direct impact on the way he views himself and his increasing self-confidence and self-esteem. He then gets into the "success breeds success" cycle. In summary, an unmotivated child is one who, for various reasons, does not have the desire to achieve, or who does not expect probable success. Re-view of the demands of the school, the home situation and the learning pat-terns of the child are necessary before changes are introduced. Changes should be made in any or all of these areas simultaneously in order to in-crease the motivation of the child. Hopefully he will get into a successful self- confident position where again learning can effectively occur. credit: Janet E. Ordway, M.D., Ordway Professional Association, Bangor, Maine. Chiropractic Harriet Cressman is a lovely lady who lives with her husband on their farm in Pleasant Valley, Pennsylvania. Early in 1963, she developed a backache. Thinking that chiropractors were "bone specialists," she went to one. He did not disappoint her. After examining her and taking an X ray, he said that her spine was "tilted" but could be corrected by spinal "adjustments." The ad-justment took place three times a week for several months. As her back symptoms improved, her treatment was reduced to twice a week, then once a week and then once a month. At this point, although Harriet felt completely well, the chiropractor suggested that she continue adjustments regularly for "preventive maintenance." She did so faithfully for ten years and had no fur-ther trouble with her back-as far as she knew. In November 1973, however, the chiropractor took another X ray and gave her bad news: the X ray showed "eighteen compressed discs and progressive osteoarthritis of the spine which was spreading rapidly." It would make her a helpless cripple if she did not have immediate treatment. He reassured her, however, that his new ma-chinery could correct her disc problem and stop the spread of her arthritis. Staggered by the news, Harriet went home to discuss the matter with her husband. But the chiropractor's receptionist had already telephoned Mr. Cressman to ask him to bring Harriet back immediately to the office. Because of the serious nature of the case, the chiropractor wished to begin "intensive treatment" that same day. The treatment would be in day-long sessions, alter-nating complete bed rest with "Diapulse" and "Anatomotor" therapy, spinal adjustments and acupuncture. Its cost would be $11,000, but with payment in advance, the doctor would accept an even $10,000. Because of her long association with the chiropractor, and because she was in no mood to trifle about her health, she unhesitatingly went about raising the money. Supplementing her life savings with a bank loan, she paid in ad-vance. For the next few months, as far as she could tell, Harriet's treatment pro-ceeded smoothly. Every week another full spine X ray was taken. Each time the chiropractor pointed out on the X ray how she improved. He also discussed other patients with her and asked her to help talk them into treat-ment with him. Advising Harriet that her condition might be hereditary, he suggested that other members of her family have spinal X rays. Harriet's son Donald did have an X ray and was told by the chiropractor that he had a "pin dot of arthritis which, if untreated, would spread like wildfire and leave him crippled within a short time." Donald's cost? With the usual 10 percent discount for advance payment-a mere $1,500! In May 1974 the chiropractor suddenly informed the Cressmans that he was moving to California. "What about us?" they asked. "Don't worry," he answered, but their worry increased and turned to suspicion when his an-swers became contradictory. Pressed by Harriet for the name of another chi-ropractor who could continue her treatment, the chiropractor named one. "Don't bother to call him before I leave," he said, "because he has already gone over your records and X rays with me." Harriet did contact her chiropractor-to-be, however, and was told that her name had been "men-tioned" but that no record or X-ray review had taken place. Shocked by the turn of events, the Cressmans consulted medical and legal authorities, who suggested that they file criminal charges for "theft by decep-tion." They did. Investigation by the Northampton County District Attor-ney's office uncovered other patients of the chiropractor who had similar ex-periences. A medical radiologist X-rayed the spines of Harriet and Donald and offered to testify at trial that neither had any condition which could pos-sibly be helped by chiropractic treatment. When news of the arrest became public, a third patient filed a criminal complaint. The chiropractor, he claimed, had cheated him out of $2,075 by promising to cure his arm and leg which had been paralyzed by a "stroke." Now it was the chiropractor's turn to be stunned by the turn of events. He disappeared from public view and communicated through his attorney. He was innocent, he claimed, but was anxious to leave Pennsylvania as soon as possible. (He could not do so until the criminal cases were settled.) If the three complainants would drop their charges, he would return their money. Under supervision of the Northampton County Court, the $13,575 was re-turned and the charges were dropped. Do you wonder whether Harriet Cressman had to be very gullible in order to part with $10,000 for such questionable treatment? Please let me assure you that she is a very intelligent person who is not at all gullible. Until the chiropractor announced that he was leaving, she simply had no reason to be suspicious. Though generally well informed, she had never encountered criti-cism of chiropractic in any newspaper, magazine, book or radio or television program. Like all chiropractors, hers was licensed by the State as a doctor. He seemed warm, friendly and genuinely interested in Harriet. And he did what she would expect a doctor to do. He examined her, took an X ray, made a "diagnosis" and prescribed a "treatment" plan. She was happy to feel better and, like most people, gave no thought to whether the "treatment" had cured her or whether she would have recovered just as quickly with no treat-ment at all. Nor did she give any thought to the nature of chiropractic itself, how it began, how its practitioners are trained or what they usually do. She certainly did not suspect that chiropractic is based on the mistaken beliefs of a grocer and his son. THE DEVELOPMENT OF CHIROPRACTIC Chiropractic is said to have begun in 1895 when Daniel David Palmer re-stored the hearing of a deaf janitor by "adjusting" a bump on his spine. Palmer thought he had helped the man by releasing pressure on the nerve to his ear. A grocer and "magnetic healer" by profession, he did not know that the nerve from the brain to the ear does not travel inside the spinal column. But no matter-he soon became certain that he had discovered the cause of disease. At first he kept the "discovery" secret, but by the end of 1895 he set up the Palmer College of Chiropractic to teach it. One of his early pupils was his own son, Bartlett Joshua, better known as "BJ." The boy began to help his father run the school soon after it opened. Gradually, however, BJ. took over. In 1906, Daniel David was charged with practicing medicine without a license and went to jail. When he was released, BJ. bought out his interest in the school. Business boomed, and many Palmer graduates opened schools of their own. Cash was the basic entrance requirement for most of them and some even trained their students by mail. As competition among chiropractors grew, and as many were jailed for practicing medicine without a license, they began to pressure state legislators to license them. Responding to this pressure, perhaps with the hope that li-censing would lead to higher standards of education and practice, states began to pass licensing laws. Chiropractors would be allowed no drugs or surgery. Most states limited chiropractic treatment to "spinal adjustment." But for what? If all disease was caused by spines which need adjustment, couldn't chiropractors treat everything? They could. And they did. Over the years, many cases have come to light where chiropractors treated patients for cancer and other serious diseases which should have had medical attention. THE SCOPE OF "MODERN" CHIROPRACTIC Does this mean that no matter what is wrong with you, if you go to a chi-ropractor today, he will diagnose your problem as a "pinched nerve" and want to treat you with spinal adjustments? According to chiropractic officials, the modem chiropractor most often treats musculoskeletal problems such as backaches and stiff necks. In 1974, Stephen Owens, D.C., Past President of the American Chiropractic Association, was asked by Medical Economics magazine what chiropractors do. Said Owens: "A chiropractor would be silly to take on a disease that's not susceptible to his kind of treatment. He'd just be inviting failure." Owens' statement was similar to what chiropractors told Congress as they lobbied for Medicare inclusion. In 1970, for example, William Day, D.C., President of the International Chiropractors Association, was questioned by U. S. Senate Finance Committee Chairman Russell Long: long: The medical profession says that your profession claims to treat all sorts of things for which it can do no good whatever. day: Let me state categorically that the chiropractor does not claim to be able to cure all conditions . . . long: How about migraine? day: No. long: You don't treat ulcers? day: No, sir. long: What about hepatitis? day: Hepatitis is an infectious disease. We would refer it to a physician. Such answers from top chiropractic officials sound quite reasonable and easy to believe. After all, who nowadays could accept Palmer's original belief that all disease had just one cause or that one method of treatment can cure everything? But many studies suggest that official chiropractic is not willing to admit what chiropractors are actually doing. In 1963 the American Chiropractic Association asked its members what conditions they treated. Of those responding, 85 percent said that they treated musculoskeletal conditions most frequently. However, the following percentages reported treating other conditions: Asthma: 89%: Pneumonia: 32%: : Gallbladder: 82%: Acute heart conditions: 31%: : Ulcers: 76%: Appendicitis: 30%: : Chronic heart condition: 70%: Pernicious anemia: 24%: : Tonsillitis: 67%: Cerebral hemorrhage: 18%: : Impaired hearing: 59%: Fractures: 9%: : Goiter: 48%: Leukemia: 8%: : Diabetes mellitus: 46%: Cancer: 7%: : Rheumatic fever: 37%: Diphtheria: 4%: : Hepatitis: 32%: : : : In 1971, skeptical about Dr. Day's testimony, the Lehigh Valley Commit-tee Against Health Fraud sent the following inquiry to 130 members of his organization selected at random from its Directory: "I have been suffering from ulcers and sometimes migraine headaches for many years. I am going to this chiropractor near my home now and he is helping me. But I have not finished my treatments and my husband has a job near you. Do you treat these conditions? Do you think I can finish my treat-ments with you?" Of the 110 who replied, 75 percent offered treatment. A similar letter asked ninety-two other chiropractors whether they treated hepatitis. Only one of seventy-two who replied answered negatively-that he might not be able to take the case because his state law required reporting of communicable disease. However, another chiropractor from the same state said that "chiro-practic offers the safest and best care for hepatitis, as well as many other conditions." In 1973, Dr. Murray Katz, a Canadian pediatrician, surveyed chiropractic offices in Ottawa, Canada. Seven out of nine displayed pamphlets which ex-aggerated what chiropractors can do. When a chiropractic official responded that use of such pamphlets would cause automatic thirty-day license suspen-sion, Katz noted that no chiropractor had ever been suspended for their use. Additional evidence that chiropractors do not know their limitations comes from advertising. The Lehigh Valley Committee Against Health Fraud has collected hundreds of chiropractic ads which contain false claims. Among them: "There are very few diseases . . . which are not treatable by chiropractic methods." "Diabetes ... the chief cause lies in displaced spinal vertebrae . . ." "question: If a surgeon cuts out a tumor of the stomach, does he not remove the cause? "answer: No, he may have removed the cause of the distress in the stom-ach, but he has not removed the cause of the tumor and it will probably grow again. A chiropractor adjusts the cause of the tumor." "If every person were under regular chiropractic care, the incidence of can-cer would be reduced by 50 percent in ten years." "There is hardly an illness that does not respond to chiropractic care." During the past six years, I have collected chiropractic journals and text-books, listened to chiropractic lectures, spoken and corresponded with hun-dreds of chiropractors and interviewed many of their patients. My effort to define the scope of chiropractic has led me to three conclusions: Many chiropractors do not know their limitations. What chiropractors say about what they do depends greatly upon who they think is listening. Chiropractors themselves are confused and cannot agree about either what they are actually doing or what they should be doing. There are undoubtedly some chiropractors who make a sincere effort to quickly refer people who need medical attention to an appropriate physician. Doing this well, however, requires a good medical education. Which brings us to the question of what chiropractors learn in school. CHIROPRACTIC EDUCATION If D. D. Palmer could look at current chiropractic schools, he would be surprised. In his day, chiropractic training lasted two weeks to one year and covered just spinal analysis and treatment. Today, chiropractic school takes four years and includes many subjects which Palmer would think were not related to his "great discovery." Among these are "basic sciences" such as anatomy, biochemistry, bacteriology and pathology, and clinical subjects such as psychiatry, study of X ray, obstetrics (delivery of babies) and pediatrics. Standard medical textbooks are used in many of these courses. There are several reasons for these changes. As licensing laws became stricter, many states required testing in basic sciences. Chiropractic schools which could not prepare their students for these exams could not remain in business, and an estimated six hundred of them have closed. Thirteen schools exist today. Because Palmer's basic theory is false, chiropractic has been under contin-ual attack from the scientific community. Since few people nowadays could believe that all diseases have just one cause or cure, many chiropractors have modified their philosophies. "Modem" chiropractic, its leaders claim, recog-nizes the value of modem medicine and refers patients who need medical care to proper physicians. "Modem" chiropractors, their leaders claim, rec-ognize that factors such as germs and hormones play a role in disease. "We would like to work together," they say. "While the medical doctor gives anti-biotics to kill germs or insulin to control diabetes, we will eliminate pinched nerves so the body can heal itself." Unfortunately, despite the "new" look of chiropractic education close ob-servation suggests that much of it is a hoax. In 1960, for example, the Stan-ford (California) Research Institute published a study which included in-spection of two chiropractic schools. They noted that although certain scientific subjects were part of the school programs, the school libraries and laboratories did not appear to be in actual use. In 1963, the AMA Department of Investigation sent applications from nonexistent persons who did not appear to meet admission requirements listed in chiropractic school catalogues. Only two out of seven were rejected. In 1966 the AMA published a study of the educational backgrounds of teachers at chiropractic schools. Fewer than half had graduated from college and many who taught basic sciences did not even have degrees in the subjects they taught. When I examined current catalogues four years later, I found that little had changed. Since that time, some chiropractic schools have affiliated with nearby colleges so that students can get training in basic sci-ences from properly trained instructors. Other chiropractic schools have added teachers who have degrees in these subjects. But neither of these changes will greatly increase the quality of chiropractic training. Basic sci-ence courses merely prepare students for the study of disease. They do not prepare them to make diagnoses or to prescribe treatment. In 1968 a large-scale study by the U. S. Department of Health, Education and Welfare concluded that "chiropractic education does not prepare its practitioners to make adequate diagnoses or to provide appropriate treat-ment." The HEW Report quotes many chiropractic statements which helped to bring about this conclusion. Among them: "For the chiropractor, diagnosis does not constitute, as it does for the med-ical doctor, a specific guide for treatment . . ." ("Opportunities in a Chiro-practic Career," 1967, prepared by American Chiropractic Association and International Chiropractors Association). ". . . chiropractic adjusting is efficacious in handling both the acute and chronic cases of coronary occlusion . . ." (Neurodynamics of Vertebral Subluxation, 1962, by A. E. Homewood, D.C. The most widely used chiro-practic textbook). "Q. Do you think that if an acute appendicitis was identified early enough in the disease process, chiropractic can cure it? "A. Yes, I do. I say this strictly from experience. I don't say it only from my experience but from the experience of all who practice." (1968 Testi-mony of H. R. Frogley, D.C., Dean of Academic Affairs, Palmer College of Chiropractic.) Chiropractic attacked the HEW Report as "biased," and implied that HEW failed to look at "modem" chiropractic. Considering that the Report was based primarily upon information submitted by leading chiropractic or-ganizations, these charges seem odd. Actually, they are true to form. When-ever chiropractic is attacked by an outsider, it claims its attacker is "biased." Whenever it is embarrassed by quotes from within its own profession, it claims they are not representative. HOW DANGEROUS IS CHIROPRACTIC? It should be obvious that to help you, doctors must first be able to figure out what is wrong with you. Yet chiropractors who believe that spinal prob-lems cause all diseases may not even try to make medical diagnoses. Accord-ing to Reginald Gold, D.C., "If you were to come to my office, I wouldn't want to know what is wrong with you. I wouldn't want to know what your symptoms are. I would want to do one thing . . . examine your spine." Gold said this at a public meeting in 1971 after a colleague introduced him as "one of the country's leading authorities on chiropractic" and a lecturer on the fac-ulty of three chiropractic schools. Currently, he is Vice President of Develop-ment of the Sherman College of Chiropractic. . Although many chiropractors share Gold's philosophy, the majority proba-bly do try to determine whether their patients need medical treatment. Most patients protect themselves from misdiagnosis by consulting medical doctors before they go to chiropractors. Those who start with chiropractors, of course, take a greater risk. Not only are chiropractors poorly trained to make diagnoses, but they are prohibited by law from doing some tests which may be crucial to medical investigation. Although spinal manipulation has a small place in the treatment of back disorders, in the hands of chiropractors it can be dangerous. I know of one man who was paralyzed from the waist down after a spinal manipulation. Unknown to his chiropractor, spinal cancer had weakened the patient's spinal bones so that the treatment had crushed his spinal cord. In another case I in-vestigated, a patient who took anticoagulants (blood thinners) had serious bleeding into his back muscles after a manipulation. Surgery was required to remove the collected blood. From time to time, broken bones, paralyses and strokes have been noted in court cases and medical journals. So have deaths from cancer and infec-tious diseases where chiropractors did not know enough to make medical re-ferral in time for proper medical treatment. Although such serious cases are relatively rare, they are inexcusable. Lesser complications such as sprains are more common, but statistics are hard to collect. Some patients are too embar-rassed to publicize them. Some do not realize that their extra discomfort is the result of inappropriate treatment. And others are sufficiently fond of their chiropractor that they cannot believe he has mistreated them. X rays by chiropractors are a leading source of unnecessary radiation. A full-spine X ray exposes sexual organs to from ten to a thousand times as much radiation as a routine chest X ray. This is dangerous because it can lead to increased numbers of birth defects in future generations. Most chiro-practors use X rays. A 1971 survey of the Journal of Clinical Chiropractic suggests that more than ten million X rays were taken each year by U.S. and Canadian chiropractors. Of these, two million were the 14x36-inch full- spine type. Chiropractic inclusion under Medicare, which began in July 1973, will probably increase these numbers greatly. Chiropractors claim that X rays help them locate the "subluxations" which D. D. Palmer imagined were the cause of "pinched nerves" and "nerve inter-ference." But they do not agree among themselves about what subluxations are. Some chiropractors believe that subluxations are displaced bones which can be seen on X rays and can be put back by spinal adjustments. Other chi-ropractors define subluxations vaguely and insist that they do not show on X rays. But what chiropractors say about X rays also depends upon who asks. When the National Association of Letter Carriers Health Plan included chiropractic, it received claims for treatment of cancer, heart disease, mumps, mental retardation and many other questionable conditions. In 1964, chiro-practors were asked to justify such claims by sending X-ray evidence of spi-nal problems. They submitted hundreds, all of which were supposed to show subluxations. When chiropractic officials were asked to review them, however, they were unable to point out a single subluxation. Some chiropractic textbooks show "before and after" X rays which are supposed to demonstrate subluxations. In 1971, to get a closer look at such X rays, our Committee challenged the Lehigh Valley Chiropractic Society to demonstrate ten sets. They refused, suggesting instead that we ask the Palmer School to show us some from its "teaching files." When we did, however, Ronald Frogley, D.C., replied, "Chiropractors do not make the claim to be able to read a specific subluxation from an X-ray film." Frogley might have answered more cautiously had he anticipated the word-ing by which Congress included chiropractic under Medicare. Payment would be made for treatment of "subluxations demonstrated by X-rays to exist." To help chiropractors get paid, the American Chiropractic Association has is-sued a Basic Chiropractic Procedural Manual which defines subluxations as anything which can interfere with spinal function and says, "Since we are obligated to find subluxations before receiving payment, it behooves us to make an objective study of what films show in the way of subluxations . . ." Referring to the Letter Carriers experience as "an unfortunate debacle which almost destroyed chiropractic credibility in Washington," it cautions, in italics, "The subluxations must be perfectly obvious and indisputable." If a chiropractor limited his practice to muscular conditions such as simple backaches, if he saw patients only on referral from medical doctors after medical diagnosis has been made, if he were not overly vigorous in his ma-nipulations, if he consulted and referred to medical doctors when he couldn't handle a problem, and if he avoided the use of X rays, his patients might be relatively safe. But he might not be able to earn a living. THE SELLING OF THE SPINE A chiropractor's income depends not only on what he treats but on how well he can sell himself. The American Chiropractic Association estimates that the "average" chiropractor earns about $31,000 per year, but the mean-ing of this figure is not clear. Many chiropractic graduates do not remain in practice and others are forced to practice part-time. Top chiropractic sales-men can earn a fortune. Intensive selling of the spine begins in chiropractic school as instructors convey the scope and philosophy of chiropractic to their students. Chiro-practic graduates can get help from many practice-building consultants, the most expensive of which is Clinic Masters. In 1973, Clinic Masters estimated that fifteen thousand chiropractors practiced actively in the United States and Canada and said it represented more than eighteen hundred of them. Its fee is $10,000-$100 on entrance and the rest payable as income rises. In 1973 its directors said, "Many of our clients have moved right on up through the $50,000, $100,000, $150,000 income levels to $300,000 and above," and that "before long practice incomes of $500,000 will not be rare." Clinic Masters promotes the idea that higher income means greater service to patients. Such service includes charging for each adjustment or other unit of treatment instead of a flat office fee, an overall "case" fee instead of charg-ing per visit, and "intensive care," which adds room or ward fees to the bill. In 1974, 132 of its clients reported charging an average of $129.43 per day for intensive care. Clinic Masters apparently wants the details of its advice to remain a pri-vate matter. Its clients sign a secrecy agreement and new applicants are checked against directory lists to make sure that they really are chiropractors. It also offers a $10,000 reward to anyone who is first to report "disparaging statements about Clinic Masters or its clients" which lead to a successful law-suit. The largest practice-building firm appears to be the Parker Chiropractic Research Foundation of Fort Worth, Texas. Its founder, James W. Parker, D.C., claims that "more than thirteen thousand chiropractors, wives and as-sistants" have attended his four-day courses. Unlike Clinic Masters, Parker has not been cautious about revealing his techniques to outsiders. In 1968 an investigative reporter named Ralph Lee Smith gained admission to Parker's course by pretending to be a chiropractor and paying its $250 fee. Emerging with a diploma that he had "completed the prescribed course of study at the Parker Chiropractic Research Seminar," Smith published what he observed. Parker's course is built around a 335-page Textbook of Office Procedure and Practice Building for the Chiropractic Profession. Parker appears to be-lieve that the scope of chiropractic is unlimited. The Textbook suggests that patients be offered a "free consultation" but led into an "examination" which costs them money. It suggests that "One adjustment for each year of age is a rough thumbnail guide of what people will willingly accept and pay for," but "If in dou