Biomedical subjects
Publications and source records attributed to S Spreat.
Clinical trends are discussed with respect to the inpatient treatment of individuals with dual diagnosis. Identified operant trends include the increased attention on functionally derived treatments and treatments designed for infrequent behaviors.
Vignette methodology was used to assess factors associated with decisions regarding the acceptability of behavior modification programs. Members (N = 198) of the American Association on Mental Retardation (AAMR) reviewed two vignettes describing proposed treatment plans for individuals who were either aggressive or self-injurious. Nine descriptor variables were nested within each vignette; no two vignettes were exactly the same. The strongest predictor of treatment acceptability was the respondents' own estimates of probable treatment success. Secondary predictors included the restrictiveness of the proposed procedure and whether other procedures had been previously tried. Members of the AAMR Psychology Division tended to be slightly more accepting of behavioral treatments than were members of other divisions.
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Of 283 mildly to profoundly retarded patients, 10 (3.5%) presented with compulsive behavior that significantly interfered with their daily functioning. Compulsions occurred in the context of obvious cerebral dysfunction and in the absence of anxiety or "ego-dystonic" qualities. The interrater reliability of the differential diagnosis between compulsions, stereotypies, and other repetitive behaviors was good (kappa = .82). A severity rating scale for the compulsive behavior yielded total scores with good interrater reliability (intraclass correlation coefficient = .82). Single items that described observable behaviors had good reliability, while inner resistance and subjective distress were not reliably assessed and contributed little to the total score. The authors suggest that the DSM-III-R diagnosis of obsessive-compulsive disorder be considered in mentally retarded patients, despite the absence of recognizable ego dystonic characteristics. Emphasis should be on the behavioral, externally observable components of the disorder, rather than on inner conflicts and anxiety. Such a diagnostic approach may also benefit nonretarded compulsive patients.
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Public residential facilities were surveyed regarding the roles played by their Human Rights Committees in the review of restrictive/aversive behavior modification procedures. Almost 98% of the responding facilities reported that they had an active Human Rights Committee, with the largest plurality of members being staff members from the facility. Review of restrictive/aversive procedures was a role for over 95% of the committees, even though most committees appeared to lack great degrees of expertise in the clinical use of behavior modification. Other areas of review were discussed.
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The safety of four general classes of contingent restraint was evaluated in a sample of 231 institutionalized mentally retarded persons. The use of mechanical restraints resulted in a significantly lower injury rate than did personal restraint. The use of restraint in emergency situations was found to be more dangerous than the planned use of such procedures.
The relationship between the adaptive and the maladaptive aspects of the construct of adaptive behavior was examined by means of a canonical correlation between Part One and Part Two of the AAMD Adaptive Behavior Scale (ABS). The sample consisted of 439 institutionalized mentally retarded persons. Four significant canonical correlations (.68, .49, .39, .28) were derived, three of which were interpretable. The redundancy index was 30 percent with Part One as the criterion and 14 percent with Part Two as the criterion. A redundancy of about 30 percent was calculated. An analysis of the pattern of canonical components suggested that the three major dimensions responsible for the overlap between ABS Parts One and Two are intellectual ability, sociability, and physical ability. An attempt to cross validate these results was made using another sample of 157 mentally retarded persons. Considerable shrinkage was observed on three of the roots.
Staff members from an American institution, Israeli institutions, and a number of American group homes were asked to rate the social tolerability of 84 types of behavior that reflected either skill deficits or social maladaptation. There was considerable agreement among the three sample groups about the relative rank ordering of the 84 items. Physical violence and socially disgusting behavior were perceived as most intolerable whereas deficits in academic skills were least intolerable. The Israeli sample was uniformly less tolerant than either American sample.
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The study sought to determine whether 100 emotionally disturbed mentally retarded subjects assigned four distinct diagnostic labels could be differentiated from each other on the basis of sex, age, degree of mental impairment, and adaptive behavior. Univariate and multivariate analyses indicated that the autism classification was distinguishable from psychosis, schizophrenia, and severe emotional disturbance in terms of degree of retardation and adaptive behavior. The primary distinguishing feature was the autistic group's low level of language development. The schizophrenics, psychotics, and severely emotionally disturbed subjects were indistinguishable from each other on the variables examined.
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