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Results for “Developmental Disabilities”

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PubMed1997

Delivering home-based case management to families with children with mental retardation and developmental disabilities.

To meet the needs of individuals with mental retardation and developmental disabilities (MR/DD) and their families living in urban setting, a noncenter-based model of case management was implemented. In contrast to traditional case management in which families and consumers come to the case manager and most service coordination is done by telephone or in meetings at the case manager/social worker's worksite, the case manager in a noncenter-based model is mobile and able to meet the consumer and family in their domains. In this model, case management is provided in conjunction with in-home residential habilitation and funded by Medicaid under the Home and Community Based Services Waiver. This funding stream provides monies for nontraditional services delivered in noncertified settings. Case managers used the Family Resource Scale to get an immediate indication of the resources and needs of each family. The scale highlights the adequacy of a person's basic and caregiving resources, as well as financial needs. The findings from this study suggest that an understanding of both disability and entitlements is essential for case managers who may have to help advocate for consumers around services and benefits. Moreover, to build and maintain an egalitarian and supportive relationship with families, the importance of caregiver-specified resources and needs must be recognized by case managers. Access to resource information and the ability to engage the family in problem-solving depends on a well-trained staff with the ability to respond to individuals with different needs and from a variety of circumstances. These essential skills prepare a case manager to assist families with their immediate requirements as well as to mobilize them to plan for future needs.

Adolescent↗

PubMed2000

Dietary fibre intake and constipation in children with severe developmental disabilities.

OBJECTIVE: Constipation is a common problem in children with severe developmental disabilities (DD). This study aimed to evaluate fibre intake of severe DD children living in a residential institution, and the possibility of reducing the use of laxatives by increasing their fibre intake. METHODOLOGY: A baseline study was performed to evaluate the fibre and macronutrient intake in a group of severe DD children. Nutrients including fibre for a standard serving in each meal were calculated and daily macronutrients and fibre intake were estimated. An intervention study was then carried out to evaluate whether increasing fibre intake could relieve constipation. A total of 20 children aged between 3 and 17 years were assessed over a 4-month period. In a residential unit for severe DD children, laxatives were routinely prescribed if there was no spontaneous bowel motion for two consecutive days. Fibre intake was increased in stages by adding All-Bran(R) (Kellogg Company, Battle Creek, MI, USA) and desserts. The mean number of laxative usage per week per child in the different stages were then compared. RESULTS: The baseline fibre intake was found to be approximately 2 g/day. The mean number of laxatives required per week per child decreased significantly from a baseline value of 1.22 (about 5 laxatives/month) (standard deviation (SD) = 0.36)) to 0.90 (about 3. 5 laxatives/month) (SD = 0.75) in the first stage, and 0.71 (about 3 laxatives/month) (SD = 0.40) in the second stage. Using paired t-test, the difference was statistically significant when compared with the baseline: P < 0.05 for the first, and P < 0.01 for the second stage of fibre supplementation. CONCLUSION: Very low daily intake of fibre of 2 g/day was documented. Relief of constipation and a significant reduction in the usage of laxatives was demonstrated by increasing fibre intake to 17 g/day (stage 1). Increasing fibre intake further to 21 g/day (stage 2), showed a further reduction in the use of laxatives. There was, however, no statistical significance between stage 1 and stage 2 of fibre supplementation. Alternative ways to further relieve constipation in severe DD children require further studies.

Adolescent↗

PubMed2006

Spectrum of general surgical problems in the developmentally disabled adults.

OBJECTIVE: This study highlights the spectrum of general surgical problems necessitating admission on intellectually disabled adult patients. Problems encountered in the management and the ways to overcome various difficulties are highlighted. METHODS: Prospective collection of data on 63 consecutive developmentally disabled adult patients admitted to the Department of General Surgery, Riyadh Medical Complex (RMC), Riyadh, Kingdom of Saudi Arabia for various indications from January 2000 through December 2004. Demographic details, clinical presentation, diagnostic modalities, associated physical and neurological disabilities, coexisting medical condition, treatment options, morbidity and mortality were analyzed. Various difficulties encountered during the management and mean to overcome these problems are addressed. RESULTS: Sixty-three patients accounted for 71 admissions. Mean age was 26.7 years with a male preponderance (4.25:1). Fifty-four patients were admitted for various emergency conditions. History of pica could be obtained in 33% of the cases. Twenty-seven patients were admitted for acute abdomen. Volvulus of the colon (22.2%) and pseudo-obstruction (18.5%) were the most common causes of acute abdomen. Twenty-one patients were admitted with upper gastrointestinal bleeding. Reflux esophagitis was the most common cause of bleeding (62%). Overall morbidity was 41% for emergency admissions and 22% for elective surgery. Hospital mortality was 21.4% for emergency surgery. There was no death in elective cases. CONCLUSION: Developmentally disabled patients comprise a special class of patients with peculiar management problems. The treating clinician should be aware of various unexpected conditions not found as frequently in the normal patient population. Apparent lack of pain does not exclude an acute emergency. Possible surgical condition should be suspected if there is vomiting, abdominal distension, fever, increased irritability of recent onset. Male gender and history of pica are added risk factors.

Adolescent↗

PubMedDate not supplied

The experiences of people with developmental disability in Emergency Departments and hospital wards.

The aim of this study was to determine whether needs of people with developmental disability were met during visits to Emergency Departments and stays in hospital. Responses to a questionnaire were obtained from 328 clients of three Victorian organizations. Of 119 respondents who had attended a hospital within a year of completing the questionnaire, most indicated that their needs were met in the areas of hydration and nutrition, medication, mobility and discharge. There were significant associations between getting enough to drink and being able to move from a bed, and having a support person stay with the patient. These results suggested a great reliance on support people during hospitalizations. Issues raised in the questionnaire were explored in follow-up interviews with 11 respondents or their support people. Reliance on support people emerged as a strong theme in interview transcripts, as did hospital staff's negative attitudes, and lack of skills and knowledge in developmental disability. These results are discussed in light of recent literature and the need to address issues in the larger context of the needs of support people and hospital staff.

Adult↗

PubMed1983

A construct validity study of the Missouri Children's Behavior Checklist with developmentally disabled children.

Evaluated the construct validity of the MCBC scales and behavior profiles by determining the relationship between the MCBC and the clinical findings and recommendations that resulted from an interdisciplinary evaluation of children (N = 217) referred to a clinic for developmental disabilities. There were few differences in MCBC scale means and percentage occurrences of behavior profiles as a function of demographic factors and broad diagnostic categories. Substantial association was found between the MCBC and clinical findings of behavior problems. The association of the MCBC and clinical findings suggestive of affective problems was not as substantial, which suggests a need to augment the sensitivity of the MCBC in this area. The findings also suggested both the potential and the need for evolving additional MCBC behavior profiles that would reflect additional clinically meaningful subgroups among developmentally disabled children.

Adolescent↗

PubMed1982

Projected impact of the functional definition of developmental disabilities: the categorically disabled population and service eligibility.

Indicators of substantial limitation in seven life activity areas defined in P.L. 95-602 were generated from a comprehensive needs assessment/screening instrument used in New York State. These indicators were then applied to a data base of over 35,000 individuals having one or more of the categorical developmental disabilities of autism, cerebral palsy, epilepsy, mental retardation, or other neurological impairments. Results of this analysis suggest that potential inclusion within the functional developmental disabilities definition of P.L. 95-602 varies as a function of categorical disability, age, and level of intellectual functioning. Implications of these findings for access to services were discussed.

Activities of Daily Living↗

PubMed1983

A participant modeling procedure to train parents of developmentally disabled infants.

Most of the procedures employed in parent training programs for handicapped children have been based on an operant conditioning model in general and contingency management procedures in particular. The purpose of the present study was to investigate the efficacy of a participant modeling procedure in training parents to work with their developmentally disabled infants. Fourteen such parents received training in which a therapist initially modeled the activities with the infant and then guided the parent as she or he mastered the procedures. Five developmentally disabled infants received a more traditional early intervention program in which the therapist provided all child training. The results indicated that those infants whose parents were trained by the participant modeling procedure evidenced significantly more developmental gains than those infants receiving traditional child training. The results suggest that cognitive behavioral procedures, such as participant modeling, are an alternative to strict operant procedures in training parents of handicapped children.

Behavior Therapy↗

PubMed1992

Foregoing life-sustaining treatment for adult, developmentally disabled, public wards: a proposed statute.

This Article proposes a procedure for making decisions to forego life-sustaining treatment for adult, developmentally disabled, public wards who are not competent to make health care decisions. Few commentators or cases address the special considerations involved in making life-sustaining treatment decisions for this patient population. The proposal attempts to fill this gap with a patient-centered process that allows decisionmakers, without prior judicial approval, to forego life-sustaining treatment for adult, developmentally disabled, public wards who have been reliably diagnosed with specific medical conditions.

Adult↗

PubMed2003

Neonatal behavioral assessment scale as a predictor of later developmental disabilities of low birth-weight and/or premature infants.

The purpose of this study was to evaluate the usefulness of the Neonatal Behavioral Assessment Scale (NBAS) as a tool to assess the risk of later developmental disabilities. The study subjects were 209 low birth-weight and/or premature infants admitted to the NICU at the Nagasaki University Hospital, Nagasaki, Japan. These infants were examined using the NBAS at 36-38 (NBAS36), 40-42 (NBAS40) and 44-46 weeks (NBAS44) of postmenstrual age, and their developmental outcome was measured using standardized assessments at 5 years of age. Based on the results of diagnosis at 5 years of age, subjects were classified into three groups: Normal, Mild Disability and Severe Disability groups. Multinomial logistic regression analysis showed that lower Motor cluster scores for all assessment periods and lower Orientation cluster scores in the NBAS40 and NBAS44 were significantly associated with an increased risk of both Mild and Severe Disability. Also, the Range of State cluster scores for the NBAS44 were significantly related to the risk of Mild Disability, and the Reflexes cluster scores in the NBAS40 and NBAS44 were the best predictor of Severe Disability. In outcome prediction using the estimated regression coefficients, 94-97% of the subjects in the Normal group, 50-78% in the Mild Disability group and 71-85% in the Severe Disability group were correctly classified. The NBAS could help clinicians to develop a management protocol for infants at risk for developmental disabilities as well as to identify neonates at risk of developmental disabilities.

Aging↗

PubMed1992

Developmental disabilities related education, technical assistance, and research activities in developing nations.

Few resources are available to identify principles, benefits, and pitfalls concerning international exchanges among professionals in the developmental disabilities field. In the present paper different models for international activities in mental retardation and developmental disabilities were described. Several principles were articulated that characterize successful international programs. These principles were illustrated in a descriptive case study of an international exchange and technical assistance project conducted between a University Affiliated Program and a developing nation.

Child↗

PubMed1987

Evaluation of multiple component relaxation training with developmentally disabled persons.

Prior studies evaluating the response of developmentally disabled persons to relaxation training procedures are largely limited to case study reports. Most often relaxation training procedures are vaguely described in these studies, and limited outcome measures are employed. In the present comparative group outcome study a specific progressive muscle relaxation training procedure was combined with auditory electromyographic (EMG) biofeedback, modeling, and reinforcement procedures in an attempt to teach relaxation skills to mentally retarded persons (N = 32) who functioned in the profound to mild range. The procedure was effective in reducing experimental group subjects' EMG levels, F (1,28) = 6.39, p less than .05, and activity level as measured with an interval recording behavior rating procedure, F (1,28) = 58.05, p less than .05. No effect was found on peripheral skin temperature. Additionally, no significant difference between the response of low functioning and high functioning subjects was seen indicating that intellectual level and adaptive behavior level failed to predict success in treatment. Scoring on a simple behavioral assessment designed to measure receptive language skills and modeling abilities thought to relate to relaxation training success also failed to correlate with outcome measures. The need to develop other predictors of relaxation training success with a mentally retarded population is discussed.

Adult↗

PubMed2000

Recent advances in the assessment of aberrant behavior maintained by automatic reinforcement in individuals with developmental disabilities.

Many aberrant behaviors exhibited by individuals with developmental disabilities are maintained by "automatic reinforcement". These behaviors are often difficult to treat, with the most effective behavioral interventions often resulting in only moderate success. However, a series of recent studies has advanced our ability to understand and treat these behaviors through the innovative use of behavioral assessment. We review the recent development of three categories of assessments: (a) nonhypothesis-based stimulus preference assessments, (b) hypothesis-based stimulus preference assessments, and (c) hypothesis-based assessments incorporating noncontingent reinforcement and sensory extinction procedures. We consider each category's contribution to both our ability to prescribe effective behavioral interventions and our ability to more fully understand the concept of automatic reinforcement.

Behavior Therapy↗

PubMed2001

Knowledge of legal terminology and court proceedings in adults with developmental disabilities.

This research compared 40 adults with mild developmental disabilities (DD) and 40 nondelayed adults (ND) in terms of knowledge of legal terms and court proceedings. For all of the 34 terms studied, with the exception of "police office" there were significant differences between the DD and ND groups with respect to degree of conceptual understanding of terms. Results indicate that all but 6 terms assessed (adjourn, allegation, crown attorney, defendant, prosecute, and court reporter) were well-defined by 85% or more of ND participants. In contrast, only 8 of the terms (police officer, lawyer, jail, court, lie, truth, judge, and witness) were reasonably conceptually understood by at least 75% of DD participants. Reported familiarity with terms in DD participants is not a reliable indicator of actual familiarity with terms. Results are discussed with respect to the need for education of DD individuals and legal professionals to support participation and fair treatment of DD individuals in legal situations.

Adolescent↗

PubMed2004

Assessment of anger and aggression in male offenders with developmental disabilities.

Systematic assessment of anger among people with developmental disabilities has been lacking, especially for hospital inpatients. Reliability and validity of anger self-report psychometric scales were investigated with 129 male patients, mostly forensic. Anger prevalence and its relationship to demographic, cognitive, and personality variables and to hospital assaultive behavior were examined. High internal and intermeasure consistency, and some concurrent validity with staff ratings, were found. Retrospective validity regarding physically assaultive behavior in the hospital was obtained. Hierarchical regressions revealed that patient-reported anger was a significant predictor of assaults postadmission, controlling for age, length of stay, IQ, violence offense history, and personality variables.

Adult↗

PubMed1990

Medical services for the developmentally disabled.

Access to medical care for people with developmental disabilities is a growing problem. The authors review the components of a health care delivery system to help meet the special medical needs of this population.

Community Health Services↗

PubMed1989

Discontinuance of antiepileptic medications in patients with developmental disability and diagnosis of epilepsy.

Fifty patients with developmental disabilities and past history of epilepsy but without reported seizures fo several years underwent trial reductions of an antiepileptic drug. After an 8-year follow-up there was recurrence of seizures in 26 patients. Predictors for a seizure free state off medication were: few documented seizures in lifetime, no gross neurological abnormalities, medication below therapeutic levels at time of discontinuance, and persistently normal EEGs before and after discontinuance. Successful withdrawal of medication may have resulted from early control of seizures or early treatment; lack of actual epileptic seizures but presence of "pseudoseizures"; isolated event seizures; or seizures that could have resulted from nonepileptic, self-limiting factors.

Adolescent↗

PubMedDate not supplied

Employment status and perceptions of control of adults with cognitive and developmental disabilities.

This study was designed to examine the relationship between individual perceptions of control and employment status among adults with cognitive and developmental disabilities. The literature implies that one factor influencing perceptions of quality of life is the amount of control the person experiences across various domains. It was hypothesized that individuals employed in competitive work situations would evidence more positive perceptions of control than would their peers currently unemployed or employed in sheltered settings. Surveys containing the Adult version of the Nowicki-Strickland Internal-External Scale and requesting information about age, gender, and employment status were mailed to self-advocacy groups. For the more than 200 respondents, there were significant differences in locus of control scores among individuals employed competitively, individuals employed full-time, respondents in sheltered environments, individuals currently unemployed, and all other groups. Individuals unemployed and employed in sheltered settings perceived themselves as having less control than individuals employed competitively. These results are examined in light of quality of life findings, focusing on the need to include choice and control in programming for people with cognitive and developmental disabilities.

Adult↗

PubMed2004

Perspectives of physicians, families, and case managers concerning access to health care by individuals with developmental disabilities.

This study of the status of medical care for Kansans with developmental disabilities consists of reports from physicians, service providers, and family members. Overall, these three groups indicated satisfaction with medical care across the four criteria of availability, accessibility, appropriateness, and affordability. The bases for these results are outlined, and suggestions for improving satisfaction with health care are presented.

Adult↗