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PubMed2005

Applying the developmental perspective in the psychiatric assessment and diagnosis of persons with intellectual disability: part II--diagnosis.

BACKGROUND: The descriptive phenomenological categorical psychiatric diagnostic systems that are currently being used in the field of intellectual disability do not adequately provide for the special needs of persons with intellectual disability. Many relevant diagnostic questions are left unanswered or are only partially accounted for. This is particularly true for persons with low developmental levels. METHOD: A solution to these stumbling blocks is sought in enhancing the contemporary categorical diagnostic systems by also applying methods derived from the developmental perspective. RESULT: By taking the levels of emotional and personality development, in addition to other developmental aspects into account, the clinical picture becomes more comprehensible and explainable. CONCLUSION: The integrative diagnosis that results from this combined approach provides an insight into the processes that have led to the disorder and enriches one's understanding of the presentation form of the disorder. This diagnosis is process- rather than symptom-oriented and is particularly useful with persons who have a low level of psychosocial development.

Adolescent↗
PubMed1999

Pain measurement in persons with intellectual disabilities.

OBJECTIVE: The goal was to study the utility of nonverbal facial expressions as a research tool for assessing pain in persons with intellectual disabilities. Biases and stereotypes related to age, gender, physical attractiveness, and intellectual disability that may influence the ability of observers to evaluate pain reactions were also examined. DESIGN: Facial reactions to an intramuscular injection of 40 adults (mean age = 49.6 years) with an intellectual disability were videotaped and objectively examined using the Facial Action Coding System. Self-reported pain ratings were obtained using a Colored Visual Analogue Scale for pain. Pain reactions were also rated by untrained observers. RESULTS: A significant proportion of participants (35%) was unable to provide valid self-report. The intensity of objectively coded facial activity as well as observer-rated pain intensity showed significant increases from baseline to injection segments. Observers' pain ratings were primarily determined by the intensity of facial activity and were not significantly affected by stereotypes based on perceived level of intellectual disability, gender, age, or physical attractiveness. CONCLUSIONS: The findings support the validity of both objectively coded and observer-rated facial expressions of pain as research tools in treatment outcome studies involving persons with intellectual disabilities. Self-report has substantial limitations for the assessment of pain in this population.

Age Factors↗
PubMed1994

A survey of aggressive behaviour among a population of persons with intellectual disability in Queensland.

A survey was conducted on aggressive behaviour within a population of 2412 persons with intellectual disability in Queensland, Australia. Two hundred and sixty-one individuals were identified who engaged in at least one form of aggressive behaviour, yielding an overall prevalence of 11%. The relative prevalence of aggressive behaviour was higher among institutionalized persons (35%) when compared to those living in group homes (17%) or other community-based facilities (3%). The aggressive behaviour sample included a higher percentage of males (64%). Most were described as functioning in the severe/profound (54%) or moderate (31%) range of intellectual disability with one-third having no intelligible speech. Two-thirds of the sample received medication for their challenging behaviour, while only one-third had behavioural programmes. Eighty per cent engaged in three or more forms of aggression. Many also displayed self-injury (34%) or property destruction (30%). Surveys of aggressive behaviour may prove useful for coordinating services.

Adolescent↗
PubMed2005

Suicide behavior in persons with intellectual disability.

Suicide is today in the Western world one of the leading causes of death and most people have had suicidal ideation at some time during their life. In the population of persons with intellectual disability some researchers have thought that impaired intellectual capacity could act as a buffer to suicidal behavior, but the fact is that the few studies conducted in that population contest this assumption and showed that the characteristics of suicidality in this population are very similar to persons without intellectual disability. This paper reviews the studies conducted and describe the symptomatology in this population. Professionals working with this population should therefore be aware of and assess for this behavior. Sadness or depression are symptoms that could indicate later suicidal behavior.

Adolescent↗
PubMed2004

An exploratory study into health care policy for persons with intellectual disabilities in Taiwan.

BACKGROUND: Although Taiwan has already had a higher quality of health care compared with other countries, there still is a need to review the quality and effectiveness of services provided. The lack of health care policy for persons with disabilities is a reflection of health care provision in Taiwan. Health care provision problems will limit persons with disabilities in their access to the health care system. The purpose of the present study was to examine the general beliefs about the current health care policies for persons with intellectual disabilities (ID) in Taiwan. METHODS: Data were obtained from two sources, namely government policies analysis and interviews with representatives for key stakeholders in the field of ID. RESULTS: The results illustrate that health care service problems for persons with ID include: how to enforce the discovery system and early intervention service, disability evaluation system, National Health Insurance medical payment and medical care resource development are still confining their quality of care. Furthermore, the links between social welfare, education and health care have been lost because the different roles and perspectives of people in these fields are fundamentally at odds with one another. Health care professionals have become less reform-minded as a consequence of the conditions of their work. Consequently, a complete and coordinated health care policy for persons with ID has become unattainable in society. The present paper draws on evidence from research and policies to explore the problems and potential of service development for persons with ID, and to identify review and action points for managing its implementation.

Health Policy↗
PubMed2005

The behavioural profile of psychiatric disorders in persons with intellectual disability.

BACKGROUND: Problems associated with psychiatric diagnoses could be minimized by identifying behavioural clusters of specific psychiatric disorders. METHODS: Sixty persons with intellectual disability (ID) and behavioural problems, aged 12-55 years, were assessed with standardized Indian tools for intelligence and adaptive behaviour. Clinical diagnoses were conferred as per International Classification of Diseases - 10th Revision (ICD-10) criteria. Subsequently Reiss Screen for Maladaptive Behaviors (RSMB) and AAMD Adaptive Behavior Scale-Part II were administered independently. RESULTS: Aggression and rebellious behaviours were more common in affective disorders and personality disorders. Psychotic and paranoid features were significantly more in psychosis group. Those with behavioural problems had significantly low scores on the sub-scales of RSMB. CONCLUSION: RSMB and AAMD Adaptive Behavior Scale-Part II will be useful to identify behavioural clusters, which will complement clinical psychiatric diagnoses in individuals with ID.

Adolescent↗
PubMed2006

Laterality in persons with intellectual disability II. Hand, foot, ear, and eye laterality in persons with Trisomy 21 and Williams-Beuren syndrome.

Laterality (hand, foot, ear, and eye) was assessed in participants with Trisomy 21 (62) and Williams-Beuren syndrome (WBS) (39). Handedness was also assessed in a card reaching task. The comparison group included 184 typically developing persons. Two independent age sub-groups were formed: 7 to 10 years old and 11 to 34 years old. We confirmed previous data: individuals with T21 were more frequently left- or mixed-handed than typically developing persons; individuals with WBS had intermediate scores. The two groups with genetic disorders had less right foot preference. Manual and foot inconsistencies characterized both groups with genetic disorders. Cross hand-foot preference was lower in the typically developing group. Differences in IQ levels did not correlate with differences in laterality scores. Overall laterality profiles were not the same in the two groups with genetic disorders: the greatest differences were observed between typically developing persons and persons with Trisomy 21.

Adolescent↗
PubMed2005

[Adaptive behavior scale for persons with profound intellectual disability].

An adaptive behavior scale for persons with profound intellectual disability was proposed. This scale consisted of 64 items from five areas: interpersonal relationship, perception, expression, interest and play, and daily life. Each item was scored on a 0-2 scale. Forty-eight institutionalized persons (23 males, 25 females) with profound intellectual disability, aged 13-69 (mean 40) years, were examined with this scale. The rating for each item was 0.02-1.81 (mean 0.88). On 69% of the items, estimates were consistent between two care-staffs. The Cronbach's alpha value was calculated to be 0.97, indicating good internal consistency. On the whole, this scale is useful in assessing adaptive behaviors of the subjects.

Activities of Daily Living↗
PubMed2004

Utilization of inpatient care and its determinants among persons with intellectual disabilities in day care centres in Taiwan.

BACKGROUND: In Taiwan, current understanding is limited concerning the manner in which health services are utilized by persons with intellectual disabilities (ID). The objective of this study is to describe the patterns of inpatient care sought by persons with ID, and factors affecting inpatient care utilization. METHOD: The primary method used in this study was a cross-sectional survey of 1390 persons with ID in day care centres. Data were obtained from responses to a questionnaire, copies of which were mailed to 30 day care centres catering for persons with ID. The questionnaire assessed demographic and health characteristics, disability status, and inpatient care utilization for the 12 months leading up to the survey. Multivariate logistic regression analysis identified factors independently associated with inpatient care. RESULTS: Findings indicated that the average age of the people with ID in the centres was 13.7 years. Fifty per cent of people were afflicted with multiple handicaps, with an average of 26 outpatient visits made per person during the 12 months, and 16% of persons having been hospitalized within the previous year. The average hospital stay was 6 days. Inpatient care was more likely to be used by those individuals with an ID who were younger, had multiple handicaps, required rehabilitation, and had other disabilities and existing illnesses. CONCLUSIONS: The study concluded that the parameters describing age of persons with ID, as having an existing illness, and requiring rehabilitative care were statistically significant in the logistic regression model of the inpatient care.

Adolescent↗
PubMed2007

Integrative treatment in persons with intellectual disability and mental health problems.

BACKGROUND: Clinical experience has proven thus far that a monodisciplinary treatment approach to behavioural and psychiatric problems in persons with intellectual disability (ID), such as psychotropic medication or behaviour modification programmes, has yielded limited success. It is clear that the complexity of behavioural and psychiatric problems in this population calls for a treatment approach from different perspectives. METHODS: A multidimensional treatment approach to the persons with ID who suffer from behaviour problems and psychiatric disorders is described. RESULTS: Four dimensions - biological, psychological, social and developmental - are represented as well in an integrative diagnosis as in an integrative treatment, embodied by cooperation of different professionals, such as a psychiatrist, psychologist, pedagogues, social worker, nurse and, where possible, the person's caretakers. The developmental dimension receives a salient attention of assessors. By introducing the developmental dimension in diagnostics and treatment, the bio-psycho-social dimensions are set in a new context, more appropriate for persons with ID. CONCLUSION: The integrative treatment should not be primarily directed towards the symptoms of the disorder but towards restoring a person's mental well-being. The disorder is combated through treatment of the underlying processes that have led to its onset. Different treatment methods from different perspectives may be applied. Strategy and methodological procedures of an integrative treatment are discussed by way of case presentations.

Adult↗
PubMed2003

Caregiving burden of families looking after persons with intellectual disability and behavioural or psychiatric problems.

BACKGROUND: During the last decade, there has been a growing interest in outpatient support services for persons with intellectual disability (ID) and psychiatric and/or behavioural problems and their families. In this study, we explore the family burden that is associated with children or adults with ID and behavioural or psychiatric problems living at home. METHOD: The research group consisted of 66 clients of In Casa, a project of outpatient treatment. Their average age is 18.97 years and their average IQ 55.37. The Reiss Screen for Maladaptive Behaviour (adults) or Reiss Scales for Children's Dual Diagnosis (children) and the Nijmegen Family Situation Questionnaire have been administered. RESULTS: About 62% of the children and 86% of the adults living at home and referred to In Casa have severe psychiatric or behavioural problems as measured by the Reiss scales. The dual diagnosis has a more negative impact on the family situation than the condition of ID only. CONCLUSION: Parents consider the psychiatric or behavioural problems of their child to be an extra burden and feel it more difficult to raise and manage such a child. This impels them to change the situation and to call on the help of external services. Some methodological questions and the implications of the findings in terms of support needs are discussed.

Adaptation, Psychological↗
PubMed2005

How do persons with intellectual disability manage in the open labour markets? A follow-up of the Northern Finland 1966 Birth Cohort.

BACKGROUND: The aim was to study how many of the individuals with intellectual disability (ID; IQ < or = 70) in an age cohort were not receiving a disability pension by the age of 34 years and what their life situation was like in terms of employment, education and morbidity. In 2000, the Northern Finland 1966 Birth Cohort (n=12,058 live-born) included 129 individuals with ID. METHOD: The outcome data on employment, education, pensions and morbidity were obtained from national registers. RESULTS: A total of 85.3% (n=110) of all the individuals with ID were on pension, and 66 of them had severe ID (IQ <50) and 44 had mild ID (IQ 50-70). Altogether 99 were drawing a pension because of ID, and 11 had a main diagnosis other than ID in the register of Social Insurance Institution. Nineteen individuals with mild ID were not on disability pension. The educational level of those without pension was low, and all whose occupation was known worked in low-level manual trades in the open labour market. During the past 8 years (1993-2000), their employment rate had been lower and unemployment rate correspondingly higher and unemployment periods longer than those of the reference group (IQ >85 or not measured). As to the morbidity, they had been hospitalized twice more often than those in the reference group and the mean of their hospitalization days was over fourfold. CONCLUSION: More attention should be paid to the vocational education and supported employment services of individuals with ID to help them to manage as independently as possible.

Adult↗
PubMed2005

Health status, utilization patterns, and outcomes of persons with intellectual disabilities: review of the literature.

A literature review was conducted to analyze existing data on health status, health care utilization, and medical outcomes of persons with intellectual disabilities. We found that barriers exist, but evidence indicates that (a) individuals with intellectual disability and medical needs are living in the community, (b) people with significant medical conditions can be maintained in community settings, and (c) medical supports can and are provided to people with intellectual disabilities and allied medical conditions to enable community living. However, some people had unmet medical needs, and the availability of and access to community-based services were problematic for others. These contradictory findings indicate that it is possible to provide services in the community, but the service delivery system needs improvement.

Adult↗
PubMed2006

Adult persons with intellectual disabilities on the island of Ireland.

BACKGROUND: Information on the numbers of adult persons (aged 20 years and over) with intellectual disability (ID) is rarely collated at a national level. This is an impediment to service planning especially for a changing population. METHODS: A database of all persons in receipt of ID services has been operating in the Republic of Ireland since 1995. In Northern Ireland, regional databases can be used to provide similar information. RESULTS: A total of 25,134 persons were known to services in 2002; an overall prevalence for the island of 6.34 per 1,000. However this rate varied for different age groupings and across the two parts of the island. General population characteristics, as well as service factors, appear to account for this. Significantly more people lived with family carers in Northern Ireland. By 2021, it was estimated that the population would increase by over 20% with around one-third of persons aged over 50 years. CONCLUSIONS: These data illustrate the variations that exist in the numbers of adult persons with ID known to services across and within regions of a country. Hence caution must be exercised in extrapolating prevalence rates derived in one area to another. The availability of comparative national data highlights issues around the equitable funding and delivery of services.

Adult↗
PubMed2006

Sexual health care in persons with intellectual disabilities.

In the past, preventive health concerning sexuality of people with intellectual disabilities was addressed through surgical sterilization as part of nationwide eugenic programs in many countries. For more than 30 years now, it has come progressively to light in the scientific literature that, besides major ethical and legal problems, these programs also failed to assess many of the individual's needs in sexual health. The fact that an increasing number of people with intellectual disabilities live in the community rather than in institutions has heightened public awareness that these individuals have sexual expectancies, desires, and needs that must be supported through both education and health services. The emergence of AIDS, including descriptions of cases among people with intellectual disabilities, has further demonstrated that surgical sterilization cannot be considered a global option to achieve preventive sexual health. The aim of this paper is to review scientific studies that have assessed the expectancies and support needs of persons with intellectual disabilities in terms of sexual health. These needs vary widely from one individual to another, according to life milieu, level of disability, and potential comorbidity. From this review, it appears that hygiene management, global gynecological care, and prevention of unplanned pregnancy, sexually transmitted diseases, and abuse have been frequently identified as areas in which the presence of intellectual disability dictates specific support needs. Different approaches that have been evaluated to address these issues will also be discussed.

Acquired Immunodeficiency Syndrome↗
PubMed2006

What am I doing in Timbuktu: person-environment picture recognition for persons with intellectual disability.

BACKGROUND: The aim of this study was to examine the effects of familiarity of depicted persons and environments in recognition of photographs for pupils with different degrees of intellectual disability (ID). METHOD: Forty-five pupils with ID participated. RESULTS: An interaction effect between the two variables, person and environment, was found in addition to main effects for both the variables. Pictures of the test person himself or herself in familiar environments were easier to recognize than in unfamiliar environments, whereas the opposite was found for pictures of other familiar persons. No interaction effects of degree of ID were found. CONCLUSIONS: The interaction pattern is explained in terms of absent, present or implausible semantic associations between the person and the environmental context. The results are discussed in relation to augmentative and alternative communication with photographs.

Adolescent↗
PubMedDate not supplied

Aging among persons with intellectual disability in Israel in relation to type of residence, age, and etiology.

This study was conducted to compare aging phenomena of persons with intellectual and developmental disability (ID) aged 40 years and older living in community residence (N = 65) with those living with their families (N = 43) in Jerusalem, Israel. All 108 persons and care givers were interviewed to ascertain health problems, sensory impairment, activity of daily living (ADL), cognitive skills, and leisure activities. Health problem had already developed by age 40 years. The most frequent were visual (33%), hearing impairments (20%) and dental problems (30%). The community residence group displayed more medical problems, whereas individuals living at home had more dental problems. Health problems in persons with Down syndrome were significantly higher. ADL functioning for all participants was high, but persons with Down syndrome and cerebral palsy had more dependence. A decline in functioning in both residential groups was observed concerning leisure time, but scores for social life leisure activities were better for the community residential group. The data provided in this study can serve as information to develop geriatric services for persons with ID and provide a basis for comparison with peers in the general population in Israel. Dental service to persons with ID living at home should be improved.

Activities of Daily Living↗