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A comparison of central coherence skills between adolescents with an intellectual disability with and without comorbid autism spectrum disorder.

Central coherence theory hypothesizes individuals with autism process information in a detail-focused fashion. The present study examined whether adolescents with an intellectual disability and comorbid autism spectrum disorder showed a weaker central coherence than age- and IQ-matched controls. The central coherence skills of 43 adolescents from schools for students with severe learning problems were examined with two cognitive tasks. In these two tasks, detail-focused processing is beneficial to global processing to perform the tasks accurately and quickly. The group with autism spectrum disorder performed better than the control group. Adolescents with an intellectual disability and with comorbid autism spectrum disorder have a weaker central coherence than age- and IQ-matched controls. Partial support was also given for variability in weak central coherence within the autism spectrum.

Adolescent↗

Physical fitness and functional ability of children with intellectual disability: effects of a short-term daily treadmill intervention.

Persons with intellectual disability (ID) and associated multiple disabilities have been found by many researchers to be a population with deficient physical fitness measures, which can be explained by an inactive lifestyle, a result of lack of awareness of the positive physical effects of physical exercise, or lack of motivation for any motor activity. Various plans for physical exercise have been put forward, but many are found impractical in nonresearch-based intervention. In this study, 15 children with ID on a motor functioning level of 7-14 months used a treadmill daily for 2 months. Our findings indicated a most significant improvement in the level of physical fitness of the participants (p < 0.005), as measured by pulse at rest and during effort. The improvement in physical fitness modestly (r = 0.5), but significantly (p < 0.05), correlated with a significant (p < 0.0007) improvement in functional ability of the participating children. Further examination a year after intervention terminated showed a return to preintervention pulse-at-rest values. The research examined the treadmill training method and found that it can be operated with the support of an unskilled staff person under the supervision of a physiotherapist. The research was performed under real-life conditions, enabling relatively easy implementation in the existing conditions of special education centers. This method is a type of exercise that is easy to operate without entailing long-term budgetary expenses and might improve the health status of children with ID, who are a population at risk for developing heart-related diseases at a young age.

Child↗

Mothers' expressed emotion towards children with and without intellectual disabilities.

OBJECTIVES: To identify factors associated with maternal expressed emotion (EE) towards their child with intellectual disability (ID). DESIGN AND METHOD: A total of 33 mothers who had a child with ID and at least one child without disabilities between the ages of 4 and 14 years participated in the study. Mothers completed self-assessment questionnaires which addressed their sense of parenting competence, beliefs about child-rearing practices, and their reports of behavioural and emotional problems of their child with ID. Telephone interviews were conducted to assess maternal EE towards the child with ID and towards a sibling using the Five Minute Speech Sample (FMSS; Magana et al. 1986), and also to assess the adaptive behaviour of the child with ID using the Vineland Adaptive Behaviour Scale (VABS; Sparrow et al. 1984). RESULTS: Mothers with high EE towards their child with ID were more satisfied with their parenting ability, and their children had more behaviour problems. Analysis of differential maternal parenting, through comparisons of EE towards their two children, showed that mothers were more negative towards their child with ID for all domains of the FMSS except dissatisfaction. CONCLUSIONS: A small number of factors associated with maternal EE towards children with ID were identified. Differences in maternal EE towards their child with ID and their other child suggest that EE is child-driven rather than a general maternal characteristic. Implications of the data for future research are discussed.

Adolescent↗

Primary health care and people with an intellectual disability: the evidence base.

There is growing awareness of the importance of evidence-based medicine in guiding health care delivery. This paper reviews the evidence pertinent to the delivery of primary health care to people with an intellectual disability. Research concerning issues of health status, specialist knowledge of health care, and barriers and solutions to health care delivery for people with an intellectual disability is presented and discussed. Recommendations for future evidence-based research are made, including suggested areas of importance.

Community Health Services↗

A 6-month follow-up of the effects of an information and communication technology (ICT) training programme on people with intellectual disabilities.

We investigated the long-term effects of an information and communication technology (ICT) training programme for people with intellectual disabilities (ID). A community-based ICT training programme was designed to enhance the computer skills of people with ID and prepare them to make use of ICT in their daily life. Of the 100 who had participated in the original ICT training programme, 59 of them and their caregivers agreed to participate in the follow-up interview. A computer skills checklist was used to assess the ICT competence of the participants before training, after training, and at the 6-month follow-up assessment. All caregivers were interviewed at the 6-month follow-up session to explore the use of ICT by people with ID and their needs for further training. Results from repeated measures ANOVA showed that participants maintained at the 6-month follow-up the basic ICT skills that they acquired during training [F=13.86, p<0.001]. Caregivers reported that participants spent more time in using the computers, but still needed occasional guidance. They also reported a need to advance their ICT skills beyond the basic computer training. We concluded that ICT training for people with ID would help them in maximizing the benefits of information technology via computers.

Adolescent↗

The role of coping in maintaining the psychological well-being of mothers of adults with intellectual disability and mental illness.

BACKGROUND: Mothers who have a child with intellectual disability (ID) or mental illness face a lifetime of caregiving responsibilities and challenges. The present study investigated changes over time in how mothers cope with the challenges of caring for an adult child with disabilities and the effects of changes in coping on maternal well-being. METHODS: A sample of 246 ageing mothers of adults with ID and 74 mothers of adults with mental illness was drawn from two parallel longitudinal studies of later-life caregiving. RESULTS: There was considerable variability at the individual level in the degree to which mothers changed over time in their use of problem-focused and emotion-focused coping strategies. For both groups, an increase in their use of emotion-focused coping led to declining levels of well-being. For the parents of adults with ID, an increase in their use of problem-focused coping resulted in a reduction in distress and an improvement in the quality of the relationship with their adult child. For the parents of adults with mental illness, an increase in the use of problem-focused coping had no effect on levels of distress, but led to an improved relationship with their adult child. CONCLUSIONS: The present study underscores the importance of coping in the lives of older mothers of adults with disabilities.

Adaptation, Psychological↗

Population prevalence of psychopathology in children and adolescents with intellectual disability: II. Epidemiological findings.

This paper reports findings from an epidemiologically derived population in a multicentre study in NSW, Australia. The design of this study is described in the accompanying paper. Those with mild intellectual disability (ID) were likely to have been underascertained, but identification and participation rates for those with more severe ID were high. The study found that in the regions surveyed 40.7% of those with ID and aged between 4 and 18 could be classified as having severe emotional and behaviour disorder or as being psychiatrically disordered. The profoundly intellectually handicapped had lower levels of disturbance overall compared with those with mild, moderate and severe ID. The level of ID affected scores on a number of behavioural dimensions, with disruptive and antisocial behaviours more prominent in the mild ID group, and 'self-absorbed' and 'autistic' behaviours more prominent in those with severe ID. Age and sex did not affect prevalence, a finding that is in contrast to that found in general child psychopathology. The study found that fewer than 10% of children with intellectual disability and major psychiatric disorder had received specialist assistance.

Adolescent↗

Children with intellectual disability in rural South Africa: prevalence and associated disability.

The objective of the present study was to determine the prevalence of intellectual disability (ID) and its associated disabilities in rural South African children aged 2-9 years. It was undertaken in eight villages in the district of Bushbuckridge, Northern Province, South Africa. A two-phase design was utilized. The first phase involved screening children on a house-to-house basis by interviewing mothers or caregivers using an internationally validated questionnaire for detecting childhood disability in developing countries. The second phase consisted of a paediatric/neurodevelopmental assessment of the children who screened positive. A total of 6692 children were screened; 722 (10.8%) had a paediatric evaluation and 238 children were diagnosed with ID, giving a minimum observed prevalence of 35.6 per 1000 children in this population. The prevalence of severe and mild ID was 0.64 per 1000 and 29.1 per 1000 children, respectively. The male:female ratio of children with ID was 3:2. In the affected children, a congenital aetiology for the ID was determined in 49 subjects (20.6%), an acquired aetiology in 15 (6.3%) and the aetiology was undetermined in 174 children (73.1%). Epilepsy (15.5%) and cerebral palsy (8.4%) were the commonest associated disabilities. The present study represents the first data on the prevalence of ID and associated disabilities in rural South African children. The prevalence of ID was comparable with results from a study performed in one other African country (Zambia) as well as those from other developing countries. The data provide an initial factual insight into ID and its associated disabilities for healthcare, social service and educational policy planners. This study provides a basis for the initiation and development of appropriate and integrated services for the best possible care of individuals affected with these disabilities, and for their possible prevention.

Child↗

Influence of macrostructure of society on the life situation of families with a child with intellectual disability: Sweden as an example.

BACKGROUND: Most studies on families with children with intellectual disability (ID) have been carried out in the UK or the USA, and are influenced by the societal organization, and political and economic climate of those countries. In the USA and the UK, the care and well-being of children, with or without ID, are seen almost exclusively as the individual family's responsibility. In Sweden, the care and well-being of children are seen more as a joint responsibility. Swedish society has developed many privileges for all parents in order to help them care for their children, and the support for parents of children with disabilities is provided exclusively by the Government and the community. The overall question explored in this descriptive, quantitative and qualitative study was: Are families in Sweden experiencing the stressors and life situations described in the studies of parents in more individualistic societies? METHODS: Two hundred and twenty-six families with children with ID and 234 control families with children ranging from 0 to 16 years of age answered mail surveys. RESULTS: Taken together, parents in Sweden describe most of the stressors proposed in the international literature with the exception of financial strain. Restricted social life and time restrictions seem to be the two most evident and bothersome stressors for Swedish families with children who have ID. CONCLUSIONS: As in previous research, the parents of children with ID and autism experienced more stressors and restrictions in their lives than the parents of children with DS and control families.

Adolescent↗

Socio-economic position, household composition, health status and indicators of the well-being of mothers of children with and without intellectual disabilities.

BACKGROUND: Many previous studies have reported that mothers of children with intellectual disabilities (IDs) are more likely to show signs of psychological distress and have lower well-being than mothers of 'typically developing' children. Our aim was to estimate the extent to which these differences may be accounted for by between-group differences in socio-economic position. METHODS: This study involved secondary analysis of happiness, self-esteem and self-efficacy variables in a nationally representative sample of 6954 British mothers with dependent children under the age of 17 years, 514 of whom were supporting a child with an ID. RESULTS: Mothers of children with IDs reported lower levels of happiness, self-esteem and self-efficacy than mothers of children without IDs. Statistically controlling for differences in socio-economic position, household composition and maternal characteristics fully accounted for the between-group differences in maternal happiness, and accounted for over 50% of the elevated risk for poorer self-esteem and self-efficacy. CONCLUSIONS: A socially and statistically significant proportion of the increased risk of poorer well-being among mothers of children with IDs may be attributed to their increased risk of socio-economic disadvantage.

Adolescent↗

Behavioural and emotional problems in children with intellectual disability attending special schools in Cape Town, South Africa.

A sample of 355 children with intellectual disability (ID) attending special schools in Cape Town, South Africa, were assessed on the Developmental Behavioural Checklist--Teacher Version (DBC-T). A prevalence rate of 31% for psychopathology was found. Boys manifested more behaviour problems than girls, especially in relation to disruptive, self-absorbed and antisocial behaviours. Children with severe and profound levels of ID showed more behavioural difficulties than those in the mild and moderate categories. Specific behaviour problems were self-absorbed and autistic behaviours in children with profound ID, communication problems and anxiety in those with severe ID and antisocial behaviour in children with mild ID. Epilepsy, but not cerebral palsy was associated with higher total behaviour scores. Ambulant children were more disruptive and antisocial, while non-ambulant children were more anxious. Non-verbal children had higher scores on all of the subscales except for disruptive behaviour.

Adolescent↗

Referral trends of people with intellectual disabilities and psychiatric disorders.

BACKGROUND: The Specialist Mental Health Service for people with an intellectual disability (ID) and psychiatric disorder (referred to throughout this paper as 'the Service') has been in operation in south-east London for the last 18 years, during which time two local, long-stay institutions have closed. AIMS: To measure the number of referrals to the Service from 1983 to 2001 and identify trends. METHODS: Data were recorded on 752 new referrals using the assessment and information rating profile. Diagnoses according to the International Classification of Diseases (10th edition) were made by two psychiatrists. Referrals for a one off consultation or assessment, or with an IQ>70 were excluded from analysis. RESULTS: Over time more non-white clients and more clients with mild ID were referred. More referrals were made in later years, and a greater proportion came from primary care. Later referrals were also more likely to have a psychiatric diagnosis than those in earlier years. CONCLUSION: Significant trends in referrals were identified, which may be explained by various external factors.

Adolescent↗

Intratester reliability of the Nicholas Manual Muscle Tester on individuals with intellectual disabilities by a tester having minimal experience.

The purpose of this investigation was to determine the intratester reliability of measurements obtained with the Nicholas Manual Muscle Tester (NMMT) by a tester having minimal experience on individuals with intellectual disabilities. Seventeen individuals classified as moderately mentally retarded between the ages of 14 and 24 (mean = 18.65) were evaluated with the NMMT using a test-retest reliability procedure after a familiarization session. Test-retest strength score relationships for dominant and nondominant elbow flexors and extensors revealed intraclass correlation coefficients from .83 to .86 (p < .001); whereas a series of paired t-tests revealed no significant differences between test and retest values. Finally, intraclass correlation coefficients ranging from .98 to .99 were evident in comparing the first trial to mean of three trials from the first testing session. It was concluded that testers with minimal experience with the NMMT could obtain reliable measurements with the NMMT for determining isometric force of elbow flexors and extensors in individuals with intellectual disabilities.

Adolescent↗

Capacity to make financial decisions among people with mild intellectual disabilities.

BACKGROUND: Although there has been growing recognition of the importance of enabling people with intellectual disabilities (ID) to be more directly involved in managing their own financial affairs, so far, little is known about this aspect of their decision- making. METHOD: Using vignettes and semi-structured interviews, the financial decision-making abilities of men and women with mild ID (n=30; mean FSIQ =61.80; SD=10.59) were compared with those of their counterparts in the 'general population' (n=16; mean FSIQ=101.56; SD=7.62) and 'very able' individuals (n=14; mean FSIQ=123.93; SD=7.60). RESULTS: Whilst the financial decision-making abilities of participants with ID were generally weaker than those of other participants, the differences were not discrete, and many individuals were judged to be able to make at least some personal financial decisions. For all three groups, understanding information relevant to the decision, and reasoning with it, were the hardest parts of the process. CONCLUSIONS: The findings support a functional approach to the assessment of financial decision-making for both legal and clinical purposes, but raise concerns about mental incapacity legislation and assessment.

Adolescent↗

Oral health status of people with intellectual disabilities in the southeastern United States.

BACKGROUND: The U.S. surgeon general's report, Oral Health in America, stated that people living below the poverty level and those with mental retardation and/or physical disabilities have poorer oral health than the general population. METHODS: The calibrated examiners (volunteer dentists and dental students) assessed the oral health status of intellectually disabled people with or without a physical disability via screening examinations provided to 12,099 Special Olympics athletes at 53 sites, including 1891 people from seven states in the southeastern United States. Measurements of gingivitis, untreated decay, missing molars, sealants, restorations and treatment urgency were recorded. RESULTS: The authors found that athletes from the very poor southeastern states were 1.6 times (odds ratio [OR] = 1.64; 95 percent confidence interval [CI]: 1.10 to 2.46) more likely to have restorations and almost one-third as likely (OR = 0.35; 95 percent CI: 0.21 to 0.60) to have sealants than were athletes from the poor states, after restricting the analysis by age. CONCLUSIONS: Among intellectually disabled people in this study, oral health disparities were associated with poverty. Special Olympics athletes from the poorest states were significantly more likely to have restorations and less likely to have received preventive treatment.

Adult↗

[Three cases with severe motor and intellectual disabilities presenting the severest condition caused by prolonged non-convulsive status epilepticus].

Three patients with severe motor and intellectual disabilities presented deterioration of the activities of daily living, which was revealed to be caused by prolonged non-convulsive status epilepticus (NCSE). Their condition improved by the treatment with antiepileptics. Case 1, a 4-year-old girl with profound psychomotor retardation and past history of West syndrome of unknown etiology, became unable to sit and eat orally above age of two years. EEG showed continuous generalized slow spike and wave bursts indicating NCSE. Continuous intravenous infusion of midazolam abolished EEG abnormalities of NCSE, and she regained the ability of oral feeding. Case 2, a 3-year-old boy with Angelman syndrome and past history of West syndrome, presented decreased mental response, poor oral intake and somnolence. EEG showed continuous slow spike and wave bursts, indicating NCSE. High-dose phenobarbital therapy and continuous intravenous injection of vitamin B6 were effective, and remarkably improved his psychomotor activities. Case 3, a 3-year-old boy with Lennox-Gastaut syndrome, developed decreased psychomotor activity and loss of vocalization and walking. He could not sit by himself and became nearly bed-ridden. EEG showed very frequent generalized spike and wave bursts, showing NCSE. Continuous infusion of thiopental diminished NCSE, and he could walk again. Psychomotor deterioration in patients with severe motor and intellectual disabilities may be caused by NCSE, which should not be overlooked.

Child, Preschool↗

Pathological study of bronchospasms/tracheomalasia in patients with severe motor and intellectual disabilities.

This report concerns two autopsy cases of severe motor and intellectual disabilities (SMID) who died of bronchospasms or tracheomalasia. One case had no anatomical change in the tracheal wall except for an endotracheal granuloma, while the other showed softening of the tracheal wall. Since patients with SMID have risk factors for bronchospasms and tracheomalasia, such as gastro-esophageal reflux, aspiration, and thoracic deformities, it is important that we suspect the possibility of these conditions, when we see the respiratory distress in cases of SMID.

Adult↗

Rehabilitation service utilization and determinants among people with an intellectual disability: preliminary findings in Taiwan.

Improving rehabilitation services for people with intellectual disabilities (ID) remains an ongoing challenge in the public health system. The purpose of this article was to investigate the types of rehabilitation services used by people with ID and determine what factors predict resource utilization in Taiwan. Samples of 957 people with ID were recruited from the Taiwan National Disability Register in a cross-sectional study in 2001. The findings indicated that 24.5% of individuals with ID had received rehabilitation services in the past 7 months. The main types of services used were speech and communication therapy (50%), psychotherapy (32.1%), occupational therapy (30.3%) and physiotherapy (25.2%). Stepwise logistic regression was carried out for the utilization of rehabilitation services (yes/no). The model revealed that the following factors: (i) Major Illness Card holder, (ii) time spent in medical care, (iii) having a family physician, (iv) having illnesses, (v) age of ID individual, and (vi) gender of the main carer, were all significantly associated with the utilization of rehabilitation services. We should reorient the healthcare system to respond adequately to the health needs of rehabilitation service users and its determinants, and further research should focus on the effectiveness and efficiency of rehabilitation for people with ID in Taiwan.

Adolescent↗