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PubMed2005

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

BACKGROUND: In generic psychiatry there has been increasing interest among scientists for the developmental perspective. However, professionals active in the mental health care of people with intellectual disability (ID) have not shown the same degree of interest. The author of this article, who has had a liberal amount of rewarding experiences with the developmental approach in the field of ID, considers the developmental perspective to be innovative and very useful in psychiatric assessment, diagnosis and treatment of this population. The aim of the article is to stimulate a wider application of the developmental perspective as well as to challenge a professional discussion on this issue. METHODS: Basic assumptions of the developmental perspective are discussed and assessment tools and methods are described. RESULTS: In a case vignette, the advantages of developmentally based assessment are emphasized. Emotional development and personality development are viewed as the developmental components that play an important role in adaptive and maladaptive behaviour as well as in the onset and presentation of psychopathology. It is clear that interpretative insight into the totality of the psychosocial aspects of these individuals cannot only be obtained by measuring the level of cognitive development. A wider frame of mind is needed for unambiguous psychiatric diagnostics. Therefore, a replacement of the three dimensional paradigm (bio-psycho-social) by a four dimensional one (bio-psycho-socio-developmental) for the assessment and diagnosis of persons with ID is proposed.

Adult↗
PubMed2003

Medical services for persons with intellectual disability in Israel.

BACKGROUND: The first school for children with intellectual disability (ID) was opened in Tel Aviv in 1929; the first boarding school for children with ID was established in Jerusalem in 1931; and the first center for assessment of children with ID established in Tel Aviv in 1936. With the establishment of the State of Israel in 1948, there was a total of four residential care centers providing services for 150 children with ID. OBJECTIVE: This paper will describe the history and development of the public health work with persons with intellectual disability from the birth of the State of Israel in 1948 until today, with a focus on medical and nursing care and ideas for future work with this population. DATA SOURCES: Studies and documents from the Office of the Medical Director, Division for Mental Retardation of the Ministry of Social Affairs in Israel. DATA EXTRACTION: The Division for Mental Retardation is in contact with approximately 23,000 persons of all ages. Residential care is provided to about 6,000 persons in 54 institutions countrywide. In addition, 2,000 persons receive residential care in hostels or protected apartments within the community. More than 50 other settings provide vocational and educational services to 15,000 persons--day-care kindergartens, day-treatment centers, sheltered workshops, or integrated care within the community. DATA SYNTHESIS: Data on the health profile, morbidity, and mortality of the residents in residential care centers are used to illustrate the medical and nursing work with this population. CONCLUSIONS: We recommend that the direction in Israel should be a combination of both community and institutional care for the population of persons with ID. We recommend the establishment of a subspecialty for physicians and nurses in intellectual disability and the establishment of a Health Division within the Ministry of Social Affairs to facilitate better service, education, and research.

Adolescent↗
PubMed1995

Short-term memory in persons with intellectual disabilities and Down's syndrome.

The present study was designed to investigate verbal and spatial short-term memory abilities in persons with Down's syndrome (DS) and intellectual disability (ID) of different aetiology. For this purpose, we compared performances of DS (n = 15; mean mental age = 5.2 years; SD = 1.2 years; mean chronological age = 16.6 years; SD = 2.9 years) and ID subjects (n = 14; mean mental age = 5.8 years; SD = 2.1 years; mean chronological age = 16.4 years; SD = 2.5 years) with those of normally developed subjects matched for mental age (n = 24) on tasks of forward and backward immediate recall of verbal and spatial sequences. Our results are discussed in the light of the Working Memory model developed by Baddeley (1986, 1990). Altogether, our data documents a deficit of verbal and spatial backward spans in persons with DS. The deficit seems to be specific for this particular aetiology group, confirming the hypothesis that ID is not a uniform condition, characterized by an undifferentiated delay of the cognitive development, but rather that it is characterized by a deficit in a complex cognitive system in which some cognitive abilities can be disrupted more than others (Detterman 1987; Vicari et al. 1992).

Adolescent↗
PubMed2006

Laterality in persons with intellectual disability. I--do patients with trisomy 21 and Williams-Beuren syndrome differ from typically developing persons?

Persons with trisomy 21 (T21) and Williams-Beuren syndrome (WBS) have different brain abnormalities which may affect manual laterality. We assessed 45 persons with T21 and 34 with WBS (mean age 13) and 81 typically developing children (TD). Manual laterality was assessed with a fifteen-item task administered two times, and Bishop's card-reaching task. We found more left-handers in the T21 group compared to the other two groups. Inconsistent laterality was higher in the two groups with genetic diseases than in the TD group. For Bishop's test, both T21 and WBS participants were less right-oriented than the TD group. They displayed different response patterns in midline crossing when reaching for the cards, but did not display more midline crossing inhibition than the TD group. Is atypical handedness linked to specific genetic syndromes and, more specifically for persons with T21, to the trisomy of some of the genes?

Aging↗
PubMed2003

Elderly persons with intellectual disability: a study of clinical characteristics, functional status, and sensory capacity.

Longer life expectancy is resulting in increasing numbers of elderly adults with intellectual disability (ID). There has been the question whether persons with ID demonstrate early signs of aging before the general population. The aim of this study was to determine if persons with ID (with and without Down syndrome) showed premature aging changes compared with a control group. Elderly persons (n = 24, average age of 61) from one residential care center in Israel and younger adults from another center (n = 37, average age of 45) were compared with elderly residents without ID in an independent living facility. The study considered demographic data, medical data, anthropometric measurements, body fat and body mass index, flexibility, and sensorimotor function tests. The results showed that the persons with ID had basically similar body composition to that of persons without ID, however, the functional performance of elderly adults with ID was more impaired. We postulate that the slower functioning responses may be explained by a less physically active lifestyle, that may accelerate the onset of disease and result in symptoms associated with aging that are detrimental to health. It is therefore important that persons with ID participate in physical activity and exercises in order to promote health and prevent disease.

Adult↗
PubMed2006

Survey on dysfunctional eating behavior in adult persons with intellectual disability living in the community.

Prevalence of dysfunctional eating behavior was investigated in 311 adult persons with mental retardation living in the West Coast of Norway. Reports from a questionnaire filled out by health workers were used as observational data. The main finding was that 64.3% of the clients showed indices of dysfunctional eating behavior. The five most frequent dysfunctional behaviors was eating to fast (27.7%) followed by bolting one's food (25.1%), refusal of food (19.9%), excessive eating (18.3%) and non co-operative during mealtime (17.0%). In 50% of the cases, one or more eating dysfunction was present every day and the intensity of the behavior was regarded as high or very high in 26.2% of the cases. It is suggested that more studies are needed to single out treatment approaches to eating dysfunction's in adult persons as has been done on food refusal in children.

Adult↗
PubMedDate not supplied

Slipping through the cracks. Dental care for older persons with intellectual disabilities.

An increasing population of men and women with intellectual disabilities and other developmental disabilities is reaching older ages. As our country continues the process of deinstitutionalization, these individuals will require treatment in communities. Dental practitioners increasingly will be involved in the needs of this population, many of whom are members of families being treated in private dental practices. A review of these developments and the particular dental needs of these patients is considered.

Aged↗
PubMed1990

The effect of differential reinforcement of incompatible behaviors (DRI) on pica for cigarettes in persons with intellectual disability.

The effect of Differential Reinforcement of Incompatible Behaviors (DRI) on pica for cigarettes in two intellectually disabled adults was studied using an A-B-A-B treatment design; in addition, the efficacy of using placebo pica stimuli (bread "cigarette butts") was evaluated. Both subjects received 10 15-minute sessions of baseline followed by 10 sessions of DRI, with a reversal to baseline and a repeat of the DRI treatment. Results support the efficacy of DRI with pica, as well as the use of placebo pica stimuli. Generalization was conducted with one of the subjects; results indicate that treatment effects were present when implemented by several ward personnel. The implications of the results for future research were discussed.

Adult↗
PubMed2003

Five clinical tests to assess balance following ball exercises and treadmill training in adult persons with intellectual disability.

BACKGROUND: Incidence rates of falling increase progressively with aging. Preventing or delaying the onset of functional decline is a crucial important goal, because more individuals with intellectual disability (ID) are living well into their sixth and seventh decades. The question of whether walking and ball exercises can effect balance performance has never been reported. This pilot study was conducted to determine the effects of therapeutic training on improving balance capabilities in adults with mild ID. METHODS: The study included 13 women and 4 men, aged 50-67 years (mean age 56.5 years) residing in a residential care center. Five clinical tests were used to determine the "real" picture of the locomotor function and balance before and after the training protocol. Baseline values were determined using 2 control groups of age-matched adults with and without ID. The tests included modified get-up-and-go, full turn, forward reach, sit-to-stand, and one-legged standing. Therapeutic training for 6 months included dynamic ball exercises and treadmill walking with a 2-3% positive inclination. RESULTS: Participants in the program showed little to no improvement in terms of their static and dynamic balance compared to their initial values. Thus, only 2 of the tests showed statistical significance. CONCLUSIONS: Lack of improvement was noted in both postural and balance control in adults with mild ID as a result of 6 months of intervention by means of ball exercise and treadmill training.

Aged↗
PubMed2006

The relationship between food refusal and social skills in persons with intellectual disabilities.

BACKGROUND: Feeding problems are common among individuals with intellectual disabilities. The aim of the current study was to determine the relationship between food refusal and social skills in people with intellectual disability. METHOD: The Screening Tool of Feeding Problems (STEP) was administered to all residents of a large developmental centre. This screening tool identified 82 residents who exhibited food refusal, and 81 residents who did not exhibit food refusal. The Matson Evaluation of Social Skills in Persons with Severe Retardation (MESSIER) was administered to the 163 participants. RESULTS: People who exhibited food refusal displayed significantly more negative nonverbal and general negative social skills when compared to controls. Food refusal was prevalent across all ages, genders, and levels of intellectual disability. CONCLUSIONS: As social skill deficits are associated with deficits in feeding skills, social skills training should be considered as a major component of behavioural interventions targeting food refusal in people with intellectual disability.

Adult↗
PubMed2004

Psychiatric diagnosis in persons with intellectual disability in India.

BACKGROUND: This study examines the rate of psychiatric diagnosis as per ICD-10 and Reiss Screen for Maladaptive Behaviours (RSMB), and distribution of psychiatric diagnosis with regard to the severity of intellectual disability (ID). It also explores the degree of agreement between Reiss screen and clinical diagnosis (ICD-10) in relation to dual diagnosis. METHODS: In this study Intelligence (IQ) and Social Quotient (SQ) were estimated on Indian adaptation of Binet's scale and Vineland Social Maturity Scales, respectively, in 60 consecutive persons with ID. Both ICD-10 and RSMB were used independently to determine the presence of psychiatric diagnosis. RESULTS: Clinically, according to ICD-10, about 60% of the sample was found to have dual diagnosis as compared to 48% on RSMB. Agreement between ICD-10 and RSMB about psychiatric comorbidity was 82%. Commonest psychiatric diagnosis was unspecified psychosis followed by bipolar affective disorders. CONCLUSION: Persons with ID do suffer from various psychiatric disorders. RSMB is a useful tool for differentiating between psychiatric problems and maladaptive behaviours. Hence RSMB can be used in the Indian context.

Adolescent↗
PubMedDate not supplied

Working memory, intelligence and knowledge base in adult persons with intellectual disability.

Previous studies have suggested that performance in working memory (WM) tasks is deficient in all etiologies and at all levels of intellectual disability (ID). Knowledge about WM structure, cognitive processes reflected in WM tasks, or the long-term memory contribution to WM capacity in ID is. however, not satisfactory. In the present study, WM capacity, WM task requirements, as well as effects between WM, skills, knowledge base, and intelligence were explored in two groups with matched fluid intelligence: adult persons with ID and normally developing children aged 3-6 years. The ID Group performed equally well as the children in WM tasks based on familiar semantic information and were significantly better on all measures reflecting skills and knowledge base. The Child Group performed better in phonological and visuo-spatial WM tasks including nonsemantic information, respectively. In particular, it appeared that the groups differed in their WM performance although they were matched for fluid intelligence. We hypothesize that the ID Group depended more on knowledge support from long-terrm memory whereas the Child Group could benefit more from efficient online WM processes.

Cognition Disorders↗
PubMed2006

Aspects of digestive tract tumors in Down syndrome: a literature review.

The purpose of this study was to describe the digestive neoplasms found in persons with Down syndrome. Due to intellectual disability, persons with Down syndrome do not convey their symptoms and pain, leading to delayed diagnosis and potentially worse outcome. It is thus important to know which organs are at risk for tumors and possible tumor risk factors. In a review of the literature, we found 13 benign tumors and 127 cancers in 1 fetus, 8 children, and 131 adults with Down syndrome. The review suggests a decreased incidence of digestive cancer, however, with a possible increased incidence of neoplasms of the pancreas and gallbladder. The distribution of cancers is distinct from that in the general population and that in persons with other intellectual disabilities who share the same life conditions, suggesting that constitutional protective factors exist. This review may allow a more specific, adapted medical follow-up for persons with Down syndrome and could help to elucidate the oncogenesis of digestive neoplasms.

Colorectal Neoplasms↗
PubMed2005

Health policy for persons with intellectual disability: experiences from Israel.

Intellectual disability (ID) is a life-long disability characterized by impaired cognitive and adaptive skills. Over the past few decades, a shift has occurred in the conceptualization and treatment of people with ID and research in health policy and health-care delivery has become increasingly global with a notable disparity between the developed and developing world. This review presents a literature overview of global health policy for ID with the intent to focus specifically on the policy and treatment within Israel. The methodology involved sites visits to care centers, discussions with stakeholders in health policy, and a literature review. We believe that Israel is in a unique position between a developed and developing culture. In particular, the distinct problems faced by the Arab and Bedouin community in terms of ID must be formally accounted for in Israel's future policies. Research from the developing world would be instructive to this end. The global approach in this presentation led to certain policy recommendations that take into account the uniqueness of Israel's position from a social, economic, religious, and demographic perspective. It is the hope that this paper will lead to an increased awareness of the challenges faced by persons with ID and their providers in all sectors of Israeli society and that the necessary policy recommendations will ultimately be adopted.

Adult↗
PubMed1997

[Prevalence of serum anti-Helicobacter pylori IgG antibody in persons with severe motor and intellectual disabilities--comparison between institutionalized persons and persons living at home].

The seroprevalence of an anti-Helicobacter pylori antibody (ELISA) was investigated in institutionalized persons with severe motor and intellectual disabilities (SMID). The rate of seropositivity was significantly higher in persons with SMID under 29 years of age than in age-matched controls and in institutionalized patients with muscular dystrophy. No difference in seropositivity among SMID patients was found between those in our and other institutions. Therefore, it is speculated that Helicobacter pylori infection occurs soon after the institutionalization of SMID patients. Persons with SMID living at home, in their teens and twenties, had lower seropositivity than that of institutionalized patients but higher than controls. These data implicate the life style of persons with SMID and long-term institutionalization as one of important risk factors of Helicobacter pylori infection.

Adolescent↗
PubMed1989

A comparison of symbol transparency in nonspeaking persons with intellectual disabilities.

This investigation compared the transparency of 11 different types of symbols representing objects with 40 nonspeaking subjects who experienced various degrees of intellectual disability. The subjects included a number of individuals with physical impairments or autism in addition to mild, moderate, or severe mental retardation. The symbol sets included: nonidentical objects, miniature objects, identical colored photographs, nonidentical colored photographs, black-and-white photographs, Picture Communication Symbols (PCS), Picsyms, Rebus, Self-Talk, Blissymbols, and written words. Statistical analyses indicated that real objects were more readily recognized than were any of the symbol sets and that Blissymbols and written words were more difficult than were any of the other sets. In addition, the results suggest the existence of a hierarchy of difficulty at the object (noun) level for the symbol sets assessed. The results are discussed in terms of their implications for selecting an initial symbol set for nonspeaking individuals. In addition, some suggestions for using the assessment protocols in clinical practice are presented, along with future research implications.

Adolescent↗
PubMed2004

Attitudes of Bedouin and Jewish physicians towards the medical care for persons with intellectual disability in the Bedouin Negev community. A pilot study.

Change in the attitudes of staff or the public towards people with intellectual disability (ID) can impact their life and health, but that change has not been studied among physicians who belong to an ethnic minority undergoing dramatic social and economic transition. The goal of this study was to explore the change of attitudes of Negev Bedouin physicians serving their community and their satisfaction with policy, care, and knowledge in the field of ID. Seventeen community physicians (7 Bedouins and 10 Jewish) were interviewed using a simple questionnaire that consisted of items measuring attitude and satisfaction. The vast majority of the Bedouin and Jewish physicians had positive attitudes toward inclusion of those in the community with ID and were ready to provide the care needed in the community with special assistance. There was a need for further education in ID and more resources. There was a belief that there is discrimination between the Bedouin and Jewish community in the provision of care to people with ID. General dissatisfaction was expressed about the policy, resources, care provision, and expertise offered to Bedouins with ID. More efforts must be directed to empower the physicians with knowledge, expertise, and resources to handle the care of Bedouins with ID in a culturally appropriate way.

Adult↗