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PubMed1989

Predicting learning and other developmental disabilities: assessment of reproductive and caretaking variables.

As the studies summarized above reflect, there has been considerable progress made toward identifying and quantifying some of the many variables that are known to place infants and children at risk for learning and other related disabilities. Of specific relevance to this chapter are the improvements that have been made in the conceptualization and measurement of reproductive and environmental/caretaking variables. Both of these classes of variables are well known to influence learning disabilities. However, additional research is now needed to firmly establish the specific nature of the influence of these variables. First, it appears that the influence of reproductive and environmental/caretaking variables is different at different age points. However, because not all longitudinal studies include measures of both reproductive and environmental/caretaking variables, it is difficult to adequately evaluate their influence on outcome measures at different ages. With more consistent use of these measures across studies and age groups it will be possible to make the needed comparisons. Second, there needs to be a closer examination across studies that have used similar samples and designs but that report conflicting findings concerning the influence of reproductive and environmental/caretaking variables. The critical differences between these studies need to be identified. For example, it appears that some studies reporting findings of no effects of reproductive measures on developmental outcome are using perinatal risk scales that are different from those used by studies that report reproductive effects. Clearly, it is critical to use perinatal risk scales that are appropriate for the characteristics of the study sample, the study design, and statistical analyses. Beyond these criteria, the selected scales need to have established validity with respect to the measurement questions under study. Overall, consideration needs to be given to the selection of valid and reliable measures of both reproductive and environmental/caretaking variables. Finally, reproductive and environmental/caretaking variables need to be included more consistently in studies as predictors of learning developmental disabilities and not just for the purpose of subject classification and description. By using these variables as predictors in statistical analyses, it will be possible to determine if these variables directly contribute to developmental outcomes and the strength (or importance) of the contributions of these variables compared to other variables. Tracking the role and strength of the contribution made by these variables across age periods will permit the assessment of possible developmental changes in susceptibility to influence by reproductive and environmental/caretaking variables.

Adolescent↗
PubMed2000

Does methylmercury have a role in causing developmental disabilities in children?

Methylmercury (MeHg) is a potent neurotoxin that in high exposures can cause mental retardation, cerebral palsy, and seizures. The developing brain appears particularly sensitive to MeHg. Exposure levels in pregnant experimental animals that do not result in detectable signs or symptoms in the mother can adversely affect the offspring's development. Studies of human poisonings suggest this may also occur in humans. Human exposure to MeHg is primarily dietary through the consumption of fish: MeHg is present in all fresh and saltwater fish. Populations that depend on fish as a major source of dietary protein may achieve MeHg exposure levels hypothesized to adversely affect brain development. Increasing mercury levels in the environment have heightened concerns about dietary exposure and a possible role for MeHg in developmental disabilities. Follow-up studies of an outbreak of MeHg poisoning in Iraq revealed a dose-response relationship for prenatal MeHg exposure. That relationship suggested that prenatal exposure as low as 10 ppm (measured in maternal hair growing during pregnancy) could adversely affect fetal brain development. However, using the same end points as were used in the Iraq study, no associations have been reported in fish-eating populations. Using a more extensive range of developmental end points, some studies of populations consuming seafood have reported associations with prenatal MeHg exposure, whereas others have found none. This paper reviews the data presently available associating MeHg exposure with development and poses some of the unanswered questions in this field.

Animals↗
PubMed1986

Training community developmental disabilities associates: a collaborative model.

Direct care staff play critical roles in contributing to the successful community adjustment of individuals with developmental disabilities. The current shortage of qualified personnel for these positions, however, will hinder future community integration efforts, particularly as individuals with more intensive needs attempt to live in the community. Improvements, both in the training of staff and in the pay and other incentives they receive, are needed. One response to this growing need is associate degree training that is being provided by a few community colleges and technical schools throughout the country. This article briefly describes the implementation and major components of such a program now being offered through Wisconsin's Vocational, Technical, and Adult Education System. Developed in response to local needs and representing an ongoing collaborative effort among the academic, advocacy, and service communities, the program also illustrates an important role the University Affiliated Facility can play in promoting exemplary training.

Allied Health Personnel↗
PubMedDate not supplied

A review of research on physical exercise with people with severe and profound developmental disabilities.

During the last two decades, a significant amount of research has examined physical exercise with people with severe and profound developmental disabilities. The research has followed three main objectives: 1) finding strategies for allowing the people to engage in physical exercise fairly independent; 2) improving the people's physical fitness; and 3) reducing the people's deviant behavior. This paper reviews the studies related to the aforementioned objectives and comments on the main findings and on the practicality and acceptability of physical exercise.

Persons with Disabilities↗
PubMed2001

Atypical antipsychotic use in treating adolescents and young adults with developmental disabilities.

OBJECTIVE: To study the usage, efficacy, and side effects patterns of atypical neuroleptics (atypicals) in adolescents and young adults with developmental disabilities (DDs) (mental retardation). METHOD: We undertook a chart review of adolescents and young adults (under age 25 years) seen by our specialized mental health team. RESULTS: Risperidone and olanzapine were by far the most frequently prescribed atypicals. Robust clinical effects were noted for both psychotic and nonpsychotic disorders. Most patients tolerated atypicals well, although a significant minority did experience neuroleptic induced movement disorders (NIMDs), particularly dystonias and dyskinesias. Female patients with DDs appear to be at particular risk of NIMDs. CONCLUSIONS: Atypicals are useful in treating various conditions associated with DDs. This population, however, seems particularly sensitive to NIMDs, hence caution and close monitoring are required.

Adolescent↗
PubMed1998

Mortality of adults with developmental disabilities living in California institutions and community care, 1985-1994.

We compared risk factor-adjusted mortality for California adults with developmental disabilities based on 22,576 adults receiving services in California, 1985-1994. Mortality rates were adjusted for factors such as age and level of functioning. Risk factor-adjusted mortality was 72% higher in community care than in institutions. The mortality pattern over the years 1993-1994, which had not previously been studied, was comparable to that of 1985-1992. The substantially increased risk in community care suggests that community settings may be less effective in preventing mortality in this population.

Adult↗
PubMed1996

A visual orientation system for promoting indoor travel in persons with profound developmental disabilities and visual impairment.

A visual orientation system was employed for promoting independent indoor travel for two young adults with profound developmental disabilities and visual impairment. The system was a portable device subjects wore and light sources that marked the routes to the various destinations. Data showed that the system was useful in helping the subjects orient and move independently in their daily environment and in a new (generalization) setting. The visual orientation system is discussed in relation to other systems previously developed.

Adolescent↗
PubMed1985

Medical needs of severely developmentally disabled persons residing in the community.

Data on the health needs and utilization of medical services were collected on 27 severely developmentally disabled persons residing in the community in order to make recommendations regarding the development of a network of generic services to meet those needs. A surprisingly low incidence of acute illness and emergencies was found, contradicting previous authors' assertions that such a population has excessive medical needs and therefore cannot be served in the community. On the contrary, community placement proved to be advantageous to this group, as they gained access to specialty medical services that were previously unavailable to them as residents of a large public facility.

Adult↗
PubMedDate not supplied

Radiography of persons with developmental disabilities.

This article is a proposal to provide guidelines for the radiographer confronted with the patient who is mentally retarded or developmentally disabled. Criteria for an informal evaluation are identified, as well as special methods of positioning and immobilization.

Adolescent↗
PubMed1984

Bus training for developmentally disabled adults.

The effectiveness of a program combining classroom and community training in the teaching of bus-riding skills to developmentally disabled adults. These skills were taught sequentially using questions about a slide presentation, role playing, and performance in the natural environment. The experimental design was based upon the work of Neef, Iwata, and Page (1978). Test trials were conducted after each phase of training. Results showed that all subjects learned the necessary bus-riding skills and maintained their performance throughout the follow-up period of at least 1 year. The combination training method proved to be efficient and cost effective.

Activities of Daily Living↗
PubMed1995

Prevalence of epilepsy and epileptic seizures in 10-year-old children: results from the Metropolitan Atlanta Developmental Disabilities Study.

With reported prevalence rates of 4-9 cases per 1,000 children, childhood epilepsy is a major public health concern. Reported prevalence rates vary, mainly because researchers often use different epilepsy definitions. In addition, total prevalence may be underestimated if incomplete case-ascertainment methods are used. We used a multiple-source case-ascertainment method that included obtaining information from electroencephalogram laboratories to estimate the prevalence of epilepsy and to classify seizure types among 10-year-old children. In the metropolitan Atlanta (GA, U.S.A.) area, we found a lifetime prevalence of childhood epilepsy of 6 per 1,000 (95% confidence interval, 5.5-6.5) 10-year-old children. However, using capture-recapture analysis, this prevalence may be as high as 7.7 per 1,000. Proportionately more boys than girls had epilepsy. The prevalence did not vary appreciably by race. Partial seizures, including secondarily generalized seizures, were the most common seizure type (58%). Of the children with epilepsy, 35% had another developmental disability (mental retardation, cerebral palsy, visual impairment, or hearing impairment). An accurate estimate of the public health burden of childhood epilepsy and determination of possible risk factors for idiopathic epilepsy both depend on conducting complete community-based case ascertainment and obtaining detailed clinical data.

Adolescent↗
PubMed1994

A behavioral neurogenetics approach to developmental disabilities: gene-brain-behavior associations.

This review provides a discussion of behavioral neurogenetics' contribution to understanding neurodevelopmental pathways in learning and developmental disabilities. A brief overview is given of several common neurogenetic disorders with various genetic etiologies including Down syndrome, Turner syndrome, Prader-Willi syndrome, Angelman syndrome, and Tourette's syndrome. Special emphasis is placed on fragile X syndrome as representative of a newly-discovered class of genetic conditions characterized by an unstable trinucleotide repeat. A spectrum of cognitive, behavioral, and social-emotional phenotypic features associated with fragile X syndrome is examined. Also included are findings from recent neuroimaging research and a discussion of the need for the classification of symptoms on the basis of underlying genetic/medical conditions.

Adult↗
PubMed2003

Prevalence of low bone density in institutionalized men with developmental disabilities.

This study investigates the prevalence and degree of low bone mineral density (BMD) in a group of 108 institutionalized men with developmental disabilities. Speed of sound (SOS) and broadband attenuation (BUA) of the calcaneus were measured to determine a quantitative ultrasound index (QUI). Comparison was made to the values for this index in a reference population of age-matched and young adult controls. Thirty-four percent of the study participants had QUI values more than 2 standard deviations (SDs) below those of age-matched controls. Fifty-one percent of this population showed QUI values more than 2 SDs below those of the young adult reference group, suggesting a high prevalence of significantly decreased BMD.

Adult↗
PubMed2001

Developmental disabilities and understanding the needs of patients with mental retardation and Down syndrome.

This article provides the dentist with a background on developmental disabilities, services, and issues related to statutory and regulatory requirements, with a focus on mental retardation and Down syndrome. Down syndrome has mental retardation as a component, yet requires additional emphasis because of its prevalence and associated craniofacial manifestations. Also discussed are treatment considerations.

Adolescent↗
PubMed2005

Parent resuscitation preferences for young people with severe developmental disabilities.

OBJECTIVE: To determine the relationship of providing explanatory information regarding resuscitation to DNR status for parents and guardians of young people who reside in a pediatric skilled nursing facility. DESIGN: Retrospective, quasi-experimental study of policy change, with each individual serving as his or her own control. Interval comparisons were made between resuscitation choices before and after information was provided to families. For those who were originally in the full resuscitation group, comparisons were also made between those who changed to DNR and those who did not. SETTING: Pediatric skilled nursing facility in Massachusetts. PARTICIPANTS: Sixty individuals with severe mental retardation and complex medical problems, between the ages of approximately 2 and 32 years. MEASUREMENTS: Review of records regarding resuscitation choices and changes, with each person serving as his or her own control. Both univariate and multivariate analyses were performed on individuals who were in the full resuscitation group at the initiation of the study to determine distinguishing characteristics between those who remained in that group from those who changed to DNR. RESULTS: The families of 11 (18%) of 60 patients had requested DNR orders prior to requirement of written preference for resuscitation or DNR in the event of cardiopulmonary arrest. After provision of informative material, there was an increase to 26 patients (43%) who were designated DNR (P < . 001). There was no significant difference in characteristics between the groups that changed to DNR and those that remained full resuscitation, although there was a marginal trend of children in the group with an acquired etiology for their developmental disabilities were more apt to have their resuscitation status changed than those with congenital diagnoses (P = .053). CONCLUSION: When families are provided with explanatory information regarding resuscitation in a nonacute, pediatric skilled nursing home setting, there is a significant increase in request for DNR.

Adolescent↗
PubMed1999

Living arrangement requirements for individuals with developmental disability and behavioural problems.

OBJECTIVE: To review the need for a wide range of living arrangements and community support services for individuals with developmental disability (DD) and behavioural problems and for their caregivers. METHODS: An analysis of a 1-year caseload of a consulting psychiatrist to 2 community support agencies for individuals with DD. RESULTS AND CONCLUSIONS: Of the individuals seen with DD and behavioural problems, one-half needed a different living arrangement, immediately in many cases. Living arrangements and support services are extensively deficient. Correcting these deficiencies requires the concerted involvement of local, provincial, and federal governments as well as of community groups and agencies.

Adult↗
PubMed2001

Measuring physical inclusion of people with developmental disabilities: evaluation of the Macomb-Oakland Regional Center.

The Macomb-Oakland Regional Center has been facilitating the movement of persons with developmental disabilities into the community for 27 years. To measure randomness of their home locations, we used a geographic-based spatial analytic approach. Involvement of allies in planning futures, number of people with disabilities residing in each home, proportion of earned income, level of disability, and level of mobility were used as explanatory variables. Monte Carlo procedures using Moran's I, a measure of spatial autocorrelation, did not reveal significant clustering of residences. Regression procedures, however, did reveal that earned income was the independent variable that most explained the degree to which people were physically included. People living in smaller homes were more randomly dispersed.

Activities of Daily Living↗