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Prevalence of criminal offending by men and women with intellectual disability and the characteristics of offenders: implications for research and service development.

The investigation of the relationship between criminal offending and the presence of an intellectual disability (ID) is problematic for two main reasons. First, because of problems associated with the definition of 'ID' and secondly, because much criminal offending goes undetected or unreported, and studies can only investigate those already involved with the criminal justice process. Studies using IQ as a continuous variable indicate that significantly below-average intellectual ability is an independent predictor of future offending. Whilst people with ID may be over-represented in parts of the criminal justice system, given the intellectual and other psychosocial disadvantages which they experience, the level of offending behaviour in this particularly vulnerable group is strikingly low. The present authors propose that two broad groups of people can be identified. The first, broader, group is one of people for whom social disadvantage and mental ill health (particularly substance abuse), coupled with a significant intellectual impairment, are the main characteristics. Secondly, there is a smaller group of people, usually already known to ID services as service users, but for whom the process whereby what might have been conceptualized as 'challenging behaviour' becomes 'offending' is far from clear. The distinction the present authors make between challenging behaviour and offending is important for understanding how 'difficult' behaviour becomes identified as 'antisocial/criminal behaviour'. They argue that research needs to move from prevalence and descriptive studies to investigating the processes which determine movement in and out the criminal justice system. The present political emphasis on public protection and proposals for significantly broader mental health legislation raise the danger of a re-expansion of institutional models of care, rather than the development of multi-agency support networks. The present paper underscores a note of caution, particularly where choices have to be made between expanding institutional models on the one hand and providing more integrated services on the other. Over and above policy decisions, these are social and political choices.

Comorbidity↗

Severe intellectual disability and transition to adulthood.

Institutional and psychological aspects of transition were explored with parents and staff involved with five young adults with severe intellectual disability whose challenging behaviour diminished after they made the transition, and five whose challenging behaviour remained high. They were selected from a previously surveyed cohort. Grounded theory analysis of interviews suggested little connection between the perspectives of parents and staff. The impact these differences have on communication about challenging behaviour was explored, and recommendations for service changes are made.

Adult↗

[Carry over: practical experience of persons with severe motor and intellectual disabilities].

Tomo clinic is a special clinic for the handicapped. We have supported a day care center and a group home for persons with severe motor and intellectual disabilities (SMID) for over ten years. It seems that physical well-being declines dramatically in persons with SMID over 20-years old. We need special cooperation with the general hospital not only for the treatment of adult diseases including esophageal cancer, but also to backup the social activities of our clinic, because we support daily lives of persons with SMID and their families who want to live together in their own communities for as long as possible. The author reported the daily medical care activities in the day care center and the group home.

Adolescent↗

An Italian-Australian comparison of quality of life among people with intellectual disability living in the community.

This paper reports the measurement of both objective and subjective quality of life in samples of people either with intellectual disability or from the general adult population, drawn from Australia and Italy. Measures were made using the Comprehensive Quality of Life Scale. Generally, it was found that the scores for all groups were comparable. This finding is consistent with the provision of generally decent objective living conditions in both countries and subjective well-being homeostasis, wherein subjective quality of life is held within a predictable range. These results are discussed in the context of measurement difficulties imposed by the need for simple Likert scales and subjective data which are strongly negatively skewed.

Adult↗

[The role of the environmental factors on the development of adaptive skills in intellectual disabilities subjects].

AIMS: The aims of the study was to evaluate if environmental factors can influence the effectiveness of therapeutic intervention of subjects with intellectual disabilities. METHODS: 46 adolescents and adults with mental retardation, in semi-residential rehabilitative treatment, have been assessed over a 2-years period. The evolution of adaptive functioning over time has been assessed through the AAMD-ABS. The development of the adaptive skills at follow-up has been correlated with socio-economic and cultural factors. RESULTS: Linear regression showed that age of both parents, mother's health status, lack of one parent, SES, and housing conditions, represent significant covariates to predicting evolution of the adaptive functioning; these factors independently influence effectiveness of the therapy from the kind of treatment. CONCLUSION: The results demonstrate that effectiveness of the therapy can be conditioned from ability to fulfil the needs of the families, through social and supporting programs.

Adaptation, Psychological↗

The trajectory of psychiatric disorders in young people with intellectual disabilities.

OBJECTIVE: This study addresses the question of how prevalence and patterns of psychiatric disorder change from childhood to adolescence in young people with intellectual disability (ID). METHOD: A representative epidemiological sample of 582 young people with ID aged 4-19 years was surveyed in 1991-1992 and again in 1995-1996. The main measure of psychiatric disturbance was the developmental behaviour checklist (DBC), a 96 item parent/carer completed questionnaire with robust psychometric properties which provided an overall score, 6 subscale or syndrome measures of psychiatric disturbance and determined caseness. RESULTS: The findings confirmed that about 40% of young people with ID had psychiatric disorders which persisted over 4 years. Clinically significant change in symptoms with either deterioration or improvement occurred in around 14% of the sample. CONCLUSION: Psychiatric disorder is 3-4 times more prevalent in young people with ID than in the general population. Less than 10% of these young people receive specialist services for a problem which is numerically as large as schizophrenia.

Adolescent↗

Rasch analysis of a new construct: functional caregiving for adult children with intellectual disabilities.

This research examined empirical evidence for a new construct, Functional Caregiving, which is a theory about mothers' caregiving of their adult children with intellectual disabilities. A sample of 108 biological mothers and primary caregivers rated survey items about their confidence to perform caregiving tasks. Rasch rating scale analysis found 61 items defined an empirical construct with three caregiving levels: Advocacy, Personal Caregiving, and Community. Results show item separation was 3.11 with high reliability, .91, and mother separation was 2.93 and reliability, .90. Both items and mothers showed adequate INFIT and OUTFIT values. Item invariance was confirmed between older and younger mothers, and principle components analysis of item residuals did not reveal any major dimensionality threats. Item decomposition analysis showed FC content theory to account for 58 percent of item calibration variance (R2 = .58, F = 42.3, p < .001). These results have important practical implications for health and social services, as well as family caregiving, interdisciplinary practices, and health policy development.

Adult↗

Development and preliminary evaluation of a questionnaire on cognitions related to sex offending for use with individuals who have mild intellectual disabilities.

BACKGROUND: A number of authors note that distorted cognitions may play a significant role in sex offending behaviour in both the people with intellectual disability (ID) and general populations. However, no scales have been specifically developed for use with individuals with ID. To date, there is no valid, reliable, self-report questionnaire that assesses cognitive factors in these individuals. This paper aims to develop a valid, reliable self-report questionnaire to assess antisocial attitudes consistent with sex offending behaviour in individuals who have mild ID. METHODS: Seventeen male individuals with ID who had sexually offended were compared with two non-sex offender groups: 19 males with and 36 males without ID. The Questionnaire on Attitudes Consistent with Sex Offending (QACSO) measure was used to establish sexual attitudes in the three groups. The reliability and validity of the QACSO was examined. RESULTS: The groups were compared and results demonstrated that the QACSO is a promising tool in terms of providing an internally consistent, reliable and valid indicator of cognitive distortions/attitudes held by sex offenders with ID. CONCLUSIONS: The limitations, suggestions for modification, potential uses of the questionnaire and directions for further research are proposed.

Adolescent↗

'As required' neuroleptics: have these drugs a place in the management of challenging behaviour in intellectual disability?

The present study examined the prescription pattern and usage of 'as required' neuroleptics (PRNs) in the management of challenging behaviours in people with intellectual disability in a hospital setting. The prescription cards and drug administration records of residents were scrutinized to see how many of them were prescribed PRNs and how many had actually received these drugs during the previous 3 months. The results were compared in the following groups: (1) males and females; (2) the behavioural and nonbehavioural sectors; (3) intensive treatment wards (ITWs) for severe challenging behaviour which had a better staff:resident ratio than the rest of the behavioural wards; and (4) those prescribed PRNs together with the daily administration of neuroleptics and those without. It was found that more females used PRNs and that the prescription rate was higher in the behavioural sector. A better staff:resident ratio did not bring about any reduction in the usage of PRNs. The use of these drugs was not influenced by whether PRNs were prescribed along with regular neuroleptics or not. Further research is required to delineate the precise role of PRNs for challenging behaviours in this population, and to determine if PRNs can be used along with other modes of therapeutic interventions, instead of administering neuroleptics on a regular basis for this indication.

Adolescent↗

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↗

Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability.

BACKGROUND: There have been very few population-based studies of the prevalence of psychiatric disorders among children and adolescents with and without intellectual disability (ID). METHODS: Secondary analysis of the 1999 Office for National Statistics survey of the Mental Health of Children and Adolescents in Great Britain was performed. This survey collected information on a multistage, stratified, random sample of 10 438 children between 5 and 15 years of age across 475 postcode sectors in England, Scotland and Wales. RESULTS: The prevalence of any diagnosed ICD-10 disorder, conduct disorder, anxiety disorder, hyperkinesis and pervasive developmental disorders were significantly greater among children with ID than among their non-ID peers. There were no statistically significant differences between children with and without ID with regard to the prevalence of depressive disorders, eating disorders or psychosis. Factors associated with an increased risk of psychopathology among children and adolescents with ID included age, gender, social deprivation, family composition, number of potentially stressful life events, the mental health of the child's primary carer, family functioning and child management practices. CONCLUSIONS: Children and adolescents with ID are at significantly increased risk of certain forms of psychiatric disorder. Careful consideration of the social and economic adversity facing such families will be necessary to ensure that support services are responsive to both the needs of child as well as the needs of the family in which they are living.

Adolescent↗

Coping with social stigma: people with intellectual disabilities moving from institutions and family home.

BACKGROUND: Social stigma and its impact on the life opportunities and emotional well-being of people with intellectual disabilities (IDs) are a subject of both practical and theoretical importance. The disability movement and evolving theories of self, now point to individuals' ability to develop positive identities and to challenge stigmatizing views and social norms. METHOD: This paper presents findings from a phenomenological study of 10 individuals making the transition from their family home to live more independently and 18 individuals moving from a long-stay hospital to live in community housing. It builds on an earlier data set obtained from people living at home with their families and examines: (1) people's awareness of stigma, and (2) their modes of adaptation to stigma. RESULTS: The participants all believed that they faced stigmatized treatment and were aware of the stigma associated with ID. They presented a range of views about self in relation to disability and stigma. These views included regarding themselves as part of a minority group who reject prejudice, and attempts to distance themselves from stigmatizing services and from other individuals with IDs. CONCLUSIONS: The findings are discussed in relation to theories of self and the importance of considering psychosocial factors is stressed in clinical work with people who have IDs.

Activities of Daily Living↗

Integrating end of life care into services for people with an intellectual disability.

End-of-life issues encompass old age, terminal illness, dying, grief, mourning and bereavement. Such issues have broad impact on older adults with intellectual deficits, their families, friends, roommates, and formal caregivers. As increasing numbers of people with a intellectual disability survive into old age, social workers regularly encounter end of life situations among very diverse individuals. Social workers in hospices, hospitals, and home care agencies are also asking how best to support people confronting the deaths of aging parents and family, housemates, friends, and staff, as well as their own terminal illnesses and dying. The history of care for people' with a disability documents their exclusion from supportive rituals and education about the end of life. Although existing systems of care continue to negatively impact people at the end of life, resources designed to assist people have expanded in the last decade. End of life education, grief counseling, bereavement services, support groups, crisis teams, and end of life committees are some of the strategies for providing more responsive end of life care.

Adult↗

Association between perceived social support and strain, and positive and negative outcome for adults with mild intellectual disability.

Social strain has been identified as a trigger for both depression and physical health problems, but has not been well researched in people with intellectual disability (ID). The present study contrasted the effects of social support with social strain on depressive symptoms, somatic complaints and quality of life over time in adults with mild ID. The level of social support explained a significant proportion of variance in quality of life 6 months later, but not depressive symptoms or somatic complaints. In contrast, the level of social strain accounted for a significant proportion of variance in depressive symptoms and somatic complaints 6 months later, but not quality of life. The results suggest that interpersonal relationships can be both positively and negatively associated with physical and mental health for people with ID.

Adult↗

Intellectual disability and psychotic disorders of adult epilepsy.

PURPOSE: To investigate the prevalence, psychopathology, and cognitive functions associated with psychotic disorders among adult epilepsy patients with intellectual disability (ID) based on a multicenter study in Japan. METHODS: The study was divided into three phases: a prevalence study of psychotic disorders among new referrals of epilepsy, a polydiagnostic comparative study of patients with psychotic epilepsy and those with schizophrenia, and a neuropsychological study of patients with psychotic epilepsy and education level-matched controls. RESULTS: Among 336 new referrals of epilepsy, a higher prevalence of psychotic disorders was found among patients with ID (24%) than among those with normal intelligence (6%). The psychotic symptoms and operational diagnoses of psychotic epilepsy patients with ID were similar to those of patients with normal intelligence. A wide range (7-86%) of psychotic epilepsy patients was diagnosed as having schizophrenia, depending on the operational criteria used. Patients with psychotic epilepsy had more disturbances in verbal memory and attention functions than controls. CONCLUSIONS: Epilepsy patients with ID show a predisposition to develop psychotic disorders. Distinguishing their psychotic symptoms from those of schizophrenia is difficult. Subtle cognitive disturbances predispose to psychotic disorders in epilepsy.

Adult↗

Maternal health in pregnancy and intellectual disability in the offspring: a population-based study.

PURPOSE: The aim of the study is to investigate the relationship between common maternal conditions and intellectual disability (ID) of unknown cause in the offspring. METHODS: Information about the maternal health of children with and without ID was obtained by using record linkage. For mothers with specific medical conditions, proportions of children with mild to moderate ID, severe ID, and autism spectrum disorder (ASD) with ID were compared with those who did not have ID. RESULTS: There was an increased risk for mild to moderate ID in children of mothers with asthma (odds ratio [OR], 1.52; confidence interval [CI], 1.26-1.83]), diabetes (OR, 1.69; CI, 1.26-2.27), a renal or urinary condition (OR, 2.09; CI, 1.39-3.14), and epilepsy (OR, 3.53; CI, 2.56-4.84). ASD risk was increased for children of women with diabetes (OR, 2.89; CI, 1.28-6.51) and epilepsy (OR, 4.57; CI, 1.69-12.31). For anemia (n = 1101), there was an increased risk for severe ID (OR, 5.26; CI, 2.16-12.80). CONCLUSIONS: The increased risk for ID in offspring of mothers with such conditions as asthma and diabetes is particularly important for disadvantaged or ethnic populations, for whom these conditions are more prevalent and may be less well managed.

Adolescent↗

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↗

Perspectives on quality of life of people with intellectual disabilities: the interpretation of discrepancies between clients and caregivers.

Large discrepancies have sometimes been found between the quality of life (QOL) experienced by clients with intellectual disabilities and their QOL as described by their caregivers. Olsen and Schober (Soc Indi Res 1993; 28: 173-193) may have provided a framework useful to conceptualize such discrepancies. They suggested that lack of concordance between objective circumstances (i.e. poverty) and perceived QOL must not be treated as measurement noise, but as a source of information. They speculated on the psychological processes that underly and explain this lack of concordance; particularly processes that try to deal with the stress induced by cognitive dissonance and learned helplessness. In this study low to moderate agreement was found between caregivers judgement of QOL of individual clients and clients' own perception of QOL. In some areas and for some clients the discrepancies indicated dissonance (caregivers are satisfied, clients are not) and in other areas and for other clients adaptation (clients are satisfied, caregivers are not). There were systematic differences between clients falling in these groups with respect to their personal characteristics and with respect to factual conditions of care. These outcomes are interpreted with respect to Olson and Schober's contentions regarding the psychological processes that underly a person's experience of QOL. The Olson and Schober framework appears to be a fruitful way to combine different sources of information regarding QOL.

Caregivers↗