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PubMed2003

Effect of aging on autonomic function in individuals with severe motor and intellectual disabilities.

Autonomic nervous function is often abnormally regulated in individuals with severe motor and intellectual disabilities (SMID). In this study, we assessed autonomic nervous function of patients with SMID and determined how it was influenced by age. The study included 21 individuals with SMID and 15 healthy adolescents (control). To determine the effect of aging, the patients with SMID were divided into an older age group (Old) and younger age group (Young). Autonomic nervous function was assessed using power spectral analysis of heart rate variability (HRV) for 24-h Holter electrocardiogram recordings. The low- and high-frequency components (LH and HF) of HRV were calculated. The ratio between LF and HF (LF/HF) was used as an indicator of sympathetic modulation, while HF alone was used as an indicator of parasympathetic modulation. The LH/HF in the control group was higher in the daytime than at nighttime, while HF had an opposite pattern of change. Therefore, circadian rhythms were observed in the control group for both sympathetic and parasympathetic nervous activities. In contrast, the LF/HF in patients with SMID had no circadian rhythm. The HF was higher in the Old SMID group than in the Young group, and it exhibited a circadian rhythm in eight patients in the Old SMID group versus none of the patients in the Young group. These findings suggest that the sympathetic nervous system is suppressed in both old and young patients with SMID. However, while the parasympathetic nervous system is suppressed in younger patients with SMID, it is activated with increasing age.

Adolescent↗

PubMed2004

Early-onset psychosis in youth with intellectual disability.

BACKGROUND: Accurate diagnosis of psychotic disorders may be very difficult in youth with intellectual disabilities. METHOD: The authors reviewed the assessment, treatment and follow-up of 21 youths with ID referred because of early onset of psychotic symptoms. RESULTS: Just over one half of the patients had a diagnosis of schizophrenia or schizoaffective disorder. One third of the sample carried the diagnosis of psychosis NOS (not otherwise specified). After careful review, five out of seven of these psychotic-like cases were assessed as non-psychotic. Patients with Psychosis NOS associated with moderate or severe ID had the worst outcome. CONCLUSION: This clinical review provides important information about the identification, diagnosis and outcome of psychotic symptoms in youth with low verbal abilities.

Adolescent↗

PubMed2004

Screening for psychiatric symptoms: PAS-ADD Checklist norms for adults with intellectual disabilities.

BACKGROUND: The Psychiatric Assessment Schedule for Adults with Developmental Disabilities Checklist (PAS-ADD Checklist) is a screening instrument designed to help carers recognize likely mental health problems in people with intellectual disabilities (ID). To date there are no published PAS-ADD Checklist data on a large nonpsychiatric population of adults with ID, an important step towards developing norms for comparative purposes. METHODS: Informants who had known participants for a median 24 months completed the PAS-ADD Checklist on 1155 adults with ID living in community, residential care and hospital settings in a county district in the North-east of England. RESULTS: Normative data were obtained for the PAS-ADD Checklist for the study population with reference to gender, age, and type of residence. The overall prevalence of mental health problems was 20.1%, and the rates for affective/neurotic, organic and psychotic disorders were 14%, 3.9%, and 10.2%, respectively. Significant differences in the rates for particular disorders were found across gender, age and, residence type. CONCLUSIONS: The rates of mental disorders found in the study population were consistent with previous studies of general populations of people with ID using over-inclusive screening instruments. The PAS-ADD Checklist appears to be an easy-to-use and sensitive tool for identifying mental health cases in ID populations, but further investigation is required concerning the specificity of the instrument.

Adolescent↗

PubMed2006

Syndrome specificity and behavioural disorders in young adults with intellectual disability: cultural differences in family impact.

BACKGROUND: This study examined whether behaviour problems and adaptive behaviour of low functioning young adults, and well-being of their families, varied by diagnostic syndrome [intellectual disability (ID) only, cerebral palsy, Down syndrome, autism], as well as by cultural group. METHODS: Behaviour disorders in young adults with moderate to severe ID were assessed from information provided by 282 caregivers during in-home interviews. The sample consisted of 150 Anglo participants, and 132 Latino, primarily Spanish-speaking, participants drawn from Southern California. RESULTS: Behaviour disorders and maternal well-being showed the same pattern across disability syndromes. Autism was associated with the highest scores in multiple behaviour problem areas as well as maternal reports of lower well-being. Down syndrome was associated with the lowest behaviour problem scores and the highest maternal well-being. When behaviour problems were controlled for, diagnostic groups accounted for no additional variance in maternal stress or depression. The pattern of behaviour problems and well-being did not differ by sample (Anglo vs. Latino), although level on well-being measures did. Latina mothers reported significantly higher depression symptoms and lower morale, but also higher positive impact from their child than did Anglo mothers. CONCLUSIONS: Caregivers of young adults with autism report more maladaptive behaviour problems and lower personal well-being, or stress, relative to other diagnostic groups, regardless of cultural group. However, cultural differences exist in caregiver reports of depression, morale, and positive perceptions. Implications for service provision aimed at families of children with challenging behaviour problems are discussed in the context of culture.

Activities of Daily Living↗

PubMed2002

Costs of village community, residential campus and dispersed housing provision for people with intellectual disability.

BACKGROUND: In recent years, a growing volume of research evidence has been generated about the relative cost-effectiveness of various types of community-based residential supports for people with intellectual disability (ID) in the UK. However, few reliable data are available to inform planners, commissioners or service providers about the quality and costs of providing support within residential or village communities. METHODS: The evaluation described in the present paper aimed to fill some of the gaps in knowledge by examining the comparative costs of supporting people in village community settings, in National Health Service (NHS) residential campuses and in dispersed, community-based housing schemes. The complete service package received by each study participant was described and costed, and a series of statistical analyses was undertaken to identify factors associated with variations in the cost of support. The analyses reported in the present paper were based on comparisons of 86 people living in village communities, 133 in residential campuses and 281 in dispersed housing schemes. RESULTS: Wide variations in cost were found, not only between models of accommodation, but between individual organizations, settings and service users. Multivariate analysis revealed that higher costs were associated with supports for people with higher levels of ID and more severe challenging behaviour. The cost of support was affected by the size of the residential setting, with smaller facilities likely to be more expensive. Associations were also found between increased costs, and services for younger users, male users and people who had not moved from a NHS hospital. Generally, more sophisticated service processes within the setting were associated with higher costs; although systematic arrangements for supervision and training of staff had a negative effect on cost. CONCLUSIONS: The cost findings should be considered alongside evidence on outcomes. A comparison of village communities and dispersed housing schemes suggests that both models of provision appear be associated with particular benefits, although different types of setting are appropriate for different individuals and therefore, the continued development of a range of residential models is important.

Adult↗

PubMed2006

Relationship between BMI, physical fitness, and motor skills in youth with mild intellectual disabilities.

INTRODUCTION: The negative impact of obesity on physical fitness and motor abilities has been documented in youth of various ages; however, this issue has not been explored in youth with mild intellectual disabilities (ID). Youth with ID are considered more overweight, less physically fit, and less motor proficient than peers without ID, so it is important to determine if these variables are associated in this population. The purpose of this study was to examine the relationship between body mass index (BMI), physical fitness, and motor skills in a large sample of youth with mild ID. METHOD: A systematic, stratified sampling method was used to select 444 youth with mild ID, aged 6-18 years, from eight special education schools in Hong Kong. Physical fitness was assessed using items from the national Hong Kong assessment: 6- (ages 6-8 years) or 9- (ages 9-18 years) minute run, sit-up, isometric push-up, sit and reach, and sum of skinfold. Functional motor skills were assessed in 244 youth from the fitness sample using the Test of Gross Motor Development-II. Subjects were categorized into normal or overweight/obese BMI groups based on international cutoff points. RESULTS: Approximately 20% of the sample was classified as overweight/obese (average BMI normal = 17.47+/-2.69; overweight/obese = 24.78+/-4.05). ANCOVA controlling for age and gender revealed group differences in the run (P = 0.001) and push-ups (P = 0.05), but not in the motor or other fitness variables. After controlling for age and gender, BMI was correlated with the run (r = -0.27, P < 0.001) and push ups (r = -0.18, P = 0.008). Age and gender were entered as the first block in hierarchical regression and accounted for most of the variance in all dependent variables, except sit and reach. The inclusion of BMI in the second block added to the model for run and push-ups only (deltaR2 run = 0.04, push-ups = 0.03, P<0.001). CONCLUSION: Overweight/obesity is minimally associated with aerobic fitness and muscular strength in youth with mild ID. BMI did not impact other fitness measures (sit-up, sit and reach) or motor skills in the sample. The undesirable level of overweight/obesity in this sample requires increased attention and immediate intervention.

Adolescent↗

PubMed1999

Supporting individuals with intellectual disability and challenging behaviour in integrated work settings: an overview and a model for service provision.

An overview of supported employment and its historical context is examined, and supported employment for individuals with both intellectual disability and challenging behaviour is discussed. A proposed model for working with such individuals is briefly outlined. This model is based on previous work in the field, and is characterized by a multi-component approach which addresses the issues of both support and behavioural intervention.

Behavior Therapy↗

PubMed2006

Vision and oral health needs of individuals with intellectual disability.

Over the past 20 years, there has been an increased emphasis on health promotion, including prevention activities related to vision and oral health, for the general population, but not for individuals with intellectual disability (ID). This review explores what is known about the prevalence of vision problems and oral health conditions among individuals with ID, presents a rationale for the increased prevalence of these conditions in the context of service utilization, and examines the limitations of the available research. Available data reveal a wide range of prevalence estimates for vision problems and oral health conditions, but all suggest that these conditions are more prevalent among individuals with ID compared with the general population, and disparities exist in the receipt of preventive and early treatment for these conditions for individuals with ID. Recommendations for health improvement in these areas include better health planning and monitoring through standardized population-based data collection and reporting and increased emphasis on health promotion activities and early treatment in the healthcare system.

Adolescent↗

PubMed2005

Risk factors for coronary heart disease among inpatients who have mild intellectual disability and mental illness.

BACKGROUND: Coronary heart disease (CHD) is a major cause of morbidity and mortality in the UK. The aim of this study was to screen inpatients with mild or borderline intellectual disability, many of whom also have mental illness, for risk factors for CHD. METHODS: Cross sectional survey. Participants were interviewed, measured and had blood samples taken. RESULTS: Of the 53 participants, 20 (37.7%) were overweight and 18 (34.0%) obese. The mean body mass index (BMI) of those participants prescribed regular antipsychotics was higher than those who were not. Nine (20.9%) had waist circumference measurements placing them at increased risk of CHD and 21 (48.8%) were at substantially increased risk. Twenty-eight (52.8%) were current smokers. Of the 49 participants who had their blood pressure measured, 3 (6.1%) had readings above the reference range. Of the 19 participants who had random blood tests, one (5.3%) had an elevated cholesterol level. CONCLUSIONS: In this population there was a high prevalence of two risk factors for CHD (obesity and smoking), requiring ongoing monitoring and long-term measures to reduce risk.

Adolescent↗

PubMed1995

Sentence imitation by adolescents and young adults with Down's syndrome and other intellectual disabilities.

Sentence imitation performance was evaluated longitudinally in 26 adolescents and young adults with Down's syndrome (DS), and 26 age- and IQ-matched non-DS individuals with other causes of intellectual disability (ID). In each of three annual assessments, the DS group began sentence repetitions more slowly and imitated sentences less accurately than the ID group. DS sentence repetition accuracy was equivalent to the ID group only for two-word sentences and was poorer for every other sentence length. Comparisons of sentence imitation and auditory digit span scores suggested that only ID subjects benefitted from the additional meaning and structure provided by sentences. Correlational analyses performed between each year's sentence imitation score and a set of language, memory and hearing measures revealed that sentence imitation was related to grammatical comprehension, auditory short-term memory and IQ in both groups, and to expressive language ability, speed of spoken word processing, speech discrimination and acoustic reflexes in the DS group only. A significant relationship between sentence imitation and middle-ear functioning was further supported by a categorical analysis in which DS subjects with bilateral abnormal tympanograms tended to perform more poorly on sentence imitation tasks than DS subjects with at least one normal tympanogram. It was concluded that sentence imitation is a task that is sensitive to the auditory-perceptual, cognitive and expressive difficulties evidenced by individuals with DS.

Acoustic Impedance Tests↗

PubMed2006

Social climate within secure inpatient services for people with intellectual disabilities.

BACKGROUND: The social climate of inpatient facilities is thought to be an important contributor to treatment outcome. However, little research has focused on this construct within secure forensic services for people with intellectual disabilities (ID). Therefore, the objective of this study was to investigate the social climate of two different types of secure units ('low' secure vs. 'medium' secure) contained within the same facility for offenders with ID. Two hypotheses were generated: (1) residents would rate the social climate of the whole facility in a more negative direction than staff, and (2) residents and staff would rate the social climate of the 'low' secure unit in a more positive direction than that of the 'medium' secure unit. METHOD: Using a 2 (factor 'Participant' = Staff or Resident) x 2 (factor 'Unit' = 'Low' or 'Medium' Secure Unit) between-subjects design, 18 residents and 37 staff members were recruited and completed the Correctional Institutions Environment Scale (CIES), a measure of social climate. RESULTS: Residents tended to rate the units in a more positive direction than staff on some sub-scales. Participants rated the 'low' secure unit in a more positive direction than the 'medium' secure unit on two sub-scales of the CIES. However, on selected sub-scales there were differences. The findings of this study suggest that the CIES may be a valid instrument for use within forensic services for people with ID, and further suggests that residents and staff have different perceptions of the shared social climate, which may have implications for service development.

Adult↗

PubMed2001

Enhanced self-determination of adults with intellectual disability as an outcome of moving to community-based work or living environments.

In recent years, the self-determination construct has received increased international visibility and utilization in the field of intellectual disability (ID). This has resulted in efforts to promote skills enhancing self-determination, and in efforts to change how adult services are funded to allocate resources to increase consumer control and direction. An important component to consider in both of these efforts is the role of the environment on self-determination. The present study examined the self-determination, autonomy and life choices of individuals with ID before and after they moved from a more restrictive work or living environment. The self-determination of adults with ID was measured for an average 6-months before and after a move from a more restrictive living or working environment to a community-based setting. Paired-sample t-tests indicated that there were significant changes, in each case in a more adaptive direction, in self-determination, autonomous functioning and life choices following a move to a less restrictive environment. The present findings contribute to emerging evidence that the self-determination of individuals with ID is limited by congregate living or work settings which limit opportunities for choice and decision-making. Alternatively, more normalized, community-based environments support and enhance self-determination. Because self-determination has been linked to positive adult outcomes and enhanced quality of life, it is important to consider ways to enable people with ID to live and work in their communities.

Activities of Daily Living↗

PubMed2002

[Selenium deficiency and electrocardiography changes in patients with severe motor and intellectual disabilities on long-term tube feeding].

In order to investigate the effect of selenium (Se) on electrocardiograms (ECG), we studied the serum Se levels and ECG in 25 patients with severe motor and intellectual disabilities. Serum Se levels in patients receiving tube feeding with enteral formulae were lower than those in orally fed patients. ECG abnormalities including an inverted T wave and depression of the ST segment were more common in patients under tube feeding. During tube feeding with enteral formulae, it is necessary to examine serum Se levels and ECG. Serum Se levels should be kept at 5 to 6 micrograms/dl to prevent cardiac dysfunction. To prevent selenium deficiency, either addition of ordinary foods, replacement by selenium-rich formula, or Se supplementation is recommended.

Adolescent↗

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↗

PubMed2001

Long-term follow-up study of Lennox-Gastaut syndrome in patients with severe motor and intellectual disabilities: with special reference to the problem of dysphagia.

A long-term follow-up study of Lennox-Gastaut syndrome (LGS) ( > 10 years) was conducted with 38 patients with severe motor and intellectual disabilities (SMID) to clarify the relationship between the rapid development of dysphagia and epileptic seizures, and to elucidate the long-term evolution of LGS in patients with SMID. Those who showed a relatively favourable seizure outcome were compared to those with a poor seizure outcome. Poor seizure outcome correlated strongly with: (a) an early appearance of dysphagia and additional deterioration of the already retarded mental function; (b) a predominance of atypical absence seizures; and (c) persistent frequent epileptiform discharges during electroencephalographic evaluations. Neither age at seizure onset nor intelligence level at the time of the last examination was correlated with seizure prognosis. Further, seizure prognosis was not related to the aetiology of LGS. Repeated seizures apparently caused development of progressive epileptic encephalopathy, in addition to the underlying severe brain damage. Since development of dysphagia burdens an already severely handicapped patient with intensive medical care, efforts to reduce the seizures and design a long-term care plan are of great importance.

Adult↗

PubMed2002

Mental health of primary family caregivers with children with intellectual disability who receive a home care programme.

BACKGROUND: The aims of the present study were to describe the change in mental health over time in a group of family caregivers with a child with intellectual disability (ID) and to explore the effect of a home care service on the psychological well-being of the caregiver. METHODS: The authors identified children with ID who received home care services in the southern part of Taiwan. A total of 46 primary family caregivers (age range = 21-65 years) were recruited for the present study. The study design was a quasi-experimental follow-up analysis. The children with ID and their families regularly received home-based care. The 12-item version of the Chinese Health Questionnaire (CHQ) was used to evaluate the subjects' mental health at three time points: (1) baseline, (2) 3 months and (3) 9 months. The validity and reliability of the CHQ have been tested in Taiwan. The Generalized Estimating Equation was used to conduct longitudinal data analyses. RESULTS: The authors found that the family caregivers showed a significant improvement in their mental health by month 9. CONCLUSIONS: The preliminary findings of this study accredit the effect of home care services and suggest that home care services are necessary for family caregivers.

Adaptation, Psychological↗

PubMed1997

Rett syndrome (RS) and profound intellectual disability: cognitive and communicative similarities and differences.

The communicative and cognitive behaviours of a group of 10 girls with Rett syndrome (RS) were compared with those of a group of girls with non-Rett profound intellectual disability (NPID). The results suggest that the girls with RS were a comparatively homogenous group demonstrating similar cognitive patterns and fewer communicative behaviours, communicative functions, and total numbers of inferred communicative acts than the NPID group. Fewer girls with RS were intentionally communicating to communicative partners. Implications of these findings will be discussed in this paper.

Child↗

PubMed2003

Risk markers associated with challenging behaviours in people with intellectual disabilities: a meta-analytic study.

A meta-analysis of prevalence and cohort studies conducted over the last 30 years was carried out to identify risk markers for challenging behaviour shown by individuals with intellectual disabilities (IDs). A total of 86 potential studies was identified from the review, with 22 (25.6%) containing sufficient data to enable a statistical analysis to be conducted. Results indicated that males were significantly more likely to show aggression than females, and that individuals with a severe/profound degree of ID were significantly more likely to show self-injury and stereotypy than individuals with a mild/moderate degree of ID. Individuals with a diagnosis of autism were significantly more likely to show self-injury, aggression and disruption to the environment whilst individuals with deficits in receptive and expressive communication were significantly more likely to show self-injury. In most cases, tests for heterogeneity were statistically significant, as expected. The meta-analysis highlighted the paucity of methodologically robust studies of risk markers for challenging behaviours and the lack of data on incidence, prevalence and chronicity of challenging behaviour in this population.

Adolescent↗