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PubMed2005

An exploratory study of assertive community treatment for people with intellectual disability and psychiatric disorders: conceptual, clinical, and service issues.

BACKGROUND: Assertive community treatment (ACT) has been applied to a number of disorders in the adult population, such as schizophrenia, with some degree of success; its use in the treatment of people with intellectual disability (ID) and mental illness has received little attention. Despite the high costs of ID in health and social care, there has been very little evidence-based practice for people with ID and mental illness, and it remains a neglected area of research. Aims The aims of this study were an exploratory comparison of the effectiveness of an ACT model for the treatment of mental illness in people with ID (ACT-ID) with a standard community treatment (SCT-ID) approach. METHOD: A Randomized controlled trial design was adopted and allocation was made by stratified randomization by an independent statistician. The prognostic factors used in the randomization were gender and psychiatric diagnosis (psychosis vs. affective). Service users were randomly allocated to either ACT-ID or SCT-ID. RESULTS: There were no statistically significant differences between ACT-ID and SCT-ID in terms of the level of unmet needs, carer burden, functioning and quality of life, but borderline evidence of a difference between treatment groups in quality of life in favour of SCT-ID. Both SCT-ID and ACT-ID groups decreased level of unmet needs and carer burden, and increased functioning. SCT-ID also led to a small increase in quality of life.

Adolescent↗

PubMed1998

Diogenes' syndrome in patients with intellectual disability: 'a rose by any other name'?

Diogenes' syndrome is characterized by marked self-neglect, domestic squalor, social withdrawal and hoarding of rubbish (syllogomania). The syndrome has been reported to occur in association with a wide variety of conditions, but the present authors were unable to find any previous reports of Diogenes' syndrome in patients with intellectual disability.

Activities of Daily Living↗

PubMed2003

Depressive symptoms in intellectual disability: does gender play a role?

BACKGROUND: Gender issues remain largely unaddressed in the dual diagnosis arena, even in the area of depression where there is a 2:1 female to male ratio in the general population. This paper argues that women with intellectual disability (ID) report higher levels of depressive symptoms than men with ID and that risk factors for depression identified for women in the general population are relevant to this group. METHOD: Findings are based on structured interviews with 99 men and women with ID, with corroborative information provided from caregivers and casebook reviews. RESULTS: Overall, women reported higher levels of depression than men. Individuals with higher depression scores were more lonely and had higher stress levels than individuals with lower scores. Women with higher depression scores were more likely to report coming from abusive situations, to have poor social support from family and to be unemployed when compared to women with lower scores, but similar differences were not found when comparing men with higher and lower depression scores. CONCLUSION: Men and women who report experiencing these psychosocial correlates of depression should be a target group for future prevention efforts, taking gender specific concerns into consideration.

Adaptation, Psychological↗

PubMed2006

Solution-focused brief therapy with families who have a child with intellectual disabilities: A description of the content of initial sessions and the processes.

Solution-focused brief therapy (SFBT) is used in a range of child services but little is known about its application to families who have a child with severe or profound intellectual disabilities. This qualitative study examines SFBT with seven such families. It considers the content of sessions and the processes that occur from the practitioner's perspective. Participants' experiences are reported elsewhere (Lloyd & Dallos, submitted). A thematic analysis of seven initial sessions indicated that SFBT highlighted parents' competencies, goals and achievements. The 'miracle question' prompted a change in rapport, discussion about the impossibility of the child becoming 'normal' and a shift away from wishful thinking towards problem solving. In sessions processes emerged of empowerment, integration of the goals into the mothers' life narrative, understanding the child's abilities and clarification of the preferred future. These themes resonated with the literature on effective coping styles for these families. The cases suggest that SFBT can generate a useful parent-professional partnership. However, difficulties were encountered when a child with autism participated in the session. Consideration is given to the 'miracle question' and the inclusion of measures of self-efficacy, coping and the therapeutic relationship.

Adaptation, Psychological↗

PubMed1998

Long-term effects of zonisamide in the treatment of epilepsy in children with intellectual disability.

Zonisamide is a new drug with broad-spectrum antiepileptic activity against partial as well as generalized seizures. The purpose of the present study was to compare the long-term efficacy of zonisamide in the treatment of epilepsy in children with intellectual disability (ID) with those with normal intelligence (NI). One hundred and thirty children (74 ID, 56 NI) were included in the study. Fifteen of the subjects were eliminated from the study because of adverse effects or aggravation of seizures. The remaining 115 children (66 ID, 49 NI) were followed up for more than one year. Twenty-eight children (6 ID, 22 NI) were in zonisamide monotherapy. The mean numbers of different antiepileptic drugs were 4.5 and 3 for the ID and NI groups, respectively. The overall improvement rates, defined as a >50% reduction in the number of seizures, were 41% (ID) and 67% (NI) (P<0.01). Side-effects were observed in 27% and 30% of subjects in the ID and NI groups, respectively. However, in the monotherapy group, side-effects were observed in 50% (ID) and in 27% (NI). In conclusion, the effectiveness of zonisamide was weaker in children with ID than those with NI. This is in agreement with the known phenomenon that epileptic children with ID are likely have more intractable seizures than those with NI.

Adolescent↗

PubMed2004

Beyond specialist programmes: a study of the needs of offenders with intellectual disability requiring psychiatric attention.

BACKGROUND: Despite the increased prevalence of psychiatric disorder amongst offenders with an intellectual disability (ID), there is very little known about the characteristics and needs of those with dual disability. METHOD: A study of admissions to a new community forensic dual disability clinic during the first 10 months of its operation. RESULTS: Typically, the offenders are male, are older than other offenders, exhibit long-standing and continuing serious behavioural disturbance (independent of their psychiatric diagnosis or level of involvement with the criminal justice system) and require supported or custodial accommodation, despite only mild or borderline levels of ID. Although only one-third have a diagnosable major nonparaphilic psychiatric disorder, three-quarters have had prior or current contact with psychiatric services and two-thirds suffer chronic medical illness. CONCLUSIONS: These offenders suffer psychosocial disadvantages far more extensive than those implied by the "psychiatric" or "disability" label. The multiple services provided to this group have been ad hoc, poorly co-ordinated and sometimes dangerously inappropriate. A service provision model is required which must be integrative and consistent. We suggest the use of multiskilled key workers, who maintain close contact with individual clients. Their role will be to implement management plans from the various specialist agencies who become involved with this group and provide long-term follow-up of their recommendations.

Adult↗

PubMed2004

Self-reported emotional intelligence, burnout and engagement among staff in services for people with intellectual disabilities.

This study examined the relationship among dimensions of self-reported Emotional Intelligence, Engagement and Burnout, using the Trait Meta-Mood Scale, Maslach Burnout Inventory and Utrecht Work Engagement Scale in a sample of Spanish professionals who work at institutions for people with intellectual disabilities. The results showed that Emotional Clarity was significantly associated with Personal Accomplishment (r=.25) and Dedication (r=.25). Further, Repair to moods was significantly correlated with all Engagement dimensions (.20 Vigor, .30 Dedication, .36 Absorption) and with Personal Accomplishment (.31). These findings extend previous research with college students in which Clarity and Repair to moods subscales were relevant predictors of well-being indexes and interpersonal functioning and suggest that the Trait Meta-Mood Scale subscales also show significant relationships with emotional functioning and work-related variables in a professional sample.

Adult↗

PubMed2005

Do children do what they say? Responses to hypothetical and real-life social problems in children with mild intellectual disabilities and behaviour problems.

BACKGROUND: Most research on children's social problem-solving skills is based on responses to hypothetical vignettes. Just how these responses relate to actual behaviour in real-life social situations is, however, unclear, particularly for children with mild intellectual disabilities (MID). METHOD: In the present study, the spontaneous and selected responses of 56 children with MID to hypothetical situations from the Social Problem-Solving Test for children with MID (SPT-MID) were compared to their actual behaviour in comparable staged standardized real-life conflict situations. Correlations to externalizing behaviour problems were assessed using the Teacher's Report Form (TRF). RESULTS: The results show children with MID and accompanying externalizing behaviour problems to behave more aggressively in the staged real-life conflicts and provide more spontaneous aggressive responses to the hypothetical vignettes than children with MID and no accompanying externalizing behaviour problems; they did not, however, select more aggressive responses from the hypothetical options provided. A moderate correlation was found between the aggressiveness of the spontaneous responses in the hypothetical situations and actual behaviour in the staged real-life situations. In addition, both the spontaneous aggressive responses under hypothetical circumstances and the actual aggressive behaviour under staged real-life circumstances were related to teacher-rated aggressive behaviour in the classroom. CONCLUSIONS: It is concluded that the hypothetical vignettes from the SPT-MID do provide information on both the actual behaviour and knowledge of social problem-solving skills of children with MID.

Aggression↗

PubMed2002

Religious and secular students' sense of self-efficacy and attitudes towards inclusion of pupils with intellectual disability and other types of needs.

BACKGROUND: The aim of the present study was to investigate whether Judaism's positive attitudes toward people with disabilities would influence greater willingness towards inclusion of such people in regular classes and a greater sense of self-efficacy in working with them. METHODS: The present authors compared religious (n = 175) and secular (n = 420) Jewish students at a teacher's college with regard to these variables. The authors used the Regular Education Initiative questionnaire, which investigates teachers' self-efficacy and attitudes towards including pupils with different types of disabilities in regular education. They analysed the results according to the college students' major and the type of disability (five types at three levels of severity). RESULTS: The results indicate that religious students are more willing than non-religious students to consider the inclusion of people with four types of disabilities and have a greater sense of efficacy for dealing with all types of disabilities. The hypothesis that the milder the disability, the higher would be the teacher's sense of self-efficacy and her/his willingness for such children to be included in a regular class was sustained. The religious special education students were the only ones who exhibited willingness to include pupils with intellectual disability, and moderate and severe emotional disturbances. Students who majored in special education scored higher than all their counterparts on both measures. The results also sustain the hypothesis that there would be a positive correlation between both measures. CONCLUSIONS: To facilitate inclusive education amongst teachers and students, the present authors recommend an intervention programme designed to help students acquire knowledge and strategies about inclusion. They also suggest enriching this programme with Jewish religious sources, which reflect positive attitudes toward people with disabilities.

Adult↗

PubMed2006

The transition to school: adaptation in young children with and without intellectual disability.

BACKGROUND: Previous research has highlighted the importance of the transition to school for young children and their families. A child's successful adaptation to school is likely influenced by a number of factors, including academic, social, emotional, behavioural and cognitive competencies. Children with intellectual disability (ID) may be at heightened risk for early school difficulties, in part due to their deficits in cognitive and adaptive behaviours. METHODS: Factors associated with the adaptive transition to school in young children with (n = 24) and without (n = 43) ID were examined. Adaptive transitions were defined as having few teacher-reported problem behaviours and positive student-teacher relationships. Child self-regulatory skills and both parent- and teacher-reported social skills were evaluated to determine if they predicted positive adaptation in school for 5- to 6-year-old children. Data were gathered from child assessments, parent reports on standardized measures, direct observations of delay of gratification tasks and teacher reports on standardized measures. RESULTS: Children with ID had significantly more teacher-reported problem behaviour, poorer overall student-teacher relationships, fewer parent- and teacher-reported social skills and fewer self-regulation skills than typically developing children. Self-regulation at child age 36 months (latency to touch a desired toy) was significantly related to adaptation to school, as were parent and teacher reports of social skills. Social skills significantly predicted adaptation to school, even after accounting for the effects of child IQ and adaptive behaviour. CONCLUSIONS: Children with ID had less positive early school experiences, as indicated by multiple indices of adaptation to school. Fostering early social skills may be an important target for increasing the positive adaptation to school for young children, especially those with ID.

Adaptation, Psychological↗

PubMed1996

Frequency of 985A-to-G mutation in medium-chain acyl-CoA dehydrogenase gene among patients with sudden infant death syndrome, Reye syndrome, severe motor and intellectual disabilities and healthy newborns in Japan.

The prevalence of the 985A-to-G mutation in the medium-chain acyl-CoA dehydrogenase (MCAD) gene among Japanese patients with sudden infant death syndrome, Reye syndrome, unknown fatty acid oxidation disorders and severe motor and intellectual disabilities was studied using the PCR/Nco-I method for molecular diagnosis. A frequency study of this common mutation was also conducted on blood samples and left over Guthrie cards from 329 healthy newborns in Japan. Neither heterozygotes nor homozygotes for the 985A-to-G mutation were identified among both patients and controls. The result of the present study accord with previous reports that MCAD deficiency is a common disorder in Caucasians, but quite rare among Japanese. Therefore, newborn mass-screening for MCAD deficiency using this method will not be practical in Japan. However, it still seems necessary to investigate a child with fatty acid oxidation disorder for the presence of MCAD deficiency, using both biochemical and molecular genetic methods.

Acyl-CoA Dehydrogenases↗

PubMed2006

Psychopathology in children and adolescents with autism compared to young people with intellectual disability.

Autism is a neurodevelopmental disorder with a specific pattern of behavioural, communication and social problems. Additional mental health problems are often poorly understood and undetected. This study investigates the level and pattern of emotional and behavioural problems in young people with autism compared with children with intellectual disability (ID). Subjects were 381 young people with autism and a representative group of 581 Australian young people with ID aged 4-18 years. Parents/carers provided details of the emotional and behavioural problems of their child using the Developmental Behaviour Checklist (DBC-P). Young people with autism were found to suffer from significantly higher levels of psychopathology than young people with ID. The implications of this finding are discussed.

Adolescent↗

PubMed2002

Prevalence of Helicobacter pylori in people with intellectual disability in a residential care centre in Israel.

In 1982, Helicobacter pylori (formerly Campylobacter pylori) was identified as a pathogenic factor in peptic ulcer disease by researchers from Australia. Because only a small number of studies of H. pylori infection have been conducted in people with intellectual disability (ID), and none of these were done in Israel, the present authors decided to conduct a pilot study on its prevalence in this population. The Israeli Division for Mental Retardation provides services to over 6000 people in 54 residential care centres (or institutions), and one centre in the south of the country with kibbutz-style living arrangements was selected for this pilot study. The study was performed as part of the yearly routine medical examination of all residents, and blood specimens were drawn for IgG antibodies to H. pylori (ELISA). Out of the 47 individuals screened, 75% (n=36) were seropositive. In addition to the reported high rates of H. pylori infection in residents with ID living in large facilities, the present pilot study suggests that people with ID living in smaller, kibbutz-style arrangements are also at high risk.

Adult↗

PubMed2002

Effects of prelinguistic milieu teaching and parent responsivity education on dyads involving children with intellectual disabilities.

This study tested the effect of a method of facilitating prelinguistic communication on parents' responsivity and children's communication and productive language development. The method involved Responsivity education for the parents and Prelinguistic Milieu Teaching for the children (RPMT). Thirty-nine prelinguistic toddlers with intellectual disabilities and their primary caregivers participated in this study. Parent-child pairs were randomly assigned to either the RPMT group or a control group. Communication and language were assessed at study entry and 6, 9, and 12 months later. RPMT facilitated parental responsivity in the posttreatment period. The effect of RPMT on growth rate of child-initiated comments (i.e., the most common type of initiating joint attention) varied by pretreatment measures of that variable. The effect of RPMT on growth rate of child-initiated requests (i.e., the most common type of initiating behavior regulation) varied by presence or absence of Down syndrome. Finally, the effect of RPMT on growth of productive language varied by pretreatment frequency of canonical vocal communication. Recommended alterations in PMT and implications for defining which nonspeaking children are appropriate for prelinguistic goals and treatment were discussed.

Child Language↗

PubMed2005

Positive contributions made by children with an intellectual disability in the family: mothers' and fathers' perceptions.

The aims of this article were to test the psychometric properties of the Positive Contributions Scale (PCS), and to compare perceptions of positive contributions reported by mothers and fathers. Participants were 140 mothers and 60 fathers of children with intellectual disabilities. Results supported the reliability and construct validity of the PCS. Internal consistency was good for all subscales bar one, and the PCS total score was associated with scores on the Positive Affect Scale. There were differences on PCS scales for mothers and fathers, with mothers generally reporting more positive contributions than fathers. The PCS is a reasonably robust measure and its use in future research should help to address questions about the nature and function of parental positive perceptions. The PCS might also be used in applied settings to help balance the effects of asking families about their difficulties and support needs.

Adult↗

PubMed2007

Referral trends in mental health services for adults with intellectual disability and autism spectrum disorders.

Researchers have paid increasing attention to mental health issues in adults with autism spectrum disorders (ASDs) over the last decades. However, little is known about how rates of clinical referrals, types of mental health diagnoses and treatment in adults with ASDs and intellectual disability have changed. We examined patterns of change in referral trends to specialist mental health services in south London from 1983 to 2000 (N = 137). The majority of the cases (58.4%) did not have a diagnosable psychiatric disorder. Schizophrenia was the most frequent psychiatric diagnosis followed by depression, adjustment reaction and anxiety. There was a significant change in the rate of referrals, an increase in the diagnosable psychiatric disorders over time and a significant reduction of medication at time of referral. There were no significant changes in the use of other therapeutic interventions. The proportion of participants living independently increased. Implications for services and future research are discussed.

Adult↗

PubMed1999

Seizure disorders in people with intellectual disability: an analysis of differences in social functioning, adaptive functioning and maladaptive behaviours.

The present study is an investigation into the effects of seizure disorders/epilepsy on psychopathology, social functioning, adaptive functioning and maladaptive behaviours using a sample of 353 people diagnosed with a seizure disorder, and either severe or profound intellectual disability. People with a diagnosis of seizure disorder were found to have significantly less social and adaptive skills when compared to developmentally disabled controls with no seizure disorder diagnosis. Additionally, patterns of maladaptive behaviours were identified for individuals with seizure disorders and found to be similar to those found in people without seizure activity. The implications of the present findings are discussed.

Activities of Daily Living↗

PubMed2006

Long-term effects of athletics meet on the perceived competence of individuals with intellectual disabilities.

The purpose was to examine the effects of the type of athletic program (integrated versus segregated) and of the type of sport (basketball versus swimming) on two domains of perceived competence (athletic competence and social acceptance), and general self-worth. Participants were 48 adolescent females with intellectual disabilities (ID) divided equally into six groups: (a) segregated basketball, (b) integrated basketball, (c) segregated swimming, (d) integrated swimming, (e) physical education (PE), and (f) sedentary. The experimental treatment was 21 months long; for sport groups, this involved 2h of training each week and 12 competitive meets. We administrated Harter's (Harter, S. (1985). Manual for the self-perception profile for children. Denver: University of Denver) Self-Perception Profile for Children seven times to determine changes in perceived competence, and general self-worth. Results indicated: (a) no changes in perceived social acceptance; (b) significantly lower perceived athletic competence for the integrated groups; (c) significantly lower general self-worth for the basketball groups compared to the PE group. The integrated environment helps adolescents with ID to adopt a more realistic evaluation of their physical competence.

Adolescent↗