[Effectiveness of intrapulmonary percussive ventilator treatment for respiratory disorders in persons with severe motor and intellectual disabilities].
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Adolescent↗
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Results for “Intellectual Disability”
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Intellectual disability, obesity and screening viewpoint.
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Decision Making↗
Seizures and intellectual disability associated with tuberous sclerosis.
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Age Factors↗
Understanding breast cancer screening: should the intellectually non-disabled make decisions for the intellectually disabled?
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Breast Neoplasms↗
The evolving role of community nurses for people with learning disabilities: changes over an 11-year period.
AIMS AND OBJECTIVES: To provide an overview of the changes in the caseload and working practices of community nurses for people with learning disabilities (CNLDs) over an 11-year period within one region of the UK. BACKGROUND: Recent reviews of government policy within the UK and internationally have highlighted the need to promote inclusion and health facilitation for people with learning disabilities (intellectual disabilities). The CNLDs have been highlighted as having an integral role in achieving these objectives. However, little is known about the current role of community nurses and how this has evolved over the past decade. DESIGNS AND METHODS: A survey design was used in which the total population of CNLDs within one region of the UK were asked to complete a postal questionnaire. RESULTS: Forty community nurses in Northern Ireland completed questionnaires. This provided information about 1559 people with learning disabilities on their current caseloads. Results showed less involvement with children, more focus on adults with physical and mental health needs and nurses often appeared to have a monitoring rather than an active clinical role. Data also identified an increasing caseload size and a pattern of referral largely from within learning disability services. CONCLUSIONS: The role of CNLDs has altered in Northern Ireland over the past 11 years with some evidence of a reorientation towards a more health-oriented focus. Further consideration needs to be given to how well this will meet the changing needs of people with learning disabilities and their families in light of the increasing emphasis on the provision of inclusive services. RELEVANCE TO CLINICAL PRACTICE: Community nurses need to review their current role, caseload management and links to primary and acute care if the policy objectives of inclusive services and health facilitation are to be achieved. It will also be necessary to revise their education preparation in light of the changing role of CNLDs.
Adult↗
[Promotion and maintenance of independence in older people with intellectual disability-results of an intervention study].
Results of gerontological research have seldom been used for the development of new concepts for housing, promotion and supply in people with intellectual disability. However, recent findings from international studies support the assumption that capability to learn and plasticity are also apparent in people with intellectual disability. The present study was designed as an empirical test of this assumption. As a theoretical starting point we describe competence as a comprehensive construct which integrates aspects of independence, self-responsibility, self-determination and experienced meaning of life. Moreover, the construct of competence refers to the impact of the physical, social, and infrastructural environment on the aforementioned aspects. We hypothesised that independent living in older people with intellectual disability could be enhanced by a more differentiated perception of respective potentials by the members of the institutional staff. An intervention program for caregivers was developed to initiate an examination of their own behaviour in daily interaction with intellectually disabled residents, particularly in terms of a possible support of dependent and ignorance of independent behaviour. We expected that unmasking contingencies between behaviour of care-givers and dependency in intellectual disabled residents should lead to increases in residents' independent behaviour and everyday competence. 40 intellectually disabled residents and 40 staff members participated in the present study. Videotapes were used to assess behaviour of staff members and residents in daily care and support. Moreover, a questionnaire was developed for further assessment of independence and everyday competence in intellectually disabled residents. Effects of the developed intervention program were tested with a pre-post-control group-design. Results show highly significant increases in residents' independence and everyday competence. Therefore, our hypothesis that independent living in older people with intellectual disability could be enhanced by a more differentiated perception of existing potentials by the members of the institutional staff received strong support.
Activities of Daily Living↗
Short- and long-term efficacy and safety of risperidone in adults with disruptive behavior disorders.
RATIONALE: Function in society can be severely affected by disruptive behaviors in adults. OBJECTIVES: To examine the efficacy and safety of risperidone in the treatment of disruptive behavior disorders in intellectually disabled adults. METHODS: Intellectually disabled patients with disruptive behavior disorder were randomly assigned to receive risperidone (n = 39) in a flexible dosage ranging from 1 to 4 mg/day (mean dosage, 1.45+/-0.08 mg/day) or placebo (n = 38) for 4 weeks of double-blind treatment. Efficacy at endpoint was measured primarily by using the Aberrant Behavior Checklist (ABC); secondary efficacy measures included the Behavior Problems Inventory and Clinical Global Impressions scales. After this 4-week period, patients could enter open-label treatment with risperidone for 48 weeks. RESULTS: Risperidone was well tolerated, and patients treated with risperidone demonstrated significantly greater improvement at endpoint on the ABC than those who received placebo [-27.3 points (52.8% improvement) versus -14.9 points (31.3% improvement); P = 0.036] and also improved on Behavior Problems Inventory and Clinical Global Impressions ratings. Over the 48-week, open-label follow-up period, there was a further decrease of 6.3 points (P < or = 0.05) on the ABC for patients who initially received risperidone and a decrease of 11.3 points (P < or = 0.05) for patients who initially received placebo and were switched to open-label risperidone. These results were achieved with a mean modal dosage of 1.8 mg/day. CONCLUSION: Risperidone is efficacious and well tolerated in managing disruptive behavior disorders in adults with intellectual disability.
Adolescent↗
Validity of a performance assessment of activities of daily living for people with developmental disabilities.
BACKGROUND: Since clients with different types of developmental disabilities often experience difficulties in activities of daily living (ADL), it is critical that assessments of ADL are evaluated in order to ensure that one can make valid judgements based on the results of the appraisal. The purpose of the present study was to evaluate the validity of a specific performance assessment instrument, the Assessment of Motor and Process Skills (AMPS), when used by occupational therapists with clients with developmental disabilities. Unlike global ADL assessments, the AMPS is used not only to evaluate the level of ADL dependence, but also to estimate the quality of each specific action performed when a person is performing ADL tasks. METHODS: Data were gathered from 1724 participants with different developmental disabilities, including intellectual disability (ID), cerebral palsy and spina bifida. Many-Facet Rasch (MFR) analysis was used to examine person-response validity, and task and item scale validity. RESULTS: Goodness-of-fit statistics showed that the tasks and items had acceptable scale validity. The participants had acceptable person-response validity on the ADL motor scale, but had slightly lower than expected levels of person-response validity on the ADL process scale. The results indicate that clients with more severe forms of ID may have a higher proportion of different performance profiles in ADL than is expected by the MFR model of the AMPS. Since the proportion of participants who did not meet the criteria was only 3% lower than expected and in accordance with other studies, the difference may not be clinically meaningful. Otherwise, the results indicated that the AMPS is a valid tool when used with clients with developmental disabilities. CONCLUSIONS: Further research is needed to evaluate the use of the AMPS in clinical assessment and intervention planning for this group of clients.
Activities of Daily Living↗
Families challenged by and accommodating to the adolescent years.
BACKGROUND: Informed by Ecocultural theory, this study explores the challenges that families caring for an adolescent with disability face and strategies they apply to sustain a meaningful family routine during the adolescent years. METHODS: In-depth Ecocultural interviews were conducted with 20 families caring for an adolescent (aged 10-21 years) with severe disabilities, including intellectual disability. Transcripts were analysed using a constant comparative approach. Two types of family level challenges were differentiated--internal and external factors impacting on daily family life. RESULTS: Two themes representing this distinction between internal and external family challenges are presented in detail. Across both younger adolescent (aged 10-14 years) and older adolescent (aged 16-20 years) groups, families were first challenged by changing family roles and relationships (an internal factor). In response, families used three strategies: dividing up family time, protecting some members from too much involvement and engaging others in family activities. Families were also challenged by service discontinuity (an external factor). Accommodation strategies included advocacy, coordinating multiple services and forfeiting a desired alternative. CONCLUSIONS: Family routine in the adolescent years is dynamic rather than static, simultaneously challenged by internal and external factors. Families use multiple strategies to accommodate these challenges, which are underpinned by their beliefs, values and resources. Professionals working with families caring for an adolescent with disability need to be aware of these in order to support families effectively to sustain a meaningful family routine during the adolescent years.
Adolescent↗
Disambiguation and mapping of new word meanings by individuals with intellectual/ developmental disabilities.
Wilkinson and Green (1998) reported that differences in the procedure by which new words were introduced to learners with cognitive impairments significantly affected their accuracy in later tests of receptive understanding of word meanings. However, a limited sample and no control group rendered the data preliminary. Here, I replicated and extended the research. First, a control group of preschool children, matched on receptive vocabulary age, was compared to individuals with intellectual disability of unspecified origin. Second, performance was also evaluated in three matched groups of varying etiology: unspecified, Down syndrome, and autism spectrum disorders. Performance on receptive word matching differed between preschool children and their matched experimental groups as well as among matched etiological groups.
Child↗
Clinical efficacy of zonisamide in childhood epilepsy after long-term treatment: a postmarketing, multi-institutional survey.
Postmarketing data about the effectiveness of zonisamide in childhood epilepsy was collected from 759 children with various forms of epilepsy (ages 3 months-15 years) to compare the long-term efficacy of zonisamide in the treatment of epilepsy in intellectually normal versus intellectually disabled children. The follow-up period was 6 months-3 years; 291 children (245 intellectually normal, 46 intellectually disabled) received zonisamide as monotherapy. The remaining patients received additional antiepilepsy drugs (AEDs); mean numbers of additional AEDs were 1.6 and 2.9 for intellectually normal and intellectually disabled groups, respectively. Effectiveness could not be evaluated in 30 of the 759 patients because of very rare or irregular seizure frequency. In the 729 patients evaluated, 78% of intellectually normal patients and 43% of intellectually disabled patients showed > or =50% reduction in the number of seizures (P < 0.001). Improvement rates seen in the intellectually normal group were almost the same for patients with generalized (82%) and partial (77%) epilepsies, whereas in the intellectually disabled group, the improvement rate was higher for partial (50%) than generalized (36%) epilepsies (P < 0.01). These results are consistent with the known phenomenon that intellectually disabled children are likely to have more intractable seizures than children with normal intelligence.
Adolescent↗
An analysis of WISC-R factors for gifted students with learning disabilities.
Intellectual patterns of gifted students with learning disabilities were studied to determine cognitive factors characterizing these children. Twenty-four gifted children with learning disabilities (LD) and a control group of nondisabled gifted children were administered the Wechsler Intelligence Scale for Children-Revised (WISC-R) (Wechsler, 1974). While differences between the two groups on individual subtests were examined, a comparison of broader factors was emphasized in discovering cognitive patterns that might suggest effective intervention. Experimental and control performances were compared on 14 factor scores, using cognitive classification systems of Bannatyne (1971), Kaufman (1975), Rapaport, Gill, and Schafer (1946), and Wechsler (1974). Gifted students with LD were more reliant on verbal conceptualization and reasoning than the control students. They also demonstrated deficiencies in short-term auditory memory and sound discrimination. The gifted group with LD exhibited the Organic Brain Syndrome factor (Wechsler, 1974) to a significantly greater extent than did the control group.
Achievement↗
Validation of the Non-communicating Children's Pain Checklist-Postoperative Version.
BACKGROUND: This study evaluated the psychometric properties of the Non-communicating Children's Pain Checklist-Postoperative Version (NCCPC-PV) when used with children with severe intellectual disabilities. METHODS: The caregivers of 24 children with severe intellectual disabilities (aged 3-19 yr) took part. Each child was observed by one of their caregivers and one of the researchers for 10 min before and after surgery. They independently completed the NCCPC-PV and made a visual analog scale rating of the child's pain intensity for those times. A nurse also completed a visual analog scale for the same observations. RESULTS: The NCCPC-PV was internally reliable (Cronbach alpha = 0.91) and showed good interrater reliability. A repeated-measures analysis of variance indicated NCCPC-PV total and subscale scores were significantly higher after surgery and did not differ by observer. Postoperative NCCPC-PV scores correlated with visual analog scale ratings provided by caregivers and researchers, but not with those of nurses. A score of 11 on the NCCPC-PV, by caregivers, provided 0.88 sensitivity and 0.81 specificity for classifying children with moderate to severe pain. CONCLUSIONS: The NCCPC-PV displayed good psychometric properties when used for the postoperative pain of children with severe intellectual disabilities and has the potential to be useful in a clinical setting. The results suggest familiarity with an individual child with intellectual disabilities is not necessary for pain assessment.
Adolescent↗
A comparison between older persons with down syndrome and a control group: clinical characteristics, functional status and sensorimotor function.
The increase in life expectancy within the general population has resulted in an increasing number of elderly adults with intellectual disability, and this is reflected in the increased life expectancy in persons with Down syndrome, currently about 56 years. The aim of this study was to study the clinical characteristics, the functional status and sensori-motor function of 10 older persons with Down syndrome (mean age 59 years), 13 younger persons with Down syndrome (mean age 44 years) and compare them with 38 adults with intellectual disability without Down syndrome and a control group of people without intellectual disability. All the persons with Down syndrome and intellectual disability resided in two residential living centres in Israel, while the 31 older persons without intellectual disability (mean age 75 years), who served as the control group, lived in an independent living facility. The study considered demographic data, medical backgrounds, physical and functional tests. The results showed that the older persons with Down syndrome in the study were more obese, shorter and had more medical problems than both the older persons with intellectual disability and the control group. The functional performance of the older adults with Down syndrome was more impaired in comparison with both other groups. It is postulated that their slower responses may be explained by a less physically active lifestyle, that may accelerate the onset of disease, resulting in symptoms associated with aging that are detrimental to health.
Adult↗
[Diagnosis and treatment of gastroesophageal reflux disease in the mentally retarded: guidelines of a multidisciplinary consensus work group. Dutch Association of Physicians in Care of Mentally Handicapped].
Gastroesophageal reflux disease (GORD) is more frequent among people with intellectual disability than among the intellectually normal population. Also GORD is more serious in this population. The diagnosis is often missed, because most intellectually disabled cannot express their complaints of GORD. For that reason a multidisciplinary working group of the Dutch Association of physicians active in the care of persons with a mental handicap has developed guidelines. The working group recommends endoscopy in case of a (alarm) symptoms: haematemesis, prolonged vomiting, irondeficiency anaemia e.c.i., and a 24 hour oesophageal pH test in case of b (aspecific) symptoms: recurrent pneumonia, refusal of food, regurgitation, rumination, dental erosions. In general most patients are cured with drug treatment (omeprazol or another proton pump inhibitor). If symptoms are not improved after 6 months of optimal treatment, surgical treatment may be considered.
Adult↗
Comparison of rating scales for the diagnosis of dementia in adults with Down's syndrome.
Making a diagnosis of dementia, particularly in its early stages, in a person with intellectual disability can be difficult Some neuropsychological tests which were originally devised for the diagnosis of dementia in the non-intellectually disabled population have been modified for use in people with intellectual disability. Observer-rated scales have also been used for making a diagnosis of dementia in people with intellectual disability. Within the context of a genetic study, the rates of diagnosis of dementia according to different criteria, namely the clinician's diagnosis (ICD-10), the Dementia Questionnaire for Persons with Mental Retardation (DMR), the Dementia Scale for Down Syndrome (DSDS) and the Mini Mental State Examination (MMSE), were compared among 62 adults with Down's syndrome (26 demented and 36 non-demented adults according to the clinician's diagnosis). A comparison between the clinician's diagnosis and the diagnosis according to DMR criteria showed specificity and sensitivity at the 0.92 level for both categories. Similarly, a comparison between the clinician's diagnosis and the diagnosis according to the DSDS criteria showed a specificity of 0.89 and a sensitivity of 0.85. A good positive correlation was also shown between the scores of the DSDS and the DMR (Pearson's r = +0.868, P < 0.001). A similar positive correlation was found between the overall DSDS score and the scores in the main subcategories of the DMR. An MMSE could be performed in only 34 (55%) out of the 62 subjects with Down's syndrome. Out of the 30 subjects who had an MMSE score of less than 24 (the usual cut-off for the diagnosis of possible dementia), 23 (77%) did not have a diagnosis of dementia according to any criteria. It seems that the observer-rated scales, rather than the direct neuropsychological tests, are more useful for the diagnosis of dementia in people with an intellectual disability.
Adult↗
Measuring stress in the mildly intellectually handicapped: the factorial structure of the Subjective Stress Scale.
The Subjective Stress Scale (SSS) was developed by Bramston and Bostock (1994) to provide a sensitive measure of stress for people with intellectual disabilities. This study examined the underlying structure of the SSS by analysing responses of 221 intellectually disabled people to the questionnaire. Exploratory factor analysis of the interitem correlation matrix yielded at least three solutions that were quite interpretable: a one-factor, a two-factor, and a four-factor solution. Factors in all three solutions bore a strong resemblance to stress dimensions reported for the general population using other stress measures. The results suggest that although the actual stressors vary, persons with mild intellectual disability are affected by the same major stress dimensions as the general population. The results also suggest that the SSS can be used as a much needed measure of subjective stress levels in people with mild intellectual disabilities.
Adult↗
Promoting friendship through best buddies: a national survey of college program participants.
Best Buddies is a nonprofit organization whose mission is to enhance the lives of people with intellectual disabilities through one-to-one friendships with individuals without disabilities. A cross-sectional survey was conducted with Best Buddies College Program participants located within the United States. Survey findings suggest that college students and people with intellectual disabilities benefited from participation in Best Buddies. The vast majority of college students and people with intellectual disabilities reported enjoying their experience and engaging in friendship activities that were mutually beneficial to those involved. Most people with intellectual disabilities also indicated their lives had been enhanced as a result of Best Buddies, although the percentage was lower than that of college students.
Adolescent↗