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PubMed1993

Family involvement in practice: issues and attitudes.

The family occupies an important role in the lives of persons with a physical, developmental, or mental disability; however, the extent and manner in which occupational therapists work with families is not known. A questionnaire concerning family-therapist involvement was sent to occupational therapists. Responses of 340 occupational therapists with a primary practice area of physical disabilities, developmental disabilities, or mental health were compared. Results indicated that the amount of contact with families of clients, reasons for family-therapist interactions, and attitudes about the family's abilities and involvement were affected by the respondent's area of practice. Respondents in all three practice areas identified scheduling difficulties as the biggest issue affecting their involvement with families of their clients. Implications discussed include the need to obtain an understanding of families' desired level of involvement and the importance of continuing education opportunities for occupational therapists in changing attitudes about working with families. This study also suggests that the role of occupational therapists with families in mental health settings needs to be better articulated and shared with professional peers.

Attitude↗

PubMedDate not supplied

Specific impairment in developmental reading disabilities: a working memory approach.

Children with developmental reading disabilities (RD) frequently display impaired working memory functioning. However, research has been divergent regarding the characteristics of the deficit. Our investigation addressed this controversy by assessing Baddeley's working memory model as a whole rather than focusing on particular aspects of it, as has been done by much of the research to date. Participants included 20 children with RD and 20 typical readers between the ages of 9 and 13. The phonological loop, visual-spatial sketchpad, and central executive were assessed according to Baddeley's model. The results demonstrated that children with RD have an impaired phonological loop but intact visual-spatial sketchpad and central executive functioning as compared to controls. In terms of the phonological loop, the deficit appears to be specific to the phonological store. Furthermore, our research supports a relationship between phonological processing and phonological loop functioning.

Adolescent↗

PubMed2004

The expression of pain in infants with developmental delays.

OBJECTIVE: To explore how infants with developmental delays express pain, we analysed facial expressions of infants receiving their routine immunization at around 4-6 months developmental age. The sample included eight infants with developmental disabilities (mean developmental age 4.8 months) and 30 typically developing infants (mean age 4 months). The Maximally Discriminative Facial Movement Coding system was used to code infant facial expressions during immunization. RESULTS: The pain expression was by far the most common of all facial expressions following immunization for both groups of infants. Those with disabilities produced significantly fewer discrete high-intensity expressions of pain, and significantly more blended expressions than typically developing infants. Expressions of fear, sadness and anger were relatively infrequent in both groups. Infants with disabilities used their upper face less often than typically developing infants, and their mid face was uncodeable more often. CONCLUSION: Infants with developmental delays were likely to show pain in facial expressions less clearly than typically developing infants. It is important for health care professionals to be aware that this may be the case when considering the administration of analgesia for such children.

Developmental Disabilities↗

PubMed2000

Self-determination and empowerment: a feminist standpoint analysis of talk about disability.

In this paper we offer a feminist analysis of talk about self-determination and empowerment in the context of disability, focusing on the case of developmental disabilities. We find strains of the same patterns feminist epistemologists have argued shape the organization of formal knowledge from the standpoint of the privileged. At the extreme, people with developmental disabilities appear as objects without selves, outside of the context of interpersonal and social structural relationships that constrain who they can be by defining them as other, often in multiple and interacting ways. Empowerment, from the dominant standpoint, becomes an abstract attribute or condition; something a person has or does not have. Taking the standpoint of women and other marginalized people offers a view of self-determination as a person's development of his or her self. Empowerment becomes a potential characteristic of a social relationship, one that facilitates the development of someone's self. The most empowering relationships are mutual, recognizing and building on the diverse contributions and needs of participants in ways that seek to minimize inequalities over time. The reason some of us are self-determining is that we are in interpersonal and social structural relationships that empower us. To construct interpersonal and social structural relationships that empower people with developmental disabilities requires challenging the way dominant conceptualizations of independence and productivity also express the standpoint of the privileged. The standpoint of women allows all of us to talk more of how we connect with and facilitate one another's developing selves within communities.

Developmental Disabilities↗

PubMed1997

Minor malformations and physical measurements in autism: data from Nova Scotia.

In the context of an epidemiological study of autism in Nova Scotia, subjects were evaluated for minor physical anomalies and physical measurements. Normal control children, children with autism and their siblings, and children with developmental disabilities and their siblings were compared. Posterior rotation of the external ears was found to be a characteristic related to autism specifically, rather than to developmental disabilities in general. Small feet and normal-to-large hands also were observed in the autism group. Children with autism had a significant reduction in interpupillary distance, but not intercanthic distance or head circumference. In contrast, children with other developmental disabilities were notable for general small stature, which affected the hands, feet, eyes, and head size, as well as height. Abnormal ear configuration was the minor malformation most characteristic of the developmental disability group, and the subset of Down syndrome children had single transverse creases of the palm and epicanthic folds that resulted in significantly increased rates of these anomalies in the developmentally disabled controls. Siblings of the two disabled groups were not significantly different from normal controls on any of the measures that characterized children with autism or other developmental disabilities. The results agree with those of several previous studies, which have suggested that abnormalities of the ears are the general category of minor anomalies most associated with autism. Recent evidence regarding the embryological origin of autism suggests that the ear effects may be an important marker of the initiating events that lead to the disorder.

Abnormalities, Multiple↗

PubMed2004

Treatment of behavior disorders in mental retardation: report on transitioning to atypical antipsychotics, with an emphasis on risperidone.

BACKGROUND: Mental illnesses are more common in people with mental retardation and developmental disabilities than in the general population. Due to the difficulty of making specific psychiatric diagnoses in these patients, the target of medication is often a behavioral symptom. For many symptoms, antipsychotic medications are effective, but the serious side effect profile of conventional antipsychotics renders their use problematic. Recent findings concerning the safety and efficacy of atypical antipsychotics for control of certain disruptive behaviors in adults and children led a Special Topic Advisory Panel to draw up guidelines for transitioning patients with specific symptoms from classical antipsychotics to risperidone and, by extrapolation, to other atypical agents. PARTICIPANTS: Participants were chosen by Janssen Pharmaceutica, based on individual achievements and lifetime experience. The Special Topic Advisory Panel on Transitioning to Risperidone Therapy in Patients With Mental Retardation and Developmental Disabilities comprised academic clinicians with at least 10 years' experience in the field of mental retardation and developmental disabilities. It included a clinical pharmacist, consultant pharmacists, a certified developmental disabilities nurse, psychiatrists, a family physician, and a psychologist. EVIDENCE: The Panel considered recent studies of the efficacy and tolerability of risperidone and other atypical antipsychotics in adults and children with mental retardation and developmental disabilities. MEDLINE searches were conducted using the name of each atypical antipsychotic and the following terms: mental retardation, developmental disabilities, and behavior disorders. Searches were conducted starting in July 2002 and done periodically through April 2004 to capture new additions to the literature. Searches were confined to English. GUIDELINES PROCESS: The Panel reviewed the available evidence, identified optimal doses and titration schedules, considered instruments and rating scales for assessing symptoms, and developed guidelines. CONCLUSIONS: The guidelines set forth initial and target doses and titration schedules of risperidone therapy for some behavioral symptoms and provide recommendations concerning withdrawal of previous medications and for procedures and rating scales for assessing symptoms. In patients with severe retardation, the goal is often to identify specific target behaviors rather than to pursue an exact diagnosis, which may be unattainable.

Adult↗

PubMedDate not supplied

Trends in special care training in pediatric dental residencies.

Pediatric dentist are often regarded by the dental community as the specialty group best prepared to treat patients with developmental disabilities. This may be because it is the only specialty that receives formal training in behavior management techniques. A questionnaire was mailed to the directors of all 55 ADA-accredited pediatric dental residency programs in the U.S. The purpose of the survey was two-fold: the first aim was to quantify the training that pediatric dental residents receive in providing care to persons with developmental disabilities. A second area of investigation addressed the issue of pediatric dentist continuing yo treat persons with developmental disabilities into adulthood. The survey determined that pediatric dental residency programs provide considerable training in "Special Care" dentistry. While adults with developmental disabilities continue to be treated in 48 percent of responding programs, 55 percent of the program directors stated outright that it should not be the role of pediatric dentist to provide treatment to this population.

Adult↗

PubMed2002

Seroprevalence of H. pylori infection and symptoms of upper gastrointestinal tract disease in two groups of health-care workers.

The purpose of this study was to determine the seroprevalence of Helicobacter pylori and risk factors for infection in gastrointestinal endoscopy personnel and those caring for developmentally disabled individuals. We administered a structured, one-page questionnaire. Helicobacter pylori status was determined serologically. In all, 107 health-care workers participated. Direct patient contact, exposure to gastrointestinal secretions, history of peptic ulcer, and acid-suppressing medicine use were more frequent among those who worked with the developmentally disabled. Seroprevalence of Helicobacter pylori was 24% in endoscopy personnel and 47% among those who cared for the developmentally disabled (P = 0.02). Bed-sharing with a sibling during childhood, working with the developmentally disabled, and direct patient contact were associated with Helicobacter pylori infection; exposure to patients' gastrointestinal secretions was not. We conclude that those caring for developmentally disabled individuals have a higher risk of occupational acquisition of Helicobacter pylori infection than endoscopy personnel.

Adult↗

PubMed1997

Tactile defensiveness and stereotyped behaviors.

OBJECTIVES: This study explores the constructs of stereotyped behaviors (e.g., repetitive motor patterns, object manipulations, behavioral rigidities) and tactile defensiveness as relevant to occupational therapy theory and practice and attempts to test their purported relationships in children with developmental disabilities. METHOD: Twenty-eight children with developmental disabilities and autism were assessed on eight factors of stereotyped behavior via a questionnaire and by four measures of tactile defensiveness. The subjects' scores from the questionnaire were correlated with their scores on the tactile defensiveness measures to see what, if any, relationship among these behaviors exists. RESULTS: Significant relationships emerged from the data, indicating that subjects with higher levels of tactile defensiveness were also more likely to evidence rigid or inflexible behaviors, repetitive verbalizations, visual stereotypes, and abnormal focused affections that are often associated with autism. No significant association was found between motor and object stereotypes and tactile defensiveness. These relationships could not be explained solely by maturational factors. CONCLUSION: The results suggest that clinicians should include observations of stereotyped behaviors, particularly behavioral rigidities, in conjunction with assessments of sensory defensiveness because these are related phenomena that may pose unique challenges for children with developmental disabilities and autism. Further study is needed to determine the causal mechanisms responsible for these relationships.

Adolescent↗

PubMed2002

Comorbidity in children with severe developmental language disability.

UNLABELLED: In a cohort of 2359 children, screened for severe developmental language disability (DLD) at 3 y of age, 45 children were identified as true positives. The development, concerning DLD and comorbidity of 41 of these children still living in the municipality of Uppsala was followed up to school start. Criteria for comorbidity were: (a) suspected or diagnosed neuropsychiatric/neurodevelopmental disability according to information from the Child Habilitation Centre and the Child Psychiatric Centre or (b) low performance IQ, signs of activity/distractibility problems according to a psychologist's examination. By school start, 61% of the children with severe DLD were identified with comorbidity. CONCLUSION: Severe DLD is often combined with other disabilities within the neuropsychiatric/neurodevelopmental spectra. The comorbidity might not be obvious at 3 y of age--the age at which severe DLD is effectively identified by the 3-y screening programme. This in turn stresses the necessity of multidisciplinary teamwork both at the referral level and during the therapy work.

Age Factors↗

PubMed2004

Children with low motor ability have lower visual-motor integration ability but unaffected perceptual skills.

The purpose of this study was to examine perceptual, visual-motor abilities and intellectual skills in children with low, average and above average motor abilities. The participants were 144 children (aged 6-10 years) attending elementary school. Three groups of children were identified on the basis of their performance at the TGMD (Test of Gross Motor Development; [Ulrich, D.A. (1985). TGMD, Test of Gross Motor Development. Austin, Texas: PRO-ED. Edizione Italiana a cura di D. Ianes, TEST TGM. Test di valutazione delle abilita grosso-motorie. 1994, Trento: Edizioni Centro Studi Erickson]). Each child received an intelligence test (K-BIT; [Kaufman, A.S., & Kaufman, N.L. (1990). K-BIT. Kaufman Brief Intelligence Test. Circle Pines, MN: American Guidance Service]) and was evaluated for perceptual and visual-motor integration abilities (DTVP; [Hammill, D.D., Pearson, N.A., & Voress, J.K. (1993). Developmental Test of Visual Perception (2nd ed.). Austin, Texas: PRO-ED. Edizione Italiana a cura di D. Ianes, TEST TPV. Test di percezione visiva e integrazione visuo-motoria. Trento: Edizioni Centro Studi Erickson]). Results highlight a significant difference in visual-motor integration between children with high and low gross-motor abilities, in the absence of significant differences in perceptual skills or intellectual ability. The findings are discussed with reference to the concept of atypical brain development [Gilger, J.W., & Kaplan, B.J. (2001). Atypical brain development: A conceptual framework for understanding developmental learning disabilities. Developmental Neuropsychology, 20, 465].

Child↗

PubMedDate not supplied

Xylitol in the prevention of oral diseases.

Special needs populations such as the mentally disabled or developmentally disabled present a unique challenge for the dental professionals providing dental treatment. Among those challenges is oral health promotion through primary prevention of dental caries and periodontal disease. There are many barriers to adequate oral care for these special needs patients that include cost, physical limitations, low levels of perceived need and lack of dental knowledge by residents and staff, if the person resides in an institution. Primary prevention to maintain oral comfort and function for these patients is a priority to support their quality of life. Typical oral health problems of these patients include hyposalivation, root-surface caries, poor oral hygiene, a high prevalence of periodontal disease and dental caries. The purpose of this paper is to review information for the inclusion of xylitol in primary preventive regimens as an adjunct for the prevention of oral diseases for special needs patients.

Cariostatic Agents↗

PubMed2006

Randomised trial of high frequency oscillatory ventilation or conventional ventilation in babies of gestational age 28 weeks or less: respiratory and neurological outcomes at 2 years.

BACKGROUND: The long term outcome of children entered into neonatal trials of high frequency oscillatory ventilation (HFOV) or conventional ventilation (CV) has been rarely studied. OBJECTIVE: To evaluate respiratory and neurodevelopmental outcomes for children entered into the United Kingdom Oscillation Study, which was designed to evaluate these outcomes. METHODS: Surviving infants were followed until 2 years of age corrected for prematurity. Study forms were completed by local paediatricians at routine assessments, and parents were asked to complete a validated neurodevelopmental questionnaire. RESULTS: Paediatricians' forms were returned for 73% of the 585 surviving infants. Respiratory symptoms were common in all infants, and 41% had received inhaled medication. Mode of ventilation had no effect on frequency of any symptoms. At 24 months of age, severe neurodevelopmental disability was present in 9% and other disabilities in 38% of children, but the prevalence of disability was similar in children who received HFOV or CV (relative risk 0.93; 95% confidence interval 0.74 to 1.16). The prevalence of disability did not vary by gestational age, but boys were more likely to have overall disability. Developmental scores were unaffected by mode of ventilation (relative risk 1.13; 95% confidence interval 0.78 to 1.63) and were lower in infants born before 26 weeks gestation compared with babies born at 26-28 weeks. CONCLUSIONS: Initial mode of ventilation in very preterm infants has no impact on respiratory or neurodevelopmental morbidity at 2 years. HFOV and CV appear equally effective for the early treatment of respiratory distress syndrome.

Child Development↗

PubMedDate not supplied

Physical activity of adults with mental retardation: review and research needs.

OBJECTIVE: To characterize physical activity levels of adults with mental retardation and identify limitations in published research. DATA SOURCES: Key word searches for "mental retardation," "intellectual disability," "learning disability," or "developmental disability" combined with "physical activity" or "habitual exercise" identified articles from MEDLINE, Academic Search Elite, Psych Articles, Health Source, and SPORT Discus. This produced a total of 801 citations. STUDY INCLUSION AND EXCLUSION CRITERIA: Published English-language literature that quantitatively measured physical activity levels of adults with mental retardation was included in this review. Fourteen articles met this criterion. DATA EXTRACTION: Characteristics of participants, study design, outcome measures, methods of analyses, and findings in terms of percentages, step counts, and accelerometer output were extracted. DATA SYNTHESIS: Data were synthesized to identify the percentage of adults with mental retardation who met published health-related physical activity criteria and compare them with adults without mental retardation and to examine study limitations. RESULTS: The studies with the greatest rigor indicate that one-third of adults or fewer with mental retardation were sufficiently active to achieve health benefits. However, data are insufficient to determine whether adults with mental retardation are less active than the general community. CONCLUSIONS: Future research would be enhanced by including appropriately powered representative samples, by including comparison groups, by validating physical activity questionnaires, and by determining the accuracy of proxy respondents.

Adult↗

PubMed1996

Labor-force participation and earnings of SSI disability recipients: a pooled cross-sectional times series approach to the behavior of individuals.

This article examines two important aspects of work behavior, labor-force participation, and earnings among persons who since 1976 have become entitled to SSI disability benefits and received payments for a full calendar year or longer during the intervening time period. A data set was developed containing the records of a random sample of all individuals who had ever received Supplemental Security Income (SSI) disability benefits and matched to earnings records maintained by the Social Security Administration (SSA). A multivariate analysis based on a pooled cross-sectional time series approach was employed using individual-level data to first estimate the probability of an SSI recipient performing work and then to estimate, among those who worked, the level of earnings. For this analysis, the SSI population was divided into three distinct groups based on their diagnosis: the nondevelopmentally disabled, the developmentally disabled (other than the mentally retarded), and the mentally retarded. The analysis provides information about the impact that individual characteristics (such as age, education, diagnosis, and so forth) play in the decision to work and in determining the level of earnings. The analysis also addresses yearly variations in labor-force participation and earnings.

Adolescent↗

PubMedDate not supplied

Self-reported health care self-care needs of transition-age youth: a pilot study.

The purpose of this pilot study was to describe the self-reported health care self-care needs and skills of transition-aged youth referred for transition services. Data were obtained from California Healthy and Ready to Work Transition Assessment Tool through a retrospective chart review. Yes, no, and with assistance responses were rank ordered according to the sample and subgroupings of youth. Of the items, 30% were answered affirmatively by 80% or more of respondents. Nearly 20% of the items were answered as "no" by respondents. A few items were answered "with assistance" by less than 30% of respondents. Data were rank ordered according to diagnostic group. The cancer group (n=8) reported 100% "yes" responses to 12 items, compared with 2 for the developmental disabilities group (n=7) and none for the "other" group (n=10). Eight of the domains had Kuder-Richardson levels >0.60 [correction]. Spearman nonparametric correlation analyses were conducted among individual questions of the six domains with low Kuder-Richardson levels (<0.60) for further analysis and to assess the problem items. Findings revealed youth with developmental disabilities had significantly higher numbers of "no" responses in nine domains than youth with cancer [correction]. Groups were compared using domain-specific summary scores of youth with cancer diagnoses with those of youth with developmental disabilities to examine differences in level of skills. Findings revealed youth with developmental disabilities had significantly higher numbers of "no" responses in seven domains than youth with cancer. Findings revealed youth with cancer had significantly higher numbers of "yes" responses in six domains than youth with developmental disabilities. Research and clinical implications are discussed.

Adolescent↗

PubMed1990

An interdisciplinary nutrition assessment and intervention protocol for children with disabilities.

Because of the multifactorial nature of the nutrition problems associated with developmental disabilities, a well-organized, interdisciplinary effort is necessary to deal with such problems. A team composed of professional and support staff, the client, and the family needs to be involved in an integrated approach to service. The team members share their knowledge and expertise in developing an individual program plan to meet identified needs. This article describes the development and implementation of a prototype for interdisciplinary nutritional evaluation and intervention in an outpatient setting. In 1987, a Regional Nutrition and Feeding Diagnosis and Evaluation Clinic was established through a contractual agreement between the University of Georgia University Affiliated Program and St. Mary's Hospital in Athens, GA. The purposes of the clinic are twofold: to offer direct services to developmentally disabled infants and children who require outpatient services and to provide a unique community-based interdisciplinary training experience for graduate students in nutrition and other health disciplines. The interdisciplinary treatment protocol is based on current knowledge in the treatment of developmental disabilities.

Ambulatory Care Facilities↗

PubMed1996

Neuropsychological assessment of developmental learning disabilities in adults.

Neuropsychology has a relatively brief history in the assessment of developmental learning disabilities (DLD) in adults. For a discipline that conceptualizes clinical assessment on the basis of neurologic understanding, DLD continues to be a challenge, even today because its neurology remains relatively unknown. Nonetheless, there have been important advances in understanding the underlying brain differences in this population as well as the advancement of theory-driven models for assessment. In the context of this body of information, neuropsychological assessment provides a comprehensive means of diagnosing DLD in adults. This article describes components of a specialized neuropsychological protocol developed to diagnose DLD in adults.

Achievement↗