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PubMed1996

Prevalence of intellectual disability in northern Sydney adults.

The prevalence of intellectual disability, defined as IQ < 70, was determined in a population of adults aged 20-50 years who lived in the northern suburbs of Sydney, Australia. Case finding was carried out in the community, and all those ascertained were interviewed and psychometrically assessed. The overall prevalence was 3.31 per thousand with severe intellectual disability (IQ < 55) 2.19 per thousand and mild (IQ 56-70) 1.12 per thousand. Down's syndrome had a frequency of 0.96 per thousand. Thirty-eight per cent of the total group were living in institutional care.

Adult↗

PubMed2005

Prevalence of intellectual disability and comorbid mental illness in an Australian community sample.

OBJECTIVE: The aim of this study was to bring to light the high prevalence of Australians affected by intellectual disability and comorbid serious mental illnesses. Results from a broad scale study are used to explore the reasons for this regularly overlooked phenomenon. METHODS: This study was based on secondary analysis of data collected in the national 'Disability, Ageing and Carers Survey, 1998'. The analysed data consisted of an Australian wide sample of 42 664 individuals living at home or in cared accommodation. Classification of intellectual disability and comorbid psychosis, anxiety and depressive disorder was based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). RESULTS: The prevalence of intellectual disability in the sampled population was 1.25%. Of these people 1.3% had a psychotic disorder, 8% had a depressive disorder and 14% had an anxiety disorder that had been present for at least 6 months and was of such severity that it too was disabling. CONCLUSIONS: Findings indicate that people with intellectual disability are at high risk of developing comorbid serious mental illness. Dual diagnosis is however, often overlooked due to difficulties associated with establishing a diagnosis of a mental disorder in people with an intellectual disability, a problem which is heightened when the individual's capacity to participate in a clinical assessment is limited.

Adolescent↗

PubMed1995

Cross-national comparisons of ageing mothers of adults with intellectual disabilities.

Ageing (55+ years) mothers of adults with intellectual disabilities in the Republic of Ireland, Northern Ireland and the United States were compared with respect to three general issues. Firstly, to what extent do the adults in these three countries differ in their level of reliance on their mothers? Secondly, do the mothers differ in the extent to which they have made plans for the future care of their son or daughter with intellectual disabilities? Thirdly, do the mothers differ in physical, social and psychological well-being? These cross-national comparisons were undertaken to examine the extent to which lifelong caregiving has either a common influence on mothers across national boundaries, or, alternatively, whether the cultural context exerts a unique influence on mothers in each country. Findings supported the latter explanation, even when background characteristics were statistically controlled.

Adult↗

PubMed2005

[Adaptive behavior scale for persons with profound intellectual disability].

An adaptive behavior scale for persons with profound intellectual disability was proposed. This scale consisted of 64 items from five areas: interpersonal relationship, perception, expression, interest and play, and daily life. Each item was scored on a 0-2 scale. Forty-eight institutionalized persons (23 males, 25 females) with profound intellectual disability, aged 13-69 (mean 40) years, were examined with this scale. The rating for each item was 0.02-1.81 (mean 0.88). On 69% of the items, estimates were consistent between two care-staffs. The Cronbach's alpha value was calculated to be 0.97, indicating good internal consistency. On the whole, this scale is useful in assessing adaptive behaviors of the subjects.

Activities of Daily Living↗

PubMed2003

Phonological and visuo-spatial working memory in individuals with intellectual disability.

Differences in the storage and rehearsal components of the phonological loop and visuo-spatial sketchpad were investigated in individuals with and without intellectual disability matched on memory span. The group with intellectual disability had specific difficulty in the rehearsal component of the phonological loop, as demonstrated by a weak word length effect compared to the group without intellectual disability. Groups did not differ in the storage component of the phonological loop as indexed by the phonological similarity effect. Also, groups did not differ in the storage or maintenance components of the visuo-spatial sketchpad, having comparable visual similarity and visual complexity effects. However, visual complexity task performance suggested that some aspects of visual processing surpass developmental level expectations for individuals with intellectual disability.

Adolescent↗

PubMed2003

Schemata and attitudes toward persons with intellectual disability in Japan.

375 parents of pupils were asked to respond to 14 questions on attitudes toward persons with intellectual disability. About 30% of variance in attitude was explained by a set of variables. The effects of schemata concerning person with intellectual disability had a great effect on attitudes toward such persons. The guess of a greater contribution of heredity as the basis of intellectual disability and of fewer such persons in the future of their own families than in the general population was associated with greater negative attitudes toward persons with intellectual disability. As these estimations relate to teachable information, the attitudes might be improved.

Adult↗

PubMed2000

Psychopathology in children with intellectual disability.

Recent advances are reviewed in understanding the heightened prevalence of psychopathology and maladaptive behavior among children with intellectual disability. Researchers have traditionally emphasized measurement and prevalence issues, using either psychiatric assessments or rating scales to identify the prevalence of various problems in children with intellectual disability. Yet the time is ripe to shift directions, and identify more precisely why children are at increased risk for psychopathology to begin with. Although several "biopsycho-social" hypotheses are reviewed, a particularly promising line of work links psychopathology to genetic intellectual disability syndromes. Psychiatric vulnerabilities in several syndromes are reviewed, as are the advantages of phenotypic work for understanding psychopathology among children with intellectual disability more generally.

Adolescent↗

PubMed2006

Is it in the best interests of an intellectually disabled infant to die?

One of the most contentious ethical issues in the neonatal intensive care unit is the withdrawal of life-sustaining treatment from infants who may otherwise survive. In practice, one of the most important factors influencing this decision is the prediction that the infant will be severely intellectually disabled. Most professional guidelines suggest that decisions should be made on the basis of the best interests of the infant. It is, however, not clear how intellectual disability affects those interests. Why should intellectual disability be more important than physical disability to the future interests of an infant? Is it discriminatory to base decisions on this? This paper will try to unravel the above questions. It seems that if intellectual disability does affect the best interests of the child it must do so in one of three ways. These possibilities will be discussed as well as the major challenges to the notion that intellectual disability should have a role in such decisions. The best interests of the child can be affected by severe or profound intellectual disability. It is, though, not as clear-cut as some might expect.

Brain Diseases↗

PubMed2002

Move of adults with intellectual disability from institutions to community-based living: changes of food arrangements and oral health.

The policy of deinstitutionalisation, integration and increased independence for individuals with intellectual disability has been accepted in the western part of the world. The aim of the present study was to evaluate the changes in oral health and eating arrangements when intellectually disabled persons move from an institution to integrated living. In 55 subjects the incidence of caries and tooth mortality was compared 4.7 years before and after the change in living arrangements. In addition, changes in oral hygiene routines, eating arrangements and weight were registered. The incidence of caries and tooth mortality was low among individuals with severe and moderate intellectual disability during 4.7 years before as well as after de-institutionalisation, and no differences could be observed between the periods. After 4.7 years of integrated living, 40% of the subjects were estimated to have gained weight. Among those subjects with an estimated decreased weight (13%), the caries incidence was higher compared to other subjects with intellectual disability. Participation in grocery shopping and cooking increased in the integrated living. The increase in weight suggests an impact on general health after almost 5 years of integrated living. No indications of a corresponding influence on oral health in individuals with severe or moderate intellectual disability could be observed after deinstitutionalisation. However, oral health in weight-losing subjects need further investigations.

Adult↗

PubMed1992

Seizures and intellectual disability associated with tuberous sclerosis complex in the west of Scotland.

Of 104 individuals with tuberous sclerosis complex ascertained from the total population of the west of Scotland, 52 were born before and 52 after 1st July 1966. Of those born before. 10 had no seizures, 14 had seizures and no intellectual disability and 28 had seizures and intellectual disability; of those born after, four had no seizures, 18 had seizures and 30 had seizures and a degree of intellectual disability. Infantile spasms or other generalised seizures as the presenting seizure type (N = 29) was strongly associated with intellectual disability; partial seizures as the presenting seizure type (N = 19) was associated with normal development. Although the onset of seizures under one year of age and the presence of multiple seizure types were associated with intellectual disability, the strongest association was with the type of presenting seizure.

Child↗

PubMed2004

Self-perceived equal opportunities for people with intellectual disability.

Despite a growing awareness of the need to promote equal opportunities for people with disabilities, little is known about the self-perceived employment opportunities for people with intellectual disability. This study adopted a qualitative approach to examine the issue of 'equalization of employment opportunities' with 18 young working adults with mild intellectual disability who participated in in-depth interviews. Content analysis and a constant comparative method were adopted for data analysis. Our findings revealed that having employment was regarded as being very important by all participants, and 17 participants had had both positive and negative employment experiences, which were mainly related to the workplace interpersonal relationships and the attitude of employers and co-workers. Eight participants might have experienced discrimination at work when employers and co-workers had misconceptions about people with intellectual disability. This study suggested that strategies such as equal opportunities education, natural support from employers and co-workers and disability education for the general public should be adopted to enable people with intellectual disability to have full participation in employment and social integration.

Adult↗

PubMed2000

Needs for oral care among people with intellectual disability not in contact with Community Dental Services.

Previous research has found an unmet need for oral care among people with intellectual disability. The key factors which have been indicated are low expectations, fear of treatment, lack of awareness among carers and problems in accessing dental services. The withdrawal of many general dental practitioners (GDPs) from the National Health Service (NHS) may have exacerbated the latter problem in the UK. The aims of the present study were: (1) to assess the extent of unmet clinical needs in a group of adults with intellectual disability living in the community who were not in contact with the Community Dental Service (CDS); and (2) to explore their perceptions of teeth and contact with dentists to identify how oral care can be improved. Interviews were completed with subjects and/or carers and a dental examination was completed. There were higher levels of untreated caries (decay), and gingival or periodontal (gum) problems among the sample than in either the general population, or in a previous survey of CDS users at day centres and residential facilities. The subjects were largely unaware of dental problems, and used the appearance and absence of pain to judge the condition of their teeth. They depended greatly on their carers for decision-making and support with regard to visiting the dentist and tooth-brushing. Carers requested training in oral care and the use of dental services, and support in dealing with clients who have problems tolerating tooth-brushing. The subjects had experienced a wide variation in the treatment provided by dentists, but had not found it difficult to access a dentist despite recent reductions in the availability of NHS dental care. They expressed a particular need for a good relationship with their dentist and for their dentist to have personal skills in relating to people with an intellectual disability. Dental screening checks and oral care training for carers should be made easily available. Care plans should include tooth-brushing and dietary issues for all clients who have their own natural teeth. There are significant training issues for dentists in developing personal skills in total communication, disability awareness and attitudes which value people with intellectual disability.

Adult↗

PubMed2005

Introduction to theme section on geographies of intellectual disability: 'outside the participatory mainstream'?

This paper introduces the following theme section on Geographies of Intellectual Disability. It outlines the historiography of geographical work on intellectual disability, noting in particular the contributions of Wolpert (Transactions of the Institute of British Geographers 5 (1980) 391) and Hall and Kearns (Health and Place 7 (2001) 237), before tracing claims made about both the 'institutional' and 'deinstitutional' eras in the changing geographies confronting and experienced by intellectually disabled people. This account, highlighting the tendency for such people to remain 'outside the participatory mainstream' in almost all circumstances, offers along the way an introduction to the four contributions that follow.

Deinstitutionalization↗

PubMed1998

The Rorschach Egocentricity Index in subjects with intellectual disability: a study on the incidence of different psychological pathologies.

The aims of the present research were to assess the level of self-concern in people with intellectual disability using the Rorschach Egocentricity Index, to correlate the Index with other Rorschach and IQ variables, and to study the effect of associated psychological pathology. The Rorschach Inkblot Test and the Wechsler Intelligence Scale were administered to a group of 75 subjects with intellectual disability, aged between 18 and 38 years, who were divided into subgroups according to their additional diagnosis (i.e. personality disorders, psychosis and depression). A fourth subgroup was composed of people with intellectual disability but without other pathologies. The Egocentricity Index was very low in the subjects with intellectual disability and differences were a result of the effects of additional psychological pathologies. The meaning of the measurement of egocentricity in people with intellectual disability is discussed.

Adolescent↗

PubMed1997

Sexual abuse perpetrated by men with intellectual disabilities: a comparative study.

This paper compares cases of sexual abuse of adults with intellectual disabilities, reported across the South East of England, which were perpetrated by men with intellectual disabilities, with those committed by other male perpetrators. The comparison provides some support for the findings of other studies, which have suggested that men with intellectual disabilities offend against more male victims than non-disabled sex offenders and that their offences are somewhat less serious, but otherwise indicates common patterns of abusive behaviour across this divide but differential service responses and support for victims. So called 'peer abuse' is a widespread problem which service agencies have failed to address: repeated offences are frequent and lack of appropriate intervention is the norm.

Adult↗

PubMed2004

[Usefulness of flexible bronchoscopy for aspiration of foods into the tracheobronchial trees in 2 patients with severe motor and intellectual disabilities].

Two patients with severe motor and intellectual disabilities who suffered from acute asphyxia and respiratory failure due to aspiration of foods into the tracheobronchial trees were reported. Numerous food particles were found in the tracheobronchial trees of both the patients. One patient showed recurrent atelectasis at various sites. After oral intubation, flexible bronchoscopy could successfully remove food particles from the tracheobronchial trees in both the patients without any complications. A rigid bronchoscope is usually recommended for removal of foreign bodies from the airways in children. However, it is difficult to use in patients with severe motor and intellectual disabilities, because their airway may show deformation or the aspirated foods may enter the peripheral bronchi. Our cases suggest that flexible bronchoscopy can be useful for removing foreign bodies from the tracheobronchial trees in neurologically handicapped patients for whom rigid bronchoscopy can not be applied.

Acute Disease↗

PubMed2006

Epilepsy, intellectual disability, and living environment: a critical review.

Epilepsy occurs at a higher incidence and is more prevalent in people with an intellectual disability than in the general population. Nonetheless, we have insufficient knowledge of the extra needs of people with epilepsy and intellectual disability, of their families, and of the living environment. The lack of information about specific needs of the living environment may, in particular, be important. A Medline search revealed that scant attention has been paid to the specific needs for patients with epilepsy and intellectual disability, and only a few studies have focused specifically on this topic. The majority of studies have been focused on medical treatment issues and the organization and availability of health and social services. There is an indication that people with epilepsy and intellectual disability lack skills training appropriate to their intellectual potential. And although several reviews have emphasized the need for information on living environment and quality of life, we did not find such studies in our search.

Anticonvulsants↗

PubMed2003

Psychopathology in people with epilepsy and intellectual disability; an investigation of potential explanatory variables.

OBJECTIVES: There are few studies on epilepsy and psychopathology in people with intellectual disability (mental retardation) despite epilepsy prevalence rates that are thirty times higher than in the general population. The aims of this study, therefore, were to identify reliable, epilepsy-specific predictors of psychiatric and behavioural disorder in these patients, and to investigate reliable predictors of carer stress. METHODS: A database of 685 patients was compiled, from which 250 were randomly selected. Structured interviews were completed on 186 of these 250 patients (74%) (108 men, 78 women; mean age (SD) 35.5 (10.1)) comprising descriptive, clinical and functional components, and validated measures of psychopathology for which comparative data were available. Logistic and linear regression methods were used to identify predictors. RESULTS: One-third of patients with epilepsy and intellectual disability met criteria for possible psychiatric disorder, particularly affective/neurotic disorder; twice the comparison rates for intellectual disability alone. Behavioural problem levels, however, were lower than population norms. Regression models explaining modest amounts of variance (R(2)< or =24%) suggested certain seizure phenomena (greater seizure severity, more seizures in past month, lesser tendency to loss of consciousness during seizures) as particular risk factors for psychiatric disorder. General disability factors such as level of intellectual, sensory or motor disability and side effects of medication, however, contributed more to explaining behavioural problems. Around half of the family carers reported significant stress, and one-third exhibited clinically significant anxiety symptoms. Younger carers were more stressed, and side effects from patients' medication also contributed to carer stress. CONCLUSIONS: Although epilepsy in itself may be a risk factor for psychopathology in a minority of people with intellectual disability, some epilepsy-specific factors may predict psychiatric disorder. Behavioural problems need to be considered separately from psychiatric disorder because general factors, more closely associated with disability, are stronger predictors of their occurrence.

Adolescent↗