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A survey of aggressive behaviour among a population of persons with intellectual disability in Queensland.

A survey was conducted on aggressive behaviour within a population of 2412 persons with intellectual disability in Queensland, Australia. Two hundred and sixty-one individuals were identified who engaged in at least one form of aggressive behaviour, yielding an overall prevalence of 11%. The relative prevalence of aggressive behaviour was higher among institutionalized persons (35%) when compared to those living in group homes (17%) or other community-based facilities (3%). The aggressive behaviour sample included a higher percentage of males (64%). Most were described as functioning in the severe/profound (54%) or moderate (31%) range of intellectual disability with one-third having no intelligible speech. Two-thirds of the sample received medication for their challenging behaviour, while only one-third had behavioural programmes. Eighty per cent engaged in three or more forms of aggression. Many also displayed self-injury (34%) or property destruction (30%). Surveys of aggressive behaviour may prove useful for coordinating services.

Adolescent

Short-term memory in persons with intellectual disabilities and Down's syndrome.

The present study was designed to investigate verbal and spatial short-term memory abilities in persons with Down's syndrome (DS) and intellectual disability (ID) of different aetiology. For this purpose, we compared performances of DS (n = 15; mean mental age = 5.2 years; SD = 1.2 years; mean chronological age = 16.6 years; SD = 2.9 years) and ID subjects (n = 14; mean mental age = 5.8 years; SD = 2.1 years; mean chronological age = 16.4 years; SD = 2.5 years) with those of normally developed subjects matched for mental age (n = 24) on tasks of forward and backward immediate recall of verbal and spatial sequences. Our results are discussed in the light of the Working Memory model developed by Baddeley (1986, 1990). Altogether, our data documents a deficit of verbal and spatial backward spans in persons with DS. The deficit seems to be specific for this particular aetiology group, confirming the hypothesis that ID is not a uniform condition, characterized by an undifferentiated delay of the cognitive development, but rather that it is characterized by a deficit in a complex cognitive system in which some cognitive abilities can be disrupted more than others (Detterman 1987; Vicari et al. 1992).

Adolescent

The effect of differential reinforcement of incompatible behaviors (DRI) on pica for cigarettes in persons with intellectual disability.

The effect of Differential Reinforcement of Incompatible Behaviors (DRI) on pica for cigarettes in two intellectually disabled adults was studied using an A-B-A-B treatment design; in addition, the efficacy of using placebo pica stimuli (bread "cigarette butts") was evaluated. Both subjects received 10 15-minute sessions of baseline followed by 10 sessions of DRI, with a reversal to baseline and a repeat of the DRI treatment. Results support the efficacy of DRI with pica, as well as the use of placebo pica stimuli. Generalization was conducted with one of the subjects; results indicate that treatment effects were present when implemented by several ward personnel. The implications of the results for future research were discussed.

Adult

[Prevalence of serum anti-Helicobacter pylori IgG antibody in persons with severe motor and intellectual disabilities--comparison between institutionalized persons and persons living at home].

The seroprevalence of an anti-Helicobacter pylori antibody (ELISA) was investigated in institutionalized persons with severe motor and intellectual disabilities (SMID). The rate of seropositivity was significantly higher in persons with SMID under 29 years of age than in age-matched controls and in institutionalized patients with muscular dystrophy. No difference in seropositivity among SMID patients was found between those in our and other institutions. Therefore, it is speculated that Helicobacter pylori infection occurs soon after the institutionalization of SMID patients. Persons with SMID living at home, in their teens and twenties, had lower seropositivity than that of institutionalized patients but higher than controls. These data implicate the life style of persons with SMID and long-term institutionalization as one of important risk factors of Helicobacter pylori infection.

Adolescent

A comparison of symbol transparency in nonspeaking persons with intellectual disabilities.

This investigation compared the transparency of 11 different types of symbols representing objects with 40 nonspeaking subjects who experienced various degrees of intellectual disability. The subjects included a number of individuals with physical impairments or autism in addition to mild, moderate, or severe mental retardation. The symbol sets included: nonidentical objects, miniature objects, identical colored photographs, nonidentical colored photographs, black-and-white photographs, Picture Communication Symbols (PCS), Picsyms, Rebus, Self-Talk, Blissymbols, and written words. Statistical analyses indicated that real objects were more readily recognized than were any of the symbol sets and that Blissymbols and written words were more difficult than were any of the other sets. In addition, the results suggest the existence of a hierarchy of difficulty at the object (noun) level for the symbol sets assessed. The results are discussed in terms of their implications for selecting an initial symbol set for nonspeaking individuals. In addition, some suggestions for using the assessment protocols in clinical practice are presented, along with future research implications.

Adolescent

Persons with intellectual disability receiving psychiatric treatment.

Determinants of (1) referral to psychiatric services and (2) the amount of mental health care consumed were analysed in a population of individuals with intellectual disability, using data from a cumulative mental health case register in a defined geographical area. Associations between level of disability, gender, age and social environment on the one hand, and psychiatric referral and service consumption on the other were expressed as odds ratios (ORs). Being older (OR = 1.9; 95% CI = 1.5-2.5), having milder intellectual disability (OR = 1.4; 95% CI = 0.9-2.3) and living alone (OR = 5.8; 95% CI = 2.8-11.9) predicted a higher probability of receiving psychiatric treatment. Living alone (OR = 15.3; 95% CI = 1.7-136.1) was also associated with higher level of mental health service consumption.

Adolescent

The prevalence of Helicobacter pylori infection among inhabitants and healthy employees of institutes for the intellectually disabled.

OBJECTIVES: The prevalence of Helicobacter pylori infection varies in the Netherlands from 5% in children to about 50% in the elderly. In the institutionalized intellectually disabled, a high prevalence of infection has been reported. It is unknown whether there are specific risk factors to obtain H. pylori infection in this population, and whether employees of such institutes are at risk for H. pylori infection. METHODS: Therefore, we analyzed the seroprevalence of H. pylori antibodies by ELISA among 338 intellectually disabled inhabitants and 254 employees of two institutes. H. pylori-positive patients were compared with H. pylori-negative controls. The intellectually disabled and the employees were evaluated for possible risk factors. RESULTS: Of the 338 intellectually disabled, 280 (82.8%, median age 51 yr) were infected with H. pylori. This rate is significantly higher than the prevalence of H. pylori in the Dutch population. The presence of H. pylori was significantly associated with male gender, longer duration of institutionalization, an IQ < 50, rumination, and a history of upper abdominal symptoms. Of the 254 employees, 69 (27.2%) were infected, which is equal to the rate for the total Dutch population. The presence of H. pylori infection among employees was, however, significantly associated with a higher level of physical contact with the intellectually disabled, longer duration of employment, and having upper abdominal symptoms. CONCLUSIONS: Intellectually disabled persons are at high risk of developing H. pylori infection. Employees with close physical contact to the intellectually disabled population for a considerable period of time are also at increased risk. H. pylori infection should be considered a job attributable risk in this profession.

Adolescent

Dental erosions and gastro-oesophageal reflux disease in institutionalized intellectually disabled individuals.

OBJECTIVE: Both exogenous acids, from the diet, and endogenous acids, from stomach juice, can dissolve the enamel mineral, resulting in dental erosions. Gastric acid may reach the mouth by gastro-oesophageal reflux disease (GERD), recurrent vomiting, rumination and regurgitation. These conditions are frequently found in the intellectually disabled population. Therefore, we investigated the presence of dental erosions in combination with GERD among intellectually disabled inhabitants, with an IQ < 50, taken from three Dutch institutes. MATERIALS AND METHODS: At random 63 individuals underwent an oesophageal pH test and dental screening and possible predisposing and attributable factors were determined. An abnormal pH level was defined as a pH < 4, > 4.5% of the measured time. Subjects with dental erosions were compared to those without dental erosions. RESULTS: In 29 out of 63 (46.0%) cases evidence of dental erosions was found. In 19 of these 29 subjects with erosions (65.5%) GERD was diagnosed, compared to nine (26.5%) out of 34 subjects without erosions (P = 0.04). In the subjects with erosions mean duration of pH < 4 was 15.6% (range: 0.5-90.5) compared to 6.3% (range 0-40.4) in subjects without erosions (P = 0.02). An IQ < 35 was found to be predisposing (P < 0.001). CONCLUSION: In this population of 63 institutionalised intellectually disabled persons dental erosions were diagnosed in 46%. Sixty-five per cent of them had GERD. Individuals with longer duration of pH < 4 than 6.3% of the measured time and with an IQ < 35 were at higher risk to develop dental erosions. This study shows that dental erosions in the intellectually disabled population might be an oral manifestation of GERD.

Adolescent

Employment, retirement and elderly persons with an intellectual disability.

A national Australian study of people with an intellectual disability of 55 years of age and over investigated their employment and retirement patterns, attitudes to work and retirement, and the degree to which they were involved in leisure or recreational programmes. Two cohorts were recruited: one included all known members of the target group who agreed to participate in the study in the states of Queensland and Western Australia; and the second was a proportional, random sample drawn from a national database on a state population basis. A large number of the participants had never been involved in full- or part-time employment, either in a competitive or supported environment, or in workshops. The majority of those who had worked expressed strong positive attitudes toward employment and concern about retirement, suggesting the need for pre-retirement programmes including transition and choice-making skills to prepare participants for the future.

Aged

Functional assessment, curricular revision, and severe behavior problems.

An adolescent female with multiple handicaps and a long history of severely disruptive behavior participated in a functional assessment linked directly to specific revisions in her school curriculum. During Phase 1, reversal designs were used to test hypotheses pertaining to antecedent and curricular influences on problem behavior. During Phase 2, a multiple baseline across afternoon and morning time periods demonstrated that the curricular revisions were effective in eliminating severely disruptive behavior and increasing on-task responding. Data also showed that inappropriate "psychotic" speech was reduced and appropriate social interactions were increased. Follow-up results showed that the changes were maintained throughout the school year. Questionnaire data provided social validation of the procedures and outcomes. The findings are discussed in relation to their implications for functional assessment, individualized curricula, and positive programming for students with disabilities and serious behavior problems.

Achievement

Hypothesis-based interventions for tantrum behaviors of persons with developmental disabilities in school settings.

We conducted a functional assessment of problem behaviors of 2 students with developmental disabilities in their classroom environments. Results of the assessments showed that although there were more tantrums in demand than in no-demand conditions, the function of the behavior was to gain attention (positive reinforcement) rather than to avoid or escape demands (negative reinforcement); demand conditions apparently served a discriminative function for the availability of attention. Therefore, intervention was based on the positive reinforcement hypothesis, resulting in a substantial reduction of tantrums for both subjects.

Attention

[Mentally handicapped: developing a personality of their own. Tasks in the planning of housing facilities].

The bases for material existence of mentally handicapped people is actually guaranteed in European countries, but the possibility for them to choose their own way of life is still strictly limited. The "principle of normalization" which is put forward here as a planning principle has nothing to do wih the normality of people but tends to normalize their living conditions. A mentally handicapped person should be allowed to live like any other citizen of his country as fat as he is capable to. Departing from the course of life which is usual in a certain country we have to plan an amount of institutions and services of assistance in order to diminish gradually the segregation of the mentally handicapped. Subsequently a concept for organizing the network of institutions and services needed is proposed, and a short outline of the actual situation of mentally handicapped people in the Kanton of zürich (Switzerland) is given. Hence the author presents 2 examples of environmental conditions which can be planned and built: - Dwelling establishements for mentally handicapped adults - The school for mentally handicapped children at Humlikon (Switzerland).

Adult

Adjustment of siblings of handicapped children: a comparison.

Compared 55 older siblings (ages 7 1/2 to 15 years) of young handicapped children (ages 1-7 years) with 55 matched siblings of nonhandicapped children. Results of standardized children's assessment scales show that siblings of handicapped children are comparable to siblings of nonhandicapped children in self-concept, behavior problems, and social competence. Differences, however, appear along certain psychological dimensions and great variations exist within each group of siblings. Further, demographic and personal attributes are differentially related to measures of adjustment in different groups of siblings. Implications for research and intervention are drawn.

Adaptation, Psychological

Structure of adaptive behavior in samples with and without mental retardation.

The structure of adaptive behavior as a function of age and status of handicap was investigated in two samples with mental retardation and five samples without retardation. Exploratory factor analysis of the subscale scores from a comprehensive, nationally standardized measure of adaptive behavior (Scales of Independent Behavior) revealed a large Adaptive or Personal Independence dimension. Although not consistently identified in all samples, secondary Academic, Personal Responsibility, and Community/Vocational dimensions were also identified. Possible differences were identified in the structure of adaptive behavior as a function of age.

Activities of Daily Living