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Tower of Hanoi and working memory in adult persons with intellectual disability.

Persons with intellectual disability (ID) have been found to perform more poorly than their mental age would suggest in the visuo-spatial problem solving task Tower of Hanoi (TOH). Inefficient performance has been assumed to be related to inability to use sophisticated problem solving strategies because of restricted working memory capacity. In the present study, the TOH performance of adult persons with ID was found to be equal to that of fluid-intelligence-matched general children. However, persons with ID violated the rules of the TOH more often, and needed more trials to solve the TOH problems than the children did. Visuo-spatial and executive working memory tasks were significantly connected to the TOH performance of persons with ID, whereas phonological working memory tasks were not. Poor inhibition ability was related to the poor performance of subjects with ID in the TOH. We suggest that for persons with ID, TOH performance is determined by individual differences in fluid intelligence, controlled attention, and inhibition ability.

Adult↗
PubMed2002

Burnout among people working with intellectually disabled persons: a theory update and an example.

The paper offers an overview of the burnout literature connected to work stress and is specially aimed at professionals with responsibilities for persons with intellectual disabilities. In the paper different important key concepts in the burnout literature are both discussed in general terms, and also connected to the different instruments used to assess burnout. The effect of stress and burnout intervention procedures is also discussed thoroughly. At the end of the paper there is an example of an intervention study among staff working with persons with intellectual disabilities. The paper concludes that future progress is to be dependent onempirical tests of theory-based models using research designs that permit causal inferences. In addition there is a growing need for longitudinal designs reporting effects of different intervention approaches, especially among the staff working with persons with intellectual disabilities.

Burnout, Professional↗
PubMed2005

Vitamin B12 deficiency in persons with intellectual disability in a vegetarian residential care community.

The goal of this study was to determine the prevalence of vitamin B12 deficiency among intellectually disabled persons in a vegetarian remedial community in Israel. In this community, 47 individuals with intellectual disability (ID) live in 7 enlarged families in a kibbutz style agricultural setting. These 47 individuals and 17 of their caregivers were screened for vitamin B12 deficiency. There were 25.5% of the disabled vs. 11.8% of the caregivers found to have levels of vitamin B12 lower than 157 pg/ml. It is concluded that persons with ID in this vegetarian residential care community seemed to be at a higher risk for vitamin B12 deficiency.

Adult↗
PubMed2006

The general picture of supportive health environments for persons with intellectual disabilities among 121 disability welfare institutions in Taiwan.

BACKGROUND: Little information is available on the provision of supportive health environments for persons with intellectual disabilities (ID) in institutions. The aim of this study was to present an overview of supportive environments for health in institutions in Taiwan. METHODS: A cross-sectional survey was conducted to examine the perceptions of 121 Taiwanese Institutional Directors on their setting's implementation of supportive healthy physical, social, and economic environments. RESULTS: Analyses showed that first-aid kits (97.5%) and medicine cabinets (85.5%) were the most common health facilities in institutions. Seventy-three per cent of institutions had set up specific areas to be used for rehabilitation practice, while only 43.1% thought their rehabilitation equipment/devices adequate for their real needs. Eighty-eight per cent of institutions implemented health promotion plans for people with ID, while 76.6% had appropriated specific health promotion plans. Sixty-three institutions (52.1%) reported employment of skilled nurses to serve people with ID, and these institutions showed statistically significant differences in implementation of each health facility. CONCLUSIONS: The present paper is the first to analyze supportive environments for health in disability institutions in Taiwan. An important focus of future research will be the extension of the present findings to consider the appropriateness of each area of supportive environments for improving the quality of institutional care for people with ID.

Attitude of Health Personnel↗
PubMed2006

Mania and intellectual disability: the course of manic symptoms in persons with intellectual disability.

Our aim was to extend the literature by examining the presence of manic symptoms in persons with intellectual deficits with and without bipolar disorder for 3 years. Three groups (bipolar, psychopathology other than bipolar disorder, and no Axis I diagnosis) were formed with 14 participants in each group. Initially, the presence of mania symptoms were examined across diagnostic groups. The bipolar group had significantly greater endorsements on the Parent Version of the Young Mania Rating Scale and the DASH-II Mania subscale item "decreased need for sleep" than did the other groups. A 3 (group) x 3 (year) ANOVA revealed that the item endorsements differed significantly over time for the bipolar group but not the other groups. Implications of these findings are discussed.

Adult↗
PubMed2006

College students' perceptions of persons with intellectual disability at three different ages.

Studies of the perception of persons with intellectual disabilities have primarily focused on the evaluator's peers without specific reference to age or gender of the target person with intellectual disability. Using the semantic differential technique (assessments based on three independent factors: evaluation, activity and potency), 320 college students evaluated 1 person with intellectual disability, where gender (male, female) and age (3, 12, 20 years) were specified. Results indicated statistically different perceptions in the activity factor by age. The older the person with intellectually disability was, the more negative the perceptions on the activity factor. Implications of the results are discussed.

Adolescent↗
PubMed2001

Helicobacter pylori infection in persons with intellectual disability in residential care in Israel.

Helicobacter pylori (formerly Campylobacter pylori ) was identified in 1982 by researchers from Australia as a pathogenic factor in peptic ulcer disease. Due to the few studies on H. pylori infection conducted in the population of persons with intellectual disability it was decided to conduct a clinical study in Israel. The purpose of the study was to determine the occurrence of H. pylori infection in persons who presented with severe dyspeptic symptoms and to monitor clinically the effect of treatment. The Division for Mental Retardation in Israel provides service to 6,022 persons in 53 residential care centers and 1 in central Israel was selected for this pilot study. The study has been performed since 1999 and each patient who came to the medical clinic of the institution with severe dyspeptic symptoms was examined clinically and a blood specimen drawn for IgG antibodies to H. pylori (ELISA, Pharmatop Millenia). In case of positive serology, triple drug treatment (amoxycillin, metronidazole, and pantoprazole or omeprazole) was initiated for 1 week. Since 1999 a total of 43 persons (total population in care was 224) had severe dyspeptic symptoms and 42 persons (98%, 26 males, 16 females, mean age 45 years, mean institutionalization 20 years) had Helicobacter infection. All patients were treated for 1 week, but six patients received an extra month of omeprazole due to persistent symptoms. At follow-up, clinically all patients had improvement and only seven still had minor complaints (83% treatment success). Persons with developmental disability, intellectual disability, or mental retardation in residential care presenting with severe dyspeptic symptoms had a high incidence of H. pylori infection. Therefore, we recommend serology or urea breath investigations in this population presenting with dyspeptic symptoms and triple drug treatment for 1 week in case of positive findings.

Adult↗
PubMed2006

Auditory status of persons with intellectual disability at the German Special Olympic Games.

Among persons with intellectual disability, the prevalence of hearing impairments is high. During the German Special Olympics Summer Games 2004, a hearing screening was conducted on 755 athletes with intellectual disabilities. Obligatory screening included ear inspection and recording of otoacoustic emissions, and optional screening included tympanometry and brief pure-tone audiometry. 38.0% of the athletes failed the screening. 53.0% needed ear wax removal. 56.1% of the fails indicated sensorineural hearing loss and 13.6% indicated mixed hearing loss. 12.5% of the fails were caused by unremovable ear wax, 1.4% by ear canal affections, and 16.4% by middle ear problems. Left ear fails were more frequent than right ear fails. A peripheral hearing disturbance can thus be expected in every third subject. The high failure rate, a considerable percentage of previously undetected profound hearing loss (1.1%), and the frequent need for ear wax removal, suggest that nearly half of persons with intellectual disabilities need regular otological or audiological consultations.

Acoustic Impedance Tests↗
PubMed2005

Fair shares? Supporting families caring for adult persons with intellectual disabilities.

BACKGROUND: Although the majority of adult persons with intellectual disabilities are cared for by their families, remarkably little is known of the characteristics of their carers, the support services they receive and their unmet needs. A particular concern is whether or not carers have equitable access to services. METHOD: Information was gathered from service staff who knew best the person with the disability. A standard pro forma was used with a representative sample of over 1500 family carers in Northern Ireland (26% of the estimated population). RESULTS: Nearly half of the people were being cared for by both parents, but around one third lived with lone carers and 20% with another relative. These subgroups of carers varied significantly in their personal characteristics and in terms of the person for whom they cared. However, Regression Analyses identified that their relative's higher dependency in person care was the only common variable that was predictive of carers' access to support services. A possible measure of unmet need for various support services was derived. CONCLUSIONS: Services need to pay greater attention to the characteristics of family carers so as to overcome some of the present inequities in supports offered to them. Further areas for future research are identified.

Adult↗
PubMed2004

Formal versus informal interventions for challenging behaviour in persons with intellectual disabilities.

BACKGROUND: Although effective, humane treatments exist for persons with intellectual disabilities (ID) who have challenging behaviour, little research has examined the extent to which clients receive formal, documented vs. undocumented interventions. METHODS: Caregivers (of 625 persons with ID living in community and institutional residences in Ontario, Canada) were interviewed to examine the prevalence of different types of interventions. RESULTS: Overall, 55% of the 2506 different interventions (for 1464 target behaviours) were informal (i.e. lacking documented input from a professional, written intervention plans, and systematic evaluation). No significant differences emerged on formality of intervention across participant gender, age, level of ID, and type of residence. There were significantly more informal than formal behavioural interventions and counselling/psychotherapy, and no significant difference in the overall prevalence of formal and informal intrusive procedures. Behaviour control medications were paired more often with formal (67%) than informal interventions for dangerous behaviours. Formal interventions were associated with higher caregiver-reported estimates of behavioural improvement, higher inter-rater agreement on the descriptions of an individual client's target behaviours and interventions, and more caregiver training and supervision. CONCLUSIONS: The low levels of intervention accountability, training and supervision may place many clients with challenging behaviour at increased risk for ineffective and unnecessary restrictive interventions, and physical abuse. The results of this survey stimulated the government to write province-wide standards (that have yet to be implemented).

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↗
PubMed2005

Narrative ethics in nursing for persons with intellectual disabilities.

Both in The Netherlands and in Britain, practices of 'life story work' have emerged in nursing for persons with intellectual disabilities. The narrative approach to care and support may at the same time be considered as an attempt to compensate for the 'disabled authorship' of many persons with intellectual disabilities and as a sign of controversy with standard practices of diagnosis and treatment that tend to neglect the personal identities of both clients and care givers, their particular historical and relational contexts and their spiritual needs. This paper argues that narrative ethics not only offers an appropriate moral framework for practices of life story work, but that these practices are a narrative ethics in action. Starting with an account of the concept of 'life story work' as it has been introduced in nursing practices in the field of intellectual disability, the paper explains its relationship with key characteristics of narrative ethics. The teleological dimension in narrative ethics and in practices of life story work sparks off a dialectic process of understanding of the client and self-understanding of the care giver. It also invites a respect for life in its openness toward the future and presupposes an openness toward other possible versions of the life narrative. The phenomenological and hermeneutic-interpretative methodologies in narrative ethics aim at a 'sudden moment of intimacy' in relationships of nurses and clients. The 'epiphany' of this essential moment of recognition, insight and engagement cannot, however, be brought about by methodology.

Attitude of Health Personnel↗
PubMed2003

Attitudes of senior psychiatry residents toward persons with intellectual disabilities.

OBJECTIVES: This study examined the attitudes of senior residents in psychiatry toward persons with intellectual disabilities. Examining residents' attitudes will highlight areas of training that could be enhanced to better prepare psychiatrists to work with individuals with intellectual disabilities. METHOD: A questionnaire was distributed to senior psychiatry residents at a Canada-wide preparatory session for the Royal College of Physicians and Surgeons of Canada. Included in the questionnaire was the Community Living Attitudes Scale Mental Retardation--Short Form (CLAS) as well as demographic items (for example, age, sex, and marital status) and questions about training in intellectual disabilities. Scores on the 4 CLAS subscales (Empowerment, Similarity, Exclusion, and Sheltering) are reported, and analyses of variance were performed to identify factors associated with each subscale score. The residents' scores are compared with those obtained in surveys of other groups. RESULTS: Fifty-eight senior residents from across Canada completed the questionnaire. The residents' scores favored Empowerment and Similarity over Exclusion and Sheltering. Men and women responded differently. Training in intellectual disabilities during residency only appeared to influence the Similarity subscale scores. CONCLUSION: Senior psychiatry residents hold attitudes toward persons with intellectual disabilities that are not entirely consistent with the community living philosophic paradigm. More research is needed to uncover how attitudes of psychiatrists develop, as well as how training can influence attitudes.

Adolescent↗
PubMed2004

Leisure activities, friendships, and quality of life of persons with intellectual disability: foster homes vs community residential settings.

Living in the community does not, in itself, guarantee social integration and inclusion for persons with intellectual disability. Friendships and leisure participation can indicate the beginning of such a process and their impact on quality of life. The present study investigated the quality of life, friendships and leisure activities of persons with intellectual disability who live in community settings or in foster families. Three hypotheses were examined: 1. Persons with intellectual disability who live in foster families have more friends than do those who live in community residential settings. 2. Persons with intellectual disability who live in community residential settings participate in more leisure activities than those who live in foster families. 3. The more friendships and leisure activities in which one is involved, the higher the quality of one's life. The sample consisted of 85 adults with intellectual disability, ranging in age from 18 to 55 years. Forty-five live in community residential settings and 40 live in foster families in Israel. Five questionnaires were used: 1) a demographic questionnaire; 2) Quality of Life Questionnaire, 1990); 3) the Revised UCLA Loneliness Scale; 4) Social Relationships List; and 5) Leisure Activities List. The main findings show no significant differences between the two groups in the number of friendships or feelings of loneliness. Foster residents were more involved and more independent in their leisure activities than were those who live in community residences. An association between friendships, leisure activities and quality of life was partly confirmed. The need for intervention programs and leisure education programs is discussed.

Adolescent↗
PubMed2004

Violence in the care of adult persons with intellectual disabilities.

BACKGROUND: Violence, for example physical, psychological, financial and sexual abuse and neglect, exists and is an under-reported problem in caring situations involving adult persons with intellectual disabilities and their caregivers, where both parties can be seen as victims and perpetrators. AIMS AND OBJECTIVES: To investigate violent situations involving Swedish adult persons with intellectual disabilities and their caregivers in group-dwellings. DESIGN: A total population-based survey. METHODS: A questionnaire, including violence towards adults with intellectual disabilities and violence towards staff members during 1 year, was sent to all staff members (n = 164) from 17 care settings for adults with intellectual disabilities with a response rate of 74%. RESULTS: Thirty-five per cent of 122 respondents admitted they had been implicated in or witnessed a violent incident towards an adult person with intellectual disabilities and 14% of the staff members admitted they themselves had been the perpetrators. Sixty-one per cent of the staff members described various situations when they were exposed to violence from an adult person with intellectual disabilities. Physical violence was most frequently reported. Most of the aggression occurred in helping situations when persons with intellectual disabilities did not co-operate or when both actors reacted with violence. The violent situations led the staff members to feel powerless and inadequate. In order to cope they discussed with each other or with the manager. CONCLUSIONS: Violence seems to be accepted as a natural part of the daily care for adult persons with intellectual disabilities. Most of the violence is physical and psychological and occurs in close helping situations. RELEVANCE TO CLINICAL PRACTICE: Supportive interventions, i.e. supervision for the staff members and training of communication skills individually or in group for the adults with intellectual disabilities.

Adaptation, Psychological↗
PubMed2004

[Japanese physicians'attitude for utilization of social support services for persons with intellectual disabilities].

We assessed physicians'attitude for the utilization of social (medical, educational, and financial) support services for persons with intellectual disabilities supplied by the Japanese government. A total of 113 physicians specializing in pediatric neurology answered our mail-in questionnaire. Medical care benefits for psychiatric outpatients and short-time stay were the most common services utilized. Whereas most physicians used various public support services regardless of their experience and affiliations, the selection of services by an individual physician correlated with the number and state of patients they usually cared. Physicians were less familiar with the services regarding residential or community care and advocacy. Knowledge of the specialists on each service will enrich assistance appropriate to the life styles of each patient with intellectual disabilities.

Child↗
PubMed2002

Conceptualization, measurement, and application of quality of life for persons with intellectual disabilities: report of an international panel of experts.

In this article a number of issues involving the concept of quality of life as applied to persons with intellectual disabilities are summarized, and a number of agreed-upon principles regarding its conceptualization, measurement, and application are presented. We realize that the concepts and models presented in this article will vary potentially from country to country, and even from area to area within countries. The cross-cultural understanding of the concept of quality of life is in its infancy, and we hope that the discourses resulting from the material presented in this article will facilitate both cross-cultural understanding and collaborative work. The article reflects current thought about the conceptualization, measurement, and application of this increasingly important and widely used concept in the field of intellectual disabilities and sets the stage for its continuing development.

Cross-Cultural Comparison↗