Office management of adolescent problems by the nonpsychiatrist physician.
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Adjustment Disorders↗
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Parental monitoring: a reinterpretation.
Monitoring (tracking and surveillance) of children's behavior is considered an essential parenting skill. Numerous studies show that well-monitored youths are less involved in delinquency and other normbreaking behaviors, and scholars conclude that parents should track their children more carefully. This study questions that conclusion. We point out that monitoring measures typically assess parents' knowledge but not its source, and parents could get knowledge from their children's free disclosure of information as well as their own active surveillance efforts. In our study of 703 14-year-olds in central Sweden and their parents, parental knowledge came mainly from child disclosure, and child disclosure was the source of knowledge that was most closely linked to broad and narrow measures of delinquency (normbreaking and police contact). These results held for both children's and parents' reports, for both sexes, and were independent of whether the children were exhibiting problem behavior or not. We conclude that tracking and surveillance is not the best prescription for parental behavior and that a new prescription must rest on an understanding of the factors that determine child disclosure.
Adolescent↗
Preschool understanding of emotions: contributions to classroom anger and aggression.
BACKGROUND: We sought to identify patterns of social cognitive differences among preschoolers that were related to risk of stable aggressive behavior with peers. Following Lemerise and Arsenio (2000), we considered the emotional components of early social cognition, reasoning that young children's substrate of emotion knowledge serves them in decoding social encounters. METHOD: One hundred and twenty-seven children from a longitudinal study from age 3 to 4 though to their kindergarten year were interviewed on their emotional knowledge initially using a puppet procedure and later with stories about mixed emotions and display rule. Each year their anger and antisocial responses to others' emotions were observed. Teachers also provided information on each child's anger and aggression. RESULTS: Children's deficits in emotion knowledge assessed at age 3 and 4 predicted subsequent years' aggression. This effect was especially pronounced for boys. CONCLUSIONS: The pattern of findings suggests that the processes implicated in Dodge's work with older children may begin earlier than previously thought, with a focus on emotions.
Aggression↗
Alcohol abuse and alcoholism in the young.
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Adolescent↗
Drinking behavior in childhood and adolescence: an evaluative review.
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Adolescent↗
Drinking and problems from drinking after a reduction in the minimum drinking age.
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Adolescent↗
Who pays for the drinking? Characteristics of the extent and distribution of social harms from others' drinking.
AIMS: To explore the extent and distribution of experienced negative consequences from other people's drinking and to explore what characterizes the victims of these harms. DESIGN, PARTICIPANTS AND MEASUREMENTS: Cross-sectional survey in a national sample of adults. Net sample comprised 2170 respondents. Negative consequences from others' drinking during the past 12 months were assessed by seven items. RESULTS: The more severe types of consequences (being physically hurt or property damage) were reported less often (by 3.1% and 4.8%, respectively) than the least severe type of consequence (being kept awake at night by drunk people, reported by 21.2%), thus leaving the four other types of consequences (being harassed in public places, being harassed in private parties, being scolded at and being afraid of drunk people in public areas) somewhere in between. The extent to which the respondents had been subject to social harm from others' drinking displayed a very skewed distribution. The majority reported not to have experienced any such harms, whereas a small proportion had been harmed repeatedly and in various ways. Multivariate analyses showed that social harms from others' drinking were most often reported by younger persons, women, those with high education level, those who reported a higher annual alcohol intake, more frequent episodes of intoxication and more frequent visits to public drinking places. The impact of intoxication frequency on victimization from alcohol-related social harms was stronger for women than for men. Similar individual characteristics were also associated with victimization from physical harm and victimization in the public sphere. CONCLUSIONS: Relatively minor harms from others' drinking are experienced quite frequently. The social victims of others' drinking tend to drink heavily themselves, yet in contrast to what characterizes social consequences of own drinking, we find that the burden of social harms from others' drinking is to a larger extent carried by women than by men.
Adolescent↗
Evaluation of a special behaviour unit for people with mental handicaps and challenging behaviour.
A descriptive evaluation is provided of a hospital-based unit for people with mental handicaps and challenging behaviours. The characteristics of clients admitted to the unit over a 15-month period are described, together with admission and discharge patterns, and treatment interventions undertaken. The progress of four clients is studied in detail via single-case studies. While reductions in levels of challenging behaviour occurred during admission, these changes were not generally maintained at follow-up. Implications for future service design are discussed.
Adult↗
Rating management difficulty: a study into the prevalence and severity of difficult behaviour displayed by residents in a large residential hospital for the mentally handicapped.
This survey assessed the prevalence and severity of difficult behaviour displayed by residents in a residential hospital for the mentally handicapped as reported by the direct-care staff. Of the hospital residents, 30.2% were reported as having at least one problematic behaviour. The men were generally more difficult than the women and those on the disturbed wards more difficult than those on residential wards. Men and women exhibited the same types of behaviours in both disturbed and residential wards. However, withdrawn/uncooperative behaviour, stealing and inappropriate sexual behaviour were more prevalent on disturbed wards; withdrawn and inappropriate sexual behaviour being exhibited by more men than women on disturbed wards. The factors most likely associated with being on a disturbed ward were sex and age; young men presenting with most management difficulty. Approximately 12% of the hospital population were defined as presenting with a 'severe' management difficulty. Difficult behaviour is the main reason for admission to and remaining in hospital. The concept of management difficulty and the implications on service provision are discussed.
Adolescent↗
An evaluation of hospital-based specialized staffed housing for people with seriously challenging behaviours.
Resident and staff activity was observed in two hospital-based staffed houses for adults with severe or profound mental handicap, and seriously challenging behaviours. The results indicated that: (1) staffing resources were inefficiently deployed, leading to low levels of support being provided to service users; (2) staff attention was inequitably distributed across users, individuals showing the highest levels of seriously challenging behaviours received disproportionately more staff attention; (3) users spent little of the time they were observed engaged in constructive activities. Comparisons with data collected previously on four of the users in institutional settings indicated that: (4) no overall changes occurred in either user participation in constructive activities or (5) duration of challenging behaviours; and (6) overall, more staff contact was provided in the specialized housing projects compared to previous institutional settings. The results are discussed in terms of the determinants of quality in residential provision for people with seriously challenging behaviour.
Activities of Daily Living↗
Development, behaviour and seizures in 300 cases of tuberous sclerosis.
Three hundred cases of tuberous sclerosis were surveyed by postal questionnaire, including 240 cases with learning difficulties. People who have tuberous sclerosis and severe learning disabilities also have a higher frequency of epileptic seizures than people with learning difficulties from all causes. Pervasive developmental disorder and hyperactive behaviour are behavioural features of the disorder. Sleep problems and the level of vigilant care required because of seizures or behaviour have implications on the level of service needed to support people with tuberous sclerosis in the community.
Adolescent↗
Asperger's syndrome: three cases and a discussion.
The recently revived academic interest in and controversy over the subject of Asperger's syndrome is briefly discussed. Gillberg & Gillberg's operational criteria for its definition are used to isolate three cases of the syndrome presenting over a single year to a mental handicap service. The cases are described in detail. Common themes and associations with the available literature are discussed. In all three cases, the struggle for clarity in the syndrome's nature or specificity in the literature is also reflected in aspects of their clinical management.
Adult↗
The use of anti-psychotic drugs with adults with learning disabilities and challenging behaviour.
The use of anti-psychotic medication with an adult population of people with learning disabilities and challenging behaviours was investigated as part of an epidemiological study covering seven district health authorities and corresponding local authorities in North West England. The study found a high rate of prescription of anti-psychotic drugs (48.1%). Chlorpromazine was the most frequently prescribed drug, followed by Thioridazine and Haloperidol. Three variables, psychiatric diagnosis, where the person was resident (hospital disturbed ward, hospital non-disturbed ward, hostel or family home) and district of origin were found to be significant determinants of prescriptions when all other variables were controlled. Of the variables reflecting individual characteristics those significantly related to prescription suggested that the socially disruptive effects of challenging behaviour were determining prescription. The results are discussed in the context of differing prescription practices across residence and district in the context of the management of socially disruptive behaviour.
Activities of Daily Living↗
Beliefs and emotional reactions of care staff working with people with challenging behaviour.
Information collected in the context of a survey of all people with learning disabilities and challenging behaviour in a single metropolitan borough indicated: (1) care staff report that a significant proportion of their colleagues usually display such emotional reactions as sadness, despair, anger, annoyance, fear and disgust to episodes of challenging behaviour; (2) respondents reported that the most significant sources of stress associated with caring for someone with challenging behaviour centred upon the 'daily grind' of caring, their difficulty in understanding the person's behaviour, the unpredictability of the behaviour and the apparent absence of an effective way forward; (3) care staff attribute the causes of the person's challenging behaviour to a diversity of internal psychological, broad environmental, behavioural and medical factors. These results are discussed in relation to their implications for staff-seeking and implementing external advice regarding the management of challenging behaviour.
Activities of Daily Living↗
The form and function of challenging behaviours.
Aspects of the topography and behavioural function underlying the challenging behaviours of all people with learning disabilities and challenging behaviour (n = 70) in a defined geographical area were investigated. Results indicated that: (1) more severe challenging behaviours were shown by people with more severe disabilities; (2) a significant minority (44%) of people showed more than one form of challenging behaviour, this rising to 79% among people with more severe challenging behaviours; and (3) cross-sectional analyses revealed specific clusters of problematic, aggressive and self-injurious behaviours. Analysis of information derived from the Motivation Assessment Scale (MAS) indicated that (5) the most common functions of challenging behaviours appeared to be 'self-stimulation' (for self-injury, destructiveness and 'other' challenging behaviours) and securing the attention of carers (for aggressive behaviours). However, (6) parametric analyses failed to identify any consistent relationships between the form and function of an individual's challenging behaviour for aggressive, destructiveness and 'other' challenging behaviours, but (7) clients with self-injurious behaviour were significantly more likely to score highly on the 'self-stimulation' sub-scale than other sub-scales of the MAS. Finally, (8) significant consistency of behavioural functions across different forms of challenging behaviours shown by the same individual were found for the two combinations of aggressive-destructive behaviours and self-injury-'other' behaviours.
Activities of Daily Living↗
The prescribing of neuroleptic drugs for people with learning disabilities living in Leicestershire.
Neuroleptics are prescribed for 23% of individuals with learning disabilities resident in Leicestershire, England. The rate of neuroleptic prescription is significantly higher in individuals resident in N.H.S. facilities (44%) than in non-N.H.S. managed community facilities (13%). Significantly higher doses of neuroleptics are prescribed to individuals resident in N.H.S. facilities. However, ratings for the level of behavioural disturbance were significantly higher in N.H.S. facilities. The decision to prescribe neuroleptics was associated with disturbed behaviour, and higher doses of neuroleptic medication prescribed were associated with more disturbed behaviour.
Antipsychotic Agents↗
The use of a low phenylalanine diet in response to the challenging behaviour of a man with untreated phenylketonuria and profound learning disabilities.
If phenylketonuria (PKU) is not treated from an early age with a reduced phenylalanine diet, irreversible brain damage may occur. Although dietary intervention can do nothing to alter this impairment once it occurs, there is some evidence to suggest that a low phenylalanine diet may help to reduce the level of behavioural disturbances frequently experienced by people with untreated PKU. Using this evidence, dietary intervention was used in response to the challenging behaviour of a 30-year-old man with profound learning disabilities. Initial improvements were observed, but overall the results were inconclusive. Possible confounding factors are discussed. An unusual reaction to neuroleptic medication whilst on the diet is also documented.
Adult↗
Community and cluster centre residential services for adults with intellectual disability: long-term results from an Australian-matched sample.
BACKGROUND: Changes in residential accommodation models for adults with intellectual disability (ID) over the last 20 years in Australia, the United Kingdom and the United States have involved relocation from institutions primarily into dispersed homes in the community. But an evolving alternative service style is the cluster centre. METHODS: This paper reports on the relocation of a matched group of 30 pairs of adults with moderate and severe IDs and challenging behaviour who were relocated from an institution into either dispersed housing in the community or cluster centres but under the same residential service philosophy. Adaptive and maladaptive behaviour, choice-making and objective life quality were assessed prior to leaving the institution and then after 12 and 24 months of living in the new residential model. RESULTS: Adaptive behaviour, choice-making and life quality increased for both groups and there was no change in level of maladaptive behaviour compared with levels exhibited in the institution. However, there were some significant differences between the community and cluster centre group as the community group increased some adaptive skills, choice-making and objective life quality to a greater extent than the cluster centre group. CONCLUSIONS: Both cluster centre and dispersed community living offer lifestyle and skill development advantages compared with opportunities available in large residential institutions. Dispersed community houses, however, offer increased opportunities for choice-making, acquisition of adaptive behaviours and improved life quality for long-term institutionalized adults with IDs.
Activities of Daily Living↗