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PubMedDate not supplied

Use of colchicine to treat severe constipation in developmentally disabled patients.

BACKGROUND: Patients with severe developmental disabilities often have concurrent decreased neuromuscular tone of the gastrointestinal tract, which can lead to a weak gag reflex, esophageal reflux, aspiration, and severe intractable constipation. High doses of multiple laxatives are frequently needed to maintain bowel motility in these patients. Colchicine, a natural alkaloid that is primarily used for the treatment of acute attacks of gout, causes an increase in gastrointestinal motility by neurogenic stimulation. The purpose of this study was to determine whether daily colchicine administration can improve bowel function and reduce laxative use in profoundly disabled patients with severe, intractable constipation who currently require large doses of multiple laxatives. METHODS: Twelve developmentally disabled patients who required three or more different laxatives to manage their chronic constipation were selected to participate in a double-blind, crossover study. Eleven patients who completed the study received placebo treatment for 8 weeks and colchicine treatment for 8 weeks. The total number of bowel movements and the total number of laxatives used during each of the two 8-week periods were compared. RESULTS: Eight of 11 patients experienced an improved bowel pattern while on colchicine compared with placebo, as defined by an increase in total number of bowel movements or a decrease in total number of rectal laxatives used. No clinically important complications were related to use of colchicine. CONCLUSIONS: Colchicine appears to be a valuable adjunct in the management of severe intractable constipation. Larger, long-term studies are needed to confirm these preliminary results.

Adult↗
PubMed1994

Contribution of developmental disabilities to childhood mortality in the United States: a multiple-cause-of-death analysis.

Although developmental disabilities are among the major chronic health problems affecting children in the United States, the contribution of developmental disabilities to childhood mortality is unknown. To investigate the magnitude of this contribution, multiple cause-of-death data were examined for US children, aged 1-19 years, for 1980 and 1983-1989. The following conditions were included as developmental disabilities: autism, attention deficit disorder, learning disorders, mental retardation, cerebral palsy, epilepsy, muscular dystrophy, blindness and deafness. Based on underlying cause only, it was found that developmental disabilities were the fifth leading cause of nontraumatic death for children between 1 and 14 years of age and the third leading cause of non-traumatic death for children between 15 and 19 years. When a multiple cause approach was used to define developmental disability-related deaths (i.e. when contributing as well as underlying cause was considered), the number of such deaths nearly doubled. On the basis of both underlying- and multiple-cause analyses, cerebral palsy was the developmental disability most frequently cited as a cause of death. Mental retardation ranked second according to the multiple-cause approach but only fourth according to the underlying-cause approach. The least frequent causes of death (autism, attention deficit disorder, learning disorders, blindness, and deafness) were the ones most likely to be coded as contributing rather than underlying causes. Developmental disability-related mortality rates were highest among children aged 1-4 and 15-19 years, highest among blacks and lowest among racial groups other than blacks and whites, and higher among males than females. Although results of multiple-cause-of-death analyses more accurately reflect the proportion of deaths related to developmental disabilities, even this approach may underestimate the degree to which mortality is associated with a developmental disability.

Adolescent↗
PubMed1999

Issues affecting the lives of older persons with developmental disabilities.

Efforts to bring the aging developmentally disabled and mentally handicapped population into the mainstream of professional training and services are encouraging. The impact of managed care on the provision and quality of services for aging developmentally disabled persons who cannot advocate for themselves must be closely researched and monitored so that public funds are used to promote comprehensive and continuous care for this vulnerable population.

Adult↗
PubMed1997

Overview and implications of Medicaid managed care for people with developmental disabilities.

The inclusion of people with developmental disabilities in managed care as part of general efforts by states to enroll and Medicaid recipients in such plans was reviewed. Managed care was defined and the processes by which managed care organizations deliver services were explained. Escalating costs and utilization were discussed as the primary reason for the shift to managed care. The use of Medicaid Section 1115 waivers by states to include Medicaid recipients was explored. The relation between acute health care and long-term care, and the utilization patterns in each, were briefly described. Finally, elements of managed care that are particularly important to people with developmental disabilities, such as care coordination, maintenance of quality, and individual and family support, were discussed.

Developmental Disabilities↗
PubMed2001

Quality of care and service as perceived by adults with developmental disabilities, their parents, and primary caregivers.

How adults with developmental disabilities perceive quality of the care and service they receive was investigated and these perceptions compared with those of their parents and primary caregivers. The sample was 34 adults with developmental disabilities, one of their parents, and their primary caregiver, all from a small Swedish municipality. We adapted Quality From the Patient's Perspective by using simple words and fewer response choices. Results showed it was possible to assess how adults with developmental disabilities evaluated actual care and service conditions. Evaluations of the subjective importance ascribed to these conditions proved too difficult. A high degree of similarity was found in ratings of perceived reality of care and service conditions by the adults with developmental disabilities, their parents, and caregivers.

Adult↗
PubMed2006

Sleep and developmental disabilities: assessment, treatment, and outcome measures.

People with developmental disabilities sleep less and experience higher incidence of clinical sleep disorders than the general population. Exploring the neurophysiology linking sleep with daytime performance in patients with developmental disabilities is now possible using minimally sufficient sleep and sleep-sensitive behavioral assays. Although frequent sampling represents the primary difficulty, it is required to untangle coincident effects of sleep quality amidst circadian variation. Recent evidence finds high quality sleep promotes brain plasticity, improves health measures, and enriches quality of life. Sleep treatments for apnea, insomnia, restless limbs, and conditioned sleep-aversion are available, although not readily provided, for people with developmental disabilities. This population would gain both clinical and behavioral benefits as improved sleep-monitoring, behavioral testing, and sleep-treatment technology is adapted to their needs.

Brain↗
PubMed1993

Choice and control. New opportunities for people with developmental disabilities.

Over the past few years, people with developmental disabilities have had an increasing number of opportunities to make choices and have control over their lives. There has also been a considerable amount of experimental research conducted on the effects of providing opportunities to make choices or to exercise control. The results of this research strongly suggest that providing opportunities for choice and control over events can affect the degree to which people participate in activities, the types of behaviors displayed during the participation, and people's perceptions about the situation. This article reviews this experimental research, discusses traditional views and current perspectives regarding choice and control for people with developmental disabilities, and presents ways of increasing the amount of choice and control available to people with developmental disabilities.

Child↗
PubMedDate not supplied

Adoption of children with developmental disabilities.

United Methodist Family Services of Virginia placed 41 developmentally disabled children in adoptive homes between August 1985 and June 1988, representing a range of chronic emotional, intellectual, and physical disabilities. This article describes the need for specialized adoption programs for children with developmental disabilities and the methods used in placing these children. The obstacles to adoption of children with developmental disabilities are also discussed.

Adoption↗
PubMed1996

Psychiatric disorders in children and adolescents with mental retardation and developmental disabilities.

Children and adolescents with mental retardation and developmental disabilities are thriving in their communities owing to special education programs that provide full inclusion in school and community life. Many youngsters, however, do not reach their full potential because of the limitations imposed by untreated psychiatric disorders. Although striking behavioral symptoms may be present, care providers often mistake them for typical aberrant behavior associated with developmental disabilities. When this occurs, these children do not receive proper psychiatric care and may suffer restrictive behavioral programming and exclusion from community living. On the other hand, children and adolescents with mental retardation and developmental disabilities frequently present with unusual symptoms associated with psychotic disorders, leading to misdiagnosis and inappropriate treatment with antipsychotic agents. The problems due to stress on these children and their families, long-terms costs in loss of educational and vocational opportunities, and the development of serious adult psychiatric disorders are enormous. By exploring the risk factors for psychiatric diagnosis in this population and presenting illustrative cases, awareness of the indicators for pediatric practice with this population is provided in this review.

Adolescent↗
PubMed1989

Disabled clients, constituencies, and counsel: representing persons with developmental disabilities.

Legal representation of people with developmental disabilities entails singular challenges. Within the past two decades, nevertheless, lawyers, clients, and constituency or self-advocacy organizations have worked to establish particular educational, residential, and activity services as legal rights. When violations of these rights occur, litigants may initiate either individual or multiparty actions capable of placing institutions or service delivery systems under mindful judicial scrutiny. Remaining barriers to instituting and sustaining effective attorney/client relationships need to be overcome, lest enforcement of constitutional and statutory rights be inhibited.

Adult↗
PubMed2004

Epidemiology of fractures in people with severe and profound developmental disabilities.

Fractures are more prevalent among people with severe and profound developmental disabilities than in the general population. In order to characterize the tendency of these people to fracture, and to identify features that may guide the development of preventive strategies, we analyzed fracture epidemiology in people with severe and profound developmental disabilities who lived in a stable environment. Data from a 23-year longitudinal cohort registry of 1434 people with severe and profound developmental disabilities were analyzed to determine the effects of age, gender, mobility, bone fractured, month of fracture, and fracture history upon fracture rates. Eighty-five percent of all fractures involved the extremities. The overall fracture rate increased as mobility increased. In contrast, femoral shaft fracture risk was substantially higher in the least mobile [relative risk (RR), 10.36; 95% confidence interval (CI), 3.29-32.66] compared with the most mobile group. Although the overall fracture rate was not associated with age, the femoral shaft fractures decreased but hand/foot fractures increased with age. Overall fracture risk declined in August and September (RR, 0.70; 95% CI, 0.55-0.89), being especially prominent for tibial/fibular fractures (RR, 0.31; 95% CI, 0.13-0.70). Gender was not a factor in fracture risk. Two primary fracture mechanisms are apparent: one, largely associated with lack of weight-bearing in people with the least mobility, is exemplified by femoral fractures during non-traumatic events as simple as diapering or transfers; the other, probably due to movement- or fall-related trauma, is exemplified by hand/foot fractures in people who ambulate. The fracture experience of people with severe and profound developmental disabilities is unique and, because it differs qualitatively from postmenopausal osteoporosis, may require population-specific methods for assessing risk, for improving bone integrity, and for reduction of falls and accidents.

Adolescent↗
PubMed2003

Medicaid managed care meets developmental disabilities: proceed with caution.

This article examines Medicaid managed care's potential impact on people with developmental disabilities. The authors discuss how the philosophy behind the skills/functional model of service provision for people with developmental disabilities is incongruent with the medical model of managed care. They discuss the policy issues that various states have had to face concerning Medicaid managed care's administration of health benefits for people with developmental disabilities. They extrapolate from the research on managed care to formulate potential models that states might use to administer the health benefits for people with developmental disabilities. Finally, the authors propose policy and research agendas to begin investigating Medicaid managed care's potential impact on people with developmental disabilities.

Child↗
PubMed1996

Issues Involved in Recognizing Obsessive-Compulsive Disorder in Developmentally Disable Clients.

Certain unusual behaviors in people with developmental disabilities might be unrecognized obsessive-compulsive disorder (OCD). Compulsions, in persons unable to think abstractly or count, can appear differently from compulsions in persons able to comprehend concepts like contamination and counting sequences. The content of obsessive speech also varies depending on the comprehension and vocabulary of the person with OCD. People not showing classic symptoms of OCD have been at risk for this disorder not being recognized. Researchers report that certain medications are ineffective or worsen OCD, and that developmentally disabled people with undiagnosed OCD are at risk for being put on such medications. This article provides information to facilitate the recognition of OCD in developmentally disabled clients.

Journal Article↗