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An art centre for adults with developmental disabilities is described, and its origins and dissemination are presented. Differences between such art centres and more traditional work-oriented programmes for people with developmental disabilities are indicated. The number of similar art centres for this population has increased substantially during the past 20 years.
OBJECTIVES: Severely and profoundly mentally retarded and developmentally disabled (MR/DD) patients are unable to communicate disease symptoms, and radiographic examinations are often difficult to perform on non-sedated patients. This clinical trial evaluated the impact on dental treatment planning of radiographic mini-panels for MR/DD patients. METHODS: With Institutional Review Board approval and informed consent of the legal guardian of each patient, a digital series of six periapical radiographs was achieved without sedation on 72 MR/DD inpatients (the survey was attempted on 74 patients). RESULTS: The average number of teeth included in each mini-panel was 20.4 compared with 22.2 teeth found clinically and 22.7 teeth determined combining both clinical and radiographic findings. Individual mini-panel images were judged technically excellent in 65% of cases, diagnostically satisfactory in 26% of cases and suboptimal in 9%. The radiographic panels were judged to affect treatment planning for more than 60% of the patients included in the trial. In 32% the detected condition was one or more periapical radiolucency. Several radiographic findings indicated potentially painful conditions that perhaps explained patient actions previously attributed to behavioural problems. Potential sources of dental pain and sepsis were treated by endodontic therapy or dental extractions on a case-by-case basis with or without general anesthesia. The trial also demonstrated a need that has translated into increased state allocations for dental treatment of MR/DD patients resident in the Commonwealth of Kentucky. CONCLUSIONS: Dental inspections of MR/DD patients are incomplete if radiographs are excluded. Whilst the mini-panel approach could be considered incomplete, it is better than no radiographs at all. 91% of images were excellent to satisfactory in diagnostic quality and a majority of patients' treatments were modified because of the radiographic information.
Thirty families with a developmentally disabled child less than 1.5 years old were compared to 30 families with a nonhandicapped child. One-half of the families lived in California, and half lived in Denmark. Findings indicated that parents with a very young developmentally disabled child see themselves more negatively after the baby's birth, and they express more negative feelings about their child. Regarding Danish--American differences, the supportive services in Denmark did not have a significantly greater impact on the parents' adjustment than did the supports in the United States. Furthermore, the use of supportive services correlated with positive adjustment in some areas and negative adjustment in others.
The fragile X syndrome is a frequent cause of developmental disabilities. It is associated primarily with nonprogressive X-linked mental retardation. The neurodevelopmental abnormalities of 25 males and 3 females are described. Mental retardation was mild in 4, moderate in 11, severe in 6, and profound in 2 patients, while 4 patients had only learning disabilities. The presence or absence of a developmental disability could not be determined in the youngest (8 months). Seven patients had had infantile autism and 7 had epilepsy. Generally no major focal neurological abnormalities were observed but most of the patients exhibited minor signs. The severity of developmental disabilities in our patients varied between and within families and between genders. All adult males had macroorchidism. Unusual facial features were present in 13 males but none were seen in the females. Familial occurrences were found in 18 cases (64%); 10 cases (36%) were sporadic. Overall, males were more severely affected than females. Diagnostic tests including computed tomographic scans, electroencephalograms, and evoked potentials did not disclose any specific abnormalities.
There were few differences between developmentally disabled foster children and those who were adopted. The foster children as a group were slightly older and more likely to have intact biological families who continued to maintain contact with them. More differences were found in the agencies' structures and practices. The major problem areas identified during the site visits appeared to be within the child welfare system itself, specifically at the interface between foster care and adoption. Bridging mechanisms were needed between units to temper the differences in perception, values, role expectations, and decision-making criteria used by the specialized staffs. When bridging mechanisms were in place, specialization of function was related to increased effectiveness in placing developmentally disabled children for adoption.
BACKGROUND: Rearing a child with a developmental disability is associated with increased parental stress. Theories of stress and adjustment and bi-directional theories of child development suggest that parenting could influence these negative outcomes. METHODS: Relationships between parenting approaches and stress in parents of children with developmental disabilities (DD) (N = 53) were examined across two age groups, 3-5 years and 9-11 years and compared with a contrast group of typically developing children (TD) (N = 60). Measures used were the Parenting Stress Index-Short Form and Rickel and Biasatti's modification of Block's Child Rearing Practices Report, classified into Baumrind's parenting styles using Reitman and Gross's method. RESULTS: Parents in the older DD group used Authoritative parenting less than parents in the younger DD group, while the opposite developmental pattern was seen in the TD group. Multivariate analysis of variance showed a significant group x parenting style interaction for Parental Distress, Parent-Child Dysfunctional Interaction and Difficult Child. Stress measures were higher for the DD group and seemed to be associated with Authoritative parenting approaches, an effect that was not observed in the TD group. CONCLUSIONS: Findings suggest that the well-established effect of group on stress may be moderated by parenting style. Authoritative parenting may be highly stressful for parents of children with DD to implement, resulting in a decrease in its use across the two age groups.
Evaluation of developmentally disabled persons for physical signs of sexual abuse presents many challenges to the practitioner. This group is especially vulnerable to all types of abuse. A group of 35 mentally retarded females from a residential treatment facility was examined by the child abuse medical team at Harbor/UCLA Medical Center after one inpatient was found to be pregnant. Patients ranged in age from 13 to 55 years (median, 26 years; mean, 31.3 +/- 13.6 years). All of the women had some degree of disability, with 24 (69%) being categorized as profoundly retarded. No patient was able to provide a history. There were 13 (37%) patients who had genital findings we believe are consistent with prior vaginal penetration. Dilemmas which arose during evaluation included the significance of healed genital lesions in this population and the implications of the findings for the residential facility. While developmentally disabled persons need an advocate in the medical and legal systems, these patients can overwhelm the practitioner. Whenever possible, a team approach is recommended to decrease the work load and frustration and provide collegial support and affirmation of findings.
Twenty-nine adults with developmental disabilities were trained by an occupational therapist to use city buses for leisure outings to local shopping malls. Program evaluation was based on the number of times each program participant used his or her mobility skills to make an independent leisure outing. These data were collected for 1 year after each person left the program and were analyzed with the use of multiple regression procedures. The results revealed that the participants maintained their mobility skills for 1 year. Older women who shared common leisure interests as well as persons who were afforded more intensive individualized training were especially likely to use the city bus for leisure outings after the treatment program ended. This study demonstrates the long-term effectiveness of occupational therapy when specific treatment goals are matched with individualized training sequences for persons with developmental disabilities.
Many clients in Hong Kong with developmental disabilities stay in mental hospitals because of mental disorders and behavioural problems. There is a need to identify strategies that promote psychological well-being and reduce problem behaviours in this group of clients. This study evaluates the impact of multisensory therapy on participants' emotional state, level of relaxation, challenging behaviour, stereotypic self-stimulating behaviour (SSB) and adaptive behaviour (AB). Using an experimental design, 89 participants were recruited from a developmental disability unit in a hospital in Hong Kong and randomly assigned to either an experimental (n = 48) or a control group (n = 41). Multisensory therapy sessions (n = 36) were conducted with experimental group and activity sessions (n = 36) were conducted with controls for 12 weeks. Multisensory therapy promoted participants' positive emotions and relaxation. However, there was no evidence that multisensory therapy was superior to activity therapy in reducing aggressive behaviour and stereotypic self-stimulating behaviour or promoting adaptive behaviour. The key variables that influence clients' behaviours in the multisensory therapy may be related to the relationship with the carer, constant environment, relaxation and freedom from demands rather than sensory input. Multisensory therapy could be used to provide leisure and promote psychological well-being, rather than for reducing problem behaviour.
We investigated whether individuals with developmental disabilities will demonstrate stimulus classes after observing another individual demonstrate the prerequisite conditional discriminations. In Experiment 1, participants learned conditional discriminations among dictated words, pictures, and printed words. They also observed a model without disabilities demonstrate conditional discriminations among a different set of dictated words, pictures, and printed words. The classes assigned to each participant belonged to a larger superordinate category, as did the classes assigned to each model. The superordinate categories were different for participants and models. All participants subsequently demonstrated full stimulus classes with the stimuli involved in direct training: They named pictures, read printed words, and matched pictures and words to one another. However, based on observing a model, none of the participants demonstrated full stimulus classes. In Experiment 2, participants learned conditional discriminations among the stimuli in three sets, and observed a model's training with the stimuli in three different sets. The classes assigned to each participant belonged to the same larger superordinate category as did those assigned to their respective model. All participants subsequently demonstrated full stimulus classes with the stimuli involved in direct training. They also demonstrated full classes with at least one of their model's sets of training stimuli. When full stimulus classes did not occur from observing a model, participants named the model's pictures, read the model's printed words, or matched the model's pictures and words. Stimulus class technology, coupled with the opportunity to observe another individual perform a skill, may be an economical and efficient means of teaching persons with developmental disabilities.
Children who are developmentally disabled are more often handicapped by a lack of social skills than by intellectual limitations. The pilot program described here improved the psychosocial functioning of such children by involving them in one-to-one relationships with caring adults.
Developmental disabilities (DD) are common childhood problems with significant impact on society. Early identification is important as there is potential for improvement through interventional/educational/(re)habilitative measures. There are currently no data revealing this situation in China. We review the current model of identification and management of Chinese children with DD in Hong Kong, a southern city in China. Our model was developed in the early 1960s and our system had been originally adopted from the Western culture due to political reasons, as Hong Kong was a British colony. This was modified over the years to suit our own unique, mixed Eastern and Western culture. With the expanding Western influence in mainland China recently, we hope this integrated model can be implemented in other parts of China.
Children and individuals with developmental disabilities (DD) compared to typical participants are disadvantaged not only by virtue of being vulnerable to risks inherent in research participation but also by the higher likelihood of exclusion from research altogether. Current regulatory and ethical guidelines although necessary for their protection do not sufficiently ensure fair distributive justice. Yet, in view of disproportionately higher burdens of co-occurring physical and mental disorders in individuals with DD, they are better positioned to benefit from research by equitable participation. Greater elucidation of this ethical dilemma is called for by researchers, institutional review boards, and funding agencies to urgently redress the imbalance. This article discusses many of the regulatory principles to ensure better research participation of children and individuals with DD: human rights, validity, distributive justice, beneficence/nonmaleficence, and autonomy.
Aggression by individuals with developmental disabilities may threaten their community placement. In a multiple baseline design across group homes, we provided group home staff with behavioral training and later with mindfulness training to assess the impact on aggressive behaviors and the number of learning objectives mastered by individuals in their care. We also assessed other outcomes including activities engaged in by the individuals, use of restraint by staff, and measures of satisfaction. The effect of varying staff-resident ratios was evaluated on all measures. When compared to baseline, the number of staff interventions for aggression showed some reduction following behavioral training, but decreased substantially only following mindfulness training. There was also some increase in the number of learning objectives mastered by the individuals following behavioral training, but greater and more consistent increases were obtained only after mindfulness training. Improvements also occurred on the other measures assessed after behavioral training, but these were always greater and more consistent following mindfulness training. In addition, consistent gains followed behavioral training only with a high staff-resident ratio whereas the larger gains after mindfulness training occurred with both medium and low staff-resident ratios. Our results suggest that the addition of mindfulness training considerably enhanced the ability of the group home staff to effectively manage the aggressive behavior and learning of the individuals.
The postural stability of four adult populations was examined through force platform methods. The four groups were classified as: (1) developmentally disabled (severely and profoundly mentally retarded) with tardive dyskinesia; (2) developmentally disabled but with no history of neuroleptic medication; (3) tardive dyskinetic but of normal intelligence; and (4) a normal and healthy control group. Postural conditions included standing still with arms at side, standing still with one arm or both arms parallel to the ground, and standing still while swinging both arms in the sagittal plane. The findings showed that both tardive dyskinetic and/or developmentally disabled groups exhibited greater sway and variability in centre of pressure motion in contrast to the control group. The developmentally disabled with tardive dyskinesia group also exhibited a strong tendency to produce a different form to the postural sway strategy in that they produced rhythmical centre of pressure motions during stance that were, to some degree, task dependent. The findings show that the combined effects of developmental disability and tardive dyskinesia produce qualitatively and quantitatively different features in postural stability patterns. The data suggest that postural stability measures may be a useful index to assess tardive dyskinesia.
Dentists providing treatment to individuals with developmental disabilities are often faced with unique medical/legal issues. Obtaining informed consent when a patient does not have capacity can be an involved process. Issues regarding therapeutic aids used for immobilization during treatment may further complicate the situation.
OBJECTIVE: To examine current training in developmental disabilities in Canadian psychiatry residency programs and to determine, from the programs' perspectives, how provinces across Canada are responding to the needs of persons with developmental disabilities and comorbid mental health disturbances (persons with a "dual diagnosis"). METHOD: A survey was completed by residency directors, or their designate, for all 16 psychiatry residency programs in Canada. RESULTS: Persons with developmental disabilities require psychiatric services throughout their lives, but inadequate training opportunities exist in many of the residency programs, particularly those involving adults and adolescents. While some didactic opportunities are usually available, supervised clinical opportunities are rare, and many of those reported are optional. CONCLUSIONS: Across Canada, there have been insufficient advances in clinical training and service developments to meet the needs of individuals with developmental disabilities and comorbid mental health disturbances.
Evolving residential requirements for individuals with mild and moderate intellectual disabilities and related developmental disabilities increasingly place these people in community settings. The increasing numbers of these individuals are dependent upon local practitioners for needed health services. National and California data are reviewed in an effort to provide a general awareness of these community living arrangements, which in turn may assist in the delivery and the follow-up of oral health services.