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On the relationship between the creative and social-emotional development of emotionally handicapped children.

Examined the relationship between the creative and social-emotional development of emotionally handicapped children (N = 78). The question of primary interest was whether changes in social emotional development over the course of treatment would parallel changes in creativity. Two samples of emotionally handicapped children were rated on their mastery of social-emotional objectives and were given similar forms of a creativity test at the beginning and end of an 8-week period. In both samples a significant relationship was found between changes in social-emotional status and creativity. Creative and social-emotional changes occurred independently of most variables known about a child at the beginning of treatment. Possible explanations and implications of this relationship are discussed.

Affective Symptoms↗

A review of criterion validation research on the Questionnaire on Resources and Stress for Families with Chronically Ill or Handicapped Members.

The Questionnaire on Resources and Stress for Families with Chronically Ill or Handicapped Members (QRS) has been used as a research instrument in studies that compared parents of clinical groups with normal controls, parents of children with different clinical conditions, and pre- and postinterventions. These studies are analyzed in terms of the relationship of 15 QRS scales to child variables (e.g., age, degree of handicap); parent variables (e.g., marital status, educational level); and family variables (e.g., nationality/culture). It was concluded that the QRS fulfills four requirements for an acceptable level of validity: (1) the relationship between predictor and criterion scores is statistically significant; (2) use of the test probably results in more correct decisions than would be made by resorting to base rates alone; (3) the test possesses some utility; it would result in some gain to the user; and (4) the test provides some unique information.

Adaptation, Psychological↗

Perinatality: French cost-benefit studies and decisions on handicap and prevention.

The Perinatal Care Programme (or 'Périnatalité') was implemented between 1970 and 1975 by the French Ministry of Health, with the aim of reducing the number of birth-related accidents, i.e. the number of deaths and injuries occurring during the perinatal period. It aimed to reduce the perinatal mortality rate from 26/10(3) in 1970 to 18/10(3) in 1980. To give an order of priorities to the actions, a cost-effectiveness evaluation was made. The ratio (Cost over 15 years)/(Number of deaths + number of handicap cases avoided during the same period) indicated that first place should go to resuscitation in the labour room, which cost only 200 francs to save a life while avoiding after-effects. The other measures concerned the training of medical personnel, the development of statistics and research, inoculation against German measles, intensification of antenatal supervision, improvement of supervision during confinement, and the creation of intensive resuscitation units. Evaluation of the programme is still going on. The perinatal mortality rate has considerably decreased, with the objective foreseen for 1980 already reached in 1975. The handicaps will be traced through the results of obligatory screenings at birth, nine months and two years.

Asphyxia Neonatorum↗

X-linked intellectual handicap and precocious puberty with obesity in carrier females.

Precocious puberty (PP) and intellectual handicap were present in 3 males in 2 generations of a Western Australian family. The 2 obligate carrier women were of normal intelligence but were grossly obese; one died of a cardiomyopathy at 55 years. The youngest affected male was found to have PP at 3 years. His mother was then pregnant, and because of her family history, was aware of the risk to have an affected male. Her mother had given birth to 2 sons with PP. By school age both of these males were mildly intellectually handicapped and this later became moderate. Apart from these 3 affected males, the 2 carriers lost 6 of their other 8 offspring, leaving only one normal woman and her unaffected son. The Fragile X test was negative on all males. This appears to be a new X-linked mental retardation syndrome, and a condition different from true idiopathic PP, or familial PP affecting both sexes, or PP with X-linked dominant inheritance.

Adolescent↗

Hearing impairment, undescended testis, circumferential skin creases, and mental handicap (HITCH) syndrome: a case report.

We report on a 3-year-old boy with circumferential skin creases as seen in Michelin tire baby syndrome (MTBS), hearing impairment, undescended testes, short stature, and mental handicap. Skin biopsy from the inguinal region showed degenerative collagen, which has never been found in MTBS. Similar clinical manifestations shared by our patient and a boy reported previously suggest a new clinical entity, in which degenerative collagen is etiologically involved. We propose an acronym to designate it: hearing impairment, undescended testis, circumferential skin creases, and mental handicap (HITCH) syndrome.

Abnormalities, Multiple↗

The prevalence of serological markers, hepatitis B virus DNA and elevated serum amino transferase values in institutionalized mentally handicapped males and females: an epidemiological study of HBV infection in residents with Down's syndrome or other forms of mental deficiency.

Conventional HBV serological markers, as well as serum alanine amino transferase and hepatitis B virus DNA (HBV DNA) were studied in a population of 667 institutionalized mentally handicapped males and females and in 676 staff members. The role of Down's syndrome (DS), sex and age-related factors with respect to the prevalence of these markers was analyzed. A young age at admission was found as one of the important factors in the development of the chronic HBsAg carrier state in females. The well-known higher prevalence of HBsAg carriership in DS patients appeared to be restricted to males. Markers indicative of viral replication, HBeAg and HBV DNA, were also more prevalent in male than in female DS residents, or OMR residents. These findings indicate that the phase of active viral replication is prolonged in male HBsAg carriers with DS. However, only 66.7 per cent of HBV DNA-positive and 26.2 per cent of HBsAg-positive residents had abnormal serum alanine aminotransferase (ALT) values. In addition, more than 50 per cent of residents with elevated serum alanine amino transferase values were negative for HBV serological markers. We conclude that male DS residents are the main source of HBV infection in institutions for the mentally handicapped and that determination of ALT values is not very useful in identifying those HBsAg carriers capable of transmission the infection.

Age Factors↗

[First experiences with an instrument for TV display of digitally encoded text information for the visually handicapped (author's transl)].

An instrument was developed which allows the display, in enlarged form--especially for visually handicapped persons--of text information as used in modern data-acquisition systems such as writing automats, screen editing devices, and television text display (in England, Ceefax). With the aid of electronic character generators, the text is displayed continually, moving from right to left in one line on the screen of a commercial TV set. Rate of movement, size, brightness, and color of the characters (and/or the background) can be selected arbitrarily. We performed a preliminary reading test with visually handicapped subjects from a rehabilitation center for blind persons. The resulting optimal parameters for text display and the achieved reading speed with the system are discussed.

Adult↗

Basal cell carcinomas cause little handicap.

Basal cell carcinoma (BCC) is the most common type of skin cancer and the incidence of BCC is expected to rise, with increased demand on dermatology resources. Little is known of the effect on people's lives of having skin cancer. The aim of this study was to quantify the handicap caused gy basal cell carcinomas before and after therapy. Forty-four patients (22 males, mean age = 65 yrs, range = 35-81 yrs) with 48 BCCs were recruited and 37 patients completed the study. Each patient completed the UK Sickness Impact Profile (UKSIP) and the Dermatology Life Quality Index (DLQI) at the initial visit to the dermatology clinic, 1 week after treatment and 3 months after treatment. Lesions had been present for a mean of 25 months (range = 1-240 months), their mean diameter was 9.6mm (range = 3-35mm) and the sites were head and neck (79%), trunk (17%) and limbs (4%). There was no relationship between the quality of life score and size of lesion. Overall the scores at presentation were very low, rising 1 week after treatment and falling to below the initial scores at 3 months (mean UKSIP 0.4%, 0.7%, 0.13%; mean DLQI 5.3% 8.7%, 1.2%). BCCs cause little handicap. This may explain the delay in seeking medical attention and should be considered in planning public health education about BCCs.

Adult↗

The experiential meaning of eating, handicap, adaptedness, and confirmation in living with esophageal dysphagia.

This article is mainly based on interview studies of pensioners' (n = 62), patients' (n = 19), and students' (n = 87) experiences of living with longstanding esophageal dysphagia. The aim is to describe the experiential meaning of dysphagic patients' lives by interpreting their experiences, problems, and emotions and by specifying these into scales according to the model of goal-directed action by Pörn [43-49]. The experiential meaning will be articulated in terms of attainment or nonattainment of goals in relation to eating, handicap, adaptedness, and confirmation. In the experiential meaning of eating, the emphasis is on the attainment of nourishing goals or goals attained by means of food with desired hedonistic qualities and linked with feelings of hope or no hope of a shared life. The experiential meaning of handicap is interpreted as the dysphagic individual's experiences of an actual nonattainment of eating goals due to swallowing disabilities and with experiences of nonattainment of other important goals and related emotions; for example, shame for human incompetence. The experiential meaning of adaptedness is understood as the dysphagic individual's experiences of actual capacity for goal attainments interpreted as a sense of control in the daily living with dysphagia and linked with security, or in the negative case, reduced self-esteem and feelings of panic or fear. The experiential meaning of confirmation is interpreted as the dysphagic individual's experiences of actual or potential repertoire for goal attainment, i.e., self-assessment strengthened by evidence obtained in relationships linked with emotions of hope of self-realization. In conclusion, a specific model for understanding the dysphagic patient's concealment of dysphagia in the medical encounter has been developed.

Adaptation, Physiological↗

Delayed cutaneous hypersensitivity in children with severe multiple handicaps treated with phenytoin.

Peripheral lymphocyte counts, T-cell and B-cell populations, DNCB skin reactions, Mantoux reactions, mitogenic transformation using PHA, and determination of serum phenytoin concentration were carried out in 45 children with severe handicaps. Twenty two of these patients were receiving phenytoin treatment. When compared with control subjects, the skin reactions were significantly depressed in the handicapped children, amongst whom those treated with phenytoin had more impaired reactions than those who were untreated. No significant relationship between the results of the skin reactions and the other parameters was found.

Adolescent↗

Epilepsy and associated handicaps in a 1 year birth cohort in northern Finland.

A 1 year birth cohort in the provinces of Oulu and Lapland in the Northern part of Finland consisted of 12058 live-born infants, this being 96% of all children born in 1966 in this area. Information on morbidity up to the age of 14 years was collected prospectively by means of questionnaires, special examinations and from national and regional registers of hospital admissions and social services contacts. The total number of children with epilepsy, defined as the occurrence of at least one afebrile epileptic seizure, was 208, 113 boys and 95 girls. The cumulative incidences for epilepsy up to the age of 14 years was 17.3 per 1000. Primary generalised epilepsy was present in 63% and partial seizures in 37%. At least one additional handicapping condition, such as cerebral palsy, mental retardation, and visual or auditory defect was present in 74 children (35.5%). Mental retardation was the most frequent additional handicap, being present in 28%, whereas 16% of the children had cerebral palsy. A total of 75% of the children were able to attend an ordinary school. The high frequency of epilepsy in this study, as compared to other studies, is explained by the cumulative registration of the cases and a high degree of ascertainment of cases with epilepsy.

Adolescent↗

Physical work capacity and effect of endurance training in visually handicapped boys and young male adults.

The purpose of the present study was to evaluate the relationship between several physical fitness parameters and eyesight divided into 3 grades in visually handicapped boys and young male adults, and to investigate the effect of mild exercise training on physical and psychic symptoms as well as cardiorespiratory fitness. Four subjects were totally blind (TB), 6 were semi-blind (SB) and 27 had amblyopia (AM). Physical fitness tests consisted of maximal oxygen uptake (Vo2max), maximal pedalling speed and power, maximal stepping rate, and isometric knee extension strength. Compared with AM and SB groups, the TB group was inferior in all physical fitness parameters. Especially, Vo2max, in TB (26 ml.kg-1.min-1) was about 56% of that in age-matched Japanese sighted subjects and was significantly low compared with the AM and SB groups. Both muscle strength and maximal pedalling power corresponded to about 50% that of the age-matched sighted group. Six SB and 4 TB students (mean = 17.7 years) were trained for 6 weeks on a bicycle ergometer at an intensity of 50% VO2max. Training was undertaken for 3 days per week and maintained for 60 min per session. After training, physical and psychic symptoms determined by the Cornell Medical Index improved significantly. These results indicate that low physical work capacity in visually handicapped boys and young male adults is due to the lack of physical activity, and that mild endurance training is effective in improving physical and psychic symptoms as well as cardiorespiratory fitness.

Adolescent↗

Examining foster care: a viable solution for placement of handicapped children?

Foster care for handicapped children has become a frequently used and even more frequently criticized procedure. Traditional methods of foster placement have resulted in a number of negative outcomes, especially for the placed children. Based on a review of some recent innovative foster care programs, this paper has isolated a number of options for the restructuring of the entire foster care delivery system. These options include: rigorous client evaluation, use of selection and training criteria for foster parents, matching of client needs to caregiver abilities in making placement decisions, and ongoing professional support and supervision after placement. Systematic consideration of these issues may help make foster care a more viable solution to the growing problem of home placement for handicapped children.

Age Factors↗

Perceptions of communication, cohesion, and adaptability in families of adolescents with and without learning handicaps.

Adaptability, cohesion, and communication patterns were studied in 30 families of learning-handicapped adolescents and 30 families of nonhandicapped adolescents. Parent and adolescent perspectives on each of these variables were solicited. The results indicated that adolescents in each of these groups had similar perspectives on adaptability, cohesion, and communication. The parents of the learning-handicapped adolescents, however, felt that their families were less cohesive and had lower levels of communication about problems than did their offspring. When levels of communication were related to adaptability and cohesion, it was evident for both groups that the families with high reported cohesiveness had the most positive communication patterns. Additionally, adolescents rated their families higher on communication if they also perceived a greater amount of flexibility in adaptation.

Adaptation, Psychological↗

Chronically ill and handicapped children and adolescents: personality studies in relation to disease.

Personality was studied in three groups of chronically ill and handicapped children and adolescents and compared to that of healthy control groups. Among physically handicapped children a pattern emerged indicating lack of emotional integration into environment without conflict. Hemophiliacs and diabetics did not differ from controls. However, there were important correlations between personality variables and clinical parameters for all three groups.

Adolescent↗

Social support and adjustment in chronically ill and handicapped children.

The relationship between social support and adjustment was investigated in children with a chronic physical illness or handicap. Mothers of 153 children with juvenile diabetes, juvenile rheumatoid arthritis, chronic obesity, spina bifida, or cerebral palsy reported on these children's family support, peer support, externalizing behavior problems, and internalizing behavior problems. Children reported as having high social support from both family and peers showed a significantly better adjustment than those with high social support from only one of these sources. Chronically ill or physically handicapped children without high support from both family and peers were reported to have significantly more behavior problems than children in general. Both family and peer support contributed negatively and independently to the variance in externalizing behavior problems, whereas only peer support did so for internalizing behavior problems. There were no interactions between type of support and either sex or age in predicting adjustment.

Adaptation, Psychological↗

Emotionally disturbed children in special schools: an analysis of ratings of disturbed behavior and perceptual handicaps.

The relationship between perceptual handicaps and adjustment was studied among 573 emotionally disturbed children from Massachusetts. Little relationship was found between perceptual handicaps and overall adjustment. Antisocial behavior was the most prominent factor related to removal from regular classrooms and placement in special residential and day schools.

Adaptation, Psychological↗

[The Exeter program of home visits by "developmental therapists". Suggestions on the procedure to follow in the presence of severe handicap in a child of less than 3 years].

The principal idea expressed in this paper is that there is a period of time between the birth of a child with a severe handicap and the realization of the parents that the child may need their specific individual attention to his general development because of that handicap: that this coincides with the period of time usually taken by doctors for diagnosis of all the aspects contributing to the developmental delay; that these periods are both likely to be two to three years. Intervention by a competent developmental therapist working weekly in the home is of specific aid to the infant, to the parents and to the doctor during this period.

Child Development↗