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PubMed1997

Intellectual disability and ageing: ecological perspectives from recent research.

Ageing in people with intellectual disabilities has become a central concern of service providers and research workers during the past 20 years. Their emergence as an identifiable population of older people with intellectual disabilities reflects, in part, improvements in medical and social service provision. However, interest in this group is primarily a reflection of the fact that, despite services developed in the light of principles of normalization, they remain readily identifiable as people in receipt of specialist intellectual disability services, in consequence typically clearly differentiated from the mainstream of older people generally. Analysis of this situation and other factors impacting on older people with intellectual disabilities can be undertaken through the use of ecological models conceptualized in terms of interacting, nested ecologies. The emergence of research on the impact of cultural influences on family carers and service provision is addressed within the framework of the ecological model, and methodological cautions are offered. The enduring the role of family carers and their motivation to continue caring is described.

Adult↗
PubMed2003

Diagnosis of Helicobacter pylori infection in adults with intellectual disability.

Helicobacter pylori infection is common among adults with intellectual disability. The acceptabilities and accuracies of different diagnostic tests in this population are unknown. We aimed to determine (i) patient acceptability and (ii) performance characteristics of serology, fecal-antigen, and urea breath tests among adults with intellectual disability. One hundred sixty-eight such adults underwent H. pylori testing with serology and fecal-antigen tests, and a portion underwent treatment. One year later, the participants were retested with fecal-antigen, serology, and urea breath tests. The numbers of specimens obtained and difficulties in collection reported by caregivers were noted. Test performance characteristics were assessed among participants and 65 of their caregivers, using serology as the reference. All participants provided at least one specimen, despite reported collection difficulties for 23% of fecal and 27% of blood specimens. Only 25% of the participants provided breath specimens; failure to perform this test was associated with lower intellectual ability and higher maladaptive behavior. The sensitivity, specificity, and positive and negative predictive values of the fecal test (baseline and 12 months versus caregivers) were 70 and 63 versus 81, 93 and 95 versus 98, 96 and 92 versus 93, and 53 and 74 versus 93%, respectively; those of the urea breath test (12 months versus caregivers) were 86 versus 100, 88 versus 95, 75 versus 89, and 94 versus 100%, respectively. With assistance, fecal or blood specimens for H. pylori assessment can be provided by most patients with intellectual disability regardless of their level of function or behavior. Only those with greater ability can perform the urea breath test. Using serology as the reference test, the limitations of performance characteristics of the fecal-antigen and urea breath tests are similar to those among a control group of caregivers.

Adult↗
PubMed2005

Adolescents with intellectual disability and suicidal behavior.

It has been assumed that impaired intellectual capacity could act as a buffer to suicidality in the population of children and adolescents with intellectual disability. The few studies that have been conducted contest this assumption and in fact the findings showed that the characteristics of suicidality in the population of children and adolescents with intellectual disability are very similar to other adolescents without intellectual disability. This paper reviews the few studies conducted and describe the symptomatology in this population.

Adolescent↗
PubMed1997

The prevalence of Helicobacter pylori infection among inhabitants and healthy employees of institutes for the intellectually disabled.

OBJECTIVES: The prevalence of Helicobacter pylori infection varies in the Netherlands from 5% in children to about 50% in the elderly. In the institutionalized intellectually disabled, a high prevalence of infection has been reported. It is unknown whether there are specific risk factors to obtain H. pylori infection in this population, and whether employees of such institutes are at risk for H. pylori infection. METHODS: Therefore, we analyzed the seroprevalence of H. pylori antibodies by ELISA among 338 intellectually disabled inhabitants and 254 employees of two institutes. H. pylori-positive patients were compared with H. pylori-negative controls. The intellectually disabled and the employees were evaluated for possible risk factors. RESULTS: Of the 338 intellectually disabled, 280 (82.8%, median age 51 yr) were infected with H. pylori. This rate is significantly higher than the prevalence of H. pylori in the Dutch population. The presence of H. pylori was significantly associated with male gender, longer duration of institutionalization, an IQ < 50, rumination, and a history of upper abdominal symptoms. Of the 254 employees, 69 (27.2%) were infected, which is equal to the rate for the total Dutch population. The presence of H. pylori infection among employees was, however, significantly associated with a higher level of physical contact with the intellectually disabled, longer duration of employment, and having upper abdominal symptoms. CONCLUSIONS: Intellectually disabled persons are at high risk of developing H. pylori infection. Employees with close physical contact to the intellectually disabled population for a considerable period of time are also at increased risk. H. pylori infection should be considered a job attributable risk in this profession.

Adolescent↗
PubMed2003

Ocular and visual defects amongst people with intellectual disabilities participating in Special Olympics.

PURPOSE: To analyse data from vision screening of people with intellectual disabilities from the UK participating in Special Olympics during the National Summer Games in Cardiff 2001, in order to determine visual status and access to eye care. METHODS: Athletes were invited to take part in vision screening, according to Special Olympics protocols. RESULTS: Testability rates were high. Findings confirmed the high prevalence of eye and vision defects reported in other studies of people with intellectual disabilities. In particular, visual acuity was below normal for most athletes. Significant improvement to acuity could be achieved with spectacles although correction after full refraction did not always provide normal vision. Over 40% of athletes undergoing full refraction had below normal corrected acuity. CONCLUSIONS: Athletes with intellectual disabilities were no more likely to access eye care and have adequate spectacle correction than other people with intellectual disabilities. Optometrists and carers need to be aware of the high prevalence of defects and the importance of regular eye examinations in people with intellectual disabilities.

Adolescent↗
PubMed2001

Reason and value: the thought of Plato and Aristotle and the construction of intellectual disability.

The thought of Plato and Aristotle in relation to the construction of intellectual disability is considered. Key elements in their thought are reviewed, which may have relevance for the construction of, and social response to, intellectual disability in Western societies. Specifically, I consider the "scale of beings"; the requirements of virtue and what constitutes a "good person"; and the relationship among reason, responsibility, and moral and legal status. My purpose was to demonstrate that the exclusion of people with intellectual disabilities is inherent in Western epistemology and that it is only change at this level that will ensure true equality for those labeled as having intellectual disabilities.

Humans↗
PubMed1999

Factors affecting decision-making by young adults with intellectual disabilities.

Young adults with intellectual disabilities were placed into high and low learned helplessness groups based on their responses to a self-report questionnaire. Within each group participants were randomly allocated to one of three conditions for presentation of vignettes depicting decision-making situations: vignette only; vignette plus two options; and vignette plus the same two options, each with one positive and one negative consequence. Participants were asked to say what they would do in the situation and to give a reason. Responses were judged according to criteria based on theories of rational decision-making. Low learned helplessness participants obtained significantly higher decision-making scores. Additional information about options or options plus consequences was not beneficial for either group. Implications for providing training and experiences in decision-making are discussed.

Adult↗
PubMed2003

A memory clinic for older people with intellectual disabilities.

Cognitive decline in older people with intellectual disabilities (ID) is often under-recognized. Following the publication of the National Service Framework for Older People and the white paper Valuing People, older people with intellectual disabilities of all aetiologies should have access to a systematic assessment of their cognitive function in order to detect decline in cognition and adaptive skills and implement appropriate treatments as early as possible. The development of a memory clinic for older people with ID is described, including instruments used and characteristics of attendees. Such projects are in line with current UK government policies and can contribute to the improvement of standards of care and support research in this vulnerable group of people.

Aged↗
PubMed2000

Working memory structure and intellectual disability.

The working memory of people with intellectual disability has been found to generally lag behind their mental age. However, studies concerning the structure of working memory or its connections to other cognitive functions are rare. The present study employs a versatile battery of tests for the evaluation of working memory structure in adults with intellectual disability of unknown aetiology. In addition, connections between working memory and cognitive skills valid for everyday functioning are evaluated. Working memory performance in the study participants was found to stem from two distinct components which could be regarded to represent phonological and general working memory. General working memory was closely related to intelligence, whereas phonological working memory was not. The subjects in the study group differed in their working memory profiles. These distinct profiles were significantly related to academic skills (e.g. reading, writing and mathematics) and sentence comprehension because the profile of the working memory predicted these abilities even when the intelligence and educational background of the participants was taken into consideration.

Achievement↗
PubMed2001

Electrophysiology and intelligence: the electrophysiology of intellectual functions in intellectual disability.

The electroencephalograms (EEGs) of 127 subjects with intellectual disability were analysed with regarding to their correlation to intellectual functions in order to further understand the relationships between EEG and intelligence. The EEG frequency spectrum was subdivided into 15, 2-Hz-wide bands and was recorded from electrodes F1, Fpz, Fp2, F7, F3, Fz, F4, F8, T3, C3, Cz, C4, T4, T5, P3, Pz, P4, T6, O1, Oz and O2. Patterns of acorrelation showed several similarities when compared to other analogous studies with normal subjects. However, the typical finding in the present study was a high number of correlations involving the frontal lobes, mainly the prefrontal portions, which is at variance with the patterns of normal subjects. Frontal lobes, especially the prefrontal regions, seem to be affected, regardless of its aetiology, in subjects with intellectual disability.

Adolescent↗
PubMed1998

A questionnaire survey of sleep and night-time behaviour in a community-based sample of adults with intellectual disability.

Two hundred and five people with intellectual disability, aged 18 years or over, and living in health- or social-services-managed community housing, completed sleep and behaviour questionnaires. An 85.7% return rate was achieved. Settling problems were present in 26.8% and night waking in 55.6% of the subjects. Parasomnias were present in 14% of subjects and 15% of the sample showed some features associated with sleep-related breathing problems. Factors associated with sleep-related problems included gender, aetiology of intellectual disability, epilepsy, treatment with antiepileptic medication, evening caffeine consumption, nocturnal urinary incontinence and ability to communicate. Significant sleep-related problems were demonstrated in this population; some of these problems might be avoided by simple measures.

Adult↗
PubMed2005

[Complications of tracheostomy in patients with severe motor and intellectual disabilities and their management].

Some patient with severe motor and intellectual disabilities have a narrow mediastinum due to severe scoliosis or thoracic deformity. Complication of tracheostomy in these patients, such as granulation of the lower end of the cannula and tracheo-innominate artery fistulae, are difficult to treat. The causes of recurrent respiratory distress after tracheostomy in four patients with severe motor and intellectual disabilities were investigated, and its management was evaluated based on chest CT and bronchoscopy. In all patients, the lower end of the cannula was in contact with the site of tracheal stenosis, accompanied by granulation with arterial pulsation. In three patients, tracheomalacia as a complication of tracheostomy was also noted. In three patients, changing the cannula to fix its lower end proximally to the lesion, combined with stent placement in one patient with tracheomalacia, resulted in regression of the granulation and respiratory distress. However, one patient with severe tracheomalacia, who had been treated by stent placement alone, died of tracheo-innominate artery fistula. To prevent complications of tracheostomy in patients with severe motor and intellectual disabilities, it is important to select cannulas with a suitable length and angle. In the absence of severe tracheomalacia, use of custom-made short cannulas that can be fixed proximally to the site of stenosis and to the proximity of arteries are appropriate for this purpose.

Adult↗
PubMed2003

Breast cancer and the uptake of mammography screening services by women with intellectual disabilities.

BACKGROUND: It is estimated that approximately 50% of women in Australia with intellectual disability will live to 70 years of age and as a result many will fall within the age group at highest risk for breast cancer (50-69 years). METHODS: Subjects were identified through the Western Australia Disability Services database. To determine the number of women diagnosed with breast cancer during the period 1982-2000, individual records (n = 2,370) were linked to the Western Australia Cancer Registry and the Mammography Screening Registry. RESULTS: The incidence of breast cancer among women with intellectual disability was 64.0 per 100,000 person-years, by comparison with 146.7 per 100,000 person-years in the general population. The uptake of breast cancer screening was examined in a subgroup of 380 women, 34.7% of whom had used mammographic screening, as opposed to 54.6% screening uptake in the general population. Failure to use screening services was highest in women who were unmarried, and was positively associated with severity of intellectual disability, presence of physical disabilities, and urban residence. CONCLUSIONS: The lower incidence of breast cancer in women with intellectual disability may in part be attributable to decreased life expectancy, but it also appears to reflect significant under utilization of the readily available screening services.

Activities of Daily Living↗
PubMed1996

The social and community involvement of older Australians with intellectual disabilities.

This paper describes the involvement of older people with intellectual disabilities in residential- and community-based activities and programmes. The 446 participants were selected from a national database of people of 55 years of age and over with intellectual disabilities in Australia. The data indicate that participants made infrequent use of public amenities and social and recreational facilities. With the exception of those living with relatives, most had limited contact with family and friends. The discussion draws attention to the need for independence training which will enable the current generation of middle-aged people with an intellectual disability to make decisions and choices about social and community activities.

Activities of Daily Living↗
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

Body weight status among adults with intellectual disability in the community.

The prevalence of obese, overweight, and healthy weight adults with intellectual disability in the community was estimated using data from the National Health Interview Survey from 1985 to 2000. Using the Body Mass Index (BMI) as a measure, the percentage of adults with intellectual disability in the obese category was higher than that for the general population and increased over the 16-year period. There was no similar detectable trend for adults with intellectual disability who were in the overweight category. Compared to their counterparts in the general population, a smaller proportion of women and young adults with intellectual disability maintained their weights in the healthy range. Implications regarding potential health risks and future research were discussed.

Adolescent↗
PubMed1997

Gastro-oesophageal reflux disease in institutionalised intellectually disabled individuals.

BACKGROUND: The prevalence of reflux oesophagitis (RO) in the normally intellectual population is about 2%, while this condition in the intellectually disabled has an estimated prevalence of 10%. METHODS: We investigated the presence of RO among 1687 intellectually disabled, with an IQ < 50, from 5 different institutes in the Netherlands. All were scored for possible associated factors and reflux symptoms, and compared with the overall population (n = 1580) from the same institutes (controls). Also, the effect of treatment on symptoms was evaluated after at least one year of therapy. RESULTS: Gastro-oesophageal reflux disease (GORD) was suspected clinically in 169 patients based on the following symptoms: vomiting, haematemesis, anaemia, rumination or behaviour problems. At endoscopy RO was diagnosed in 107 of 1687 patients (6.4%): 17 (15.9%) grade I, 34 (31.8%) gr. II, 42 (39.3%) gr. III and 14 (13.1%) gr. IV RO (Savary-Miller classification). Cerebral palsy, constipation, anticonvulsant drugs, an IQ < 35, underweight and gastrostomy feeding appeared to be possible associated factors, while as reflux symptoms persistent vomiting, haematemesis, iron deficiency anaemia, rumination, and behaviour problems were found. Concerning therapy, surgery was found to be effective in 38%, H2 receptor antagonists in 60% and the proton-pump inhibitor omeprazole in 96%. CONCLUSIONS: In this group of Dutch intellectually disabled patients with IQ < 50 RO was diagnosed in about 6% (107 of 1687), mostly severe grades of oesophagitis. Several possible associated factors were significantly present. From non-specific reflux symptoms persistent vomiting was the most indicative factor. In this population the most effective treatment of RO was long-term omeprazole therapy.

Adolescent↗
PubMed2003

Jurors' perceptions of adolescent sexual assault victims who have intellectual disabilities.

Children and adolescents with intellectual disabilities are especially likely to be sexually abused. Even so, their claims are not likely to be heard in court, possibly because people assume that jurors will not believe them. We tested this assumption in a mock-trial study in which 160 men and women watched videotaped excerpts from an actual trial. As predicted, when the 16-year-old sexual assault victim was portrayed as "mildly mentally retarded" instead of as "having average intelligence," jurors were more likely to vote guilty and had more confidence in the defendant's guilt; considered the victim to be more credible and the defendant to be less credible as witnesses; and rated the victim as more honest, less capable of fabricating the sexual abuse accusation, and less likely to have fabricated the sexual abuse accusation. Men and women were affected similarly by the disability manipulation, but women were generally more pro-prosecution in their case judgments and perceptions than were men. Finally, jurors who had more liberal views toward persons with disabilities were more likely than other jurors to make pro-prosecution judgments on measures of guilt. Implications for psychological theory and the law are discussed.

Adolescent↗