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PubMedDate not supplied

Four adult Rett patients at an institution for the handicapped.

We report the clinical, laboratory, and magnetic resonance imaging results of 4 adult patients (ages 25, 26, 29, and 35 years) with stage IV Rett syndrome. The patients were diagnosed at an institution for the handicapped. Two of them had been previously diagnosed as having cerebral palsy. All were microcephalic and had seizures, although the frequency of seizures decreased with advancing age. Three patients had scoliosis. Magnetic resonance imaging demonstrated marked craniofacial disproportion in 2 patients, bilateral atrophy of the frontotemporal lobes in 3, and cerebellar atrophy in 1. The cerebrospinal fluid concentrations of biopterin and homovanillic acid did not differ significantly in these Rett syndrome patients from age-matched controls.

Adult↗
PubMed1987

The effectiveness of three sets of school-based instructional materials and community training on the acquisition and generalization of community laundry skills by students with severe handicaps.

This study examined the effectiveness of three sets of school-based instructional materials and community training on acquisition and generalization of a community laundry skill by nine students with severe handicaps. School-based instruction involved artificial materials (pictures), simulated materials (cardboard replica of a community washing machine), and natural materials (modified home model washing machine). Generalization assessments were conducted at two different community laundromats, on two machines represented fully by the school-based instructional materials and two machines not represented fully by these materials. After three phases of school-based instruction, the students were provided ten community training trials in one laundromat setting and a final assessment was conducted in both the trained and untrained community settings. A multiple probe design across students was used to evaluate the effectiveness of the three types of school instruction and community training. After systematic training, most of the students increased their laundry performance with all three sets of school-based materials; however, generalization of these acquired skills was limited in the two community settings. Direct training in one of the community settings resulted in more efficient acquisition of the laundry skills and enhanced generalization to the untrained laundromat setting for most of the students. Results of this study are discussed in regard to the issue of school versus community-based instruction and recommendations are made for future research in this area.

Educational Measurement↗
PubMed1987

Vocational integration for persons with mental handicaps: a cross-cultural perspective.

Descriptive information was presented which related to the vocational integration of persons with mental handicaps in five Western European countries. The investigator based his findings on a five-month visit to Denmark, Great Britain, Italy, Switzerland, and West Germany. Observations, interviews, and documents were synthesized to draw conclusions about employment programs. Inferences were made about the development of vocational models in these countries and the United States. Potential variables were identified which influence systems change toward integrated models of work.

Cross-Cultural Comparison↗
PubMed1987

Increasing positive social interactions by handicapped individuals during a recreational activity using a multicomponent treatment package.

A multicomponent treatment package increased the rate of positive statements among handicapped youth during a social/leisure activity at a work training setting. The package of role playing, graphic feedback, contingent reinforcement, and self-monitoring was directly replicated across three experiments in producing normative rates of positive verbal statements. There was no evidence of generalization to other stimulus activities. There was limited response generalization to a class of negative verbal statements. The study further examined the critical components of the maintenance package through a withdrawal design. It was found that contingent reinforcement and self-monitoring could maintain substantial rates of positive behaviors. In the third experiment it was further demonstrated that self-monitoring alone could maintain positive statements in three of the four students in the group.

Adolescent↗
PubMed1988

Social validation of decelerative (punishment) procedures by special educators of severely handicapped students.

Ratings on the acceptability, intrusiveness, restrictiveness, and efficacy of 18 commonly used interventions for decelerating behaviors were obtained from 58 special educators of students with severe handicaps. Results indicated that consensually high and low mean ratings were obtained for restrictiveness, intrusiveness, and acceptability. Ratings of efficacy, however, were generally neither consensually high nor low, and demonstrated lower variability across the 18 interventions, and lower reliability across raters than did ratings on the other three dimensions. Additionally, ratings of restrictiveness were negatively correlated with ratings of acceptability, ratings of intrusiveness and restrictiveness were positively correlated, and ratings of acceptability and efficacy were positively correlated. We interpreted these results as suggesting that: (a) special educators may not be certain of the efficacy of interventions they use, despite previously reported use in classrooms, and (b) the constructs of restrictiveness and intrusiveness may not have discriminant validity at present. Implications for ongoing training for special educators were discussed.

Attitude↗
PubMed1988

A comparison of forward and concurrent chaining strategies in teaching laundromat skills to students with severe handicaps.

This study compared the relative efficiency of forward and concurrent chaining strategies in teaching the use of a commercial washing machine and laundry soap dispenser to four high school students with severe handicaps. Acquisition and maintenance of the laundromat skills were assessed through a multielement, alternating treatment within subject design. Results indicated that the concurrent chaining strategy was more efficient than forward chaining in facilitating acquisition of the activities. Four week and eight week follow-up probes indicated that concurrent chaining resulted in better maintenance of the activities. The implications of these results for teaching community activities and future research in building complex chains are discussed.

Adolescent↗
PubMed1988

Training social skills to severely mentally retarded multiply handicapped adolescents.

Three severely mentally retarded, multiply handicapped, adolescents were treated in a classroom setting for social skills deficits. Two of these children exhibited symptoms of autism including periods of echolalia, and fascination with tactile and visual stimulation. One of the pair was deaf. The third child was profoundly mentally retarded and had minimal expressive language skills. All had received sign language training to facilitate communication. Treatment focused on increasing the frequency of eye contact, in seat and response to verbal prompt behaviors, skills deemed necessary to facilitate use of sign language communication and to increase social interaction. Baseline and treatment were evaluated in a multiple baseline, alternating treatment design across children. Baseline was taken on responses to 10 standard questions, asked by the teacher, based on verbal presentation and sign language. This same procedure was then continued during the initial treatment phase following training sessions. During training, the children received social reinforcement, performance feedback and edible reinforcement, in the form of candy, for appropriate performance. Physical and verbal prompts as well as pictorial cues were employed to shape appropriate behavior. In the second treatment phase, training was implemented in the classroom in which baseline data had been collected. Improvement in target behaviors, via training sessions held four days a week, was noted. These data suggest that use of a combination of visual stimuli, operant and social learning methods can remediate social skills deficits in children with multiple psychological and physical deficits. The implications of these findings for current and future research are discussed.

Achievement↗
PubMed1990

Teaching autistic and severely handicapped children to recruit praise: acquisition and generalization.

Autistic and severely handicapped children were taught to ask questions (e.g., "How did I do?") and make requests (e.g., "Check it out") to recruit or set the occasion for praise from an adult. Teaching occurred during structured sessions in a community-based group home. Generalization of the children's use of these behaviors was evaluated during other activities in the teaching area, with other staff members in different areas of the home, and at each child's academic classroom. The children learned the behaviors to cue or set the occasion for praise independently and used these behaviors in all of the generalization settings. In the generalizations settings, the children were frequently successful in recruiting praise.

Adolescent↗
PubMed1990

Assessing placement tendency in families with children who have severe handicaps.

Data are reported from a brief measure to assess placement tendency of parents who have young children with severe handicaps. Parents of 84 severely retarded children were interviewed in their own homes, three times, 18 to 24 months apart. Their thoughts and actions regarding out-of-home placement for their child were assessed each time on a six-point Placement Tendency Index. Results indicate trends in placement tendency that are linear; from the point that parents begin to entertain the idea of placement it may still be one or two years until the act of placement is completed. These findings suggest that the act of placement is an ongoing process rather than a single discrete behavior. The implications of assessing placement tendency for service providers and other professionals who may assist families in decision-making are discussed.

Child↗
PubMed1990

Language behavior by mildly handicapped and nonretarded children on complement clauses.

Comprehension of complement clauses embedded into four matrix verbs in Greek, equivalent to English in syntactic and semantic constraints, was investigated with mildly handicapped (MH) and nonretarded children (NR). The results suggest that: (a) the MH children use the same syntactic information in comprehension of complement clauses as the NR children, (b) verbal MA cannot best predict linguistic performance by MH and NR children. (c) Digit Span does not correlate with comprehension nor does verbal IQ in MH., (d) Digit Span and verbal IQ are significantly correlated with NR children's comprehension, (e) the psychological status of the minimal distance principle (MDP) is debatable, while the semantic role principle (SRP) is partially supported by the data, (f) MH children lack metalinguistic ability compared to young NR children.

Adolescent↗
PubMed1991

Regulating behavioral procedures for individuals with handicaps: review of state department standards.

We reviewed standards (i.e., mandatory policies or recommended guidelines) from 39 state departments of special education and 41 state departments of developmental disabilities/mental retardation (DD/MR) to determine how they addressed the use of behavioral procedures. Results indicated that many standards described procedures to change behaviors of individuals with handicaps and identified ways to regulate usage. Major findings were that (a) standards from state departments of DD/MR addressed behavioral procedures more frequently than standards from special education departments; (b) many standards addressed procedures to decrease, but not increase, behavior; (c) several standards identified safeguards to clients' rights, such as prior approval requirements and periodic review of behavioral procedures' effects; (d) some standards prohibited and/or restricted the use of specific procedures, such as those judged to be aversive; (e) about one-fifth of special education standards and two-thirds of DD/MR standards described staff training requirements for using some procedures; and (f) relatively few standards used decision models to select behavioral procedures. Implications of these findings for policy makers, service providers, and future research efforts are discussed.

Aversive Therapy↗
PubMedDate not supplied

Using decelerative contingencies to reduce the self-injurious behavior of people with multiple handicaps: the effects of response satiation?

The response satiation model of instrumental performance was used to establish contingencies to reduce the self-injurious behavior (SIB) of two adults with profound mental retardation and multiple handicaps. In Experiment 1, withdrawal designs indicated behavior reductions of 68% and 82%, respectively, when contingencies were implemented that required the participants to engage in leisure activities at greater than baseline levels if they continued to perform the SIB at their baseline level. Experiment 2 involved the transfer of the treatment to the participants' respective living areas using staff as trainers. The largest reductions in behavior were associated with treatment packages that contained response satiation contingencies, and generality of the treatment packages across locations and trainers occurred. The limitations of this study as an analysis of response satiation theory were noted; however, it was concluded that the response satiation approach to establishing contingencies for reducing SIB was worthy of future investigation.

Adult↗
PubMedDate not supplied

Final report of the Bawnmore Personal Development Programme: staff attitudes and sexuality programme development in an Irish service organisation for people with mental handicap.

In this paper, issues on sexuality and mental handicap are reviewed, and recognition of the growing importance of sex education to integration is noted. The development of a sex education programme and staff training provided within a service organisation, with some involvement from other services within an Irish setting, are described, and their evaluation is reported. Attitudes towards involvement prove of particular interest, and factors influencing continuation or discontinuation are identified. The need for attitude change among staff and administration towards the priority given to sex education is highlighted, and a need for structural change in staffing arrangements to facilitate such education is indicated. Failure to recognise sexuality as a research issue in evaluating the success of integration efforts is noted, and such research is recommended as a top priority for the future.

Adult↗
PubMedDate not supplied

Out-of-home placement of children and adolescents with severe handicaps: behavioral intentions and behavior.

This study tracked the thoughts and actions regarding out-of-home placement in 100 families who had a child or early adolescent with severe handicaps. Parents' behavioral intentions regarding out-of-home placement were assessed using a single item measure of placement tendency (The Placement Tendency Index) four times over a total period of approximately 6 years. Statistical models used to predict time until placement indicated that the Placement Tendency Index had modest predictive capacity in the long run, but increased predictive utility over shorter periods. Closer examination of the movement of scores from one wave of data collection to the next revealed three patterns, indicating variability in the speed and direction with which parents move along the scale.

Activities of Daily Living↗
PubMed1995

[Handicaps in the perinatal period. I. Perinatal pathology and difficulties in school].

BACKGROUND: Major handicaps are closely related to perinatal events. However, relationship of these events with other moderate disabilities such as school problems are still unclear. POPULATION AND METHODS: A representative sample of 1,408 children at school age and born in Lorraine in 1984 was studied. Two hundred and fifty children with problems were compared with 602 controls without school problems, using a multivariate analysis. RESULTS: The incidence of school difficulties among 6-year old children (in the last year of nursery school) is 17.8%. Children are at higher risk of school problems if their parents are not (odds ratio [OR] = 7.9) or are poor school graduate (OR = 2.7), if they are boys (OR = 2.0), if they are born at the end of the year (OR = 1.1) and also if they are preterm (OR = 2.7) or small for gestational age (OR = 2.5). Preterm delivery and intra-uterine growth retardation accounted for 9.6% of school difficulties. CONCLUSION: The relationship between perinatal events and school difficulties warrants to continue with prevention during pregnancy, especially among groups with multiple risk factors.

Child, Preschool↗
PubMed2005

Eligibility for publicly funded orthodontic treatment determined by the handicapping labiolingual deviation index.

INTRODUCTION: Access to orthodontic care for Medicaid patients has been limited, in part because of orthodontists' reluctance to treat severe malocclusions for low reimbursements. Limited orthodontic treatment in the mixed dentition (phase 1 treatment) has been proposed to address this issue, because the intent of phase 1 treatment is to improve or prevent severe malocclusions. Orthodontists might be more willing to provide shorter, simpler treatment. The purpose of this study was to determine whether phase 1 treatment would reduce malocclusion severity to the extent that eligibility for subsequent Medicaid-funded treatment was significantly reduced. METHODS: Eligibility was determined by the handicapping labiolingual deviation (HLD) index, which is used by several states for this purpose. Eligibility was also determined with the index of complexity, outcome, and need (ICON). This allowed us to compare these 2 indexes. Pre-phase 1 and post-phase 1 index scores were calculated by using study casts from 193 patients treated at the University of Washington orthodontic clinic and the Odessa Brown Children's Dental Clinic, both in Seattle. RESULTS: Using the HLD index, we found that eligibility for orthodontic treatment decreased by 62% after phase 1 treatment. This change was statistically significant at P < .0001. The ICON found significantly more treatment need before phase 1 (90%) than did the HLD index (35%) (P < .0001). CONCLUSIONS: Early interceptive treatment significantly reduces eligibility for comprehensive Medicaid-funded orthodontic treatment. The HLD index is a useful tool for determining Medicaid eligibility.

Adolescent↗
PubMed2003

[The concept of handicap].

The notion of disability appears recently in the medical and medico-legal field. It is the origin of a fundamental discussion about the health, and an ethical debate about human person. Indeed it drives to identify among the health users a particular group: disabled persons for whom the methods used with success in the field of diseases are not convenient. For ethical point of view: it is the identity of the person in a situation of disability, its dignity, its self-esteem and the respect through the regard of others which are in question. The debate was amplified when the project of a classification of handicap, as consequences of diseases, (Wood, WHO) was published, in 1980. Two tendencies were in opposition: one of them is "medicinal", following the opinion of Wood, the second is "anthropological and social", supported by scientific and disabled associations. The first proposition of Wood, after a long discussion, is abandoned. It is replaced by a "Classification of functioning, disability and health", adopted by the Mondail assembly of WHO in May 2002. This device is a compromise between the precedent tendencies. This document is heavy, confusing, imprecise and very difficult to use. We suggest a definition with dimensions, separating clearly the body modifications, the universal functional capacities for a human person and the situations of life. The subjectivity is individualised as a special dimension of assessment.

Persons with Disabilities↗
PubMed2005

[Assessment of functional abilities, handicap and quality of life in patients with spinal cord injuries].

OBJECTIVES: A literature review of the methods of evaluating function, handicap and quality of life in patients with spinal cord injuries. METHODS: The literature review was based on the available French and English articles published since 1990 in 3 databases: MEDLINE, Pascal and Embase. RESULTS: The literature is dominated by descriptions of tools for evaluating functional limitations in motor deficiencies. Such descriptions involve the validation of generic tools for patients with spinal cord injuries or of specific tools during the evaluation of a particular intervention such as surgery of the tetraplegic hand or adaptation of technical help. CONCLUSION: The tools to assess patients with spinal-cord injuries are sufficiently numerous and varied to allow us to evaluate physical, functional and psychosocial dimensions. Rigorous methodological validation is continuously at the base of those proposed tools and thus reinforces our choice to use them. Unfortunately, few evaluation tools for patients with spinal cord injuries have been published, translated into French and validated.

Disability Evaluation↗