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In mental handicap, communication is frequently disrupted not only by the lack of linguistic skills but also by behaviour problems, in particular communicative withdrawal. Three cases illustrate types of withdrawal and interview features and show how the Communicative Style Scale (CSS) is used to analyse strategies by which mentally handicapped subjects maintain withdrawal.
OBJECTIVE: The objective of this study was to describe the psychiatric assessment of Aboriginal patients from remote Aboriginal communities in Central Australia. METHOD: The method consisted of a summary of the experiences gained during a dissertation year placement as senior registrar with the Northern Territory Remote Area Mental Health Team. RESULTS: Remote area Aboriginal psychiatry entails learning a whole new set of skills in terms of history taking and the mental state examination, a knowledge of the importance of extended kinship ties and cultural issues, the use of Aboriginal mental health workers as partners in assessing and managing patients via their families and accepting referrals from a wide range of sources. CONCLUSIONS: Working on a service providing psychiatric care to remote area Aboriginal communities can be a deeply rewarding personal and professional experience.
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Experience over the past 10 years in the diagnosis and comprehensive management of females with Rett syndrome has given us a better understanding of the potential skills and abilities which need to be identified. This condition is unique in that after a period of early regression of development there appears to be stabilization with some improvement. The potential for these girls to achieve some functional skills and maintain them presents a challenge, but one that needs to be addressed. Medical management should include stabilization of uncontrolled seizures. Developing a comprehensive plan for feeding disorders is required so that resulting nutritional problems and constipation can be corrected. Recognition of gastroesophageal reflux and its proper management may prevent respiratory complications. Appropriate intervention strategies using different therapeutic techniques are described which have been effective in facilitating communication, maintaining hand function and ambulation, and preventing deformities. Progression of scoliosis can be managed with intensive physical therapy. Management encompasses a comprehensive medical, therapeutic, educational, and psychosocial approach, which is best provided by a team in collaboration with community agencies that serve children with special needs and their families.
Two severely dysarthric speakers who had previously spelled entire messages on an alphabet board were taught a system in which they pointed to the first letter of each word as they spoke. Rate and intelligibility of speech produced with (aided) and without (unaided) the communication system were judged by observers who viewed videotaped samples. The rate of aided and unaided speech was markedly faster than spelling the entire message. Aided speech was slower but more intelligible than unaided speech. Further analysis revealed that intelligibility was influenced by at least two factors: (1) rate and (2) information provided by the identification of the first letter of each word. For one speaker both factors contributed to increased intelligibility, while for the other speaker only initial letter information appeared to influence intelligibility.
This paper reports collective data analysis for the Behavioural Status Index insight and communication and social skills subscales. This is an instrument designed specifically for health care practitioners to measure behavioural and social functioning among mental health clients, in particular those in forensic care. Data were collected, using a repeated measures method by primary nurses, from a sample of 503 patients in two high security mental health hospitals in the UK. Results are reported for interscalar item correlations and factor analysis. Data trends are indicative of clinically interesting relationships. A six-factor structure emerged suggesting groupings of intra- and interscalar behaviours. The first of these contained all the Behavioural Status Index insight items. Significant differences were found on a number of factors between independent groups. Generally, results indicate that patients on lower dependency wards scored more normatively on the factors, adding to instrument validity. Men were found to score more normatively than women. According to Mental Health Act 1983 classifications, psychopathically disordered patients scored more normatively than mentally ill patients, who in turn scored more normatively than patients with learning disability. Clinical practice implications and ongoing European studies examining the use of the instrument in clinical practice and its association to treatment planning are discussed.
Longitudinal follow-up data on development and school placement are presented for three groups of patients. Having had or not having had early surgical intervention and stimulation distinguishes the two groups of patients with craniosynostosis. The third group is patients with cleft lip and palate who received early intervention but did not achieve minimal criteria for communication by age 22 months. Educational placement (for patients 8 to 20 years of age) follows the pattern of distribution of students nationally for patients who had early intervention.
Prenatal cocaine and opiate exposure are thought to subtly compromise social and emotional development. The authors observed a large sample of 236 cocaine-exposed and 459 nonexposed infants (49 were opiate exposed and 646 nonexposed) with their mothers in the face-to-face still-face paradigm. Infant and maternal behaviors were microanalytically coded. No opiate-exposure effects were detected. However, mothers of cocaine-exposed infants showed more negative engagement than other mothers. The cocaine-exposed dyads also showed higher overall levels of mismatched engagement states than other dyads, including more negative engagement when the infants were in states of neutral engagement. Infants exposed to heavier levels of cocaine showed more passive-withdrawn negative engagement and engaged in more negative affective matching with their mothers than other infants. Although effect sizes were small, cocaine exposure, especially heavy cocaine exposure, was associated with subtly negative interchanges, which may have a cumulative impact on infants' later development and their relationships with their mothers.
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Studies are needed to better understand the broad autism phenotype in young siblings of children with autism. Cognitive, adaptive, social, imitation, play, and language abilities were examined in 42 non-autistic siblings and 20 toddlers with no family history of autism, ages 18-27 months. Siblings, as a group, were below average in expressive language and composite IQ, had lower mean receptive language, adaptive behavior, and social communication skills, and used fewer words, distal gestures, and responsive social smiles than comparison children. Additionally, parents reported social impairments in siblings by 13 months of age. These results suggest that the development of young non-autistic siblings is affected at an early age and, thus, should be closely monitored, with appropriate interventions implemented as needed.
Children with Smith-Magenis Syndrome (SMS) exhibit deficits in adaptive behavior but systematic studies using objective measures are lacking. This descriptive study assessed adaptive functioning in 19 children with SMS using the Vineland Adaptive Behavior Scales (VABS). Maladaptive behavior was examined through parent questionnaires and the Childhood Autism Rating Scale. Cognitive functioning was evaluated with an age-appropriate test. Children scored below average on VABS Communication, Daily Living Skills, and Socialization scales. Learning problems and hyperactivity scales on the Conner's Parent Rating Scale were elevated, and girls were more impulsive than boys. Stereotypic and self-injurious behaviors were present in all children. Cognitive functioning was delayed and consistent with communication and daily living skills, while socialization scores were higher than IQ.
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Little attention has been paid to how patients' personality traits interfere with the communication and the outcome of physician-patient interaction. We performed an experimental study with students with high and low trait anxiety as patients. One physician conducted a single consultation with 41 students applying two beforehand-specified consultation styles. Patients completed questionnaires concerning emotional state and satisfaction. The actual content of the consultations was analyzed by Roter interaction analysis system (RIAS). The physician gave more biomedical information to low-anxiety students than high-anxiety students. Students who provided a lot of biomedical information themselves were less tense after the consultation. However, students with high anxiety were more dependent on the physician actively asking biomedical questions for them to be able to deliver that same information. In contrast to low-anxiety students, those with high anxiety were less satisfied after consultations involving many psychosocial questions posed by the physician and a good deal of emotional talk on their own part. Compared to low-anxiety students, students with high anxiety were less satisfied and tenser after consultations with much positive emotional talk on the part of the physician. We conclude that physicians and educators should be aware that psychological and emotional communication may be experienced as intrusive and inappropriate by patients with high trait anxiety when they present minor somatic problems.
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Behaviour disturbance was investigated in mentally handicapped adults who were living in hospital or at home. The first part of the study describes an empirically derived typology of disturbed behaviour patterns and gives the details of a scale by means of which behaviour disturbance can be quantified along six dimensions: aggression, mood disturbance, communicativeness, antisocial conduct, idiosyncratic mannerisms, and self-injury. The second part of the study used the scale in a longitudinal study of behavioural disturbance. Different forms of disturbed behaviour exhibited different kinds of longitudinal stability, and the long-term changes in one aspect of disturbance depended on subjects' other disturbance scores.
Children with unbalanced karyotypes or other genetic syndromes are generally supposed to be developmentally retarded and mentally handicapped. This has to be ascribed to defect oriented views, leading to negative valuations of their unusual physical condition including slow motor development. A new dialogue oriented view and working concept is presented. It accepts physical differences as biological facts, which primarily do not restrict brainpower. The development of intelligence, behaviour and personality depends largely on the environment. Impeding factors should be searched here and eliminated as far as possible with the aim to prevent secondary mental disability after a syndrome diagnosis. In general, children with genetic syndromes are able to understand language. Thus, they can be educated like other children. They should learn to accept rules and limits, answer questions and follow demands. Their communicative tools may be words, gestures, mimics or written language. While physical support has to be given if necessary, their principally open mind needs stimuli according to their chronological age. Normal mental capacities should be expected, unless the opposite is proven.