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A case of a mentally handicapped female with unbalanced form of translocation deletion between chromosomes 6 and 22 is reported. Clinical features, mental disorder and abnormal dermatoglyphs of the propositus are described.
Twenty-seven severely mentally handicapped children in three matched groups were trained on both a complex and a simple visual discrimination task with: (1) prompt fading on S+; (2) prompt fading on S-; or (3) no prompting (trial-and-error training). On the complex discrimination task, differences between groups were obscured by a floor effect. Only one subject from each group acquired the discrimination. However, on the simple discrimination task all nine S+ fading, eight S- fading and six trial-and-error training subjects attained criterion. Both S+ and S- fading groups made significantly fewer errors than the trial-and-error group but did not differ significantly from each other. Sixteen children who failed to acquire the complex discrimination in Experiment 1 also participated in Experiment 2. Subjects received additional training on the task by one of four procedures. Neither continued trial-and-error training, continued S+ or S- fading, reversals of the prompt between S+ and S-, or intensity fading resulted in acquisition of the task. Results are discussed in terms of overshadowing and task difficulty.
Sixty-six neuroleptic medicated mentally handicapped subjects in a hospital were studied to determine the prevalence of drug-induced akathisia. Tardive dyskinesia was also rated on the AIMS scale. Only motor manifestations of akathisia could be assessed as the subjective component of akathisia was difficult to elicit in this population with difficulties in verbal communication. As all the subjects had been on neuroleptics for at least 3 years, only chronic akathisia could be studied. Five subjects had akathisia. Correlational analysis did not reveal any specific associations with any of the demographic, clinical and pharmacological variables studied. A step-wise multiple regression analysis indicated that younger age could be a predictor. Tardive dyskinesia was associated in two of the subjects. The overall conclusion was that 7% of the subjects had chronic akathisia and no specific risk factors could be identified.
To determine optimal learning conditions in the profoundly handicapped, an approach which assesses state through a prediction analysis is proposed.
To assess the effects of modified relaxation training on subsequent disruptive behaviour, two groups of six non-institutionalized mentally handicapped adults were compared. At the end of 3 weeks training, those given relaxation training showed 71% more relaxation after relaxation sessions and 74% less disruptive behaviour later in the day, whereas controls who were only told stories showed no decrease; aggression and verbal disruption showed the most consistent effects. This suggests that modified relaxation is rapidly effective in inducing relaxation and in reducing disruption.
In 1987, a survey of eye abnormalities was undertaken of the mentally handicapped patients in Stoke Park Hospital, Bristol. The total population was 367 patients (262 females and 105 males). Of the 367 patients reviewed, 218 were found to have one or more eye anomalies (including the Down's Syndrome group), which shows that more than half the patients suffered from eye disorders (59%). The prevalence of the following anomalies is presented in detail: strabismus, refractive errors and cataracts. Corneal anomalies, nystagmus, retinopathy, glaucoma and other eye pathologies associated with various syndromes are noted. Eye anomalies in 31 patients suffering from Down's syndrome in the sample are recorded. Preventative measures to ameliorate the defects of eyesight, particularly in the aging population, relevance of regular eye examination and medical or surgical treatment of eye disorders are discussed.
Two experiments are reported which tested short-term recall of lists of four sign or four word labels by severely handicapped children. The findings suggest that the subjects were more efficient at processing words than signs in short-term memory, and that their organization of sign and word lists were affected by the length of time the material had to be held in short-term store. Both of these effects were influenced by whether or not the subjects had to use the stimuli as labels when making a response.
A descriptive evaluation is provided of a hospital-based unit for people with mental handicaps and challenging behaviours. The characteristics of clients admitted to the unit over a 15-month period are described, together with admission and discharge patterns, and treatment interventions undertaken. The progress of four clients is studied in detail via single-case studies. While reductions in levels of challenging behaviour occurred during admission, these changes were not generally maintained at follow-up. Implications for future service design are discussed.
A survey (involving questionnaire, screening and assessment procedures) of 793 adults with mental handicaps revealed that 6.3% of the population had ideopathic dysfluencies. Issues in the differential diagnosis between stuttering, cluttering and other dysfluency are considered, and the contaminating factors involved in this diagnosis discussed.
This survey assessed the prevalence and severity of difficult behaviour displayed by residents in a residential hospital for the mentally handicapped as reported by the direct-care staff. Of the hospital residents, 30.2% were reported as having at least one problematic behaviour. The men were generally more difficult than the women and those on the disturbed wards more difficult than those on residential wards. Men and women exhibited the same types of behaviours in both disturbed and residential wards. However, withdrawn/uncooperative behaviour, stealing and inappropriate sexual behaviour were more prevalent on disturbed wards; withdrawn and inappropriate sexual behaviour being exhibited by more men than women on disturbed wards. The factors most likely associated with being on a disturbed ward were sex and age; young men presenting with most management difficulty. Approximately 12% of the hospital population were defined as presenting with a 'severe' management difficulty. Difficult behaviour is the main reason for admission to and remaining in hospital. The concept of management difficulty and the implications on service provision are discussed.
This paper reports on a longitudinal study of sleep problems in 200 children with severe mental handicap. Sleep problems were extremely common: 51% of children had settling problems, 67% of children had waking problems, and 32% of parents said they rarely got enough sleep. Sleep problems were also very persistent: between a half and two-thirds of children who exhibited sleep problems at Time 1 still had them 3 years later. Sleep problems were associated with a number of child characteristics: poor communication skills, poor academic skills, poor self-help skills, incontinence, daytime behaviour problems and epilepsy. There were no relationships with family variables such as social class, income, family composition or housing tenure. However, maternal stress, maternal irritability and perceived impact on the family were related to sleep problems. A Sleep Index was constructed, and path analysis was used to trace the main causal pathways of the child, family and social characteristics. Ten variables explained 50% of the variance in the Sleep Problems Index. Communication skills played a pivotal role. The implications of the findings for intervention strategies are discussed.
To assess the efficacy of paradoxical directives, levels of challenging behaviour during 2 weeks of paradox, reprimand and extinction were compared with baseline levels in four adults with mental handicaps attending a day centre. Paradox was the most effective procedure for reducing the frequency and severity of challenging behaviour by an average of over 70% by the end of 2 weeks and up to 90% in certain subjects; extinction was least effective. Paradox was most effective with more defiant subjects, when staff rated treatment success as low, when improvement using extinction and reprimand was poorest, and in reducing aggressive behaviour. The present authors suggest the overjustification effect offers an explanation for the effects of paradox.
This study examines both oral and object counting, and the ability to read numerals in a group of 51 children with a moderate degree of mental handicap. The findings indicate deficiencies in basic counting competencies across a wide spread of ability. There is also evidence for a distinction between oral and object counting on a cognitive skills basis. The findings are discussed within a remediation context.
There are four administrative areas (Health and Social Services Boards) in Northern Ireland. Two prevalence surveys, carried out several years apart, show that there is a significant geographical gradient in the rates of severe mental handicap (IQ less than 50). The rates in the 20-29-year-old groups in the Eastern and Northern Boards range between 4.07 and 4.82 per thousand; comparable rates in the Southern and Western Boards range between 5.17 and 6.37. A similar gradient was discernible in the distribution of Down's syndrome.
An experiment is reported in which eight severely handicapped children were taught to rehearse lists of five manual sign labels or five word labels during the delay periods of a short-term, free-recall task. The results showed that the rehearsal training had an overall facilitatory effect on recall and that this effect was more pronounced for signs than for words, especially in the recency portion of the serial position curve. Follow-up after 3 weeks showed that the differential facilitatory effect for signs was maintained. The findings are discussed in the context both of existing memory studies for signed stimuli and in terms of their implications for the use of signs in educational settings.
Stereotypy is one of the most common behaviours demonstrated by persons with mental handicaps. As such, it has generated a number of theories concerning its origin or maintenance. One of these theories, the homeostatic one, suggests that some persons engage in stereotypies and other motor behaviours in order to maintain a relatively constant level of responding. If this was indeed true, the fact would have important implications for treatment, i.e. those persons who varied rates of both stereotypy and other movements but retained an overall level of motoric responding would seem to be those for whom procedures like the differential reinforcement of incompatible behaviour would be highly appropriate. The purpose of this paper was to determine whether some people do engage in constant levels of responding, and it did so by collecting data on stereotypy and other motor movements of 12 persons with retardation. Collected throughout the school day for 5 consecutive days on micro-computers, the data showed (1) that the stereotypic responding of four subjects was extraordinarily consistent, with the most deviant day's total being only 15 or 16% from the mean of the 5 days, (2) that other motor movements were inconsistent for all but one subject, but (3) that total movement (i.e. stereotypy plus other motor movements) was very high and was consistent for most subjects. The data were discussed in terms of assessing baselines for subjects for whom reinforcing adaptive motor movements would seem an appropriate means for reducing stereotypic responding.
Policy on the role and function of day services for adults with mental handicaps has changed considerably during the last 2 decades. What such settings offer their users has also changed as services have attempted to evolve in line with policy. However, the impact of these changes has gone largely unevaluated. This paper describes a study of two day centres to categorize the activity programmes of these services, and to assess service user and staff behaviour prior to a larger scale study of such services in Wales. The two centres were found to differ significantly in their programmes but not in the extent to which activities were organized in the community. Service user participation in activities varied with activity type, group composition and activity location. Whether activities were organized for the full duration of the timetabled sessions was critical to the interpretation of the extent of service user engagement. Staff showed a commendable orientation to clients and their activities in both services. Differences in the activity programmes of the two centres are discussed in terms of a continuing lack of clarity over the purposes of such day services in general. The relevance of some activities to objectives is questioned. Concern is also expressed about the resulting level of engagement achieved in planned activity.
Fifty-two mentally-handicapped in-patients with associated behavioural disorders were entered into this double-blind trial comparing zuclopenthixol dihydrochloride tablets (10 mg) with placebo. The study consisted of a 6-week open phase, in which all patients were treated with zuclopenthixol tablets, followed by a 12-week double-blind phase where approximately half of the patients were transferred to placebo tablets. Demographic data was obtained from the patients at entry to the study. Clinical assessments were performed at weeks 6, 7, 8, 10, 14 and 18 using the Clinical Global Assessment (CGA), a Behavioural Disorder Assessment prepared specially for this study, and a side-effect check list. Analyses of the rating scales showed significant differences in favour of zuclopenthixol at end-point on the item 'improvement in behaviour disorder' from the CGA and at week 14 and end-point on the Assessment of Behavioural Disorder. All other results demonstrated a favourable trend towards the zuclopenthixol treatment. Side-effects were reported slightly more frequently in the zuclopenthixol group, but generally, they were not a problem.