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PubMed1992

Behavioural continence training in mental handicap: a 10-year follow-up study.

Ten years after continence training, 14 severely and profoundly mentally handicapped individuals were found to have substantially maintained their improvements in bladder control. Completely independent self-initiated toileting had not been maintained, but the level of prompting to toilet was considerably less than before training. Those who had received intensive individual training fared much better than those who had received less intensive group training. Intensive individual training was found to be cost effective and resulted in very substantial savings in career time.

Adolescent↗
PubMed1993

Staff turnover in ordinary housing services for people with severe or profound mental handicaps.

The characteristics and turnover of direct-care staff in two housing services for adults with moderate, severe or profound mental handicaps are described. Both staff groups were predominantly female with a good representation of staff aged under 30, and between 30 and 50 years. Most had prior experience in a caring capacity before taking up their current posts, but only a quarter to a third had a relevant vocational qualification. Turnover was similar in the two services, but varied considerably between settings in each. Average annual turnover ranged from 8 to 39% in one and from 5 to 48% in the other. However, most houses still had a core of long-serving staff providing continuity over time. The implications of the level of staff turnover found for management and staff training are discussed, as are the reasons for leaving given by former staff of one of the services, together with their views on job satisfaction, conditions of work, and the adequacy of management and training.

Adult↗
PubMed1993

The nature and extent of aggressive behaviour amongst people with learning difficulties (mental handicap) in a single health district.

This paper describes the method and results of a survey of aggressive behaviour amongst people with learning difficulties. The study was confined to a single health district in the South Western Region of the UK with a general population of about 370,000. At the time of the survey, the Mental Handicap Register for the district recorded 1,362 people as having a learning difficulty. The overall prevalence of aggressive behaviour amongst people with learning difficulties for whom base population data was available was 17.6%. The lowest rate was identified amongst day facilities (9.7%) and the highest in hospitals within the district (38.2%). The prevalence rate amongst those attending schools for children with severe learning difficulties was 12.6%. Proportionately more males than females were reported to present problems of aggressive behaviour. The gender difference appeared to be largely accounted for by the disproportionate number of men identified within day facilities. There was no significant evidence of an association between the person's gender and the presence aggressive behaviour within schools or hospitals. The results indicated that, although physical and verbal aggression were the most frequently reported behaviours, many of the sample were also said to engage in other forms of challenging behaviour, particularly self-injurious, ritualistic, stereotypical and withdrawn behaviour. The risk of a serious or very serious injury to another person was very low; 0.7% or six people with learning difficulties from the district were reported to be currently presenting such a risk. Similarly, only 2% of the base population (n = 18) were reported to be extremely difficult to manage. The implications of the findings are discussed.

Adolescent↗
PubMed1993

Initial encounters between people with a mild mental handicap and psychiatrists: an investigation of a method of evaluating interview skills.

This study reports the results of an initial study into the ability of psychiatrists to interview people with a mild mental handicap who are accompanied by a caregiver. Initial interviews by 12 psychiatrists of different ages (30-57 years) and differing levels of experience with this client group were recorded on video tape. Three of the recordings were used to train four judges who were familiar with examining clinical interactions, though not between doctors and patients. The judges used a specially designed rating scale. The remaining nine interviews were evaluated independently by the four judges. There was a correlation of 0.65 (Kendall's coefficient of concordance, W) for the judges' evaluations using the rating scale for the nine interviewers. However, there was greater agreement between judges as to who were the best and worst interviewers (W = 0.86). Some of the aspects of the interviews which contributed to the variability in the judgments are discussed.

Adult↗
PubMed1993

Epidemiology of hepatitis B virus in non-institutionalized children and adolescents affected by handicap.

The aim of the study is to evaluate the prevalence of hepatitis B virus (HBV) markers in a population of non-institutionalized handicapped 1-19-year-old patients. Thirty-six out of 70 patients lived in southern Italy and 19 were affected by Down's syndrome. Only three (4.2%) were positive for anti-HBc (one of these also for anti-HBs) and none for HBsAg. Low prevalence seems to indicate that no particular anti-HBV vaccination strategy is to be considered on this subset of population and on their contacts. Serum prevalence of HBV among nurses and other members of personnel was 11.3%.

Adolescent↗
PubMed1994

Somatic sexual hallucinations and erotomanic delusions in a mentally handicapped woman.

A case of erotic delusion and concurrent somatic sexual hallucination is described in a 66-year-old mentally handicapped woman. The history, mental state and biological investigations convey the impression of erotomania, or de Clerambault's syndrome. Treatment with Pimozide has resulted in a remarkable improvement such that the patient has been symptom free for 8 months at the time of reporting. In the authors' opinion, the case lends support to the argument that erotomania exists as a mono-delusional disorder and is equivalent to the DSM-III-R classification of Paranoid Disorder, Erotomanic Type.

Aged↗
PubMed1994

Mental and physical health and ageing in mental handicap: a review.

With some exceptions, the mental and physical health problems of elderly mentally handicapped people are similar to those of the elderly population as a whole. Psychiatric disorder is more common due to a higher frequency of behaviour disorders. Increased longevity has been accompanied by a progressive increase in deaths from age-related conditions and in individuals with Down's syndrome exposed a predisposition to premature senility and dementia. Service issues include general health care, preventive measures, provision for those with psychiatric and age-related problems, and staff training.

Adult↗
PubMed1995

Mortality in a hospitalized mentally handicapped population: a 10-year survey.

The mortality experiences of a hospitalized mentally handicapped population between 1981 and 1990 (inclusive) were examined. A continued trend for increasing longevity in both males and females was found, with mean ages at death now approaching those in the general population. The commonest cause of death was non-tubercular respiratory infection, from which patients were particularly at risk during the months of December to February (inclusive). Patients diagnosed as suffering from psychoses other than schizophrenia and mood disorder had an increased mortality and should be thoroughly investigated for the presence of organic pathology. Epilepsy and Down's syndrome were associated with increased risk of earlier death, although in the case of Down's syndrome there has been a marked increase in longevity.

Adult↗
PubMed2004

Using the Diagnostic Assessment of the Severely Handicapped-II (DASH-II) to measure the therapeutic effects of risperidone.

BACKGROUND: Within the scope of a double-blind, placebo-controlled, crossover medication study, the Diagnostic Assessment of the Severely Handicapped-II (DASH-II) was evaluated as a measurement for determining the effectiveness of the medication risperidone in treating the problem behaviour of 21 people with intellectual disabilities (ID). METHOD: Participants' caregivers completed the DASH-II during the placebo/baseline phase of the study and the maintenance phase of the study, and completed the Aberrant Behavior Checklist - Community (ABC-C) weekly throughout the entire study. The results obtained using the DASH-II were compared to those obtained using the ABC-C, an instrument shown to be well correlated with the DASH-II. RESULTS: Results suggest that while the DASH-II and the ABC-C were well correlated during the placebo/baseline phase of the current study, they were not well correlated at completion of the 6-month maintenance phase of the medication trial. CONCLUSION: The DASH-II, while appropriate for assisting in the diagnosis of psychopathology in people with ID, does not appear to monitor changes in problem behaviour as a result of risperidone use as well as the ABC-C. Differences in the frequency of problem behaviour that each measure evaluated and the applicability of using the DASH-II to measure medication effects on problem behaviour are discussed.

Antipsychotic Agents↗
PubMed2005

Handicaps and the development of skills between childhood and early adolescence in young people with severe intellectual disabilities.

BACKGROUND: While a number of studies have examined the development of skills in children with intellectual disabilities (ID), most have been cross-sectional, most have been concerned with particular syndromes such as Down's syndrome or autism and few have attempted to identify factors associated with improvements in skills. METHODS: From a sample of 111 children with severe ID who had been identified from the registers of six special schools at 4-11 years of age, 82 were traced and reassessed 5 years later at the age of 11-17 years. On both occasions, information on the children's handicaps and skills was collected by interviewing their main carers using a shortened version of the Vineland Adaptive Behaviour Scales and the Disability Assessment Schedule. RESULTS AND CONCLUSIONS: There were small but statistically significant improvements in Vineland age-equivalent communication and daily living skills scores, but not in Vineland Socialization scores, over the 5-year period of follow-up. This pattern of improvement was observed in most aetiological subgroups. Improvement in skills was greatest in younger children, and was associated with reductions in behaviour problems and in levels of parental stress. In spite of the improvements in age-equivalent scores, Vineland standard scores showed significant declines over the same period of time, indicating that the improvements observed were smaller than would be expected in a general population sample of children of the same age. The dangers of using standard scores or quotients to quantify the level of functioning of children with severe ID are highlighted.

Activities of Daily Living↗
PubMed1990

Hand handicap and rheumatoid arthritis in a fish-eating society (the Faroe Islands).

In the county of Klaksvik, the Faroes, a simple hand test was used for screening all inhabitants between the ages of 40 and 74 years. With its high sensitivity and specificity it revealed a diagnostic panorama entirely different from that seen in previous investigations in other nordic countries. In Klaksvik the prevalence of hand handicap was about 40%, which is due to the high incidence of osteoarthrosis. The prevalence of rheumatoid arthritis was 1.1%. The high functional capacity and the lower occurrence of rheumatic nodules and erosions found in the patients with rheumatoid arthritis as compared with previous studies suggest that the disease takes a milder course in Klaksvik. This should support the hypothesis that RA patients benefit from a diet rich in fish.

Adult↗
PubMed1992

Standardised method of follow-up assessment of preterm infants at the age of 5 years: use of the WHO classification of impairments, disabilities and handicaps. Report from the collaborative Project on Preterm and Small for gestational age infants (POPS) in The Netherlands, 1983.

A nationwide, prospective study was initiated in The Netherlands in 1983, involving 1338 liveborn infants with a gestational age less than 32 weeks and/or a birthweight less than 1500 g. Pre- and perinatal data, methods and results of follow-up until the corrected age of 2 years have been published previously. In this paper, methods of follow-up at the age of 5 years are described. At that age, 966 children were alive, of which 927 (96%) were assessed during a home visit 2 to 6 weeks after their fifth birthday by three specially trained paediatricians. A questionnaire served to collect data on medical history, respiratory function, behaviour and socio-economic factors. Standardised tests were carried out covering the following 10 areas: congenital malformations, neuromotor function, mental development, hearing, visual function, language and speech development, behaviour, musculoskeletal system, respiratory tract and ENT problems, and growth. The outcome was recorded for separate areas and for the child as a whole using the WHO classification of impairments, disabilities and handicaps.

Abnormalities, Multiple↗
PubMed1986

Effect of sibship position on reproductive behavior of couples after the birth of a genetically handicapped child.

We compared the reproductive behavior of 132 white married couples of whom 44 had a child with cystic fibrosis, 44 with either Down Syndrome or neural tube defect, and 44 with cerebral palsy to that of the general USA white married population. The three groups of couples were similar respecting race, religion, maternal age, parental occupation and education, and sex of affected child. Most couples had received some genetic counseling and all were followed for at least 3 years after diagnosis of the affected child. Regardless of the degree of recurrent risk and availability or not of prenatal diagnosis, couples were several fold more likely to reproduce again when the affected child was the 1st rather than later born. From this study and others, we conclude that the three major determinators of reproductive behavior in couples after having a genetically handicapped child are the same as those for the general population. Specifically, these are: parental desire for children, past reproductive experiences (that is, sibship size and perhaps also outcome), and maternal age.

Adolescent↗
PubMed2005

Development and behavior of non-handicapped preterm children from a developing country.

BACKGROUND: There are many studies, mainly conducted in industrialized countries, concerning developmental and behavioral outcomes of preterm children. However, little is known about the outcomes of preterm children from developing countries. METHOD: Forty-three non-handicapped Turkish preterm children, 15 with very low birth weight and 28 with low birth weight at preschool age, as well as 36 term controls were compared on rates of developmental, emotional and behavioral impairments. Data were collected by review of hospital records and application of various questionnaires and inventories to both children and their parents. RESULTS: Preterm children had significant delays in general development and significant rise in somatic complaints with unknown medical etiologies. The very low birth weight group also had significant delay in language and cognitive development. Parents of the preterm children displayed significantly higher rates of democratic attitudes. Developmental outcome was significantly associated with birth weight and authoritarian parental attitudes where behavioral outcome was significantly influenced by birth weight. CONCLUSION: Presence of developmental delay is in accordance with existing data on the outcomes of preterm children from industrialized countries. An isolated increase in somatic complaints is an uncommon finding which might also be related to cultural factors.

Case-Control Studies↗
PubMed1983

Peripheral and central handicap and encoding.

A linear model of information processing led to many experiments on learning difficulties in the subnormal and severely subnormal. It assumes learning can result from a break in the chain of information flow at any point but overlooks compensatory mechanisms common to a developing organism. To compensate for the model's difficulties, we compared blind and deaf children with subnormal and subnormal autistic children (i.e. localized with general cognitive incapacities). Absence of a modality led to alternative encoding strategies, but in certain circumstances they also occurred in the centrally handicapped. Reasons for the similarities and differences are discussed.

Adolescent↗
PubMed1986

Sleep problems in handicapped children: a preliminary study.

Data are reported from an exploratory study looking at the prevalence of sleep problems (broken sleep and limited hours of sleep) in a population of handicapped children. Some degree of difficulty occurred in over a third of the population. There were strong associations with age, a range of serious daytime behavioural difficulties and indices of family stress. Some support for distinct subgroups (night waking, limited hours) was obtained. The implications of these findings are discussed.

Adolescent↗