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This article describes the development of a curriculum and appropriate placements for diploma students, with particular reference to the care of people with learning disabilities. The authors describe how the curriculum was developed, as well as the contacts made with appropriate placement centres.
The reliability of the Spanish version of the Social Behaviour Schedule (SBS) was tested in a vocational setting on a sample of 64 subjects with learning disabilities. Test-retest assessment showed a good percentage of agreement (80%) and adequate kappa values for most SBS items. The overall percentage of agreement of inter-rater reliability was 85% and kappa values were moderate to nearly perfect for 52% of items. Inter-informant analyses produced poorer results, with an average agreement of 43% and inadequate kappa values on 42% of items. The intraclass correlation coefficient (ICC) was 0.64 for test-retest, 0.76 for inter-rater assessment and 0.94 for inter-informant assessment. The Spearman correlation coefficient was adequate on the test-retest and inter-rater analyses, but not on inter-informant analysis. This low inter-informant agreement could be attributed to environmental factors which alter the reliability of reports from different informants in community settings with high levels of normalization. In such environments, an interview with a key informant may not suffice, and both a careful review of the clinical record and a direct interview with subjects may enhance the reliability of the information attained.
This study examines the validity of Reitan and Wolfson's General Neuropsychological Deficit Scale (GNDS). The GNDS differentiated nondisabled, learning-disabled, and head-injured young adults matched for FSIQ with greater accuracy than Halstead's Impairment Index.
Health inequalities are a major concern of the UK government which provides a good opportunity to look at the equity of access to health services for people with learning disabilities. To investigate how the whole system of care can be improved, this article will focus on a common problem that spans both primary and secondary care: heart disease. It uses access to a potentially life-saving procedure, the coronary artery bypass graft, as an indicator of equity. Opportunities can arise for nurses to overcome inequality for their clients, e.g. through nursing involvement in commissioning by primary care groups.
This report examines binaural fusion for dichotically and diotically presented pass-bands of filtered speech in a group of 18 normal children and 18 children with language-learning disabilities. Binaural masking level differences for tonal stimuli and auditory brain stem responses for click stimuli are also reported. Results indicate lower overall scores for the experimental group on the diotic as well as dichotic conditions for the binaural fusion tasks, although both groups scored relatively higher in the diotic condition. Masking level differences and auditory brain stem responses were not significantly different for the two groups. These findings suggest the potential usefulness of binaural fusion measures in the assessment of auditory processing abilities in children, although certain cautions regarding their application and interpretation must be exercised.
OBJECTIVES: This study was conducted to investigate the efficacy of gentle teaching when compared with individual educational programming (IEP) for a group of people with complex learning disabilities and challenging behaviour. DESIGN: An A-B design was used, in which gentle teaching was introduced as an addition to the IEP procedures already in place. Other designs, such as reversal, multiple baseline or group comparisons would have been impractical in this clinical setting. METHODS: Thirteen students and seven staff were observed, using a hand-held computer for direct observations, and video-recordings for measures of interaction. Staff attitudes to gentle teaching and to the IEP system were also assessed. The intervention was systematic workshop-based training in gentle teaching for all staff. Measures were taken pre-intervention for 13 weeks and post-intervention for 23 weeks. Approximately 45 hours of direct observational data and over 50 hours of video-recording were analysed. RESULTS: We found very few effects of gentle teaching. Wherever there were differences between gentle teaching and IEP these were in favour of gentle teaching, although they were generally relatively minor in terms of clinical (rather than statistical) significance. Inter-rater reliabilities were generally poor, although the figures for those categories where there was a difference between gentle teaching and IEP were amongst the most respectable. CONCLUSIONS: Gentle teaching did not have a major impact on staff behaviour, and no discernible effect on student behaviour, but it did not lead to poorer interactions and may be a useful adjunct to more structured approaches such as individual educational programming.
K-TEA Comprehensive Reading scores of 34 elementary boys in either resource rooms or regular settings were compared. The boys were identified as learning disabled in reading. They were pretested at the beginning of the school year and posttested at the end. Treatment was one year of daily instruction in reading provided by six teachers in resource setting and six teachers in regular settings. K-TEA Reading Decoding and Reading Comprehension scores, separately compared in 2 x 2 repeated-measures analysis of variance, were not significantly different.
Profiling exercises provide vital data for effective and efficient deployment of resources and for monitoring the development of services. A survey, focusing solely on community nurses for people with learning disabilities in Northern Ireland, was carried out in 1992. The findings showed, among other things, a higher caseload per nurse than the UK average. While more than half the workforce had multiple qualifications there was a lack of clinical specialist training.
In recent years, there has been increasing concern about the identification of and provision of appropriate services to children and adolescents who are deaf and hard of hearing (D/HH) and who have concomitant learning disabilities (LD). Although it is unclear just how many youths who are D/HH also might have educationally significant learning problems, results from limited survey research and clinical practice provide evidence that such a group exists and that a significant portion of the school-age population of children and adolescents who are D/HH comprise a subgroup of youths who have concomitant LD. The overriding interest of those who advocate the cause of children and adolescents who are D/HH with concomitant LD is in finding effective ways to help these youths acquire future academic competence and attain competent levels of psychosocial functioning and emotional well-being. With creative research efforts and efficacious approaches to psychoeducational practice, we can seize the opportunity to establish high-quality diagnostic and educational services for children and adolescents who are D/HH and who have accompanying LD and set the stage to optimize positive developmental, academic, vocational, social, and economic outcomes for these youths.
Cognitive behaviour therapy (CBT) has been acknowledged as one of the most successful treatments for mental health problems. However, only a small number of practitioners engage in CBT with people with learning disabilities. A group of eight clinical psychologists who currently use CBT with this population gave details about their work in an attempt to gain a consensus on how to adapt CBT. The collective experiences of a wider group of experts produced a wealth of knowledge and suggestions to promote the use of CBT with this client group. Results suggested that although CBT needs to be creatively delivered, it does not necessarily need extensive adaptation.
This article details the process of peer review accreditation during the formation of a nursing development unit (NDU) in a community home for people with learning disabilities. The process involves thorough preparation and an accreditation visit. It necessitates professional openness, the sharing of ideas, and a willingness to collaborate with colleagues. The authors describe the aims of the new NDU, its philosophy of care and its ongoing quality management mechanisms.
In a two-part article, Robert Jenkins considers how nursing care needs to develop in order to support the growing numbers of people with learning disabilities who are living into older age. Here, he looks at definitions, health issues and nursing needs.
The implementation of clinical governance (Department of Health, 1997) requires the review of practice by consideration of complaints and clinical incidents. A systematic review of the clinical incident forms in group homes for those with learning disabilities, within an NHS community trust, highlighted issues for concern. This led to an audit being conducted of drug administration procedures involving examination of records and observation of practice. It demonstrated that there was general adherence to the trust's policies. The audit stimulated debate, and a number of potential areas for action were identified. The review of drug administration with clients who have learning difficulties raised wider questions about the scarcity of evidence in this area to support practice, the culture of client-centred homes and whether monitoring systems are sufficiently robust.
This study explores the application of Weiner's cognitive-emotional model of helping behaviour to care staff responses to challenging behaviour of people with learning disabilities. Participants were 20 residential care staff who worked with people with challenging behaviour and 20 who did not. Six examples of challenging behaviour were presented, and for each behaviour participants were asked to give a probable cause, rate attributions of stability, internality, globality and controllability for their cause, their optimism for change of the behaviour, their evaluation of the behaviour and a person showing the behaviour, their emotional response to the behaviour and their willingness to put extra effort in to helping change the behaviour. Data were analysed using correlation and regression methods. Carers working with people with challenging behaviour were more likely to evaluate the person more positively and report they would be more likely to offer extra effort in helping. A path analysis showed that helping behaviour was best predicted by optimism, which was best predicted by negative emotion which was best predicted by the attribution of controllability. We conclude that attributions and emotions reported by carers in response to challenging behaviour are consistent with Weiner's cognitive-emotional model of helping behaviour. Formulating carer behaviour using such models offers the possibility of using cognitive-behavioural methods in working with staff beliefs, emotions and behaviour in response to challenging behaviour.
This article investigates the effects of a combination of direct speech, language therapy and staff training on the communication skills of nursing and support staff working with people who have a severe learning disability and challenging behaviour. The approach aimed to help staff choose, prioritize and implement changes in communication. The input was effective in increasing the knowledge of the staff group with regard to challenging behaviour and communication breakdown, and in changing the communicative behaviour of staff. The changes measured were those of longer interactions occurring between staff and service users, and the use of non-verbal communication to support interactions. The implementation of the communication strategies is being audited.
Although the past two decades have seen an unprecedented interest among professionals in issues related to death, bereavement and grief, there is still a great deal of ignorance about grief among people with learning disabilities. Such ignorance can affect the overall care of bereaved people and may cause professionals to interpret normal grief reactions incorrectly (1).
The symptom complex of finger anomia, right-left disorientation, dysgraphia, and dyscalculia constitutes Gerstmann's syndrome. It is mostly described in adults and is caused by acquired lesions of the dominant parietal lobe. It is infrequently described in children with learning disabilities and has been designated developmental Gerstmann's syndrome. Developmental Gerstmann's syndrome goes unnoticed if not specifically sought by clinicians. A detailed evaluation will reveal subtle neurologic deficits, behavioral problems, and neuropsychologic and specific speech and language abnormalities. Ten such patients are reported; six of the children demonstrated improvement with intensive speech training. Early identification and intervention is therefore crucial, and even more important in cultures in which students are required to be biliterate or triliterate, further increasing the constraints on writing. A selective writing, reading, or calculation abnormality in the presence of normal oral communication triggers several interesting possibilities for the brain mechanisms behind normal language processing. Similarly, the association of acalculia with finger anomia and agraphia with right-left disorientation may have specific implications in the neuropsychologic processing of the evolution of calculation and writing. A theoretical possibility of oral and written language processing from the observation of the language behavior of these children is also described.
The brain, undoubtedly the most complex organ in the mammalian body, is the culmination of a long and interrelated sequence of molecular, cellular and tissue events. Brain function hinges on the orderly progression of these, each of which must occur correctly, temporally and spatially. Impingement on any one will give rise to a less developed system of cellular connections, and hence impaired function. Moreover, the neurons of the central nervous system are not self-renewing and thus neuronal loss cannot be repaired through repopulation. Reanalysis of the data on the prenatally exposed survivors of the atomic bombing of Hiroshima and Nagasaki suggests that severe mental retardation occurs primarily, if not exclusively in the period from the 8th through the 15th week following fertilization. Within this window of vulnerability, the increase in mental retardation appears linear with dose and without threshold. More subtle functional effects also occur as reflected in diminished performance on intelligence tests and in school. These findings and their implications for space travel and regulatory agencies charged with the specification of acceptable risks should not require further elaboration in this article given the focus of the radiobiological presentations at this meeting.