Volume 17, Number 11, March 31, 2008

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Book - Item H1101 

N. Bouras, et al.

Cambridge, UK: Cambridge University Press, 2007, 440 pages

Entirely revised and updated, this new edition of a well-received and successful book provides the essentials for all those involved in the fields of intellectual, developmental and learning disabilities and mental retardation, drawing both on clinical experience and the latest research findings. An international, multidisciplinary team of experts cover the available literature in full and bring together the most relevant and useful information on mental health and behavioural problems of people with intellectual, developmental and learning disabilities and mental retardation. In addition, this book highlights the principles behind clinical practice for assessment, management and services. It offers hands-on, practical advice for psychiatrists, psychologists, nurses, therapists, social workers, managers and service providers.

Contents:

Reprint - Item H1102

Psychological Problems In Children With Cerebral Palsy:
A Cross-Sectional European Study

J. Parkes, et al.

Journal Of Child Psychology And Psychiatry, 2008, Vol. 49, No. 4, 405-413 (Reprint # 6385)

Objectives: To describe psychological symptoms in 8-12-year-old children with cerebral palsy; to investigate predictors of these symptoms and their impact on the child and family. Design: A cross-sectional multi-centre survey. Participants: Eight hundred and eighteen children with cerebral palsy, aged 8-12 years, identified from population-based registers of cerebral palsy in eight European regions and from multiple sources in one further region. Results: About a quarter of the children had TDS > 16 indicating significant psychological symptoms, most commonly in the domain Peer Problems. Better gross motor function, poorer intellect, more pain, having a disabled or ill sibling and living in a town were independently associated with TDS > 16. Among parents who reported their child to have psychological problems, 95% said they had lasted over a year, 37% said they distressed their child and 42% said they burdened the family at least ‘quite a lot’. Conclusions: A significant proportion of children with cerebral palsy have psychological symptoms or social impairment sufficiently severe to warrant referral to specialist services. Care must be taken in the assessment and management of children with cerebral palsy to ensure psychological problems are not overlooked and potentially preventable risk factors like pain are treated effectively. The validity of the SDQ for children with severe disability warrants further assessment.

Reprint - Item H1103

Research-Based Interventions For Children And Youth With A Fetal Alcohol Spectrum Disorder:
Revealing The Gap

S. Premji, et al.

Child: Care Health And Development, 2006, Vol. 33, No. 4, 389-397 (Reprint # 6386)

Background: Alcohol use during pregnancy can result in a continuum of effects including growth deficits, dysmorphology and/or complex patterns of behavioural and cognitive difficulties that influence an individual’s functioning throughout their lifespan. We conducted a systematic review to identify research-based interventions for children and youth with a fetal alcohol spectrum disorder and areas for future study. Methods: We identified the substantive literature by searching 40 peer-reviewed and 23 grey literature databases, as well as reference lists. We hand-searched eight relevant journals, and undertook a systematic search of Internet sites and review of reports and documents received from key stakeholders. Results: Ten intervention studies were identified, of which three were experimental or quasi-experimental, and four were non-experimental. A meta-analysis could not be undertaken because the included studies examined different interventions or outcomes. Interventions targeted in the included studies were as follows: (i) psychostimulant medications; and (ii) Cognitive Control Therapy. The identified studies were limited by very small sample sizes and weak designs. Conclusion: There is limited scientific evidence upon which to draw recommendations regarding efficacious interventions for children and youth with a fetal alcohol spectrum disorder. Clinicians, researchers, service providers, educators, policy makers, affected children and youth and their families, and others need to urgently collaborate to develop a comprehensive research agenda for this population.

Reprint - Item H1104

Fetal Alcohol Spectrum Disorders:
Understanding The Effects Of Prenatal Alcohol Exposure And Supporting Students

J. H. Green

Journal Of School Health, 2007, Vol. 77, No. 3, 103-108 (Reprint # 6387)

Fetal alcohol spectrum disorders (FASD) affect a significant number of children in this country. This article addresses diagnostic issues related to fetal alcohol syndrome (FAS) and other alcohol-related disabilities, discusses associated features and behaviors of FASD, and introduces interventions to support children with FASD in school settings. A comprehensive review of FAS and FASD literature as it relates to school functioning was conducted. Prenatal alcohol exposure can result in a broad range of negative developmental consequences, including deficits in cognitive and academic functioning, psychological disorders, behavioral problems, and difficulties with independent living. Children with prenatal alcohol exposure are at risk for a spectrum of difficulties at school. Successful interventions will need to balance the use of environmental modifications, immediate and meaningful positive and negative consequences for behaviors, and opportunities to teach children skills to monitor and modify their behavior.

Reprint - Item H1105

Sobering Thoughts:
Town Hall Meetings On Fetal Alcohol Spectrum Disorders

D. M. Ryan, et al.

American Journal Of Public Health, 2006, Vol. 96, No. 12, 2098-2101 (Reprint # 6388)

Prenatal exposure to alcohol is one of the leading causes of preventable birth defects and developmental disabilities. During the past 30 years, fetal alcohol spectrum disorders (FASD), including fetal alcohol syndrome, have gradually begun to attract attention. However, awareness and understanding of the disorders remain low, and people who are affected are seriously underserved. The FASD Center for Excellence held a series of town hall meetings in 2002 and 2003 to gauge the issues surrounding FASD nationwide. On the basis of its findings, the center proposed a series of recommendations to begin to remedy some of the deficiencies that were identified.

Reprint - Item H1106

Persons With Developmental Disability Exposed To Interpersonal Violence And Crime:
Approaches For Intervention

G. Focht-New, et al.

Perspectives In Psychiatric Care, 2008, Vol. 44, No. 2, 89-98 (Reprint # 6389)

Purpose: Psychoeducational and psychotherapeutic interventions, by psychiatric advanced practice registered nurses and caregivers working with people with developmental disabilities exposed to interpersonal violence and crime, are recommended to help the individual resolve the intrapsychic trauma. Conclusions: Persons with developmental disabilities experience the full affective range of the effects of trauma and may benefit from a variety of interventions. What may be different in comparison to other survivors are the ways psychotherapeutic and psychoeducational interventions are adapted so that emotions, resultant actions, and ongoing concerns can be effectively expressed and addressed. Practice Implications: Advanced practice registered nurses have an important role in addressing the sequelae of trauma by employing flexible, creative, and direct therapy with individuals. Additionally significant is provision of educational and supportive measures for the caregivers, who have the potential to generate an ongoing socially therapeutic environment.

Reprint - Item H1107

Learning Among Older Adults With Lifelong Intellectual Disabilities

G. M. Boulton-Lewis, et al.

Educational Gerontology, 2008, Vol. 34, No. 4, 282-291 (Reprint # 6390)

This article includes a description of conceptions of aging and engagement with learning for 16 older people (52 to 80 years; mean age 62 years) with a lifelong intellectual disability. The sample also included the care workers and family member/friend. The older people had sufficient verbal skills to participate in the interviews. Half the sample was in Queensland and half in Victoria. The data are from research that describes a model of active aging for people who have a lifelong intellectual disability. The interviews were transcribed and analyzed using phenomenography to identify conceptions of aging and an inductive determination of engagement with learning. Semihierarchical conceptions of aging were identified including no conception, limited awareness, awareness of aging effects, aging as requiring preparation, and an overall understanding. Engagement with learning was classified as low, medium, or high. Most learning occurred at a low level involving observation and copying rather than formalized education. The relationship between participants’ conceptions of aging and engagement with learning are discussed. Although there is information in the literature about what older people believe constitutes active aging, there is little about active aging and
learning for people with a lifelong intellectual disability.

Reprint - Item H1108

Persons With Developmental Disabilities Exposed To Interpersonal Violence And Crime:
Strategies And Guidance For Assessment

G. Focht-New, et al.

Perspectives In Psychiatric Care, 2008, Vol. 44, No. 1, 3-13 (Reprint # 6391)

Purpose: Persons with developmental disabilities are frequently exposed to interpersonal violence and crime, directed at themselves and others, and are in need of specific interventions tailored to their unique needs. Conclusions: What may be different in comparison to other survivors are the ways therapeutic interventions are adapted so that fears and ongoing concerns can be effectively expressed and addressed. Practice Implications: Persons with developmental disabilities may benefit from a variety of interventions in the treatment of intrapsychic trauma after exposure to interpersonal violence and crime.

Reprint - Item H1109

Recognizing The Role Of Parents In Developmental Outcomes:
A Systems Approach To Evaluating The Child With Developmental Disabilities

L. S. Head, et al.

Mental Retardation And Developmental Disabilities Research Reviews, 2007, Vol. 13, No. 4, 293-301 (Reprint # 6392)

When developmental concerns arise in children, a clinical assessment focuses on the child’s developmental profile to achieve three goals (1) determine diagnosis, (2) develop interventions, and (3) evaluate progress. Parents often have needs during this time that are not addressed by professionals because of the exclusive focus on the child during the evaluation. In this article, we suggest that clinicians take a "systems" approach to the assessment process by recognizing how the well being of family members can impact a child with a developmental disability. We review systems theory and its conceptualization of individual functioning and discuss how parental well-being differs according to child diagnosis. Finally we suggest a systems-based model to use during the assessment process.

Reprint - Item H1110

Psychological Impact Of Illness Intrusiveness In Epilepsy - Comparison Of Treatments

S. Poochikian-Sarkissian, et al.

Psychology, Health And Medicine, 2008, Vol. 13, No. 2, 129-145 (Reprint # 6393)

Chronic illnesses are associated with multiple stressors that compromise quality of life (QOL). Implicit in many of these is the concept of illness intrusiveness, the disruption of lifestyles and activities attributable to constraints imposed by chronic disease and its treatment. This study tested the illness intrusiveness theoretical framework in epilepsy and compared the impact of pharmacological and surgical treatments on illness intrusiveness and QOL. Cross-sectional data compared three epilepsy groups (N = 145): (a) 40 patients admitted for presurgical evaluation to an Epilepsy Monitoring Unit; (b) 52 patients treated pharmacologically; and (c) 53 post-surgical patients. Illness intrusiveness differed significantly across epilepsy patients with the differences primarily related to seizure control. Illness intrusiveness varied inversely with seizure control (p < .05). Seizure freedom, whether achieved by surgical or pharmacological treatments, was associated with maximal reduction of illness intrusiveness. Increased illness intrusiveness correlated significantly with decreased QOL and increased depressive symptoms. Perceived control over diverse life domains correlated positively with QOL and psychosocial outcomes. Path analysis supported the validity of the illness intrusiveness theoretical framework in epilepsy. Illness intrusiveness is an important determinant of the psychosocial impact of epilepsy and its treatment. Effective pharmacological or surgical treatment may reduce illness intrusiveness in epilepsy. Findings also offer encouragement that QOL in epilepsy, as in other chronic conditions, may be enhanced by multidisciplinary bio-psychosocial efforts. Health care providers should consider multifaceted interventions to reduce illness intrusiveness and, thereby, improve QOL.

Reprint - Item H1111

Advancements In The Treatment Of Epilepsy

B. A. Leeman, et al.

Annual Review of Medicine, 2008, Vol. 59 No. 1, 503-523 (Reprint # 6394)

Diagnostic tools and treatment options for epilepsy have expanded in recent years. Imaging techniques once confined to research laboratories are now routinely used for clinical purposes. Medications that were unavailable a few years ago are now first-line agents. Patients with refractory seizures push for earlier surgical intervention, consider treatment with medical devices, and actively seek nonpharmacologic alternatives. We review some of these recent advances in the management of epilepsy.

Reprint - Item H1112

Prevalence, Characteristics And Causes Of Aggressive Behaviour Observed Within A Neurobehavioural Rehabilitation Service:
Predictors And Implications For Management

N. Alderman

Brain Injury, 2007, Vol. 21, No. 9, 891-911 (Reprint # 6395)

Primary Objective: To describe the characteristics and determinants of aggressive behaviour observed within a neurobehavioural unit. Research Design: Statistical analysis of a database of routinely administered clinical measures, including the Overt Aggression Scale-Modified for Neurorehabilitation. Methods And Procedures: Records of aggressive behaviour shown by 108 patients over 14 days were studied. Patient characteristics were also captured using 23 items from the Rehabilitation Institute of Chicago-Functional Assessment Scale. Four factors were identified: ‘communication’, ‘cognition/function’, ‘neurobehavioural disability’ and ‘mood and self-esteem’. Relationships between patient characteristics, external factors and their interactions with aggression were examined. Main Outcomes And Results: Many (5548) episodes of aggression were recorded. Whilst most comprised verbal aggression, 729 physical assaults were made on others. Aggressive behaviour typically followed staff prompting or no obvious antecedent. Medical intervention was rare, most aggression was managed by staff not reinforcing this behaviour. Over 80% of physical assaults were made by people rated as having severe symptoms of neurobehavioural disability and poor communication. Conclusions: Neurobehavioural units require sufficient staff resources to engage patients in purposeful activities as these were associated with the least severe aggression. Despite increased OAS-MNR usage, a standardized methodology for investigating aggression is required to ensure compatibility between datasets.

Reprint - Item H1113

Framing The Public Health Of Caregiving

R. C. Talley, et al.

American Journal Of Public Health, 2007, Vol. 97, No. 2, 224-228 (Reprint # 6396)

Caregiving has only recently been acknowledged by the nation as an important topic for millions of Americans. A psychological or sociological approach to caregiving services has been most often applied, with little attention to the population-based public health outcomes of caregivers. We conceptualize caregiving as an emerging public health issue involving complex and fluctuating roles. We contend that caregiving must be considered in the context of life span needs that vary according to the ages, developmental levels, mental health needs, and physical health demands of both caregivers and care recipients.

Reprint - Item H1114

A Review Of Critical, Person-Centred And Clinical Approaches To Reminiscence Work For People With Intellectual Disabilities

J. Van Puyenbroeck, et al.

International Journal Of Disability, Development And Education, 2008, Vol. 55, No. 1, 43-60 (Reprint # 6397)

The present article reviews reminiscence research with regard to people with intellectual disabilities. Although the term "reminiscence" is not often used in intellectual disability research, the concept offers a useful framework for charting the different approaches in literature, thanks to its multidisciplinary character and eclectic theoretical background. Three main perspectives are identified: a critical approach, in which reminiscence is stimulated to let people with intellectual disabilities become critically aware of their past; a person-centred approach, in which reminiscence serves informational and social purposes; and a clinical approach, in which reminiscence is presented as an alternative diagnostic instrument and/or a "low-threshold" narrative counselling method for people with intellectual disabilities. The three approaches differ in language use, aims, and backgrounds, but there is congruency amongst the approaches in that reminiscence work can strengthen the identity of people with intellectual disabilities, raise self-esteem, and enhance social contacts. The review concludes that a more balanced view of reminiscence, better methodological procedures, and more evaluation studies on the effect and process of reminiscence work are needed in future research.

Reprint - Item H1115

Community-Based, Consumer-Directed Services:
Differential Experiences Of People With Mild And Severe Intellectual Disabilities

S. L. Neefy-Barnes, et al.

Social Work Research, 2008, Vol. 32, No. 1, 55-64 (Reprint # 6398)

Two intervention concepts have become widely accepted in the developmental disability field: (1) that residential services should be provided in the person’s own home and (2) that consumers should have choice in services. Yet, there has been little empirical research to support these practices. In particular, it is unclear whether some individuals are better able to gain access to services delivered under this practice framework and experience more benefits than others. This study uses data from Washington State’s National Core Indicators 2002 consumer survey to address these questions. Two subgroups, the first having a
severe intellectual disability (ID) profile (n = 101) and the second having a mild ID profile (n = 220), were identified in the data set and compared. Individuals with mild intellectual disabilities experienced greater choice and smaller residential settings than did those with severe intellectual disabilities. Next, a multigroup path analysis assessed paths from size of living unit and consumer choice to community inclusion, revealing significant relationships between variables for the severe group but not for the mild group.

Reprint - Item H1116

Women With Disabilities:
Cultural Competence In Rehabilitation Psychology

M. E. Banks

Disability And Rehabilitation, 2008, Vol. 30, No. 3, 184-190 (Reprint # 6399)

Women with disabilities represent a cultural group with specific issues. Rehabilitation psychologists are encouraged to familiarize themselves with some of those issues in order to deliver culturally relevant treatment. An overview is provided of psychological guidelines for attending to cultural issues in assessment, treatment, and research. Broad issues faced by women with disabilities are described. Disability-specific safety concerns are discussed with attention to ways in which they might be addressed by rehabilitation psychologists.

Reprint - Item H1117

Improving Evaluation Of Psychotropic Medication For Adults With Developmental Disabilities Living In Community Settings

D. Blough, et al.

Behavioral Interventions, 2006, Vol. 21, No. 2, 73-83 (Reprint # 6400)

We evaluated the effectiveness of a series of staff management and training interventions to increase the use of objective data collection in the evaluation of psychotropic medications. Participants were 110 direct care staff, and 19 supervisors. Individuals served were adults with developmental disabilities who were residing in community group homes and apartments. Baseline data were collected on (1) staff data collection, and (2) graphing data for behavior problems directly related to the prescription of psychotropic medications. Following two ineffective antecedent interventions, didactic staff training was instituted in a multiple baseline across data collection and graphing. When staff training was followed by direct feedback to first line supervisory staff, both data collection and graphing increased. A subsequent maintenance condition, in which feedback was thinned, was effective in maintaining increased data collection and graphing.

Reprint - Item H1118

Development Of A Community-Based Sex Offender Treatment Programme For Adult Male Clients With A Learning Disability

H. Garrett

Journal Of Sexual Aggression, 2006, Vol. 12, No. 1, 63-70 (Reprint # 6401)

This article describes the development of a community-based sex offender treatment programme for learning disabled clients (CB-SOTP-LD), the Keep Safe Programme (KSP), by the Learning Disabilities Team of County Durham and Darlington Priority Services (CDDPS) NHS Trust. The aim of this paper, by the treatment lead, is to share experiences of successfully setting up CB-SOTP-LD and to offer suggestions to those undertaking similar tasks in the future.