Showing papers in "Journal of Developmental and Physical Disabilities in 1998"

Individual and Group Psychotherapy Approaches for Persons with Mental Retardation and Developmental Disabilities

Abstract: Although the prevalence of mental illness among persons with mental retardation and developmental disabilities (MR/DD) is well documented, most psychotherapists have not expanded their practices to include patients from this population. The majority of reports in the early literature documented that people with MR/DD could benefit from treatment, and reports from recent years continue to inspire optimism about the effectiveness of psychotherapy. To some extent, many professionals have favored the use of training groups (e.g., social skills training) over group therapy, and this is unfortunate as the therapeutic value of groups has a powerful, generalized effect promoting self-confidence and improvements in mental health. Those that have worked with patients who have MR/DD have, however, found that a standard list of adaptations can be applied by psychotherapists interested in working with this population, independent of theoretical orientation and training background. It is imperative that psychotherapists be encouraged to treat patients with MR/DD and be given the information to successfully adapt their skills for work with this population.

Early Peer Rejection and Aggression: Longitudinal Relations with Adolescent Behavior

Abstract: The purpose of the present study was to examine the longitudinal relations between peer nominations for aggression and rejection in first grade, and aggressive behavior, pyschological-well being, and academic achievement in early adolescence. We found that peer nominations of aggression as early as the first grade are predictive of multiple indicators of aggressive behavior in early adolescence, particularly for boys. Early peer rejection also appears to make a unique contribution to adolescent aggressive behavior and psychological wellbeing in the form of depressive symptoms. For girls, peer rejection also appears to be linked to poorer academic achievement. The present findings support the need for early interventions with aggressive and rejected children. Future research is needed to further delineate the processes by which early peer rejection and aggression are linked to later outcomes.

Teachers' Personal Concerns About Including Children with a Disability in Regular Classrooms

Abstract: Regular class teachers are increasingly being asked to accommodate children with intellectual and physical disabilities in their regular classrooms. This research in Western Australia considers the personal concerns that regular class and special education teachers entertain regarding inclusive educational practices. It is proposed that an increased understanding of teachers' concerns regarding inclusive practices will provide a substantial base upon which to implement new methodologies for inclusion and improve the likelihood of the effectiveness of such practices.

Assessment and Treatment of Mood Disorders in Persons with Developmental Disabilities

Abstract: This article reviews the gradually emerging literature on the diagnosis and treatment of major depression and mania in persons with developmental disabilities. By analyzing prevalence data in the general population and large samples of people with mental retardation, the tendency to underdiagnosis mood disorders becomes apparent. The utility of a method of assessing symptomatic behaviors, which reflect the underlying depressive and manic symptoms, is demonstrated in individuals not able to self-report. A literature review on treatment of mood disorders in persons with developmental disabilities reveals virtually no research on psychotherapy and a modest number of case reports on the successful use of psychopharmacology.

Assessing Conditional Use of Graphic Mode Requesting in a Young Boy with Autism

Abstract: The present study focused on conditional use of generalized requesting in a 6-year-old boy with autism and severe communication impairment. Conditional use was defined as pointing to a generalized request symbol “WANT” when preferred items were placed out of reach, but reaching directly for items that were within reach. Baseline observations indicated that the child reached for, but did not request each of three preferred objects. Generalized requesting was acquired during the subsequent intervention phase. Conditional use was then assessed when preferred items were presented within reach and then out of reach. The child frequently pointed to the “WANT” symbol even when the preferred item was within reach, suggesting overgeneralization of requesting. Conditional use was then established by alternating placement of items on a trial-by-trial basis and with differential reinforcement for reaching and requesting. Results highlight the need to assess conditional use of augmentative communication.

Obesity and Developmental Disabilities: Pathogenesis and Treatment

Abstract: In this paper, we review information and data relating to the confluence of mental retardation and obesity. The paper is divided into four sections. In the first section, a description of the major syndromes associated with both mental retardation and obesity is presented, as well as a brief review of the association of obesity with “general” mental retardation. In the second section, information on the treatment of obesity in individuals with mental retardation is presented. In the third section, we describe how the occurrence of syndromes involving both mental retardation and obesity can be used to map genes that may influence body weight regulation in the general population. Fourth and finally, suggestions for future research are provided.

Defining the Savant Syndrome

Abstract: Current uses of the term (idiot) savant are reviewed. In contrast to the original use of the term, which emphasized certain kinds of exceptional skill and general mental deficit, recent usage has expanded to include a variety of disabling conditions and levels of exceptionality. It is suggested that the implications of any particular study depend upon a careful documentation of the level of skill present and the nature of the accompanying deficit. A conceptual approach is outlined which compares working definitions of “savant” with those of “learning disability.”

Treatment of Self-Injurious Hand-Mouthing in a Child with Multiple Disabilities

Abstract: A 15-year-old boy with multiple disabilities was treated for self-injurious hand-mouthing that appeared to be reinforced by automatic sensory reinforcement. The treatment program combined differential positive reinforcement and contingent response immobilization and was evaluated using a multiple baseline across settings design. The child's frequency of hand-mouthing was reduced rapidly as an outcome from treatment. The procedures represent a relatively benign approach toward a challenging behavior displayed by many children with developmental disabilities. Issues of treatment formulation and implementation are discussed.

Choice Availability and Persons with Mental Retardation: A Longitudinal and Regression Analysis

Abstract: Service delivery systems for persons with disabilities have undergone vital changes recently, and issues of quality of life and choice availability remain at the forefront of concern. Preliminary research indicates that choice availability varies across living environments and is related to adaptive and maladaptive behavior in persons with disabilities. The present study sought to replicate and extend previous work in this area by examining, over a 15-month period, 67 persons with severe or profound mental retardation, some of whom were relocated to other living facilities. Regression analyses with 122 participants were also conducted to identify which aspects of choice availability are best predictive of adaptive and maladaptive behavior. Marked changes in choice availability and behavior characterized only those persons relocated during the study. In addition, choice availability was found to be strongly related to adaptive but not maladaptive behavior. Results are discussed with recommendations for direct-care staff and researchers.

Mild Retardation, Academic Achievement, and Piagetian or Psychometric Tests of Reasoning

Abstract: Unidimensional classification, unidimensional seriation, and number conservation were measured for 80 elementary school children diagnosed as having mild mental retardation. Scores on the Slosson Intelligence Test (SIT), Peabody Picture Vocabulary Test (PPVT-R), and Peabody Individual Intelligence Test (PIAT) were obtained for the same children. Correlations between scores on the Piagetian and Slosson measures of reasoning ability ranged from .56 to .85, and were generally higher for mental age than IQ. Correlations between the Piagetian measures and the vocabulary the children had achieved as measured by the PPVT-R ranged from .61 to .80. Scores on the PLAT achievement measure correlated .57 to .73 with the Piagetian measures. This PIAT achievement measure correlated .72 with SIT MAs. The correlation between the SIT MA and PPVT-R was .88. Raw scores on the PPVT-R and PIAT produced a correlation of .77, an index of convergent validity for these two achievement measures when applied to elementary-school aged children with mild mental handicaps. The SIT had predictive validity for the same population, since both IQ and MA scores correlated with absolute achievement on both standardized measures. The same was true for the Piagetian measures of reasoning ability. The moderate to high correlations between SIT and classification, seriation, and conservation measures indicates that all express important aspects of reasoning for this population. This suggests the possibility of improving some children's reasoning and consequently their academic achievement by helping them to improve their abilities to classify, seriate, and conserve number.

Classification and Diagnosis of Psychiatric Disorders in Persons with Developmental Disabilities

Abstract: This article presents a brief historical overview of psychiatric diagnosis in persons with developmental disabilities, including a review of the relationship between applied behavior analysis and dual diagnosis. The purposes of diagnosis are then outlined. The definitions of developmental disabilities, mental disorder, and dual diagnosis are reviewed and some of the problems when making a psychiatric diagnosis in persons with developmental disabilities are discussed. Special attention is given to the problem of diagnosing mental retardation in persons with mild through borderline mental retardation and to the problem of diagnosing psychiatric disorders in persons with severe and profound mental retardation. Finally, an overview of common issues in the process of collecting and combining information to make a psychiatric diagnosis in persons with developmental disabilities is given.

Efficiency in Programming for Generalization: Comparison of Two Methods for Teaching Expressive Labeling to Preschoolers with Developmental Delays

Abstract: An adapted alternating treatments design was used to compare the efficiency of two methods of programming for generalization. Four preschool subjects with developmental delays were taught expressive identification of object pictures. During Condition I, single exemplars for each of two objects were trained to acquisition successively until generalization criterion was met. During Condition II, five exemplars for each of two objects were trained concurrently until generalization criterion was attained. Efficiency was measured by comparing the following sets of data for each treatment condition: (a) number of trials/training sessions through acquisition and generalization criteria, (b) rate of errors during acquisition, and (c) total instructional time through generalization criterion. Overall, data indicate that training exemplars concurrently resulted in both faster acquisition and generalization, although the total percentage of errors was greater.

Family Attitudes to Deinstitutionalization Before and After Resettlement: The Case of a Scandinavian Welfare State

Abstract: North American research tends to show that the families of people with developmental disabilities oppose deinstitutionalization, but that they change their minds after resettlement has taken place. This paper presents a study of family attitudes to similar service changes in a political and social context rather different from North America: A Scandinavian Welfare State. It is based on Norwegian data on family attitudes and on resident living conditions before and after facility closures. The U.S. pattern of initial opposition and “after the fact” support is largely replicated. Family attitudes and attitudinal changes are related to characteristics of the resident, the respondent (relative), the old services, and the new services; none of which appear to be good predictors of family attitudes. Family participation in the resettlement process is briefly described and related to attitudes. Results are discussed in relation to problems of democracy/paternalism and families' general readiness to prefer current services.

Community Habilitation and Integration of Adults with Psychiatric Disorders and Mental Retardation: Development of a Clinically Responsive Environment

Abstract: Ten individuals with mental retardation and psychiatric disorders who failed in their community placements due to aggression, property destruction, and suicidal ideation were provided an environment emphasizing a network of mental health and developmental disabilities services. The focus of programing was the application of psychiatric rehabilitation principles and environmental behavior support strategies. Components of the treatment model included goal-setting, comprehensive case management, social skills training, positive reinforcement, crisis intervention, competency-based skills teaching, medication monitoring, data-based outcome measurement, and community-living arrangements. Results indicated that in contrast to their preintervention status, all individuals demonstrated significant reductions in targeted behaviors, maintained extended placement within the community without emergency hospitalizations, developed effective and adaptive social skills, secured job placement, and reported satisfaction with their quality of life.

The Effects of Technology-Enhanced Anchored Instruction and Situated Learning on Preservice Teachers in a Special Education Methods Course: An Exploratory Study

Abstract: This study measured the effects of a technology innovation termed anchored instruction or integrated media on the quality of examples used by students to support their answers on essay tests. Potential affects of anchored instruction on the ability of the students to remember examples of teaching strategies and student satisfaction were also measured. Results suggest the anchored instruction improves the quality of work for those students who received “B's” and “C's” in the course, but had little effect for those receiving “A's.” Student satisfaction relating to the anchored instruction was high. A focused interview of four of the 13 students who participated was conducted after student teaching. The information from these students suggests that the anchored instruction helped them to maintain the visual images over time and to better understand the instructional strategies learned during the course.

The Effects of Funding Packages on the Outcomes of Integration and Independence of Adults with Developmental Disabilities in Two Rural States

Abstract: This study presents a method for measuring outcomes, and for making comparisons between funding packages and between states about the effectiveness of programs in encouraging integration and independence, while controlling for potentially confounding factors. Adults with developmental disabilities, (N = 3,291), were served in two very rural Western states, and in a medium-sized Midwestern city. Information about the individuals served was taken from the Inventory for Client and Agency Planning (ICAP); fiscal information about the types and amounts of funding, provider and geographic information factors were used to explain the outcomes. Analyzing the combined data with analyses of covariance to control for possibly confounding factors, it was found that federally-funded people are more likely to be involved in the more restrictive living and day settings than people supported by state general funds. Residential independence was highest for people with state funding, intermediate for those paid by Home and Community Based (HCBS) waivers, and lowest for those living in Intermediate Care Facilities for the Mentally Retarded (ICFs/MR). Significant differences in independence between HCBS and ICF/MR were not substantiated for daytime settings, however. The disability level of the individual served was the best predictor of independence. Factors used in the study explained 85% of all of the variance in residential independence and 52% for daytime independence. The methodology shows value in establishing clear outcome-based quality measures, and doing so economically since it uses existing databases.

Ecobehavioral Treatment of Challenging Behaviors

Abstract: Presented here is a discussion of the ecobehavioral model in treating challenging behaviors of adults with psychiatric disorders and developmental disabilities The history and definition of the term “ecobehavioral” is presented Research, case studies, and case examples are provided to demonstrate the successful use of the ecobehavioral model in reducing challenging behaviors Procedural variations, advantages, and limitations of an ecobehavioral approach toward treatment are discussed

Behavioral Assessment, Analysis, and Support in a Psychiatric Partial Hospitalization Program for Adults with Developmental Disabilities

Abstract: This article describes the objectives and operations of a behavioral psychology service within a partial hospitalization program for adults with psychiatric disorders and developmental disabilities. Partial hospitalization programs are an effective model of psychiatric service delivery but are not common for patients with mental retardation/mental illness. Phases of intake behavioral assessment, treatment planning and implementation, and discharge are described with an emphasis on functional assessment, data-based accountability, outcome measurement, and positively oriented behavioral support. The article concludes with a discussion of challenges which confront the design and application of behavior analysis procedures within the context of a psychiatric partial hospitalization program.

Use of Bayley Scales in Individuals with Profound Mental Retardation: Comparison of the First and Second Editions

Abstract: Assessment of individuals with profound mental retardation is complicated by the limited number of instruments available. Our experience has been to use the Bayley Scales of Infant Development to obtain an estimate of developmental level. When comparing the first and second editions, we have found a decline in functioning for residents in instances where there has been no medical or neurological reason to account for such decline. Our results show that raw scores and age equivalents are lower with administration of the second edition of the scale. Clinicians should report a range of scores and functioning, rather than following a strict basal and ceiling rule for administration.

Case Report: The Effects of Selective Serotonergic Reuptake Inhibitors Combined with Behavioral Treatment on Self-Injury Associated with Lesch-Nyhan Syndrome

Abstract: A 6-year-old African-American male child with Lesch-Nyhan syndrome participated. Because of the occurrence of unmanageable self-injurious behavior (SIB) in a group home, “James” at the age of 3.5 years was admitted to a large residential facility for persons with mental retardation. A behavior treatment program was implemented soon after admission and produced a large decrease in SIB; however, rates of SIB remained clinically unacceptable and a danger to him. The program consisted of differential reinforcement, extinction, and noncontingent protective restraint. Because SIB may be caused by decreased serotonergic activity, open trials of serotonergic drugs in combination with a serotonergic diet were conducted. The use of a serotonergic diet alone resulted in no change in SIB. Dose-dependent reductions in SIB occurred during paroxetine and sertraline phases, suggesting some benefit in the use of serotonergic drugs.

Automatic Processing: Implications for Job Training of Individuals with Mental Retardation

Abstract: Historically, individuals with mental retardation have often been designated as being rigid and inflexible. Because of this designation, these individuals are frequently given entry-level jobs requiring repetitive actions, such as assembly-line type tasks. The focus of this review is on issues related to training individuals with mental retardation on these types of tasks. Specifically, the implications of the development of automatic processing and the consequences of automatic processing are discussed in relation to job training.

The Validation of the Transition-to-Work Inventory: A Job Placement System for Workers with Severe Disabilities

Abstract: The reliability and validity of the Transition-to-Work Inventory (TWI; Friedman et al., 1996), which is designed to diagnose worker/job fit problems for individuals with severe disabilities, was assessed. Worker/job analyses were conducted using the TWI for 64 workers with severe disabilities, in 35 jobs at 11 different organizations. These analyses were performed by supported employment staff members and other job-content experts. Worker's capabilities (as determined by the worker analysis) and the job's requirements (as determined by the job analysis) were directly compared to each other to determine potential “target item” problems for the worker (i.e., items designating activities that the worker may have difficulties performing). Once target items had been determined, their importance to task performance was rated, and correlations between the items' importance to tasks and actual performance were computed. Results indicated that TWI ratings of both worker capabilities and job requirements were reliable. In addition, the TWI was determined to have predictive validity. The more important the worker's target items were rated for task performance, the greater were the decreases in the worker's performance appraisal ratings. Results indicate that specific problems for worker performance can be assessed using this instrumentation.

Some Guidelines for the Use of Stimulus Modifications in Teaching Response Topography to People with Developmental Disabilities

Abstract: The use of stimulus modifications in teaching involves altering the materials of a task in order to simplify its execution. Though their use in teaching stimulus discriminations to people with developmental disabilities has been extensively investigated, less attention has been given to their utilization in teaching response topography. This paper offers some general guidelines about their use for this purpose. In relation to their design, it is suggested that the aim should be to reduce the demands made by task components, to eliminate components, and/or to increase the attentional value of the discriminating features of the response topography. In relation to their application, guidelines are suggested about when they should be employed in conjunction with response prompts; when they should be used, either alone or in conjunction with response prompts, in preference to response prompts alone; whether one or a series of modifications is required; and at what point during teaching should probe trials on the unmodified task be introduced.

Phonologic and Acoustic Analyses of Final Consonant Omission

Abstract: Acoustic analyses have recently been brought to bear on the phonological error pattern of final consonant omission. The results from such acoustic analyses have generally supported the correctness of the phonological analyses. The purpose of this report is to present seemingly conflicting results from a generative phonological analysis and an acoustic analysis of one misarticulating child who omitted word-final obstruents. The apparent conflict is resolved in terms of two possible explanations with differing treatment implications.