Journal of Intellectual Disability - Diagnosis and Treatment

1-11

Authors: Moushami S. Kadkol

Sensory Processing (SP) difficulties in children are seen to be increasing in today's world. Quite a few typically developing children are reported to have difficulties in coping with school, home and play environments. Their difficulties are mostly labeled abnormal behaviors and with superficial assessments these children often receive traditional treatments that marginally decrease their problems without giving long term functional gains. Hence their SP dysfunctions make them adopt pathological behaviors as they grow, making them incompetent as compared to their peers. One of the factors behind these children getting unnoticed at an early age is lack of awareness about SP difficulties among the parents, teachers and medical fraternity in India. The other important factors include unavailability of contributory study in this area done on the Indian population and the use of non-normated, generalized evaluation tools done for evaluation of these difficulties. Further less information on what is age related typical SP makes it trickier to differentiate between a typical behavior and SP difficulty. The present study is the first study that would make an effort to understand the age related SP in Indian preschoolers aged 3-7 years. The QOSP includes observations based on literature and theoretical constructs of SP which are graded and made quantitative for ease of administration and interpretation. This study intends to establish the age appropriate expected response and estimate the children posing risk to develop SP dysfunctions. The study further attempts to understand correlations between the different parameters of QOSP and tries to identify those parameters that can be considered red flags for SP difficulties. The results of the study suggest about 3% of children in the typically developing group to be at the risk of having SP difficulties. About 20% are estimated to be having difficulties in at least one of the SP areas when compared with behaviors rated on Sensory Processing Measure. Apart from typically developing children the tool was also used in co-morbid conditions and was found to be useful in understanding the underlying Sensory Processing difficulties. Thus the QOSP can be considered a good measure not only in screening children with suspected sensory processing difficulties but also to gear the intervention program to be streamlined and goal oriented.

21-32

Authors: Margareta Adolfsson, Christina Westerberg, Kerstin Möller

This study investigated present and future everyday life situations (ELS) in home, school, work, and leisure environments for a group of school-aged children with severe disabilities, including complex disorders and a combination of disabilities. The purpose was to explore universal ELS; clarify how the children can be supported in their development of autonomy; and to gather information on potential overall goals for interventions. To make data comparable, all reported ELS were linked to the International Classification of Functioning, Disability and Health, Child and Youth version (ICF-CY) and listed along with information on the setting. Both today, and in the future, recreational activities and participation in school or work were of highest importance, but few reported ELS involved directly interacting with other children. More ELS were predicted to occur outside the home and with a higher degree of autonomy. Therefore, interventions would be focused on the overall goal that children with severe disabilities take initiatives to become independent and to form relationships with others.

42-45

Authors: Paula Approbato de Oliveira, Carolina Fuentes Moreira, Sandra Scivoletto, Cristiana Castanho de Almeida Rocca, Daniel Fuentes, Paulo Jannuzzi Cunha

Background: Studies have shown that stressful events in childhood are associated with impairments in cognitive functions and intellectual disability. Objective: Compare the intellectual functioning in groups of Brazilian children and adolescents with a history of stressful events with lifetime history of depression and without lifetime history of depression. Method: 30 children and adolescents underwent psychiatric evaluation and neuropsychological assessment of estimated intellectual quotient (EIQ), verbal knowledge, and visuospatial skills. Results: 15 patients (50%) had EIQ within the average and 6 had EIQ in the lower average (20%) for Brazilian standardized norms. The other part had at least some degree of intellectual disability and they were classified as: 2 mild mental retardation (6.7%) and 7 borderline (23.3%). Also, half of the sample had at least one lifetime depressive episode, and the performance in EIQ and visuospatial skills was worse in this group. Conclusion: 50% of the children and adolescents with a history of early stressful events and social deprivation had at least some degree of intellectual disability. In addition, a subgroup with history of depressive episodes had worse EIQ performance when compared to those without depression, possibly due to a greater impairment in visuospatial skills. The specific role of impaired right cerebral hemisphere, corpus callosum, and prefrontal cortex associated with depressive disorders and maltreatment should be investigated in further studies.

54-58

Authors: Andrew Donohue, Jack Samuels, Robert Thompson, Clarence Watson, Gerard Gallucci

Individuals with intellectual disability are over-represented in forensic settings, including jails, prisons and forensic psychiatric treatment units. Identification of intellectual disability is important in such settings, especially in light of the implications of intellectual disability in legal issues including competency to stand trial, criminal responsibility and capital sentencing. We examined the utility of a brief test of intelligence (PROFOKS), assessing knowledge of proverbs, fund of knowledge and similarities in a series of 29 inpatients residing in a forensic psychiatric unit. PROFOKS correlated strongly with performance on the Wechsler Abbreviated Scale of Intelligence (WASI), including the full scale, verbal and performance IQs and WASI subscales. The PROFOKS appears to be a useful screening tool in identifying intellectual disability in a forensic psychiatric population

68-82

Authors: Janet L. Dodd, Lauren K. Franke, Jeanette K. Grzesik, Jenna Stoskopf

Legal mandates established under IDEA specify a student must be assessed in all areas of suspected disability. Never is this task more overwhelming than its application to the assessment of a student suspected of a diagnosis of autism. The assessment of an individual suspected of an autism spectrum disorder (ASD) diagnosis is a complex task and is dependent on the integration of information gleaned from assessments conducted by an array of professionals, each with their own distinct area of expertise. The purpose of this article is to introduce the Comprehensive Multidisciplinary Assessment Protocols-Autism Spectrum Disorder, referred to as the CMAPs, as a mechanism for organizing multidisciplinary team assessments. The CMAPs were developed in response to the challenges experienced by school-based assessment teams in developing appropriate and legally defensible assessment plans. The CMAPs provide teams a systematic, organizational, and comprehensive platform to organize the assessment of students across the spectrum of the disorder with the goal of making the task less overwhelming. Each assessment protocol considers the assessment needs of individuals with ASD using their communication skills as a preliminary starting point.

85-95

Authors: Monika Parchomiuk

Author’s research discussed in the following article was aimed at determining which model of intellectual disability is preferred by teachers and students, and what the differences are between these respondents in this respect. The assumptions characteristic for the individual model focused on the person with disability, and in particular, on his or her biological (physical) defects. The defects that caused limitations in functioning were treated as the basis of disability. Professional activities (mostly medical) focused on adjusting to the state of limited functioning, seen in a reductionist way: as accepting the loss of ability or independence. The social model situated the origin of disability in society. In this perspective, it defined disability as the product of specific social and economic structures, and its main interest focused on the problems of oppression and discrimination of persons with disability. Research was carried out with special needs teachers who work with individuals with intellectual disability, teachers working with able-bodied individuals, and students of special pedagogy. The Likert type scale, called “The model of an intellectual disability”, was used to determine the model of intellectual disability. The research had a cognitive goal but also a significant practical goal related to the specialists’ professional training. The article offers general recommendations for shaping attitudes and assessments connected with noticing possibilities in the lives of individuals with intellectual disability, taking into account the influence of environmental factors

103-112

Authors: D.M. Rivera-Oliveros, L.M. Rico-Navarro, M.R. Acosta-Barreto

The aim of this research was to compare the neuropsychological performance of executive functions of school children in a state of malnutrition caused by thinness and risk of thinness and a control group of a District educational institution of the locality of Ciudad Bolívar in Bogotá, Colombia. The research used a descriptive cross-sectional comparative design, where children aged between 7 and 12 years were selected based on the diagnosis of malnutrition. The executive functions assessed were fluency, working memory, problem solving, inhibitory control and cognitive flexibility, through the Neuropsychological Battery for Children [ENI, for its Spanish acronym] and the original version of Stroop and Wisconsin tests. Results showed statistically significant differences in executive functioning between the children with thinness, thinness risk and the control group. The students with thinness showed a low performance in verbal fluency, visual fluency, working memory, cognitive flexibility and inhibitory control compared with students in a state of malnutrition due to thinness risk and those with normal weight (control group). In conclusion, a strong association was found between the effect of child malnutrition and poor performance in executive tasks where there is evidence that executive functioning is more affected in children with malnutrition due to thinness (severe malnutrition) than in children with malnutrition due to thinness risk and in those of the control group.

1-5

Authors: Michael G. King

Attention is drawn to a putative WISC anomaly, specific to the case of Intellectual Disability (ID) IQ assessment. With ID, at best the WISC-IV Picture Concepts (PCn) is not a consistent part of the underlying “ability” represented by Perceptual Reasoning Index (PRI) factor, while at worst the PCn score may be “wrong”. This worst case situation is marked by a “very high PCn score” in an otherwise low profile and this outcome awaits a better interpretation which would be meaningful to the target child with Intellectual Disability. The literature relating to PCn scores in cases of “intellectually different” cohorts shows conflicting published evidence that the sub-test may be either generally lower than the cohort average, or generally above that average, for example in cases of Autism. The present paper proposes that the broad explanation for the PCn anomaly is explained by deriving an answer to each item from a focus on single-feature solution rather than an integrative approach. Future research may clarify the frequency and the meaning of this issue, while the present paper raises a caution in the “standard” interpretation of intellectual disability IQ profiles

15-21

Authors: Saric Edina, Mehmedinovic Senad, Bratovcic Vesna, Ahmetovic Sadik

The aim of the research was to identify psychosocial factors and functional characteristics of the elderly. The survey covered a stratified sample of 60 patients with advanced age, both sexes, living in a family environment. In order to assess functional and psychosocial characteristics of older persons were used: Barthel index test, self-assessment scale for depression, self-esteem Rosenberg scale, PD Questionnaire / Form A scale for assessing the degree of social support, as well as Structured questionnaire of personal data which we collected data on gender, age, marital status, number of children, diagnosis, and self-economic situation. Data analysis was performed using parametric and nonparametric statistics. To determine the latent space of applied variables factor analysis was used. Based on the results of the study there are four (4) factors: Factor of somatopsychic dimensions of existential anxiety, Factor of socioeconomic status, Factor of social status and Health status factor.

28-43

Authors: Durga Roy, Pamela Hoffman, Melissa Dudas, Alan Mendelowitz

Introduction: Aggression is a common behavioral problem seen in patients with intellectual disabilities (ID). The safety and efficacy of second generation antipsychotics (SGAs), mood stabilizers and antidepressants in the management of aggression in these individuals have minimally been studied. This review aims to 1) summarize the studies conducted using second generation antipsychotics, mood stabilizers and antidepressants in treating aggressive behaviors in patient with ID and 2) determine based on the existing literature, which medications have been examined in the most rigorous study design that might suggest the most efficacy for use in clinical practice. Methods: Literature searches using PUBMED Central, CINAHL Plus, PsychINFO, and Embase databases were conducted using the following terms: intellectual disability/disabilities, mental retardation, developmental disability/disabilities, aggression, agitation, behavior disorder, adult, treatment, management. Studies predominantly including children with ID, and autism/pervasive developmental disabilities spectrum disorders were excluded. Analyses were done by class of medication: SGAs, mood stabilizers and antidepressants. The primary outcome measure was reduction in aggressive or self injurious behaviors as measured by each individual study. Results: The most rigorous study designs found using these agents were randomized controlled trials (RCT). A total of 10 RCTs were found, the majority being with risperidone (3) and lithium (2). Treatment with risperidone showed reduction in aggression when compared to placebo in most RCTs with the exception of one study in which risperidone was not better than placebo. Both lithium studies showed reduction in aggression when compared to placebo. The most abundant literature exists in retrospective chart reviews. The most commonly studied agent was risperidone which showed reduction in aggression in majority of the studies. Conclusions: Limited data exists for treatment of aggression in adults with ID. There are very few studies examining pharmacologic agents using RCTs. Given that risperidone and lithium were the most commonly studied agents in the most rigorous experimental design, it is suggested that these two agents prove efficacious for treatment of aggression in patients with ID. Limitations to most of these studies included concomitant psychotropic administration with variations in types and dosing, severity of ID, and the idea that a wide variety of aggression scales were used to assess outcome. Further research with more scientific rigor is required in this field.

55-66

Authors: Carl Chr. Bachke

The background of this research is that few studies on inclusive education internationally, use parents as informants. Even fewer emphasize their positive experiences only. From the Norwegian support organisation for people with intellectual disability 14 parent-members were selected and qualitatively interviewed about their positive experiences with inclusive education for their offspring. By means of a discourse analytic approach their statements about constructive factors were benchmarked with twelve formerly identified literature-based factors in order to investigate which of twelve factors were validated by parental experiences, and to detect possible new factors. The general research question illuminated is which factors do parents of offspring with intellectual disability experience as promoting inclusive education for their children? The results are linked to the following four sub-questions: (1) which of the factors, disclosed in current literature, is frequently mentioned by the informants; (2) which new factors are disclosed; (3) which factor is so frequently mentioned that it is considered substantial; and (4) which factors might be combined, and possibly renamed? The results show that the informants contributed all in all with 18 factors. In the discussions it was argued that five factors were interpreted as new, four factors proved to be substantial, that a fifth factor almost gained equal status, while three more factors were considered vital. These eight factors represented the main answer to the research question, and were summarised in metaphoric model, baptized "the school-house of inclusive education."

74-84

Authors: Jane Squires, Misti Waddell, Kristin Funk, Marisa Macy

Partnering with families to administer and interpret assessments for preschool children with disabilities is a cornerstone of effective early childhood practice. Parent-professional partnership in the assessment process encourages effective intervention practices, including targeting of appropriate goals and using strategies based on family cultural and daily practices. An assessment approach that focuses on collaborative practices between professionals and parents of young children with cognitive and other developmental delays is presented. Two strategies shown to provide a common language for parent and professional communication and facilitate cooperation between professionals and parents are described. Parent-completed developmental screening tests and parent assistance with completion of curriculum-based assessments are also discussed in the context of a tiered approach to intervention. A case study is presented to illustrate these strategies in practice.