Journal of Intellectual Disability - Diagnosis and Treatment

3-16

Authors: Lina Slim, Genevieve Pinto Zipp

Increased prevalence of Autism Spectrum Disorder (ASD) has generated higher special needs enrollment in schools requiring teachers and therapists to acquire, incorporate and implement specialized strategies needed to address unique educational and behavioral challenges facing children diagnosed with ASD. Budget cuts have generated a shortage of qualified professionals with expertise in autism interventions. Currently, staff training is minimal, ineffective or lacking on how to do acquire these skills. More effective staff training may provide an avenue for addressing this shortage. This study investigates the impact that an Interprofessional Staff Training Procedure (STP), consisting of Video Self‐Monitoring (VSM), Performance Feedback (PF) and Reflection (R) with and without Mentoring has on sustained and generalized teacher performance on two Dependent Variables – application of the Learn Unit (LU) and Rate of Effective Instruction (ROI). An exploratory study was conducted with 10 female teachers instructing 3‐5 year old autistic children in two private schools utilizing principles of Applied Behavior Analysis. Teacher performance on LU and ROI was evaluated after: Phase 1 – 2‐hour workshop; Phase 2 – training period using STP with and without Mentoring and Phase 3 – follow‐up period when STP and Mentoring are removed. While the STP appeared to enhance teacher performance and sustainability of procedural integrity, the greatest and most consistent improvement in performance was observed among teachers who received STP plus Mentoring as opposed to STP alone. Findings revealed that adding Mentoring to an existing STP appears to enhance teacher performance and Procedural Integrity with sustainable outcome.

25-28

Authors: Caren M. Cajares, Carolyn M. Rutledge, Tina S. Haney

Purpose: Individuals with intellectual and developmental disabilities (IDD) suffer from poor oral hygiene and periodontal disease that may predispose them to systemic diseases. In order to receive dental care, the assistance of a certified registered nurse anesthetist (CRNA) is often needed. The role of the CRNA is to provide sedation to reduce the high level of anxiety demonstrated by many individuals with intellectual disabilities in the dental suite. However, this can become a challenge with patients that are anxious when they arrive. The purpose of this paper is to describe an interprofessional dental team that added a certified therapy dog and handler to reduce anxiety of individuals with IDD when they arrive in the dental suite. Methods: A convenience sample of 30 individuals with intellectual disability seen for dental care in an outpatient setting met with a therapy dog prior to receiving preventative dental care. Comparisons were made between observed anxiety levels and behaviors measured by the ADAMS (anxiety scale) and a researcher-developed behavior tool prior to and after the interaction with the therapy dog. Results: This program suggested that the addition of the therapy dog to the interprofessional team prior to sedation decreased anxiety levels and improved the behavioral outcomes of the individual with intellectual disabilities. Conclusions: The incorporation of a certified therapy dog and handler as part of an interprofessional healthcare team in the dental suite may pay great dividends in improving the compliance and comfort of the individual with intellectual and developmental disabilities during dental care visits.

41-43 PDF

Authors: Pat Frankish

The service is providing supported living for a number of people, male and female, age 21 to 55, who all have intellectual disability and a range of extra needs. These include physical disability, communication difficulties, trauma related personality difficulties, self-harming behaviour and aggression towards others. They are all perceived to have emotional developmental needs, all having suffered traumatic experiences in early childhood, causing developmental delay. All have difficulties with relationships associated with attachment disorders. All direct support staff are trained in models of emotional development and how to assess the emotional level, which leads to identifying the needs. Managers of services are alto trained to support the staff to provide the level of support needed, and to understand the systemic effects of trauma so as to be able to provide trauma-informed-care. The training, supervision, support and individual therapy for clients, where needed, is provided by psychologists and psychotherapists trained in Disability Psychotherapy. The comprehensive approach allows people with very complex and distressed behaviour to live in ordinary housing in the community. Data is provided on 10 people, the history, the initial problem behaviour and the present position after being provided with the emotionally nurturing environment

55-62

Authors: Ching Fen Hsu

Contextual integration is seldom explored in people with Down syndrome (DS). This study aimed to investigate this ability by comparing causal inferences made by people with DS who were presented with homonyms embedded within sentences and asked to choose which of three interpretations (figurative meaning, literal meaning, or unrelated meaning) was correct. Accuracy was the dependent variable. Each homonym was presented in a scenario familiar to the participants. The results revealed that the participants with DS were the least accurate in responding to figurative meanings and erred most compared to matched controls in chronological age and mental age. It was concluded that people with DS were developmentally delayed in causal inferences and weak central coherence is indeed a syndrome-general phenotype across populations with developmental disorders.

74-78

Authors: Hideaki Kanemura, Masao Aihara

Some epilepsy is, in general, often associated with cognitive problems that can also affect a patient's adjustments. Epileptic seizures result from an excessive, synchronous discharge of cerebral neurons. Interictal paroxysmal electroencephalogram (EEG) abnormalities are regarded as a correlate of persistent pathological neuronal discharges. Thus, correlation between cognitive deterioration and seizure severities/EEG paroxysmal abnormalities should be investigated. We have previously measured frontal/prefrontal lobe volumes using three-dimensional (3D)-magnetic resonance imaging (MRI) in children with benign childhood epilepsy with centrotemporal spikes, epilepsy with continuous spike-waves during slow sleep, frontal lobe epilepsy, and Panayiotopoulos syndrome, and confirmed that longer active seizure period as frequent spike-waves coupled with the occurrence of frequent seizures and presence of status epilepticus may be associated with prefrontal lobe growth disturbance, which relates to cognitive impairments. These findings suggest that seizure severities such as repeated seizures and presence of status epilepticus, and the subclinical paroxysmal EEG abnormalities may induce prefrontal lobe growth disturbance, which leads to intellectual impairments. Achieving better seizure control and remission for paroxysmal EEG abnormalities is a key to improve quality of life (QOL) in children with epilepsy. From the perspective of decreased cognitive problems and improving QOL, management may be required to remit seizures and paroxysmal EEG abnormalities as soon as possible to achieve optimal prognosis in epilepsy.