Journal of Intellectual Disability - Diagnosis and Treatment

155-163

Authors: Ángel Sánchez Cabeza, Patricia Ruíz de Martín Esteban Corral

Assess the effect that BAT (Bilateral Arm Training) produces on the upper limb motor control in patients with chronic brain injury assessed by the Wolf Motor Function Test (WMFT). Assess if there is a statistically significant correlation between motor control improvement and disability perceived by the Quick Dash questionnaire application. A quasi-experimental study with pre-post treatment measures during three months was performed in a sample of twelve patients with chronic brain injury. Patients received twelve sessions of forty-five minutes from bilateral training with a frequency of three times per week. WMFT and QD were used for the procedure assessment. Outcomes were statistically analyzed by the SPSS v 17.0 software. The study was executed at Polibea. Study´s inclusion criteria were as follows: no serious cognitive deficits, one or both upper limb´s control motor affected, attend to Polibea two times per week and no sensitive aphasia. After the BAT treatment we observed a statistically significant difference on motor control improvement in the WMFT. However the disability perceived through QD was not statistically significant. In conclusion, BAT improves motor control in our patients with chronic acquired brain injury.

169-176

Authors: Prathibha Karanth, Tanya Dash, Tanushree Saxena-Chandhok

This article highlights the transition from a more traditional IQ measure to a profile based approach of assessment, in children with developmental disabilities. Clinically, developmental disorders are heterogeneous conditions, which have made uniformity of assessments across settings, centers and countries elusive. A decade ago, intelligence tests were given priority for assessing children. However, IQ scores had little direct bearing for the planning of intervention. This article highlights an assessment tool that, not only provides a quick understanding of the child's overall skill across eight essential developmental domains, but also offers guidance for intervention planning on the basis of assessment.

Mezquita-Hoyos 124-132

Authors: Guadalupe Elizabeth Morales, Ernesto Octavio Lopez, Claudia Castro-Campos, David Jose Charles, Yanko Norberto Mezquita-Hoyos

Background: This paper aimed to explore the ability of people with Down syndrome (PWDS) in recognizing facial emotion by considering automatic cognitive processing levels of face recognition. Method: A sample of PWDS and participants with typical development (PWTD) participated in a set of two affective priming studies. In each study, participants had to categorize an emotional or neutral target face that was preceded by another emotional face. Stimuli presentation for each facial set (one face after another) was conducted by using an stimulus onset asynchrony (SOA) of 300 ms with the inter-stimulus interval (ISI) set at 50 ms. The first affective priming study manipulated emotion congruency between prime and target emotional faces to explore emotion classification abilities and to identify the cognitive mechanisms underlying automatic recognition of some emotional faces. The second study explored the effect that gender of a face has over categorization of facial emotion and difficulty in recognizing negative facial expressions. Results: The results strongly suggest that not all of the PWDS present difficulties in recognizing negative facial emotions. PWDS' performance pattern in categorizing emotion was similar to that of PWTDs if they had to use broad classification categories (e.g., emotion vs. no emotion). However, differences between both samples occurred if PWDS had to use a specific category task (e.g., classification of happiness, sadness, etc.). Conclusions: At least two emotion information processing styles can be identified in PWDS. Methodological and theoretical implications for exploring the emotional capabilities of people with DS are discussed.

94-100

Authors: Shogo Hirata, Hideyuki Okuzumi, Yoshio Kitajima, Tomio Hosobuchi, Mitsuru Kokubun

Purpose: To investigate the relationship between motor and cognitive control in adults with intellectual disabilities (ID), focusing on two aspects, speed and accuracy. Method: Participants were 62 adults with ID aged 20 to 47 years. Their intelligence quotients (IQ) ranged from 13 to 61. Nine of the adults with ID had Down syndrome, and 8 of the adults had autism. We conducted three tasks: seal affixation task, tray-carrying task, and the Matching Familiar Figures Test (MFFT). The seal affixation and tray-carrying tasks are motor tasks we devised that can separately measure the speed and accuracy of motor control. MFFT is a cognitive control task that can be used to evaluate cognitive styles, such as impulsive-reflective. Results: Adults with ID showed high motor accuracy and similar motor speed regardless of their MFFT performance. That is, discrepancies between motor and cognitive control existed in adults with ID. Conclusions: The results of this study indicate that some types of motor control problem may become unclear with growth. A longitudinal investigation focused on the motor skill development of persons with ID is therefore necessary.

112-118

Authors: Meglena Achkova, Harieta Manolova

The authors make a synthesized overview of the evolution of the understanding of autism in historical context and a critical analysis of the development of diagnostic criteria in the spirit of the Diagnostic and Statistical Manual (DSM). Based on personal research and extensive clinical experience they put forward a number of debatable issues and own views about the nature of autistic disorder by outlining the trends and directions for future research. Discussed is the issue of "core" and "additional" symptoms of autism and the need for comparison of categorical and dimensional data when constructing empirical studies for the autistic population. The article contains reflections on the underlying impairment which, according to the authors, is a disturbance in the processing and integration of the incoming information, especially at the level of filtration of significant and insignificant stimuli and their linking into a mental sequence appearing at different levels and with varying degree of severity. Noted is the importance of the detailed assessment of mental functioning for early diagnosis and individualized targeting of the therapeutic efforts. In this regard is emphasized the need to search for a new paradigm in the methodology of future research on autism that would make possible the comparison of interdisciplinary results and identification of connections between the relevant scientific achievements. Thus it will be possible to identify trends that will bring us closer to revealing the etiology, perhaps will have an impact on the criteria for diagnosis and on the overall construction of future therapeutic strategies.

133-143

Authors: Shirley F. Evans, Leigh E. Tenkku, Tay Kennedy, Roger Zoorob, P. Kevin Rudeen

Fetal alcohol spectrum disorders (FASD) occur as a result of prenatal alcohol exposure and are commonly associated with intellectual disability. Maternal alcohol consumption affects fetal development resulting in numerous lifelong physical, mental, and neurobehavioral abnormalities. To promote prevention of prenatal alcohol exposure and intervention to mitigate alcohol’s postnatal effects, the Centers for Disease Control and Prevention (CDC) provides continuing education to healthcare providers through their FASD Regional Training Centers (RTCs). An online survey evaluated healthcare providers’ perceived competency after training. Cover letters with the survey link were electronically mailed to healthcare providers, who received training between 2002 and 2009 from the Midwest and Southeast RTCs. Eighty-two providers who treated women or children responded to the survey (7.5% response rate). Approximately 86% of providers who treated women have identified women ‘at risk’ for alcohol abuse with 90% indicating they would refer to Substance Abuse or Mental Health Services. However, over 25% perceived lack of training and limited time as barriers in treating women of childbearing age for at-risk drinking. Over 90% of providers who treated children reported feeling competent in recognizing FAS and other alcohol-related effects. Yet, only 23% of providers for children reported using FASD diagnostic schema and were more apt to use growth charts (70%) rather than lip philtrum guides (58%) or palpebral fissure length measurements (50%), tools typically used in FAS determination. These results suggest a need for training to focus on methodology that assists providers to easily incorporate screening, diagnostic, and treatment procedures into their daily practice.

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.