基于ICF的智力残疾模式、测量方法及社会支持系统研究

目的探讨基于ICF的智力残疾的定义、结构与术语体系,理论架构、社会支持与服务模式,以及智力残疾的测量方法。方法采用ICF的理论与方法以及美国智力与发展障碍协会(AAIDD)相关理论与方法进行分析。结果智力残疾是以智力功能损伤和适应性行为有显著活动受限为特征的障碍。适应性行为主要表现在概念性、社交性以及实践性适应技能方面,智力残疾发生于18周岁之前。本文还提出了基于ICF的智力残疾服务与支持架构、主要领域与内容,以及基于新的智力残疾定义的测量方法。结论基于ICF的智力残疾理论架构与方法、服务与支持系统以及测量方法符合现代残疾理论架构,为智力残疾的测量、康复、教育与社会服务提供了理论和方法。     

当代智力残疾测量与统计方法和社会支持与服务体系研究

目的研究基于ICF的智力残疾测量与统计方法,以及社会支持和服务体系。方法采用ICF的理论与方法以及文献研究方法进行研究。结果基于ICF的功能和残疾的理论,现代的智力残疾是以智力功能受损和适应性行为显著受限为主要特征,并且发生于18岁之前。基于ICF的智力残疾的理论架构,重构了智力残疾的理论架构,并改进了智力残疾的测量方法,从身体功能与活动和参与方面对智力功能以及适应性行为进行测量,并从环境因素角度分析社会支持与服务体系。本文还讨论了智力残疾率的相关问题。结论基于ICF的智力残疾理论与方法,构建了新的智力残疾的概念、测量与统计方法,并整合了社会支持与服务体系。     

智力残疾人的健康状况与健康服务研究

目的探讨智力残疾人的健康状况、影响因素与健康服务发展状况,为发展智力残疾人的健康服务提供循证支持。方法基于ICF功能和残疾的理论与方法分析智力残疾人主要功能障碍,运用流行病学方法分析智力残疾人的主要疾病、功能障碍表现、致病和致残因素。结果美国智力残疾现患率约为1.1%,中国为0.75%。智力残疾人主要健康问题为超重、肥胖、营养不良、口腔问题、消化系统疾病等;主要功能障碍有认知障碍、孤独症谱系障碍、视觉或听觉障碍、学习障碍、运动障碍、广泛性发育障碍等;因智力残疾导致的继发性障碍会加重在概念技能、社会技能和实用技能等方面的障碍程度。生物学和环境两方面的因素是智力残疾人致病和致残的主要健康风险因素。结论现代健康服务要关注智力残疾人的健康状况与健康行为的特殊性,提升智力残疾人的健康服务能力,提高智力残疾人健康水平。     

轻度智力残疾儿童的自尊与心理地位特征

目的 研究轻度智力残疾儿童的自尊、心理地位特征,以及适应性行为对自尊和心理地位的影响。方法 2019年11月至2020年1月,对上海162例轻度智力残疾儿童进行调查。采用适应性行为评定量表第二版(ABAS-Ⅱ)、Rosenberg自尊量表(SES)和心理地位量表(LPS)进行评价。使用结构方程模型研究适应性行为对自尊与心理地位的具体影响。结果 轻度智力残疾儿童的SES评分为(23.52±5.49),显著低于常模(28.75±4.86) (t = -12.140, P < 0.001);LPS评分为(50.76±11.85)。结构方程模型显示,适应性行为中的概念技能对轻度智力残疾儿童的心理地位有负向影响(B = -0.450, P < 0.05);社会技能(B = 0.480, B = 0.331, P < 0.05)和实用技能(B = 0.490, B = 0.294, P < 0.05)对轻度智力残疾儿童的心理地位和自尊有正向影响。结论 轻度智力残疾儿童的自尊水平略低,心理地位水平达到理论中值。适应性行为中,社会技能和实用技能均对自尊和心理地位有显著的正向影响,概念技能对心理地位有负向影响。     

智力残疾青少年生活技能训练

生活技能的掌握对于促进智力残疾人适应性行为的发展很有帮助,而青春期则是对生活技能进行系统训练的关键时期。生活技能训练应主要从独立生活、寻找并维持工作以及沟通与参与3方面展开,以提高智力残疾青少年的日常生活技能、个人与社会技能、工作技能、人际沟通技能和社会参与技能。为确保有效性,训练的实施应遵循标准的训练程序,选择恰当的训练策略和训练情景。     

基于ICF的智力残疾个别化服务与支持方案设计研究

目的基于ICF的功能和残疾理论与方法,分析智力残疾人的服务与支持需求,建立结构化和标准化的个别化服务支持系统方案。方法采用ICF的理论与方法对智力残疾个别化服务方案的过程进行分析,从智力功能与适应性行为和个体的服务需求入手,构建结构化、标准化的个别化服务支持方案。结果基于ICF的功能与残疾架构,对智力残疾人的功能与服务需求进行系统分析,构建涉及智力残疾人的功能诊断、服务需求报告以及个别化服务支持过程的结构化、标准化服务支持方案。结论运用ICF可以对智力残疾人的功能进行系统分析,对服务与支持需求进行结构化报告,从而构建针对个体功能特点和服务需求的结构化、个别化的智力残疾服务与支持方案,以促进智力残疾人的整体康复。     

心理学视角的成年智力残疾人社会融合工作

随着社会残疾观的变化,如何更好地帮助智力残疾人融入正常的社会生活,不仅仅是特殊教育和残疾人康复事业的热点问题,同样也是心理学家关心的问题之一。为了促进智力残疾人的社会融合,心理学家应该从个体和社会支持系统两个水平为智力残疾人的提供评估、干预和支持,并提出相关的政策性建议。     

应用智力和社会能力评测分类教学提高学生相关智商水平的效应

目的：对广州市番禺区部分中小学生进行智力评测和社会适应能力的评定，分析学习成绩与智力的关系。 方法：于2004—10／2005-06对广州市番禺区的石楼、南沙、鱼窝头镇的28所小学和5所中学提供的538名学习成绩差的中、小学生进行韦氏儿童智力测查及婴儿一初中学生社会生活能力量表的评测，对有智力障碍并达到国务院残疾评定标准的，给予残疾等级评定。 结果：共发放问卷538份，回收有效问卷538份，有效率100％。（1）对538例儿童进行韦氏儿童智力测查及婴儿一初中学生社会生活能力量表测查。结果符合一级智力残疾标准0例；符合二级智力残疾标准的6例，符合三级智力残疾标准的39例；符合四级智力残疾标准的203例。属边缘水平的216例；属正常的74例。（2）年龄大的符合智力残疾的比例较高，学习成绩差的学生中男生比女生多，但符合智力残疾标准的男女比例差异无显著性。（3）符合智力残疾标准的有248例，智商平均值分别为：语言商59．6；操作商67．3；全量表64．4。 结论：对成绩差的学生作智力评测，给予分类教学，是提高教学质量所必要的。从小抓好教学。特别是抓好智力正常和接近正常的男生的学习是很重要的，充分发挥智力残疾学生的操作能力较强的优点，从操作诱发他们记忆、学习和工作的能力，达到教育康复的目的。     

国际功能、残疾和健康分类架构在智力残疾标准制订中的应用探讨

智力残疾(intellectualdisability) ,又称智力落后(mentalretardation) ,其标准及分类是随着人们对智力残疾本质的认识而不断完善起来的。智力残疾的概念经历了一个长期演化的过程,因此,关于智力残疾的标准及分类也不断被修正。自195 9年美国智力落后学会(AmericanAssociationonMentalRetardation ,AAMR)把适应性行为引入智残的诊断以来,理论界对智力和适应性行为作为智残标准已无大异议,但在适应性行为的结构问题上却一直存在着争论[1] ,因此,智力残疾的标准及分类仍然是一个悬而未决的问题。2 0 0 1年5月,第5 4届世界卫生大会通过了《…     

应用智力和社会能力评测分类教学提高学生相关智商水平的效应

目的:对广州市番禺区部分中小学生进行智力评测和社会适应能力的评定,分析学习成绩与智力的关系。方法:于2004-10/2005-06对广州市番禺区的石楼、南沙、鱼窝头镇的28所小学和5所中学提供的538名学习成绩差的中、小学生进行韦氏儿童智力测查及婴儿-初中学生社会生活能力量表的评测,对有智力障碍并达到国务院残疾评定标准的,给予残疾等级评定。结果:共发放问卷538份,回收有效问卷538份,有效率100%。①对538例儿童进行韦氏儿童智力测查及婴儿-初中学生社会生活能力量表测查,结果符合一级智力残疾标准0例;符合二级智力残疾标准的6例,符合三级智力残疾标准的39例;符合四级智力残疾标准的203例,属边缘水平的216例;属正常的74例。②年龄大的符合智力残疾的比例较高,学习成绩差的学生中男生比女生多,但符合智力残疾标准的男女比例差异无显著性。③符合智力残疾标准的有248例,智商平均值分别为:语言商59.6;操作商67.3;全量表64.4。结论:对成绩差的学生作智力评测,给予分类教学,是提高教学质量所必要的,从小抓好教学,特别是抓好智力正常和接近正常的男生的学习是很重要的,充分发挥智力残疾学生的操作能力较强的优点,从操作诱发他们记忆、学习和工作的能力,达到教育康复的目的。     

An Interdisciplinary Approach to Self-Injurious and Aggressive Behavior

Many individuals with mental retardation engage in self-injurious or aggressive behavior. Causes for this behavior are multifactorial; therefore, effective assessment and treatment must be multifactorial as well. An interdisciplinary approach to self-injurious and aggressive behavior is more likely to result in accurate diagnosis and appropriate treatment. This paper explores the roles of members of the interdisciplinary team in the assessment and treatment of self-injurious and aggressive behavior in individuals with mental retardation and provides several case studies as examples.     

A Comparison of Social and Adaptive Functioning in Persons with Psychosis, Autism, and Severe or Profound Mental Retardation

Despite the findings that persons with mental retardation are several times more likely to experience mental health disorders than are persons of normal intelligence, relatively little is known about the nature of these disorders and related social and adaptive deficits. This situation is especially true for persons with severe and profound impairment who experience psychotic disorders. The purpose of this research was to examine the adaptive and social behavior of individuals with severe and profound mental retardation (MR) who are diagnosed with a psychotic disorder. Scores on measures of adaptive and social behavior for these individuals were compared to those of 2 other groups, both of whom had severe or profound MR, and who experienced mental health conditions commonly confused with psychotic disorders (e.g., autism/PDD, nondiagnostic behavior problems). Individuals in the psychotic disorders group displayed significantly higher levels of some social and many adaptive skills than did individuals in both control groups, with the most striking differences appearing between the psychotic disorders and autism/PDD groups. Results underscore the need to consider social and adaptive variables during the diagnostic and treatment planning process.     

智力落后研究的积极心理学取向

现有的大量关于智力落后研究都集中在适应行为、生活质量、双重诊断、个性动机和家庭等领域,很少涉及幸福感、美德等。随着智力落后者生活条件的逐渐改善,有必要将关注点转移到其内在状态或积极方面的研究中去。随着积极心理学的蓬勃发展,作为积极心理学重要研究方向的积极体验和积极个人特质等研究结果,可以指导智力落后研究的新方向。智力落后在积极心理学领域可以扮演重要的角色,但仍需要进一步的研究和数据支持。     

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

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.     

120例精神发育迟滞司法鉴定分析

目的 探讨精神发育迟滞患者的司法精神医学鉴定特点。方法 回顾性分析120例精神发育迟滞患者司法精神病鉴定特点。结果 精神发育迟滞占同期鉴定案例的16％，以年龄在15—29a女性为多见。轻度精神发育迟滞患者的性自卫能力和民事行为能力以部分责任能力和无责任能力为主；中度和重度精神发育迟滞以无责任能力、无性自卫能力和无民事行为能力为主。结论 精神发育迟滞患者涉及刑事案件和民事案件有一定特点，其责任能力和性自卫能力评定分歧较大，鉴定时应掌握全部材料作综合分析，并重视社会适应能力的调查。     

Evaluation of pharmacologic treatment of destructive behaviors: Aggregated results from single-case experimental studies

In this investigation, 20 clients with mental retardation and destructive behavior disorders were treated with psychotropic medication based on symptoms associated with a psychiatric disorder. For each patient, single-case design and direct observation procedures were utilized to evaluate outcome. Three clients (15%) showed at least a 50% reduction in destructive behavior; seven (35%) experienced a 50% or greater increase in destructive behavior; 10 (50%) experienced no change in their destructive behavior. The best response was to stimulant medications prescribed on the basis of pervasive hyperactivity and distractibility. The worst response was to lithium prescribed on the basis of manic-like symptoms (e.g., psychomotor agitation) or cyclical behavior disturbance. The low response rate was hypothesized to be a function of the unique underlying brain dysfunction in severely to profoundly retarded individuals with destructive behavior disorders, and the difficulties with applying psychiatric diagnoses in the population. Given the individual variability of response among clients and the prevalence of behavior dysfunction of the population, single-case methodology may have a useful role in the assessment of psychopharmacotherapy with individuals with severe to profound mental retardation and destructive behavior disorders.     

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

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.     

Assessment and Prediction of Mental Retardation in Saudi Children

Cross-cultural patterns and characteristics are a necessary but largely lacking area of research with respect to mental retardation. This study examined 115 Saudi youth to assess whether commonly used instruments for cognitive functioning and adaptive behavior would predict level of mental retardation. Results indicated this to be so for overall cognitive and communicative functioning. The findings support a degree of congruence among youth with mental retardation in the United States and in Saudi Arabia.     

Perceived Social Support and Mental Retardation: A Social–Cognitive Approach

Adults with mental retardation tend to have difficulty accurately interpreting social situations as well as the emotions of others. Predictions from a social–cognitive model of perceived social support were tested with 50 adults with mild mental retardation. Videotaped scenes portraying three levels of support were presented. The ratings of support perceptions provided by adults with mental retardation were contrasted with those of 40 staff working in the field of mental retardation and 22 community members. As hypothesized, social support and loneliness predicted perceptions of support of individuals with mental retardation, after controlling for depressed mood and receptive language ability. Individuals with mental retardation rated the videotaped interactions as more supportive than did staff and community members. This is the first study to address the contribution of cognitive level to perceived social support. Findings suggest that for those individuals with cognitive deficits, as with other groups, one's interpretations of social support are based in part on one's prior conceptions about social support.