Profiles and cognitive predictors of motor functions among early school-age children with mild intellectual disabilities

Background The purpose of the study was to describe sensorimotor profile in children with mild intellectual disability (ID), and to examine the association between cognitive and motor function. Methods A total of 233 children with mild ID aged 7 to 8 years were evaluated with measures of cognitive, motor and sensory integrative functioning. Results Children with mild ID performed significantly less well on all test measures. 44.2% of children scored in the impaired range on seven out of 22 sensorimotor measures. They had weaker fine motor skills than gross motor skills. Sensory integrative functions were only mildly impaired. Total IQ substantially predicted overall performance on each motor test. Specifically, verbal comprehension and processing speed indexes were significant predictors of gross and fine motor function. Conclusions Sensorimotor dysfunctions were found to be very frequent in children with mild ID. Early identification of sensorimtor impairments is essential to prompt early intervention and facilitate better integration into regular school settings.     

Oxidative stress as a biomarker of respiratory disturbance in patients with severe motor and intellectual disabilities

Oxidative stress plays an important role in aging and various diseases such as cancer, cardiovascular diseases, diabetes mellitus and bronchial asthma. However, little is known about a potential role of oxidative stress in the pathogenesis of severe motor and intellectual disabilities (SMID) in terms of respiratory disturbance, which is the most common complication. In the present study, we examined the urinary levels of oxidative stress markers, 8-hydroxy-2′-deoxyguanosine (8-OHdG), hexanoyl-lysine adduct (HEL) and acrolein-lysine adduct (ACR) in patients with SMID. The mean level of urinary 8-OHdG in SMID patients was significantly higher than that in normal controls (18.8 ± 9.0 ng/mg Cre and 10.5 ± 2.9 ng/mg Cre, respectively) (p < 0.01). There was no significant difference of the mean level of urinary HEL between patients with SMID and normal controls (81.9 ± 40.3 pmol/mg Cre and 69.2 ± 37.7 pmol/mg Cre, respectively), while the mean level of ACR in patients with SMID was higher than that of normal controls (220.5 ± 118.6 nmol/mg Cre and 144.9 ± 62.0 nmol/mg Cre, respectively) (p < 0.05). In addition, the level of 8-OHdG was strongly correlated with the severity of respiratory disturbance evaluated as the respiratory disturbance score (RDS) (Spearman r = 0.73, n = 14, p < 0.01). In contrast, there was no correlation between the levels of these oxidative stress markers and age or medication of antiepileptic drugs. These results suggest that urinary 8-OHdG is a potentially useful biomarker for evaluating the severity of respiratory failure in patients with SMID.     

Skin temperature responses to cold stress in patients with severe motor and intellectual disabilities

Patients with severe motor and intellectual disabilities (SMID) often suffer from autonomic nervous system disturbances. At the same time, the caregivers of patients with SMID face challenges to understand the patients’ chronic health problems effectively by simply observing them. Therefore, recognizing specific symptoms is important to improve support for SMID. We investigated the autonomic nervous function in patients with SMID with skin vasomotor responses to cold stimuli. The relationship of the results of cold stress and autonomic symptoms observed by the main caretakers was also examined. We analyzed 38 patients with SMID. Their hand skin temperature was measured before and after cold stimuli using infrared thermography. A ‘distal-dorsal difference’ (DDD) at baseline, and the recovery rate of the second fingertip and dorsum were calculated. All main caregivers filled out questionnaires evaluating autonomic symptoms. The recovery rate of the second fingertip and dorsum after cold stimuli was lower than 80% in 64% and 60% patients, respectively. The baseline DDD was greater than 1 °C in 84% of the patients. A DDD > 1 °C was associated with a reduced recovery rate. All caregivers recognized some autonomic-related symptoms. Patients with constipation or snoring demonstrated a reduced recovery rate. However, none of the observed symptoms can predict the presence of a reduced rate with cold stimuli in a statistically significant way. This study showed excessive sympathetic nerve activities in patients with SMID. The baseline DDD could be a valuable parameter accessing their microvascular circulation. To improve the life of a person with SMID, accessing autonomic function using a noninvasive method, such as thermography is warranted without directly observed symptoms.     

An external focus of attention enhances motor learning in children with intellectual disabilities

Background The present study examined whether the learning benefits of an external focus of attention (i.e. on the movement effect) relative to an internal focus (i.e. on the movement), found previously in non‐disabled children and adults would also be found in children with intellectual disabilities (IDs). Methods Participants (n = 24; average age: 12.2 years) with mild intellectual deficiency (IQ = 51–69) practiced throwing beanbags at a target. In the external focus group, participants were instructed to direct their attention to the movement of the beanbag, while in the internal focus group, participants were asked to direct their attention to the movement of their hand. The practice phase consisted of 40 trials, and attentional focus reminders were given after every third trial. Learning was assessed 1 day later by retention and transfer (greater target distance) tests, each consisting of 10 trials. No focus reminders were given on that day. Results The external focus group demonstrated more effective learning than the internal focus group, as evidenced by more accurate tosses on the transfer test. Conclusions The present findings show that instructions that induce an external focus of attention can enhance motor learning in children with IDs.     

Psychosis and adults with intellectual disabilities

Objective To determine the point prevalence, incidence, and remission over a 2-year period of psychosis in adults with intellectual disabilities, and to investigate demographic and clinical factors hypothesised to be associated with psychosis. Method A population-based cohort of adults with intellectual disabilities (n = 1,023) was longitudinally studied. Comprehensive face-to-face mental health assessments to detect psychosis, plus review of family physician, psychiatric, and psychology case notes were undertaken at two time points, 2 years apart. Results Point prevalence is 2.6% (95% CI = 1.8–3.8%) to 4.4% (95% CI = 3.2–5.8%), dependant upon the diagnostic criteria employed. Two-year incidence is 1.4% (95% CI = 0.6–2.6), and for first episode is 0.5% (95% CI = 0.1–1.3). Compared with the general population, the standardised incidence ratio for first episode psychosis is 10.0 (95% CI = 2.1–29.3). Full remission after 2 years is 14.3%. Visual impairment, previous long-stay hospital residence, smoking, and not having epilepsy were independently associated with psychosis, whereas other factors relevant to the general population were not. Conclusions The study of psychosis in persons with intellectual disabilities benefits the population with intellectual disabilities, and advances the understanding of psychosis for the general population. Mental health professionals need adequate knowledge in order to address the high rates of psychosis in this population.     

Person-centred planning: factors associated with successful outcomes for people with intellectual disabilities

Background Recent research in the USA and UK indicates that person‐centred planning (PCP) can lead to improvements in lifestyle‐related outcomes for people with intellectual disabilities (ID). It is clear, however, that the introduction of PCP does not have an equal impact for all participants. The aim of the present paper was to identify factors associated with the probability of delivering a plan and with improvements in outcomes for those who did receive a plan. Methods Information on the life experiences of participants was collected over a period of approximately 2 years for a cohort of 93 adults with ID. Results There were powerful inequalities in both access to and the efficacy of PCP in relation to participant characteristics, contextual factors and elements of the PCP process. Conclusions Results are discussed in relation to implications for policy and practice for increasing the effectiveness of PCP and reducing inequalities in the life experiences of people with ID.     

Resting energy expenditure prediction using bioelectrical impedance analysis in patients with severe motor and intellectual disabilities

Introduction

Resting energy expenditure (REE) is expected to be lower in with severe motor and intellectual disabilities (SMID) patients than in healthy subjects because of their relatively low fat-free mass (FFM). Therefore, an REE predictive equation for SMID patients may be required. The aim of this study was to validate existing REE predictive weight-based equations (Harris-Benedict, WHO, Mifflin, Owen, Schofield) and FFM-based REE equations (Mifflin, Owen and Cunningham) and to develop a new SMID patient-specific FFM-based REE equation.

Interviewing alleged victims with intellectual disabilities

Background When interviewing alleged victims of crime, it is important to obtain reports that are as accurate and complete as possible. This can be especially difficult when the alleged victims have intellectual disabilities (ID). This study explored how alleged victims with ID are interviewed by police officers in Sweden and how this may affect their ability to report information as accurately as possible. Methods Twelve interviews with 11 alleged victims were selected from a larger sample. The complainants were interviewed when their chronological ages ranged from 6.1 to 22 years. A quantitative analysis examined the type of questions asked and the numbers of words and details they elicited in response. Results Instead of open‐ended questions, the interviewers relied heavily on focused questions, which are more likely to elicit inaccurate information. When given the opportunity, the witnesses were able to answer directive questions informatively. Conclusions Interviewers need special skills in order to interview alleged victims who have ID. In addition to using more open‐ended questions, interviewers should speak in shorter sentences.     

A study of complicated grief symptoms in people with intellectual disabilities

Introduction Previous studies have shown a significant association between familial bereavement and the onset of challenging behaviours and psychopathology in people with intellectual disabilities (ID). However, little work has been done to accurately describe the specific symptoms of grief, in particular symptoms of complicated grief in this population. Consensus criteria for the diagnosis of complicated grief have been drawn up and tested for validity in the general population. Aims To examine the occurrence of symptoms of complicated grief, and to explore the relationships between complicated grief and bereavement experience. Method A bereavement history questionnaire and a newly developed measure examining for symptoms of complicated grief were administered to a group of carers of people with mild or moderate ID, who had experienced a parental bereavement within the previous 2 years. The questionnaires were also administered to a matched comparison group, who had not been bereaved. Results/Conclusions This carer‐based comparison study has revealed that bereaved individuals with ID experience complicated grief symptoms following the death of a parent, with one‐third of the bereaved group experiencing 10 or more clinically apparent symptoms. In addition, complicated grief symptoms were more likely to occur with higher rates of bereavement ritual involvement. These findings have both clinical and research implications.     

Psychiatric symptoms and problem behaviours in people with intellectual disabilities

Background Previous studies have suggested different patterns of associations between psychiatric symptoms and problem behaviours in people with intellectual disabilities (ID). The aim of this study was to investigate which problem behaviours are associated with specific psychiatric symptoms and the relative strength of these specific associations. Method A cross sectional survey using the Psychiatric Assessment Schedule for Adults with Developmental Disabilities Checklist and the Disability Assessment Schedule was carried out in a sample of 214 adults with ID. Results Self‐injurious and, to a lesser extent, aggressive problem behaviours were most associated with affective type symptoms. Screaming and destructive behaviours tended to be more associated with autism‐related social impairment rather than conventional psychiatric symptoms. Conclusions This study gives further evidence of associations between psychiatric symptoms and specific problem behaviours in people with ID. It may be particularly useful to consider the diagnosis of affective disorders if a person with ID shows self‐injurious or aggressive behaviours.     

Measurement of perceived competence in Dutch children with mild intellectual disabilities

Background Little research has been conducted on the perceived competence of children with mild intellectual disabilities (MID). One of the reasons for the marked absence of research appears to be the lack of reliable and clearly valid measurement instruments for this particular group of children. In the present study, it was examined whether a pictorial scale originally designed to measure perceived competence in typically developing children could successfully be used with children with MID. Methods The pictorial scale was administered to a group of 106 children with MID. The construct validity, reliability and stability of the scale were investigated. Results The results of the exploratory factor analyses and the confirmatory factor analyses supported the conceptual framework proposed. The construct validity was also supported by the pattern of intercorrelations between the subscales. The scale had adequate internal consistency and the stability analyses showed sufficient stability across a 4-month period. Conclusions The findings show the psychometric properties of the pictorial scale to justify its use with children with MID.     

Predictors of work participation of young adults with mild intellectual disabilities

Individuals with intellectual disabilities (ID) are three to four times less often employed compared to their non-disabled peers. Evidence for factors associated with work participation of young adults with ID is limited. Furthermore, studies on predictors for sustainable work participation among young adults with ID is lacking altogether. Therefore, the aim of this study was to investigate which factors predict finding as well as maintaining employment of young adults with mild ID. We obtained data on 735 young adults with mild ID, aged 15–27 years, applying for a disability benefit. The follow-up period ranged from 1.25 to 2.75 years. Motivation, expectations regarding future work level and living situation predicted finding work as well as maintaining employment for at least 6 months. In this study, especially personal factors were influential in predicting work outcome and may be suitable factors to include in interventions.     

Concept of death and perceptions of bereavement in adults with intellectual disabilities

Background Bereavement is potentially a time of disruption and emotional distress. For individuals with an intellectual disability (ID), a limited understanding of the concept of death may exacerbate this distress. The aim of the present study was to investigate how individuals with ID understand and explain death and make sense of life without the deceased. Method Thirty‐four people with ID were interviewed using simple vignettes describing death‐related incidents. Participants were asked about the causes of death, the status of the body after death and whether all living things die. In addition, participants were asked about reactions to death and for their views on post‐bereavement support. Results Nearly one quarter of participants had a full understanding and over two‐thirds a partial understanding of the concept of death. Death comprehension was positively correlated with cognitive ability and adaptive functioning. While cause of death was predominantly associated with illness and old age, participants viewed death as final and understood that all living things die. The role of religious beliefs was also found to be important for many participants. Conclusions The results support earlier findings that suggest people with ID have only a partial understanding of the concept of death leaving them vulnerable to factually incorrect thoughts. The study highlights the considerable scope for making sense of death using religious and spiritual themes and emphasises the need for teaching individuals biological explanations of the life cycle. The results also provide some insight into the views of individuals with ID for carers involved in providing post‐bereavement support.     

An exploratory study into health care policy for persons with intellectual disabilities in Taiwan

Background Although Taiwan has already had a higher quality of health care compared with other countries, there still is a need to review the quality and effectiveness of services provided. The lack of health care policy for persons with disabilities is a reflection of health care provision in Taiwan. Health care provision problems will limit persons with disabilities in their access to the health care system. The purpose of the present study was to examine the general beliefs about the current health care policies for persons with intellectual disabilities (ID) in Taiwan. Methods Data were obtained from two sources, namely government policies analysis and interviews with representatives for key stakeholders in the field of ID. Results The results illustrate that health care service problems for persons with ID include: how to enforce the discovery system and early intervention service, disability evaluation system, National Health Insurance medical payment and medical care resource development are still confining their quality of care. Furthermore, the links between social welfare, education and health care have been lost because the different roles and perspectives of people in these fields are fundamentally at odds with one another. Health care professionals have become less reform‐minded as a consequence of the conditions of their work. Consequently, a complete and coordinated health care policy for persons with ID has become unattainable in society. The present paper draws on evidence from research and policies to explore the problems and potential of service development for persons with ID, and to identify review and action points for managing its implementation.     

Prevalence of fractures in women with intellectual disabilities: a chart review

Background Numerous studies have demonstrated high rates of osteoporosis and fractures in women with intellectual disabilities (IDs). All of the studies use either institutionalized women or women in the community recruited at adult day‐care centres or specialty clinics. We examined the prevalence of fractures in women with IDs who attend a primary care clinic, and assessed osteoporosis‐prevention/intervention activities. Methods This was a chart review study. Charts were identified of women with an ICD‐9 diagnosis code for ID, Down syndrome or developmental disabilities. All charts reviewed were patients of one of 13 family medicine clinics affiliated with Department of Family Medicine, the University of Wisconsin. Results A total of 93 charts were reviewed. More than 32% (30/93) of the charts contained a history of an adult‐onset fracture. Increasing age, being postmenopausal and taking anticonvulsant medications were significantly associated with having a fracture. The average age of first fracture was 41.7 years. Of the women with a fracture, 35.5% were placed on a medication to maintain bone density, 67.7% received a recommendation for a calcium supplement, and 38.7% obtained a bone density test. Discussion The prevalence of fractures in women with IDs attending a family medicine clinic was very high, and fractures occurred at young ages. Primary care providers need to consider women with IDs at a high risk for fractures and begin preventive counselling in young women.     

The use of contraception by women with intellectual disabilities

Background Worldwide, contraception is frequently used by women for the prevention of conception, to regulate or postpone menstrual bleeding. The study aims to determine the use (number and method) of contraception by women with intellectual disabilities (ID), the indications, sources of referrals and relations with level of ID and age of the women concerned. Methods The study group consisted of 234 women aged between 15 and 59 years and residing at a Dutch service provider for persons with ID. Data were obtained via the pharmacy database, attending physicians and individual medical files. Results Nearly one half (48%, n = 112) of the 234 residential women used some method of contraception: 87 (78%) took pharmacological contraceptive methods, 23 (20%) underwent surgical contraception and 2 (2%) both. Main reasons for contraception were problems with menstruation, behaviour and/or prevention of pregnancy. Requests for contraception were initiated mainly by physicians and parents. Differences between users of different contraceptives with regard to age and level of ID were not statistically significant. Conclusions Further studies should focus on the development and implementation of adequate health promotion materials on this subject.     

Neuropsychological predictors of everyday functioning in adults with intellectual disabilities

Background Very little is known about the neuropsychological correlates of adaptive functioning in people with intellectual disabilities (ID). This study examined whether specific cognitive deficits and demographic variables predicted everyday functioning in adults with ID. Method People with ID (n = 101; ages 19–41 years; mean education = 11 years; 34% women; 54% competitively employed; 41% with mild ID) completed a comprehensive neuropsychological battery grouped into four cognitive domains: processing speed, verbal memory and comprehension, visual perception/constructive function, and executive function. In addition, parents completed an 89‐item rating scale developed to assess a wide range of independent living skills. Results Confirmatory factor analysis results confirmed a correlated four‐factor model of cognitive function and a unidimensional model of everyday functioning. Furthermore, structural equation modelling results supported the predictive relationship of verbal memory/comprehension and employment status (standardized regression coefficients 0.45, 0.22, P ≤ 0.01 for each) to measures of everyday functioning. The two variables together explained 35% of the variance in everyday functioning. Conclusions Both general cognitive dysfunction and specific verbal memory and comprehension deficit impair daily functions in people with ID. These findings have implications for predictive models of adaptive functioning, and for cognitive rehabilitation and deficit compensation strategies for this group.     

Screening for psychiatric symptoms: PAS-ADD Checklist norms for adults with intellectual disabilities

BACKGROUND: The Psychiatric Assessment Schedule for Adults with Developmental Disabilities Checklist (PAS-ADD Checklist) is a screening instrument designed to help carers recognize likely mental health problems in people with intellectual disabilities (ID). To date there are no published PAS-ADD Checklist data on a large nonpsychiatric population of adults with ID, an important step towards developing norms for comparative purposes. METHODS: Informants who had known participants for a median 24 months completed the PAS-ADD Checklist on 1155 adults with ID living in community, residential care and hospital settings in a county district in the North-east of England. RESULTS: Normative data were obtained for the PAS-ADD Checklist for the study population with reference to gender, age, and type of residence. The overall prevalence of mental health problems was 20.1%, and the rates for affective/neurotic, organic and psychotic disorders were 14%, 3.9%, and 10.2%, respectively. Significant differences in the rates for particular disorders were found across gender, age and, residence type. CONCLUSIONS: The rates of mental disorders found in the study population were consistent with previous studies of general populations of people with ID using over-inclusive screening instruments. The PAS-ADD Checklist appears to be an easy-to-use and sensitive tool for identifying mental health cases in ID populations, but further investigation is required concerning the specificity of the instrument.