Anger, depression and self-concept in adults with mental retardation

ABSTRACT. Self-report measures of anger, depression and self-concept that were designed for non-retarded children were adapted for adults with mental retardation. The measures were administered to 130 adults with mental retardation who lived in the community. Informants rated the subjects on shortened forms of the three emotional indices. Informant self-concept ratings were negatively correlated with ratings of anger and depression. On the self-report measures, subjects who reported low self-concept also reported high levels of depression. Mildly mentally retarded subjects were more likely to report anger than severe/moderately retarded subjects. Informant and self-report measures were significantly correlated for self-concept and depression, but not for anger. The results provide preliminary normative data on indices of emotional adjustment for community-based adults with mental retardation.     

The use of drugs for physical conditions in adults with mental retardation

ABSTRACT. A survey of the drugs given for physical complaints in two mental handicap hospitals is described. Thirty-six per cent of 537 adults in hospital A and 43% of 944 adults in hospital B received medications and, of those who did, over hall in each hospital received only one drug. The hospital populations differed significantly but both showed a significant increase in total drug usage with increasing age in both sexes, higher among females in every group. This increase was greatest with C.V.S. drug usage, but it did not reach significance for the three most frequently prescribed groups, which were gastrointestinal drugs (to 13% of the total patients), vitamins and nutritional supplements (11%), dermatological (10%) and cardiovascular (10%) drugs. Menial level was significantly indirectly related to usage of gastrointestinal drugs, drugs for anaemia, and vitamins and nutritional supplements, and directly to usage of cardiovascular drugs.     

Fluoxetine treatment of depression and associated self-injury in two adults with mental retardation

ABSTRACT. The use of fluoxeiine to treat chronic depression and associated self-injurious behaviour (SIB) in a woman with severe mental retardation and a man with profound mental retardation is reported. In the first case, behavioural monitoring of treatment response revealed a dramatic decrease in SIB and a normalization of the woman's sleep disturbance. In the second case, SIB and the use of mechanical restraint decreased substantially. In both cases, anecdotal reports also indicated a diminution of other depressive symptoms. These cases highlight the need to consider an affective disorder as a cause of SIB in persons with severe and profound developmental disabilities. The behaviour monitoring system proved to be a practical aid in the diagnosis of depression and evaluation of antidepressant treatment in individuals who were incapable of self-report.     

Joint occurrence of depression and aggression in children and adults with mental retardation

ABSTRACT. The relationship between aggression and depression was evaluated for 528 adults, adolescents and children, who were rated on either the adult or child versions ofthe Reiss instruments for dual diagnosis (Reiss 1988; Reiss & Valenti-Hein 1990). Criterion levels of depression were evident in about four times as many aggressive as nonaggressive subjects. Anger was significantly associated with both aggression and depression. Although anger may play a mediational role in the correlation between aggression and depression, in this study there was a significant correlation even after the effects of anger were held constant. The findings provide an initial step toward improving diagnostic specificity when evaluating aggressive behaviour in people with mental retardation.     

Screening for osteoporosis in community-dwelling adults with mental retardation

Osteoporosis screening of adults ages 40 to 60 who attended community-based adult training centers was conducted utilizing dual-energy X-ray absorptiometry (DEXA) measurements of the calcaneus. Valid measurements were obtained on 107 individuals, a response rate of 94%. One fifth of the sample (21%) had osteoporosis and 34% had osteopenia. On multiple regression analysis, the most significant predictors of BMD were Down syndrome, mobility status, and race. Future studies involving larger samples of middle-age adults with mental retardation/developmental disabilities will clarify the need and optimum age for osteoporosis screening.     

Walking habits of adults with mental retardation

The walking activity of men and women with mental retardation residing in community settings was described. Participants were 38 women (M age=.7, SD=9.5) and 65 men (M age=35.9, SD=11.2). They wore pedometers for 7 days. A 2 x 2 factorial ANOVA indicated no significant gender differences in total step counts or between participants with and those without Down syndrome. A post-hoc analysis revealed that participants walked less on Saturday than during the weekdays. Only 21.1% of the women and 21.5% of the men with mental retardation accumulated the recommended 10,000 steps per day.     

Development of the fear survey for adults with mental retardation

This paper describes the development of the fear survey for adults with mental retardation (FSAMR) and provides initial evidence of its psychometric properties. The FSAMR was designed to be sensitive to the assessment needs of individuals with mental retardation. The items were developed through open-ended interviews, a review of existing measures, expert input, and pilot testing. The sample consisted of 138 adults with mental retardation (73 from institutional settings and 65 from community settings). Cronbach's alpha internal consistency coefficients were 0.97 for the scale, and above the 0.60 threshold set for the study for all but the acquiescence response set (ARS) subscale. Significant concurrent validity coefficients with anxiety measures were in the moderate range (r=0.32 and 0.40) and are comparable to other similar studies. Implications for using the FSAMR are discussed.     

Health care decision-making by adults with mental retardation

Abilities of adults with mild, moderate, or no mental retardation to understand hypothetical treatments was investigated using the Assessment of Consent Capacity-Treatment developed for this study based on Appelbaum and Roth's psycholegal consent standards. Performance in all groups decreased with increasing psycholegal complexity of consent decision-making. Most adults with mild and no mental retardation and almost half of adults with moderate mental retardation were able to make and justify treatment choices and fully or partially understand treatment information. Most adults without mental retardation, 50% with mild, and 18% with moderate mental retardation were able to partially appreciate relevance of treatment choice to patient's situation and weigh treatment risks against benefit. Implications of findings for patient rights are discussed.     

Quality of life for young adults with mental retardation during transition

The quality of life of 188 young adults with moderate or severe mental retardation was examined. Schalock and Keith's (1993) Quality of Life Questionnaire (QOL-Q) was used as the primary outcome measure. Young adults who had exited high school had significantly higher overall quality of life scores than did those who were still attending school. Individuals who had jobs in the community also had significantly higher levels of quality of life. Although young adult adaptive functioning was the single largest indicator of the QOL-Q index total score and three of the four subscales, it was not related to scores on the Satisfaction subscale. Here, family- and environment-related variables played a greater role. Implications and directions for future research are discussed.     

A cross-sectional test of the similar-trajectory hypothesis among adults with mental retardation

The similar-sequence and the similar-structure hypotheses are the two mainstays of the developmental approach to mental retardation. In the present study, a third way, the similar-trajectory hypothesis, is described and illustrated using the WAIS-R results of adults with and without mental retardation aged from 20 to 54 years. The whole sample (N=633) comprised 306 participants with mental retardation and 327 without mental retardation. Hierarchical regression analyses comparing the two groups showed similar evolutions of scores with increasing age for verbal and performance scales. These results seem to validate the similar-trajectory hypothesis, at least for the present samples and for the aspects of cognitive development considered here. Some weaknesses and implications of the study are considered in the discussion.     

Diathesis-stress and depressed mood among adults with mental retardation

The impact of diatheses, stress, and their interaction on depressed mood was evaluated to determine the appropriateness of cognitive diathesis-stress models of depression for adults with mental retardation. We also tested hopelessness as a mediator in the prediction of depressed mood to evaluate the hopelessness theory of depression. Seventy-three adults with mental retardation and adequate receptive vocabulary participated in semi-structured interviews. Experiencing life stressors and possessing a negative attributional style, but not their interaction, served as predictors of depressed mood. Similar results were obtained using frequency or impact ratings of life stress. Conditions were not met to test hopelessness as a mediator. Treatment implications for depression among adults with mental retardation are highlighted.     

ECT: use in individuals with mental retardation

Electroconvulsive therapy (ECT) is an effective treatment of a variety of serious psychiatric and neurologic disorders. There are infrequent case reports of its use in individuals with mental retardation (MR). We describe 10 patients with MR and complex comorbid psychiatric disorder treated with ECT. Seven patients had an excellent response to treatment. Side effects of treatment were minimal and transitory.     

Factors influencing direct-care paraprofessionals' decisions to initiate mental health referrals for adults with mental retardation

Direct-care paraprofessionals' recognition of psychopathology of varying severity in persons with mental retardation was evaluated. Factors that may influence paraprofessionals' decisions to initiate referrals for mental health services on behalf of individuals with mental retardation were also evaluated. Results suggest that staff members recognized and differentiated psychopathology of varying levels of clinical severity. Results also suggest that paraprofessionals are more likely to initiate making a referral when professionals are perceived as being competent in treating individuals with mental retardation, and when providers' interventions are consistent with the referring agency's philosophy.     

Later-life planning for older adults with mental retardation: a field experiment

A quasi-experimental design was used to assess the efficacy of a leisure education-based later-life planning model for 10 older adults with mental retardation. Prior to the initiation of the planning process, they were interviewed and completed three standardized scales designed to assess life and leisure satisfaction and leisure constraints. A comparison group completed these scales but did not participate in the planning process. At the completion of the study, both groups completed the same scales. Results demonstrated that the planning-process group had significantly higher life and leisure satisfaction at the end of the study. Many participants also made changes to their lifestyles consistent with plans made during the study. Results suggest that a later-life planning process may contribute to the quality of life of older adults with mental retardation.     

Diagnosis and treatment of depression in patients with mental retardation

Depression in mentally retarded individuals is not uncommon and usually is treatable. However, studies of the diagnosis and treatment of psychiatric illnesses in general and depression specifically in this population are relatively rare. Although Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria can be applied to mildly and moderately retarded individuals, the diagnosis of depression in those with intelligence quotients below 35 is challenging. However, the diagnosis of depression in the latter group is possible using modified criteria emphasizing observational data. Criteria include symptoms such as sadness, irritability, decreased social interaction, regression of skills, sleep disturbances, diurnal variation, and aggression. Furthermore, there is a growing body of evidence that antidepressant treatments, especially administration of selective serotonin reuptake inhibitors, are effective in treating depression in mentally retarded patients. This article reviews numerous studies elaborating on the diagnosis, phenomenology, and treatment of depression in mentally retarded individuals.     

Predictors of job tenure for new hires with mental retardation

This study describes job tenure and wages for people with mental retardation and factors affecting movement from noncompetitive jobs to competitive jobs. In South Carolina 10,169 individuals with mental retardation (MR) were served by the state disability agency and 22.7% were employed during 1997-2000. Each year, during that period, 68% sustained their job for over 1 year. For the 474 new hires in 1997, the job responsibilities associated with at least 80% of the group having 3 years of job tenure were manufacturing/assembly, janitorial, dishwasher, lawn maintenance, grocery bagger, and restaurant host/store. The substantial majority of individuals who worked at least 3 years were employed by companies engaged in food service (28%), manufacturing (18%), disability services (15%), groceries (10%), and retail (5%). In the general population, as reported by the Department of Labor, employment tenure was 1.5 years for food service to 2.7 years for cleaning and building services. In our group with mental retardation employment tenure was 2.2 years for food service to 2.3 years for cleaning and janitorial services.     

Evaluation of screening tools for dementia in older adults with mental retardation

We compared groups with and without diagnosed dementia matched on IQ, age, and presence of Down syndrome. The Dementia Scale for Down Syndrome and Dementia Questionnaire for Mentally Retarded Persons were used to assess participants. We developed two performance tasks to determine whether they were useful in separating subjects with and without dementia and also used the Reiss Screen. Both dementia scales and both performance tasks discriminated between groups. The dementia scales were not related to premorbid IQ, age, or gender, whereas performance tasks were related to dementia and IQ but not age or gender. Various Reiss Screen subscales also discriminated between groups. Subscales of the screening instruments and performance tasks were significantly related, indicating congruent validity. Logistic regression was conducted to assess which combination of tests discriminated best between groups.