It's not where but how you live: Choice and adaptive/maladaptive behavior in persons with severe handicaps

Although it is generally accepted that beneficial effects accrue when relocating persons with severe handicaps from large to smaller facilities, a specific analysis of concurrent environmental changes is needed. The present study investigated the relationship between choice availability and levels of adaptive and maladaptive behavior in persons with severe handicaps following their relocation to smaller residential facilities. Specifically, 57 residents of a large developmental center (30 men and 27 women, mean age 35 years) were relocated to either a transitional developmental center before placement into smaller residential facilities or directly into separate smaller community residences. AAMD Adaptive Behavior Scale, Vineland Maladaptive Behavior Scale, and Resident Choice Assessment Scale data were obtained for both groups over a 1-year follow-up period. Degree of resident choice was significantly correlated with areas of adaptive and, to a lesser extent, maladaptive behavior. Choice availability is proposed as a meaningful variable for modifying residential programs, developing effective behaviors, and classifying living facilities for persons with severe handicaps.     

Staff Training Regarding Choice Availability for Persons with Mental Retardation: A Preliminary Analysis

Quality of life and choice availability remain critical aspects of new treatment programs for persons with mental retardation. The present study preliminarily investigated a brief training program for staff members to increase choice availability in living environments. A program of education, modeling, role-play, and feedback was used over a 5–week period for staff members in two intermediate care facilities. Two other facilities served as controls. Results indicated significant improvement in overall level of choice availability from preintervention to follow up for the treatment but not the control group. Contrary to expectations, however, levels of adaptive and maladaptive behavior remained unchanged. This study indicates that a cost-effective training program may be useful for enhancing choice availability in the short-term, but that other choice-oriented procedures may be necessary to generate further changes in effective behavior.     

Social competence and maladaptive behavior of people with dual diagnosis

This study describes the social competence and maladaptive behavior of mentally retarded individuals with psychiatric impairments and examines the validity of five major psychiatric diagnoses as applied to the mentally retarded population: schizophrenia, personality disorders, autism, adjustment disorders, and conduct disorders. The adaptive and maladaptive behavior of individuals with a dual diagnosis (N=3,975) have been compared with the behavior of control samples who were selected by a pair-wise matching procedure on age, sex, IQ, and type of residence (i.e., own home or independent living, community care facilities, and state institutions). Among the dual diagnosis population, schizophrenic adults and autistic children have shown disturbances in many areas of adaptive and maladaptive behavior in comparison to their nonpsychiatric counterparts. Conduct disturbances, personality disorders, and adjustment disorders have shown significantly higher maladaptive behavior than their non- psychiatric counterparts. The results indicate a strong need for refined diagnostic techniques for identifying personality disorders and adjustment disorders in the mentally retarded population.     

Training Social Problem-solving Skill to Reduce Maladaptive Behaviours in Intellectual Disability Groups: The Influence of Individual Difference Factors

A critical review of the literature relevant to social problem-solving skills training (SPSST) in individuals with intellectual disabilities concluded that although there is some evidence that training may be effective, the evidence is weak. It is suggested that little is known about factors which may moderate the effectiveness of training; in particular the impact of age, general intellectual ability and place of residence (community or institution). A five-stage view of the social problem-solving process is offered as a means for planning and evaluating SPSST programmes, and detailed outcome criteria are proposed for assessing the effectiveness of training. A group (n = 29) of adults with intellectual disabilities was given SPSST. Comparisons were made with an untrained control group (n = 17) matched to the trained group on age, general intelligence, adaptive and maladaptive behaviour. A statistically significant improvement was found in the trained group (p < 0.01), but not in the control group (NS), on degree of maladaptive behaviour as rated by independent judges. Improvement occurred only in trainees resident in the community but was not influenced by age or level of general intelligence. Furthermore, reductions in maladaptive behaviour were associated with improvements in some but not all social problem-solving skills.     

A participatory program evaluation of a systems change program to improve access to information technology by people with disabilities

Purpose.?To pilot-test and evaluate an innovative program providing information technology (IT) access to people with disabilities transitioning out of nursing homes into the community using a participatory approach.

Methods.?Pre- and post-training data was collected on the 61 program participants to reflect three broad areas related to the IT training experience: performance; self-efficacy; importance, satisfaction and control. Additionally, semi-structured interviews were conducted with seven participants and five members of the program staff to explore environmental barriers to IT access for this group and the efficacy of the program in addressing these barriers. Data analyses followed a mixed methods approach incorporating both qualitative and quantitative techniques.

Results.?Participants showed substantive changes in different spheres of IT use after completion of training. Post-training changes were significant particularly in areas related to self-efficacy, importance and satisfaction pertaining to use of IT. Qualitative findings substantiated the quantitative results and also revealed the numerous barriers to IT access that persons with disabilities continue to face within their communities.

Conclusion.?Results indicate the feasibility, effectiveness and value of IT access to people with disabilities particularly those transitioning from institutional life to community living. Further action research aimed at increasing IT access for this group within local communities and neighborhoods is needed to address this issue at a broader societal level.     

Classification and Diagnosis of Psychiatric Disorders in Persons with Developmental Disabilities

This article presents a brief historical overview of psychiatric diagnosis in persons with developmental disabilities, including a review of the relationship between applied behavior analysis and dual diagnosis. The purposes of diagnosis are then outlined. The definitions of developmental disabilities, mental disorder, and dual diagnosis are reviewed and some of the problems when making a psychiatric diagnosis in persons with developmental disabilities are discussed. Special attention is given to the problem of diagnosing mental retardation in persons with mild through borderline mental retardation and to the problem of diagnosing psychiatric disorders in persons with severe and profound mental retardation. Finally, an overview of common issues in the process of collecting and combining information to make a psychiatric diagnosis in persons with developmental disabilities is given.     

Stay Well and Healthy! Pilot Study Findings from an Inhome Preventive Healthcare Programme for Persons Ageing with Intellectual and/or Developmental Disabilities

Background While disparities in the health status for persons ageing with intellectual and developmental disabilities have been well documented, interventions that address individual risks in physical, emotional, social and environmental health among this population are lacking. This pilot study evaluated the feasibility of two inhome interventions designed to reduce health risks and improve health outcomes among persons ageing with intellectual and developmental disabilities. Method Interventions and assessment tools were developed. Adults with intellectual and developmental disabilities, aged 32 and over (n = 201) living in non‐institutional settings were recruited and assigned to either an advance practice nurse (APN) intervention of inhome multidimensional assessment, targeted recommendations and follow‐up visits (n = 101) or an inhome health risk appraisal (HRA) with printed feedback only (n = 100). Results The development and pilot testing of the interventions, assessment tools and methods demonstrated feasibility in the population from mild to moderate intellectual and developmental disabilities. In addition, high levels of health risks were identified (mean = 5.0; range 0–16) in the sample suggesting the need for effective interventions. Both pilot groups showed significant reduction in health risks between baseline and follow‐up. Further rigorous randomized field trials are required to test the effectiveness of each intervention. Conclusions Community‐based preventive interventions are feasible for randomized trials in this population.     

Community participation of persons with disabilities: volunteering,donations and involvement in groups and organisations

Purpose: This study examined similarities and differences between persons with and without disabilities on volunteering, donations and group participation. Method: A sample of 1548 individuals participated and 60% of the sample were persons with disabilities. Data for this research was drawn from a major statewide survey in a Midwestern state in the United States. Community participation was measured through involvement with civic, religious and other community-based groups, volunteering activities and donations. Logistic regression was pursued to test the effect of disability on community participation. Results: Findings support different trends in participation between persons with and without disabilities. Individuals without disabilities are more likely to volunteer, donate money and participate in civic organisations (e.g. clubs) and other groups. Employment and household income have a significant contribution in explaining these differences.

Conclusions: This study found significant differences in community participation between persons with disabilities and persons without disabilities. Regression analysis outcomes underscore the importance of employment and income in eliminating disparities in community involvement between persons with and without disabilities.

• Implications for Rehabilitation

• Policy change in rehabilitation agencies to fund supported volunteering services.

• Improve the representation of persons with disabilities in volunteering pursuits by making volunteering positions accessible to them (educate persons with disabilities to be more aware of these opportunities, provide reasonable accommodations at work sites, etc.).

• Educate stakeholders about the benefits of volunteering and being part of civic, and other community based groups in improving the quality of life of persons with disabilities.

• Identification of barriers for persons with disabilities in these pursuits (physical and attitudinal barriers, lack of resources).

• Identifying and utilising natural supports in the work site for persons with disabilities to receive peer support on the job from full-time employees.

     

Inadequacies in computer access using assistive technology devices in profoundly disabled individuals: An overview of the current literature

Purpose. This study sought to provide a review of the contemporary literature regarding computer access for persons with severe and multiple disabilities using assistive technology (AT). Anecdotally, persons with severe disabilities are assumed to be underserved by the AT community, and the causalities behind this perception were explored.

Method. An online comprehensive search of literature pertaining to computer access for persons with severe and multiple disabilities was initiated. Due to the fact that personal computers (PCs) have been widely been available for nearly 25 years, ‘contemporary literature’ was defined as any source(s) from that era relevant to persons with severe disabilities accessing a computer. Databases including the Educational Resources Information Center (ERIC) and the United States National Institutes of Heath (PubMed) were accessed for information in scholarly journals and for Web Postings. Additionally, the Coleman Institute's Assistive Technology Literature Database which provides a comprehensive listing of AT Journals was utilized, and each of the Websites of these journals was accessed and searched. Search engines on the web including Google Scholar, Altavista, Infomine, and Scirus were utilized as well.

Conclusion. The study depicts the evolution from a ‘medical model’ to a ‘social model’ in rendering AT services for these individuals. Prescribing the proper device to enable computer access to persons with severe disabilities is a complex undertaking, and services have been inadequate. Technological advances that enable computer access for persons with disabilities have not reached those persons that need it most, particularly those with severe disabilities, for a number of reasons. The literature is replete with explanations for the underutilization of AT for computer access including prejudicial views towards persons with disabilities, inadequate assessments, lack of a person-centered approach, and methods for practice that are not evidence based.     

Dysfunctional Attitudes, Coping, and Depression Among HIV-Seropositive Men Who Have Sex with Men

Several studies have documented elevated levels of psychological distress among HIV-seropositive (HIV+) symptomatic men who have sex with men (MSM). However, very little is known about the role of dysfunctional attitudes and coping strategies in maintaining and ameliorating distress levels in ways that can inform those developing psychosocial interventions for HIV+ persons. This study evaluated relations between dysfunctional attitudes and depression and examined the role of coping as a mediator of this relationship among 115 HIV+ symptomatic MSM. Higher Dysfunctional Attitude Scale scores were associated with more reported depressive symptoms. The use of adaptive coping strategies such as active coping was associated with lower depression, whereas use of maladaptive strategies such as denial was related to higher levels of depression. Both adaptive and maladaptive coping strategies mediated the relationship between dysfunctional attitudes and depression. Findings suggest that interventions aiming at reducing psychological distress in this population using cognitive restructuring and related techniques may achieve their effects by enhancing adaptive coping strategies on the one hand and reducing maladaptive strategies on the other.     

Problems with accessibility to health services by persons with disabilities in São Paulo,Brazil

Purpose.?To describe the occurrence of self-reported problems of accessibility to health services used by persons with disabilities in terms of social and health services variables.

Methods.?We performed a cross-sectional household survey designed to assess problems with accessibility to health services faced by persons with disabilities. We interviewed 333 persons in São Paulo city, in 2007. Variables related to the presence of accessibility problems, disabilities, gender, age, family head income, ethnicity, use of health services and others were analysed using frequencies, percentages, χ²-test, ANOVA and Poisson regression models.

Results.?15.92%% of the interviewed persons reported problems with accessibility to health services. Persons having multiple (prevalence ratios; PR == 2.91) or mobility disability (PR == 6.46) had more problems with accessibility than persons with hearing disability. Persons younger than 78 years old had more problems with accessibility; those who needed help to go to the health service (PR == 3.01) also.

Conclusions.?Persons with multiple or mobility disability, younger than 78 years, and those who needed help of others to go to the health service were more likely to have problems with accessibility to health services. This information could be one of the first steps to the management and/or planning of appropriate health services for persons with disabilities.     

Characteristics of disabilities in patients with subacutemyelo-optico-neuropathy living at home: Satisfaction in daily life and short form-36

Purpose. The aim of this study was to investigate the characteristics of disabilities in patients with subacute myelo-optico-neuropathy (SMON), and to reveal whether the satisfaction in daily life (SDL) or short form-36 (SF-36) correlated with these disabilities.

Method. The subjects consisted of 97 patients with SMON living at home, who were mailed a questionnaire concerning the patient's profile, SMON severity (disability scale for SMON), basic activities of daily living (self-rating Barthel Index, SR-BI), lifestyle (self-rating Frenchay Activities Index, SR-FAI), SDL and SF-36. A relationship with SDL, SF-36 and disabilities was analysed by using Spearman's rank correlation coefficient.

Results. Fifty-eight out of 97 patients with SMON responded, and their mean age was 76.1 years. The mean of SMON severity was 8.0; SR-BI, 70.8; SR-FAI, 11.1; SDL, 27.3; physical component summary of SF-36 (PCS), 26.3; mental component summary of SF-36 (MCS), 39.5. The SMON group had significantly lower scores for SDL than those for the age- and sex ratio- matched elderly persons. With respect to SDL, a significant correlation was observed with SMON severity, SR-BI, SR-FAI, SDL, and PCS and MCS of SF-36, but no significant correlation was observed regarding SMON severity and either the PCS or MCS.

Conclusions. The subjective domains of the quality of life in patients with SMON were observed to have decreased. SDL was considered to closely reflect the characteristics of the disabilities observed in patients with SMON.     

The impact of humorous media on attitudes toward persons with disabilities

Purpose: To examine the relationship between disability-related humor and attitudes toward persons with disabilities in business students (i.e. “future employers”). Method: Students watched one of two films designed to reduce negative attitudes toward persons with disabilities (one humorous in tone and the other serious in tone) or no film at all, and completed a measure of attitudes toward persons with disabilities. Results: Results indicated that, after controlling for previous contact with persons with disabilities, age, and gender, students who watched the humorous film reported significantly more positive attitudes toward persons with disabilities. Conclusions: Disability humor may be an effective means of positively influencing attitudes toward persons with disabilities in future employers.

Implications for Rehabilitation

• The acceptance and integration of persons with disabilities into society continues to be limited by negative attitudes.

• Previous research has shown that employers with positive attitudes toward persons with disabilities may be more likely to hire a person with a disability than employers with negative attitudes.

• In this study, students who watched a humorous film reported significantly more positive attitudes toward persons with disabilities than students who watched a serious film or no film at all.

• Consequently, it may be beneficial to embed disability humor into job-placement strategies in order to improve attitudes and positively influence hiring decisions.

     

Characteristics of suicidal individuals: A review

Abstract

Evidence on the demographic characteristics of suicidal people is mixed. Demograph-ically, at relatively higher risk are men, whites, older adults or adolescents, and native Americans. In terms of personality, suicidal individuals are described as having maladaptive affect (depressed, irritable, aroused, and socially isolated) or maladaptive cognitions (hopeless, having negative expectations, field dependent, cog-nitively rigid, and impulsive). In contrast, some recent research has investigated whether suicidal persons lack important adaptive characteristics. The Reasons for Living Inventory (RFL) was developed with this emphasis and has the advantages of a positive focus (reasons for not committing suicide), six separate subscales, and strong reliability and validity. A more thorough understanding of adaptive characteristics through the use of such instruments as the RFL may help clinicians and researchers in treating and preventing suicidal behavior.     

Current perspective regarding adults with intellectual and developmental disabilities accessing computer technology

Purpose: This article was written to summarize current efforts in the research community in regards to assisting adults with severe developmental and intellectual disabilities to access a computer. Method: A literature search was conducted to determine contemporary research that has been conducted to enable computer use in persons with significant developmental disabilities utilizing databases such as ERIC or PubMed. Results: Although various assistive technology devices and interventions have been developed for persons with all types of disabilities, a lack of research into methods to help persons with severe developmental disabilities access a computer is evident. This perpetuates the underutilization of computers in this population such as those attending day programs or residing in residential facilities. Conclusions: Persons with developmental disabilities, particularly adults, are often overlooked and are not thought to be capable of using a personal computer. Though communities have endeavored to further enhance participation by persons with disabilities in many aspects of mainstream society, there is a scarcity of research pertaining to how adults with intellectual disabilities can access a computer, especially those with severe impairments. Once formal schooling is over, there appears to be scant interest in supporting adults using computers.

Implications for Rehabilitation

• Helping a person to access a computer use should be considered to be within the purview of rehabilitation professionals, even when an individual has an intellectual disability.

• Research into methods to enable access to computer technology should incorporate persons with severe intellectual disabilities, including adults.

• Assistive technology devices, including those associated with computer technology should be developed with persons with severe developmental disabilities in mind to facilitate access.

• Rehabilitation professionals such as speech therapists, occupational therapists and physical therapists should work in concert to develop guidelines and protocols founded on research to aid persons with severe and multiple disabilities who want to access a computer.

     

Cognitive modification with depression-prone psychiatric patients

This research examined modifying specific maladaptive covert language patterns in depression-prone psychiatric outpatients. Five cognitive processes that seemed to activate depressive covert and overt language patterns were defined. These processes were (1) self-evaluation, (2) self-reporting of affect, (3) reaction to stress, (4) choice making, and (5) assuming nonpunitive responsibility for behavior. Patients were taught to reduce maladaptive covert language patterns related to the five target cognitive processes, while learning more adaptive covert patterns. Twenty moderately depressed adult psychiatric outpatients were randomly assigned either to a cognitive modification condition or to a waiting condition consisting of medication and support. Subsequent to treatment and at 6-month follow-up, patients receiving cognitive modification treatment were rated as less depressed, saw themselves as less depressed, and elicited more adaptive, nondepressive verbalizations concerning their own mental status than did patients receiving medication and support only. Implications of the results for the assessment and treatment of depression are discussed.     

Framing disability among young adults with disabilities and non-disabled young adults: an exploratory study

Abstract

Purpose: To explore how young adults frame disability and to compare the meanings of disability between persons with and without disabilities. Method: Snow ball sampling was used to recruit the participants. The sample comprised of 14 young adults from Upstate New York area; nine were non-disabled, five had a physical disability. Data were collected by semi-structured interviews. Qualitative content analysis was used to analyze the data. Results: Five themes emerged from the analysis: disability as a deviation from “the norm”, disability as inability, disability as something one needs to overcome, the role of the environment in disability, and disability as a negative phenomenon. The findings suggest that persons with disabilities hold somewhat different meanings of disability compared with non-disabled persons. Conclusions: While the biomedical frame of disability was somewhat challenged, disability is mainly understood via a biomedical lens. Disability should be framed as form of human diversity, not as a mark of Cain.

• Implications for Rehabilitation

• The ways through which disability is framed-as a medical issue or a social one-influences social attitudes and behaviors toward persons with disabilities as well as the shaping of disability policies and services. These, in turn, effect the well-being and impact the lives of persons with disabilities.

• In a relatively small sample which comprised of young adults with disabilities and non-disabled young adults, this study shows that while medical definitions of disability are somewhat contested, the medical definition of disability seems to prevail.

     

An Exploratory Factor Analysis of the ICAP Maladaptive Behavior Items

This paper reports the results of an exploratory factor analysis of Individual Client and Agency Planning (ICAP; Bruininks, R. H., Hill, B. K., Weatherman, R. F., and Woodcock, R. W. (1986). Examiner's Manual. ICAP: Inventory for Client and Agency Planning. DLM Teaching Resources, Allen, Texas.) maladaptive behavior items. Subjects included 300 persons living in a state school. Most were adults and two-thirds had profound mental retardation. A principal-components analysis with varimax rotation was performed. A scree plot identified only 1 factor. The items that loaded most highly on this factor were socially offensive behavior, uncooperative behavior, hurts others, disruptive behavior, and property destruction. This factor accounted for 36.3% of the variance. It was labeled external maladaptive behaviors. Results of a factor analysis constraining the number of factors to 3 factors yielded extrapersonal and intrapersonal maladaptive factors and 1 that could not be clearly labeled. The internal consistency of the ICAP maladaptive items was very high.     

A community living management program for people with disabilities who have moved out of nursing homes: a pilot study

Purpose: This study describes implementation and evaluation of the Stepping Stones program, a community living management program designed to assist people with disabilities to gain community living skills after moving out of nursing homes. Methods: Thirteen people with diverse disabilities participated in the 10-week Stepping Stones program. The participants attended two sessions a day every week, over a 5-week period. Interviewer-administered surveys were used at baseline and 1 week post-intervention to evaluate the impact of the program. Focus group interviews were conducted at 1 week post-intervention. Results: Analyses of quantitative data demonstrated improved self-efficacy in community living management skills, with medium-to-high effect sizes. Participants reported improved sense of empowerment and confidence in finding resources and managing community living. They also reported high satisfaction with the program. Conclusions: Preliminary findings suggest that the Stepping Stones program is beneficial to the target group. The study indicates that application of social learning and self-efficacy theories is effective to empower and enable people with disabilities to manage their lives in the community. The Stepping Stones program may be provided as a risk management intervention after individuals' transition into the community.

• Implications for Rehabilitation

• Long-term institutionalization negatively influences people with disabilities' self-esteem, autonomy and ability to independently live in the community.

• Successful community living requires complex management involving the coordination of personal, social, resource and environmental factors.

• This study shows that programming on choice and control and community living skill development improved participants' confidence in managing community living.