From “cabbages” to “kings”* in one month: or,with the deaf-blind,you never know till you try

In 1974 L. G. Stewart wrote a paper on the problems and needs of severely handicapped deaf persons and suggested programmes that were needed to meet these needs. He entitled his paper “We have met the enemy and he is us”. He concluded that we have not met the needs of severely handicapped deaf persons, largely because we have not tried hard enough. Though Stewart was writing solely about deafness, this situation can be said to be true of sensory handicap in general. Kropka and Williams (1980) wrote that research into the blind and partially sighted had brought to light hitherto unsuspected service deficiencies for this “hidden” minority, as well as for the hearing impaired minority investigated earlier (Kropka, 1979). It was concluded that fine grain analysis of specific sub-groups within mental handicap institutions would highlight the under-estimation of the number of people involved and the lack of suitable programmes for them.     

Evidence of minimal cerebral asymmetries for the processing of English words and American sign language in the congenitally deaf

Previous investigators reported that auditory association cortex is usually larger within the left than within the right hemisphere, even in the newborn. They suggested that this asymmetry could play a causal role in the predominant tendency for language processes to lateralize in the left rather than in the right hemisphere. For congenitally deaf persons, however, the role of auditory association area asymmetry presumably would be nullified. This question was addressed by comparing the performances of congenitally deaf college students and hearing persons on lateralized tachistoscopic tasks thought to reflect hemispheric language and spatial processing efficiencies. The results indicated that indicated that congenitally deaf Ss showed minimal half-field asymmetries for both English word stimuli and for American Sign Language stimuli (drawings of hand configurations representing letters and words for the deaf Ss). Results were interpreted as supporting auditory experience as a major determinant of cerebral functional asymmetries and as contradictory to clinical reports that had suggested that the cerebral organization of “communicative” functions were entirely comparable in deaf and hearing persons.     

Special issues regarding psychotherapy with the deaf

The authors interviewed 10 therapists and supervisors who had clinical experience in working with deaf patients. The responses centered on issues related to the necessity of visual rather than auditory communication, problems of diagnosis and assessment, therapist and patient expectations, special strengths of deaf patients, involvement of third parties, and modification of therapeutic technique. The authors emphasize that additional resources and research are necessary for clinicians to meet the needs of this large but still underserved population.     

Does it exist?: "a psychopathology of deafness"

This work aims to study the relationship between psychopathology and deafness. These results show that the most frequent diagnosis among the deaf are disorders of mood and post-traumatic syndrome. Psychotic disorders and mental retardation, once widely diagnosed among deaf populations, are less frequent. The accuracy of these findings results from studies conducted by a team that is specialized in the care of the deaf and that also masters the socio-linguistic aspects of the deaf culture. The high prevalence of erroneous diagnosis posed by non-specialist teams in support of deaf persons, shows the need for the establishment of a bio-psycho-socio-specific language for the deaf.     

Attitudes of children and adolescents toward persons who are deaf,blind, paralyzed or intellectually disabled

This study aimed to explore Dutch students’ attitudes toward deaf, blind, paralyzed or intellectually disabled persons and to determine whether age, self-esteem, gender, religion and familiarity with a disabled person have a significant effect on these attitudes. The attitudes of 200 high school and 144 university students were determined with two questionnaires, the CATCH and MAS. Only the CATCH was applicable with all four disabled groups. Two factors were found: behavior–positive affect and cognition–negative affect. With regard to the first factor respondents had more positive attitudes toward deaf, blind and paralyzed persons than toward intellectually disabled persons. The cognition and negative affect factor showed that respondents had more positive attitudes toward deaf and blind persons than toward paralyzed and intellectually disabled persons. Being older and familiarity with a disabled person had a significant positive effect on attitudes, while self-esteem and gender had only a partial effect and having religious beliefs was not a significant predictor in this study.     

Law,policy, and involuntary emergency room visits

The authors present data showing that the number of mentally ill individuals brought by police officers to psychiatric emergency rooms in New York City increased by 69 percent from 1983 to 1989. They conclude that while the statutory criteria for the involuntary removal of mentally ill persons to hospitals have not changed, case law decisions and public policies that facilitate the involuntary treatment of patients who neglect their essential needs have contributed to this trend. The impact of these visits on hospital based psychiatric emergency room is discussed in terms of increased clinical and legal responsibility for the disposition of persons who are considered dangerous including those who are self-neglectful of their own essential needs.     

Stutter-like dysfluencies in Flemish Sign Language users

The purpose of this communication is to report on the occurrence of stutter-like behaviour in Flemish Sign Language users. A questionnaire was sent to 38 Flemish Sign Language interpreters and 28 employees of special needs schools adapted to deaf and partially deaf pupils inquiring whether they had ever observed dysfluencies in the manual communication of the deaf and partially deaf. Of the 13 individuals who responded, nine indicated to have perceived such behaviour. The characteristics of the observed dysfluencies are summarized and implications are discussed.     

Psychiatric Diagnoses and Psychosocial Needs of Outpatient Deaf Children and Adolescents

Deaf youth may be more vulnerable to psychiatric disorders but very little research data is available. The current study identified prevalence rates of psychiatric disorders and examined the psychosocial needs and strengths of deaf youth aged 4–17 receiving specialized outpatient mental health services for the deaf. Compared to hearing peers, deaf youth had greater rates of attention deficit hyperactivity disorder, conduct, autism-spectrum and bipolar disorders and spent three times longer in treatment than their hearing peers. In the deaf subsample, moderate-severe risk was found in social functioning (33.3 %) and suicidal behavior (14 %). Deaf youth had moderate to severe impairment in social relationships (54.8 %), school functioning (42.9 %). Over one-third of deaf youth had impaired family relationships, living situation, communication, judgment and physical health. Deaf youth present with higher rates of certain clinical disorders and have deficits in multiple life domains that may impact functioning and create a longer treatment course.     

Comorbidity of schizophrenia and prelingual deafness: its impact on social network structures

Background: Prelingually deaf persons usually gain only a rudimentary command of speech and prefer sign language to communicate within the deaf community without the handicap they experience in the hearing world. Maintaining social contact within this rather scattered community, however, requires higher degrees of social initiative and mobility. The aim of the present paper was to study the quantity and quality of social integration among a group of prelingually deaf schizophrenic patients (n = 49) and two control groups comprising prelingually deaf psychiatric but non-psychotic patients (n = 38) and hearing schizophrenic patients (n = 30), with account being taken of the special socialisation conditions of deaf persons and of their cultural standards and values. Method: Data were collected with the help of semi-structured interviews; with the deaf patients these were conducted in German sign language. Using rating procedures we assessed seven social support components, selected items from a history schedule for schizophrenia, and the probands' visual and verbal language skills. Results: The social networks of the two deaf groups were found to have larger gaps than those of the hearing schizophrenic patients, with significant differences being registered most clearly in the comparison between deaf schizophrenic and hearing schizophrenic patients. Comparison of the verbal and visual language skills of the two deaf groups revealed a substantial deficit among the deaf schizophrenics. Visual language skills were found to correlate more strongly than verbal language skills with the social support components. Conclusion: Prelingual deafness has a strong impact on the course of schizophrenia. In the long run, many of these patients belong to a “minority within a minority”. Accepted: 16 July 1999     

The pathway to meeting need for mental health services in Sweden

OBJECTIVE: Mental health problems are often underrecognized and undertreated. Knowledge of the characteristics associated with the pathway to having a need for mental health care by appropriate treatment (met need) can help to correct this deficit. This study used data from a population-based study to determine the characteristics of persons whose needs were meetable, who were aware of the need for mental health care, who requested care, and whose needs were met. METHODS: A total of 10,443 randomly selected persons in Stockholm, Sweden, aged 20 to 64 years answered a survey that included questions about mental health problems. A subsample of 1,093 persons was then interviewed by psychiatrists, who determined whether the respondents had a psychiatric disorder according to DSM-IV criteria. The interview also assessed need for care, service use, and whether an evidence-based treatment was available for the mental health problem. RESULTS: Among the 1,093 persons interviewed 462 were found to have a mental health problem for which psychiatric treatment was available (meetable need for care). Among the 462 persons with a meetable need for care, 70 percent fulfilled the DSM-IV diagnostic criteria for having a psychiatric disorder; the rest had various symptoms, mostly depressive. Among the persons with a meetable need for care, 84 percent were aware of this need, 37 percent had requested care, and 17 percent had their needs met by evidence-based treatment. Persons whose needs were met tended to be female, have more education, and have good social support. Also, they were less likely to report that feelings of shame would prevent them from requesting psychiatric care. CONCLUSIONS: The characteristics associated with unmet need suggest that strategies that focus on specific groups (for example, males and persons with less education) could increase the percentage of persons whose needs are met.     

Comparison of two nonverbal intelligence tests among children who are deaf or hard-of-hearing

The primary goal of the current study is to evaluate the concurrent validity of the Leiter International Performance Scale-Revised (Leiter-R Brief IQ) and Differential Ability Scales – Second Edition (DAS-II Nonverbal Reasoning Index) in a group of children who are deaf or hard-of-hearing. Knowing the breadth of cognitive tools appropriate for use in children who are deaf or hard-of-hearing is highly beneficial, given that clinical and school psychologists are often challenged to reliably assess cognitive functions in the context of hearing loss. Participants included 54 children between three and six years of age with permanent bilateral hearing loss. As part of the study, neurocognitive assessments were conducted by a pediatric neuropsychologist or licensed clinical psychologist with extensive experience administering assessments to children with developmental disabilities, including children with hearing loss. The Leiter-R Brief IQ score was similar to the DAS-II nonverbal reasoning index, with no significant difference in the mean scores across the two assessments. The severity of hearing loss was not correlated to either the Leiter-R or the DAS-II nonverbal IQ. Nearly a quarter of the children evaluated had meaningful intra-individual differences between scores on the Leiter-R and DAS-II that were more than one standard deviation from one another. Conducting accurate intellectual assessments in children who are deaf and hard-of-hearing is fundamental in determining and designing interventions and educational services. More comprehensive neuropsychological test batteries utilizing several tasks to assess a single domain (such as nonverbal reasoning) may be warranted for children who are deaf or hard-of-hearing.     

Social cognition as a mediator of cognition and outcome among deaf and hearing people with schizophrenia

It has been suggested in the research literature that facial affect processing (FAP) and theory of mind (ToM) are both potential mediators of the well-established relationship between cognition and functional outcome among people with schizophrenia. The current project tests the mediating potency of these two domains of social cognition among deaf and hearing people with schizophrenia. Sixty-five people (34 deaf, 31 hearing) were assessed using measures of verbal and visual memory, attention, visual processing, FAP, and ToM. The results suggest that each domain of cognition, save vigilance, exerts an effect on functional outcome indirectly through its influence on social cognition. The patterns of mediation varied when the samples were broken down by hearing status and analyzed separately. Namely, the cognitive tasks directly involving linguistic ability (early visual processing [EVP] and word memory) were best mediated by social cognition for hearing subjects. For deaf subjects, the nonlinguistic cognitive tasks (e.g., visual-spatial memory-recall and copy [VSM-recall and VSM-copy]) were best mediated by social cognition. While FAP and ToM were equally effective as mediators for hearing subjects, FAP was a more potent mediator than ToM for deaf subjects. This study extends prior work in the area of social cognition and schizophrenia and indicates that the development of cognitive rehabilitation strategies should include not only interventions targeting specific cognitive abilities, such as attention and memory, but should include an emphasis on social-cognitive domains, including FAP and ToM. Further, deaf and hearing subjects may benefit from interventions addressing aspects of cognition that support linguistic ability, especially as they relate to social cognition.     

Assessing Fitness for Trial of Deaf Defendants

It is not common for mental health professionals to encounter deaf individuals in their clinical practice. Forensic assessments of deaf people within the criminal justice system, for example fitness to stand trial, can be particularly challenging. There are issues of social justice, access and equity for deaf defendants where culture, sign language and English literacy can impede accurate assessment and thereby compromise the rights of the individual. Working with deaf people in mental health settings requires specific knowledge and skills. This article aims to raise awareness of some of the issues faced by prelingually deaf people who encounter the mental health and criminal justice systems and to provide practical advice to those who are charged with the task of determining fitness for trial.     

Time for change: the role of nonpharmacological interventions in treating behavior problems in nursing home residents with dementia

This paper discusses the etiology of behavior problems in dementia and concludes that a substantial portion of such behaviors arise when care does not appropriately address the underlying causes. The needs of persons with dementia are frequently unrecognized and not addressed because of a combination of factors including communication problems, the multidimensional nature of etiologies and needs, the discounting of the needs of the patient with dementia, an environment that lacks knowledge and resources, and the improper allocation of resources on the part of policy makers, clinicians, and caregivers. The paper delineates some of the steps that are needed to move toward a more appropriate treatment of persons with dementia who manifest behavior problems.     

Therapy for Parkinson’s Disease: What is in the Pipeline?

Despite advances in the treatment of Parkinson’s disease there are still many unmet needs, including neuroprotection, treatment of motor complications, treatment of dyskinesia, treatment of psychosis, and treatment of nondopaminergic symptoms. In this review, I highlight the obstacles to develop a neuroprotective drug and some of the treatment strategies recently approved or still in clinical trials designed to meet these unmet needs.     

Morphometric comparison of the human corpus callosum in deaf and hearing subjects: an MRI study

Auditory cortices are interconnected to each other by fibers passing through the corpus callosum (CC). In totally deaf persons no auditory impulses are conveyed to the auditory cortices, hence the auditory pathways become nonfunctional. It was reported that there has been cross-modal plasticity between auditory, visual, and somatosensory cortices. In this study, our aim was to make a comparison in the CC morphometry in hearing subjects and in a selected group in which the auditory system was deprived before the age of 2. 18 deaf and 18 hearing male, handedness matched volunteers, ages varying between 28 and 56 years old were examined. Audiometrical tests were applied to both groups and then T1-weighted midsagittal MR images were obtained. Certain dimensions and areas were measured on these images. There were no statistically significant difference between deaf and hearing subjects, either when dimensions and areas were analyzed by multivariate analysis of variance or when areas were analyzed by univariate analysis of variance. Absence of any significant morphometric difference in the CC of deaf subjects could be thought as an evidence of reflection of functional cortical plasticity.     

People with an Intellectual Disability in the Australian Criminal Justice System

Intellectual disability (ID) is not accurately identified early enough in the criminal justice system. The extent to which each jurisdiction addresses the needs of persons with ID is inconsistent. Magistrate Court diversion programmes aiming to identify defendants with ID needs vary throughout Australia. This article argues the need for a national approach for the diversion of persons with ID from the criminal justice system. This will be important for persons with and without coexisting mental illness and will affirm international developments protecting the rights of persons with ID (including those in the criminal justice system) to improved and accessible health care.     

Developmental disability training in Canadian psychiatry residency programs.

OBJECTIVE: To examine current training in developmental disabilities in Canadian psychiatry residency programs and to determine, from the programs' perspectives, how provinces across Canada are responding to the needs of persons with developmental disabilities and comorbid mental health disturbances (persons with a "dual diagnosis"). METHOD: A survey was completed by residency directors, or their designate, for all 16 psychiatry residency programs in Canada. RESULTS: Persons with developmental disabilities require psychiatric services throughout their lives, but inadequate training opportunities exist in many of the residency programs, particularly those involving adults and adolescents. While some didactic opportunities are usually available, supervised clinical opportunities are rare, and many of those reported are optional. CONCLUSIONS: Across Canada, there have been insufficient advances in clinical training and service developments to meet the needs of individuals with developmental disabilities and comorbid mental health disturbances.     

Survey and analysis of dental caries in students at a deaf-mute high school

The present cross-sectional study was conducted to assess and compare the prevalence of dental caries of 229 deaf adolescents in a special senior high school and to identify factors related to dental caries, with a match group of 196 healthy adolescents in a normal senior high school, in Jiangsu province of East China. In this study the prevalence of dental caries was 55.9%, Decayed, Missing and Filled Teeth (DMFT) index in deaf students was 1.40±1.89; in healthy students was 13.8% and 1.36±1.72, respectively. Relatively lower proportion of awareness on dental health knowledge and lower proper practice of dental health behavior have been observed among deaf students compared with the control group. Multiple logistic regressions showed that the risk factors of dental caries in deaf students involved high frequency of consuming dessert and carbonated beverage. Poor oral health, lack of oral health knowledge and proper oral health practice could be found in deaf students. The dental treatment for the two groups was urgently needed. The dental health education concerning dietary behavior and prevention program to the deaf students and their parents should be reinforced; the supervision of oral health behavior for deaf and healthy students needs to be strengthened.