The psychometric properties of the Multi-Dimensional Observation Scale for Elderly Subjects (MOSES) in middle aged and older populations of people with mental retardation

OBJECTIVE: To assess the internal consistency, inter-scale correlations and factor structure of the MOSES with older adults with mental retardation. METHOD: A series of outpatients with mental retardation were assessed with the MOSES. 163 middle aged and older adults with mental retardation living in community settings participated. RESULTS: The subscales and total scale of the Multi-Dimension Observation Scale for Elderly Subjects (MOSES) were highly internally consistent. The pattern of correlations between the five scales was very similar to that reported by Dalton et al. (1999). The results of a factor analysis using varimax rotation indicated a three-factor structure corresponding to adaptive behavior, externalizing and internalizing maladaptive behaviors. CONCLUSIONS: The MOSES appears to be was a psychometrically adequate instrument to screen older adults with mental retardation.     

Maladaptive behaviors related to adaptive decline in aging adults with mental retardation

Changes in patterns of maladaptive behavior related to age-associated adaptive declines were investigated in 529 adults with mental retardation. Although individuals with no significant adaptive decline displayed stable patterns of maladaptive behavior over a 3-year period, those with declines in function showed more variable patterns. Certain maladaptive behaviors were related to the onset of adaptive declines, with some becoming of increasing concern even before adaptive declines were noted (e.g., lack of boundaries). Other behaviors increased as adaptive declines developed (e.g., withdrawal). In general, findings suggest similarities in the course of age-associated dementia of adults with and without mental retardation and indicate that increases in selected areas of maladaptive behavior may be early indicators of concern for individuals at risk.     

The Reiss Screen for Maladaptive Behaviour: its reliability and internal consistencies

The inter-rater and test-retest reliabilities, and intemal consistencies of the Reiss Screen for Maladaptive Behavior (Reiss 1987) were evaluated on a random sample of adults with moderate through profound mental retardation living in an institutional setting. Generally, the Reiss Screen showed good inter-rater reliability, modest to good test-retest and good intemal consistency. This suggests that the Reiss Screen has moderate to good psychometric robustness.     

Vigorous,aerobic exercise versus general motor training activities: Effects on maladaptive and stereotypic behaviors of adults with both autism and mental retardation

Examined the effects of antecedent exercise conditions on maladaptive and stereotypic behaviors in 6 adults with both autism and moderate to profound mental retardation. The behaviors were observed in a controlled environment before and after 2 exercise and 1 nonexercise conditions. From the original group of 6 participants, 2 were selected subsequently to participate in aerobic exercise immediately before performing a community-integrated vocational task. Only antecedent aerobic exercise significantly reduced maladaptive and stereotypic behaviors in the controlled setting. Neither of the less vigorous antecedent conditions did. When aerobic exercise preceded the vocational task, similar reductions were observed. There were individual differences in response to antecedent exercise. Use of antecedent aerobic exercise to reduce maladaptive and stereotypic behaviors of adults with both autism and mental retardation is supported.The authors acknowledge the important assistance provided by the following people: The staff and management of the Behavior Development and Learning Center at Camarillo State Hospital and Developmental Center directed by Israel Perel, Ellie Kimbauer, Judy Baptista, Kristine Herman, and especially the participants.     

Weight,lipids, glucose,and behavioral measures with ziprasidone treatment in a population with mental retardation

BACKGROUND: Atypical antipsychotics effectively reduce maladaptive behavior in individuals with mental retardation, yet bring significant weight gain and metabolic anomalies. Ziprasidone, a weight-neutral antipsychotic in patients with schizophrenia or schizoaffective disorder, has not been studied in a population with mental retardation and maladaptive behaviors. METHOD: Forty patients with mental retardation and maladaptive behaviors who had gained excessive weight or were inadequately responsive to other agents were switched to ziprasidone. Weight, total cholesterol, HDL, LDL, triglycerides, and frequency of maladaptive behavior were recorded at baseline and after 6 months of ziprasidone treatment. RESULTS: Ziprasidone treatment was associated with a significant weight loss of 8.1 lb (3.6 kg) as well as a significant reduction in total cholesterol and triglycerides (p < or =.05). The monthly frequency of the maladaptive behavior remained unchanged or improved in 72% (18/25) of the patients in whom maladaptive behavior was assessed. CONCLUSION: Ziprasidone effectively reduces the frequency of maladaptive behavior in a patient group with mental retardation without causing weight gain or metabolic disturbances.     

Incidence and temporal patterns of adaptive behavior change in adults with mental retardation

The age-associated incidence of significant decline in adaptive behavior and the temporal pattern of decline in specific functional skill domains were examined in 646 adults with mental retardation through 88 years of age. Cumulative incidence of significant decline for adults with Down syndrome increased from less than.04 at age 50 to.67 by age 72, whereas cumulative incidence of significant decline for adults with mental retardation without Down syndrome increased from less than.02 at age 50 to.52 at age 88. Among adults experiencing overall decline, four clusters of behaviors were identified based upon the sequence and magnitude of changes, suggesting a pattern of loss not unlike that noted in the population without mental retardation with dementia.     

Association of maladaptive parental behavior with psychiatric disorder among parents and their offspring

BACKGROUND: A longitudinal study was conducted to investigate the role of maladaptive parental behavior in the association between parent and offspring psychiatric disorder. METHODS: Psychosocial and psychiatric interviews were administered to a representative community sample of 593 biological parents and their offspring from 2 counties in the state of New York in 1975, 1983, 1985 to 1986, and 1991 to 1993. In 1975, the offspring were a mean age of 6 years. Maladaptive parental behavior was assessed in 1975, 1983, and 1985 to 1986. Parent and offspring psychiatric symptoms were assessed in 1983, 1985 to 1986, and 1991 to 1993. RESULTS: Maladaptive parental behavior substantially mediated a significant association between parental and offspring psychiatric symptoms. Parents with psychiatric disorders had higher levels of maladaptive behavior in the household than did parents without psychiatric disorders. Maladaptive parental behavior, in turn, was associated with increased offspring risk for psychiatric disorders during adolescence and early adulthood. Most of the youths that experienced high levels of maladaptive parental behavior during childhood had psychiatric disorders during adolescence or early adulthood, whether or not their parents had psychiatric disorders. In contrast, the offspring of parents with psychiatric disorders were not at increased risk for psychiatric disorders unless there was a history of maladaptive parental behavior. CONCLUSIONS: Maladaptive parental behavior is associated with increased risk for the development of psychiatric disorders among the offspring of parents with and without psychiatric disorders. Maladaptive parental behavior appears to be an important mediator of the association between parental and offspring psychiatric symptoms.     

Recognition of facial expressions of emotion by persons with mental retardation. A matched comparison study.

Children and adults with mental retardation were tested on their ability to recognize facial expressions of emotion. The sample consisted of 80 children and adults with mental retardation and a control group of 80 nonhandicapped children matched on mental age and gender. Ekman and Friesen's normed photographs of the six basic emotions (anger, disgust, fear, happiness, sadness, and surprise) were used in a recognition task of facial expressions. Subjects were individually read two-sentence stories identifying a specific emotion, presented with a randomized array of the six photographs of the basic facial expressions of emotion, and then asked to select the photograph that depicted the emotion identified in the story. This procedure was repeated with 24 different stories, with each of the six basic emotions being represented four times. Results showed that, as a group, individuals with mental retardation were not as proficient as their mental-age-matched nonhandicapped control subjects at recognizing facial expressions of emotion. Although adults with mild mental retardation were more proficient at this task than those with moderate mental retardation, this finding was not true for children. There was a modest difference between the children with moderate mental retardation and their nonhandicapped matched controls in their ability to recognize facial expression of disgust.     

Maladaptative parenting and the association between parental and offspring psychiatric disorders

A longitudinal study was conducted to investigate the role of maladaptive parental behavior and the association between parent and offspring psychiatric disorders. Psychosocial and psychiatric interviews were carried out in a representative community sample of 593 biological parents and their offspring from two counties in the state of New York in 1975, 1983, 1985-86, and 1991-93. In 1975, the mean age of offspring was 6 years. Maladaptive parental behavior was assessed in 1975, 1983, and 1985-86. Parent and offspring psychiatric symptoms were assessed in 1983, 1985-86, and 1991-93. Maladaptive parental behavior substantially mediated a significant association between parental and offspring psychiatric symptoms. Parents with psychiatric disorders had higher levels of maladaptive behavior in the household than did parents without psychiatric disorders. Maladaptive parental behavior, in turn, was associated with increased offspring risk for psychiatric disorders during adolescence and early adulthood. Most of the youths that experienced high levels of maladaptive parental behavior during childhood had psychiatric disorders during adolescence or early adulthood, independent of whether or not their parents had psychiatric disorders. In contrast, the offspring of parents with psychiatric disorders were not at increased risk for psychiatric disorders unless there was a history of maladaptive parental behavior. Maladaptive parental behavior is associated with increased risk for the development of psychiatric disorders among the offspring of parents with and without psychiatric disorders. Maladaptive parental behavior appears to be an important mediator of the association between parental and offspring psychiatric symptoms.     

Brief Report: Effects of Clozapine on Self-Injurious Behavior of Two Risperidone Nonresponders with Mental Retardation

A typical antipsychotic medications for self-injurious behavior (SIB), aggression, and destruction among people with mental retardation and development disabilities are becoming increasingly accepted. Most studies are on risperidone and fewer have been conducted on clozapine. The present single-blind study reports marked reductions in SIB and aggression of two persons with profound mental retardation who were nonresponsive to all other behavioral and psychopharmacological interventions, including risperidone. The most effective dose was 200 mg/day. Side effects were mild and the drug was tolerated well.     

Tremor frequency profile as a function of level of mental retardation

The characteristic slowness of movement initiation and execution in adult individuals with mental retardation may be driven by the slower frequency profile of the dynamics of the system. To investigate this hypothesis, we examined the resting and postural finger tremor frequency profile (single and dual limb) of adults as a function of level of mental retardation (moderate, severe, profound). There was a progressive increase in the contribution of slow frequency components to the enhanced amplitude of tremor as a function of mental retardation, particularly in the group with profound mental retardation. Findings support the hypothesis of mental retardation inducing a slower frequency to the system dynamics that may fundamentally drive the characteristic slowness of movement behavior.     

Maladaptive behaviour in Prader-Willi syndrome in adult life

Thirty adults with Prader-Willi syndrome (PWS) were compared with 30 adults with non-specifrc learning disability matched for age, sex and severity of mental retardation. Maladaptive behaviors was assessed with the Aberrant Behavior Checklist (ABC), a 58-item structured Interview which rates behaviors from 0 (not a problem) to 3 (severe problem) and which yields five factors (I) irritability, agitation; (II) lethargy, withdrawal; (III) stereotypic behavior; (IV) hyperactivity, non–compliance; and (V) inappropriate speech). The PWS sample had significantly higher factor I (P < 0.001) and factor V (P < 0.05) scores. The PWS sample had mean scores above 1 for 17 ABC items; the contrast subjects had no mean scores above I. The factor I scores for the PWS sample were similar to those of inpatients in hospital facilities for adults with mental retardation and mental illness or severely challenging behaviors. The results support previous work, and extend it by suggesting that temper tantrums, self-injury, impulsiveness, lability of mood, inactivity and repetitive speech are characteristic behaviours in PWS in adult life. Studies of the reasons for heterogeneity in behaviors are now needed.     

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.     

Neuropsychological assessment of a group of UK patients with Cohen syndrome

Cohen syndrome is a rare autosomal recessive syndrome with a distinctive clinical phenotype that includes mental retardation and a characteristic sociable disposition. Variability in the level of learning disability and the behavioural phenotype is seen in the published literature. In a cohort of Finnish Cohen syndrome patients, severe mental retardation and non-maladaptive behaviour were described. Outside of Finland, autistic-spectrum behaviour has been reported in a few isolated Cohen syndrome patients but in a recent UK study was found to be highly prevalent. We report the results of neuropsychological studies in a group of 16 genetically heterogeneous patients, all with the characteristic clinical features of Cohen syndrome. Of the 9 patients who underwent formal neuropsychological testing, all but one was functioning in the severely mentally impaired range. Of the remaining patients, 3 were below the age of formal testing and 4 had such profound learning and behavioural problems that they were deemed unable to participate in testing. Mild maladaptive behaviour was observed in 13 patients and 3 were documented as having significant maladaptive behaviour. In contrast to the Finnish group of Cohen syndrome patients, this UK study identifies significant neuropsychological impairment combined with maladaptive behaviour as a characteristic of Cohen syndrome. Although autistic-type behaviour was observed, an increased prevalence of autism in Cohen syndrome was not confirmed.     

The understanding and use of interpersonal gestures by autistic and Down's syndrome children

Autistic adolescents with mild, moderate, and severe degrees of mental retardation, Down's syndrome adolescents, and clinically normal 4-, 5-, and 6-year-old children were compared in their ability to understand a set of simple instrumental gestures. Almost all gestures were perfectly understood, that is, correctly responded to, by normal children from age 5 onwards, and by all the handicapped groups, regardless of diagnosis or degree of retardation. However, the ability to initiate such gestures on verbal request was generally less good, especially in the less able autistic groups. The same subjects were unobtrusively observed in the playground and during mealtime at their schools. Peer interactions were least frequent in the autistic subjects, regardless of degree of mental retardation. However, relative to interaction frequency, the autistic group used nonverbal instrumental gestures as a means of communication to the same extent as the other groups. Unlike Down's syndrome adolescents, or normal preschool children, no autistic adolescent ever used expressive gestures.Institute of Education, MRC Developmental Psychology ProjectOur particular thanks are due to the Dedisham School for Autistic Children and to many special schools in Croydon and Herefordshire.     

Childhood adversities,interpersonal difficulties,and risk for suicide attempts during late adolescence and early adulthood

BACKGROUND: Data from a community-based longitudinal study were used to investigate the association between childhood adversities, interpersonal difficulties during adolescence, and suicide attempts during late adolescence or early adulthood. METHODS: A community sample of 659 families from Upstate New York was interviewed in 1975, 1983, 1985 to 1986, and 1991 to 1993. During the 1991-1993 interview, the mean age of the offspring was 22 years. RESULTS: Maladaptive parenting and childhood maltreatment were associated with an elevated risk for interpersonal difficulties during middle adolescence and for suicide attempts during late adolescence or early adulthood after age, sex, psychiatric symptoms during childhood and early adolescence, and parental psychiatric symptoms were controlled statistically. A wide range of interpersonal difficulties during middle adolescence were associated with risk for suicidal behavior after the covariates were controlled. Profound interpersonal difficulties during middle adolescence mediated the association between maladaptive parenting or childhood maltreatment and suicide attempts during late adolescence or early adulthood. CONCLUSIONS: Maladaptive parenting and childhood maltreatment may be associated with a risk for severe interpersonal difficulties during adolescence. These interpersonal difficulties may play a pivotal role in the development of suicidal behavior. Youths who are at an elevated risk for suicide may tend to be in need of mental health services that can help them to cope with an extensive history of profound interpersonal difficulties, beginning in childhood and continuing through adolescence.     

Capacity of persons with mental retardation to consent to participate in randomized clinical trials

OBJECTIVE: Adults with mental retardation have histories of cognitive and adaptive deficits posing unique ethical challenges for research consent assessment. This study examined the capacity of persons with mental retardation to consent to participate in randomized clinical trials. METHOD: A total of 150 adults (50 each with mild and moderate mental retardation and 50 comparison subjects without mental retardation) responded to a set of consent questions for a hypothetical randomized clinical trial testing a medication for aggressive disorders. Intelligence, adaptive behavior, medical treatment history, and consent history were evaluated. Univariate and multivariate methods were used to compare performance across and within groups. RESULTS: Comparison subjects scored significantly higher on measures of consent capacity than participants with mild mental retardation, who scored higher than those with moderate mental retardation. Most subjects with mental retardation were able to make a participation choice, and many understood research methods and appreciated the protagonist's disorder and the consequences of participation. Almost half of those with mild mental retardation understood human subject protections. Performance was weakest on understanding the purpose of research and reasoning about whether to participate, suggesting vulnerability to the therapeutic misconception. Psychiatric and experiential factors did not predict consent capacity. CONCLUSIONS: While adults with mental retardation as a group showed consent deficits, many attained consent capacity scores comparable to those of comparison subjects. Investigators should consider individual differences and a consent format suited to deficits in language, memory, and attention before restricting consent opportunities for persons with mental retardation.     

Adrenocortical function and depressive illness in mentally retarded patients

The authors administered a 1-mg dexamethasone suppression test (DST) to 85 institutionalized adults with mild to profound mental retardation after screening to exclude false-positive nonsuppression. Thirty-one (36%) of these subjects had baseline hypercortisolemia, which was significantly correlated with age, symptoms, and "modified" DSM-III criteria for major depressive disorder. Twenty (24%) of the 85 subjects were nonsuppressors (5 micrograms/dl) after testing; nonsuppression was significantly related to age, female sex, level of retardation, symptoms, and "modified" DSM-III criteria for major depressive disorder (sensitivity 41%, specificity 81%). First-order partial correlations maintained significant relationships between age and severity of retardation but not sex. Mental retardation itself did not appear to invalidate the DST.     

Implicit memory in aging adults with mental retardation with and without Down syndrome

Effects of age and IQ on implicit memory in adults with mild or moderate mental retardation with and without Down syndrome were examined. When the etiologically defined groups were equated on age (and IQ), an age-associated difference in implicit memory performance was not evident. When data were reanalyzed, including only participants with unspecified mental retardation from a broader age range, we found a significant but small age-related difference and a significant but small IQ-related effect on implicit memory. In summary, although implicit memory showed an age-associated difference and IQ-associated variation in adults with mental retardation, these effects were relatively small. Data support existing theories proposing the relative invariance of implicit processes across a range of individual differences in age and intelligence.     

Implicit learning in children and adolescents with mental retardation

The literature on implicit learning in persons with mental retardation is scarce and contradictory with respect to the relationship between degree of intellectual disability and impact of implicit-learning processes on performance. We examined children and adolescents with mild or moderate mental retardation and typically developing children matched on MA with regard to their implicit learning. Individuals with mental retardation modified their behavior after an implicit training procedure in a way similar to MA- or CA-matched controls. The impact of implicit learning did not vary as a function of IQ or age. However, some differences appeared between groups in their explicit remembering of the training conditions. The theoretical implications of these results are discussed.