Effects of living room, Snoezelen room, and outdoor activities on stereotypic behavior and engagement by adults with profound mental retardation

Two experiments were conducted to test the effect of a room with sensory equipment, or Snoezelen room, on the stereotypic behavior and engagement of adults with profound mental retardation. In Experiment 1, participants were observed in their living room before and after attending the Snoezelen room. Results showed that there tended to be a reduction in stereotypy and increase in engagement when participants went from their living room to the Snoezelen room, and a return of these behaviors to pre-Snoezelen levels in the living room. Positive effects in the Snoezelen room did not carryover to the living room. In Experiment 2, the living and Snoezelen rooms were compared to an outdoor activity condition with the same participants and target behaviors. Results showed that the outdoor condition was superior, the Snoezelen condition intermediate, and the living room least effective in their impact on stereotypic behavior and engagement. Conceptualizations regarding factors that maintain stereotypic behavior and engagement were discussed in the context of the three experimental conditions.     

Functional assessment of problem behaviors in adults with mental retardation

Functional assessment has significantly improved the success of behavioral treatment of problem behaviors in adults with mental retardation. Functional assessment methods (i.e., techniques that yield a hypothesis of functional relationships) include direct observation, interviews, and checklists. Functional analysis consists of empirical methods that demonstrate behavioral function in controlled settings. Each method has advantages and limitations that reflect differences in both available resources and individual client characteristics. These methods and issues are reviewed, and future directions for both the research field and the adult population are suggested.     

Analog language teaching versus natural language teaching: Generalization and retention of language learning for adults with autism and mental retardation

Examined the effects of two instructional methods on language generalization and longterm retention in 23 adults with autism and severe to profound mental retardation. Analog language teaching employed discrete trials in a controlled setting concentrating on discrimination and identification of materials. Natural language teaching emphasized instruction through interactions that occurred incidentally to training students in the use of materials to perform functional tasks. Assessments were conducted under conditions favoring analog teaching to assure against partiality toward natural language teaching. Under such disadvantageous conditions, the methods of natural language teaching would be supported by results showing either no difference or an advantage in their favor. Both techniques increased initial and long-term generalization though the results suggest no relative superiority for either method under these assessment conditions. A significant interaction was found between prior functioning level and sequence of instruction. Because natural language teaching has many strengths, few drawbacks, and produces equal generalization and retention under disadvantageous conditions, it is strongly supported as preferable for people with autism and mental retardation.The authors acknowledge the important assistance provided by the following people: the staff and management of the Behavior Development and Learning Center at CSH/DC directed by Israel Perel, Lisa Kramer, Steve Hafferkamp, James Lowdermilk, and, finally, and especially, to the participants themselves.     

Longitudinal study on the adaptive and challenging behaviors of deinstitutionalized adults with mental retardation

Adaptive and challenging behavior changes associated with movement from Minnesota's state institutions to community homes were examined. Most of the 148 participants who moved had severe or profound mental retardation, significant challenging behavior, and several decades of institutionalization. Adaptive and challenging behavior were assessed in the institution and thereafter annually in the community. Relative to institutional levels, adaptive behavior declined among residents who moved to community ICFs/MR but was unchanged for the HCBS Waiver group. Challenging behavior tended to worsen initially but, except for internalized behavior, no longer differed from institutional levels by the second community assessment. Change in challenging behavior was unrelated to community residence type. Previous papers involving these participants showed consistent lifestyle enhancements and reduced service costs relative to the institution.     

Effects of Snoezelen room, Activities of Daily Living skills training, and Vocational skills training on aggression and self-injury by adults with mental retardation and mental illness

Multi-sensory stimulation provided in a Snoezelen room is being used increasingly for individuals with mental retardation and mental illness to facilitate relaxation, provide enjoyment, and inhibit behavioral challenges. We observed aggressive and self-injurious behavior in three groups of 15 individuals with severe or profound mental retardation and mental illness before, during, and after being in a Snoezelen room. All participants were receiving psychotropic medication for their mental illness and function-derived behavioral interventions for aggression, self-injury, or both. Using a repeated measures counterbalanced design, each group of participants was rotated through three experimental conditions: Activities of Daily Living (ADL) skills training, Snoezelen, and Vocational skills training. All other treatment and training activities specified in each individual's person-centered plan were continued during the 10-week observational period. Both aggression and self-injury were lowest when the individuals were in a Snoezelen room, followed by Vocational skills training and ADL skills training. The levels in the Snoezelen room were significantly lower than in both the other conditions for aggression but only in ADL skills training for self-injury. The difference in levels before and after Snoezelen were statistically significant with self-injury but not with aggression. The order of conditions showed no significant effect on either behavior. Snoezelen may provide an effective context for reducing the occurrence of self-injury and aggression.     

Health characteristics and behaviors of adults with mental retardation residing in three living arrangements

Three hundred and twenty-nine subjects (aged 17–70 years) residing in an institution (N = 184), group home (N = 39), or with one or more family members (N = 106) were evaluated on body composition, blood lipids, and health behaviors. Subjects in the institutional group had lower body weights than those in the group home and natural family settings (p < .001) and also had lower BMIs and percent body fat levels compared to those in the natural family (p < .001). The institutional group also had lower total cholesterol and LDL-C levels than the group home and natural family groups (p < .001) and lower TG and ratio of total cholesterol to HDL-C than the natural family group (p < .01). Although overall use was quite limited, residents in the group home setting smoked more cigarettes, drank more alcohol and coffee, and exercised less than those in the institution and natural family (p < .001). Group home residents also exercised less. Health promotion and disease prevention initiatives for persons with mental retardation living in group homes, in supported living placements, and with their natural families should be undertaken and carefully evaluated.     

Effects of visual arts instruction on the mental health of adults with mental retardation and mental illness

Single-subject multiple probe designs were employed in two studies with 5 young adults who had a dual diagnosis of mental retardation and mental illness. Our aim was to determine effects of instruction designed to teach visual arts activity skills and promote personal expressiveness on acquisition, maintenance, and generalization of these skills and behaviors associated with these persons' mental health. In Study 1, a 5-second constant time delay procedure was used to teach three chosen art activities. In Study 2, an instructional package was used to promote personally expressive behaviors. After learning the skills in Study 1, participants in Study 2 displayed improvement in occurrence of behaviors associated with mental illness and increases in personally expressive behaviors.     

Effects of aerobic,resistance and balance training in adults with intellectual disabilities

Adults with intellectual disability (ID) have decreased cardiovascular fitness and strength present with lower rates of physical activity (PA), and often have balance and functional impairments. The purpose of this study was to investigate the effect of a combined PA program (CPAP) utilizing aerobic, strength and balance training on cardiovascular fitness, strength, balance and functional measures in a controlled clinical trial. Adults with mild to moderate ID were assigned into either the intervention group (IG; n = 37) or the control group (CG; n = 29). The IG trained 3 day/week, 1 h/day over 14 weeks, while the CG did not participate in any exercise program. Cardiovascular fitness, strength, balance, flexibility and functional ability were assessed pre-post training. The IG increased cardiovascular fitness (26.8 vs. 29.3 ml kg⁻¹ min⁻¹), handgrip strength (19.2 vs. 21.9 kg), leg strength, and balance following the training period (p < .05). Body weight (70.1 vs. 68.1 kg) and body mass index (27.4 vs. 26.6 kg m⁻²) decreased (p < .05) in the IG group. The CG showed no changes in any parameter. These data suggest a combined aerobic, strength and balance exercise training program is beneficial among individuals with ID.     

Weight gain in a controlled study of risperidone in children, adolescents and adults with mental retardation and autism

As part of an ongoing, prospective, ABA design, double-blind crossover study of risperidone versus placebo for the treatment of aggressive, destructive and self-injurious behavior in persons aged 6-65 years with mental retardation (MR) and autism, we measured the weight of 19 subjects at each study visit. We compared mean weight gain during the 16-week acute phase and 24-week open maintenance phase with that during the initial and middle placebo phases statistically, using a linear mixed model procedure. Results of the linear mixed model analysis showed that relative weight gain observed during the acute and maintenance drug phases was significantly greater than that observed during the initial and middle placebo phases respectively (p = .0001 and p = .0001). Over approximately a year, children aged 8-12 (n = 5) gained a mean of 8.2 kg (range = 2.7-17.7 kg); adolescents (n = 6) aged 13-16 gained a mean of 8.4 kg (range 3.6-15.5 kg); adults aged 21-51 (n = 8) gained a mean of 5.4 kg (range 0-9.5 kg). Weight gain observed in this controlled study of risperidone treatment in children, adolescents, and adults with MR and autism was significant. It may be greater in this population than in others reported and in this study was not limited to an acute effect only. Rate of weight gain diminished rapidly on tapering and stopping the drug. Further studies are urgently needed, including those incorporating diet and exercise programming.     

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.     

Effects of verbal elaborations on memory for sentences in adults with mental retardation

We examined the effects of verbal elaborations on memory for verbal material in adults with mental retardation and a control group of adults of normal intelligence. During acquisition, three types of sentences were presented that differed in elaboration of the subject-adjective relationship: a) non-elaborated base sentences; b) base sentences with arbitrary verbal elaborations; and c) base sentences with explanatory verbal elaborations that clarified the significance of the subject-adjective relationship. At test, we varied the retrieval context by presenting either base sentences alone or base sentences with the verbal elaborations. A three-alternative, forced-choice recognition procedure was used to test memory for the target adjectives. Results yielded a positive effect of retrieval support (elaborations present at study and test) on recognition performance for adults with mental retardation. These data imply that the retrieval context plays an important role in recognition memory for adults with mental retardation.     

Toilet training and behaviors of people with autism: Parent views

Individuals with autism often present with toileting problems, yet there is little information about the nature of these problems. This investigation surveyed 100 parents of people with autism of a mean age of 19.5 years. Results indicated that lower cognition and lower verbal levels were significantly correlated with age of accomplishment of bowel and urine training; some subjects were not trained at the time of the study. The average duration of urine training was 1.6 years, bowel training 2.1 years. On the average, training started more than 21/2 years before the average age of diagnosis of autism. Fifty-six percent of the sample had to be taught to self-initiate, 42% were taught to ask to use the toilet, and 49% were taught using a schedule. Reinforcement was used by 78% of the parents of males and by 100% of the parents of females. Punishment, primarily scolding was used by 37% of the parents. The most common problems reported were urinating in places other than the toilet, constipation, stuffing up toilets, continually flushing, or smearing feces. More fears related to toileting were noted for verbal subjects.We thank Susan K. Gray who helped with the survey questions, and Jan E. Hendrix who conducted the pilot study.     

Effects of aerobic exercise training and relaxation training on cardiovascular activity during psychological stress

Students who reported experiencing a high number of stressful life events were randomly assigned to: (a) an aerobic training condition, (b) a relaxation training condition, or (c) a no treatment control condition. Immediately before and after the 11 week training/control period, subjects' aerobic fitness and cardiovascular responses to acute psychological stress were assessed. Results indicated that: (1) subjects in the aerobic training condition showed significantly greater improvements in aerobic fitness than subjects in the other conditions, and (2) the subjects in the aerobic training condition showed significantly greater reductions in heart rate during all phases of the stress than subjects in the other conditions. Post-training differences between aerobic and control conditions during the moderate psychological stress were as great as 17 b.p.m. These results provide evidence for the utility of aerobic training for reducing cardiovascular activity during psychological stress, and they are consistent with earlier findings linking fitness to less illness following stress, reductions in depression and enhanced recovery in cardiac patients.     

Psychosocial effects on siblings of children with autism and mental retardation: a population-based study

The probands of this study were 60 children and young adults between 5 and 20 years of age, 20 of whom had siblings with autism, 20 of whom had siblings with mental retardation, and 20 of whom had siblings who were free of handicap. The three proband groups were matched for gender, birth order and socioeconomic status. The children were questioned about their sibling relationships and about particular problems they faced concerning their handicapped brothers or sisters and about problems concerning themselves. Parents were interviewed about the healthy child's behaviour and social adjustment. Mothers completed the Eysenck Personality Inventory concerning themselves. Siblings of handicapped children and especially siblings of children with autism were more concerned about the future. They also felt lonely more often and many of them had peer problems. They often regarded their handicapped siblings as a burden. They tended to have only one sibling. Siblings often did not know why their handicapped brother or sister was different from other children. There were more behaviour disturbances in the siblings of handicapped children and mothers with a child with autism reported more ‘stressful events’. There were no differences as regards the personality of the mothers and the self-concept of the children between the three groups.     

Effects of a peer-mediated aerobic conditioning program on fitness levels of youth with mental retardation: two systematic replications

The generality of a peer-mediated exercise program designed to enhance aerobic fitness of 17 children with moderate and severe cognitive disabilities was evaluated. Two systematic replications of the program were conducted. Participants' ages, disability levels, and school settings varied. Target participants were paired with peers without disabilities. These students encouraged their peers to maintain requisite levels of exercise intensity and monitored their heart rates. A between-group multiple-baseline design was used to evaluate program effects. Results replicated earlier findings. Aerobic fitness of participants, measured by exercise heart-rates, improved when the exercise program was introduced. Results for individual participants reflected more variability than combined group data. Implications for overcoming motivational barriers and obtaining valued outcomes correlated with the program are discussed.     

The relation between general cognitive level and adaptive behavior domains in individuals with autism with and without co-morbid mental retardation

This study examined the association between adaptive behavior and general cognitive level in individuals with autism or PDD-NOS with and without comorbid mental retardation. Data from the screening version of the Vineland Adaptive Scales and the Wechsler Intelligence Scales were analysed in a sample of 67 subjects. While in the higher functioning individuals (IQ > 70, n = 34) IQ and adaptive behavior level differed significantly, performances were fairly comparable in subjects showing lower cognitive functioning (IQ < 70, n = 33). Regression models revealed a higher correlation between IQ and single adaptive behavior domains in the non-mentally retarded participants, with the domain Communication reaching the highest predictive power of the single adaptive behavior areas. Findings indicate, the relationship between adaptive and cognitive function in autistic disorders is mediated by the presence of a qualitative reduction of intelligence. Methodological limitations of the study are discussed.     

Effects of physical training and calcium intake on bone mineral density of students with mental retardation

The purpose of this study was to investigate the effects of physical training and calcium intake on bone mineral density (BMD) of students with mental retardation. Forty mentally retarded boys (age 7–10 years old) were randomly assigned to four groups (no differences in age, BMD, calcium intake and physical activity): training groups with or without calcium supplementation (Tr+Ca+ and Tr+Ca?) and nontraining groups with or without calcium supplementation (Tr?Ca+ and Tr?Ca?). The intervention involved 45 min of physical training performed 3 sessions a week and/or the addition of dietary calcium-rich food using enriched cow milk with vitamin D containing 230 mg calcium per serving, over 6 months. Paired-samples t-test and ANOVA analysis was used to determine the main and combined effects of training and calcium on BMD. All groups showed greater femoral neck BMD after 6 months. The increase in femoral neck BMD in the Tr+Ca+ group was 10% greater than increase in the Tr+Ca? group (not significant). Apparently, the effect of training was greater than calcium intake because the Tr+Ca? group achieved 4% greater BMD than Tr?Ca+ group (not significant). In this study, both training groups had greater BMD than the control group (Tr?Ca?) (P < 0.05).In these participants with inadequate calcium intakes, additional exercise and calcium supplementation resulted in a 6–20% greater increase in BMD than controls at the loaded site (femoral neck). These results help to provide more evidence for public health organizations to deal with both exercise and nutrition issues in children for the achievement of peak BMD.