The effect of physical training on static balance in young people with intellectual disability

Intellectual disability affects all spheres of people's lives who suffer from it. It lowers the level of intellectual functioning, often stigmatizes, characteristically changing features, and decreases motor performance. Unfortunately, modern medicine cannot cure intellectual disability; however, there is a chance to improve the quality of life of people with mental retardation by means of physical exercises and by enhancing coordination, the quality of gait and efficiency in performing everyday activities. This paper deals with observations of static balance in 40 young females and males with mild Down syndrome, out of which 20 were subjected to a three-month sensorimotor training programme. The participants performed exercises with rehabilitation balls and air pillows twice a week, and the remaining persons constituted a control group. The balance platform test conducted at the beginning of the experiment revealed that the level of static one-legged balance was similar in both groups. A significant difference was noted in the length of the path of the general centre of gravity (COG) and the time frame in which the vertical projection of COG remained within the 13 mm radius circle, between the result of the test conducted under visual control and with the eyes closed, both in the group of the participants performing exercises and the ones who did not do them. After the training sessions the results of both tests improved in the group of the persons subjected to the training programme, however differences between the groups were not statistically significant, apart from the comparison of the time of keeping COG within the 13 mm radius circle at the beginning and at the end of the experiment by the participants who were physically active. Our results lead to a conclusion that exercises with the use of unstable surfaces improve deep sensibility in people with mild mental retardation.     

Confidence of group home staff in supporting the health needs of older residents with intellectual disability

Background Increased life expectancy for people with intellectual disability is accompanied by increased age-related health concerns. People ageing with intellectual disability experience more health conditions and are relocated to aged care earlier than their age peers.

Method Group home staff were surveyed about their (a) training and confidence in 11 health conditions and 7 health procedures, and (b) attitude to relocating residents with health needs to aged care.

Results Staff training in each of 10 health conditions and 7 health procedures was positively associated with increased confidence in supporting residents with those health issues. Higher staff confidence in caring for residents with 9 conditions and requiring 4 procedures was negatively associated with a likelihood of recommending that a person with those health needs should relocate to aged care.

Conclusions Targeted training of staff in age-related health issues may contribute to better health care and delay residents relocating to aged care.     

Evaluating a staff training program on the interaction between staff and people with intellectual disability and challenging behaviour: An observational study

Background: The aim of this study was to evaluate the effects of a training program focusing on improvement of emotional intelligence (EI) and support staffs’ awareness of their behaviour towards people with an intellectual disability based on interactional patterns. The support provided regarding the needs for autonomy, relatedness, and competence was observed in line with self-determination theory (SDT).

Method: A pre-test–post-test control group design (N?=?29) was used, with 17 support staff participating in the experimental group. For both groups, video recordings of interactions between staff and clients were analysed with an SDT-observation system.

Results: The results showed that a training program focusing on EI and interactional patterns positively affected the support provided by staff with regard to clients’ needs for autonomy, relatedness, and competence.

Conclusions: As most EI studies focus on insights and understanding of oneself, this study is an important first step in focusing on staff behaviour during daily interactions.     

Family burden related to clinical and functional variables of people with intellectual disability with and without a mental disorder

Few studies have been found that to assess the factors that explain higher levels of family burden in adults with intellectual disability (ID) and intellectual disability and mental disorders (ID-MD). The aims of this study were to assess family burden in people with ID and ID-MD and to determine which sociodemographic, clinical and functional disability variables account for family burden. The sample is composed of pairs of 203 participants with disability and their caregivers, of which 33.5% are caregivers of people with ID and 66.5% of ID-MD. Assessments were performed using scales of clinical and functional disability as the following instruments: Weschler Adult Intelligence Scale-III (WAIS-III), Inventory for Client and Agency Planning (ICAP), Psychiatric Assessment Schedule for Adults with Development Disability (PAS-ADD checklist), Disability Assessment Schedule of the World Health Organization (WHO-DAS-II) and family burden (Subjective and Objective Family Burden Inventory - SOFBI/ECFOS-II). People with ID-MD presented higher levels of functional disability than those with ID only. Higher levels of family burden were related to higher functional disability in all the areas (p < 0.006-0.001), lower intelligence quotient (p < 0.001), diagnosis of ID-MD (p < 0.001) and presence of organic, affective, psychotic and behavioral disorders (p < 0.001). Stepwise multiple regression showed that behavioral problems, affective and psychotic disorder, disability in participation in society, disability in personal care and presence of ID-MD explained more than 61% of the variance in family burden. An integrated approach using effective multidimensional interventions is essential for both people with ID and ID-MD and their caregivers in order to reduce family burden.     

Family impact in intellectual disability, severe mental health disorders and mental health disorders in ID. A comparison

Family impact (or family burden) is a concept born in the field of mental health that has successfully been exported to the ambit of intellectual disability (ID). However, differences in family impact associated with severe mental health disorders (schizophrenia), to ID or to mental health problems in ID should be expected. Seventy-two adults with intellectual disability clients of the Carmen Pardo-Valcarce Foundation's sheltered workshops and vocational employment programmes in Madrid (Spain), 203 adults diagnosed with schizophrenia from four Spanish Community Mental Health Services (Barcelona, Madrid, Granada and Navarra) and 90 adults with mental health problems in ID (MH-ID) from the Parc Sanitari Sant Joan de Déu Health Care Site in Sant Boi de Llobregat, Barcelona (Spain) were asked to participate in the present study along with their main caregivers. Family impact experienced by caregivers was assessed with the ECFOS-II/SOFBI-II scale (Entrevista de Carga Familiar Objetiva y Subjetiva/Objective and Subjective Family Burden Interview). In global terms, results showed that the higher family impact was found between caregivers to people with MH-ID. The interaction of both conditions (ID and mental health problems) results in a higher degree of burden on families than when both conditions are presented separately. There was also an impact in caregivers to people with schizophrenia, this impact being higher than the one detected in caregivers to people with intellectual disability. Needs of caregivers to people with disability should be addressed specifically in order to effectively support families.     

Integrative treatment in persons with intellectual disability and mental health problems

Background Clinical experience has proven thus far that a monodisciplinary treatment approach to behavioural and psychiatric problems in persons with intellectual disability (ID), such as psychotropic medication or behaviour modification programmes, has yielded limited success. It is clear that the complexity of behavioural and psychiatric problems in this population calls for a treatment approach from different perspectives. Methods A multidimensional treatment approach to the persons with ID who suffer from behaviour problems and psychiatric disorders is described. Results Four dimensions – biological, psychological, social and developmental – are represented as well in an integrative diagnosis as in an integrative treatment, embodied by cooperation of different professionals, such as a psychiatrist, psychologist, pedagogues, social worker, nurse and, where possible, the person’s caretakers. The developmental dimension receives a salient attention of assessors. By introducing the developmental dimension in diagnostics and treatment, the bio‐psycho‐social dimensions are set in a new context, more appropriate for persons with ID. Conclusion The integrative treatment should not be primarily directed towards the symptoms of the disorder but towards restoring a person’s mental well‐being. The disorder is combated through treatment of the underlying processes that have led to its onset. Different treatment methods from different perspectives may be applied. Strategy and methodological procedures of an integrative treatment are discussed by way of case presentations.     

The effect of a combined strength and proprioceptive training on muscle strength and postural balance in boys with intellectual disability: An exploratory study

The aim of our study was to investigate the effect of a combined strength and proprioception training (CSPT) program on muscle strength and postural balance in children with intellectual disability (ID). The maximum voluntary contraction (MVC) and postural parameters (CoP_Vm, CoP_LX, CoP_LY) of 20 children with ID were recorded before and after 8 weeks of a CSPT program. The participants were divided into two groups: an experimental group who attended a CSPT program and a control group who continued with daily activities. In the trained group, the MVC increased significantly (p < 0.001) after the training period and the postural parameters decreased significantly in Double-Leg Stance (DLS) and One-Leg Stance (OLS) during the firm surface condition as well as in the DLS during the foam surface condition; in both eyes open (EO) and eyes closed (EC) conditions. A CSPT program improves postural balance in children with ID could be due to the enhancement in muscle strength and proprioceptive input integration.     

Spiritual care for people with intellectual and developmental disability: An exploratory study

Background: A faith-based (pseudonym, Adam’s House – AH) and a non-faith-based care service (pseudonym, Greenleaves – GL) were explored to find out if and how spiritual support was provided for people with intellectual and developmental disabilities (IDDs).

Method: Six months were spent volunteering within each service and a mixed-methods approach was utilised including applied and ethnographic methods to explore and describe if and how spirituality was embedded within the two services.

Results: Themes found included community of value; homely functional care; and barriers to spiritual care. GL staff tended to provide what we termed “religious spiritual care” while AH staff administered both “religious” and “non-religious” spiritual-based support. This difference may be related to the type of training found only at AH which included spiritual dimensions.

Conclusion: Services could benefit from acknowledging the importance and significance of spiritual care training and education for effective and varied spiritual care for people with IDD who desire such support.     

Epilepsy in children with intellectual disability in Bosnia and Herzegovina: Effects of sex, level and etiology of intellectual disability

The purpose of this study was to examine the occurrence of epilepsy in children with intellectual disability. An additional goal was to determine if there were statistical differences in the occurrence of epilepsy related to the sex, level and etiology of intellectual disability of children. The sample consisted of 167 children with intellectual disability attending two special education schools in Sarajevo, Bosnia and Herzegovina. The method for data collection was the examination of the children's medical records. A chi-square test was performed to determine if there were any significant differences in the occurrence of epilepsy among different categories of children with intellectual disability. Additionally, Phi coefficient and Cramer V coefficient were calculated to determine the strength of association. The occurrence of epilepsy in children with intellectual disability is high and certain etiological categories are associated with an even higher risk of epilepsy.The study confirmed a high occurrence of epilepsy in children with intellectual disability. Some psycho-educational implications of epilepsy were discussed and in the future there should be better cooperation between medical and educational institutions in treating the bio-psycho-social issues of a child with epilepsy.     

Characteristics influencing attendance at a primary care health check for people with intellectual disability: An individual participant data meta-analysis

BackgroundHealth checks benefit adolescents and adults with intellectual disability, however uptake is low despite government–funded incentives.AimTo assess the characteristics of people with intellectual disability who, when offered a health check with their primary care physician at no cost, completed the health check.Methods and proceduresData from three randomised controlled trials considering health checks in people with intellectual disability living in the community were included in an individual-patient data meta-analysis. The studies used the same health check and the participant characteristics investigated (age, sex, cause of disability, level of disability and socio-economic position) were defined identically, but participants were sourced from different settings: adults living in 24-h supported accommodation, adults living in private dwellings, and school-attending adolescents.Outcomes and resultsIn total 715 participants were offered health checks. Compared to participants with Down syndrome, participants with other known causes of disability were more likely not to attend their health check (odds ratio;95%CI) = (2.5;1.4–4.7), as were participants with no known cause of disability (2.3;1.2–4.3). These associations remained significant after adjusting for potentially confounding variables.Conclusion and implicationDown syndrome was the only characteristic positively associated with health check attendance across all study settings. Future research should focus on strategies to increase health check uptake in this population.     

Rates of breastfeeding and exposure to socio-economic adversity amongst children with intellectual disability

Children with intellectual disability are at increased risk of experiencing poor health relative to their typically developing peers. Previous research indicates that exposure to socio-economic disadvantage contributes towards this disparity but that additional factors (including parenting practices) may be involved in mediating/moderating pathways. This study examined duration of breastfeeding amongst children with and without intellectual disability by a secondary analysis of data from the UK Millennium Cohort Study. Children with intellectual disability were significantly less likely to have been ever breastfed; breastfed exclusively or at all at 3 months or breastfed at all at 6 months relative to children without intellectual disability. None of these differences remained significant when other psycho-social risk factors for reduced breastfeeding were controlled for. The study adds to both the sparse literature on breastfeeding practices amongst families of children with intellectual disability and research demonstrating relationships between socio-economic disadvantage and wellbeing for children with intellectual disability.     

Route learning and shortcut performance in adults with intellectual disability: a study with virtual environments

The ability to learn routes though a virtual environment (VE) and to make a novel shortcut between two locations was assessed in 18 adults with intellectual disability and 18 adults without intellectual disability matched on chronological age. Participants explored two routes (A ⇔ B and A ⇔ C) until they reached a learning criterion. Then, they were placed at B and were asked to find the shortest way to C (B ⇔ C, five trials). Participants in both groups could learn the routes, but most of the participants with intellectual disability could not find the shortest route between B and C. However, the results also revealed important individual differences within the intellectual disability group, with some participants exhibiting more efficient wayfinding behaviour than others. Individuals with intellectual disability may differ in the kind of spatial knowledge they extract from the environment and/or in the strategy they use to learn routes.     

Psychiatrists' knowledge,training and attitudes regarding the care of individuals with intellectual disability

Background Psychiatrists are responsible for providing proper care for people with intellectual disability who have psychiatric disorders. This study examined psychiatrists' perceptions of their own training, knowledge and therapeutic skills, as well as their attitudes towards this population. Methods Questionnaires were distributed to 679 psychiatrists working within the public sector in Israel. Results Completed questionnaires were returned from 256 psychiatrists (38% response rate). Most (90%) participants reported having had limited training in the diagnosis and treatment of people with intellectual disabilities, while between 34% and 72% reported having inadequate knowledge in specific areas. Conclusion The findings of limited training and self‐perceived inadequate knowledge are at least partially explained by the service model, wherein people with intellectual disabilities are cared for by general mental health services. The identified inadequacies could be overcome through the implementation of a model in which specially trained psychiatrists are deployed within generic services.     

A validity study of the Working Group's Autobiographical Memory Test for individuals with moderate to severe intellectual disability

The purpose of the present study was to investigate the validity of the Working Group's Autobiographical Memory Test as a dementia screening tool for individuals with moderate to severe intellectual disabilities (ID). Twenty-one participants with Dementia of Alzheimer's Type (DAT) and moderate to severe ID and 42 controls with similar levels of ID were tested. The majority were re-tested one year after the initial evaluation. The DAT group scored considerably lower than the control group on the initial evaluation. The controls with DS exhibited a considerable decline on the follow-up evaluation whereas other participants exhibited little changes. This demonstrates an insignificant overall difference between the DAT group and the control group on the follow-up evaluation. Virtually all participants exhibited the same scores on 3 out of 6 test items and the percentage of participants who correctly answered the remaining three test items were not significantly different from the DAT or control groups. In conclusion, the Working Group's Autobiographical Memory Test may be useful as a dementia screening tool for individuals with moderate to severe ID from DS when validated with a large sample size study. However, it is questionable whether this test is a reliable dementia screening tool for individuals with moderate to severe ID from non-DS etiologies. This test has a significant psychometric weakness because of the restricted score variability among the participants.     

A prospective case control study of psychiatric disorders in adults with epilepsy and intellectual disability

Purpose: No study to date has prospectively investigated the impact of epilepsy on psychiatric disorders among adults with an intellectual disability (ID). This study aimed to determine prospectively the influence of epilepsy on the development of psychiatric disorders in adults with ID. Method: Psychiatric symptoms were measured prospectively over a 1‐year period among 45 adults with ID and active epilepsy and 45 adults with ID without epilepsy, matched on level of ID. The 1‐year incidence rate (IR) of commonly occurring Axis 1 psychiatric disorders was compared with and without controlling for possible confounding factors. Total psychiatric symptom scores over the period were compared between the two groups using repeated‐measures analysis of covariance. Key Findings: Adults with epilepsy and ID had a more than seven times increased risk for developing psychiatric disorders, particularly depression and unspecified disorders of presumed organic origin, including dementia, over a 1‐year period compared to those with ID only. Comparison of the psychiatric scores showed the epilepsy group to have significantly higher unspecified disorder and depression symptom scores. Significance: The findings point to an increased risk of depression and unspecified disorders, including dementia, among adults with ID and epilepsy. Further exploration of the nature and treatment of these unspecified disorders may help the care of people with epilepsy and ID.     

Forensic psychiatric perspective on criminality associated with intellectual disability: a nationwide register-based study

Background   Contrasting views exist over the association of intellectual disability (ID) and criminal offending. This nationwide study attempts to shed further light to expand understanding to substantiate the relation between socio-demographic characteristics, psychiatric co-morbidity and criminal behaviour among the Finnish forensic population with ID.
Method   We reviewed all forensic psychiatric examination reports of individuals with ID who underwent a pre-trial forensic psychiatric evaluation in Finland during an 11-year period (1996–2006).
Results   One-third of the offenders had been regularly and sufficiently treated as outpatients. Half of the offenders had previous criminality, and the single most common crime was arson. Almost half of the offenders were diagnosed with alcohol abuse/dependence and two-thirds with any substance abuse/dependence. Furthermore, almost half were intoxicated during the index crime. Antisocial personality disorder was diagnosed in 25% of the offenders. Almost half of the offenders were placed in involuntary special care for the ID, which lasted ca 2 years. Among the last-mentioned, two-thirds of the nursing care plans lacked recommended structure.
Conclusions   The offenders with so-called triple diagnosis – substance abuse, mental illness and ID – form a small subgroup of criminal offenders with complex needs. The results of the present study underline the importance of close, long-term cooperation among specialists in the field of ID, addiction service, mental health services and forensic psychiatry.     

Daily living skills in children with autism spectrum disorder and intellectual disability: A comparative study from Turkey

BackgroundBetter daily living skills (DLS) are associated with increased independence and positive functional outcomes in Autism Spectrum Disorder (ASD).MethodThe present study aimed to investigate daily living skills (DLS) and the associated factors in 51 children with ASD and intellectual disability (ASD group) and 51 age- and gender-matched controls with intellectual disability (ID group). The severity of the autistic symptoms was measured with the clinician-rated Childhood Autism Rating Scale and the parent-reported Autism Behavior Checklist (ABC) in all children. The mothers also completed the Pediatric Quality of Life Inventory and the Basic DLS Questionnaire.ResultsThe ASD group scored lower than the comparison group in the total DLS score, personal hygiene, dressing, safety and interpersonal skills, despite being comparable in the parent-reported quality of life. Regression analysis of the whole sample demonstrated that the child’s age, intellectual level, speech level, autism symptom severity and the monthly household income were independent correlates of the total DLS. Exploratory analyses for each group revealed differential effects of these variables: in the ASD group; a higher speech level and monthly income, while in the ID group; an older age, a higher intellectual level and monthly income and a lower ABC score emerged as significant predictors of higher DLS.ConclusionsDeficient DLS in Turkish children with ASD, given their IQ, suggest that lower level of adaptive skills is inherent in ASD, rather than culture-specific to US and Western Europe.     

Prevalence and incidence of health problems in people with intellectual disability

The objective of this study was to determine the prevalence and incidence of the most frequent chronic health problems in relation to age in people with intellectual disabilities living in residential facilities in the Netherlands. A prospective cohort study was done with four data collections, each with an interval of one year. Data were collected by means of questionnaires which were completed by each person's physician. Striking results included the reported high prevalence and incidence of visual and hearing impairment, which was even more pronounced in people with Down's syndrome than in people with intellectual disability resulting from other causes. Gastrointestinal problems also appeared to have high incidence rates. Dementia was frequently reported in people with Down's syndrome aged 40 years and older. The results reflect the need for a more predictive policy which can anticipate health problems in people with intellectual disability.     

Efficacy and tolerability of pregabalin in patients with difficult-to-treat epilepsy and intellectual disability

In a retrospective evaluation of 32 inpatients with therapy-resistant epilepsy and intellectual disability, the efficacy of pregabalin (PGB) treatment was assessed after 6 and 12 months. The combined efficacy measure included the percentage reduction in seizure frequency, as well as the Clinical Global Impression (CGI) scale. Tolerability was assessed using a list of the 10 adverse effects most frequently observed in the regulatory studies and also by the CGI scale. After 6 months, the retention rate was 75%. Six patients (18.75%) were responders (50% seizure reduction and/or “good” or “very good” effect on CGI). No patient was seizure free. Seven patients had adverse effects that were not impairing. Eight patients had side effects that were essentially impairing. Weight gain, somnolence, asthenia, and ataxia were the most frequent adverse effects. Rare adverse events were severe mental slowing and loss of daily life capacities on a low dose of PGB in one patient and increase in auto-aggression in another patient. After 12 months, the retention rate was 40.6%, the responder rate was 25%, and one patient was seizure free. Statistical analysis did not identify any predictor of outcome (seizure type, epilepsy syndrome, co-medication, degree of intellectual disability). In this highly selected population, the efficacy of PGB was only moderate.