Transfer and interference of motor skills in people with intellectual disability

Atypical laterality (i.e. the lack of a clear pattern of lateralization) has been found to be a characteristic feature of individuals with intellectual disability (ID). The evidence for this has been based on ‘handedness’ studies which have contained little information about the ability of people with ID to carry out interhemispheric tasks reflecting bilateral transfer or interference. The present study examined this capacity in individuals with ID by utilizing bilateral transfer and interference paradigms. Right‐handed subjects with ID (IQ = 55–76) and controls matched for age and sex were tested for bilateral transfer of motor skill in contralateral hands with a mirror‐drawing task. The subjects were also tested for their ability to perform a finger‐tapping task while processing verbal and non‐verbal stimuli. The findings indicated that people with ID are significantly deficient relative to matched controls in bilateral transfer of motor skills from their non‐preferred (left) hand to their preferred (right) one. The effect of interference during performance of the dual task was significantly greater in individuals with ID. Subjects with ID were found to perform better with their non‐preferred than with their preferred hand. A within‐group comparison revealed that right‐handed performance was more affected by interference than left in these subjects.     

Sequelae of bereavement resulting from suicide

Although clinical experience suggests that individuals who have been bereaved as a result of suicide may be especially vulnerable to adverse sequelae, such as unusually severe grief or increased risk of committing suicide themselves, the idea that this type of bereavement is special has received only limited systematic investigation. The authors review the literature on the subject, with special attention to the clinical and research evidence about whether bereavement resulting from suicide is different from bereavement due to other types of death, and make suggestions for further clinical and epidemiological research on this question.     

College students' conceptualizations of deficits involved in mild intellectual disability

Precedential rulings in recent capital murder trials may, in some cases, leave it up to a jury to determine whether or not an individual meets criteria for an intellectual disability (ID) and should be spared from the death penalty. Despite the potential for misconceptions about ID to bias decisions, few empirical studies have examined the public's conceptualizations of individuals with ID. This study sought to examine 890 college students’ conceptualizations of the deficits involved in mild ID. Students were asked to respond to two online surveys about the cognitive and adaptive behavior deficits that people with mild ID may experience. While most students were correct about basic facts, such as ID is not contagious and not curable, there was no clear consensus regarding beliefs about individuals with ID getting married, having children, or engaging in other mainstream activities of adult living. Students’ responses are examined in light of results of studies that identify and examine bona fide deficits and areas of successful mainstreaming among persons with ID. Implications of misconceptions are discussed.     

Grief and its complications in individuals with intellectual disability

Bereavement and loss have significant impact on the lives of individuals with intellectual disability (ID). Although there is a growing impetus to define the symptoms of grief that predict long-term functional impairment, little is known about maladaptive grieving among individuals with ID. We examine the literature concerning the phenomenology of traumatic grief (TG) in the general population, along with what is known about the manifestations of grief in individuals with ID. We then apply modern theories of grief and grief resolution to individuals with ID in order to highlight potential areas of vulnerability in this population and to lay the groundwork for interventions that will facilitate their adaptation to loss. We provide a theoretical framework for the proposition that individuals (including children and adults) with ID are more susceptible to TG, based on an increased risk of secondary loss, barriers to communicating about the loss, and difficulty finding meaning in the loss. We conclude that individuals with ID should be considered as potential candidates for targeted bereavement interventions. Further research is required, however, in order to develop population-appropriate measurement scales for testing these hypotheses.     

Health issues and quality of life in women with intellectual disability

Background Although there is anecdotal evidence of an increase in both period pain and premenstrual syndrome (PMS) in women with intellectual disabilities (ID), there are only brief mentions of it in the literature. Method Questionnaires were distributed to parents of women with Down syndrome (DS) or Autism Spectrum Disorder (ASD), resulting in 24 respondents from Australia and New Zealand. The purpose of the study was to ascertain how period pain and PMS presents in women with ID. Results Results were analyzed by disability group, and communication ability. Women with DS were more often able to state that they had pain, or point to the location of the pain than women with either autism or Asperger Syndrome (AS). Additionally, women with DS or ASD appeared to have a higher rate of period pain than women in the general population, but the presence of pain more often had to be deduced from behavioural changes. Conclusion Further research with a larger number of women with disability, and across a wider range of disabilities is required to determine generalizability of these findings.     

The conceptualisation of dreams by adults with intellectual disabilities: relationship with theory of mind abilities and verbal ability

Background Empirical studies suggest that individuals with intellectual disabilities (ID) have difficulties in conceptualising dreams as perceptually private, non‐physical, individuated and potentially fictional entities. The aim of the current study was to replicate the results found by Stenfert Kroese et al. using a comparative sample size, and to examine putative cognitive correlates of accurate dream conceptualisation [receptive language and 1st order theory of mind (ToM) abilities]. Method Conceptualisation of dreams, real objects and photographs was assessed with a structured closed‐question interview schedule, together with receptive language, and ToM abilities. Results Findings from the current study replicated those of previous research, finding that many adults with ID tend to think that dreams take place around them, can be witnessed by others, can be touched and manipulated, can be shared by others and are about real events. The ability to accurately conceptualise dreams was found to increase along with receptive language ability, and there was a non‐significant association between ToM ability and the ability to understand that dreams can be about potentially fictional entities. Conclusions Some individuals with ID have a different understanding of mental phenomena such as dreams, which has implications for several aspects of care and support, particularly relating to mental health and therapeutic work.     

Management of chronic pain syndromes: issues and interventions

Treatment of chronic, nonmalignant pain syndromes has been largely suboptimal and the most debilitating conditions--such as LBP, arthritis, and neuropathic pain--continue to pose a significant burden to individuals and society. Although significant scientific advances in delineating pathophysiologic mechanisms have facilitated the development of targeted pharmacologic and interventional treatments, the integral role played by psychologic, behavioral, and social factors in generating, perpetuating, and individualizing the pain experience has been largely ignored. Consequently, adequate pain relief may still be an achievable goal, but one that is often realized only with a concomitant, cognitive, behaviorally based, functional restoration approach. A multidisciplinary integrative approach that places equal emphasis on understanding the cellular and molecular mechanisms underlying pain, as well as the multidimensional interplay of cognitive, behavioral, and environmental influences is essential to improving outcomes. Although there are presently a paucity of data that identify specific characteristics that define which individuals will benefit from any particular modality, evidence clearly demonstrates that the MPC setting offers patients an opportunity to achieve both adequate pain relief and improved physical, behavioral, and psychologic function. A key challenge for clinicians lies in changing the approach to pain "treatment" and in bridging the gap between the current evolving understanding of pain mechanisms and clinical management. Physiatrists' focus on maximal functional restoration is a critical contribution to cost-effective pain medicine practice. Wisely combining effective pain management techniques within a functional restoration program has the best chance of improving the quality of life for patients with chronic pain disorders and diseases.     

Health professionals' attitudes and emotions towards working with adults with intellectual disability (ID) and mental ill health

Objectives Mainstream mental health services are providing more care for individuals with an intellectual disability (ID); this has implications for staff and service users. Attitudes of staff towards people with ID in mental health services may be negative and negative staff attitudes may have a detrimental impact on service provision. Design A cross‐sectional design was used. Methods A questionnaire designed to investigate the attitudes and emotions of staff towards delivering mental health care to adults with ID was completed by 84 staff from mainstream and specialist ID services. Results Staff in both services experienced more positive emotions when working with clients whom they are currently employed to work with. When the frequency of contact with adults with ID, the number of individuals worked with and the amount of formal ID training received were considered, there was no significant difference between the attitudes of staff in both services. Positive correlations were found between attitude scores and positive emotional experiences in both services. Conclusions The research suggests that numerous factors, including the role of emotional experience and a number of environmental aspects, need to be considered in the context of providing mental health services to adults with ID to ensure the highest quality. Research limitations and clinical implications of the study are also considered.     

Cardiorespiratory fitness in individuals with intellectual disabilities—A review

Cardiorespiratory fitness is the ability of the circulatory, respiratory and muscular systems to supply oxygen during sustained physical activity. Low cardiorespiratory fitness levels have been found in individuals with intellectual disabilities (ID), which puts them at higher risk for cardiovascular diseases and all-cause mortality. The aims of this review were to update previous reviews about (a) the cardiorespiratory fitness levels and their determinants in individuals with ID, and (b) the validity and reliability of cardiorespiratory fitness testing in individuals with ID. We searched the databases of Pubmed and Embase for relevant studies, resulting in 31 included articles. These studies mainly included younger participants with mild to moderate ID. Results confirmed previous findings of low cardiorespiratory fitness levels in individuals with ID. Cardiorespiratory fitness levels of children and adolescents with ID are already low, with further decline with increasing age. Furthermore, females have lower cardiorespiratory fitness levels than males. Physical inactivity and chronotropic incompetence are most likely to contribute to low cardiorespiratory fitness levels. Peak cardiorespiratory fitness levels of individuals with ID can be assessed with maximal treadmill protocols, after allowing for familiarization sessions. Although, predicting maximal oxygen uptake from field tests is problematic, field tests have been found valid and reliable as indicators of cardiorespiratory fitness.     

Carer-led health interventions to monitor,promote and improve the health of adults with intellectual disabilities in the community: A systematic review

Using carers to help assess, monitor, or promote health in people with intellectual disabilities (ID) may be one way of improving health outcomes in a population that experiences significant health inequalities. This paper provides a review of carer-led health interventions in various populations and healthcare settings, in order to investigate potential roles for carers in ID health care. We used rapid review methodology, using the Scopus database, citation tracking and input from ID healthcare professionals to identify relevant research. 24 studies were included in the final review. For people with ID, the only existing interventions found were carer-completed health diaries which, while being well received, failed to improve health outcomes. Studies in non-ID populations show that carers can successfully deliver screening procedures, health promotion interventions and interventions to improve coping skills, pain management and cognitive functioning. While such examples provide a useful starting point for the development of future carer-led health interventions for people with ID, the paucity of research in this area means that the most appropriate means of engaging carers in a way that will reliably impact on health outcomes in this population remains, as yet, unknown.     

Neuropsychiatric syndromes in adults with intellectual disability: Issues in assessment and treatment

The purpose of this article is to present a survey of important neuropsychiatric issues and recent findings regarding the evaluation and treatment of neuropsychiatric symptoms and syndromes in patients with intellectual disability (ID). The cause of ID, environmental or genetic, can be determined in few patients. Etiology is idiopathic in most patients. ID and psychiatric illness are not mutually exclusive; individuals with ID have increased rates of psychiatric illness. Although recognition of significant axis I psychopathology is important, not all challenging behaviors in persons with ID will have a clear axis I diagnosis. Psychologic, behavioral, and environmental treatments are appropriate measures, but pharmacotherapy often is needed. Our experience has shown us that the more severe, disruptive, and dangerous the behavior, the stronger the indication for empirical drug treatment trials. Community-based models of support with neuropsychiatric intervention can be a potent therapeutic combination in the management of challenging behaviors in individuals with ID.     

Sexual health services and support: The views of younger adults with intellectual disability

Abstract

Background?The sexual health needs of younger adults with intellectual disability (ID) are not currently being met by mainstream sexual health services. Little research has been conducted into improving these services’ accessibility.

Method?Thirty-four people with ID aged 16–35, who attended ID services in Lothian, Scotland, completed a questionnaire at a face-to-face interview about whom they could go to for advice and information about sex and relationships, which information sources they used, their experiences of sexual health services, and their preferences regarding these services.

Results?Most participants wanted to attend mainstream services and felt staff from these services should be able to meet their special needs. Preferences on services varied between individuals.

Conclusions?It is important that there continues to be a variety of sexual health services available and that staff are appropriately trained in working with people with ID. Further research is needed to identify and resolve unmet needs in this area.     

Reports of life skills training for students with intellectual disabilities in and out of school

Background Life skills can be critical to the success of individuals with intellectual disabilities (ID) in terms of postschool outcomes. Yet, research suggests a decreasing emphasis on the acquisition of life skills in school for students with ID, raising the question if students then receive training in these areas after graduation. Method This study represented a secondary analysis of the National Longitudinal Transition Study‐2 data to understand the reported receipt of life skills instruction in school and out of school for individuals with mild and moderate/severe ID. Frequency distributions, significant tests and a t‐test were used to understand receipt of life skills in and out of school for both individuals with mild and moderate/severe ID. Results The results suggest low‐reported receipt of life skills instruction/training in school and postschool for individuals with mild ID, few students with moderate/severe ID report receiving life skills training out of school, and receipt of life skills instruction in school is not related to receipt of life skills training/therapy after school by either individuals with mild ID or moderate/severe ID. Conclusions Given the current educational policy situation (i.e. a predisposition towards inclusive general education placements for students with disabilities and participation in the accountability system for all students), educators who believe in the value of a life skills curriculum will need to be creative in its implementation and look towards transition plan and activities to provide students with the needed training. Regardless, teachers will need to rectify providing students with the academic skills they need to be successful on a general large‐scale assessment with providing them with the life skills (e.g. independent living, daily living, financial) to be successful after school in employment and independent living.     

Substance abuse among individuals with intellectual disabilities

Individuals with disabilities are a growing population that confronts multiple disadvantages from social and environmental determinants of health. In particular, the 7-8 million people in the U.S. with an intellectual disability (ID) suffer disproportionately from substance use problems, largely because of a lack of empirical evidence to inform prevention and treatment efforts for them. Although available research could inform future research efforts, studies are scattered across disciplines with the last review synthesizing findings written more than five years ago. To consider more recent findings with earlier works, PubMed, PsychINFO, and Google Scholar were searched and produced 37 peer-reviewed texts across multiple disciplines, 15 from 2006 or later. While the prevalence of alcohol and illicit drug use in this population are low, the risk of having a substance-related problem among ID substance users is comparatively high. Gaps in the research and population subgroups that warrant special attention are identified, such as individuals with borderline and mild ID, individuals with co-occurring mental illness, and individuals who are incarcerated. Compared with substance abusers without ID, ID substance abusers are less likely to receive substance abuse treatment or remain in treatment. Research is needed to better gauge the magnitude of substance use problems, identify prevention strategies, and specify treatment components that meet the unique needs of individuals with ID.     

Post-traumatic stress disorder in young people with intellectual disability

Background Post-traumatic stress disorder (PTSD) is common and treatable. There is extensive research on people of average intelligence yet little on individuals with developmental disabilities. Methods We report two people with intellectual disability (ID) who experienced PTSD. The relevance of their developmental difficulties, social and communication profiles, attentional skills, and causes of these, to their presentations is discussed. Results Both individuals have fragile X syndrome and severe ID. One has Diagnostic and Statistical Manual – 4th Edition (DSM-IV) autistic disorder; the other DSM-IV attention deficit-hyperactivity disorder. They experienced developmental and psychological regressions, new challenging behaviours and exacerbations of existing ones coincident with emotional trauma. PTSD symptoms and phenomena were identifiable despite intellectual and communicatory impairments. Conclusion Presentation of PTSD is influenced by degree and cause of ID, social circumstances, social and communicatory skills, nature and timing of traumatic experience and subsequent management. The paucity of literature suggests it is missed frequently in individuals with ID who risk having problems misattributed to other causes with potential for inappropriate interventions.     

A study of complicated grief symptoms in people with intellectual disabilities

Introduction Previous studies have shown a significant association between familial bereavement and the onset of challenging behaviours and psychopathology in people with intellectual disabilities (ID). However, little work has been done to accurately describe the specific symptoms of grief, in particular symptoms of complicated grief in this population. Consensus criteria for the diagnosis of complicated grief have been drawn up and tested for validity in the general population. Aims To examine the occurrence of symptoms of complicated grief, and to explore the relationships between complicated grief and bereavement experience. Method A bereavement history questionnaire and a newly developed measure examining for symptoms of complicated grief were administered to a group of carers of people with mild or moderate ID, who had experienced a parental bereavement within the previous 2 years. The questionnaires were also administered to a matched comparison group, who had not been bereaved. Results/Conclusions This carer‐based comparison study has revealed that bereaved individuals with ID experience complicated grief symptoms following the death of a parent, with one‐third of the bereaved group experiencing 10 or more clinically apparent symptoms. In addition, complicated grief symptoms were more likely to occur with higher rates of bereavement ritual involvement. These findings have both clinical and research implications.     

Relationship between theory of mind and language ability in children and adolescents with intellectual disability

Background The present study was designed to evaluate the validity of the false belief task as a measure of theory of mind development in individuals with intellectual disability (ID). In most if it variants, the false belief task is linguistically demanding. This raises the possibility that the finding that individuals with ID do poorly on it might reflect language difficulties rather than theory of mind difficulties. Complicating matters further, however, is the fact that there are theoretical reasons to suppose that there might be a relationship between some dimensions of language ability and theory of mind development in individuals with ID (as well as in other populations). Method In the present study, children and adolescents with ID and typically developing (non‐verbal) mental age matches completed a standard false belief task and several tasks designed to measure language ability. Results We reasoned that a pattern in which false belief performance was correlated with all measures of language ability would reflect an artefactual relationship, whereas a more highly circumscribed, theoretically sensible pattern of correlations that was similar across both groups would support the validity of the false belief task. Conclusions The results indicated that for individuals with ID who have limited narrative language skills, those limitations contribute substantially to their failure on the false belief task. For individuals with ID who have more highly developed narrative language skills (about 40% of the sample tested), however, the false belief task may provide a valid measure of their progress towards acquiring an adequate theory of mind. This latter conclusion was suggested by the fact screening out individuals who failed to meet linguistic and cognitive prerequisites for dealing with the performance demands of the false belief task yielded non‐significant correlations between false belief performance and the language measures for both the group with ID and the typically developing comparison group.     

Physical activity and its determinants among adolescents with intellectual disabilities

Physical inactivity is a global public health problem, and it has been linked to many of the most serious illnesses facing many industrialized nations. There is little evidence examining the physical activity profile and determinants for the vulnerable population such as people with intellectual disabilities (ID). The present paper aims to describe the regular physical activity prevalence and to examine its determinants among adolescents with intellectual disabilities in Taiwan. Participants were recruited from 3 special education schools in Taiwan, with the entire response participants composed of 351 primary caregivers of adolescents with ID (age 16–18 years). There were 29.9% ID individuals had regular physical activity habits, and the main physical activities were walking, sports, and jogging. There were only 8% individuals with ID met the national physical activity recommendation in Taiwan which suggests at least exercise 3 times per week and 30 min per time. In a stepwise logistic regression analysis of regular physical activity habit, we found that the factors of caregiver's educational level and preference toward physical activity were variables that can significantly predict ID individuals who had regular physical activity habit in their daily livings after controlling other factors. To maximize the positive effect of physical activity on people with ID, the present study suggests that it is needed to initiate appropriate techniques used for motivation to participate in physical activity for this population.