Health pedagogic foster families. A model for the rehabilitation of handicapped children from families at-risk

Rehabilitation of retarded children puts an enormous strain on parents. Families with various social risk factors are frequently not able to cope with these problems. Admission to institutes is a frequent consequence. Since 1982 47 mentally and psychologically handicapped children from families with various psychosocial problems were admitted to foster families. Foster parents were carefully selected and educated by a team of physicians, psychologists and social workers and given continuing supervision. Children were evaluated by medical and psychological testing: The majority of children showed significant improvement of performance in psychologic testing, alleviation in their psychosocial as well as medical problems. Numbers and duration of hospital admissions were substantially reduced. The overall condition of these children was markedly improved by foster families.     

Psychosocial characteristics of the handicapped children

This paper deals with some psychosocial characteristics of 1215 handicapped children. These cases were reported to the Centre for Handicapped Children, Institute of Child Health, Calcutta between January 1975 and March, 1985. For each child, after taking detailed case history, through medical, clinical, psychiatric and psychological examination were held for diagnosis and treatment. It was found that majority of the handicapped children were boys (63·8%) and a high portion of the handicapped children were mentally retarded (49·30%). The second largest group was emotionally disturbed followed by cerebral dysrhythmia. Ages of the children varied from 1 year 7 months to 15 years. Findings also indicated association between mental retardation and parents' socio-economic condition, mother's age and education, and family history of psychiatric illness.     

Improving resources for foster care.

The number of foster children and their psychological and medical morbidity are growing. To gain insight into how to recruit and retain foster homes, characteristics of 64 foster families were determined by interview. Foster parents had low-to-moderate incomes, were approaching middle age, had underutilized home space, and wanted more children. Most enjoyed foster care and planned to continue. Twenty-three percent of the 64 had half of all foster children in the study in their homes at interview and had cared for seven times as many children in the past, including 66% of all the teens and 83% of all the handicapped children who had been in the 64 homes. These "high providers" functioned like group homes for mentally handicapped individuals. Adapting the group-home concept to foster homes could improve care, especially for children with special needs.     

Aetiology of mild mental retardation.

A clinical and family study was carried out in 169 children attending schools for the mildly mentally retarded in Southampton to assess the prevalence of recognised medical risk factors; 71 children (42%) had such risk factors. These were prenatal in 22, perinatal in 41, and postnatal in eight. Risk factors of possible, but less certain, significance were found in a further 63 children (37%). In 86 families (51%) there was a history of serious educational problems in both parents. The prevalence of both types of risk factor was higher in the children whose parents had no educational problems. There were, however, 25 children (15%) whose parents had no history of educational problems and in whom medical risk factors were either absent or minimal.     

Die verlorene Gurtfixierung

We report the case of a 13 year old mentally handicapped boy who ingested a foreign body. The patient developed no symptoms, although the 4 cm long foreign body was located in the upper third of the oesophagus. The extraction of the foreign body was performed via endoscope without complications.The ingestion of foreign bodies by mentally retarded or handicapped children has a higher morbidity and mortality rate in comparison to healthy individuals. Typical clinical signs of foreign bodies can be missing or are misinterpreted in the context of the underlying handicap. Parents, caretakers, and health professionals should be aware of this. In order to avoid complications it is essential to listen carefully to the reports of parents/caretakers of mentally handicapped infants. Without the observation of the parents the foreign body could have been easily missed in the reported infant. Complications would have been very likely.     

Parental attitudes toward children with handicaps: new perspectives with a new measure

Research on attitudes toward the disabled generally has focused on adult perceptions of disabled adults, or children's attitudes toward peers. In view of changing social practices, such as mainstreaming in education and community integration of children with special needs, measures of adults' attitudes toward disabled children are needed. This paper reports on the development and validation of a 30-item self-report questionnaire assessing parental attitudes toward children with handicaps, and presents information concerning several determinants of parental attitudes. The measure is easy to use, reliable, and shows good evidence of construct validity. It detects differences among parents by gender, by parental education and occupational status, by cultural background of parents, by parental familiarity with a handicapped person, and by stimulus (physically disabled vs. mentally retarded child referent). Results are discussed in relation to determinants of parental attitudes toward handicaps. Potential applications of this measure for evaluation of teacher attitudes are suggested.     

Facial Expressions of Affect in Autistic, Mentally Retarded and Normal Children

This study examined the facial affect expressions of autistic, mentally retarded and normal children. Affect was coded using the Maximally Discriminative Movement Coding System. Results indicated that the autistic children were more flat/neutral in their affect expression than the mentally retarded children. Moreover, they displayed a variety of ambiguous expressions not displayed by any of the other children. This unique pattern may be related to the difficulties that autistic children have in sharing affect, and to the difficulties that others experience in reading their affective signals.     

PARENTS TEACHING THEIR YOUNG MENTALLY HANDICAPPED CHILDREN

This paper reports a fine-grained analysis of interaction between 21 mothers and fathers and their young mentally handicapped children. Parent-child dyads were videotaped at home on two occasions with a 'roundabout' toy. The sessions were analysed by means of a detailed coding system which reflected the reciprocal nature of interaction and which attended to sequences of behaviour. Results are reported on short-term stability of various features of communication and comparisons of dyads involving mothers and fathers. Implications of the results are outlined for interventions designed to help parents to teach their young mentally handicapped children.     

Attachement et handicap mental à l’adolescence : un regard rétrospectif sur la prime enfance

Assessing the representations of attachment of mentally handicapped adolescents still belongs to an exploratory approach because of the few works on attachment of mentally handicapped subjects. With an assessment tool, usually used with children, “the attachment story completion task” a rich clinical material could be gathered from mentally handicapped adolescents and a control group. In spite of the small size of the samples, it appeared that the mentally handicapped adolescents all had an unresolved attachment. The trauma experienced by their parents, at the beginning of their life, due to the announcement of the handicap, may be considered as the major explanatory factor of the specificities of the early environment of these subjects.     

COGNITIVE ABILITIES AND BEHAVIOURAL CHARACTERISTICS OF CHILDREN WITH IDIOPATHIC INFANTILE HYPERCALCAEMIA

An investigation of the psychological characteristics of 44 children aged 6-16 years with documented evidence of idiopathic infantile hypercalcaemia revealed cognitive abilities and behavioural patterns which distinguish these children from other mentally handicapped groups. The children were all mildly to severely mentally handicapped, but exhibited superior verbal skills compared to their visuo-spatial and motor abilities. They showed high rates of behavioural disturbance, particularly in terms of hyperactivity, social isolation, anxiety, and eating and sleeping difficulties. Other aspects of behaviour, spoken language and personality that were commonly encountered are also described and quantified. From these observations approaches to remedial teaching are suggested.     

Working capacity of deaf and visually and mentally handicapped children

Using bicycle ergometers, physical working capacity was determined in 61 deaf, 22 visually handicapped, and 67 mentally retarded children 8 to 17 years of age. Compared to the normal population, the working capacities per kilogram body weight of the deaf children, particularly the girls, were superior to the other groups and to the normal population. The visually handicapped had lower working capacities, while those of the retarded children were similar to the normals.The work efficiency was similar in both groups. For the boys and younger girls, the maximum oxygen uptakes per kilogram body weight were similar in the deaf and visually handicapped, results that were contrary to the working capacity studies. The difference could be explained by postulating that the deaf children did not work to maximal values though lactic acid and respiratory quotient data suggested that they did. The maximum heart rates of the deaf children were lower than the visually handicapped.     

Vécus de familles d’enfants autistes en période de confinement : étude exploratoire

ObjectiveThe lockdown periods associated with the Covid-19 pandemic are a particularly significant challenge for families of children with autism. Exchanges by e-mail and interviews were aimed at collecting testimonies from parents for a better understanding of their difficulties and the help provided by the mobilization of professionals.Methods and resultsEight parents of autistic children living in the Seine-Saint-Denis area agreed to testify about their experience, either in person, taking into account the barrier measures after the first lockdown, or by telephone during the second lockdown. By way of comparison, e-mails were exchanged with a mother and two fathers of autistic children from higher socio-economic backgrounds living in other parts of France or Belgium. While at the beginning of the first lockdown, some children may have felt soothed by being at home with their parents, the extension of the situation led to crises related to feelings of anxiety or boredom. Despite the closure of many medical-social facilities, professionals mobilized to continue helping families and children whose routines were disrupted.ConclusionDepending on the conditions of lockdown, the families’ experiences differed and evolved over time. The major problems encountered by some families were the worsening of their child's troubles (self-harm, tantrums, violence, and shouting). Pedagogical tools were adapted by the teachers, activity sheets were sent out, group workshops were organized, and consultations were given at a distance. The teams of the child psychiatry services and the medico-social services have mobilized themselves and have shown reactivity and inventiveness in order to ensure the care and follow-up of children and their families.     

THE EFFECTS OF MENTALLY HANDICAPPED CHILDREN ON FAMILIES–A CONCEPTUAL REVIEW

Recent research which examines the effects of mentally handicapped children upon families is reviewed. The studies are grouped into three categories based on the underlying conceptions which appear to guide them. The first category examines which families are most vulnerable to the presumed stress of a mentally handicapped child. The second category emphasises the material and practical problems families experience. The third category stresses the competence of families and describes the resources used to develop coping strategies. Links are drawn between these three categories and to parallel developments in related areas, and implications for future research are discussed.     

THE SELF-CONCEPT OF PHYSICALLY HANDICAPPED CHILDREN AND THEIR NON-HANDICAPPED SIBLINGS: AN EMPIRICAL INVESTIGATION

Following a brief review of studies devoted specifically to the self-concept of the child with a physical handicap and the non-handicapped sibling, 20 pre-adolescent physically handicapped children attending normal schools and their siblings nearest in age were administered the Piers-Harris Self-Concept Scale for Children. Their responses were then compared with those of 13 physically handicapped children attending special schools and their siblings, and with 18 non-handicapped children and their siblings. It was found that mean total scores were lower for both groups of physically handicapped children when compared to mean scores for the non-handicapped controls, with similar results amongst the groups of siblings, the mean scores for siblings of handicapped children being generally lower than those of the controls. The same results were found when the handicapped children's groups were pooled and analysed according to diagnosis. It was also found that there were few significant differences between pairs of target children and siblings, irrespective of their groupings.     

Infant Health and Development Program for low birth weight, premature infants: program elements, family participation, and child intelligence.

The Infant Health and Development Program was an eight-site randomized controlled trial testing the efficacy of early intervention to enhance the cognitive, behavioral, and health status of low birth weight, premature infants. The 377 intervention families received for the first 3 years of life: (1) pediatric follow-up, (2) home visits, (3) parent support groups, and (4) a systematic educational program provided in specialized child development centers. The control group (n = 608) received the same pediatric follow-up and referral services only. This paper describes the delivery of the intervention and its outcomes. A Family Participation Index that was the sum of participation frequencies in each of the program modalities unique to the intervention revealed that program implementation was not different across the eight sites. Index scores did not vary systematically with mother's ethnicity, age, or education or with child's birth weight, gender, or neonatal health status; but they were positively related to children's IQ scores at age 3. Only 1.9% of children of families in the highest tercile of participation scored in the mentally retarded range (IQ less than or equal to 70), whereas 3.5% and 13% of children in the middle and lowest participation terciles, respectively, scored in the retarded range. Similar findings were obtained for borderline intellectual functioning. These findings are consistent with previous research linking intensity of intervention services with degree of positive cognitive outcomes for high-risk infants. The determinants of variations in individual family participation remain unknown.     

L’autisme à Marseille Nord : inégalités territoriales,précarité et pénurie de services publics

ObjectiveIn order to illustrate the obstacles to healthcare and schooling for children with autism, we chose to explore the experiences of families and the systems implemented to accompany children and their parents in the northern districts of Marseille, where precarious situations are numerous and the shortage of places and means affects both the public and the private sectors.Methods and resultsInterviews conducted with 26 families and 18 professionals showed that the parents were overall satisfied with health, medical and social services when they had access to them. All of them noted the difficulties encountered for school inclusion, and they all stressed the weariness, the stress and the deterioration in quality of life for the family as a whole. The moral obligation to use intensive educational programmes as early as possible, often generates feelings of guilt among parents who cannot afford this type of service.ConclusionThe present policy, consisting in favouring services rather than specialised establishments and in promoting ever-greater implication on the part of parents leads to a work overload for families, with professional and financial consequences that are particularly great for the mothers, in particular, those in precarious situations.     

Behavioral training for mothers of mentally handicapped children: teaching of self-help skills.

Deficits in self help skills are an inevitable problem with the mentally handicapped. The acquisition of self-help skills, learned effortlessly by more intelligent children, is a crucial aspect of the overall development of the mentally handicapped child. In the present study, thirty seven mothers of mentally handicapped children aged between 3 1/2 and 8 years, with an IQ of less than 70, were trained in behavioral techniques such as shaping, task analysis, prompting, and modelling, to develop independent self-help functioning in their children. The self-help areas were toileting, feeding, bathing, washing, and dressing. Thirty two per cent of mothers reported complete skill learning. The problems encountered in the course of training and the subsequent evaluation of its efficacy are discussed.     

Medical,legal, and mental health service utilization by physically abused children and their caregivers

The use of medical, legal, and mental health services was examined among 37 Medicaid-eligible, physically abused children and their caregivers. Fewer than half of the children received a medical examination related to the physical abuse, but the majority had received basic wellness care, including immunizations. Roughly half of the cases were heard in family court. Fewer than half of the children were receiving mental health services. Children were more likely to receive services if the maltreating caregiver was not in the home. More maltreating caregivers received mental health services than did their children, but this still only accounted for half of the parents. Caregivers were more likely to receive treatment if they acknowledged the abuse. Children who participated in treatment showed reductions in parent-reported problem behaviors but showed increases in anxiety in comparison to children who did not participate in treatment.     

PARENT EXPECTATIONS FOR PROFESSIONALS PROVIDING SERVICES TO THEIR HANDICAPPED CHILDREN

Sixty-six parents of children who were diagnosed within the first two years of life as having some type of physical or mental disability or developmental delay were interviews to ascertain the needs and expectations these parents desired for professionals who provided ongoing services to the children. The children were under six years of age and were enrolled in various infant development programs in the Southern California area. Several sources of variance affecting the expectations were explored. Results revealed that parents of young handicapped children has specific needs and expectations for professionals and that these were given certain priorities. Although the parents tended to agree on the priority of needs and expectation, there were some differences among the ranking of items based on specific traits of parent and children.     

Pediatricians’ Knowledge,Attitudes, and Practice Patterns Regarding Special Education and Individualized Education Programs

ObjectiveThe medical community has called upon pediatricians to be knowledgeable about an individualized education program (IEP). We sought to: 1) evaluate pediatricians’ knowledge and attitudes regarding special education; 2) examine the relationship between perceived responsibilities and practice patterns; and 3) identify barriers that impact pediatricians’ ability to provide comprehensive care to children with educational difficulties.MethodsSurveys were mailed to a national sample of 1000 randomly selected general pediatricians and pediatric residents from October 2010 to February 2011.ResultsThe response rate was 47%. Of the knowledge items, respondents answered an average of 59% correctly. The majority of respondents thought pediatricians should be responsible for identifying children who may benefit from special education services and assist families in obtaining services, but less than 50% thought they should assist in the development of an IEP. The majority of pediatricians inquired whether a child is having difficulty at school, but far fewer conducted screening tests or asked parents if they needed assistance obtaining services. Overall, the prevalence of considering a practice a pediatrician’s responsibility is significantly higher than examples of such a practice pattern being reported. Financial reimbursement and insufficient training were among the most significant barriers affecting a pediatrician’s ability to provide care to children with educational difficulties.ConclusionsIn order to provide a comprehensive medical home, pediatricians must be informed about the special education process. This study demonstrates that there are gaps in pediatricians’ knowledge and practice patterns regarding special education that must be addressed.