bluuebunny/crossref_metadata_2025 huggingface dataset:
A3. Can linseed (flaxseed) help to regulate blood glucose levels when incorporated into the diabetic diet?
Authors: Booth S. K.
Published: March 2003

Background It has been suggested that linseed (flaxseed) may help to reduce the risk of heart disease and cancer due to its relatively high concentration of both alpha‐linolenic acid and nonstart polysaccharides (
Vaisey‐Genser & Morris, 1997). In view of this, and given the associated risk of heart disease with diabetes (
Fuller et al. 1980
), can linseed be used in the diabetic diet to help regulate blood glucose levels?

Aim The aim of this experimental crossover design study was to investigate the glycaemic response of linseed in scones compared to white bread (a standard reference food).

Method Fifteen healthy female subjects (n = 15) participated in two single‐meal study periods with a 7‐day washout period in‐between. Finger prick blood samples were taken at 30, 60, 90 and 120 min postprandial and analysed using the Reflotron glucose method (
Boehringer Mannheim, 1974).

Results Using anova, a significant difference was found between the incremental blood glucose values following consumption of the linseed scone in comparison with the white bread [P < 0.008], which demonstrated that there was a more gradual glycaemic response with the linseed scone.

Conclusion As diabetics should avoid severe peaks and troughs in their blood glucose levels, linseed may help to regulate blood glucose when incorporated into certain foods which have a relatively high glycaemic response, e.g. bread.
A7. A survey of current dietary recommendations for post‐transplant renal patients in the UK and Ireland
Authors: MaCleod R.
Published: March 2003

Background In recent years there has been a rise in medical knowledge and scientific information in the area of nutritional disorders and nutritional treatment in patients with renal disease and those with acute or chronic renal failure.

Aim To establish the current dietary management of renal transplant patients in the United Kingdom (UK) and Ireland.

Methods A total of 47 renal transplant units were identified in the UK and Ireland and a postal questionnaire was sent to each of these units.

Results Thirty‐three units replied giving a 70% response rate: Only one did not have a dietitian to advise transplant recipients on their diet. In the majority of units energy requirements of early and late post‐transplant patients were calculated using 30–35 kcal/kg/day or using the Schofield equations. 42% of units gave early post‐transplant weight loss advice for the overweight patient but 88% of units gave late post‐transplant weight loss advice. 52% or units at both early and late transplant stages gave advice on weight gain for underweight or malnourished patients.

50% of total energy intake from carbohydrate was frequently recommended in early and late post‐transplant, with restriction of simple sugars as required. A fat intake early post‐transplant of 30% of total energy intake was prescribed by the majority of respondents with a fat intake of less than 30% of total energy intake during late post‐transplant stage to control for hyperlipidaemia, improved graft outcome and to encourage healthier eating. 18% of transplant units reported that vitamins and minerals would be supplemented early and late post‐transplant, if the patient had a poor appetite, inadequate diet or if nutrient deficient.

Conclusions The dietary prescriptions were similar except for some variation in protein and electrolyte prescriptions. The findings from this study indicate that a policy on dietary management for post‐transplant patients could be developed with respect to Carbohydrate, Fat and Energy prescription. Protein and electrolytes should continue to be calculated on an individual basis by a renal transplant unit dietitian. It was noted that dietitians adapted their recommendations for individual care in relation to changes in nutritional and biochemical status.

This study also highlighted the need for further research to be conducted on optimal protein and micronutrient prescriptions with respect to immunosuppressive drug interactions and graft survival.
Nutrition Assessment Score validation and the implications for usage
Authors: Oakley C. , Hill R.
Published: March 2003

Introduction Malnutrition in hospital is a well‐documented and significant problem and contributes to increased recovery times, length of stays, cost to the NHS and patient mortality and morbidity. Malnutrition in hospitals has been found to be in excess of 40% of admissions. In spite of the fact that nutritional support has been found to benefit patients, referral rates to dietetic services do not reflect these levels. A study was carried out in Hairmyres Hospital to validate a nutritional assessment score (NAS) and assess the benefits and costs of introducing this assessment as a routine part of nursing care.

Methods  An NAS was completed for all patients admitted to two medical and two surgical wards over a 4‐week period and nutritionally assessed by a dietitian. Assessment was carried out on admission and weekly thereafter, for 118 patients, resulting in a total of 150 assessments.

Results  With a scoring system of: On Admission: Refer if score is 6 or above, On Review: Refer if score is 4 or above, it was found that 92% of patients at risk of malnutrition would be appropriately referred on admission and 100% of those patients not appropriately referred would be referred on review.

Discussion and conclusions The study shows the NAS to be a valid tool for nutritional assessment and a useful aid to nursing staff in assessing risk of malnutrition and need for nutritional support. It suggests that the NAS could be used to indicate the need for nursing and dietetic intervention. The Dietetic Department could anticipate approximately 1880 new nutritional support referrals per year from general medical and surgical wards. The introduction of such an assessment tool has resource implications for dietitians, nurses and catering staff but should provide benefits to the patients and the hospital.
Nutrition and diet in the clinical management of multiple sclerosis
Authors: Payne A.
Published: March 2003

For many years, medical interest in the relationship between nutrition and multiple sclerosis (MS) has focused largely on aetiology and the influence of dietary fat on the rate and severity of disease. While the cause of MS remains unknown and the influence of dietary fat is unclear, recent studies on antioxidant intake and oxidative stress in MS are strengthening the rationale in support of a healthy eating regime following diagnosis.

Dietary intake in MS and the influence of advanced disease on nutritional status are less well researched and documented. Both obesity and malnutrition may occur with detrimental consequences to functional abilities. Cognitive difficulties, dysphagia and the side‐effects of drug treatment may further contribute to deterioration in nutritional status.

This paper aims to provide a practical overview of dietary management in MS. It reviews the available evidence relating nutrition to MS and discusses dietary management, with particular emphasis on the identification and alleviation of factors affecting nutritional status.
The relative validity of a short Dutch questionnaire as a means to categorize adults and adolescents to total and saturated fat intake
Authors: Van Assema P. , Brug J. , Ronda G. , Steenhuis I.
Published: March 2003

Background

To assess the relative validity of a short food frequency questionnaire, the Fat list, to be used in (the evaluation of) nutrition education programmes.

Methods

Forty‐five adults and 50 adolescents (12–18 years old) completed the Fat list at home, and subsequently kept diet records for seven subsequent days.

Results

Pearson correlations of about 0.7 for adults and 0.6 for adolescents were observed between fat scores derived from the Fat list and total and saturated fat intake in grams estimated by the 7‐day diet records. Correlations varied among subpopulations based on sex, age, education, household size and responsibility for cooking and shopping. Lower correlations were especially found for female adolescents and older adolescents (16–18 years old). Pearson correlations between the Fat list and percentages energy from fat were low for both adults and adolescents. Gross misclassification, defined as disagreement between the two fat consumption assessments beyond an adjacent tertile, was less than 6% for all but the female adolescents.

Conclusions

The Fat list can be used in adult and male adolescent populations to classify subjects in broad categories of total and saturated fat intake in grams and to assess differences in absolute and saturated fat intake between groups as a result of nutrition education programmes.
Intensive lifestyle intervention combined with the choice of pharmacotherapy improves weight loss and cardiac risk factors in the obese
Authors: Frost G. , Lyons F. , Bovill‐Taylor C. , Carter L. , Stuttard J. , Dornhorst A.
Published: March 2003

Background  Obesity is on the increase yet within the National Health Service (NHS) treatment approaches differ greatly and service is patchy. Our aim was to compare current practice within a general dietetic clinic with a new clinic developed specifically for patients of higher morbidity risk.

Methods  Locally referred patients to the dieticians from within or without Hammersmith Hospitals NHS Trust of higher morbidity risk were invited to attend a new Lifestyle Clinic. Treatment was of a contractual nature and included more time with the dietitian, the offer of pharmacotherapy if appropriate and an emphasis on achieving a realistic weight loss of 10% within a 6‐month period. Cognitive behavioural strategies were utilized focusing on achieving changes in dietary intake and physical activity levels.

Results  A total of 103 patients have been enrolled of whom 34 have been discharged before completion of the clinic programme. Twenty‐six patients have completed (18 started pharmocotherapy with Orlistat and eight remained on lifestyle advice only), with the remainder still attending the Lifestyle Clinic. The results for these 26 patients demonstrate clinically significant benefits with regard to exercise tolerance390.8 ± 37.5 m vs. 473 ± 46.6 m (P < 0.001), waist measurement 121.5 ± 4.4 cm vs. 110.9 ± 3.6 cm (P < 0.001), and total cholesterol : HDL ratio 1.17 ± 0.05 mmol L−1 vs. 1.27 ± 0.07 mmol L−1 (P < 0.05). A weight loss comparison with historical data collected in the general dietetic clinic achieves a 7.8 ± 0.7 kg reduction in weight (with pharmocotherapy 8.96 ± 0.98 kg, with lifestyle only 5.23 ± 0.657) vs. 1.7 ± 0.4 kg (P < 0.05).

Conclusion  Lifestyle clinics facilitate beneficial lifestyle changes which impact positively on morbidity risk factors demonstrating an improvement on current service offered within the NHS. There is an obvious resource implication of offering an intensive management package. There is need for a randomized control trial with analysis to evaluate whether there is cost benefit from this type of intervention.
Dietitians' views of overweight and obese people and reported management practices
Authors: Harvey E. L. , Summerbell C. D. , Kirk S. F. L. , Hill A. J.
Published: March 2003

Objectives  To examine dietitians' views of overweight and obese people, to explore the role of level of severity on these perceptions (overweight vs. obesity), and to explore the relationship between dietitians' views and their reported weight management practices.

Design  An independent measures survey, questioning dietitians about either overweight or obese people.

Participants  One‐hundred and eighty‐seven members of the British Dietetic Association.

Measurements  A questionnaire exploring beliefs about the causes, attitudes, perceptions of responsibility and reported weight management practices.

Results  Physical inactivity was identified as an important causative factor for both overweight and obesity. Mood, eating too much of the wrong foods, repeated dieting and interpersonal factors were also seen as relatively important for both groups. Attitudes were mixed, but were generally neutral to positive. The most negative attitudes were described in terms of perceived reduced self‐esteem, sexual attractiveness and health. Dietitians rated obese people more negatively than overweight people. They viewed both overweight and obese people as being responsible for their excess weight. They also reported very similar management practices for overweight and obese people. Beliefs about the causes of overweight explained more of the variance in practice than dietitians' attitudes towards or perceived responsibility of overweight and obese people. However, these associations were not consistent and strong, and other factors not investigated here are likely to have a greater influence on weight management practices.
Clumsiness in autism and Asperger syndrome: a further report
Authors: Ghaziuddin M. , Butler E.
Published: March 2003

Clumsiness has been proposed as a diagnostic feature of Asperger syndrome (AS), a type of pervasive developmental disorder recently introduced in the ICD‐10 and DSM‐IV. However, the extent to which this symptom is specific to AS is not clear. To investigate this issue, we compared a sample of AS children with age‐ and sex‐matched groups of children with autistic disorder and pervasive developmental disorder not otherwise specified (PDDNOS). Twelve subjects with AS (ICD‐10/DSM‐IV; 11 males; average age 11.4 years; mean full‐scale IQ 104.9) were compared with 12 subjects with autistic disorder (DSM‐III‐R; 11 males; average age 10.3 years; mean full‐scale IQ 78.4) and 12 subjects with PDDNOS (DSM‐III‐R; 10 males; average age 10.1 years; mean full‐scale IQ 78.2). The BruininksOseretsky test, a standardized test of motor coordination, was administered blind by the same investigator to all the three groups. While coordination deficits were found in all three groups, children with AS were found to be less impaired than those with autistic disorder and PDDNOS. However, no significant relationship was found between coordination scores and diagnosis after adjusting for the level of intelligence. These findings suggest that some patients with AS may be less clumsy than those with autistic disorder and that this difference may be the result of their higher level of intelligence. Studies based on larger samples using multiple measures of coordination are needed to further clarify the role of clumsiness in the classification of pervasive developmental disorders.
Antipsychotic medication, psychiatric diagnosis and children with intellectual disability: a 12‐year follow‐up study
Authors: Gralton E. J. F. , James D. H. , Lindsey M. P.
Published: March 2003

This study is a follow‐up to an original survey carried out in the early 1980s of all children with an identified intellectual disability in Cornwall, England. The purpose of this second study was to review the use of antipsychotic medication in these children and to relate it to their various diagnoses. This is a relatively under‐researched area, and the few comparable studies in children have not been designed to specify diagnoses, psychiatric or otherwise. A positive relationship between the diagnosis of autistic spectrum disorders in children and the use of antipsychotic medication was one of the important findings which emerged from the research. The possible reasons for this association are discussed.
A five‐year follow‐up study of older long‐stay clients with intellectual disability using the Disability Assessment Schedule
Authors: Ashaye O. , Fernando L. , Kohen D. , Mathew G. , Orrell M.
Published: March 2003

The emphasis on community care means closure of the long‐stay institutions for people with intellectual disability. Studies have indicated that older people with intellectual disability in particular may not be adequately cared for because of poor monitoring of their changing needs and inadequate provision of services. The use of rating instruments to monitor changes, and to predict outcome or needs in this population may help to improve care by assisting with planning and projection of service requirements. In 1991, all residents of a long‐stay hospital for people with intellectual disability were assessed using the Disability Assessment Schedule (DAS). Five years later, the 1991 scores of the older residents (aged > 50 years) were reviewed and compared under three outcome groups: in‐patients, discharged and deceased. Furthermore, all older people resident in the hospital in 1996 were reassessed using the DAS. Out of the 144 older clients resident in 1991, five years later, 78 were still in‐patients, 38 had been discharged into the community and 28 were deceased. In 1991, the deceased group had the greatest problems with continence and symbolic behaviour, while the discharged group had the greatest problems with self‐help, vision, hearing, communication, social interaction, echolalia and repetitive speech. In comparison with 1991, the 1996 DAS scores of older residents showed that there were increasing problems with vision, hearing, communication, behaviour and symbolic activities. The present study suggested that the DAS is a useful instrument for monitoring change and predicting outcome in older people with intellectual disability.
A longitudinal study of the quality of life of older people with intellectual disability after leaving hospital
Authors: Dagnan D. , Ruddick L. , Jones J.
Published: March 2003

A study was made of the quality of life of 29 older people with intellectual disability who left hospital to live in ordinary three‐ or four‐bedroom houses. A short version of the Questionnaire on Quality of Life was used to measure quality of life before moving and at three points in the first 53 months after changing residence. Results showed that there were improvements in quality‐of‐life subscales in the first 41 months with an eventual levelling out after 53 months. Social and leisure activity have been identified as particular important in the quality of life of older people. Therefore, items from the scale that measure participation in community leisure activities, contact with people without intellectual disability during these activities and engagement in leisure activities within the home were selected for detailed analysis. These data also showed increased activity and contacts in the first 41 months with a levelling out after 53 months.
Lionel Sharples Penrose (1898–1972): aspects of the man and his works, with particular reference to his undertakings in the fields of intellectual disability and mental disorder
Authors: Berg J. M.
Published: March 2003

The Penrose Club, named after Professor L. S. Pen rose, is a society of academic psychiatrists in the UK with a particular focus on research in the sphere of intellectual disability. The inaugural lecture of the Club was delivered at the Institute of Psychiatry, London, on 29 November 1996. It is distinctly fitting that this lecture should appear in print in the Journal of Intellectual Disability Research in the centenary year of Professor Penrose's birth, both because of his major pioneering contributions to the field with which JIDR is concerned and because he played a crucial role in the founding of the Journal.
Daytime behaviour problems and maternal stress in children with Down's syndrome, their siblings, and non‐intellectually disabled and other intellectually disabled peers
Authors: Stores R. , Stores G. , Fellows B. , Buckley S.
Published: March 2003

The present study investigates the occurrence of daytime behaviour problems and mammal stress in a group of children with Down's syndrome (DS) compared with a group of their non‐intellectually disabled siblings, a group of non‐intellectually disabled children from the general population and a group of children with an intellectual disability other than Down's syndrome. The Aberrant Behavior Checklist (ABC) and the Malaise Inventory were completed by the mothers. Associations between daytime behaviour problems and maternal stress were also explored. Overall, the children with DS and the children with other intellectual disabilities showed significantly higher rates of behavioural disturbance on all five of the ABC subscales (Irritability, Lethargy, Stereotypies, Hyperactivity and Inappropriate Speech) and on the Total ABC score. However, the children with other intellectual disabilities also showed significantly higher scores than the children with DS on four of the ABC subscales: Irritability, Lethargy, Stereotypies and Hyperactivity, as well as the Total ABC score. The siblings and children from the general population showed very similar behaviour scores. A number of significant age and sex differences were found in the occurrence of daytime behaviour problems. Maternal stress was significantly higher in the group with other forms of intellectual disability than the other three groups, and a number of significant associations were found between parental ratings of daytime behaviour problems and maternal stress in all four samples. The implications of the findings are discussed, including the need for early assessment to minimize adverse effects on the child's development and on family life.
Age‐related fractures in people with intellectual disability and epilepsy
Authors: Jancar J. , Jancar M. P.
Published: March 2003

The present paper describes age‐related fractures in 68 people with intellectual disability and epilepsy (39 females and 29 males). A higher incidence of fractures in epileptic subjects (269%) was noted when they were compared with non‐epileptic patients (15%). In the sample of 263 epileptics (121 females and 142 males), a higher number of females (32%) sustained fractures than their male counterparts (20%). The peak period of all fractures is between 40 and 49 years of age. The highest incidence of fractures in females occurred during the periods from 10 to 19 and 40 to 49 years, while the peak was between 30 and 39 years for males. The causes of fractures and preventative measures are discussed, and further avenues for research are indicated.
Opportunity and the promotion of activity among adults with severe intellectual disability living in community residences: the impact of training staff in active support
Authors: Jones E. , Perry J. , Lowe K. , Felce D. , Toogood S. , Dunstan F. , Allen D. , Pagler J.
Published: March 2003

Active support, a package of procedures which includes activity planning, support planning and training on providing effective assistance, was introduced in five community residences serving 19 adults with severe intellectual disability following a multiple baseline design. The residents were directly observed to ascertain the level of assistance they received from staff and their engagement in activity. The introduction of active support increased the levels of assistance residents received, their engagement in domestic activities and their total engagement in activity. The intervention did not affect the level of social engagement. Across individuals, increases in assistance and engagement in activity were significantly and positively correlated. Both were significantly inversely related to resident adaptive behaviour. At baseline, staff gave more attention and assistance to people who were behaviourally more able. After the introduction of active support, receipt of attention was unrelated to adaptive behaviour and the behaviourally less able received more assistance. The disparity in activity between the more and less able was reduced. Gains were maintained in the majority of houses.
Proxy respondents and the reliability of the Quality of Life Questionnaire Empowerment factor
Authors: Stancliffe R. J.
Published: March 2003

Previous studies have questioned the reliability of Quality of Life Questionnaire (QOL‐Q) Empowerment scores, and reported marked disagreement between consumers’ self‐reports and proxy data from staff informants. The present study examined agreement between consumer self‐reports and proxy responses from community living staff for 63 adults with intellectual disability. Substantial positive correlations between consumers and staff were evident. No significant difference was found between total QOL‐Q Empowerment scores for self‐ or staff reports. It was concluded that the QOL‐Q Empowerment factor is sufficiently reliable for use both by self‐report and proxy respondents. Even so, proxy data are not a substitute for consumer self‐reports and the two data sources should not be treated as being interchangeable.
Mortality in Down’s syndrome in relation to congenital malformations
Authors: Frid C. , Drott P. , Lundell B. , Rasmussen F. , Annerén G.
Published: March 2003

Down’s syndrome (DS) is the most common form of intellectual disability. The syndrome is characterized by congenital malformations, especially of the heart and gastrointestinal tract, which can result in high mortality rates in the affected population. Many improvements have been made in the medical treatment of this syndrome during the past few decades and the survival of individuals with DS has increased in the industrial world. The aim of the present study was to investigate mortality in relation to congenital malformations. Medical records from all liveborn children with DS delivered between 1973 and 1980 in northern Sweden were studied, and malformations and causes of death were recorded. Out of the 219 children included in the study, a congenital heart defect was reported in 47.5% of subjects, 42.1% of whom had complete atrioventricular septal defect. Gastrointestinal tract malformations were present in 7.3% of subjects, and was frequently associated with a cardiac malformation and a very high mortality rate. Other major and minor congenital anomalies were present in 5.5% and 5.5% of subjects, respectively. In the 14.5‐year follow‐up of 213 children, the rate of survival was 75.6%. Mortality rates within one and 10 years after birth were 14.6% and 23.5%, respectively. Mortality within 10 years differed significantly between children with (44.1%) and without (4.5%) a congenital heart defect. A very high mortality rate was observed among children with a congenital heart defect, especially when it was combined with a gastrointestinal malformation.
Mediator analysis: an overview of recent research on carers supporting people with intellectual disability and challenging behaviour
Authors: Allen D.
Published: March 2003

Families and front‐line care staff are often key agents in helping deliver behavioural interventions to people with intellectual disability and challenging behaviour. The present paper reviews factors which may impact on the effectiveness of such interventions. Both PsychLit and MedLine were used to conduct an automated literature search which included the terms’learning disability’,’mental handicap’,’mental retardation’,’intellectual disability’,’challenging behaviour’,’families’ and’staff’. This search was substantially augmented by additional citations obtained from books and journal articles. The impact of attitudes, beliefs and emotional states as setting conditions for interventions was highlighted. A variety of more general setting conditions related to intervention effectiveness were also identified. Implications for both clinical practice and future research were discussed.
The Thomas S. case: report on progress with court compliance issues
Authors: Dudley J. R. , Conroy J. W. , Calhoun M. L.
Published: March 2003

The present paper is a brief summary of the progress which has been made in the Thomas S. case, a U.S. Federal Court lawsuit. The suit focused on adults with intellectual disability who had been inappropriately placed in state psychiatric hospitals in conditions which violated their constitutional rights. These constitutional rights include safety, protection from harm, treatment under safe conditions, freedom from undue restraint, and minimally adequate habilitation or treatment. The present report summarizes the progress made by the 239 class members after they had received a Thomas S. service plan for 6–24 months. Overall, the results suggest that the class members have made significant progress in several areas. Two areas needing continued attention are the challenging behaviours of some class members and their lack of employment opportunities.
Review: Antipsychotic medication for challenging behaviour in people with intellectual disability: a systematic review of randomized controlled trials
Authors: Brylewski J. , Duggan L.
Published: March 2003

A study was performed to determine the effectiveness of antipsychotic medication for people with intellectual disability (ID) and challenging behaviour. Randomized controlled trials comparing antipsychotic medication to placebo in people with ID and challenging behaviour were identified by electronic searching and hand‐searching. Reviewers independently evaluated and analysed data on an intention‐to‐treat basis. Only three randomized controlled trials could be included in the analyses. These trials provided no evidence as to whether antipsychotic medication does or does not help adults with ID and challenging behaviour. There is limited data on this important issue and good quality research is urgently needed.
Case Report: Diagnosis and treatment of a severe psychotic illness in a man with dual severe sensory impairments caused by the presence of Usher syndrome
Authors: Hess‐Röver J. , Crichton J. , Byrne K. , Holland A. J.
Published: March 2003

The present paper reports the case history of a 50‐year‐old man born with Usher syndrome, who developed a psychotic illness later in life, to illustrate the specific diagnostic problems, and the value of direct observation and a detailed assessment of communication. The subject had had a significant hearing impairment since birth, problems with balance and developed retinitis pigmentosa, leaving him with progressively limited vision in adult life. A pattern of bizarre and aggressive behaviour, and a disintegration in his ability to communicate using signs developed over 3 months. An initial diagnosis of depression was made, but it later became clearer that the subject had developed a psychotic illness. This condition responded well to a combination of antidepressant and antipsychotic medication. The possible association between Usher syndrome and psychotic illness is also discussed.
Diagnosis of fragile‐X syndrome: the experiences of parents
Authors: Carmichael B. , Pembrey M. , Turner G. , Barnicoat A.
Published: March 2003

In order to assess some aspects of the quality of care for families seeking the cause of their child(ren)s intellectual disability, a postal questionnaire was sent to parents of children with fragile‐X syndrome, who were members of the UK Fragile‐X Society. Although the interval taken to get a diagnosis (‘lagtime’) has fallen over time, other aspects of care could still be improved. Most families feel that having a diagnosis is an advantage, but many still find the diagnostic process distressing and feel unsupported. Not all families are referred for genetic counselling, and even those who are do not always understand or retain the information given. Most families feel that having a diagnosis is a benefit rather than a disadvantage.
Evaluation of a computer‐aided system providing pictorial task instructions and prompts to people with severe intellectual disability
Authors: Lancioni G. E. , Van den Hof E. , Furniss F. , O'Reilly M. F. , Cunha B.
Published: March 2003

The present study extended the evaluation of a computer‐aided system providing pictorial instructions and prompts to promote task performance in people with severe intellectual disability. Four people were presented with two sets of tasks. The participants used the computer‐aided system for one set and a card (control) system for the other. The results indicate that the computer‐aided system was more effective than the card system with all participants. Three of the participants preferred the computer‐aided system, while one favoured the card system.
Test battery for the diagnosis of demntia in individuals with intellectual disability
Authors: Burt D.B. , Aylward E.H. ,   on behalf of the members of the Working Group for the Establishment of Criteria for the Diagnosis of Dimentia in Individuals with intellectual Disability
Published: March 2003

A working battery of tests for the diagnosis of dementia, which is applicable to most adults with intellectual disability, is proposed by an international Working Group. The battery, reflecting contemporary research and practice findings, includes scales for informant report of functioning and tests for direct assessment. The Working Group recommends the international use of the battery both as part of ongoing and new longitudinal research, and in clinical practice. The widespread use of a common battery will enhance communication and collaborative opportunities among researchers and clinicians at various sites, and will help to standardize diagnostic protocols and research findings. The collaborative evaluation of such a battery will address one of the greatest challenges in the field, that of differentiating change associated with ageing from that associated with dementia.
The prevalence of constipation in institutionalized people with intellectual disability
Authors: Böhmer C. J. M. , Taminiau J. A. J. M. , Klinkenberg‐Knol E. C. , Meuwissen S. G. M.
Published: March 2003

Constipation is a common problem in people with intellectual disability (ID). Laxatives are frequently prescribed with disappointing results. The prevalence of constipation was investigated in a random population of 215 people with ID (IQ < 50) and constipation was correlatead with clinical symptoms. All subjects were scored for bowel habits. Constipation was defined as having a bowel movement less than three times a week or the necessity of using laxatives more than three times a week. Further possible accompanying factors were evaluated. The control subjects were defined as individuals who did not use laxatives. Subjects with constipation were defined as patients and were compared to subjects without constipation (controls). One hundred and forty‐nine out of 215 cases (69.3%) showed constipation. Constipation was significantly correlated with non‐ambulancy, cerebral palsy, the use of anticonvulsive medication or benzodiazepines, H2‐receptor antagonists or proton pump inhibitors, food refusal, and an IQ < 35. Fifty‐eight per cent of the patients used bisacodyl or magnesium oxide, 39% lactulose, 13% sodiumlaurylsulphoacetate/sodium citrate/sorbitol and only 10% were given sodium phosphate enemas. Faecal soiling was found in 15% of subjects, while manual evacuation of faeces was performed in nearly 7% of cases. Constipation was randomly demonstrated in almost 70% of the population with ID. Subjects with the above‐mentioned accompanying factors are especially at risk for constipation. Contrary to the general population, constipation in people with ID is associated with little use of phosphate enemas, microlax, a low incidence of faecal soiling and manual evacuation of faeces, suggesting an aetiology without distal faecal impaction. The regimen and effect of therapy has to be studied to define adequate treatment schedules.
Complexity of staff communication and reported level of understanding skills in adults with intellectual disability
Authors: Bradshaw J.
Published: March 2003

Staff reports of the communication acts taking place with 22 adults with intellectual disability were compared with video observations of the communication acts used by staff with 12 of these service users. The interactions were coded in terms of the form of communication used, the function of the act and the level of complexity. The results show that staff tend to underestimate their own use of verbal communication and overestimate their use of non‐verbal communication. The findings also indicate a mismatch between the reported level of understanding of the service user and the level of complexity of the language used. Staff appeared unable to adapt their communication to the skills of the service user and an average of 45% of communicative acts were outside the reported understanding skills of the individual. The implications of these findings are discussed and possible explanations for staff behaviour are suggested.
Causal explanations, concern and optimism regarding self‐injurious behaviour displayed by individuals with Cornelia de Lange syndrome: the parents' perspective
Authors: Hyman P. , Oliver C.
Published: March 2003

Research into behaviours associated with specific syndromes, such as Cornelia de Lange syndrome (CdLS), has neglected to explore the parents' perspective, particularly the potential impact of the notion of behavioural phenotypes on parents' causal explanations. Given the research focus on self‐injurious behaviour (SIB) in CdLS, the present study examined parental concern across four topographies of challenging behaviour, causal explanations for these behaviours and optimism for change. As part of a larger study, a questionnaire survey of 86 parents of children and adults with CdLS was conducted. Quantitative data on parental concern and optimism with regard to behaviour problems were collected. Causal explanations for behaviour problems were examined by subjecting open‐ended responses to a content analysis. Parents were as concerned about physical aggression and disruptive behaviours as they were about SIB. The majority of parents had deconstructed how CdLS might be associated with SIB in terms of other factors associated with CdLS, such as degree of intellectual disability. Parents did not believe that CdLS influenced SIB more than other challenging behaviours and their beliefs did not effect optimism regarding future change in the behaviour. Despite the focus of research on SIB in CdLS, parents of children and adults with CdLS are also concerned about other challenging behaviours. There was no evidence that a deterministic perspective had been adopted by parents and causal explanations were unrelated to optimism for future change.
Effect of unexpected outcomes and causal attributions on key workers' expectancies of goal attainment
Authors: Stanley B. , Standen P. J.
Published: March 2003

Goal planning is an integral part of the role of the key worker in services for people with intellectual disability. The present study investigated the effect of the Weiner stability–expectancy principle on unexpected outcomes in goal planning. Four hundred and twenty‐two actual goal attainment scales were constructed, with each scale describing the key workers' expected levels of outcome. Two hundred and twenty‐six (54%) unexpected outcomes, both successful and unsuccessful, were then rated by key workers to provide a causal explanation for each outcome. These explanations were then grouped according to whether the attributions represented stable or variable causes. Finally, key workers were asked to provide a new expectancy rating to forecast future goal attainment. Two predictions from Weiner's model were confirmed by statistical analysis: (1) that success attributed to stable factors would lead to higher revised forecasts of goal attainment than success attributed to variable factors; and (2) that failure attributed to stable factors would lead to lower revised forecasts of goal attainment than failure attributed to variable factors. The results of the present study confirm that stability attributions do alter key workers' revised forecasts of goal attainment. The results are discussed in terms of the possible consequences for key worker behaviour, such as goal abandonment, differential treatment of service users and the need for a knowledgeable approach to performance appraisal by managers.
Enhanced self‐determination of adults with intellectual disability as an outcome of moving to community‐based work or living environments
Authors: Wehmeyer M. L. , Bolding N.
Published: March 2003

In recent years, the self‐determination construct has received increased international visibility and utilization in the field of intellectual disability (ID). This has resulted in efforts to promote skills enhancing self‐determination, and in efforts to change how adult services are funded to allocate resources to increase consumer control and direction. An important component to consider in both of these efforts is the role of the environment on self‐determination. The present study examined the self‐determination, autonomy and life choices of individuals with ID before and after they moved from a more restrictive work or living environment. The self‐determination of adults with ID was measured for an average 6‐months before and after a move from a more restrictive living or working environment to a community‐based setting. Paired‐sample t‐tests indicated that there were significant changes, in each case in a more adaptive direction, in self‐determination, autonomous functioning and life choices following a move to a less restrictive environment. The present findings contribute to emerging evidence that the self‐determination of individuals with ID is limited by congregate living or work settings which limit opportunities for choice and decision‐making. Alternatively, more normalized, community‐based environments support and enhance self‐determination. Because self‐determination has been linked to positive adult outcomes and enhanced quality of life, it is important to consider ways to enable people with ID to live and work in their communities.
Mental disorder in adults with intellectual disability. 2: The rate of behaviour disorders among a community‐based population aged between 16 and 64 years
Authors: Deb, S. , Thomas M. , Bright C.
Published: March 2003

Despite the difficulty of defining behaviour disorder, most previous studies have reported a high rate of behaviour disorders in people with intellectual disability (ID). The aim of the present study was to establish the overall rate and types of behaviour disorders in a population‐based sample of adults with ID. The other aim was to explore the possible risk factors that are associated with the overall rate as well as different types of behaviour disorders. One hundred and one adults with ID aged between 16 and 64 years were randomly selected from a sample of 246 such adults, i.e. those who were known to the Vale of Glamorgan Social Services Department in South Wales, UK. Thirteen behaviour disorders were rated according to the Disability Assessment Schedule. Background data on subjects were also collected, and were subsequently analysed to assess the relationship between different risk factors and behaviour disorders. Sixty‐one subjects (60.4%) had at least one behaviour disorder of any severity or frequency. Twenty‐three per cent of subjects showed aggression, 24% self‐injurious behaviour, 36% temper tantrum, 26% overactivity, 29% screaming, 38% attention‐seeking behaviour, 20% objectionable habits, 18% night‐time disturbance and 12% of subjects showed destructiveness. Statistically significant associations were seen between the rate of overall behaviour disorder and the use of psychotropic medication, and between family and group home residence. The rate of aggression was significantly associated with the use of psychotropic medication. The rate of self‐injurious behaviour was significantly associated with the severity of ID, female gender and poor communication abilities. The rate of temper tantrum was significantly associated with the use of psychotropic medication. Twenty‐four subjects showed severe or frequent aggression, destructiveness, self‐injury or temper tantrum, and 11 individuals showed real challenging behaviours. Severe behaviour problems were significantly associated with female gender, severity of ID, the presence of a history of epilepsy and attendance at day activities.
Behaviour/mental health problems in young adults with intellectual disability: the impact on families
Authors: McIntyre L. L. , Blacher J. , Baker B. L.
Published: March 2003

Background The present authors studied the impact of dual diagnosis [i.e. intellectual disability (ID) and mental disorder] in young adults on their mothers’ perceived levels of stress and decisions about placement.

Methods The mothers of 103 young adults with severe ID were interviewed using a 2–3‐h in‐depth protocol of measures designed to assess their child’s adaptive functioning, maladaptive behaviour, mental health problems and negative impact on the family, as well as their own thoughts on out‐of‐home placement. The Scales of Independent Behavior – Revised Problem Behavior Scale assessed problem behaviours and the Reiss Screen assessed mental disorder.

Results These measures were highly correlated (r = 0.64), but tapped some different domains of maladaptive behaviour and proved to be most predictive when employed together. Behaviour and/or mental health (B/MH) problems significantly predicted the mothers’ perceived negative impact of the young adult on the family, even after controlling for other young adult characteristics. These problems also predicted the family’s steps toward seeking out‐of‐home placement, as did better young adult health and the mother’s higher educational attainment; stress did not predict additional variance in placement once these variables were accounted for.

Conclusions The discussion focuses on the implications for service provision to families of young adults with B/MH problems.
The potential of virtual reality in social skills training for people with autistic spectrum disorders
Authors: Parsons S. , Mitchell P.
Published: March 2003

Background

People with autism experience profound and pervasive difficulties in the social domain. Attempts to teach social behaviours tend to adopt either a behavioural or a ‘theory of mind’ (ToM) approach. The beneficial aspects and limitations of both paradigms are summarized before an examination of how virtual reality technology may offer a way to combine the strengths from both approaches.

Methods

This is not an exhaustive review of the literature; rather, the papers are chosen as representative of the current understanding within each broad topic. Web of Science ISI, EMBASE and PsycInfo were searched for relevant articles.

Results

Behavioural and ToM approaches to social skills training achieve some success in improving specific skills or understanding. However, the failure to generalize learned behaviours to novel environments, and the unwieldy nature of some behavioural methodologies, means that there is a need for a training package that is easy to administer and successful in promoting learning across contexts.

Conclusions

Virtual reality technology may be an ideal tool for allowing participants to practise behaviours in role‐play situations, whilst also providing a safe environment for rule learning and repetition of tasks. Role‐play within virtual environments could promote the mental simulation of social events, potentially allowing a greater insight into minds. Practice of behaviours, both within and across contexts, could also encourage a more flexible approach to social problem solving. Virtual environments offer a new and exciting perspective on social skills training for people with autistic spectrum disorders.