There are only a limited number of Dutch validated measurement instruments for measuring behavioral problems in people with a moderate to profound intellectual disability. In this study, the psychometric properties of a Dutch version of the behavior Problems Inventory-01 (BPI-01; Rojahn et al., 2001) have been investigated among 195 people with a moderate to profound intellectual disability who live in a residential facility. The BPI-01 was completed by 42 informants (staff members) of 23 care units. The inter-rater reliability, intra-rater reliability and internal consistency turned out to be good. Factor analysis confirmed two of the three a priori factors and the third factor was a mix of self-injurious (SIB) behavior and stereotypic behavior. The BPI-01 was compared to the Aberrant Behavior Checklist (Aman et al., 1985a) and showed a good convergent validity. This study shows that a Dutch version of the BPI-01 has good psychometric properties for measuring behavior problems in individuals with moderate to profound intellectual disability.
Reliability and concurrent validity of the Behavior Problems Inventory (BPI-01; Rojahn et al., 2001) was examined in a sample of 130 community residing adults with mild to profound intellectual disabilities with high rates of behavior problems and concurrent mental health problems. The BPI-01 and the Inventory for Client and Agency Planning (ICAP; Bruininks et al., 1986) were administered twice within a mean time interval of 7.8 weeks by 20 trained and experienced staff members. All three BPI-01 subscales had high inter-rater agreement (Self-Injurious Behavior [SIB]: mean ICC=.84; Stereotyped Behavior: mean ICC=.75; Aggressive/Destructive Behavior: mean ICC=.82), and stable test-retest reliability (SIB, mean ICC=.91; mean Stereotyped Behavior, mean ICC=.89, and Aggressive/Destructive Behavior, mean ICC=.88); internal consistency ranged from poor (SIB: alpha=.61) to excellent (Stereotyped Behavior, alpha=.90). Using the ICAP as criterion measure, the BPI-01 showed robust convergent validity. Solid relationships between BPI-01 subscales and corresponding ICAP subscales corroborated the concurrent validity of the BPI-01.
The aim of the present study was to evaluate the psychometric properties and factor structure of the Behavior Problems Inventory (BPI-01) in a community population. The Swedish version of the BPI-01 was administered by interviewing care staff of all adults (n = 915) with administratively defined intellectual disabilities (IDs) living in Örebro County, Sweden. Sixty-two percent of the participants had at least one behavior problem. Altogether, 30.9% showed self-injurious behavior, 41.3% stereotyped behavior, and 34.8% aggressive/destructive behavior. All but the self-injurious behavior scale reached acceptable levels of internal consistency. Confirmatory factor analysis supported the unidimensionality of the subscales as well as the proposed three factor structure of the original BPI-01. The present study demonstrates that the three subscales are highly similar constructs across different language and cultural settings, and that the BPI-01 is applicable in research on populations with varying mental functioning, diagnoses, ages, and living arrangements.
It is important to identify Developmental Coordination Disorder (DCD) early in a child's life to allow for proper and timely intervention and support, and to reduce the negative secondary consequences associated with this condition. In this study we assessed the psychometric properties (construct validity, concurrent validity, reliability and test accuracy) of the Developmental Coordination Disorder Questionnaire (DCD-Q-07) in preschool children. A community-based sample of children ages 4-6 (n=181) were screened for motor difficulties using the Movement Assessment Battery for Children (M-ABC-2). Use of the M-ABC-2 resulted in the identification of 29 children below the 15th percentile, which we classified as probable DCD. Parents of these children concurrently completed the DCD-Q-07 to report their child's motor performance. The DCD-Q-07 demonstrated high internal consistency for both the full scale (alpha=0.881) and each subscale: control during movement (alpha=0.813), fine motor and handwriting (alpha=0.869) and general coordination (alpha=0.728). Moderate correlations (r=0.47-0.63) were also seen between the subscales on the DCD-Q-07, the strongest correlation being between control during movement and general coordination (r=0.63). Based on published age and sex cut points, the DCD-Q-07 showed poor sensitivity (20.7%) but high specificity (92.1%) against the M-ABC-2. Overall agreement with the M-ABC-2 was low using ROC analysis (area under the curve=0.654). Although it is important to screen for DCD in young children, the DCD-Q-07 may not be the best choice as a screening tool for DCD in preschool children ages 4-6 due to its low test accuracy.
This literature review summarizes knowledge gained from 151 articles on child language intervention published between 1978 and 1988. A general theoretical framework for viewing language development is offered as a basis for evaluating progress in the development of language intervention efforts. New developments and issues requiring further investigations are highlighted for five themes that characterize much of the language intervention research in recent years: (1) the development of augmentative and alternative communication systems, (2) the provision of language stimulation to take advantage of observational learning, (3) the teaching of various language functions, (4) the teaching of language as a means of environmental- and self-control, and (5) the study of different types of generalization processes.
Intellectual disability (ID) and autism spectrum disorders (ASDs) covary at very high rates. Similarly, greater severity of one of these two disorders appears to have effects on the other disorder on a host of factors. A good deal of research has appeared on the topic with respect to nosology, prevalence, adaptive functioning, challenging behaviors, and comorbid psychopathology. The purpose of this paper was to provide a critical review and status report on the research published on these topics. Current status and future directions for better understanding these two covarying disorders was reviewed along with a discussion of relevant strengths and weaknesses of the current body of research.
The maintenance of learned behavior is a problem faced frequently by teachers of persons with severe disabilities. The present study examines the use of a self-management procedure to improve and maintain work performance of young adults with severe disabilities in integrated job settings. Students were taught to self-monitor work rate on job tasks, evaluate daily performance against a criterion, and recruit contingent feedback from supervisors. A multiple baseline design across subjects, and two within series reversals, indicate a functional relationship between self-recruited feedback and maintenance of improved work rate. Self-monitoring of work rate alone was not a consistently effective maintenance strategy. Results are discussed in terms of the need for a comprehensive technology of maintenance that requires a low response cost to apply over long periods of time.
The present study provides a qualitative analysis of mothers' childrearing behaviour focused on the coercive-inductive dimension, in particular in an effort to show that coerciveness is not always negative, but may be adaptive to the child's characteristics. Thirty-one mothers provided self-reports from a structured interview on their childrearing behaviour to the child in diverse situations. Data analyses examined the associations between the ratings of the mother's reports on the coercive-inductive dimension and three measures: the child's disability (mental, sensory and multiple), the child's personality traits and the child's observable behaviour. Results demonstrated that the mothers' childrearing behaviours were adapted to their child's characteristics, in particular by combining degrees of coercive and inductive strategies according to situations. They contribute to qualify in a more articulated way the mothers' childrearing behaviour than through more simple quantitative measures. The discussion finally underlies the interest in analyzing mothers' reports for research on parent-child interaction and for clinical issue.
An abbreviated version of the Minnesota Multiphasic Personality Inventory, the MMPI-168(L), modified for use with clients who have moderate or mild mental retardation, was administered to 58 clients, most of whom had co-existing dual psychiatric diagnoses. Another recently developed instrument, the Assessment of Dual Diagnosis (ADD), was administered by interviewing a knowledgeable care giver. Correlations were examined among the raw scores on the 13 ADD scales and T scores of the 13 MMPI-168(L) scales. Contrary to expectations few correlations were found between the scales of the two instruments including scales purported to assess similar psychological constructs. The major exception was the Mania scale of the MMPI-168(L), which correlated moderately well with the Schizophrenia and Dementia scales of the ADD. Client age correlated strongly and negatively with scores on the Conduct Disorder and Sexual Disorder scales of the ADD. Finally, intra-instrument scale correlations were surprisingly large and, from a clinical and diagnostic perspective, meaningful. However, the large number of intra-instrument correlations showed that the scales of both instruments possess considerable overlap, which could make differential diagnosis problematic. It is suggested that it might be necessary to administer both instruments, and carefully consider behavioral history, to accurately diagnose psychiatric disturbances or personality characteristics of individuals with mental retardation.
Relationships between repetitive behaviors (RBs) and associated clinical features (i.e., cognitive and adaptive functioning levels, sleep problems, medication use, and other behavioral problems) were examined in two groups (High nonverbal IQ > or = 97 versus Low nonverbal IQ < or = 56) of children with autism spectrum disorders (n = 14; mean age = 10 years, 7 months). For the group as a whole, nonverbal cognitive ability (NVIQ) (as measured by the Leiter-R), adaptive functioning level, the presence of sleep problems, and three scales of the Aberrant Behavior Checklist (ABC) (Irritability, Lethargy, and Hyperactivity) were highly correlated with total RB scores on the Repetitive Behavior Scale-Revised (RBS-R). After controlling for NVIQ, adaptive level, sleep problems, and two scales of the ABC (Irritability and Lethargy) were not significantly associated with RB scores. However, there remained a significant positive correlation between the presence of RBs and the Hyperactivity scale of the ABC. Parent ratings of their stress levels and the presence of RBs in their children were highly correlated. The relationship between RBs and associated clinical features in autism is complex and future studies should control for cognitive ability when examining the direct and indirect relationships of these variables with RBs.
Studies evaluating behavioral treatment of autism from 1980 to the present were reviewed. Studies included were published in journal articles and utilized behavioral methodology. A total of 251 studies were included in the review. Each study was analyzed for target behaviors and behavioral techniques implemented. Target behaviors were divided into categories, which included aberrant behaviors, social skills, language, daily living skills, and academic skills. Behavioral techniques were classified as positive, negative, extinction, or combined. Results were presented for each category. Recent trends in the treatment literature were also reviewed, and recommendations for future research were presented.
During the last 15-20 years, a significant amount of research has focused on the issue of choice among people affected by severe-profound developmental disabilities. Studies have been directed at (a) assessing the ability of those people to choose between different options and express preferences that could be used for reinforcement or occupational purposes, (b) building choice opportunities within those people's daily situations, and (c) evaluating the possible effects of choice making on those people's performance and behavior. This paper reviews the aforementioned studies and comments on the main findings and related questions.
This paper describes an evaluation of a group intervention for reducing inappropriately expressed anger (as aggression) in people with intellectual disabilities. Group intervention was compared to a treatment as usual group consisting of people referred to the group but who had to wait to participate. The intervention used was based on the work of Novaco (1976; 1978) and Benson (1994). However, further modifications to the group that emphasized the contextual perspective of anger, such as the participants being accompanied by a support worker and more collaborative recording procedures, were devised. A reduction in expressed anger and measured levels of depression occurred after group treatment. Reductions in expressed anger were maintained at 6 and 12 months follow up. However, scores on the depression scale tended to increase on follow up. While caution must be expressed when considering these results, this type of intervention shows promise for reducing inappropriately expressed anger in people with intellectual disabilities Suggestions are made for future research and clinical practice.
The present study sought to examine the longitudinal psychoeducational, neurocognitive, and psychiatric outcomes of children and adolescents with chromosome 22q11.2 deletion syndrome (22q11DS), a population with a high incidence of major psychiatric illnesses appearing in late adolescence/early adulthood. Little is known of the developmental changes that occur in the early teen years, prior to the age of highest psychosis risk. Data were collected from 71 participants (42 subjects with 22q11DS and 29 control subjects) at Time 1 (T1) and Time 2 (T2), approximately 3.5 years later. The 22q11DS group was significantly lower functioning than controls on IQ, neurocognition, and academic achievement at both T1 and T2. Children with 22q11DS also showed significantly greater social-behavioral difficulties and psychiatric symptoms, and were more likely to meet criteria for psychiatric disorders at both time points. In evaluating change over time from T1 to T2, the 22q11DS group did not show significant changes in psychoeducational or psychiatric outcomes relative to the controls, however, lack of expected age-related gains in attention regulation were noted. Within the 22q11DS group, an increase in the Attenuated Prodrome for Schizophrenia (number of psychiatric symptoms) was noted from T1 to T2 and four children with 22q11DS met criteria for Psychosis for the first time. Predictors at T1 that uncovered psychopathology symptoms at T2 included full-scale IQ, externalizing symptoms, and problem social behaviors. Overall, younger adolescent and preadolescent children with 22q11DS in this study exhibited slowed growth in attention regulation, with an increase in subclinical symptoms of schizophrenia, suggestive of increasing impairments in domains that are relevant to the high risk of Schizophrenia. Early predictors of later psychopathology included both cognitive and behavioral abnormalities. These findings begin to elucidate the trajectory of changes in psychopathology in children with 22q11DS in the years leading up to the onset of major psychiatric illnesses.
The development of learning difficulties is associated with problems in external (executive) and extensive behaviour in a co-occurrence with psycho-emotional problems beginning from pre-school, school age, and adolescence up to adulthood. Through the current survey, we aim to emphasise the early role of learning difficulties during the school age and adolescence of prisoners and their effects on the onset of offending behaviours in adulthood, such as criminal behaviour. Altogether, we studied 117 Greek adult prisoners from 18 to 70 years old who were accused of different types or degrees of offences. Through statistical analyses, the following factors were observed with high statistical significance as early indicators of criminal behaviour in the adult lives of the prisoners: (i) learning difficulties, (ii) family problems, (iii) behaviour disorders, (iv) developmental disorders, and (v) psycho-emotional disorders. As a result, the learning difficulties were assumed to be the most decisive factor in the developmental progression of prisoners because they manifested early in the prisoners' lives, weakened the prisoners to be competitive and robust, provoked a bad self-image and low self-esteem, and, in the frame of a weak or negative family and educational environment, they accompanied antisocial behaviour and psycho-emotional disorders even from adolescence, which continued into adulthood.
Toys that provoke the use of both hands are required to develop a test of bimanual performance in children 8-18 months with unilateral cerebral palsy (Mini-AHA). To choose the toys, a conceptual model based on perception-action theory and object use was used to guide a literature review. Evidence was sought for three critical relationships identified in the model which help determine bimanual performance: (1) the child-toy relationship, (2) the child-task relationship, and (3) the toy-task relationship. Evidence for both typically developing children and children with unilateral CP in this age range was sought. Thirty-five papers provided information about one or more of the relationships in typically developing children. No evidence was found for children with unilateral CP. Synthesis of the evidence from these three relationships informed toy selection for this new assessment.
The study aims to determine hepatitis B vaccination coverage rates among community-dwelling teenagers with an intellectual disability in Taiwan and to identify the possible influencing factors of their vaccination. The present paper was part of the results of the "2007 National Survey on Healthy Behaviors and Preventive Health Utilizations of People with Intellectual Disabilities in Taiwan," which was a cross-sectional survey of 1111 intellectually disabled (ID) teenagers ranging from 12 to 18 years of age. The results showed that the completed hepatitis B vaccination rate was 72.9%, a rate lower than that in the general population of Taiwan considering the same age group. There was no gender difference between each age group in the vaccination rate in this population. Multilevel logistic regression analyses revealed that those ID individuals whose primary caregivers were parents or siblings (OR = 2.45, 95% CI = 1.29-4.64), whose household monthly income was 20,000-59,999 NTD vs. less than 20,000 NTD (OR = 2.47, 95% CI = 1.00-6.12), and who had ever undergone an oral health exam (OR = 2.29, 95% CI = 1.24-4.01) were more likely to receive a complete hepatitis B vaccination than their counterparts. The study highlighted that most teenagers had received complete hepatitis B vaccination. Nonetheless, better public health strategies may be needed to deliver the hepatitis B vaccine to those who do not comply with the vaccination schedule in the community.
We wanted to develop and validate an extension of the Autism Spectrum Screening Questionnaire (ASSQ)-the ASSQ Revised Extended Version (ASSQ-REV)--for better capturing the female phenotype of autism spectrum disorders (ASD). Clinic girls and Clinic boys, most of whom with ASD and/or attention-deficit/hyperactivity disorder (ADHD), and Community girls without a clinical diagnosis of any kind of neuropsychiatric disorder were compared on the results of the parent-rated ASSQ and on a new set of items (ASSQ-GIRL). The ASSQ-REV discriminated well between cases and non-cases. Certain single ASSQ-GIRL items were much more typical of girls than of boys with ASD. The most striking of these were "avoids demands", "very determined", "careless with physical appearance and dress" and "interacts mostly with younger children". The issue of whether or not there is a gender-specific ASD for phenotype is discussed.
The statistics for 1983, issued by the Swedish National Board of Health and Welfare, show among other things, that the age structure among mentally retarded persons has undergone a striking change since 1973, but that the number and proportion of mentally retarded persons in the total population has not changed; there are fewer children and young persons and more adults. The author of this article considers that the reasons for the changes which have taken place during one single decade may preliminarily and hypothetically be attributed to prenatal diagnosis, improved techniques in obstetrics, the introduction of antibiotics in 1948, as well as further noticeable improvements in the medical and social care provided for mentally retarded persons. Apart from prenatal diagnosis, the measures mentioned were not intended to have exactly this result in each specific case, but if the hypotheses--totally or partly--are true, knowledge of the underlying factors will have consequences, first and foremost for future public health and medical services planning. Steps cannot be taken for the restriction or increase of the number of Caesarean sections or prenatal diagnosis, for example, with no thought of the consequences for the increase, respectively decrease in the number of mentally retarded persons. This means that the number of mentally retarded persons in society can be controlled.
The identification of leading researchers and institutions is important in clarifying expert resources in the area of developmental disabilities. We assessed productivity of authors and research institutions in this area. Journals were peer-reviewed, published in the English language, and were focused on developmental disabilities. Researchers were tabulated without regard to order of authorship. Results identified prominent leaders in research, the top 3 researchers accounting for a significant portion of research completed over the last 20 years. The majority of researchers identified were male and affiliated with university settings. Results also revealed a need for an increase in productivity across service delivery settings.
Starin and Fuqua seriously misread a critical study cited in their recent review in failing to characterize it as an experimental analysis of four treatment procedures, and therefore inappropriately criticized it for several shortcomings. This misreading and a tendency to equate vomiting with and without rumination compromise their conclusions regarding treatment choice. At the present time, the data base favors selection of several aversive procedures and the nonaversive satiation procedure over others, but the number of studies on nonaversive operant treatment procedures remains remarkably limited.
We conducted a 10 year review of the literature pertaining to psychopharmacology and mental retardation. Studies were included or excluded from the review based on meeting one or more of the methodological criteria normally considered fundamental for sound scientific research. The vast majority of studies conducted in the last 10 years in this area had major methodological flaws. While a large number of medications were prescribed for various psychological disorders and behavior problems, most drug administrations were not based in science, were not evaluated appropriately, and generally did not follow best practices for treatment of persons with mental retardation. Very few medications prescribed were behavior or psychiatric symptom specific; that is, most medications were given to suppress a myriad of aberrant behaviors thus chemically restraining the individual in question. Practices such as these present serious problems for service providers due to the deleterious side effects of many psychotropic medications and the federal government's intervention into the care-provision practices of developmental centers, community homes, and other living arrangements for persons with mental retardation. Implications of our review are discussed.
The purposes of the present study were to describe the welfare expenditure for people with disabilities and examine its relation to national economic growth from 1991 to 2006 in Taiwan. We analyzed data mainly from the information of population with disabilities, disability welfare expenditure and national economic growth and gross national product (GNP) per capita in Taiwan from 1991 to 2006. The percentage and overtime trend were used to examine the change in disability welfare expenditure, national economic growth and GNP per capita. Taiwan's economy continued its steady expansion on record an annual average growth of 5.4% and GNP per capita of 5.7% for the year 1991-2006. At the same period of time, the registered population with disabilities increased nearly five times (204,158 persons in 1991 to 981,015 persons in 2006), the government disability welfare expenditure was dramatically increasing to over 10 times from 1991 to 2006 (US$ 74 million to US$ 784 million). Although the total disability budget increased, the beneficiary of the individual with disability increased only 2.2 times. In the content of annual welfare budget for people with disabilities, it is difficult to figure out the increase pattern of the budget growth. However, the local government plays a vital role in disability welfare services gradually, it provides more than 85% welfare budget for people with disabilities. Finally, the author emphasizes that government should examine the long term effects of welfare budget allocation shifting from central government to local government to ensure the right of people with disabilities.
This paper provides an overview of behavioral strategies used for reducing hand-related stereotypies (i.e., hand/finger mouthing, eye poking, self-slapping, and other hand-to-head/body responses) of persons with severe to profound intellectual and multiple disabilities. Computerized and manual searches were conducted to identify the studies carried out in this area between 1995 and 2007. Forty-one studies were identified which used five main strategies: (1) mechanical restraints employed alone or together with other intervention variables, (2) response blocking alone or together with other intervention variables, (3) noncontingent stimulation (environmental enrichment) with or without prompting or contingent reinforcement events, (4) contingency manipulations differing from those relied upon by the other strategies, and (5) programs based on microswitch clusters. The outcomes of the studies tended to be positive but occasional failures also occurred. Outcomes were discussed in terms of the characteristics of the strategies employed, the implications of the strategies for the participants' overall stimulation and occupational situation, and the overall practicality, applicability, affordability and potential of the strategies in the short and long term. Issues for future research were also examined.
This study aims to examine trends in outpatient psychotropic drug use among people with intellectual disabilities in Taiwan. The NHI outpatient medication records between January 1, 1997 and December 31, 2007 for people with intellectual disabilities were analyzed to observe the percent change, prevalence and prescription trends in psychotropic drugs. The overall prevalence of psychotropic medication increased from 17.82% to 23.22% during the study period. Results from stepwise logistic analysis demonstrated that females, the elderly, and individuals suffering from catastrophic disease were more prone to receive psychotropic drugs and that those with mild intellectual disability were less likely to receive psychotropic drugs. The percentage change in prescription rates of antipsychotics, hypnotics/sedatives, and antidepressants were 85.30%, 127.25%, and 167.50%, respectively, and the trends were statistically significant (p<0.05). Taiwan's NHI program and off-label use of psychotropic drugs might have attributed to this trend.
The main purposes of the present analysis were to describe the causes of intellectual disability (ID) and examine its overtime change from 2000 to 2007 in Taiwan. Data of the present study mainly come from the public web-access information which collected by the Department of Statistics, Ministry of the Interiors, Taipei, Taiwan. Data were obtained from two ways of 2000-2007 national data: (1) The physically and mentally disabled population by cause; (2) Taiwan general population by age. The present results found that the congenital disability and the disease were the main causes among the ID population in Taiwan. The overtime trend (2000-2007) of causes among the ID population illustrated that the percentage of congenital-caused ID was decreasing and the disease-caused ID was increasing slightly. However, both of above two causes - congenital- and disease-caused ID prevalence - were increasing slightly in the Taiwan general population in the year 2000-2007. The present analysis suggests that the current disability registers should re-examine the ID-caused categories according to the evidence-based literatures regarding attributive risks for this group of people in Taiwan.
Childhood disability is not uncommon, but data at the national level are limited, especially those on the changes in the prevalence over time. On the basis of the Disabled Welfare Act, Taiwan began to certify disabled residents and provide various services in 1980. All the cases receiving services are registered, and the registry provides a rare opportunity for studying childhood disability at the national level. Using the data from 2000 to 2011, we calculated the age-specific prevalence of all disability combined and assessed the changes over time. We also calculated the prevalence rate and the proportion in all disabilities combined for each disability category and assessed the trends. As certification before 3 years old is generally discouraged by the government, we limited analyses to children between 3 and 17 years old. We found that the registered cases ranged from 49,242 to 61,717 from 2000 to 2011 and that intellectual disability (ID), had been the leading category all through the years. The proportion of autism spectrum disorders (ASD) had been increasing rapidly and become the third leading disability in 2011. The prevalence of all disabilities combined increased constantly from 9.98/1000 to 15.41/1000 (p<0.01), and increases were generally observed every year in all age groups (p<0.01). The increase could largely be attributable to the increases in ID and ASD, while the increasing trends were also significant in "multiple disabilities," "speech or language impairment," and "other disabilities listed by the Department of Health" (p<0.01 for all the five categories). An increase with age in the prevalence of all disabilities combined could be observed all through the years (p<0.01 in all calendar years). We concluded that the prevalence of childhood disability has been increasing in Taiwan, with ID contributing the most cases and ASD as an emerging problem. However, the increase of prevalence cannot be attributed entirely to the increase in the occurrence of cases, and an increase in the proportion of cases registered was an more important factor, which may be in turn attributable to a better service of the related agencies, lower discrimination against the patients, higher awareness of the disorder, and more willingness of the guardians to register.
Primary prevention of intellectual disability (ID) has long been a goal of public health professionals, without a clear picture of the ID population, efforts to understand its nature and improve the lives for this group of people will be impossible. The purpose of this paper was to describe the over time prevalence of ID from 2000 to 2007 in Taiwan, particular focused on the age and gender distributions. We analyzed data for the present study from the 2000 to 2007 Taiwan national disability registers, mainly were obtained from two ways: (1) the Physically and Mentally Disabled Population by Aged and Level; and (2) Taiwan General Population by Age. The results revealed that the registered number of people with ID drastically increased from 71,012 to 91,004 and the general population was slightly increasing from 22,276,672 to 22,958,360 in the year of 2000 and 2007 in Taiwan. The increase rate of population in ID cases is 13.67 times of the general population (ID=28.15%, general population=2.06%) and the ID prevalence was increasing from 0.318% to 0.396% in this period of time. Males occupied more percentage than female in ID population (roughly the male/female ratio was 1.37). The ID population was particularly significant increased during the age periods of the school and young adult. However, in the elderly age groups (>==60 years) showed the percentage of Taiwan general population was 2.9 times of ID population percentage to the age structure in 2007 in the analysis. The present analysis suggests that the prevalence is varied in different time. Therefore, it is needed to conduct the incidence as a choice in the public health system to monitoring and measuring the occurrence of people with ID in the community.
Parent-managed behavioral interventions for young children with autism are under-researched. We analysed data from 66 children served by 25 different early intervention consultants. After a mean of 31.6 months of intervention, IQ scores had not changed (N = 22). Vineland adaptive behavior scores had increased significantly by 8.9 points (N = 21). No children aged >72 months attained normal functioning, i.e., IQ > 85 and unassisted mainstream school placement (N = 42). Progress for 60 children across 12 months was found for mental age (5.4 months), adaptive behavior (9.7 months), and language (5.1 months). The interventions did not reproduce results from clinic-based professionally directed programs. The effectiveness of the parent-managed intervention model as it has developed and the adequacy of professional services in that model are discussed.
The purposes of the present study were to describe the institutional care for people with disabilities included service types, service capacity and service utilization from 2002 through 2007 in Taiwan. Data were obtained from four ways of national data: (1) The condition of service institution for the physically and mentally disabled; (2) The physically and mentally disabled population by aged and grade; (3) The physically and mentally disabled population by cause; (4) Taiwan general population by age. We used percentage and overtime trend figures to examine the change in service capacity and the institutional care utilization of people with disabilities. The results revealed that the administrative prevalence of disabilities was increasing from 3.69% to 4.45% from 2002 to 2007 (increase rate 22.8%) in Taiwan. The number of disability institutions was increasing from 223 to 254 and yield an increasing rate 12.2%. The service capacity of institutional care was 16,664 persons in 2002, and it was increasing to 20,707 persons in 2007 (increase rate=24.3%). The cases admitted to institutional care were increasing from 12,611 in 2002 to 17,002 in 2007 (increase rate=34.8%). The male individuals with disabilities were more likely to admit to institutional care than the female cases. The data of the present study provided can be a basis for further discussion on the debate of institutional care or community care for people with disabilities in Taiwan community.
The objectives of this study were to examine trends related to the staffing of disability welfare institutions caring for people with disabilities in Taiwan. Nationwide data from the 2002 to 2007 "Service Manpower in Disability Welfare Institutions" report, which are derived mainly from the Department of Statistics, Ministry of the Interior, Taiwan, were analyzed. The data included number of workers, job type and gender distribution of staff working in welfare institutions catering for the disabled. We also used the disabled population and those who had been admitted to institutional care to analyze the service load per staff member. Based on analyses of current governmental statistics, the results showed that staff numbers in institutions for the disabled increased from 6191 to 7820 (20.8% increase), and the female/male ratio these staff increased from 4.18 to 4.51 from 2002 to 2007. Educator/training personnel (33.3-36.7%) accounted for a higher proportion of staff than other job categories, and each staff member served 5.8-6.3 persons with disabilities on average. The second largest group was living assistant (18.4-20.5%; 9.9-11.8), and the remaining personnel were administrative staff (13.5-14.6%; 13.9-15.9), nursing staff (6.4-8.7%; 24.9-32.0), social workers (6.2-7.5%; 28.8-32.8), and counseling staff (3.8-6.3%; 21.9-57.1). Curve estimation tests showed a significant change over the period of the study in the number of disabled people attended to on average by administrative staff, social workers, nurses and other staff. The results highlight the requirement for further study to explore the needs of the majority service provider--female staff--to provide them with adequate professional or psychological support to enable them to work with people with disabilities in institutions. In addition, further analysis should focus on a review of staff numbers for different types of institutions, to examine their adequacy.
Sexual violence against people with disabilities is widespread and linked to negative public health and social outcomes. The objectives of the present study were to describe and analyze and thus provide an overview of the current state of affairs concerning sexual assault among people with disabilities, including reported prevalence and trends, over the period from 2002 through 2007 in Taiwan. The present study analyzed nationwide data from the 2002-2007 "Sexual assaults report system" derived primarily from the Council of Domestic Violence and Sexual Assaults Prevention, Ministry of the Interior, Taiwan. The data took into account the number of cases and disability type in persons reported to have been sexually assaulted, and to analyze the reported rate of sexual assaults among this section of the population in Taiwan. In addition, the study used a linear estimation model to examine with time (2002-2007) in the rate of reported sexual assaults. The rate of increase of sexual assault reported among people with disabilities was 2.7 times that of the general population (469-173%) during the period of 2002-2007. Government statistics showed that intellectually disabled persons accounted for the largest proportion (>50%) of reported sexual assault cases among the disabled, followed by persons with chronic psychosis, who accounted for one-third of the reported sexual assault cases among the disabled population. The reported rate of sexual assault increased from 0.9 to 2.42 per ten-thousand people in the general population and from 1.24 to 5.74 per ten-thousand disabled persons. Intellectual disability, chronic psychosis and voice and speech impairments were consistently associated with a higher prevalence of sexual assault than the general population. The line of best fit estimated from a linear model showed a significant change over the study period in the reported number of sexual assault cases among disabled people. The results highlight the requirement for further study to explore the needs of people with disabilities with regards to education and other strategies to prevent sexual assault, particularly in the most vulnerable group-those with intellectual disability.
Feeding problems are common problems seen in premature infants following their discharge from the NICU. However, the prevalence of feeding issues and failure to thrive among preterm infants in Taiwan is uncertain. All former studies of prevalence and identifications of feeding issues were from western countries. Those findings are therefore not representative. The objectives of this study were to understand the proportion of feeding problems and its trend in Taiwanese children who were born prematurely as well as to identify the medical and rehabilitation needs related to feeding difficulties in children with premature history. We investigated the prevalence of feeding problems in 2003-2006 using random subjects of 5% of the enrollees in the National Health Insurance program of Taiwan. Databases used in this study include 'monthly claim summary for ambulatory care claims', 'inpatient expenditures by admissions', 'details of ambulatory care orders, etc. ICD-9 codes of preterm infants and related diagnoses were used as variables. According to this systematical sampling data, there is a rise in the percentage of children admitted to the hospital with low birth weight. High percentage of these children experienced feeding related issues/difficulties in their first 5 years of life. However, under-utilization of rehabilitation services were noted with these low birth weight children who had feeding problems. There is a high co-occurrence between low birth weight children and feeding problems in their first 5 years of life measured by frequency of hospital admissions or outpatient ambulatory care services requirement. It is recommended based on our results that children with low birth weight should be screened automatically for potential feeding difficulties during the hospital stay. Furthermore, feeding monitoring/management as well as parental education on potential risk for feeding difficulties should be incorporated in the early intervention program.
This paper was a population study with developmental delays and it included an examination of the trends the overtime change trend and reported channels of this group of people in Taiwan. We analyzed data for the present study mainly from the Department of Statistics, Ministry of the Interiors, Taipei, Taiwan: "Number of early intervention for children with developmental delays in Taiwan" from 2003 through 2007. The reported number of children with developmental delays slightly increased from 13,231 to 14,250 (increase rate=7.7%) from the year of 2003 through 2007 in Taiwan. More than one-half of children with developmental delays were reported during the age 3-5 years. Aged 0-2 group has the highest increasing reported numbers in the previous 5 years which changed dramatically increased from 4139 (31.3%) in 2003 to 6201 (43.5%) in 2007 (increase rate=49.8%). The medical care setting was the main reported channel of the children with developmental delays and the results also showed that the reported prevalence of the aged 0-2 developmentally delayed children was 57.4-102.2 per 10,000 children; aged 3-5 was 79.0-105.1 per 10,000 children from the year 2003-2007 in Taiwan. The present concluded that early intervention based on the precise affected population would provide important supports for families of children with developmental delays. Therefore, the health care system should be strengthened to increase the proportion of children identified at the earlier age and to decrease the variability in the age at identification for most of the conditions of children with developmental delays.
Studies document various associated health risks for children with developmental disabilities (DDs). Further study is needed by disability type. Using the 2006-2010 National Health Interview Surveys, we assessed the prevalence of numerous medical conditions (e.g. asthma, frequent diarrhea/colitis, seizures), health care use measures (e.g. seeing a medical specialist and >9 office visits in past year), health impact measures (e.g. needing help with personal care), and selected indicators of unmet health needs (e.g. unable to afford needed prescription medications) among a nationally representative sample of children ages 3-17 years, with and without DDs. Children in four mutually exclusive developmental disability groups: autism (N = 375), intellectual disability (ID) without autism (N = 238); attention-deficit/hyperactivity disorder (ADHD) without autism or ID (N = 2901); and learning disability (LD) or other developmental delay without ADHD, autism, or ID (N = 1955); were compared to children without DDs (N = 35,775) on each condition or health care measure of interest. Adjusted odds ratios (aORs) were calculated from weighted logistic regression models that accounted for the complex sample design. Prevalence estimates for most medical conditions examined were moderately to markedly higher for children in all four DD groups than children without DDs. Most differences were statistically significant after adjustment for child sex, age, race/ethnicity, and maternal education. Children in all DD groups also had significantly higher estimates for health care use, impact, and unmet needs measures than children without DDs. This study provides empirical evidence that children with DDs require increased pediatric and specialist services, both for their core functional deficits and concurrent medical conditions.
To estimate the prevalence of cerebral palsy (CP) and the frequency of co-occurring developmental disabilities (DDs), gross motor function (GMF), and walking ability using the largest surveillance DD database in the US.
We conducted population-based surveillance of 8-year-old children in 2006 (N=142,338), in areas of Alabama, Georgia, Wisconsin, and Missouri. This multi-site collaboration involved retrospective record review at multiple sources. We reported CP subtype, co-occurring DDs, Gross Motor Function Classification System (GMFCS) level, and walking ability as well as CP period prevalence by race/ethnicity and sex.
CP prevalence was 3.3 (95% confidence interval [CI]: 3.1-3.7) per 1000 and varied by site, ranging from 2.9 (Wisconsin) to 3.8 (Georgia) per 1000, 8-year olds (p<0.02). Approximately 81% had spastic CP. Among children with CP, 8% had an autism spectrum disorder and 35% had epilepsy. Using the GMFCS, 38.1% functioned at the highest level (I), with 17.1% at the lowest level (V). Fifty-six percent were able to walk independently and 33% had limited or no walking ability.
Surveillance data are enhanced when factors such as functioning and co-occurring conditions known to affect clinical service needs, quality of life, and health care are also considered.
This paper presents a comprehensive synthesis of six meta-analyses of early intensive behavioral interventions (EIBI) for young children with autism spectrum disorders published from 2009 to 2011. Analysis was conducted in three steps to account for different formats of treatment delivery and the extent to which parents took part in treatment. The three components of the synthesis were (a) descriptive analysis, (b) effect size analysis, and (c) mediator analysis via partial correlation and linear regressions. We completed the analysis by obtaining standardized mean difference effect sizes for 13 comparative studies ordered by comparison study type and 22 mean change effect sizes ordered by treatment delivery type. Results suggest that EIBI leads generally to positive medium-to-large effects for three available outcome measures: intellectual functioning, language skills and adaptive behaviors. Although favorable effects were apparent across comparative studies, analysis by type of delivery format revealed that EIBI programs that include parents in treatment provision are more effective. Mediator analyses suggest that treatment variables and child characteristics impact program effectiveness when accounting for the extent of parent inclusion. Clinical implications toward individualized treatment tailoring are discussed.
The diagnosis of autism spectrum disorder has systematically risen since Kanner's description in 1943 and Asperger's definition in 1944. An increase in numbers has met with an increase in litigation regarding autism spectrum disorder (ASD) and the Individuals with Disabilities Education Improvement Act (IDEIA). Outcomes that first favored parents (2002-2004) have moved to outcomes favoring school districts. The authors update the reader on case outcomes for 2010 and discuss how pending changes in legislation and diagnostic criteria may impact navigation through the education system as individuals seek a free appropriate public education (FAPE) and placement in the least restrictive environment (LRE).
▶ The above article contained an error on page 245. ▶ The mistake originated in Osterlind (1983) and was unfortunately reproduced in the text and computations. ▶ Given the matching of participants, the correction of the concerned parameter hardly affected the results. ▶ The conclusions of the study thus remain unchanged.
Early intervention has been reported to improve outcome in children with autism spectrum disorders (ASDs). Several studies in the field have been randomized controlled trials (RCTs). The aim of this study was to assess ASD outcome in a large naturalistic study. Two hundred and eight children, aged 20-54 months, with a clinical diagnosis of ASD were given intervention and monitored prospectively in a naturalistic fashion over a period of 2 years. The toddlers were considered representative of all but the most severely multiple disabled preschool children with ASD in Stockholm county. They fell into three cognitive subgroups: one with learning disability, one with developmental delay, and one with normal intellectual functioning. Data on intervention type and intensity were gathered prospectively in a systematic fashion. Intervention was classified into intensive applied behaviour analysis (ABA) and non-intensive, targeted interventions, also based on ABA principles. Children were comprehensively assessed by a research team before the onset of intervention, and then, again, 2 years later. Change in Vineland adaptive behaviour scales composite scores from intake (T1) to leaving the study (T2) was set as the primary outcome variable. The research team remained blind to the type and intensity of interventions provided. One hundred and ninety-eight (95%) of the original samples stayed in the study throughout the whole 2-year period and 192 children had a complete Vineland composite score results both at T1 and T2. Vineland composite scores increased over the 2-year period. This increase was accounted for by the subgroup with normal cognitive functioning. There was no significant difference between the intensive and non-intensive groups. Individual variation was considerable, but no child in the study was "problem-free" at follow-up. Our data do not support that children with ASD generally benefit more from the most intensive ABA intervention programs than from less intensive interventions or targeted interventions based on ABA.
Oxygen consumption at peak physical exertion (VO(2) maximum) is the most widely used indicator of cardiorespiratory fitness. The purpose of this study was to compare two protocols for its estimation, cycle ergometer testing and the 20 m shuttle run, among children with and without probable developmental coordination disorder (pDCD). The shuttle run test was conducted during regular school hours, usually in the gymnasium. Children were then invited to a lab to complete the cycle ergometer protocol. Children were categorized as possible cases of DCD using the Movement-ABC-2. The analysis was performed using cut-points at both the 5th (n=38) and 15th (n=51) percentiles. The average age of children in the study was 12 years (SD=0.5). Children with pDCD had poorer VO(2) maximum when compared to typically developing children based on both the shuttle run and the cycle ergometer. The correlation between tests is in the moderate to high range (r=0.71, p<0.001); 0.78 for girls, and 0.73 for boys. The overall difference in correlations between typically developing children and children with pDCD based on the 15th percentile was 0.12 (p=0.27). For children with pDCD based on the 5th percentile however, the difference between groups was larger (difference in r=0.25), and was statistically significant (p=0.02). In multivariate analyses, there was no difference in the effect of the shuttle run results in predicting VO(2) maximum obtained through the cycle ergometer test for children with pDCD compared to those without the condition. Regardless of the test, the patterns of association between children with pDCD and typically developing children were the same reinforcing the findings of previous field-based reports. Moderate to good correlations, at the 15th percentile cut-point, between tests suggests that the shuttle run test is a reliable substitute in this population when lab based assessments of VO(2) maximum are not feasible.
A total population study was undertaken in two areas of England to identify the situation and characteristics of people reported to exhibit challenging behaviors. We found that: (1) challenging behaviors are shown by 10-15% of people with mental retardation who are in contact with educational, health or social care services for people with mental retardation; (2) the most common forms of challenging behaviors reported were 'other' behavior (shown by 9%-12% of all people screened), aggression (7%), destructive behavior (4%-5%) and self-injury (4%); (3) the majority of people identified showed two or more of these four general forms of challenging behavior; (4) approximately two-thirds of the people identified were boys/men; (5) close to two-thirds of the people identified were adolescents or young adults; (6) approximately 50% of the people identified as showing more demanding challenging behavior were living with their families; (7) people who showed more demanding challenging behavior were more likely to need greater levels of assistance in eating, dressing and washing, be incontinent and have more restricted expressive and receptive communication.
The primary objective of this study was to study the impact of ASD/ADHD on general intellectual ability and profile, executive functions and visuo-motor skills in children and adults with 22q11 deletion syndrome (22q11DS). A secondary aim was to study if gender, age, heart disease, ASD, ADHD or ASD in combination with ADHD had an impact on general intellectual ability and profile. One hundred consecutively referred individuals aged 1-35 years with 22q11DS were given in-depth neuropsychological assessments. Mean full scale IQ was 71 with a normal distribution around this mean. Higher IQ for females than males, and a negative trend for IQ with higher age were found. Intellectual impairment, as well as visuo-motor dysfunction, was found to be related to 22q11DS per se and not to ASD/ADHD. In the area of executive function, the presence of ASD/ADHD predicted poor planning ability in the children in the study.
This study assessed the prevalence and type of associated neuropsychiatric problems in children and adults with 22q11 deletion syndrome. One-hundred consecutively referred individuals with 22q11 deletion syndrome were given in-depth neuropsychiatric assessments and questionnaires screens. Autism spectrum disorders (ASDs) and/or attention deficit/hyperactivity disorder (ADHD) were diagnosed in 44 cases. ASD was diagnosed in 23 cases of whom only 5 had autistic disorder. ADHD was diagnosed in 30 individuals. In nine of these cases with ASD or ADHD there was a combination of these diagnoses. Mental retardation (MR) with or without ASD/ADHD was diagnosed in 51 individuals. ASD, ADHD, and/or MR were present in 67 cases. Females had higher IQ than males. The results of this study showed that the vast majority of all individuals with 22q11 deletion syndrome have behavior and/or learning problems and more than 40% meet criteria for either ASD, ADHD or both. Neuropsychiatric and neuropsychological evaluations are indicated as parts of the routine clinical assessment of individuals with 22q11 deletion syndrome.
The 22q11.2 deletion syndrome (22qDS) and schizophrenia have genetic and neuropsychological similarities, but are likely to differ in memory profile. Confirming differences in memory function between the two disorders, and identifying their genetic determinants, can help to define genetic subtypes in both syndromes, identify genetic risk factors for the emergence of psychosis, and develop pharmacological interventions for cognitive dysfunction. However, no study has compared memory function between 22qDS and schizophrenia, while indirect comparisons are confounded by marked differences in IQ between the two populations. We compared verbal and visual memory in 29 children and adolescents with 22qDS and 15 intellectually matched youths with schizophrenia using age-appropriate, directly comparable, Wechsler scales. Verbal memory was markedly superior in the 22qDS group by 21 points. There were no group differences in visual memory. The inherently low COMT activity in 22qDS merits investigation as a potential protective factor for verbal memory.