摘要:

ABSTRACT.It has been argued that, in the consideration ofthe use of aversive stimuli in treatment, the issues are ideological and philosophical as well as technical. Adopting Homer's (1990) definition of what is meant by‘aversive’in the ideological debate, it is suggested that the crucial issue is the inability of making clients to give their informed consent. It is proposed that proxy consent might be an alternative, but that this would be unacceptable if aversive procedures could be shown to be never'm the best interests ofthe client, or shown to violate clients’rights or to be against the interests of society because of anticipated harm or injustice to others. It is concluded that it is difficult to be certain that it is ever in the best interests ofthe client for aversive procedures to be employed, that aversive interventions appear not to violate clients’rights necessarily (except possibly the right to dignity and respect while the intervention is operating, and perhaps the right to choice at the beginning of the intervention), but that the inescapable difficulty in the use of aversive interventions is the likelihood that they will be misused with other clients than the ones for whom they may be initially d

ISSN:0964-2633    

DOI:10.1111/j.1365-2788.1993.tb01280.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT.This paper describes the method and results of a survey of aggressive behaviour amongst people with learning difficulties. The study was confined to a single health district in the South Western Region of the UK with a general population of about 370000. At the time of the survey, the Handicap Register for the district recorded 1362 people as having a learning difFiculty. The overall prevalence of aggressive behaviour amongst people with learning difficulties for whom base population data was available was 17.6%. The lowest rate was identified amongst day facilities (9.7 %) and the highest in hospitals within the district (38.2%). The prevalence rate amongst those attending schools for children with severe learning difSculties was 12.6%. Proportionately more males than females were reported to present problems of aggressive behaviour. The gender difference appeared to be largely accounted for by the disproportionate number of men identified within day facilities. There was no significant evidence of an association between the person's gender and the presence aggressive behaviour within schools or hospitals. The results indicated that, although physical and verbal aggression were the most frequently reponed behaviours, many of the sample were also said to engage in other forms of challenging behaviour, particularly self‐injurious, ritualistic, stereotypical and withdrawn behaviour. The risk of a serious or very serious injury to another person was very low; 0.7% or six people with learning difiSculties firom the district were reponed to be currently presenting such a risk. Similarly, only 2% of the base population (n=18) were reponed to be extremely difficult to manage. The implications of the findings are discusse

ISSN:0964-2633    

DOI:10.1111/j.1365-2788.1993.tb01281.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT.The production of sequences by two mentally retarded adults and a normally capable preschooler was assessed after each was trained to touch five physically dissimilar and nonrepresentative forms in an experimenter‐specified order (denoted A1→A2→A3→A4→A5). Performance on the 10 constituent two‐term sequences was examined (e.g, A→A2, A2→A3, Al→A3 and A2→A4). The probe data were largely consistent with the five‐term sequence performance trained explicitly and suggest the formation of stimulus relations based on relative position rather than a rote stimulus‐response chain. The procedures and results were replicated with a second five‐term sequence (B1→B2→B3→B4→B5). The subjects× performances were also assessed on trials in which mixtures of the two sets of stimuli were presented as either two‐term probes (e.g. A2→B4 and B2→A4; with all three subjects) or five‐term probes (e.g. Al→B2→A3→B4→A5; with the two adult subjects). Again, the subjects' performances were consistent with their baseline training. The mixed‐probe data extend prior research on sequence production and suggest the formation of classes of mutually substitutable sequence stimuli. The overall findings highlight the importance of experiential variables in the formation of ordi

ISSN:0964-2633    

DOI:10.1111/j.1365-2788.1993.tb01282.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT.This study repons the results of an initial study into the ability of psychiatrists to interview people with a mild mental handicap who are accompanied by a caregiver. Initial interviews by 12 psychiatrists of different ages (30–57 years) and differing levels of experience with this client group were recorded on video tape. Three of the recordings were used to train four judges who were familiar with examining clinical interactions, though not between doctors and patients. The judges used a specially designed rating scale. The remaining nine interviews were evaluated independendy by the four judges. There was a correlation of 0.65 (Kendall's coefficient of concordance, W) for the judges' evaluations using the rating scale for the nine interviewers. However, there was greater agreement between judges as to who were the best and worst interviewers (W=0.86). Some of the aspects of the interviews which contributed to the variability in the judgments are discusse

ISSN:0964-2633    

DOI:10.1111/j.1365-2788.1993.tb01283.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT.The prevalence of increased anterior atlanto‐odontoid distance (AAOD), a risk factor for spinal cord compression, and degenerative disease of the cervical spine (DDCS) in a population of institutionalized adults with Down's syndrome (DS) was determined and compared with age‐ and sex‐matched‘normals’presenting to a hospital emergency department. Radiographs of the cervical spines of 99 adults with DS and 198‘normals’were compared using a standardized rating scale. The prevalence of an AAOD of 3 mm or greater, the threshold of risk from the literature, was 8% for DS cases and 2% for controls (P<0.01). The mean AAOD for DS cases was 2.0±l mm and for controls l.5±0.5 mm (P<0.01). There was a negative correlation between AAOD and age of DS cases. The prevalence of any degree of DDCS among the DS cases was 64%, the controls 39% (P<0.001); for moderate or severe DDCS the prevalence among DS cases was 45%, controls 12% (P<0.001). The prevalence of DDCS increased with age in both groups, but the severity of DDCS was significantly greater for DS individuals in all age groups. The levels of the cervical spine affected ranged from C2 to C6; the most commonly affected level was C5‐C6. While DS adults are at increased theoretical risk for spinal cord compression due to increased AAOD, its clinical significance would appear to be small and to decline with age. Of more concern is the high prevalence of DDCS; adults with DS are at high risk for this condition and consideration should be given to this diagnosis in the appropriate

ISSN:0964-2633    

DOI:10.1111/j.1365-2788.1993.tb01284.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT.The relationship between aggression and depression was evaluated for 528 adults, adolescents and children, who were rated on either the adult or child versions ofthe Reiss instruments for dual diagnosis (Reiss 1988; Reiss&Valenti‐Hein 1990). Criterion levels of depression were evident in about four times as many aggressive as nonaggressive subjects. Anger was significantly associated with both aggression and depression. Although anger may play a mediational role in the correlation between aggression and depression, in this study there was a significant correlation even after the effects of anger were held constant. The findings provide an initial step toward improving diagnostic specificity when evaluating aggressive behaviour in people with mental retardatio

ISSN:0964-2633    

DOI:10.1111/j.1365-2788.1993.tb01285.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT.The aim ofthe study is to evaluate the prevalence of hepatitis B virus (HBV) markers in a population of non‐institutionalized handicapped 1–19‐yearold patients. Thirty‐six out of 70 patients lived in southern Italy and 19 were affected by Down's syndrome. Only three (4.2%) were positive for anti‐HBc (one of these also for anti‐HBs) and none for HBsAg. Low prevalence seems to indicate that no particular anti‐HBV vaccination strategy is to be considered on this subset of population and on their contacts. Serrum prevalence of HBV among nurses and other members of person

ISSN:0964-2633    

DOI:10.1111/j.1365-2788.1993.tb01286.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT.The use of fluoxeiine to treat chronic depression and associated self‐injurious behaviour (SIB) in a woman with severe mental retardation and a man with profound mental retardation is reported. In the first case, behavioural monitoring of treatment response revealed a dramatic decrease in SIB and a normalization of the woman's sleep disturbance. In the second case, SIB and the use of mechanical restraint decreased substantially. In both cases, anecdotal reports also indicated a diminution of other depressive symptoms. These cases highlight the need to consider an affective disorder as a cause of SIB in persons with severe and profound developmental disabilities. The behaviour monitoring system proved to be a practical aid in the diagnosis of depression and evaluation of antidepressant treatment in individuals who were incapable of self‐rep

ISSN:0964-2633    

DOI:10.1111/j.1365-2788.1993.tb01287.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT.Structural autosome defects have rarely been described in autism. In ihis report, the authors describe the association of autism and mental retardation in a girl with mosaicism for a duplication ofthe long arm of chromosome 18 and a deletion ofthe short arm of chrotnosome 18.

ISSN:0964-2633    

DOI:10.1111/j.1365-2788.1993.tb01288.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

ABSTRACT.A case report of a male mentally handicapped patient who developed delusions of passion is described. The relationship of this case to de Clerambault's syndrome and its pathogenic features are described.

ISSN:0964-2633    

DOI:10.1111/j.1365-2788.1993.tb01289.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY