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Research shows that almost half of children with intellectual disabilities (ID) experience mental ill-health at any given time point. However, traditional cognitive behaviour therapy (CBT) may not be appropriate for children with ID due to the cognitive deficits associated with their diagnosis. The Fearless Me! © CBT program for anxiety is adapted to accommodate the cognitive abilities of children with ID. The aim of the current study was to provide the first qualitative evaluation of the Fearless Me! © program by exploring participant experiences. Eight mother-child dyads were interviewed using a semi-structured protocol. The responses were transcribed and analysed using thematic analysis. Identified codes and themes were cross-checked with an independent researcher and discrepancies were resolved. Parents found the program to be positive and useful for acquiring knowledge. They commented on features of the program, significance of inter- and intra-personal factors and whether the program suited the capability of their child. They also discussed features of treatment outcomes. The qualitative results highlighted that experiences of the program varied. Themes identified included those relating to barriers and facilitators to participation and treatment-related change. The themes provide guidance for program revisions and can inform future delivery of the Fearless Me! © program., Author(s): Senali Panditaratne [sup.1] , Anastasia Hronis [sup.1] , Rachel Roberts [sup.2] , Ian Kneebone [sup.1] Author Affiliations: (1) grid.117476.2, 0000 0004 1936 7611, Discipline of Psychology, Graduate School of [...]

Adult siblings are potentially important sources of care, support, advocacy, and friendship for their brothers and sisters with intellectual and developmental disabilities (IDD). Drawing on data about 851 adult siblings who completed an online national survey, we examined predictors and potential key moderators of siblings' mental distress, wellbeing, quality of life, and health outcomes. Moderated regression analyses indicated that siblings experiencing higher levels of subjective poverty; siblings with brothers and sisters with lower levels of independence; and siblings who are carers and also experiencing low levels of subjective poverty, had worse outcomes and may be in need of specific supports. Compared to normative samples, adult siblings of people with IDD had worse outcomes across the measures., Author(s): Nikita K. Hayden [sup.1] , Richard P. Hastings [sup.1] [sup.2] , Clare Kassa [sup.3] , Frances Danylec [sup.3] Author Affiliations: (1) grid.7372.1, 0000 0000 8809 1613, Centre for Educational [...]

Pairing discriminative stimuli with unique reinforcers provides an additional cue to correct responding. In the current study, we evaluated the effectiveness of the differential outcomes procedure in teaching novel tacts and facilitating transfer of tacts to novel discriminative stimuli. Four children diagnosed with developmental or intellectual disability were taught a unique pair of related tacts both under a differential outcomes condition and under a nondifferential outcomes condition where the reinforcers were uncorrelated with the sample stimuli. In the former, the different outcomes were two forms of the same reinforcer. Three out of four participants met the mastery criterion sooner under the differential outcomes condition. Two participants also generalized to novel stimuli under the differential outcomes condition. When we tested for the inclusion of the reinforcers in the stimulus class, three participants demonstrated the acquisition of emergent stimulus-outcomes and response-outcomes relations. The study provides support for the use of the differential outcomes procedure as a cost-effective means of enhancing the acquisition of discriminated responses in an applied setting. Keywords Differential outcomes effect * Conditional discrimination * Tact training * Translational research, Under a differential outcomes procedure (DOP) stimulus-specific reinforcers are used during the concurrent acquisition of several discriminated responses. Researchers have found that when reinforcers for correct responding are specific to [...]

Byline: Aseem. Mehra, Susanta. Padhy Despite the availability of electroconvulsive therapy (ECT) and being one of the safest modalities of treatment, the use of ECT is still underused in patients [...]

Psychiatric hospitalization of children with autism spectrum disorder and/or intellectual disability is common, however, the effectiveness of this intervention is largely unknown. Thirty-eight clinically-referred children 8-19 years old admitted to a specialized inpatient psychiatry unit were assessed by a consistent caregiver on the Aberrant Behavior Checklist-Irritability (ABC-I) subscale at admission, discharge and 2 months post discharge. There was a decrease in the mean ABC-I score from admission (27.3, SD 7.4) to discharge (11.9, SD 8.8), which was sustained at 2 months post discharge (14.8, SD 9.3) (p < 0.001). Seventy-eight percent of the subjects were rated as 'Improved' on the clinician Clinical Global Impressions Improvement scale at discharge. The study is limited by lack of a control group, but offers preliminary evidence for specialized inpatient psychiatry as an intervention for serious behavioral disturbance in this population. Keywords Autism * Psychiatric * Hospitalization * Intellectual disability, Introduction Psychiatric hospital treatment of individuals with autism spectrum disorder (ASD) and intellectual disability (ID) has evolved from early twentieth century practices of long term institutionalization, through the movement for [...]

This longitudinal randomized-control trial investigated the effectiveness of scientifically based reading instruction for students with IQs ranging from 40 to 80, including students with intellectual disability (ID). Students were randomly assigned into treatment (n = 76) and contrast (n = 65) groups. Students in the treatment group received intervention instruction daily in small groups of 1 to 4 for approximately 40 to 50 min for 1 to 4 academic years. On average, students in the treatment group made significantly greater progress than students in the contrast condition on nearly all language and literacy measures. Results demonstrate the ability of students with low IQs, including students with mild to moderate ID, to learn basic reading skills when provided appropriate, comprehensive reading instruction for an extended period of time., The ability to read influences success in school, employment, and general quality of life, so it is troubling that students with intellectual disability (ID) often exit school with very limited [...]

Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts. Researchers have proposed that BPD may be associated with neurocognitive dysfunction. However, the diagnosis of BPD in patients with intellectual disability, where developmental brain abnormality is inherent, has rarely been reported in the literature. Furthermore, it is uncommon to see the diagnosis of BPD made in individuals with intellectual disability in clinical practice. The cases of three patients diagnosed with BPD in the context of intellectual disability are presented. Challenges in making the diagnosis of BPD in this population are discussed, as is the importance of making an accurate diagnosis for guiding effective treatment.

The (pro)renin receptor [(P)RR] plays a pivotal role in the renin-angiotensin system. Experimental models emphasize the role of (P)RR in organ damage associated with hypertension and diabetes. However, a mutation of the (P)RR gene, resulting in frame deletion of exon 4 [[DELTA]4-(P)RR] is associated with X-linked mental retardation (XLMR) and epilepsy pointing to a novel role of (P)RR in brain development and cognitive function. We have studied (P)RR expression in mouse brain, as well as the effect of transfection of [DELTA]4-(P)RR on neuronal differentiation of rat neuroendocrine PC-12 cells induced by nerve growth factor (NGF). In situ hybridization showed a wide distribution of (P)RR, including in key regions involved in the regulation of blood pressure and body fluid homeostasis. In mouse neurons, the receptor is on the plasma membrane and in synaptic vesicles, and stimulation by renin provokes ERK 1/2 phosphorylation. In PC-12 cells, (P)RR localized mainly in the Golgi and in endoplasmic reticulum and redistributed to neurite projections during NGF-induced differentiation. In contrast, [DELTA]4-(P)RR remained cytosolic and inhibited NGF-induced neuronal differentiation and ERK1/2 activation. Cotransfection of PC-12 cells with (P)RR and [DELTA]4-(P)RR cDNA resulted in altered localization of (P)RR and inhibited (P)RR redistribution to neurite projections upon NGF stimulation. Furthermore, (P)RR dimerized with itself and with [DELTA]4-(P)RR, suggesting that the XLMR and epilepsy phenotype resulted from a dominant-negative effect of [DELTA]4-(P)RR, which coexists with normal transcript in affected males. In conclusion, our results show that (P)RR is expressed in mouse brain and suggest that the XLMR and epilepsy phenotype might result from a dominant-negative effect of the [DELTA]4-(P)RR protein. brain (P)RR expression; functional (P)RR; X-linked mental retardation

Case reports on the discovery and identification of SYNGAP1 mutations which are responsible for autosomal nonsymdromic mental retardation are presented. The identification is very vital as it will help develop pharmacologic treatments for associated complications, and also add to work aimed at improving cognitive functioning.

The aim of the present study was to demonstrate the efficacy of combining two operant learning procedures--shaping and fading--for treating selective mutism. The participant was a 12-year-old boy with mental retardation presenting a severe long-term selective mutism. The treatment was aimed at increasing the loudness of his vocalizations in an increasingly social milieu. The treatment was conducted over the course of about 20 weeks, with four 15-minute sessions per week. A gradual increase in speech loudness was observed. Data indicated a close correspondence between the changes in speech loudness and the criteria for reinforcement successively applied by the therapist, thereby confirming the causal link between the child's progress and the changes in reinforcement contingencies. In addition, good generalization was noted during the stimulus fading phase. Six-month follow up showed that loudness of verbalizations was still satisfactory in the classroom despite a change of school and peer group. The impressive improvement of the child's verbal behavior shows that the implementation of a treatment package including both shaping and stimulus fading is a worthwhile therapeutic option, even in the case of severe long-term selective mutism associated with mental retardation.

In this article, ethical issues related to the treatment of families with a member with mental retardation are discussed. The history of psychotherapeutically treating the community with mental retardation and accompanying concerns, such as dual diagnosis and diagnostic overshadowing, are discussed. Ethical considerations of the informed consent and assent process are discussed and applied to more modern areas of confidentiality, treatment goals, and individual sexuality. Marriage and family therapists are encouraged to bring clarity and balance to the process of informed consent and assent when working systemically with the population with mental retardation and their families.

Progressive-ratio (PR) schedules were used to identify the break point (i.e., the last schedule value completed) for 2 reinforcers under single and concurrent schedules. After the respective break points were established, the same reinforcers were presented under concurrent fixed-ratio (FR) schedules that were yoked to the break points obtained with the PR schedules. Results suggested that the participants responded more for the high-preference item than for the low-preference item, regardless of the presentation arrangement (single or concurrent presentations). This pattern of responding was maintained when the reinforcers were presented under dissimilar FR schedules. The results suggest that responding for differentially preferred stimuli may vary as a function of differences in schedule requirements. DESCRIPTORS: autism, concurrent schedules, fixed ratio, mental retardation, positive reinforcement, progressive ratio

What unique assessment issues do evaluators face when conducting mental retardation evaluations in capital cases? This article describes 4 assessment issues and reports how 20 evaluators in 1 state have approached them: (a) What methods are appropriate for evaluating adaptive functioning in this context? (b) Should information about criminal behavior be used as evidence of adaptive functioning? (c) Should correctional officers serve as informants regarding adaptive behavior? and (d) How should the Flynn effect influence the interpretation of intelligence test scores? Implications for practice are that practitioners should expect to be asked about the relation between criminal behavior and adaptive functioning, must think carefully about the validity of tests of adaptive functioning for inmates, and must be knowledgeable about the current state of Flynn effect research. Keywords: mental retardation, adaptive functioning, forensic, capital case, Flynn effect

The availability of and access to health care for individuals with mental retardation (MR) and other disabilities has received increased public attention in the past several years. (1-3) Healthy People […]

Individuals with mental retardation and mental illness often have difficulty receiving necessary services in the community. Individuals with dual diagnosis are often overlooked by professionals due to the clear separation between the mental health and mental retardation service systems. This paper examines the specific problems surrounding service provision to people with dual diagnosis and highlights several community programs designed to overcome service barriers. Specific recommendations for designing comprehensive and collaborative treatment and service programs for this population are described in order to guide more communities toward overcoming the barriers to serving individuals with dual diagnosis., A 28-year-old male with mild mental retardation and several possible psychiatric disorders has fallen through the cracks of local service programs on several occasions. The suggested psychiatric diagnoses include major [...]

Mental retardation is defined as a disease characterized by the incomplete development of the mind and impairments of skills. It occurs in more than 1% of the child population and boys are more affected than girls. Its etiology may be traced to prenatal causes, inborn errors of metabolism and environmental influences. The disease frequently occurs with cerebral palsy, autism, epilepsy and other psychiatric disorders. A work-up with a neurologist, neuropsychiatrist or a pediatrician is recommended in all cases of mental retardation.

The effectiveness of a person-centered later life planning training program for older adults with mental retardation and Down Syndrome is evaluated according to its benefits and limitations. The evaluation indicates that the participants were able to learn basic concepts and skills covered in the program with the greatest improvement in the area of leisure and recreation education. The training program also showed a decrease in ratings of life satisfaction which is attributed to low satisfaction with residential settings., This study examines the effectiveness of a person-centered later life planning training program for older adults with mental retardation, their family, and staff. It is conceptually based on two complementary [...]

The high incidence of mental health disorders in persons with mental retardation has resulted in various diagnostic and treatment approaches. The challenges to diagnostic approaches consist of psychiatric diagnoses of institutionalized persons with severe to profound mental retardation, and use of standardized diagnostic instruments to examine behavioral disorders among people with mental retardation. The treatment approaches include psychopharmacologic drug treatments, psychotherapy, group therapy and behavior management programs., Mental health needs of people with mental retardation have become increasingly recognized in recent years, both in the United States and other parts of the world, as demonstrated by a [...]

Multidisciplinary care is essential for commnuity care of people with mental retardation and mental illness. A study has evaluated an innovative model of service delivery to people with dual diagnosis at a community mental health agency in Michigan. Multidiscipliary services were provided on an individual basis through weekly visits to home or work environment. The model facilitated greater understanding of clients and facilitated proactive rather than reactive care. For example, staff were able to quickly detect and respond to changed symptoms. However, operational costs were 40% higher thantraditional service delivery costs., Habilitative services for persons with mental retardation who suffer from significant mental health problems are deficient in availability, accessibility, and adequacy. An active treatment case management model was developed and [...]

Mutation of the gene fragile X mental retardation 1 (FMR1) is believed to be a cause of mental retardation and other familial disorders throughout the life span of an individual. Screening of newborns might help in early detection of the disorder and help in early intervention for proper treatment.

Descriptive and experimental analyses of stereotypy by a woman with severe mental retardation showed that the behavior was maintained by escape from demands. A sequence of high-probability requets issued immediately prior to a task-related request established a momentum of compliance that increased compliance with task-related demands. Increases in compliance werer accompanied by collateral reductions in stereotypic behavior. A mechanism of response covariation, called functional incompatibility, and an animal analogue study for testing the validity of this mechanism are proposed. DESCRIPTORS: behavioral momentum, functional analysis, basic research, stereotyped behavior, response covariation

An unconventional treatment that has been utilized for Down syndrome is called cell therapy. The procedure involves administration of lyophilized (freeze-dried) cells from the fetuses of animals such as sheep and rabbits. Even though there are no research data supporting the value of cell therapy, it continues to be used for Down syndrome and various other illnesses, ranging from cancer to infertility, in Europe. Cell therapy is illegal in the United States, but American patients have been treated in Germany, and the materials have also been mailed into the US. One specific type of cell therapy is called sicca cell therapy. Proponents claim that these treatments render improvement in intelligence, social skills, movement, height, memory, immune function, and even the facial features characteristic of Down syndrome. To further evaluate the purported value of cell therapy, 190 subjects with Down syndrome, 21 of whom had previously received cell therapy, were assessed on 18 different criteria. The criteria included measures of growth, motor skills, and mental and social development. The subgroup of patients who had received cell therapy previous to this study scored no better than the group that had not undergone cell therapy; the two groups were matched for sex, age, cardiac history and socioeconomic status. These results show no evidence of benefit from cell therapy in individuals with Down syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

In this study, we report on a 12-year-old boy with autism, mental retardation, and a history of severe gastrointestinal problems who presented with total liquid and food refusal. Backward chaining was used to shape drinking from a cup, and a fading procedure was used to increase the quantity of water he was required to drink. DESCRIPTORS: backward chaining, fading, liquid refusal