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Dramatic changes in societal approaches to people with intellectual and developmental disabilities (IDD), and the services and supports they receive are reflected in a new paradigm that we name the shared citizenship paradigm. The shared citizenship paradigm (1) incorporates an updated and contemporary set of values and beliefs about people with IDD and their right to participate fully in all aspects of life and society; (2) is characterised by a holistic approach to IDD, a contextual model of human functioning, disability rights principles and person-centred implementation strategies; (3) incorporates the exponential growth in knowledge about the causes and characteristics of IDD and factors influencing the elimination of barriers to positive outcomes for people with IDD; and (4) is reflected in international covenants, such as the United Nations Convention on the Rights of People with Disabilities (UNCRPD), and in international policy goals and associated personal outcome domains.We conducted a preliminary survey on the cross-cultural status of the shared citizenship paradigm with a small purposefully sampled international group of professionals known to have extensive knowledge, experience, and publications regarding their country's current IDD-related policies and practices.One or more paradigm components were evident to a moderate degree in the respondents' countries, and the paradigm is being used to provide individualised services and supports, to guide organisation transformation and systems change, and, to a lesser degree, to frame evidence-based inquiry.Core components of the shared citizenship paradigm are present internationally. To further enhance implementation and confirmation of the paradigm, we propose implementation strategies and confirmation techniques.

Goals and objectives as mentioned in Individual Support Plans (ISPs) were analysed to explore what domains of quality of life they are associated with, what support resources are referenced for achieving the goals, and how domains and resources are related to clients age, gender and intellectual disability (ID) level.A total of 209 ISPs for persons with ID from eight residential Dutch service provider organisations were analysed. Mixed linear regression analyses were conducted to examine the relations between client characteristics and the content of goals and support resources.Results showed that ISPs of people with mild and moderate ID had significantly more goals related to independence and social participation as compared to the ISPs of people with severe and profound ID. ISPs of clients with profound ID addressed quality of life factors related to 'well-being' more than ISPs of all other clients. ISPs of people aged 20-34 years had significantly more goals on independence than the two other age groups. ISPs of people under the age of 50 had significantly fewer goals with respect to well-being than found in ISPs of older people. Regarding the use of resources, 42.6% of the ISP goals were associated with resources from specialised services, 31.5% associated with natural resources and 25.9% associated with a combination of both natural and specialised services. In ISPs of people with mild ID, natural resources are more often mentioned, and specialised service-based resources are less often mentioned than for other people.This study offers empirical feedback on ISP practices in the field of ID in the Netherlands. In light of current ISP practices, results suggest that attention should be paid to: (1) distinguishing between a 'service contract' and an ISP; (2) keeping a focus on the whole person in all age groups and levels of functioning and (3) involving the service recipient in ISP development and implementation.

The Diagnostic Adaptive Behaviour Scale (DABS) is a new standardised adaptive behaviour measure that provides information for evaluating limitations in adaptive behaviour for the purpose of determining a diagnosis of intellectual disability. This article presents validity evidence and reliability data for the DABS.Validity evidence was based on comparing DABS scores with scores obtained on the Vineland Adaptive Behaviour Scale, second edition. The stability of the test scores was measured using a test and retest, and inter-rater reliability was assessed by computing the inter-respondent concordance.The DABS convergent validity coefficients ranged from 0.70 to 0.84, while the test-retest reliability coefficients ranged from 0.78 to 0.95, and the inter-rater concordance as measured by intraclass correlation coefficients ranged from 0.61 to 0.87.All obtained validity and reliability indicators were strong and comparable with the validity and reliability coefficients of the most commonly used adaptive behaviour instruments. These results and the advantages of the DABS for clinician and researcher use are discussed.

The changed societal views of persons with disabilities are reflected in the 2006 United Nations Convention on the Rights of Persons with Disabilities. However, what is not specified in the Convention is how to operationalise and measure the Articles composing the Convention, and how to use that information to further enhance the human rights of persons with disabilities.The authors analyse the relationships between eight core quality of life domains and the 34 Articles contained in the Convention.There is a close relationship between the core quality of life domains and the 34 Articles contained in the Convention. Furthermore, the current status of these Articles can be evaluated through the assessment of indicators associated with the eight core quality of life domains.Based on the assessment of these quality of life-related outcomes, three strategies can be used to enhance the human rights of persons with intellectual disability. These three are to employ person-centred planning, publish provider profiles and implement a system of support.

The current functional models of disability do not adequately incorporate significant changes of the last three decades in our understanding of human functioning, and how the human functioning construct can be applied to clinical functions, professional practices and outcomes evaluation.The authors synthesise current literature on human functioning dimensions, systems of supports and approaches to outcomes evaluation for persons with intellectual disability (ID), and propose a functionality approach that encompasses a systems perspective towards understanding human functioning in ID. The approach includes human functioning dimensions, interactive systems of supports and human functioning outcomes.Based on this functionality approach the authors: (1) describe how such an approach can be applied to clinical functions related to defining ID, assessment, classification, supports planning and outcomes evaluation; and (2) discuss the impact of a functionality approach on professional practices in the field of ID.A functionality approach can increase focus on the integrative nature of human functioning, provide unified language, align clinical functions and encourage evidence-based practices. The approach incorporates a holistic view of human beings and their lives, and can positively affect supports provision and evaluation.

In the field of intellectual disabilities (ID), the quality of life concept has been developing rapidly in Chinese societies including Hong Kong, mainland China and Taiwan. However, there is a lack of locally validated instruments to measure the quality of life of people with ID. The study reported in this paper attempted to validate the Chinese Quality of Life Questionnaire - Intellectual Disabilities adapted from the Quality of Life Questionnaire developed by SchalockKeith.People with mild/moderate ID aged 15 years or above were recruited from special schools, skills centres, community service units and residential units in different regions of Hong Kong. A number of procedures were followed including reliability tests, factor analysis, content validity and construct validity.A total of 359 participants were recruited for the study. Factor analysis was conducted according to the rotated component matrix method, in which 23 items were extracted from the original 40-item version of the Quality of Life Questionnaire and three domains (renamed satisfaction, competence and daily choice making/interpersonal relations) were observed. The items in each domain were shown to have factor loadings ranging from 0.42 to 0.90. Construct validity tests indicated the positive nature of the relationship between earnings, and that self-determination and social interaction increase with more independent living environments and less segregated work environments achieving higher scores (P0.000, P0.01 and P0.05 respectively). The scale also achieved a good degree of reliability (Cronbach's α=0.79).Initial validity tests indicated that the Chinese Quality of Life Questionnaire - Intellectual Disabilities may be a useful instrument for measuring the quality of life of Chinese people with ID. Cultural issues are discussed and recommendations for future research and service development are made.

The 1992 American Association on Mental Retardation's (AAMR) definition and classification of mental retardation is different from the previous classification system in that: (a) a single diagnostic code of mental retardation is used if the person meets the three criteria of age of onset (18 or under), significantly subaverage abilities in intellectual functioning, and related limitations in two or more adaptive skills areas; (b) the person's strengths and weaknesses are described in reference to four dimensions: intellectual functioning and adaptive skills; psychological and emotional well-being; health, physical well-being, and etiology; and life activity environments; and (c) a profile of needed supports is developed across the four dimensions. In this article we discussed six major implications of the 1992 System for the field of mental retardation.

The current status of 85 persons placed into independent housing and competitive employment 15 years ago was evaluated. Two primary groups emerged: those in and those not in MR/DD services (19% and 59% of sample, respectively). Personal interview and observational data were used to evaluate the person's life (e.g., social and support networks, life style and role functions, activity patterns, measured quality of life, and expressed satisfaction). The two groups were compared on these data sets as well as on previously obtained behavioral skill data and family support levels. Implications of the study were discussed in reference to natural and long-term support needs, the recent paradigm shift in habilitation and evaluation strategies, and the ongoing concern about quality of life of individuals with disabilities.

This article examines the "supported employment" approach, which tries systematically to integrate severely disabled men and women into the open labour market. After describing the target population, we shall outline the specific support required, along with the benefits, risks and problems involved. Examples from a few industrialized countries, demonstrating the viability of training and employing severely disabled people, will illustrate the new approach. The activities described in this article are inn line with the goals of the ILO Vocational Rehabilitation and Employment (Disabled Persons) Recommendation, 1983 (No. 168), which calls for "research and the possible application of its results to various types of disability in order to further the participation of disabled persons in ordinary working life".

The current status of state mental retardation/developmental disability agency information systems related to day and employment programs for persons with disabilities was described, and data regarding the number and characteristics of persons served in different day-employment programs and the funding sources for these persons were summarized. Suggestions were made regarding data utilization and information systems design.

The administration of para-chloro-D,L-phenylalanine (PCPA) produces a high incidence of aggressive (filicidal) behavior in pre-, postpartum, and nulliparious rodents. PCPA inhibits brain tryptophan 5-monooxygenase and can produce a reduction in whole brain serotonin. Apparently PCPA mediates the release of a natural latent aggressive tendency which is potentiated by the interference in, or reduction of, a suppressing system governed primarily by serotonin. Latency of attack, intensity phases, and characteristics of the filicidal behavior were found to vary inversely with brain serotonin content, and be reversed or eliminated by replacement of serotonin i.e., via 5-hydroxytryptophan, serotonin's immediate precursor. Although aggressive tendencies were in evidence prior to filicide, filicide became evident once the apparently minimal whole brain level of serotonin reached ca 0.10 μg/g. Neither the parturition process nor severe food deprivation are strong causative factors in the precipitation of filicidal behavior. Since not all animals become filicidal, other behavioral and/or biological variables must be involved in the mediation of this aggressive phenomenon.

Biochemical and behavioral effects of pre- and postpartum hyperphenylalaninemia were evaluated on 52 Sprague-Dawley rats. Biochemical results indicated elevated plasma phenylalanine levels during both the prepartum (Gestation Days 15-21 and postpartum Days 1-60 of age) injection phases. Behaviors were evaluated beginning at 81 days of age. Compared to control or postpartum subjects, prepartum subjects demonstrated significant decrements on each of the following: initial DRL: 12 learning; fearfulness (inverse relationship); activity; exploration; and sociability. Compared to controls, postpartum subjects were significantly less active and less exploratory.

Data from two (1984-1985 and 1985-1986) national surveys of facilities providing vocational services to adults with developmental disabilities were used to analyze employment placement patterns and client-referenced outcomes. Most of these adults were working in sheltered environments; however, 17 to 19% of those served were placed into nonsheltered settings during the respective survey periods. Effects of individual and environmental characteristics on a variety of individual and facility-level employment outcomes were examined. Research and policy implications were discussed.

The extent of community and program success of 166 mentally retarded clients placed into a community-based program was evaluated over a 9-year period. Twenty predictor variables measuring institutional factors, client characteristics, training variables, and community characteristics were related to community or program success. Successful community placement was associated with sensorimotor and work skills, appropriate social-emotional behavior, gender, and family acceptance of community placement and involvement with the interdisciplinary team process. Program success was associated with language and psychomotor skills, education received prior to community placement, community and institution size, and family involvement. Sixteen percent of the clients were reinstitutionalized into either the state mental retardation facility or a mental health facility. Factors associated with successful placement and program progression were discussed as was a model for future deinstitutionalization research.

Behavioral outcomes of a behavioral-chemical intervention procedure on stereotypic and non-compliant behavior were evaluated. One group (n = 22) of community-based mentally retarded clients was initially on psychotropic medication (major tranquilizers). Their dosage was either increased, decreased, or kept the same following behavioral intervention. A second group (n = 19) was placed on psychotropic medication following behavioral intervention. A nonequivalent between-groups design was employed that permitted 36 outcome combinations involving Conditions X Subject X Group. The effects of behavioral intervention, the validity of drug-intervention decision rules, drug-intervention effects, and the validity of the behavioral-chemical intervention model were evaluated. Results indicated that the behavioral-chemical intervention produced expected and desirable behavioral change as well as reduced levels of psychotropic drug usage.

The emerging need to view improved quality of life as an outcome measure from human service programs was described, and a Quality of Life Index was proposed that can be used as either an outcome measure or the criterion for the goodness-of-fit between persons and their environments. Data were presented from 685 adult clients within Nebraska's Community Based Mental Retardation Programs demonstrating the use of this Index as both an outcome measure and a criterion of the goodness-of-fit between persons who are disabled and their environments. Administrative and programmatic uses of such data were explored, along with a number of cautions to consider when assessing a person's quality of life.

Services for mentally retarded adults have undergone major changes over the past 15 years in the United States of America. Through the impact of "normalization", the calls for implementing fundamental civil rights for all citizens, and by applying methods of an essentially behavioural nature, services have gradually been moved out of the institutional sector and into the local communities. A regional service delivery model established in the state of Nebraska illustrates this development toward individualized living and competitive employment in the community.

The placement success and quality of life of 69 mentally retarded persons placed into independent housing 5 years previously was evaluated. Eighty percent (n = 55) were still in their original independent housing placement. On the basis of multiple regression analysis, the most significant predictor variables were the behavioral skill areas of personal maintenance, communication, community integration, clothing care and use, and food preparation. Unsuccessful placements were related to bizarre behavior, nutritional problems, and inadequate home maintenance. Quality of life variables analyzed included employment, finances, community utilization, leisure-time usage, and friendship patterns. Analysis of the quality of life variables presented a mixed picture: Part of the data reflected low income and possible loneliness; on the other hand, community utilization occurred frequently and involved normal activities. Clients reported that they were proud of their apartments and felt good about "doing their own thing." In light of the results, an extended assistance-training model was presented.

Mentally retarded clients (N = 131) placed during a 2-year period from either an independent living or competitive employment training program were evaluated as to placement success. Thirteen percent returned to the training program. Successful independent living placement was related to intelligence and demonstrated skills in symbolic operations, personal maintenance, clothing care and use, socially appropriate behavior, and functional academics. Successful employment was related to sensorimotor, visual-auditory processing, language, and symbolic-operations skills. Major reasons for returning from a job to the competitive employment training program included inappropriate behavior or need for more training; returning from community living placement was related to money management, apartment cleanliness, social behavior, and meal preparation.

Subcutaneous injections of para-chloro-D, L-phenylalanine (pCl-Phe) and phenylalanine (Phe) over the last third of pregnancy were found to produce hyperphenylalaninemic states in maternal and fetal rats. The pCl-Phe, when administered to maternal animals alone or in conjunction with Phe, was associated with maternal muricide. The muricide was counteracted by the administration of 5-hydroxy-D, L-tryptophan prior to delivery. Prolonged treatment of maternal animals with pCl-Phe and Phe suppressed normal weight gain and resulted in smaller offspring. The elevated levels of maternal plasma Phe decreased with time, reflecting a lessening of pCl-Phe inhibition of maternal phenylalanine hydroxylase and normal Phe clearance. Fetal plasma Phe levels mirrored those of treated maternal animals. Similarly, fetal brain Phe reflected the increase in fetal plasma Phe.