Monographs of the American Association on Mental Retardation最新文献

The 1985-86 data from 308 children and young adults under age 25 with autism and from 326 with severe or profound mental retardation can be compared to national data from the 1980 MNCUES and the 1987 NMES because the methods are similar. These data provide detailed answers to the questions, what health care services are used? what are the expenses? Who pays them? Until now, the absence of comprehensive national data had hindered the development of new approaches to financing the care of children with serious, lifelong conditions. These data permit policymakers to take into account the needs and expenditures for severely developmentally disabled children when reforming the health care financing system. None of the children or young adults had expenditures in excess of $50,000, and very few reached the upper $20,000s. For children with autism the average annual health care expenditure was about $1,000 and about $1,700 for young adults, compared to the $414 average for all American children. They received an average of four physician visits annually, slightly above the U.S. average for children. Their hospitalization rate was twice the average for children. Hospitalization accounted for one-third the health care expenditures among children with autism, but for two-thirds among young adults. For children and young adults with severe retardation the average expenditure on health care was about $4,000, due to the physical impairments in two thirds of the children. They averaged about 12 physician visits annually, falling to 8 among young adults. Children were hospitalized about eight times the national rate, and young adults about twice. Among severely retarded children and young adults living at home, hospitalization accounted for over half the health care expenses, but for only one third for those in residential placement. Unfortunately, preventive and habilitative services were but a tiny fraction of health care expenditures and were demonstrably underutilized. Only 60% of these children had routine dental examinations within the last 12 months, a worse record than the average child. For the individuals whose primary physicians judged that they would benefit from physical or speech therapy, less than one quarter were receiving them. Care for seriously, chronically disabled children places great burdens on immediate family members. Only 20% of the severely retarded youngsters from age 10 to 24 could be left alone at home, even for a few minutes, and only 30% of the autistic ones. These developmental disabilities create needs for personal care and family support that traditionally have not been considered health services.(ABSTRACT TRUNCATED AT 400 WORDS)

The contemporary behavior analyst, to operate ethically and effectively, must be aware of many more factors affecting behavior than simple consequences. Although the literature demonstrating the effectiveness of active behavior management is impressive, a compelling argument can be made that a great number of behavior problem seen in individuals with developmental disabilities may be attributable to factors other than consequences. Our experience has been more often than not that physiological, organic, medication, or situational variables are the actual culprits in maladaptive behavior. Individuals with severe or profound retardation may respond to aversive features of their environment by displaying noncompliance, tantrums, aggression, or self-injurious behavior. These antecedents can affect their behavior just as powerfully as can the consequences of their behavior. Behavior analysts must become sensitive to these potential factors and be prepared to employ behavioral diagnostic strategies in the search for the causes of maladaptive behavior. Finally, they must be prepared to design rather unconventional passive behavior management treatment programs involving the manipulation of the antecedent environment. In the case of Carrie, from the example at the beginning of this paper, the analysis yielded the hypothesis that her face scratching was a reaction to sinus blockage caused by seasonal allergies. Her treatment involved daily dosages of antihistamines administered by our nurses and subsequent elimination of the scratching. Tom was found to be suffering from "wheelchair fatigue." When he was allowed to recline on other surfaces (e.g., bean bag chair, mat, bolster) on a regular basis, he did not attempt any form of self-injury. Melissa was found to have a severe case of Pre Menstrual Syndrome as well as seizure disorder, and was treated with the appropriate medications. Her headbanging was reduced to a few minor incidents per month. Walter's tantrums on closer inspection seemed part of a chain of behavior leading to seizure-like attacks. Preliminary evidence suggests that when he is treated with phenobarbital the tantrums and aggression disappear. And finally, Debbie was found to be very sensitive to a variety of discomforting events. She would cry, sob, and scream when she was wet, thirsty, hungry, and tired. Changing her regularly, offering her water every hour and extra snacks in the morning as well as short naps in the early afternoon eliminated the crying and sobbing. She now participates with the other clients and seems to enjoy the house activities.(ABSTRACT TRUNCATED AT 400 WORDS)