Monographs of the American Association on Mental Deficiency (1982)最新文献

We found, not surprisingly, that most nonretarded adults can either give accurate and adequate sets of directions to their places of residence or recognize their inability to do so and refuse to attempt to give any--86% of those in our sample. We found also that this is the case for many mentally retarded adults who reside in the community--45% of those in our sample. These individuals responded in perfectly appropriate ways to a request for directions. However, 55% of the mentally retarded sample gave inaccurate or ineffective directions. Of these, 64% made errors that differed in quantity--both in terms of total number of errors and number of errors per set of directions--but not in kind from the errors made by the nonretarded sample. This leaves 13 mildly mentally retarded individuals--20% of our total sample, 36% of those who gave inaccurate directions--who made errors that were unlike those made by nonretarded adults: errors of communicative competence that involved a lack of knowledge of the structure and function of directions or a lack of ability in communicative design. In our studies of other everyday speech events such as narratives, we have suggested that one of the reasons for the impression interlocutors have that something is different or wrong with the way that mildly mentally retarded persons speak is that although they make the same sorts of errors that nonretarded speakers make, they make them more frequently. Because of the nature of the speech events we have studied, we have been unable to demonstrate this conclusively. However, as we pointed out at the beginning of this paper, the nature of directions is such that one can make objective judgements of accuracy and of type and number of errors. For this speech event at least, our suggestion that mildly mentally retarded speakers make errors that are like those made by nonretarded speakers but make them more frequently, is confirmed. Furthermore, we have found that difficulties with communicative design that are not usually exhibited in the speech of nonretarded persons are present not only in the narratives of mentally retarded speakers but in the directions that they give as well. Traditionally, studies of language and mental retardation have concentrated on subjects' phonological, morphological, lexical, and syntactic deficits. But for the mildly retarded, such deficits are relatively insignificant.(ABSTRACT TRUNCATED AT 400 WORDS)

The specific target behavior of encopresis in individuals with mental retardation and developmental disorders (MR/DD) is not well-defined in the literature on encopresis or in the literature on specific interventions with MR/DD populations. The criteria for establishing a diagnosis of encopresis in individuals with MR/DD are not clear. The literature on encopresis was reviewed for two factors: (1) definitions according to three major definitional criteria of age, defecation patterns and etiology; and (2) the relationship between etiology and intervention in specific, MR/DD, and nonspecific populations. This review yielded no clinical description of encopresis in MR/DD children, no guidelines for differentiating encopresis from generalized developmental delay and no substantive treatment guidelines. Although no definitions or treatment formulations specific to MR/DD were identified, information and definitional guidelines derived from the general literature on encopresis are relevant to identification, definition and treatment issues for MR/DD populations. Interdisciplinary or team approaches are appropriate for individuals with multiple problems or developmental disorders and intractable encopresis. An interdisciplinary approach, neurodevelopmental-behavioral intervention, which was successfully employed with a 5-year-old encopretic child with multiple developmental problems, is described.

Eighteen severely and profoundly retarded adolescents were treated in a research and demonstration project within a state institution by behavior modification methods for 30 months. Most showed traits of autism, phobias and persistant vulnerability. Restraints had acquired stimulus control. Programming, an aversive event, evoked SIB as avoidance reaction. Effect of pharmacotropic medication was transitory at best. Combination of several behavior modification techniques obtained complete suppression of SIB in 66.6%, partial in 16.7% and none in 16.7%. Non-aversive behavior modification methods, though slow-acting and time-consuming, produced permanent results in 72.7%. Aversive stimulation by remote controlled ESS suppressed SIB instantaneously and made SIB residents accessible to behavior modification and training. In 43%, durability of extinction was limited, despite concomitant intensive full-day behavior modification programs. Extinction was maintained through booster ESS. In two of seven cases ESS lost its aversive qualities. The use of ESS appears justified when non-aversive treatment modalities have failed and life-threatening situations persist.

This chapter summarizes issues relevant to analyzing and treating LTB. This is a difficult area in which to conduct research and develop functional interventions; however, it is important to the welfare and dignity of those afflicted with LTB. This chapter has suggested the development of a unified approach to the study and treatment of LTB. We should view LTB as a system or class of systems (composed of multiple behavioral components) rather than isolated incidences of maladaptive behavior. It has been shown that the various classes of LTB have common ground, including 1) theoretical orientation; 2) intervention techniques; and 3) future research strategies. Finally, because many of the factors controlling the occurrence of LTB are unknown, research should be directed toward those factors. Once these factors are understood and effective treatment methods and procedures are established, it will be necessary to conduct direct and systematic replications to establish empirical validity and generality (Sidman, 1960).

A survey of 2,858 persons in three institutions indicates an overall prevalence of 14.1% for SIB. Topography of SIB, number of forms in each subject, and intensity and frequency are related to the circumstances surrounding SIB, personnel reactions, age, sex, diagnosis and degree of retardation. Analyses of these relationships provide an SIB profile for the aggressive/severely-profoundly retarded. Direct observation of SIB in the wards indicates a low rate of antecedent and subsequent events. These findings are interpreted in relation to alternative explanatory hypotheses of SIB.

A taxonomy of feeding problems is proposed based on the two dimensions of cause (behavior-, neuromotor-, or physical-related) and problem area (drinking, eating, self-feeding, social, or self-injurious). Studies representative of each area were identified and one area, behavior-related eating problems, was selected for indepth review. Examples of children with problems in this area were described and a rationale for intervention was presented based on nutrition and health and normalization. Nine variables in treatment approaches were identified and compared. Integration of four of the variables was described as a viable approach to treating behavior-related eating problems in mentally retarded persons. Personnel involved with the development of mentally retarded students at the severe and profound levels are often concerned with eating and feeding problems. Such problems are extensive within those populations and may be life-threatening. In addition, caregivers often expect that reduction of these problems will also reduce the amount of care such students require. Problems include self-feeding, normal eating (i.e., chewing and swallowing patterns) and appropriate social behavior at mealtime. While bountiful information exists concerning many aspects of feeding and eating, information on some aspects of critical importance is scattered. A taxonomy of feeding and eating problems is presented in this review to show the relationship of available information.