People with severe and profound intellectual disability: Nurse carer experiences in a South African setting

We explored nurse carer experiences with people with severe and profound intellectual disability in a care and rehabilitation centre in South Africa. Informants were a convenience sample of 10 nurses (females = 7; males = 3; mean years of service = 7.8, SD = 4.8 years). They completed an unstructured interview on their care provision experiences. The data were thematically analysed using Tesch’s method of open coding. Findings resulted in the following three themes to characterise the nurse carer experiences: compassion, person-centred care, and importance of parent involvement. Compassionate and person-centred care is fundamental to the establishment of a therapeutic relationship between nurse carers and people with severe and profound intellectual disability.     

Psychology and Medical Rehabilitation: Moving Toward a Consumer-Driven Health Care System

Changes in health care will provide both opportunities and threats for rehabilitation psychologists. We must demonstrate the relevance of our clinical services to important outcomes or risk being excluded as treatment providers. With shifts to nonhospital settings, we can provide increasing clinical and administrative leadership. However, we must redefine models of treatment to include home care and telepsychology, practice guidelines and critical paths, involvement of paraprofessionals, case management, injury prevention, and health promotion. We should be involved when datasets are established to define disability-related health policies and reimbursement and be proactive in Medicare, Medicaid, and managed care reform to develop treatment packages to decrease long-term handicap. Collaboration with consumers is critical. We must frame research questions to address current policy issues. Our skills can help improve the effectiveness of human behavior, whether it be patients with illness, consumers with disability, health care providers, health systems managers, or legislators.     

On the need for structurally competent counselling and psychotherapy: Neoliberal ideology,disability and the psy disciplines

This article highlights and problematises the psy disciplines' articulations with neoliberalism, with a particular focus upon disability and upon counselling and psychotherapy. Recent years have witnessed burgeoning scholarly interest in the potential complicities of the psy professions in a neoliberal agenda of individualisation, pathologisation and responsibilisation of human suffering. Such complicities are, in state therapy settings, driven by a growing need for these professions to offer cost-effective, evidence-based interventions to secure funding in an increasingly competitive market. Whilst the entwining of neoliberal ideology with therapy practices may be innocuous for some, it is contended that disabled people may be at particular risk of harm. A case is then made for training and practice to foreground structural competency, an awareness of how therapy encounters and client concerns are shaped by socio-structural factors, including, but not limited to, politics and political ideology. This would require not only an appreciation of the sociopolitical context in which therapy unfolds and its indubitable shaping of subjectivities, but also greater recognition of disability as a source of social inequity and oppression, as opposed to an individual phenomenon. Moreover, structural competency would require theoretical and demographic diversity in training and practice, which, in turn, would necessitate identifying and addressing barriers to inclusion for disabled people. Points raised are deemed of particular importance given the emergence of long COVID.     

Assessing the accuracy of the WISC-IV seven-subtest short form and the child and adolescent intellectual disability screening questionnaire in identifying intellectual disability in children

Little research has been conducted into the accuracy of abbreviated assessments in identifying children and young people with an intellectual disability (ID). The present study compared two such methods in a clinical population of individuals with (n = 106) and without (n = 170) ID: a 7-subtest short form of the Wechsler Adult Intelligence Scales for Children—fourth edition (WISC-IV) proposed by Crawford and colleagues and the Child and Adolescent Intellectual Disability Screening Questionnaire (CAIDS-Q). Both the CAIDS-Q and the WISC-IV short form had high and comparable levels of predicting group classification (88% and 91% correct classification, respectively). Both methods would appear to offer clinicians and researchers an efficient and accurate means of identifying those who are likely to have ID. The WISC-IV short form was slightly more accurate, but the CAIDS-Q may offer the advantages of being shorter to administer and having no requirement for the user to have a particular qualification or training.     

The clinical utility of the Rey Auditory-Verbal Learning Test in medical rehabilitation

Recent research has reported the Rey Auditory-Verbal Learning Test Trial V (RAVLT-V) score to be a sensitive indicator of global cognitive functioning, not merely verbal learning skills. The concurrent validity of the RAVLT-V relative to other neuropsychological measures frequently utilized in medical rehabilitation was investigated in a sample of 64 outpatients diagnosed with traumatic brain injury (TBI). The sample was predominantly male (77%), white (97%), youthful (31.4±11.5 years), high school educated, and an average of 53 months postinjury. Using stepwise multiple regression analysis, a three-variable model consisting of gender, Wechsler Memory Scale-Revised Delayed Memory Index, and Trailmaking Part B (time) accounted for 61% of the variance in RAVLT-V scores. These findings suggest that in TBI patients, the RAVLT taps not only specific verbal learning and memory, but also global cognitive functions. Sensitivity to diffuse neuropsychological changes and ease/speed of administration make the RAVLT a valuable tool in medical rehabilitation settings.     

Factor structure of the construct of adaptive behavior in children with and without intellectual disability

Although the presence of significant limitations in adaptive behavior constitutes one of the three necessary criteria for diagnosing intellectual disability, adaptive behavior structure has always been the subject of considerable controversy among researchers. The main goal of this study is to extend previous research results that provide further support to a multidimensional structure of conceptual, social, and practical skills compared to the unidimensional structure. One-factor and 3-correlated factors models as measured by 15 observable indicators were analyzed by means of confirmatory factor analysis (CFA), as well as their relationships with one second-order factor (i.e., adaptive behavior). To that end, 388 children with and without intellectual disabilities were assessed with the Diagnostic Adaptive Behavior Scale (DABS). Results of CFA indicated that the 3 first-order factors solution provides the best fit to the data. Reliability and validity of the multidimensional model were also analyzed through different methods such as the composite reliability and the average variance extracted. Finally, implications of these findings and possible directions for future research are discussed.     

The usefulness of assessing suggestibility and compliance in prisoners with unidentified intellectual disabilities

Søndenaa, E., Rasmussen, K., Palmstierna, T. & Nøttestad, J. A. (2010). The usefulness of assessing suggestibility and compliance in prisoners with unidentified intellectual disabilities. Scandinavian Journal of Psychology, 51, 434–438. This present study explored the relationship of interrogative suggestibility (n = 133) and compliance (n = 118) to intellectual functioning among prison inmates. The Norwegian versions of the Gudjonsson Suggestibility Scale (GSS) and the Gudjonsson Compliance Scale (GCS) were used. The results supported previous findings of a negative correlation between the Gudjonsson scales and IQ, and the scales were found useful throughout the IQ range. The impact of a memory artifact was discussed in the light of recent studies and criticism of the scales.     

The relationship between the severity and duration of physical disability and body esteem

The current study investigated the association between the severity and duration of physical disability and body esteem. A total of 748 participants (367 males, 381 females) who had a physical disability and 448 participants (171 males, 277 females) who were able-bodied participated in the study. The results demonstrated that people with more severe physical disability experienced lower levels of body esteem than people with milder physical disabilities and able-bodied people. The duration of physical disability was not related to levels of body esteem. Except for the face, people with physical disabilities devalued all aspects of their body more than able-bodied people. For males with physical disability, the unique predictors of high body esteem were decreased need for assistance, higher self-esteem, lower depression and higher sexual esteem; for females with physical disability, the unique predictors were higher self-esteem and higher sexual esteem. Overall, the study suggested that people with physical disability, particularly those with severe disabilities, may be particularly vulnerable to problems associated with their body esteem.     

Disability as a test of justice in a globalising world

This paper shows how most modern theories of justice could require or at least condone international aid aimed at alleviating the ill effects of disability. Seen from the general viewpoint of liberal egalitarianism, this is moderately encouraging, since according to the creed people in bad positions should be aided, and disability tends to put people in such positions. The actual responses of many theories, including John Rawls's famous view of justice, remain, however, unclear. Communitarian, liberal egalitarian, and luck egalitarian thinkers alike have to consider their attitude towards cosmopolitan ideals before they can extend their theories across national borders. The only view of justice that automatically rejects the obligation of international aid based on disability is libertarianism. This is significant for two reasons. Libertarianism is arguably the economic doctrine of globalisation; and its moral appeal to voluntary charity draws attention to the foundations of voluntary corporate social responsibility. Is the latter a prompt for greater or lesser social and political responsibility in global matters?     

Speed of processing and reading disability: a cross-linguistic investigation of dyslexia and borderline intellectual functioning

English and Italian children with dyslexia were compared with children with reading difficulties associated with low-IQ on tests of simple and choice RT, and in number and symbol scanning tasks. On all four speed-of-processing tasks, children with low-IQ responded more slowly than children with dyslexia and age-controls. In the choice RT task, the performance of children with low-IQ was also less accurate than that of children of normal IQ, consistent with theories linking processing speed limitations with low-IQ. These findings support the hypothesis that dyslexia is a specific cognitive deficit that can arise in the context of normal IQ and normal speed of processing. The same cognitive phenotype was observed in readers of a deep (English) and a shallow (Italian) orthography.     

The association between biopsychosocial factors and disability in a national health survey in South Africa

The association between psychosocial factors and disability is less clear. This study investigated the biological and psychosocial (employment and psychological distress) factors associated with level of disability in an adult sample in South Africa. Data were analysed from a cross-sectional survey among adults aged 18–64 (n = 4974). Multiple linear regression was used to investigate the associations of the selected variables with disability. The mean percentage score on the WHODAS scale of disability was 5.31% (95% CI: 4.74–5.88). Age (p < 0.001) and race (p = 0.0002) were significantly associated with disability, and history of stroke (β = 7.19, 95% CI: 3.19–11.20) and heart-related conditions (β = 2.08, 95% CI: [0.23–3.93) showed positive associations. Of the psychosocial variables, psychological distress (β = 10.49 [8.63–12.35]) showed a strong positive association while employment (?1.62 [?2.36 to ?0.88]) showed a negative association with disability. The association between demographic factors, medical conditions and increased disability confirms the findings in the literature. The finding that psychological distress is associated with increased disability has not been frequently reported. This study highlights specific psychosocial targets that may be usefully addressed by health policies and interventions in order to improve disability management.     

On the possibility of contextual-quantitative inquiry

The potential contributions of quantitative methods are rarely discussed in the qualitative research and theoretical literatures in psychology. However, it is possible that some forms of quantitative research can fit theoretically within an interpretive framework and provide useful methodological resources for contextual, interpretive inquiries. Such research, which would examine dynamic modes of existence and lived experience in context, would extend more flexible and diverse methodological resources to researchers. This article describes how some types of quantitative research can perform this function and suggests several caveats regarding their use.     

Honoring the duallium: disability,environmental ethics,and the implicit religion of gardening

In recent years, the pilgrimage shrine of La Sainte-Baume has attracted an increasing number of non-Catholic pilgrims influenced by the ‘New Age’ and the Neopagan movement. These pilgrims consider Mary Magdalene as a sort of female counterpart of Jesus and the mountain of La Sainte-Baume, where according to a Christian legend she spent the last part of her life, as a ‘power place’ charged with ‘healing energy’. Based on 3 years of field work among Mary Magdalene pilgrims and drawing on Tanya Luhrmann's idea of ‘interpretive drift’ (1989), the essay describes the way in which these pilgrims gradually shift from their previous Christian background towards what they generally identify as ‘spirituality’. The pilgrims reconceptualise La Sainte-Baume and its saint, and make their own a shrine they feel was misappropriated and unjustly monopolised by the ‘Church’.     

Illness representations,pain and physical function in patients with rheumatic disorders: between- and within-person associations

Objectives: Rehabilitation for patients with rheumatic diseases improves both illness representations (IR) and clinical outcomes such as pain and physical functioning (PF). However, it is unclear whether IR may affect and, in turn, are affected by pain and PF. In this study, we examined both between-person associations and within-person associations between IR and pain/PF over time on three measurement occasions. Furthermore, cross-lagged relationships were examined.

Design and main outcome measures: This secondary analysis is based on data from N?=?186 patients with rheumatic diseases. Data on pain, PF and IR were assessed using self-report questionnaires at the beginning, the end and three months after a 3-week inpatient rehabilitation.

Methods: To separate between- and within-person level, data were analysed using random-intercept cross-lagged panel models.

Results: On both the between-person level (r?=?|0.21|???|0.44|) and the within-person level (r?=?|0.15|???|0.46|), pain and PF were related to cognitive and emotional IR. In addition, we found within-person bidirectional cross-lagged effects between emotional IR and PF.

Conclusion: IR show complex relationships with pain and PF. Improving PF might improve subsequent illness-related emotional distress and vice versa.     

A comparison of pain management outcomes for disability compensation and non-compensation patients

Abstract

In this study, 50 men in an in-patient comprehensive rehabilitation program receiving disability compensation were compared with 25 non-recipients with respect to pre-and post-program measures of personality functioning. physical functioning and reported pain. On the pre-program measures. the only significant difference emerging between the two groups was found on the Mf scale of the MMPI, with the compensation group showing a slightly lower mean score. The two groups responded equally well on virtually all outcome measures. One interesting exception was found on the subjective measure of pain. which showed the compensation group reporting a higher level of subjective pain, and the non-compensation group a lower level than would be predicted on the basis of pre-program scores. Overall. and contrary to popular belief. the results suggest that compensation recipients can derive considerable benefit from pain management interventions despite the ostensible reinforcement provided by disability payments.     

Identifying the nature of impairments in executive functioning and working memory of children with severe difficulties in arithmetic

An age-matched achievement-matched design was used to examine whether the executive functioning and working memory impairments exhibited by children with severe difficulties in arithmetic (SDA) are better viewed as developmental lags or as cognitive deficits. Three groups of children were included: 20 SDA children, 20 typically achieving children (CM) matched in chronological age with the SDA children, and 20 younger typically achieving children (AM) matched in achievement with the SDA group. While children with SDA did not exhibit impairments in color-word inhibition and verbal working memory, they did demonstrate impairments in shifting, quantity-digits inhibition, and visuospatial working memory. As children with SDA did not perform more poorly than their AM counterparts on any of these tasks, impairments in specific areas of executive functioning and working memory appear to reflect developmental lags rather than cognitive deficits.     

论自主性与公正之间的张力--一试管受精案例引起的伦理困境

高科技医疗技术,如试管受精技术在医疗实践中往往引发伦理原则之间的冲突.通过对英国一试管受精案例的分析,展示自主性原则与公正原则之间存在的深层张力.在对两个基本范畴作哲学解析的基础上,寻找两个基本原则的契合点,为解决类似的伦理困境提供一奈可能的途径.