Testing measures of the quality of residential care: A pilot study

This paper summarizes the results from a pilot study, designed to test a method of measuring the quality of care provided in two residential units for severely mentally handicapped children. The overall aim has been to devise general measures of the learning conditions (the quality of care) within residential units, which relate to groups of clients, and which are equally applicable at different times of the waking day. Such measures will only constitute a helpful monitoring instrument if they are shown to be reliable; to have, at least, face-validity: to be based upon representative and accurate data; and if they differentiate between settings which, intuitively, appear to differ in the extent to which the clients' appropriate behaviour is prompted and reinforced.     

Training severely and profoundly mentally handicapped nocturnal enuretics

The problem of nocturnal enuresis in the institutionalized mentally handicapped is a major one which reduces independence in many handicapped adults and has major implications for hospital resources. Much work, which has looked at initial success rates, relapse rates, and factors involved in these, has been carried out with non-handicapped populations. However, there have been remarkably few such studies with the mentally handicapped. A study is reported in which five severely and profoundly mentally handicapped adolescents or young adults were successfully trained over periods ranging from 18 to 92 weeks. Several interesting features of the data are discussed.     

Mental Handicap and Citizenship

ABSTRACT Mentally handicapped people have been taken in philosophical work as an obvious exception to the canons which are applied to other, 'rational'individuals. This paper argues that mentally handicapped people should be accorded the same rights as others. If there are human rights, then mentally handicapped people are entitled to them as humans; and if there are rights which apply in general to citizens, the same rights apply equally to mentally handicapped people. The argument for the inclusion of mentally handicapped people as citizens is first, that there is a presumption of inclusion: if citizenship is accorded to all other individuals, there is no reason why citizenship should not be accorded to mentally handicapped people on the same basis as others. Second, mentally handicapped people cannot successfully be excluded without effectively challenging the presumption of inclusion applied to other groups. Third, and perhaps most important, there are positive reasons why mentally handicapped people, as a particularly vulnerable group, need to have rights to protect them against particular abuses.     

Reaction times, using fine and gross motor movements of moderately and severely mentally handicapped adults to auditory and visual stimuli

This experiment investigated the reaction times, when using fine and gross motor movements, of 24 moderately and severely mentally handicapped adults to light and sound stimuli. Unlike results of prior studies of normal and mildly mentally handicapped subjects, there were no significant differences among variables.     

Acquisition and performance difference between normal and mentally handicapped adults on a complex assembly task

Several single studies concerned with work training with the mentally handicapped have been reported in the literature (Bitter & Bolanovich, 1966; Huddle, 1967; Gold, 1969; Screven, Straka & Lafond, 1971). Most have been concerned with issues of acquisition and motivation to perform. No studies have been reported which focus on the evaluation of different techniques of training or which assess rate of acquisition against that of non-handicapped controls. The aim of this experiment is twofold. It uses a complex task, analysed by MTM-2, to enable comparison between the performances of mentally handicapped adults and adults from a 'normal' population, in the acquisition of new work skills. Various strategies of training were compared and the increase in the rate and quality of performance following acquisition was measured for both, in terms of speed and accuracy of production. Results add further support for the notion that the potential of mentally handicapped individuals is commonly underestimated. It is hoped that the findings provide a basis from which further experiments can be developed and evaluated.     

Some developmental questions on the organization of psychiatric care in East Germany--25 years after Rodewisch

Following an appreciation of the recommendation made 25 years ago at the Rodewisch symposium on the organisation of psychiatric care in the DDR, verious misconceptions and impediments affecting the development at a complex system of psychosocial care at Area Health Authority level are discussed, with special attention to securing the care of the chronically mentally sick and handicapped and the mentally retarded. The paper indicates current requirements in obtaining the further acceptance of a gradually achievable system of area care.     

Group therapy with dual-diagnosed adolescents

This paper presents an eclectic orientation to group therapy, which guides the authors' clinical work with adolescents diagnosed as both mentally ill and mentally handicapped. Highlighted are the treatment needs and the difficulties working with this population, theories of group process and their implication for treatment, and specific clinical techniques that foster individual and group growth. Specificallly, this paper outlines the clinical rationale and group interventions used in a process-oriented group for dual-diagnosed adolescents residing in a residential setting. This group is designed to develop the clients' interpersonal understanding and skills, which will hopefully enhance their overall adaptation and functioning in the residential milieu. It is believed that the integration of a variety of theoretical approaches is critical for group therapy with this population.He was Senior Cottage Therapist or Unit Director at the William Roper Hull Child and Family Services, Calgary, Alberta, while doing group work with dualdiagnosed adolescents.He was a Cottage Therapist at Hull Child and Family Services, while doing the group work cited in this pape     

The Marxist-Leninist concept of personality and its significance for the integration of psychiatric patients

The Marxist view of man as the "ensemble of social relations" is a prerequisite for understanding the personality of the mentally handicapped. The dialectic relationship between biological and social events permits the conclusion that restrictedly developed versions of the personality must be accepted as natural. The particular obligation of society is to ensure the all-round integration, encouragement and care of such handicapped persons. The task of the medical fraternity is to establish a comprehensive system to prevent such handicaps.     

Evaluation of a home-based language training programme with severely mentally handicapped children

A home-based Language Training Programme was carried out with pre-school and school-age severely mentally handicapped children, over a 16–18-month period. Compared to control groups, the experimental groups did not show significantly greater progress on normreferenced measures of language development, although all groups showed significant improvement over time. The implications of these findings are discussed in the light of a number of methodological problems with the study.     

Ethics and Marginal Cases: the rights of the mentally handicapped

ABSTRACT  Some beings, including children, animals and the mentally handicapped, seem to deserve moral consideration, despite the fact that they are not rational or moral agents. These so-called marginal cases create a problem for theories that heavily stress the role of moral and/or rational agency in ethics: the latter seem unable to account for the former's moral status. This paper discusses the recent and original attempt of Loren Lomasky to solve this problem. It is argued that Lomasky's arguments are self-defeating because they can only succeed by relying on common-sense morality and, thus, by giving up the heavy stress on the role of rational agency in ethics.     

Developmental auditory agnosia in the severely retarded: A further investigation

The hypotheses were investigated that (a) ability to recognize the auditory perceptual stimuli for familiar events is a developmental correlate to language acquisition and (b) the low functioning mentally handicapped suffer from auditory agnosia and are impaired in this ability. The subjects were 42 nonretarded children of ages 3 through 6 and 53 severely and moderately retarded, noninstitutionalized students. The retarded subjects were matched by mental age to the chronological age of the nonretarded children. The stimuli were 49 environmental sounds; the task consisted of sound-and-picture matching-to-sample. Group membership and developmental age were the factors in an analysis of variance design. The results revealed a strong effect of developmental age (p <. 0001). The effect of group was not significant, indicating that auditory agnosia may not be common among the lower functioning retarded. The assumption that agnosia may be a major factor underlying the language disability of the severely retarded was reexamined. It was suggested that the severely retarded achieve the requisite perceptual-semantic knowledge base for language too late, after the critical age for spontaneous and efficient language learning has passed.     

视觉障碍儿童人格特征的比较研究

以《缺陷儿童人格诊断量表》为工具对视觉障碍儿童进行人格评定,并将其测验分数与先前有关其他特殊儿童和正常儿童的同一量表测验结果加以比较。比较结果表明．视觉障碍儿童与正常儿童、智力落后儿童的人格特性有明显差异,而与听觉障碍儿童的人格差异相对要小一些。随年龄、障碍程度的不同．视觉障碍儿童的人格特性也有明显差异。     

Using the ADI-R to diagnose autism in preschool children

The use of an investigator-based interview (Autism Diagnostic Interview—Revised; ADI-R) in the diagnosis of 51 autistic and 43 nonautistic mentally handicapped preschool children of equivalent mental and chronological age is described. Significant differences occurred between the groups on every diagnostic subdomain from the DSM-IV/ICD-10 draft criteria, except specific aspects of stereotyped language, still relatively rare in these young children. All but one of the 51 children judged to be autistic by clinical observation and only two of the 30 nonautistic mentally handicapped children with mental ages of 18 months or higher met criteria for autism on an algorithm to DSM-IV/ICD-10 draft criteria. However, discrimination using domain totals between autistic and the 13 nonautistic, nonverbal mentally handicapped children with mental ages under 18 months was poor. Quality of social overtures to adults and peers, play, and unusual sensory behaviors and mannerisms continued to differentiate these two groups. The relevance of these findings to the diagnosis of autism in preschool children is discussed.     

A SUPERVISION PROGRAM FOR INCREASING FUNCTIONAL ACTIVITIES FOR SEVERELY HANDICAPPED STUDENTS IN A RESIDENTIAL SETTING

This study was designed to increase the amount of time severely handicapped students living in a residential facility engaged in age-appropriate and functional activities. After a brief in-service training, a program involving instructions to supervisors and staff feedback was implemented in a multiple-baseline design across settings. Results showed that after the supervision program was implemented, the students' participation in activities increased. Further, these increases maintained when feedback was reduced from an average of 3 days a week during treatment, to once a month for a 5-month period.     

Favourite objects of autistic children

Favourite objects (FOs) of autistic children were compared with the FOs of healthy preschool and school children as well as mentally handicapped children. Three clusters of objects were obtained for normal children (comprising primary transitional objects and their forerunners, secondary transitional objects, and non-cuddly toys). When autistic children and mentally handicapped children were included, a fourth cluster of deviant objects was found. Frequency distributions of the two handicapped groups in the clusters were similar. Similarities between the two handicapped groups were also found within each cluster. The occurrence of secondary transitional objects was rare in the handicapped groups. The characteristics of "autistic" FOs reported in earlier case studies (e.g. being hard, often having an exciting effect, not being used in their adequate functions) were typical only of objects in the fourth cluster.     

Muscle Stiffness in Down Syndrome and Other Mentally Handicapped Subjects

An attempt was made to determine the effects of strength training on elbow flexor stiffness of Down syndrome, non-Down syndrome mentally handicapped, and nonhandicapped subjects. It was hypothesized that stiffness would be affected by the training. Results showed that only half of the individual subjects increased their maximum voluntary contraction (MVC) level as a result of the training and that premeasures and postmeasures of MVC were not significantly different for any of the three groups. As expected, for both premeasures and postmeasures, nonhandicapped subjects had a significantly higher MVC than the other groups who were not significantly different. An important finding was that measures of stiffness (slopes of the IEMG × Torque) were not significantly different for the three groups. This finding is consistant with recent studies (Davis & Kelso, 1982; Shumway-Cook & Woollacott, in press) but raises serious doubts about the popularly held opinion that Down syndrome individuals are hypotonic. It was also found that both the Down syndrome and other mentally handicapped subjects produced significantly less torque at the maximum level than the nonhandicapped subjects. These findings suggest that deficits in mentally handicapping conditions result from a decrease in the range of a primary motor control parameter λ (see Feldman, 1986).     

Teaching dancercise to persons who are mentally handicapped: Programming transfer of stimulus control to a community setting

This study demonstrated procedures to promote the acquisition and transfer of stimulus control of an age-appropriate exercise skill. Three young adults diagnosed as mentally handicapped in a residential setting were taught a commercial dancercise routine during individual training sessions using a package of instructional procedures. A combination of a multiple baseline across subjects and a multiple baseline across response groups design showed that skill acquisition occurred only after each subject received training, and that performance did not generalize across exercise response groups. Training progressively incorporated more participants, new teachers, and new settings. Ultimately, subjects performed in a community dancercise class attended by 100 nonhandicapped persons.     

Divine Hiddenness and Discrimination: A Philosophical Dilemma

Since its first delivery in 1993, J.L. Schellenberg’s atheistic argument from divine hiddenness keeps generating lively debate in various quarters in the philosophy of religion. Over time, the author has responded to many criticisms of his argument, both in its original evidentialist version and in its subsequent conceptualist version. One central problem that has gone undetected in these exchanges to date, we argue, is how Schellenberg’s explicit-recognition criterion for revelation contains discriminatory tendencies against mentally handicapped persons. Viewed from this angle, our present critique imparts Schellenberg’s position with a philosophical dilemma: (1) endorsing divine discrimination to the effect that God does not love ‘cognitive-affective outsiders’ or (2) giving up on explicit recognition. Either way, the hiddenness argument does not succeed.     

Problems involved in toilet-training profoundly mentally handicapped adults

Toileting difficulties constitute a severe problem in institutions for the mentally handicapped. The present study, in a British institution, is a cross-validation of the approach to toilet training outlined by Azrin et al. in the U.S.A. Although Azrin's approach was basically successful, a number of differences were found in running the programme. These differences, together with practical difficulties encountered, are discussed.     

Understanding public opinion relating to the establishment of community mental health facilities: implications of a discourse analytic approach

This paper demonstrates a novel approach to investigating the problem of public opposition to community mental health facilities. With the move towards community care, organizations setting up mental health facilities have encountered public opposition. It has been argued that this is due, in part, to the attitudes held by the public towards mentally ill people. A knowledge and understanding of attitudes towards this client group therefore has the potential to be of practical use to policy makers and practitioners who have a responsibility to consult on, and implement, community care for mentally ill people. The survey approaches and hypothetical situations used in previous British studies of community attitudes towards mentally ill people have, however, failed to take account of the rhetorical richness and complexity of the attitudes likely to be expressed in real‐life community care contexts. By contrast, the study reported in this paper used a discourse analytic approach to explore the views expressed about mentally ill people in a ‘hot situation’. Specifically, people's views were explored in the contexts of the arguments they used to challenge or advocate a supported accommodation project for mentally ill people in their community. This paper examines some of these arguments and discusses the theoretical implications for traditional approaches to attitude research. In conclusion, the potential practical utility of the findings is considered. Copyright © 1999 John Wiley & Sons, Ltd.