Prevalence of dual diagnosis in an institution for individuals who are developmentally handicapped

The prevalence of dual diagnosis (developmental handicap with accompanying mental illness) was examined in a population of 71 persons who are institutionalized and developmentally handicapped. The Reiss Screen for Maladaptive Behavior (Reiss, 1988) revealed that 69% of the popula- tion had a dual diagnosis. The incidence of dual diagnosis was not related to level of functioning, although the type of psychopathology varied considerably across levels of functioning. In contrast to findings from the Reiss Screen, previous psychiatric diagnosis indicated a much lower rate of dual diagnosis (26.8%), as did current psychiatric assessment. There was little agreement between the two psychiatric assessments, or between the Reiss Screen and the psychiatric assessments. The Reiss Screen appears to provide information of more practical value for community placement decisions than is provided by the psychiatric assessments. Limitations to the concept of ?dual diagnosis’? for characterizing the mental health needs of persons with a developmental handicap are discussed.     

Parental assessment of temperament in handicapped children

The New York Longitudinal Study (NYLS) Parent Questionnaire assesses parental report of children's temperament on nine variables: Mood, distractibility, persistence, activity, rhythmicity, adaptability, approach-withdrawal, threshold and intensity. The present research was designed to assess the interrater reliability of this instrument and to provide cross-validation data regarding the nine scales. Questionnaires were validly completed by both parents of 47 children who had previously been evaluated at the Neuropsychology Laboratory of the Louisiana State University Medical Center. For each of the nine temperament variables, the scores obtained by each child when rated by his or her mother was significantly correlated with the score received on that variable when rated by the father. Thus, under the limitation imposed by the research design, it appears that parents are relatively consistent when evaluating the temperamental characteristics of their children. The correlations between each individual item and the factor it loads on were consistently highly significant. The nine temperamental variables are adequately assessed by the items included in the NYLS Questionnaire.     

Behavioral skills workshop for staff and supervisor in a community residence for developmentally handicapped adults

A behavioral skills workshop for counselors and a supervisor in a community group home was developed and evaluated. The workshop included group skills training, individual supervised in vivo practice, and supervisor training. Supervisor training taught behavioral staff management skills that were delivered in a multiple baseline design across subjects. Positive changes in staff behavior occurred for each group only after supervisor intervention. Significant positive changes occurred by the end of the workshop and were maintained at follow-up for staff self-evaluations of expertise and confidence to resolve problems, severity of client problems, and behavioral observations of positive client behaviors.     

Survey of current practices in the psychological assessment of limited-english-proficiency handicapped children

This article discusses current psychological and educational assessment practices used with elementary school limited-English-proficiency (LEP) children, as revealed by a nationwide study of 21 local education agencies (LEAs) that had LEP handicapped children mainstreamed in bilingual education classrooms. Data were obtatained through telephone and personal interviews of bilingual and special education directors, inspection of documents, and site visits. The testing approaches most frequently used with LEP students were the common culture approach (which relies on nonverbal measures) and translated tests. In many of the LEAs, translations were done while testing was in progress. An average of 12 psychological, language, and educational tests were used with each LEP child. The assessment instruments used were not normed on LEP populations. Only a third of the LEAs studied were incorporating multicultural pluralistic approaches in their assessment procedures. The professionals involved in the assessment of LEP children were the same as those used for English-speaking children except that they were bilingual. Most of the LEAs reported serious shortages in bilingual assessment personnel. LEAs have tried to cope with this problem in various ways, including the use of trained or untrained interpreters, the use of central teams or contracted professionals, and the use of nonverbal tests administered by nonbilingual personnel. However, many children remain to be assessed, and LEAs have been forced to establish priorities.     

Treatment of epilepsy in the multiply handicapped

The medical management of epilepsy in the multi-handicapped patient requires careful evaluation, classification, and pharmacologic treatment. It is estimated that 20-40% of patients with mental retardation and cerebral palsy have epilepsy. This review reports the clinical trial data and personal experience related to the use of newer AEDs in the chronic management of epilepsy syndromes in children and adults, as well as information available on the treatment of seizures in individuals with mental retardation and associated handicaps. Furthermore, clusters of seizures, prolonged seizures and status epilepticus are more commonly seen in the multiply handicapped and mentally retarded population and require special attention. The new antiepileptic drugs felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, vigabatrin and zonisamide show specific advantage in some multiply handicapped patients, be it for seizure control or medication tolerance. Furthermore, new modalities of treatment for prolonged seizures allow better efficacy both outside of hospital and within hospital facilities. The treatment of epilepsy in multi-handicapped and retarded adults and children has significantly advanced in the past few years, and much of this improvement can be attributed to improved knowledge and monitoring of new antiepileptic drugs. Conventional anticonvulsants remain first line therapy for most clinicians, but newer AEDs must broaden the therapeutic option and do allow improved therapy for some multiply handicapped patients.     

Issues concerning the early identification of handicapped children

Despite the awareness that early identification promotes early intervention, most handicaps go undetected until children become school age. Recently some states have initiated statewide early identification projects, many of which are modifications of traditional procedures. However, there is evidence which suggests that conventional methods are ineffective in detecting children with less apparent handicaps. To discover effective and efficient child find procedures, several variables must be examined: (1) population to be screened, (2) massive campaign vs. specific contact, (3) agency effort vs. community-based effort, and (4) referral mode vs. screening mode.     

Why the handicapped child case is hard

This paper discusses the handicapped child case and some other variants of Derek Parfit's non-identityproblem (Parfit, 1984) The case is widely held to show that there is harmless wrongdoing, and that amoral system which tries to reduce wrongdoing directly to harm (``person-affecting morality')is inadequate.I show that the argument for this does not depend (as some have implied it does) on Kripkean necessity of origin. I distinguish the case from other variants (``wrongful life cases') of the non-identityproblem which do not bear directly on person-affecting morality as I understand it. And finally, I describe a respect in which the handicapped child case is puzzling and counter-intuitive, even on the supposition that it is a case of harmless wrongdoing. I conclude that the case is ``hard': it will take more than the rejection of person-affecting morality to remove its puzzling character.