A cascade of disparities: health and health care access for people with intellectual disabilities

People with ID represent approximately 2% of the population and, as a group, experience poorer health than the general population. This article presents recent conceptualizations that begin to disentangle health from disability, summarizes the literature from 1999 to 2005 in terms of the cascade of disparities, reviews intervention issues and promising practices, and provides recommendations for future action and research. The reconceptualization of health and disability examines health disparity in terms of the determinants of health (genetic, social circumstances, environment, individual behaviors, health care access) and types of health conditions (associated, comorbid, secondary). The literature is summarized in terms of a cascade of disparities experienced by people with ID, including a higher prevalence of adverse conditions, inadequate attention to care needs, inadequate focus on health promotion, and inadequate access to quality health care services. Promising practices are reviewed from the perspective of persons with ID, providers of care and services, and policies that influence systems of care. Recommendations across multiple countries and organizations are synthesized as guidelines to direct future action. They call for promoting principles of early identification, inclusion, and self-determination of people with ID; reducing the occurrence and impact of associated, comorbid, and secondary conditions; empowering caregivers and family members; promoting healthy behaviors in people with ID; and ensuring equitable access to quality health care by people with ID. Their broadscale implementations would begin to reduce the health disparity experienced by people with ID.     

The meaning and suitability of various effect sizes for structured Rater x Ratee designs

Four types of analysis are commonly applied to data from structured Rater x Ratee designs. These types are characterized by the unit of analysis, which is either raters or ratees, and by the design used, which is either between-units or within-unit design. The 4 types of analysis are quite different, and therefore they give rise to effect sizes that differ in their substantive interpretations. In most cases, effect sizes based on between-ratee analysis have the least ambiguous meaning and will best serve the aims of meta-analysts and primary researchers. Effect sizes that arise from within-unit designs confound the strength of an effect with its homogeneity. Nonetheless, the authors identify how a range of effect-size types such as these serve the aims of meta-analysis appropriately.     

Action relations, semantic relations, and familiarity of spatial position in Balint’s syndrome: Crossover effects on perceptual report and on localization

We contrasted effects of the action relationship between objects, relative to effects of semantic relation and familiarity of spatial location, in a patient with Balint’s syndrome. We found enhanced perceptual report of objects placed in the correct colocations for action in comparison with when the objects (1) were placed in incorrect locations for action (Experiment 1), (2) were associatively related (Experiment 2), or (3) fell in familiar locations but were not action related (Experiment 4). In contrast, the ability to localize the objects was affected by whether the objects were in familiar as opposed to unfamiliar locations with respect to one another. Action relations between objects facilitate joint attention to both objects but do not facilitate binding to location. Familiar spatial relations facilitate spatial binding, but do not cue joint attention to the stimuli. Effects of action relation on attention and localization can be dissociated from effects of semantic relationship and familiarity of spatial location on attention and localization.     

The relationship between miscellaneous symptoms and major symptom factors in obsessive-compulsive disorder

The diverse symptomatology of obsessive-compulsive disorder (OCD) is being increasingly regarded as reducible to a few symptom dimensions. However, prevailing factor-analytically derived models of symptom structure omit a number of the well-recognized “miscellaneous” symptoms of OCD. This study sought to determine whether miscellaneous OCD symptoms, ascertained by the Yale-Brown Obsessive-Compulsive Scale symptom checklist, could be differentially and reliably predicted by four symptom factors (obsessions and checking, symmetry and ordering, contamination and cleaning, and hoarding) in two independent groups of individuals with OCD (n = 381 and n = 107). Logistic regression analyses were used to determine the association of each of the miscellaneous symptoms with the symptom factors; then a single confirmatory factor analysis was conducted to test the model of associations in the smaller sample. Sixteen (89%) of the 18 symptoms examined were reliably predicted by one (11 items) or two (5 items) of the factors, with obsessions and checking and symmetry and ordering emerging as foremost predictors. The expanded four-factor model showed good fit with data from the second sample. Results are conceptually meaningful, but suggest the inadequacy of groupings based solely upon overt behaviors. These findings may aid clinical understanding of OCD and be of value to studies using symptom factors to guide investigation of its causes and correlates.     

Same-sex couple perceptions of family support: a consensual qualitative study

Few studies have examined the family context in which same-sex couples negotiate their lives and relationships. Consensual qualitative research methods (Hill, Thompson, & Williams, 1997) were used to analyze 14 same-sex couples' conversations about family support. Couples perceived that their families are positively supportive, non-supportive, or ambivalent in their support. These perceptions led to positive or negative emotional reactions in the couple members and to specific coping. The majority of couples perceived that family support (or lack of support) had an effect on the quality of their couple relationship. No general or typical response strategies to lack of family of origin support emerged, suggesting a lack of models or norms for same-sex couples. The implications for psychotherapeutic interventions with same-sex couples are discussed.     

Testing the concurrent and predictive relations among articulation accuracy, speech perception, and phoneme awareness

The relations among articulation accuracy, speech perception, and phoneme awareness were examined in a sample of 97 typically developing children ages 48 to 66 months. Of these 97 children, 46 were assessed twice at ages 4 and 5 years. Children completed two tasks for each of the three skills, assessing these abilities for the target phoneme /r/ and the control phoneme /m/ in the word-initial position. Concurrent analyses revealed that phoneme-specific relations existed among articulation, awareness, and perception. Articulation accuracy of /r/ predicted speech perception and phoneme awareness for /r/ after controlling for age, vocabulary, letter-word knowledge, and speech perception or phoneme awareness for the control phoneme /m/. The longitudinal analyses confirmed the pattern of relations. The findings are consistent with a model whereby children's articulation accuracy affects preexisting differences in phonological representations and, consequently, affects how children perceive, discriminate, and manipulate speech sounds.     

Borderline personality features and instability of daily negative affect and self-esteem

We used a daily process design and multilevel modeling to examine the role of borderline personality features in the day-to-day stability of college students' negative affect and self-esteem and their reactivity to interpersonal stressors. At the end of each day for two weeks, students completed a checklist of daily stressors and measures of state affect and self-esteem. We predicted that high scores on a measure of borderline features would be related to more daily interpersonal stressors, greater negative affective and self-esteem reactivity to these stressors, and less day-to-day carryover of negative mood and self-esteem. The first and third hypotheses were supported, but not the second. The findings demonstrate the utility of a daily process methodology and multilevel modeling to study the day-to-day functioning of individuals with borderline features.     

A test of whether attributions provide for self-enhancement or self-defense

It is well known that people often make attributions in a way that is favorable to their self-concepts (see R. L. Collins, 1996, for a review). However, it is less clear whether the primary effect is to enhance self-esteem or to defend against the possible loss of self-esteem. The authors performed an experiment to test these possibilities against each other. In a completely between-participants design, participants recalled either a positive behavior or a negative behavior that was performed by themselves or others. They then judged the positivity or negativity of the behavior and made trait attributions about the actor (i.e., himself, herself, or others). The results indicated that although judgments and trait attributions for positive behaviors were similar for the self and for others, judgments and trait attributions for negative behaviors were less negative for the self than they were for others. The authors interpreted these and other findings as supporting a defensive strategy rather than an enhancive strategy.