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 regional genetic and newborn screening service collaboratives: the first two years

Newborn screening and genetic technologies are expanding and changing rapidly, increasing the demand for genetic specialty services. Because of the scarcity and geographic maldistribution of genetic specialty services, access to these services is a critical issue. This article discusses some of the efforts initiated by the Maternal and Child Health Bureau of the Health Resources and Services Administration, particularly the establishment of regional genetic and newborn screening collaboratives to improve access to these services and expertise.     

In the aftermath of September 11: group interventions with traumatized children revisited

The terrorist attacks of September 11, 2001, affected thousands of children psychologically, necessitating the mobilization of multifaceted mental health interventions in an ecological context. This paper reviews the major role of large and small group modalities in this challenging effort, with many of them based on earlier group work with child-victims of trauma.     

The relationship between age, verbal working memory, and language comprehension

A structural modeling approach was used to examine the relationships between age, verbal working memory (vWM), and 3 types of language measures: online syntactic processing, sentence comprehension, and text comprehension. The best-fit model for the online-processing measure revealed a direct effect of age on online sentence processing, but no effect mediated through vWM. The best-fit models for sentence and text comprehension included an effect of age mediated through vWM and no direct effect of age. These results indicate that the relationship among age, vWM, and comprehension differs depending on the measure of language processing and support the view that individual differences in vWM do not affect individuals' online syntactic processing.     

Prevalence of Attention-Deficit/Hyperactivity Disorder Symptoms in 4- to 17-Year-Old Children in the General Population

The purposes of this study were (a) to estimate the prevalence of Attention-Deficit/Hyperactivity Disorder (AD/HD) symptoms in the general preschool and school population; and (b) to analyze the influence of gender, age, and socioeconomic status (SES) variables on AD/HD symptoms. Out of the 80,000 preschool and schoolchildren living in Manizales, Colombia, a random sample of 540 children was selected. Two gender, three age (4- to 5-year olds, 6- to 11 -year olds, and 12- to 17-year olds), and three SES (low, middle, and high) groups were used. The 18 DSM-IV symptoms corresponding to AD/HD Criterion A were assessed on a scale of 0 (never) to 3 (almost always). All three demographic variables established statistically significant differences: AD/HD symptoms were more frequent in 6-to 11-year-old, low-SES, male participants. DSM-IV Criterion A for AD/HD was fulfilled by 19.8% of the boys and 12.3% of the girls. However, this difference was marginally significant only in the AD/HD Subtype I: Combined. It was concluded that demographic variables are significant correlates of the AD/HD diagnosis. The prevalence found in this study was higher than usually reported, even though only the symptomatic DSM-IV AD/HD criterion was analyzed. We failed to confirm the assumed AD/HD gender ratio.     

Integrity in Pastoral Counseling

This essay suggests that pastoral counseling involves a spiritual and emotional quest for wholeness. The personal quest of the pastoral counselor has a parallel impact upon the quest of those who seek his or her counsel. The essay presents the view that faith must be established in the life of the pastoral counselor in at least four areas: in community, in the use of one's spiritual gifts, in the love of mercy and the doing of justice, and in communion with God.     

Aspects of body image perception in obese and normal-weight youngsters

Perceptual and projective aspects of body image in obese youngsters (not in psychological treatment) and normal-weight youngsters 8–9 years of age and 12–13 years of age were investigated. The results indicate that perceptual distortions in estimating various body dimensions of oneself are primarily a function of age rather than weight status. The accuracy of estimating the weight of peers and an adult showed an association with the sex of the subject. No group differences were found in terms of projective aspects of body image as measured by barrier and penetration responses. This study suggests that obese youngsters in the middle childhood and entering puberty periods in comparison to normal-weight youngsters of the same age do not manifest differences in perceptual factors of body image.     

Laboratory and field interview methods for the study of shiftworkers

Gordon, Tepas, Stock, and Walsh (1979) describe the manner in which shiftworkers were selected as research subjects through the cooperation of labor union organizations. In this paper, we describe the methods used to select and orient the workers to serve in a laboratory study involving measurement of the psychophysiological correlates of sleep. Procedures used for field interviews with the same subjects are also described. Some of the advantages and disadvantages of using a multimethod (laboratory and field interview) approach to the study of shiftwork effects are detailed.     

Aggression in dyadic interaction

It is shown that the notions of aggressive behavior as ‘intentional emission of noxious stimulation’ (Buss, 1961, 1963, 1966, 1971) and that of ‘injuriating goal response’ (Dollard, Doob, Miller, Mower and Sears, 1939) are identical. The usefulness of these theories to predict S's reaction to the reception of a given noxious stimulation is questioned. It is suggested that S's reactions to noxious stimulation may or may not be aggressive, depending on whether the noxious stimulation S receives is interpreted as being a behavior justified by the nom in the situation, or as reflecting an aggressive intent of O. It is hypothesized that the norms established in the situation depend on (i) victim's perception of the noxious stimulation received as being instrumental for O's goal attainment, (ii) victim's perception of the value of O's goal, and (iii) the value of victim's own goal. The establishment of norms regulating the exchange of noxious stimulation between Ss is operationalized in two experiments. Aggression, defined as an infringement of these norms, is measured. In Experiment I, participate 56 female students, and in Experiment 2, 80 male students. Subject is alternately victim (he performs a sensorimotor task and receives an electric shock) and aggressor (he shocks the other S). In Experiment I it is found that Ss counteraggress faster and more frequently if they interpret the shock received from the partner as an infringement of the norm. In Experiment 2, Ss do not counteraggress more frequently, but they do counteraggress faster and evaluate O more negatively. It is concluded that the results clearly contradict current positions and favor the authors' cognitive reformulation of the determinants of aggressive behavior.