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Abstract : Pharmacologic Management of Aggression in Adults with Intellectual Disability
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Abstract: Introduction: Aggression is a common behavioral problem seen in patients with intellectual disabilities (ID). The safety and efficacy of second generation antipsychotics (SGAs), mood stabilizers and antidepressants in the management of aggression in these individuals have minimally been studied. This review aims to 1) summarize the studies conducted using second generation antipsychotics, mood stabilizers and antidepressants in treating aggressive behaviors in patient with ID and 2) determine based on the existing literature, which medications have been examined in the most rigorous study design that might suggest the most efficacy for use in clinical practice. Methods: Literature searches using PUBMED Central, CINAHL Plus, PsychINFO, and Embase databases were conducted using the following terms: intellectual disability/disabilities, mental retardation, developmental disability/disabilities, aggression, agitation, behavior disorder, adult, treatment, management. Studies predominantly including children with ID, and autism/pervasive developmental disabilities spectrum disorders were excluded. Analyses were done by class of medication: SGAs, mood stabilizers and antidepressants. The primary outcome measure was reduction in aggressive or self injurious behaviors as measured by each individual study. Results:The most rigorous study designs found using these agents were randomized controlled trials (RCT). A total of 10 RCTs were found, the majority being with risperidone (3) and lithium (2). Treatment with risperidone showed reduction in aggression when compared to placebo in most RCTs with the exception of one study in which risperidone was not better than placebo. Both lithium studies showed reduction in aggression when compared to placebo. The most abundant literature exists in retrospective chart reviews. The most commonly studied agent was risperidone which showed reduction in aggression in majority of the studies. Conclusions: Limited data exists for treatment of aggression in adults with ID. There are very few studies examining pharmacologic agents using RCTs. Given that risperidone and lithium were the most commonly studied agents in the most rigorous experimental design, it is suggested that these two agents prove efficacious for treatment of aggression in patients with ID. Limitations to most of these studies included concomitant psychotropic administration with variations in types and dosing, severity of ID, and the idea that a wide variety of aggression scales were used to assess outcome. Further research with more scientific rigor is required in this field. Keywords: Intellectual disability, mental retardation, treatment.Download Full Article |
Abstract : Subtypes of Intellectual Disability in School-Aged Children
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Abstract: Purpose: To explore the presence of subtypes of intellectual functioning in children with mild intellectual disability (ID) and to externally validate the subtypes on measures of academic, adaptive and psychosocial functioning. Method: Participants were 167 children age 6-16 years with a mild ID. All children completed the WISC-III, WIAT, VABS, and PIC-R. Results: Based on a two-stage cluster analysis on the four WISC-III Index scores four subtypes emerged reflecting distinct profiles: (1) language-strength subtype; (2) nonverbal strength subtype; (3) symbol-processing strength subtype; and (4) global deficits subtype. The subtypes were externally validated on tests of academic achievement, adaptive functioning, and psychosocial functioning. Conclusions: Rather than only demonstrating a global or “flat” pattern of cognitive deficits, the findings suggest that children with mild ID have certain profiles of intellectual functioning that are similar to those seen in normal children and children with learning disabilities. Keywords: Intellectual disability, cognitive strengths, children, neurodevelopmental disorders.Download Full Article |
Abstract : Which Factors do Parents of Offspring with Intellectual Disability Experience as Promoting Inclusive Education for their Children?
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Abstract: The background of this research is that few studies on inclusive education internationally, use parents as informants. Even fewer emphasize their positive experiences only. From the Norwegian support organisation for people with intellectual disability 14 parent-members were selected and qualitatively interviewed about their positive experiences with inclusive education for their offspring. By means of a discourse analytic approach their statements about constructive factors were benchmarked with twelve formerly identified literature-based factors in order to investigate which of twelve factors were validated by parental experiences, and to detect possible new factors. The general research question illuminated is which factors do parents of offspring with intellectual disability experience as promoting inclusive education for their children? The results are linked to the following four sub-questions: (1) which of the factors, disclosed in current literature, is frequently mentioned by the informants; (2) which new factors are disclosed; (3) which factor is so frequently mentioned that it is considered substantial; and (4) which factors might be combined, and possibly renamed? The results show that the informants contributed all in all with 18 factors. In the discussions it was argued that five factors were interpreted as new, four factors proved to be substantial, that a fifth factor almost gained equal status, while three more factors were considered vital. These eight factors represented the main answer to the research question, and were summarised in metaphoric model, baptized” the school-house of inclusive education”. Keywords: Inclusion, learning disability, parental experiences, successful factors, empirical-pragmatic perspective, metaphoric model.Download Full Article |
Abstract : Number Sense in Siblings of Children with Mathematical Learning Disabilities: A Longitudinal Study
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Abstract: Number sense, counting and logical thinking were assessed in 14 siblings of children with Mathematical Learning Disabilities (MLD) and in 41 age matched children without family members with MLD. The children were tested in kindergarten and followed up in grade 1. A 0-100 number line estimation paradigm with three formats (Arabic digits, dots and number) was used as a measure of number sense. Results reveal that siblings of children with MLD are less proficient in number line placements compared to non-siblings, with both groups having a logarithmic representation in kindergarten and grade 1. Siblings also differ from non siblings on procedural and conceptual counting knowledge and logical thinking in kindergarten. In addition, our findings suggest that nnumber line estimation in kindergarten is especially predictive for untimed procedural calculation performances in grade 1, whereas procedural counting knowledge is related to timed fact retrieval skills in grade 1. Our findings also reveal that MLD had a familial aggregation. Clinical siblings especially differ from non-clinical siblings on the estimation with Arabic numbers (in kindergarten and grade 1) and number words (in grade 1), pointing to the fact that especially symbolic number line estimation tasks on a 0-100 scale can be used as screeners for MLD. Implications for the understanding and diagnosis of MLD are discussed. Keywords: Mathematical learning disabilities, number sense, siblings, number line estimation, Arabic numbers, number words, counting, logical thinking, arithmetic.Download Full Article |
