Abstract: This study examined the relationship between adaptive functioning on the Vineland Adaptive Behavior Scale (VABS) and intellectual functioning on the Stanford-Binet Intelligence Scale, 4th edition (SB-IV) in autistic children and nonautistic retarded children of comparable CA and SB-IV composite score (IQ). The autistic group had lower scores than the retarded group in VABS adaptive composite, Socialization domain, and Communication domain, and SB-IV Verbal Reasoning area. VABS domain scores yielded higher classification rates than the SB-IV area scores in discriminating the two groups. Correlations between the two measures were much higher for the autistic group than for the retarded group. Results support the conclusion that the cognitive impairment in autism is reflected in greater impairment in adaptive behaviors than in mental retardation without autism.

Abstract: Simple sight-word reading tasks have demonstrated utility in the estimation of premorbid intelligence, although the effects of progressive dementia on such tasks has not been thoroughly examined. The present investigation sought to examine estimated IQ scores from the National Adult Reading Test-Revised (NART-R; Blair & Spreen, 1989) in relation to a WAIS-R-based (Wechsler, 1981) estimate of IQ in a series of patients with probable Alzheimer's disease across varying levels of dementia. Results suggest that while NART-R scores do show a decrement with dementia severity, this decline is mild, in contrast to traditionally based IQ scores and other measures of cognitive function, which show more marked declines. Similarly, compared with other tasks, the NART-R showed the strongest correlation with education across the sample as a whole, while the other indices were more related to level of dementia. These findings support the use of measures such as the NART-R in estimating premorbid intellectual functioning in patients at various levels of dementia severity, including those with more advanced cognitive deterioration.

Abstract: The intellectual functioning of 105 inpatients with multiple personality disorder and dissociative disorder not otherwise specified was assessed using the Wechsler Adult Intelligence Scale-Revised as part of a comprehensive research protocol. There were no significant intellectual differences between the groups on any major intelligence quotient summary score or any of the age-adjusted empirical factor scores. The anecdotal but widely accepted hypotheses that dissociative patients either have above average premorbid intelligence or that their current intellectual functioning is deleteriously affected by their fluctuant psychiatric disorder were not supported in this sample. A significant subsample of the multiple personality disorder group manifested abnormal interest scatter on the Wechsler Adult Intelligence Scale-Revised verbal subtests, and this variability was attributed to subtle neuropsychological deficits on the Memory/Distractibility factor. We speculate that dissociative patients might need to be evaluated for attention deficit disorder in addition to the range of dissociative symptoms in a comprehensive evaluation.

Abstract: BackgroundThe aim of the study was to test among people undergoing vocational rehabilitation six measures of disability and health status commonly used in medical rehabilitation. Method A cross-sectiona l survey was carried out on 30 people with disabilities on an occupational programme at a non-medical rehabilitation facility in England. Measures used were the Barthel index, Extended Activity of Daily Living (EADL) scale, the Off ice of Population Censuses and Surveys (OPCS) disability questionnaire, the Functional Independence Measure (FIM), the Nottingham Health Profile (NHP) and the Medical Outcome Study Short Form 36 (SF36). The main outcome measures were item non-response and time for completion of each measure, profile of disability and health status described by each measure, including pertinent domains detected or missed, and floor and ceiling effects. Results Item non-response was very low with all the instruments; the Barthel index was on average the quickest to complete (mean time 2-2 minutes) and the SF36 the longest (mean time 9-1 minutes). The study group were characterized as having problems in mobility or locomotion and bladder or bowel control, but some of the instruments were insensitive, detecting no disability in many subjects (e.g. 33 per cent showed no disability on the Barthel index). The SF36 scores were the least affected by floor and ceiling effects; mean SF36 scores on all scales except physical functioning were similar to those for the general population of similar age. Some problems were detected by only one of the instruments (e.g. pain and sleep by the NHP, problems with intellectual functioning by the OPCS scale). Conclusion Disability measures commonly used in medical rehabilitation, such as the Barthel score and FIM, may be less useful in vocational rehabilitation where disabilities are less severe. Other measures show more promise but further testing is needed.

Abstract: Forty four children (ages 6–13 years) with moderate mental retardation to borderline intellectual functioning participated in a double-blind, placebo-controlled trial of methylphenidate (Ritalin) involving .3 and .6 mg/kg medication doses and a placebo. Sixty six percent of subjects were found to be responders to medication based upon weekday school reports or data obtained while attending a weekly Saturday laboratory classroom. The assessment of medication effects on learning was conducted via a daily work task (number of problems completed and work accuracy) and a short-term auditory memory task. Results indicated beneficial medication effects on work output during the weekday and Saturday program, but gains in work accuracy in the weekday classroom only. No significant medication effects were noted on the short-term auditory memory task. Results are consistent with previous research and suggest that children with mental retardation and ADHD require supplemental programming, such as the teaching of specific learning strategies or behavioral interventions, to take full advantage of gains resulting from medication.

Abstract: This paper considers the extent to which awareness of the growing number of older people with intellectual disability in the UK has translated into action. It does so by looking at current policy, training and services for older people with intellectual disability. Information was collected from two sources: an analysis of the 1993/1994 Community Care Plans and a national survey on policy, training and services for older people with intellectual disability. The analysis of Community Care Plans revealed that 67% made no reference to older people with intellectual disability. The remaining 33% mentioned such people mainly in the context of the need for service development. 82% of the 236 replies to the national survey indicated that there was no policy in relation to older people with intellectual disability and 74% indicated an absence of specific staff training. 53% of respondents were aware of services in their area specifically for older people with intellectual disability and 76% were aware of generic services for the elderly in their area that were used by older people with intellectual disability. Finally, the results of a consultation exercise regarding the development of a training pack in ageing and intellectual disability are presented. The results highlight a lack of consensus about how services should be provided and, in many cases, a lack of provision.

Abstract: JB is a 31-year-old man who has been described as having borderline intelligence/mild learning disability. (His overall IQ is difficult to assess, but has been estimated as around 70, or above.) Over the period of his childhood, he was assessed by numerous child psychiatrists and psychologists, all of whom agreed that he had a diagnosis of autism or some related pervasive developmental disorder, although his presentation was always described as ‘atypical’. The cause of his developmental disorder has never been established, despite the conventional extensive biological, genetic and other physical investigations (Gillberg, 1990).

Abstract: A most significant life event in the first years of life is a disease, especially if it is of early onset, severe, life threatening, with an uncertain prognosis, and with the necessity of frequent diagnostic and therapeutic interventions. Psychological implications are a significant parts of the illness, not a marginal component; they can affect prognosis and outcome. The authors describe the different psychological implications of an experience of chronic disease in children and adolescents and their families (parents and siblings). Congenital disease (for example congenital heart failure) has a peculiar significance: since it is diagnosed early, it influences mother-infant interactions from the beginning, in a crucial moment of the infant's psychological development; diagnostic and therapeutical interventions are early and frequent; congenital defects determine the strongest guilt feelings in the parents. Some specific psychological aspects can be described: the weakening of the Bodily self, the inhibition of thinking, the theories the child and the family formulates on the disease, the death feelings. Emotional features in children and adolescents with congenital cardiopathy are described: inhibition of emotions, marked anxiety, depressive reaction, with loneliness, low self-esteem and inadequacy, emotional lability, with oscillation between omnipotence and inadequacy; impulsiveness; weakness of self identity; especially in bodily Self. Some psychopathological aspects in children and adolescents with heart transplant and their families are also described. Intellectual level of patients with congenital heart disease is in the normal range, although significantly lower than normal controls. There is a positive correlation between worsening of intellectual functioning and clinical severity of the heart disease; this clinical severity is related both to restrictions in normal daily life activities, and blood oxygen saturation. It is hard to tease apart the role of early physical limitations versus the role of chronic hypoxia, in affecting intellectual development. Some methodological considerations are described, relating to the role of the physician, the psychological support to the children and adolescents and their families, the problem of the shared-cares between main centres and local hospitals, where primary health-care team operates.

Abstract: This Special Issue reflects a number of trends for those adults with developmental disabilities that have surfaced within the last decade or so in the United States. For professionals in rehabilitation assisting those with developmental disabilities new demands are being made for community inclusion, autonomous decision making, independent living, supported employment, career development and retirement planning. These are new requirements in some cases for those with developmental disabilities and reflect fundamental changes in how those with developmental disorders are perceived professionally and publicly. However, such changes in "mind set" (Harper, 1991) and emphases on developmental disabilities are reported to be slow to move into graduate training programs (Szymanski et al., 1991) in psychology or medicine. The topics in this Special Call (mental retardation and psychiatric disorders - dual diagnosis, vocational assistance of adults with specific learning disabilities, habilitation of adults with autism, career planning in developmental disabilities, and retirement planning for aging adults with mental retardation) have appeared only within the last decade. Moreover, numerous authors and forecasters (Borsay, 1986; Jongbloed and Crichton, 1990; Harper, 1993) have noted a dissatisfaction with existing static-disease models for viewing disability in adults and children and chronicled the movement from an individualistic conception of disability to a socio-political definition. Disability differences, traumatic or developmental, can certainly be understood from an ecological perspective that includes the reality of the physical differences and their adaptive limitations but as importantly their genesis in social and economic environments. The implicit and explicit messages in each of these manuscripts in this Special Call is that personal growth flourishes for those with developmental disorders in environments that promote increasing autonomy in real life settings. Changes in rehabilitation potential also reflect newer understandings of developmental disorders (e.g., autism as a neurobehavioral communication disorder) and most importantly activism of consumers (Fine and Asch, 1988). The following paragraphs detail some of the key issues and contemporary trends in understanding the emerging needs of adults with developmental disabilities. Those with developmental disabilities, in particular adults with significant mental retardation are living longer (Walz, Harper, and Wilson, 1986; Harper, 1989, 1991) and residing in community settings in greater numbers (Wadsworth, Harper, and McLeran, 1995). This simple fact has placed more demands on all rehabilitation service sectors. It is likely that this trend will continue and increase in other developmental disorders (e.g., cerebral palsy), (Janicki, 1989). These increases in longevity are in part a function of general growth in longevity for all Americans as well as related to better access to ongoing health care and more healthy and active lifestyles available to all those with developmental disorders now living in community settings. As part of another contemporary trend having an impact on rehabilitation professionals, the definition of mental retardation as a major component of developmental disabilities is changing and evolving (Luckasson et al., 1992). This current definition "represents a paradigm shift, from a view of mental retardation as an absolute trait expressed solely by an individual to an expression of the interaction between the person with limited intellectual functioning and the environment," (Luckasson, et al., 1992). This definition is described as a move from a "deficiency-model to a support-based-model of mental retardation" (Reiss, 1994, p1). This support-based model is viewed by many as part of the response to and dissatisfaction with science as truth in the "post-modern epoch" (Merydith, 1995). Mental retardation is viewed as a "state" which implies limitations on current functions of the person. …

Abstract: Neuroblastoma, a catecholamine-producing childhood peripheral tumor derived from the neural crest, is intriguing because of its genetic aberrations and its expression of neurotrophins, neuropeptides, and their receptors. The hypothesis that this tumor would be associated with alterations in cognitive functioning in children was tested. Depending on the age of the child, the Wechsler Intelligence Scale for Children (either WISC-R or WISC-III) or the Stanford-Binet Intelligence Scale: Fourth Edition (SB-IV) was administered. The Neuroblastoma group (n = 23) had a significantly higher (p = .001) mean global IQ (M = 112.8, SD = 13.9) than a gender-matched cancer comparison group (n = 20; M = 98.9, SD = 17.0), after the effects of socio-economic status, age, and amount of schooling missed due to illness were statistically controlled by covariance. For the children who completed the Wechsler scales (n = 33), 7 with neuroblastoma obtained a maximum subtest scaled score of 19 whereas only 1 comparison ch...

Abstract: The objective of this study was to assess a broad range of cognitive functioning in a dual diagnosis sample (individuals with a chronic psychotic disorder and substance abuse/dependence) and offer recommendations for programme design and treatment interventions. The Neurobehavioural Cognitive Status Examination (NCSE) was administered to twenty-seven subjects. Statistical comparisons with a normative and psychiatric sample were conducted. The results revealed that two-thirds of the sample demonstrated cognitive impairments as measured by the NCSE, with 37% scoring in the impaired range on three or more of the ten subtests. Great variability between subjects was recorded. Deficits at the p<0.05 level were recorded for seven of the ten subtests in the young group, and for two of the ten subtests for the old group as compared to a normal population. For both age groups memory and judgement were the most statistically deficient. This study supports assessment of cognitive status for dual diagnosis clients, in order to offer treatment appropriate to varied levels of intellectual functioning and suggest a number of treatment options. Copyright © 1996 Whurr Publishers Ltd.

Abstract: Diabetes mellitus patients may develop changes in the brain that can lead to an impairment in cognitive performance. This paper reviews the results of research conducted with numerous neuropsychological assessment instruments. Cognitive impairment is particularly relevant among diabetic patients in the following domains, memory, attention, information processing, motor performance and executive functions. Several biomedical and psychosocial factors have been identified that increase the risk of developing cognitive impairment among this population duration and time of onset of the illness; the presence of several complications, such as peripheral neuropathy and recurrent severe hypoglycaemia; and premorbid intellectual functioning. The methodological difficulties involved in carrying out research in this field are discussed, as well as new research hypothesis.

Abstract: Eighteen children with ADD/ADHD, some of whom were also LD, ranging in ages from 5 through 15 were randomly assigned to one of two conditions. The experimental condition consisted of 40 45-minute sessions of training in enhancing beta activity and suppressing theta activity, spaced over 6 months. The control condition, waiting list group, received no EEG biofeedback. No other psychological treatment or medication was administered to any subjects. All subjects were measured at pretreatment and at posttreatment on an IQ test and parent behavior rating scales for inattention, hyperactivity, and aggressive/defiant (oppositional) behaviors. At posttreatment the experimental group demonstrated a significant increase (mean of 9 points) on the K-Bit IQ Composite as compared to the control group (p<.05). The experimental group also significantly reduced inattentive behaviors as rated by parents (p<.05). The significant improvements in intellectual functioning and attentive behaviors might be explained as a result of the attentional enhancement affected by EEG biofeedback training. Further research utilizing improved data collection and analysis, more stringent control groups, and larger sample sizes are needed to support and replicate these findings.

Abstract: The interactions among short stature, growth hormone (GH) and cognitive functions have been extensively studied so far. However, although it seems well established that short stature is associated with cognitive problems, little effort has been made to point out the presence of specific psychological effects related to the different forms of short stature. In 'short normal' children, the presence of a scholastic underachievement seems to suggest that short stature 'itself' might predispose these patients to some of their psychosocial difficulties. The higher incidence of academic failure, in presence of a normal intellectual functioning, has been attributed to environmental and psychosocial factors, including over-protective parents and low self-esteem resulting from the impact of short stature. These problems appear to be common also to other forms of short stature (such as Turner's syndrome) where, however, they are frequently associated with other specific deficits. The in vivo model which might allow, at least in part, better understanding of GH (per se)-dependent effects is represented by GH deficiency (GHD), in which, however, the specific role of GH on psychological functioning is frequently masked by the presence of associated hormonal deficiencies. Children with isolated GHD are reported to have specific educational deficits, in particular learning disability and attention-deficit disorders, which have been tentatively attributed to a compromised intellectual potential. The psychological effects of long-term GH treatment in children with GHD still remain controversial, with some retrospective studies describing a generally beneficial outcome. Since early experiences in school are closely related to success in adult life, the possible implications that GHD during childhood holds during adulthood have been recently considered. Although regional differences have been observed in subgroups of adults with GHD, it seems that these patients have normal cognitive functions and educational attainment, but are more likely to be unemployed (and unmarried) than members of the general population. In general, patients with GHD, who have been treated at centers where psychological counselling was an integral part of the treatment program, seem to be better adjusted in adult life. For these reasons, a multidisciplinary treatment approach could allow early detection of problems in academic achievement and psychosocial development in patients with short stature, being immediately able to provide the appropriate educational and counselling interventions.

Abstract: Eighteen children with ADD/ADHD, some of whom were also LD, ranging in ages from 5 through 15 were randomly assigned to one of two conditions. The experimental condition consisted of 40 45-minute sessions of training in enhancing beta activity and suppressing theta activity, spaced over 6 months. The control condition, waiting list group, received no EEG biofeedback. No other psychological treatment or medication was administered to any subjects. All subjects were measured at pretreatment and at posttreatment on an IQ test and parent behavior rating scales for inattention, hyperactivity, and aggressive/defiant (oppositional) behaviors. At posttreatment the experimental group demonstrated a significant increase (mean of 9 points) on the K-Bit IQ Composite as compared to the control group (p<.05). The experimental group also significantly reduced inattentive behaviors as rated by parents (p<.05). The significant improvements in intellectual functioning and attentive behaviors might be explained as a result of the attentional enhancement affected by EEG biofeedback training. Further research utilizing improved data collection and analysis, more stringent control groups, and larger sample sizes are needed to support and replicate these findings.

Abstract: Objective. To assess the independent relation of neonatal cranial ultrasound (US) abnormalities in low birth weight (LBW) infants to cognitive outcomes at 6 years of age. Design. Prospective cohort study. Sample and Methods. Six-year follow-up data were obtained on a regional birth cohort of LBW infants (<2 kg) systematically screened as neonates with serial US. US abnormalities were dichotomized into isolated germinal matrix/intraventricular hemorrhage (GM/IVH) and parenchymal lesions/ventricular enlargement (PL/VE). Global cognitive outcomes (mental retardation, borderline intelligence, and normal intelligence) and selected specific cognitive abilities were assessed at 6 years of age with standardized instruments. Multivariate techniques were used to assess the effects of US independent of maternal social disadvantage at birth and other perinatal and neonatal risk factors. Results. The sample as a whole had a significantly elevated rate of mental retardation (MR ; 5%), almost all moderate to profound in severity. PL/VE was independently related to MR (odds ratio [OR], 65.8 ; confidence interval [CI], 19.1 to 22.4) and borderline intelligence (OR, 3.7 ; CI, 1.3 to 10.8) ; isolated GM/IVH was more modestly related to MR (OR, 4.6 ; CI, 1.2 to 18.6) but not related to borderline intelligence. Approximately half of the cases of MR were attributable to PL/VE independent of other factors. Of non-US factors, the number of days receiving mechanical ventilation increased the risk for MR. Maternal social disadvantage increased the risk for borderline intelligence but not MR. Among children of normal intelligence, those with PL/VE, but not isolated GM/IVH, performed more poorly than those without US abnormalities on tests of visual perceptual organization but not on tests of language, memory, or quantitative skills. Conclusion. Prevention of white matter injury would substantially improve cognitive outcomes for LBW infants.

Abstract: BACKGROUND Four previous studies of homeless adults have yielded conflicting results regarding the presence of cognitive impairment. METHOD A consecutive series of 80 roofless entrants to a hostel for homeless men were sampled and 62 (76%) completed a range of assessments, including measures of mental state, cognitive functions and substance use. RESULTS Estimated premorbid IQ (mean = 96), current IQ (mean = 84) and cognitive speed were significantly lower than the norm. There was a significant IQ drop in all diagnostic groups. IQ drop, but not current IQ, correlated with duration of rooflessness. Those with schizophrenia or alcohol problems were roofless for longest. Alcohol misuse did not correlate with IQ drop, excepting alcohol withdrawal symptoms in those with schizophrenia. CONCLUSION The hypothesis that low IQ is a risk factor for rooflessness is supported. However, length of rooflessness was more closely related to IQ drop than to current IQ, suggesting that some third factor may be affecting both rooflessness and intellectual functioning. Roofless men with schizophrenia or alcohol problems may be especially at risk of long-term rooflessness.

Abstract: A procedure was developed by which the attachment-related experiences of adults with learning disabilities could be explored and the reliability and construct validity of the measure were investigated. Thirty-one subjects with mild to severe learning disabilities were interviewed using a semi-structured interview and a third of the subjects were interviewed again three months later. To examine the convergent and discriminant validity of the measure, the relationship between it and measures of self-esteem, independence and general intelligence was investigated. The reliability of the procedure was found to be high over time (kappa = 0.80) and, as predicted, it was found to be significantly related to self-esteem and level of independent behaviour in the home. It was not found to be related to general intellectual functioning. Unexpectedly, it was not found to be related to level of independent behaviour outside the home.