[Quality of life in dementia, opinions among people with dementia, their professional caregivers, and in literature]. / Kwaliteit van leven bij dementie. Opvattingen onder mensen met dementie, hun zorgverleners en in de literatuur.

Different definitions of quality of life (QOL) are found in the literature. This raised the question which domains are viewed as really important by persons with dementia. In an explorative study the opinions of persons with dementia (community-dwelling and living in nursing homes), were compared to those of professional carers and instruments for QOL in dementia. Data were gathered through interviews, focus groups and literature study. Most QOL-domains mentioned as important by persons with dementia were also acknowledged by carers and in measurement instruments. Some domains, however, were not mentioned by the carers ('sense of aesthetics', 'financial situation', 'being useful' and 'spirituality'), or not selected in the measuring instruments ('security and privacy', 'self-determination and freedom', 'being useful' and 'spirituality'). This indicates differences in perspectives on quality of life between persons with dementia, professional caregivers and researchers. Subsequently it was studied to what degree professionals focus on the QoL-domains that persons with dementia consider essential. Caregivers working on 29 units and 3 day care facilities of 13 nursing homes and in 12 meeting centers filled out a questionnaire (N = 374). They reported to focus at least to some degree on most domains considered important by persons with dementia. However, little attention was paid to the domains 'financial situation' and 'being useful'. Professionals offering daytime activities focused more than 24-hour care staff on 'attachment', 'enjoyment of activities', 'sense of aesthetics', and 'being useful'. This article is a translation and merging of 1) Dröes et al. Quality of life in dementia in perspective; an explorative study of variations in opinions among people with dementia and their professional caregivers, and in literature. Dementia: The International Journal 2006; 5 (4): 533-558, and 2) Gerritsen et al. Differences in perspective: do professional caregivers focus on the Quality of life domains that are important for people with dementia? American Journal of Alzheimer's Disease and Other Dementias 2007; 22:176-183.

Time-delay discrimination training: replication with different stimuli and different populations.

Two time-delay conditions for teaching complex visual discriminations to normal preschoolers and children with mild and moderate intellectual handicaps were compared. One condition involved spatially separating the distinctive components from the redundant parts of both stimuli (multiple dynamic distinctive-feature prompts). The other condition involved adding a colored field to the correct stimulus (single static nondistinctive-feature prompt). The effect of the latter condition was assessed with unlearned and learned tasks. The study consisted of four experiments. In one experiment, children were also required to use the prompts for self-monitoring responses given before prompting had occurred. The results indicated that for all populations and stimuli (a) time delay of multiple dynamic distinctive-feature prompts consistently produced learning, and (b) time delay of the single static nondistinctive-feature prompt almost never produced learning and frequently led to a complete loss of discriminative performance on previously learned tasks. The resistance to disruption was a function of the training history (i.e., with or without time delay) and IQ level. Self-monitoring increased the efficacy of time delay when multiple dynamic distinctive-feature prompts were used but not when the single static nondistinctive-feature prompt was used.

Establishing sound blending in moderately mentally retarded children: implications of verbal instruction and pictorial prompting.

The present study evaluated a program for establishing blending of consonants (C) and vowel-consonant (VC) syllables in moderately mentally retarded children. The study consisted of two experiments. Experiment 1 assessed whether the subjects' failure to blend was due to the task requirements per se, or to the inadequacy of the instructional terminology ("Say together"). Experiment 2 evaluated the implications of using pictorial prompts in the acquisition and generalization of C-VC blending. The data revealed that (a) adequate verbal instruction had a modest but significant effect on the subjects' blending performance (Experiment 1), and (b) training without pictorial prompts resulted in better blending of trained and untrained C-VC items than training with pictorial prompts (Experiment 2).

Teaching moderately mentally retarded children basic reading skills.

The present study assessed the efficacy of a program for teaching moderately mentally retarded children basic reading skills. Central to the program were the use of a phonemic alphabet as well as the application of pictorial cueing and stimulus manipulation techniques. The program consisted of six phases. It started with the training of graphemes for vowels (Phase 1) and ended with the training of two-syllable words (Phase 6). Four moderately mentally retarded students participated. Given time constraints, not all subjects completed all phases of the program. The training ended with the reading of one-syllable three letter words for one subject, one-syllable four letter words for two subjects, and two-syllable words for one subject. Subsequent generalization tests revealed that all subjects were capable of reading untrained words of the same complexity as those previously trained; and to read and, to a lesser extent, understand simple sentences. The execution of the program required an average training time of 35 hours per subject. Aspects pertaining to the validity of the program, the efficacy of the procedures, and the relevance of the learned skills are discussed.

Effect of conditional discrimination learning on subsequent multiple-cue discrimination in children.

Thirty-six five-year old children were exposed to a visual multiple-cue discrimination task and to a test which assessed the control over responding acquired by the cues. The training and the test followed a treatment that varied between three groups of twelve children. A conditional discrimination task and a multiple-cue discrimination task were arranged in two different groups. No pretraining was given to a third group. Conditional discrimination training led to fewer errors on the test that followed the multiple-cue task than each of the other treatments. There was no reliable different between the numbers of errors after the other treatments. The results can be explained by an observing response account of transfer in discrimination learning.

Using stimulus shaping and fading to establish stimulus control in normal and retarded children.

The present study was an effort to investigate whether, in addition to his IQ level, the child's ability to identify all relevant stimulus components would affect the frequency of overselective responding. Children of different IQ levels (i.e. normal, educably retarded, and trainable retarded children) participated. Subjects were trained to learn the meanings of four sets of fictitious words, i.e. two sets containing words printed in Roman letters (Roman words), and two sets containing words printed in Hebrew letters (Hebrew words). All subjects could identify the words of each set. The normal and educably retarded subjects could read aloud the Roman words, whereas the trainable retarded subjects could not. None of the subjects could read the Hebrew words. Two training procedures were used, one requiring transfer of stimulus control (fading), and one which did not (stimulus shaping). The results indicated that, firstly, the discrimination learning of the normal and educably retarded subjects covaried with the IQ level and their ability to read the words. The learning rate was not affected by the training procedures. Secondly, the trainable retarded subjects learned much better through stimulus shaping than through fading. Their acquisition rates were slow and not affected by the types of letters. Thirdly, the training procedures had no effect on the breadth of stimulus control. Instead, it covaried as a function of the IQ level (all groups) and of the child's ability to read the words (normal and educably retarded subjects). Fourthly, the training procedures had, however, considerable effect on which letters controlled the discriminations. When overselective selective responding was evident, the letters that had been associated with the prompts were more often functional than the other letters, but only for the words trained through stimulus shaping.

Effects of different stimulus manipulations of the acquisition of word recognition in trainable mentally retarded children.

The present study was designed to assess the efficacy of different procedures for establishing transfer of stimulus control from pictorial representations to printed words in trainable mentally retarded school children. The study consisted of two experiments. In experiment 1, four training conditions were used, i.e. two conditions (stimulus shaping and stimulus connected prompt fading) in which the subjects' attention was guided to the training stimuli, and two conditions (stimulus disconnected prompt fading and no fading) in which the subjects were allowed to respond only to the prompts. The results showed that stimulus shaping and stimulus connected prompt fading were far more effective than either one of the other procedures. Subsequent analyses revealed that 1 the stimulus control of the trained words was restricted to one or two letters, and 2 in case it was restricted to one letter, this was frequently a letter other than the one used for training. Furthermore, it was noted that the learned discriminations deteriorated as time or training progressed. Experiment 2 was designed to replicate some of the findings of experiment 1, and to control for one of the variables contributing to the superior efficiency of stimulus shaping over stimulus connected prompt fading. In general, the results of this experiment confirmed those obtained in experiment 1.