ABSTRACT
Seizures can be debilitating across a number of physical, social, occupational, and personal variables. Given the deficits in all of these areas frequently present in persons with mental retardation, effective assessment and subsequent treatment of seizures is a primary goal for individuals with both mental retardation and epilepsy. To thoroughly address the behavioral domains related to seizures in persons with mental retardation and epilepsy, areas of assessment should include seizure behavior, triggering stimuli, reinforcing consequences, and antiepileptic medication side effects. Assessment of these areas in this population often deviates from methods typically used with persons of normal intelligence. Specifically, direct behavioral observation and third-party report with structured interviews are the most viable and accessible means of assessment, and efforts to establish reliable and valid protocols have been successful in some areas. This article reviews this assessment methodology and discusses the extant issues in establishing and proliferating such approaches.
Subject(s)
Epilepsy/diagnosis , Intellectual Disability/diagnosis , Behavior Therapy , Brain Damage, Chronic/diagnosis , Brain Damage, Chronic/epidemiology , Brain Damage, Chronic/psychology , Comorbidity , Cross-Sectional Studies , Epilepsy/epidemiology , Epilepsy/psychology , Humans , Intellectual Disability/epidemiology , Intellectual Disability/psychology , Intelligence , Patient Care Team , Risk AssessmentABSTRACT
Metoclopramide is an anti-emetic medication that has been associated with movement disorders such as extra-pyramidal reactions and tardive dyskinesia (TD). Reports of these reactions have been documented in the general population, but investigations of side effects in persons with mental retardation are scant. Given the high incidence of gastrointestinal disturbance in persons with mental retardation, and the popularity of this medication to treat such problems, these individuals could be at risk for developing movement disorders resulting from metoclopramide use. We compared incidence rates of TD over a 1-year period in developmentally disabled individuals taking either metoclopramide, typical antipsychotics, or no psychotropic medications (Table 1). Assessment was completed using the Dyskinesia Identification System--Condensed User Scale (DISCUS), a standardized measure of TD found to be reliable and valid for persons with mental retardation. No significant differences in DISCUS scores between the metoclopramide and antipsychotic treated groups were noted across four measurements taken during the course of 1 year. Additionally, no difference was found between these two groups for a number of participants who met criteria for probable TD on at least one of the DISCUS administrations. Comparisons between all three groups on one testing occasion revealed a significant difference between groups. The no psychotropic control group showed significantly less TD symptomology than the antipsychotic or metoclopramide groups.
Subject(s)
Antiemetics/adverse effects , Dyskinesia, Drug-Induced/etiology , Intellectual Disability/drug therapy , Mental Disorders/drug therapy , Metoclopramide/adverse effects , Adult , Antiemetics/therapeutic use , Antipsychotic Agents/adverse effects , Antipsychotic Agents/therapeutic use , Comorbidity , Drug Interactions , Drug Therapy, Combination , Dyskinesia, Drug-Induced/diagnosis , Female , Humans , Male , Metoclopramide/therapeutic use , Middle Aged , Neurologic Examination/drug effects , Risk FactorsABSTRACT
OBJECTIVES: To assess the social functioning of individuals with severe and profound intellectual impairment who displayed maladaptive behaviour for one particular reason, as assessed by a functional analysis checklist. DESIGN: The social skills of 100 persons with severe and profound intellectual impairment were studied. The Matson Evaluation of Social Skills for the Individuals with Severe Retardation (MESSIER) was used to assess social functioning. Participants were placed into one of four groups according to function of maladaptive behaviour as assessed by the Questions About Behaviour Function Scale (QABF). METHODS: A multivariate analysis of variance and follow-up univariate F-tests were conducted using MESSIER subscales as the dependent variables and QABF function as the independent variable. To identify specific social skill strengths and weaknesses associated with each function group, the means of MESSIER items were calculated for each function group, and the 10 most frequently endorsed items were displayed. RESULTS: Significant differences were found for all the MESSIER subscales except one. A list of most commonly displayed behaviours for each function group was identified. DISCUSSION: This research represents the first attempt to systematically identify social strengths and weaknesses associated with behaviour function. Results revealed a pattern of social behaviours among groups, indicating that positive and negative social behaviour varies somewhat with behaviour motivation. The implications of these findings for clinical utility are discussed.
