Interrater agreement and stability of the Functional Independence Measure for Children (WeeFIM): use in children with developmental disabilities

OBJECTIVE: Examination of the interrater agreement and stability of ratings obtained using the Functional Independence Measure for Children (WeeFIM) in a sample of children with developmental disabilities. DESIGN: A relational design was used in which two sets of WeeFIM scores were collected under four conditions: same rater-short interval; same rater-long interval; different rater-short interval; and different rater-long interval. SETTING: WeeFIM scores were collected in outpatient developmental rehabilitation centers, school programs, and the children's homes. PARTICIPANTS: Data were collected for 205 children ranging in age from 11 to 87 months. All children had a medical diagnosis of disability and were receiving habilitative-educational intervention or follow-along services including neurodevelopmental surveillance. INSTRUMENT: The WeeFIM instrument examines basic daily living and functional skills in children from birth to 7 years of age. The WeeFIM is modeled after the Functional Independence Measure (FIM) for adults and includes 18 items in the following subscales: self-care, sphincter control, transfers, locomotion, communication, and social cognition. RESULTS: Kappa values for items ranged from .44 to .82. Intraclass correlation coefficients (ICC) for the six subscales ranged from .73 to .98. Total WeeFIM ICC values were greater than .95 for all analyses. CONCLUSIONS: The WeeFIM ratings for the 205 children with developmental disabilities participating in this investigation were consistent across raters and time.     

Early intervention and early experience.

For 4 decades, vigorous efforts have been based on the premise that early intervention for children of poverty and, more recently, for children with developmental disabilities can yield significant improvements in cognitive, academic, and social outcomes. The history of these efforts is briefly summarized and a conceptual framework presented to understand the design, research, and policy relevance of these early interventions. This framework, biosocial developmental contextualism, derives from social ecology, developmental systems theory, developmental epidemiology, and developmental neurobiology. This integrative perspective predicts that fragmented, weak efforts in early intervention are not likely to succeed, whereas intensive, high-quality, ecologically pervasive interventions can and do. Relevant evidence is summarized in 6 principles about efficacy of early intervention. The public policy challenge in early intervention is to contain costs by more precisely targeting early interventions to those who most need and benefit from these interventions. The empirical evidence on biobehavioral effects of early experience and early intervention has direct relevance to federal and state policy development and resource allocation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing the child with disabilities

PURPOSE: To describe the prevalence of disabilities and the medical conditions and risk factors associated with mobility and agility disabilities among seniors. METHODS: In the 1986 and 1991 Canadian Census, every fifth person answered a screening question about activity limitation and disabilities. A probability sample of both those reporting and not reporting disability was selected to complete the Health and Activity Limitations Surveys (HALS) in 1986 and 1991. These two cross-sectional surveys conducted five years apart collected detailed activity limitation information about persons over 15 years of age. The current analysis was based on only respondents aged 65 years and older. The sample size for 65 years and older was 38518 in 1986 and 5106 in 1991. A computer link with the Census data provided household income and additional socio-demographic data for all respondents. RESULTS: Over 40% of Canadian seniors reported at least one disability, and approximately a quarter of disabled seniors were classified as severely disabled. Mobility and agility disabilities accounted for over 80% of all disabilities reported by seniors, and senior women were more likely than men to report having a mobility or agility disability. Arthritis/rheumatism was reported as the cause of over 30% of all mobility and agility disabilities. CONCLUSIONS: The continued monitoring of disabilities through surveys such as HALS will help determine the prevalence as well as aid in the identification of the causes of disabilities. Such information may be used to guide the implementation of appropriate public health interventions that will meet the changing health care needs of seniors.     

Treatment of learning disorders

INTRODUCTION: The child neurologist, developmental pediatrician or child psychiatrist involved in the care of children with learning disabilities has a crucial role that extends beyond diagnosis. DEVELOPING: Despite the lack of sound scientific studies on treatment interventions for children with learning disabilities there are specific interventions that are helpful in the remediation of children with learning disabilities. CONCLUSIONS: The role of the health professional in the treatment of learning disabilities includes: 1. Making specific recommendations regarding early intervention strategies; 2. Putting into a neurological perspective the types of educational interventions that will maximize a child's potential; 3. Discussing the role of medications in the management of learning disorders, as well as using medications in appropriate situations, and 4. Coordinating the multimodal approach which is essential to the long term treatment of all children with learning disabilities.     

Prevention of occupational asthma including medical surveillance

The high figures of occupational asthma worldwide necessitate the intensification of appropriate primary, secondary, and tertiary preventive measures. Based on new scientific data on dose-response relationships as well as our own experience and ethical aspects, we focus on medical surveillance within the framework of secondary prevention. We propose that medical surveillance programs be mandatory for workplaces/occupations with an asthma incidence of > or = 200% than that of the general population. Medical surveillance programs are recommended if asthma frequency is elevated but below 200%. A stepwise approach of monitoring workers at risk for developing occupational asthma including a screening by questionnaire and a personal interview and diagnosis confirmation is presented. In addition, we briefly comment on the management of affected subjects.     

Guidelines for optimal surveillance of Clostridium difficile infection in hospitals

The availability of surveillance data on C. difficile infection in hospitals in England and Wales is being jeopardised by the trend not to culture the organism for diagnostic purposes. NHS trust laboratories that no longer have the ability to isolate C. difficile cannot investigate putative outbreaks or monitor antimicrobial susceptibilities. These laboratories may now need to rely on their local public health laboratory for such investigations. Recent recommendations from the Department of Health(DH)/PHLS have highlighted the need for culture in outbreak investigations, for surveillance purposes, and for monitoring antimicrobial susceptibilities. It is important, therefore, that NHS diagnostic laboratories and public health laboratories, in particular, retain the ability to isolate C. difficile. A cost-effective approach is described that will facilitate surveillance by typing of strains and also enable their antimicrobial susceptibilities to be monitored.     

Disabilities of arithmetic and mathematical reasoning: perspectives from neurology and neuropsychology

Current research on brain-behavior relationships in disabilities of arithmetic and mathematical reasoning is reviewed from both a neurological and a neuropsychological perspective. Although no entirely satisfactory statement of the relationship between arithmetic skills and brain functions has yet emerged, investigators in this area have provided evidence regarding the involvement of some brain systems in processes of calculation. Also, the developmental importance of right- versus left-hemisphere integrity for the mediation of arithmetic learning and performance has been suggested. We propose that an account of brain-behavior relationships in children intended to explain and predict developmental disabilities of arithmetic learning needs to address several important content and processing distinctions in order to (a) encompass empirically derived subtypes of children with learning disabilities who exhibit difficulties with arithmetic and (b) provide adequate direction for future subtyping and intervention research.     

Effects of computer surveillance on perceptions of privacy and procedural justice.

Electronic workplace surveillance is raising concerns about privacy and fairness. Integrating research on electronic performance monitoring, procedural justice, and organizational privacy, the author proposes a framework for understanding reactions to technologies used to monitor and control employees. To test the framework's plausibility, temporary workers performed computer/Web-based tasks under varying levels of computer surveillance. Results indicated that monitoring job-relevant activities (relevance) and affording those who were monitored input into the process (participation) reduced invasion of privacy and enhanced procedural justice. Moreover, invasion of privacy fully mediated the effect of relevance and partially mediated the effect of participation on procedural justice. The findings are encouraging for integrating theory and research on procedural justice and organizational privacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychologist on the multidisciplinary developmental disabilities team.

The psychologist in the multidisciplinary developmental disabilities unit provides a view of the intrapsychic, psychosocial, developmental picture of the reality of the child. Common role expectations are discussed, emphasizing the importance of the psychologist's assessment role within the mentally retarded/developmental disabilities unit. This role allows for professional growth in several areas of practice: teaching, research, assessment, and counseling. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The achievement test desk reference: A guide to learning disability identification, second edition.

Reviews the book, The achievement test desk reference: A guide to learning disability identification, second edition by Dawn P. Flanagan, Samuel O. Ortiz, Vincent C. Alfonso, and Jennifer T. Mascolo (2006). The Second Edition of the Achievement test desk reference comes only four years after its first edition. Its content echoes the first edition, with the chapters now re-organized and updated. However, this edition is also timely; its significant contributions are its theoretical and practical model for defining and assessing learning disabilities (LD) and its update of practical information for interpreting many of the new standardized achievement tests. The goal for this edition was to provide an integrated and systematic framework for achievement testing within the framework of the Cattell-Horn-Carroll (CHC) theory of human cognitive abilities and the Response to Intervention (RTI) movement. Part 1 of provides an update of the theories, definitions, assessment, interpretation, and identification of LD. Part 2 describes and reviews the psychometric, theoretical, and qualitative features of achievement tests published between 1996 and 2006 and normed on people from the United States. Part 3 provides a comprehensive, step-by-step process for assessing learning disabilities under the Individuals with Disabilities Education Improvement Act (IDEA 2004). This volume guides practitioners to choose the best achievement tests to use. It shows how to get the most efficient and effective evaluations of students' academic skills that could account for their difficulties and possible learning disabilities. This book will be essential reference material for effective LD assessments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A concept analysis of, and proposed new term for, challenging behaviour

While the term 'challenging behaviour' is used frequently in literature with reference to people who have learning disabilities, the concept has not been defined comprehensively and empirical indicators for the presence of the phenomenon have not been defined from the perspective of nurses for people with learning disabilities. In this paper the concept 'challenging behaviour', as used in the area of nursing people who have learning disabilities, is analysed. It is suggested that it is an ambiguous term which is unsuitable for use in the field of learning disabilities. A new term is synthesized to replace that of 'challenging behaviour' and an attempt to develop concise indicators which will demonstrate the concept's presence in individuals who have a learning disability will be undertaken. It is suggested that the proposed term is less ambiguous than 'challenging behaviour' and, as such, is more user-friendly for both nurses and other carers of people who have learning disabilities. The paper concludes with the recommendation that further refinement is required in practice to expand and define the operational indicators of the proposed new term 'problematic behaviours'.     

Person-centered play therapy for adults with developmental disabilities.

Due to problems in communicating with psychologists, counselors, and other daily helpers, adults with developmental disabilities may experience a lifetime of daily routines that involve few if any opportunities for emotional expression, validation, and growth. This paper presents two case studies that utilize an adapted form of Child-Centered Play Therapy in working with adults with developmental disabilities (ages 22 and 24 yrs). Person-Centered Play Therapy is used to help two adults with developmental disabilities overcome behavioral and emotional difficulties. Results indicate positive growth and changes in self-expression, self-direction, self-efficacy, and emotional well-being. Changes are indicated both within sessions, and outside of sessions in a residential day treatment program. Possibilities for future work with this population are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pediatric HIV disease: What psychologists need to know.

Current estimates of the prevalence of pediatric HIV indicate that in 1992 there may be 10,000–20,000 infected infants and children. These youngsters are at risk for developmental disabilities, intellectual and academic impairment, and emotional and behavioral difficulties, and it is likely that psychologists will encounter HIV-infected children in schools, hospitals, and community-based clinics. Basic concepts of pediatric HIV disease are elucidated, and recent research investigating affected psychological processes is provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epiduroscopy with access via the sacral canal. Some constructional equipment requirements from the anatomic and biomechanical viewpoint

Food safety is a complex matter that depends on a number of interrelated environmental, cultural, and socioeconomic factors. The purpose of epidemiology and surveillance is to define these factors, how they interact, and their relative importance in foodborne infections. The tools epidemiologists use to study foodborne disease include surveillance of specific infections in humans, monitoring of contamination with specific pathogens in foods and animals, intensive outbreak investigations, collecting reports of outbreaks at the regional or national level, and studies of sporadic infections. With sufficiently elaborate systems of surveillance and investigation, it is possible to provide quantitative risk data for foodborne diseases that will permit the wisest allocation of food safety resources.     

Graduate nursing education: developmental disabilities and special health care needs

As children and adults with developmental disabilities and special health care needs are integrated into home, school, and community life, nurses are being required to provide leadership, advocacy, and training in community settings to a much greater extent than in the past. To assess the school and community need for formal graduate preparation for nurses who work with individuals with developmental disabilities and/or special health care needs, 25 nurses in leadership positions representing urban and rural health agencies throughout Minnesota took part in a 5-hour focus group discussion. Analysis of data summarized from this process shows five features of the recommended curriculum necessary for advanced practitioners in this specialty area: (a) discipline-specific core competencies, (b) discipline-specific specialty competencies, (c) genetic competencies not specific to nursing but necessary to function in nursing roles, (d) interdisciplinary and intradisciplinary learning experiences, and (e) clinical experiences with preceptors. The authors recommend the development of interdisciplinary graduate programs designed to prepare nurses to assume leadership roles in school health, public health, home health care, and systems management that will affect public policy and, ultimately, promote change in the systems charged with responsibility to serve this population.     

Multimodal evaluation of risperidone for destructive behavior: Functional analysis, direct observations, rating scales, and psychiatric impressions.

Risperidone, an atypical neuroleptic, has become a popular option for treating destructive behaviors of persons with developmental disabilities. A few studies have been conducted that evaluate the effects of risperidone on destructive behavior; however, none of these studies have combined objective measures with rating scales to evaluate the effects of risperidone on destructive behavior across home and clinical settings. This study evaluated the wide range of effects of risperidone on destructive behavior of 2 persons with developmental disabilities using weekly functional analysis sessions, daily observations, hourly home data, weekly rating scales, and monthly psychiatric impressions. Results indicate that risperidone does decrease destructive behavior and that, for the most part, all of the various measures yielded similar results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social acceptance and rejection of preschool children with disabilities: A mixed-method analysis.

Eighty children with disabilities enrolled in a nationally distributed set of inclusive preschool programs participated in this study. The average age of the participants was 3.9 years, and 60% were male. The children exhibited a range of disabilities and developmental levels. Using a mixed-method approach, the authors established quantitative criteria for identifying children with disabilities who were socially accepted and socially rejected by their peer group, and qualitative methods revealed themes associated with social participation of each group. Cluster analyses of themes identified 3 clusters associated with social acceptance (e.g., awareness-interest, communication-play, friendship-social skills) and 2 clusters associated with social rejection (e.g., social withdrawal, conflict-aggression). Subsequent cluster analyses of children and matrix analyses illustrated how child social participation was related to superordinate theme clusters and constructs of acceptance and rejection. Socially accepted children tended to have disabilities that were less likely to affect social problem solving and emotional regulation, whereas children who were socially rejected had disabilities that were more likely to affect such skills and developmental capacities. Implications of this research for theory and practice are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"We'll cross that hurdle when we get to it". Teaching athletic performance within adaptive physical education

Persons with developmental and physical disabilities who are enrolled in educational programs often participate in adaptive physical education classes. Primarily, these classes are designed to provide individuals with the opportunity to develop their physical abilities. However, they can also serve as a training ground for the Special Olympics. Teaching the motor skills that are prerequisite to participation in many adaptive physical education and Special Olympics activities can be a formidable objective. This study demonstrates how a person with developmental disabilities was taught, by way of stimulus control shaping, the necessary motor skills to enable him to participate in the hurdling event at the Special Olympics.