Development of a psychopathology rating scale for children with mental retardation

A total of 583 children and adolescents with mental retardation were rated on a new psychometric instrument designed to screen for dual diagnosis (psychopathology in individuals with mental retardation). Two psychiatrists and two clinical psychologists judged the items to have face validity as expressions of psychopathology in children and adolescents with mental retardation. Cronbach's alpha coefficient was .91 for the total score and varied between .57 and .86 for 10 psychometric scales. Children and adolescents who had a dual diagnosis obtained total scores approximately 1 standard deviation higher than those who did not have a dual diagnosis. Each of 4 diagnostic groupings had test profiles in accordance with expectation. The results suggest that the instrument is particularly well suited for use in screening and for help in the analysis of the relationships between certain behavior problems and psychopathology.

Issues in defining mental retardation

Responses were made to MacMillan, Gresham, and Siperstein's (1993) criticisms of the new AAMR definition. The new AAMR definition does not raise the IQ limit and is not intended to increase the number of people considered to have mental retardation. There is no intent to change who is and who is not considered to have mental retardation. Instead, the intent is to change how people think about mental retardation: The old deficiency model is replaced with a new support model. MacMillan et al.'s criticisms are based on unfortunate misstatements of both the 1983 and the 1992 AAMR definitions of mental retardation and on misunderstandings of psychometric science. On the one hand, they argued that intelligence tests are culturally biased. On the other hand, they criticized the AAMR for not making greater use of inflexible IQ cutoffs in defining mental retardation. They misunderstood that cultural bias is an argument for, not against, flexibility in the interpretation of intelligence tests.

The changing conception of mental retardation: implications for the field

The 1992 American Association on Mental Retardation's (AAMR) definition and classification of mental retardation is different from the previous classification system in that: (a) a single diagnostic code of mental retardation is used if the person meets the three criteria of age of onset (18 or under), significantly subaverage abilities in intellectual functioning, and related limitations in two or more adaptive skills areas; (b) the person's strengths and weaknesses are described in reference to four dimensions: intellectual functioning and adaptive skills; psychological and emotional well-being; health, physical well-being, and etiology; and life activity environments; and (c) a profile of needed supports is developed across the four dimensions. In this article we discussed six major implications of the 1992 System for the field of mental retardation.

Development of a psychopathology rating scale for children with mental retardation

A total of 583 children and adolescents with mental retardation were rated on a new psychometric instrument designed to screen for dual diagnosis (psychopathology in individuals with mental retardation). Two psychiatrists and two clinical psychologists judged the items to have face validity as expressions of psychopathology in children and adolescents with mental retardation. Cronbach's alpha coefficient was .91 for the total score and varied between .57 and .86 for 10 psychometric scales. Children and adolescents who had a dual diagnosis obtained total scores approximately 1 standard deviation higher than those who did not have a dual diagnosis. Each of 4 diagnostic groupings had test profiles in accordance with expectation. The results suggest that the instrument is particularly well suited for use in screening and for help in the analysis of the relationships between certain behavior problems and psychopathology.

Development of a new injury cost scale

The Automobile Technique Research Association at Frankfurt, the Institute for Forensic Medicine at Mainz, the Federal Highway Research Institute at Bergisch-Gladbach, the German Motor Vehicle Inspection Association at Stuttgart, and the German Worker's Compensation at St. Augustin have completed a joint research project dealing with injury costs due to automobile accidents. The data for this social cost analysis were based on costs for administrative expenses, medical treatment, rehabilitation measures, social security payment, and loss of income, which were all paid by Worker's Compensation for single, well-documented injuries to the working population in West Germany (15 to 65 years old). The data base used included 15,407 injured and 1,026 fatal road accident victims. Tables are presented which show the costs associated with various injury levels. The result is an injury cost scale (ICS) that might be a base for establishing priorities of safety measures. The ICS has to be seen as supplemental to the AIS.

Joint occurrence of depression and aggression in children and adults with mental retardation

The relationship between aggression and depression was evaluated for 528 adults, adolescents and children, who were rated on either the adult or child versions of the Reiss instruments for dual diagnosis (Reiss 1988; Reiss & Valenti-Hein 1990). Criterion levels of depression were evident in about four times as many aggressive as nonaggressive subjects. Anger was significantly associated with both aggression and depression. Although anger may play a mediational role in the correlation between aggression and depression, in this study there was a significant correlation even after the effects of anger were held constant. The findings provide an initial step toward improving diagnostic specificity when evaluating aggressive behaviour in people with mental retardation.

Assessment of a man with a dual diagnosis

This case assessment of a man with dual diagnosis exemplifies the use of recent psychological measures, computerized programs, and structured assessment, including the Reiss Screen for Maladaptive Behavior, the Psychopathology Inventory for Mentally Retarded Adults, the Apperceptive Personality Test, and the Residential Services Indicator. In this case, computerized scoring of two very different tests (the Reiss Screen and the Apperceptive Personality Test) yielded very similar results.

Doctors and AIDS

Just a year ago most authorities considered the chances of patients contracting AIDS from doctors and other healthcare workers a virtual impossibility. But last week a Florida woman who got AIDS from her dentist lay near death, and two Minneapolis physicians admitted they had treated hundreds of patients since being diagnosed with the virus. Although doctors are at far greater risk than patients, the Minneapolis cases renewed the debate over the right of sides to know each other's HIV status.

Identifying danger and anxiety expectancies as components of common fears

The hypothesis was the common fears can be analyzed into separate factors for danger and anxiety expectancies. Six scales were constructed to measure danger and anxiety expectancies for the fears of flying, heights, and public speaking. The internal reliabilities of the scales were assessed in Study 1. The unreliable items were then deleted, and the revised scales were assessed in Study 2. The revised scales were found to have a satisfactory degree of internal consistency and test/retest reliability. For each fear, the items of the danger and anxiety expectancy scales were pooled and then submitted to a factor analysis. The danger and anxiety expectancy scales formed separate factors for each fear. The results were near-perfect; 51 of 53 items had factor loadings that were consistent with the distinction between danger and anxiety expectancies. It also was found that danger and anxiety expectancies are specific for each fear; that is, a person can have one fear that is danger-based and another that is anxiety-based. The findings have implications for understanding fears. Future research is suggested to test Reiss and McNally's (1985) hypothesis that desensitization might be more effective than credible placebo in the treatment of danger-based fear but that both desensitization and credible placebo are about equally effective in the treatment of anxiety-based fear.

Social skill deficiencies associated with depressed mood of mentally retarded adults

Specific social skill deficiencies associated with depressed mood were identified in a group of 45 mentally retarded adults with mixed or no psychiatric diagnoses. Self-report and informant-rated measures of social skills, social support, and depressed mood were obtained. One set of results replicated previous findings that high levels of depressed mood are associated with poor social skills and low levels of social support. Another set of findings identified 30 social skill deficits associated with depressed mood. We found that the retarded subjects with depressed mood were withdrawn and interacted less with others and that their social interactions were more inappropriate and ineffective. Some instances of antisocial behavior might be motivated by depressed mood.

Psychosocial correlates of depression in mentally retarded adults: II. Poor social skills

This is the second report on the results of an investigation of the psychosocial correlates of depression in mildly mentally retarded adults. Results of the present study showed that depression was associated with informant ratings of poor social skills. The results of the entire investigation suggest that further research is necessary on the associations among poor social skills, low levels of social support, and the occurrence of depression in mentally retarded adults.

Surfactants: a survey of short-term genotoxicity testing

The available results for tests on over 200 surfactants in nine short-term genotoxicity assay systems were reviewed. These tests included the Salmonella/microsome mutation assay, bacterial DNA repair tests, mitotic recombination in Saccharomyces cerevisiae, the mouse lymphoma cell-mutation assay, unscheduled DNA synthesis and sister chromatid exchange assays in mammalian cells, mammalian chromosome damage tests in vitro and in vivo, the dominant lethal test in rodents, and mammalian cell-transformation tests. The collected data cover all four major classes of surfactants: anionic, cationic, nonionic and amphoteric. The results of these genotoxicity tests were overwhelmingly negative. Although there were occasional positive results in bacterial or cell-transformation systems, the testing performed to date indicates that surfactants have negligible potential to cause genetic damage. The available data also indicate that none of the assays were incompatible with testing surfactants for genotoxicity.

Awareness of negative social conditions among mentally retarded, emotionally disturbed outpatients

Many mentally retarded people experience negative social conditions for long periods in their lives. These include the stigmatizing effects of being labeled mentally retarded, rejection and ridicule, segregation, infantilization, social disruption, restricted opportunities, and victimization. Many mildly and some moderately retarded people are highly aware of these negative social realities and can articulate them in detail during psychotherapy interviews; the authors describe three such patients. There is a need for research on the possible effect of prolonged exposure to negative social conditions on the mental health of mentally retarded persons.

Diagnostic overshadowing and professional experience with mentally retarded persons

Possible associations between professional experience with mentally retarded people and diagnostic overshadowing were evaluated. In a 3 X 2 factorial experiment, psychologists at state developmental disabilities facilities (high-experience group), psychologists at state mental health facilities (moderate-experience group), and clinical graduate students (low-experience group) rated a case history of a person with schizophrenia on 11 scales of psychopathology. For approximately half of the subjects within each group, the client was mentally retarded in addition to schizophrenic; for the remaining subjects, the client had average intelligence. Professional experience was associated with diagnostic ratings but not with overshadowing. We concluded that diagnostic overshadowing is unrelated to a broad range of professional experience with retarded people.

Generality of diagnostic overshadowing across disciplines

In a 2 X 2 experimental design, advanced students in social work and clinical psychology rated the same case description of a debilitating fear on eight scales of psychopathology and need for therapy. The fear was rated as less neurotic, less irrational, and less likely to require desensitization therapy when the client was mentally retarded vs. of average intelligence. There were no significant differences in the ratings of the students in clinical psychology vs. social work. The results suggest that diagnostic overshadowing is not specific to the discipline of psychology and point to the need for explicit training of future mental health professionals in diagnosing emotional disturbances accompanying mental retardation.

Emotional disturbance and mental retardation: diagnostic overshadowing

Two experiments evaluated the effects of the condition of mental retardation on psychologists' impressions of emotional problems of a retarded subject. In Experiment 1 we found that the same debilitating phobia was less likely to be considered an example of a neurosis or an emotional disturbance when the subject also was suggested to be mentally retarded as compared to intellectually average. Experiment 2 provided a conceptual replication of the results of Experiment 1 and extended findings of diagnostic overshadowing to cases involving schizophrenia and personality disorder. The magnitude of these effects did not differ significantly as a function of whether the case description suggested schizophrenia or personality disorder. The results validate the existence of a diagnostic overshadowing phenomenon.

Bronchial effects of aerosolized delta 9-tetrahydrocannabinol in healthy and asthmatic subjects

Effects on airway dynamics, heart rate, and the central nervous system of various doses of delta9-tetrahydrocannabinol administered in a random, double blind fashion using a Freon-propelled, metered-dose nebulizer were evaluated in 11 healthy men and 5 asthmatic subjects. Effects of aerosolized delta9-tetrahydrocannabinol were compared with aerosolized placebo and isoproterenol and with 20 mg of oral and smoked delta9-tetrahydrocannabinol. In the normal subjects, after 5 to 20 mg of aerosolized delta9-tetrahydrocannabinol, specific airway conductance increased immediately, reached a maximum (33 to 41 per cent increase) after 1 to 2 hours, and remained significantly greater than placebo values for 2 to 3 hours. The bronchodilator effect of aerosolized delta9-tetrahydrocannabinol was less than that of isoproterenol after 5 min, but significantly greater than that of isoproterenol after 1 to 3 hours. The magnitude of bronchodilatation after all doses of aerosolized delta9-tetrahydrocannabinol was comparable, but 5 mg of delta9-tetrahydrocannabinol caused a significantly smaller increase in heart rate and level of intoxication than the 20-mg dose. Smoked delta9-tetrahydrocannabinol produced greater cardiac and intoxicating effects than either aerosolized or oral delta9-tetrahydrocannabinol. Side effects of aerosolized delta9-tetrahydrocannabinol included slight cough and/or chest discomfort in 3 of the 11 normal subjects. Aerosolized delta9-tetrahydrocannabinol caused significant bronchodilatation in 3 of 5 asthmatic subjects, but caused moderate to severe bronchoconstriction associated with cough and chest discomfort in the other 2. These findings indicate that aerosolized delat9-tetrahydrocannabinol, although capable of causing significant bronchodilatation with minimal systemic side effects, has a local irritating effect on the airways, which may make it unsuitable for therapeutic use.