Cognitive reserve proxies for individuals with intellectual developmental disability: A scoping review

BACKGROUND

Cognitive reserve (CR) has not been studied in people with Intellectual Developmental Disability, a population with a high incidence of dementia. Commonly adopted CR proxies should be adapted to reflect more specifically the experiences of people with Intellectual Developmental Disability.

METHOD

This scoping review intended to identify CR proxies relevant to people with this condition.

RESULTS

Some of these were the same already detected in a population without intellectual disabilities (education, occupation, physical activity, leisure, community and social activities); others were found to be specifically relevant for this population: type of schooling, parental educational level, environmental stimulation and living place.

CONCLUSIONS

These proxies need to be considered in studies on CR and Intellectual Developmental Disability and in clinical practice. Research on the protective effect of CR aims to encourage policies promoting lifestyle-based educational and preventive interventions and overcome participation barriers for people with Intellectual Developmental Disability.

The Social Networks and Activity Patterns of Adults with Severe Disabilities: A Correlational Analysis

This article reports information on the interrelations among measures of lifestyle quality for 20 adults with severe disabilities living in the community. Using two interview-based measures, data were collected on the social networks and activity patterns of the participants. The results indicate that the overall size of the social networks and the number of family members were highly associated with a greater frequency and variety of activities across home and community settings. The results also indicate that neither the number of social network members paid to provide support, nor the number of friends were significantly related to activity patterns. Finally, implications for measuring lifestyle quality and the use of outcome-based measures for assisting people to build and maintain social relationships are presented.

Honoring Activity Preferences in Individualized Plan Development: A Descriptive Analysis

The activity preferences of 15 adults with intellectual disabilities from eight community-based residential programs were assessed by the participants themselves, residential program staff, and advocates. The study provides descriptive information concerning the degree to which participants' perceived activity preferences were subsequently included in their Individualized Habilitation Plans (IHPs). Results indicate that 78% of participants' IHP objectives were preferred activities. Further analyses revealed that preferred activities requiring a greater degree of staff support were included on the IHP as training objectives, and preferred activities that participants performed infrequently were included as participation objectives. The study indicates a need for more information about how to assess and honor the preferences of people with severe disabilities.

Building an Ecology of Support: A Case Study of One Young Woman with Severe Problem Behaviors Living in the Community

This case study describes 30 months in the life of a young woman with a history of life-threatening self-injurious behaviors (SIB) who moved from a large public institution to her community. Quantitative and qualitative research methods were employed to provide a nonexperimental description of her behavior and lifestyle in the community. Quantitative measurements included: (a) activity patterns, (b) social network, (c) self-injurious behaviors, (d) aggression against others, and (e) staff changes. Qualitative results emerged from semistructured interviews and participant observations conducted over a 6-month period. Together, these data revealed a young woman actively involved in a lifestyle characterized by an increase in the frequency and diversity of activities performed in the community. Problem behaviors occurred at low levels for extended periods, yet there continued to be times with major regression. Qualitative results also indicate a general reduction in the intensity of self-injurious behaviors. Results are discussed in terms of the importance of multicomponent positive interventions, the need to design environments that promote lifestyle changes, and the value of collaboratively employing quantitative and qualitative research methods.

Application of a Lifestyle Development Process for Persons with Severe Intellectual Disabilities: A Case Study Report

This report summarizes the results of four data-based case studies that examined the efficacy of the Lifestyle Development Process (LDP) for persons with severe disabilities. The process involves five steps, described in detail in the paper. The planning process was implemented by means of a consultant model, and involved planning meetings, on-site visits, in-service training, problem solving, written program planning, and demonstrations of instructional techniques. The consulting teams were composed of educational and behavioral consultants. Four persons with severe disabilities and challenging behaviors were participants. These individuals resided in four communities in the Province of British Columbia, and received consultative services from 1989 through 1991. All four individuals engaged in a greater number of preferred, integrated activities during the mid- and posttests than at baseline. Their social networks and program quality scores also showed various degrees of improvement. The behavior problems that were reported at the referral stage were substantially reduced at the posttest for all individuals. These results are discussed in relation to previous research in the areas of lifestyle planning and behavior management. Problems in implementing the process by means of a consultant model are also discussed, and areas for future research are identified.

Self-Determination for Individuals with the Most Severe Disabilities: Moving beyond Chimera

Individuals with the most severe disabilities may be unsuccessful in effecting changes in their environment for various reasons. Because of limitations in cognitive and expressive language skills, their attempts at communicating may be overlooked or misunderstood, or may be knowingly or inadvertently obstructed. Consequently, self-determination is often dependent on our interpretation of what people with the most severe disabilities are communicating. This article explores the implications of making interpretations, the need for such interpretations, and the dangers. Current progress in supporting and promoting self-determination are acknowledged. It is suggested that although these procedures may be intended to increase self-determination, they do not automatically do so. In fact, they may function to limit self-determination. Strategies and methodologies must be critically evaluated to ensure that such efforts reflect the tenets and spirit of self-determination.

Compatibility of person-centered planning and applied behavior analysis

In response to Osborne (1999), the aims and practices of person-centered planning (PCP) are compared to the basic principles of applied behavior analysis set forth by Baer, Wolf, and Risley (1968, 1987). The principal goal of PCP is social integration of people with disabilities; it qualifies as a socially important behavior, and its problems have been displayed sufficiently. However, social integration is a complex social problem whose solution requires access to system contingencies that influence lifestyles. Nearly all of the component goals of PCP proposed by O'Brien (1987b) have been reliably quantified, although concurrent measurement of outcomes such as friendship, autonomy, and respect presents a formidable challenge. Behavioral principles such as contingency and contextual control are operative within PCP, but problems in achieving reliable implementation appear to impede an experimental analysis.

Investigating the validity of a structured interview protocol for assessing the preferences of children with autism spectrum disorders

PURPOSE

To investigate the congruent validity of a structured interview protocol for assessing the preferences of seven children with autism spectrum disorder (ASD).

METHOD

Using the structured interview protocol described by Green et al., parents were asked to provide a rank ordering of their child's preferred foods, drinks, toys and sensory stimuli. The resulting rank order was then compared to the results of a multiple-stimulus without replacement preference assessment by calculating the Spearman rank order correlation coefficients.

RESULTS

The results revealed a high level of correspondence between the rank orderings of both assessments for four of the six participants for food and drink items and four of the seven participants for play items and sensory stimuli.

CONCLUSION

Results support the use of the structured interview protocol to determine the preferences of children with ASD. Practical implications and directions for future research are discussed.

The role of residential homelikeness in promoting community participation by adults with mental retardation

We tested the influence of (1) the homelike appearance of residences, (2) residential staff-members' attitudes about people with mental retardation and (3) Client IQ on the number of activities adults clients with mental retardation conducted in their community. We tested the hypothesis these three variables exerted their influence by promoting positive staff-member interactions with clients. This was assessed by measuring the duration of Staff-initiated Social Interactions with residential clients. In our initial path model, Residential Homelikeness, Positive Staff Attitudes and Client IQ had no significant direct effect on Community Activities. In the final model, however, Residential Homelikeness and Positive Staff Attitudes exerted a statistically significant influence on Staff-initiated Social Interactions with clients, which in turn, exerted a statistically significant influence on Community Activities. This model illustrated: (1) the nearly equal influence of Staff Attitudes and architectural characteristics on Staff-initiated Interactions; and (2) the role of Staff-initiated Interactions in mediating the influence of Residential Homelikeness on community participation by adults with developmental disabilities.

Alzheimer dementia in Down's syndrome: the relevance of cognitive ability

More years of education have been found to be associated with a lower rate of Alzheimer disease (AD) in individuals without intellectual disability. It has been proposed that education reflects greater 'synaptic reserve' and that greater synaptic reserve may defer the development of AD. The present study compared individuals with Down's syndrome (DS) who were found to have symptoms of dementia with those who remained symptom-free to determine if the two groups differed in their level of education, employment, recreational activities, years in an institution or overall level of cognitive functioning. Thirty-five adults with DS aged between 29 and 67 years were assessed. The participants were recruited from a community health facility and included individuals with a wide range of ability levels. Neuropsychological testing, caregiver report and the Dementia Scale for Down Syndrome (Gedye 1995) were used to identify decline in participants over periods of 6 months to 3 years. After the effect of age was statistically removed, multiple regression analyses revealed that level of cognitive functioning was significantly associated with decline such that a higher level of cognitive functioning predicted less decline. None of the environmental variables (i.e. educational level, years in an institution and employment) were directly associated with decline; however, a post hoc regression using level of cognitive functioning as the outcome variable revealed that level of cognitive functioning itself was associated with these environmental variables. A higher level of cognitive functioning was associated with fewer cases of dementia in individuals with DS, and level of cognitive functioning appears to be associated with environmental factors such as level of education, years in an institution and employment. The present findings suggest that environmental interventions aimed at improving level of cognitive functioning may also be useful in deferring the onset of dementia.

Feedback to staff on resident lifestyle. A descriptive analysis

Providing feedback has been found to affect the behavior of staff of school and community programs. The present article presents a descriptive analysis of feedback provided to staff members concerning the lifestyle of 33 participants in 18 community residential programs in Oregon. Staff from four cohorts of programs were trained to monitor the physically and socially integrated activities experienced by program participants, and to review those data at weekly meetings. Examination of the results before and after programs had used the monitoring system indicated increases in the average number of community activities experienced by participants, the average number of activities they did with community people, the size of their social networks, and the number of individuals they identified as friends. Results were discussed in terms of the role of feedback in improving community support, the need for further research for understanding staff behaviors responsible for observed gains, and the need to better understand the relationship between observed patterns of activities and individual quality of life.

Validating predicted activity preferences of individuals with severe disabilities

We examined the accuracy of 24 staff members' predictions of activities preferred by 14 individuals with severe disabilities. For each of 144 activities, staff members assigned a client preference rating of "likes a lot," "likes," or "dislikes." Two activities from each category were randomly selected for each individual with disabilities. Pairs of selected activities were presented to the individuals, who were prompted to choose an activity. Staff members' activity preference ratings correctly predicted the choices made by the individuals with disabilities for 78% of the trials. The more divergent the preference ratings of the paired activities, the more likely staff members were to predict correctly the activity selected by a participant.