Tracking subtle stereotypes of children with trisomy 21: from facial-feature-based to implicit stereotyping

Trisomy 21 and Congenital Heart Disease: Impact on Health and Functional Outcomes From Birth Through Adolescence: A Scientific Statement From the American Heart Association

Due to improvements in recognition and management of their multisystem disease, the long-term survival of infants, children, and adolescents with trisomy 21 and congenital heart disease now matches children with congenital heart disease and no genetic condition in many scenarios. Although this improved survival is a triumph, individuals with trisomy 21 and congenital heart disease have unique and complex care needs in the domains of physical, developmental, and psychosocial health, which affect functional status and quality of life. Pulmonary hypertension and single ventricle heart disease are 2 known cardiovascular conditions that reduce life expectancy in individuals with trisomy 21. Multisystem involvement with respiratory, endocrine, gastrointestinal, hematological, neurological, and sensory systems can interact with cardiovascular health concerns to amplify adverse effects. Neurodevelopmental, psychological, and functional challenges can also affect quality of life. A highly coordinated interdisciplinary care team model, or medical home, can help address these complex and interactive conditions from infancy through the transition to adult care settings. The purpose of this Scientific Statement is to identify ongoing cardiovascular and multisystem, developmental, and psychosocial health concerns for children with trisomy 21 and congenital heart disease from birth through adolescence and to provide a framework for monitoring and management to optimize quality of life and functional status.

Awareness of down syndrome screening among educated Muslim women is associated with a favorable attitude toward testing

OBJECTIVE

There is a general assumption that Muslim women refuse Down syndrome screening, and therefore, many health practitioners do not offer it or briefly discuss it with their participants. This study aims to objectively assess women's awareness, knowledge, and attitudes toward Down Syndrome screening (D.S.S) in a Muslim-majority population.

METHODS

We conducted a cross-sectional study among attendees of antenatal clinics at a major university hospital in Saudi Arabia, aiming for a sample size of at least 385 Muslim women. A semi-structured questionnaire assessed awareness of different D.S.S. options and the source of that information (2 items), specific knowledge of D.S.S. (14 items), and attitudes (4 items). The knowledge and attitudes scores were calculated using a five-level agreement Likert-type scale.

RESULTS

Among 434 participants, with an even distribution among all age groups and a majority of a college degree holder or higher (71%), 178 (41.0%) reported awareness of D.S.S. Factors associated with increased awareness were maternal age above 40 or those under 30, nulliparity, and extended family history of fetal congenital anomalies (P-value = 0.03,0.015, and 0.017, respectively). Recognized tests were ultrasound measurement of nuchal translucency (71.9%) and first-trimester serum screening (58.4%). The sources of knowledge were obstetricians (53.9%), followed by family and friends (27.0%). The overall mean ± SD knowledge score was 53.9 ± 8.7 out of 70, and the mean attitude score was 17.4 ± 2.9 out of 20. Having 1 or 2 children is associated with a higher knowledge score, and most participants who reported awareness of D.S.S. (51.7%) had a favorable attitude toward screening.

CONCLUSION

Awareness of D.S.S. among Muslim women is associated with favorable attitudes towards testing, contradicting the general assumption and highlighting the need for systematic education to increase awareness and subsequent testing uptake.

Adolescents' implicit and explicit attitudes toward their peers with genetic conditions

INTRODUCTION

Previous research has demonstrated that children lacking knowledge about genetic disorders may have harmful attitudes toward people with disabilities, but disability awareness can successfully modify these attitudes. We explored adolescents' implicit and explicit attitudes toward peers with genetic conditions to determine whether improved genetics/genomics literacy can mitigate the impact of ableism in this population.

METHODS

English-speaking adolescents (10-18 years) from British Columbia were invited to complete a Disability Attitudes Implicit Association Test (DA-IAT) and participate in a semi-structured focus group centering on a fictionalized vignette about an adolescent with Down syndrome. We used pragmatism as an analytical paradigm. Descriptive and inferential statistics were used to analyze DA-IAT and sociodemographic data; phronetic iterative analysis with constant comparison as a coding strategy for transcripts; and interpretive description to develop a conceptual model.

RESULTS

Twenty-two adolescents completed the DA-IAT and participated in one of four focus groups. Participants had a statistically significant implicit preference for non-disabled people (D-score = 0.72, SD = 0.44; t = 7.18, p < .00001). They demonstrated greater diversity in their explicit attitudes during the focus groups. Although participants articulated a positive attitude toward improved genetics education, results demonstrate their belief that social and personal interactions with disabled peers would be essential to address negative perceptions.

CONCLUSIONS

This study lays important groundwork to understand, explain, and influence the negative attitudes of adolescents toward individuals with disabilities. Findings will be used to inform the design of interventions that address biased perceptions of people with genetic disorders, with the goal of reducing prejudices and improving social interactions.

Explicit and implicit attitudes of occupational therapy workshops' staff towards people with intellectual disabilities

The aim of this article is to present explicit and implicit attitudes of occupational therapy (OT) staff towards people with intellectual disabilities. The study was conducted on a group of 77 OT employees. To explore the explicit attitude, the Conditional Respect for Persons with Disabilities Questionnaire (Kurtek, Roczniki Psychologiczne, 2018, 4, 327-344) was used, while to estimate the implicit attitude, the Intellectual Disability Attitudes Implicit Association Test was applied (Kurtek, Roczniki Psychologiczne, 2021, 1, 43-64). At the explicit level, OT staff tended to tolerate negative and overrate positive behaviours of people with intellectual disabilities, which indicates a tendency to favour the individuals. However, the opposite devalorizing tendency was observed at the implicit dimension, which indicates aversive ableism. Although the study confirmed the independence of the two dimensions of the personnel's attitude, relationships were observed between the disclosure of negativity towards antagonistic behaviours of the people with intellectual disabilities and a decrease in the level of their implicit devaluation.

Unconscious Bias among Health Professionals: A Scoping Review

BACKGROUND

Unconscious biases are one of the causes of health disparities. Health professionals have prejudices against patients due to their race, gender, or other factors without their conscious knowledge. This review aimed to provide an overview of research on unconscious bias among health professionals and to investigate the biases that exist in different regions of the world, the health professions that are considered, and the research gaps that still exist.

METHODS

We conducted a scoping review by systematically searching PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and AMED. All records were double-screened and included if they were published between 2011 and 2021.

RESULTS

A total of 5186 records were found. After removing duplicates (n = 300), screening titles and abstracts (n = 4210), and full-text screening (n = 695), 87 articles from 81 studies remained. Studies originated from North America (n = 60), Europe (n = 13), and the rest of the world (n = 6), and two studies were of global scope. Racial bias was investigated most frequently (n = 46), followed by gender bias (n = 11), weight bias (n = 10), socio-economic status bias (n = 9), and mental illness bias (n = 7). Most of the studies were conducted by physicians (n = 51) and nurses (n = 20). Other health care professionals were rarely included in these studies.

CONCLUSIONS

Most studies show that health professionals have an implicit bias. Racial biases among physicians and nurses in the USA are well confirmed. Research is missing on other biases from other regions and other health professions.

The importance of disability representation to address implicit bias in the workplace

Introduction

People are disabled by barriers in society, not by their impairment. Barriers can be physical or be caused by people's implicit and explicit attitudes towards people with disabilities.

Methods

We utilise the Implicit Association Test to investigate implicit attitudes towards people with disabilities among Human Resource professionals and people involved in making hiring decisions.

Results

We find no significant differences between people who work for large companies or Small- to Medium-sized Enterprises. Similarly, working in Human Resources (or making recruitment decisions) has no effect on implicit bias. We supply the first evidence linking a person's own health status (measured using EQ-5D-5L) to their implicit bias. We find that a worse health status is associated with lower implicit bias towards people with disabilities. In addition, we find women have lower implicit bias than men.

Discussion

The discussion reflects on the need for greater disability representation within the workplace - especially in making hiring decisions.

Prospects for limiting access to prenatal genetic information about Down syndrome in light of the expansion of prenatal genomics

Down syndrome (Trisomy 21) is a mild to moderate intellectual disability. Historically, this condition has been a primary target for prenatal testing. However, Down syndrome has not been targeted for prenatal testing because it is an especially severe illness. The condition was just one that could be easily identified prenatally using the techniques first available decades ago. We are moving into an era in which we can prenatally test for a vast range of human traits. I argue that when we can test for anything, there is no longer any reason to continue targeting Down syndrome. I present an argument based on the value of nondiscrimination. It is justified to set limits on access to prenatal information if the information is going to be used for discriminatory purposes. I use the examples of (1) prenatal testing for misogynistic fetal sex selection, and (2) homophobia-motivated prenatal testing for potential homosexuality, as compelling analogies.

A reassessment of Jackson's checklist and identification of two Down syndrome sub-phenotypes

Down syndrome (DS) is characterised by several clinical features including intellectual disability (ID) and craniofacial dysmorphisms. In 1976, Jackson and coll. identified a checklist of signs for clinical diagnosis of DS; the utility of these checklists in improving the accuracy of clinical diagnosis has been recently reaffirmed, but they have rarely been revised. The purpose of this work is to reassess the characteristic phenotypic signs and their frequencies in 233 DS subjects, following Jackson's checklist. 63.77% of the subjects showed more than 12 signs while none showed less than 5, confirming the effectiveness of Jackson's checklist for the clinical diagnosis of DS. An association between three phenotypic signs emerged, allowing us to distinguish two sub-phenotypes: Brachycephaly, short and broad Hands, short Neck (BHN), which is more frequent, and "non-BHN". The strong association of these signs might be interpreted in the context of the growth defects observed in DS children suggesting decreased cell proliferation. Lastly, cognitive assessments were investigated for 114 subjects. The lack of association between the presence of a physical sign or the number of signs present in a subject and cognitive skills disproves the stereotype that physical characteristics are predictive of degree of ID.

Attitudes Toward People With Intellectual Disability Associated With Integrated Sport Participation

Direct, meaningful contact with people with intellectual disability, such as through integrated sport, may be related to positive attitudes. The current study aimed to compare implicit (unconscious) and explicit (conscious) attitudes between adults involved in integrated sport events and those in a comparison group who were not and examine the association between attitudes and degree of integrated sport involvement. An online survey measuring attitudes was completed by 295 adults without intellectual disability who participated in integrated sport activities and 450 adults who did not. Individuals involved in integrated sport reported less negative behavioral and affective attitudes relative to the comparison group, with mixed results for cognitive attitudes. Groups did not differ on implicit attitudes. Greater integrated sport involvement was related to some aspects of explicit attitudes. Involvement in integrated sport may be linked to how participants view intellectual disability, which has important implications for enhancing social inclusion and informing positive attitudes.

The Prevalence of Congenital Heart Diseases in Syndromic Children at King Khalid National Guard Hospital from 2005 to 2016

Background Congenital heart diseases (CHDs) are abnormalities that present in the heart since birth and are one of the leading causes of infant mortality in the world. CHDs are more common among children with dysmorphic syndromes. The current study aims to estimate the prevalence of many CHDs in different dysmorphic syndromes. Methods This was a retrospective chart review study conducted on all dysmorphic syndrome patients who attended genetic clinics at King Khalid National Guard Hospital in King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia from 2005 to 2016. Dysmorphic pediatric patients less than 14 years old who had genetic testing to confirm their diagnosis were included in the study. Patients who did not have any previous echocardiography were excluded. Results A total of 212 individuals (47% males and 53% females) were included. Eighty-five percent of Down syndrome patients had CHDs, and the most common CHD was an atrial septal defect (ASD) (51%). In patients with Turner syndrome, 45% of them had CHDs, and bicuspid aortic valve (BAV) (40%) was the most common defect. In DiGeorge syndrome, 81% of patients had CHDs, and ventricular septal defect (VSD) (41%) was the most common. In Williams syndrome, 83% of patients had CHDs. All patients with Noonan, Edwards, CHARGE (coloboma, heart defects, atresia choanae (also known as choanal atresia), growth retardation, genital abnormalities, and ear abnormalities), and Rubinstein-Taybi syndromes were found to have CHDs. In Patau syndrome and Joubert syndrome, 50% of patients in each had CHDs. Patients with Prader Willi syndrome had normal findings in the echocardiogram. Conclusion The highest prevalence of CHDs was found in Down syndrome. This study has a significant impact on the future of managing and directing the resources to improve the quality of life for syndromic patients. Further studies are needed to confirm these findings and to increase the local data in the field of CHDs in Saudi Arabia among syndromic patients.

Impact of an Inclusive Postsecondary Education Program on Implicit and Explicit Attitudes Toward Intellectual Disability

People with intellectual disability (ID) experience negative consequences as a result of stigmas held by the public. Students with ID involved in inclusive postsecondary education (IPSE) programs demonstrate positive outcomes. This study examines the impact of an IPSE program on typically matriculating student attitudes toward ID. Explicit and implicit attitudes were measured at the start and end of a semester among IPSE volunteer peer mentors (n = 17) and an uninvolved student group (n = 14). Findings indicate that volunteers demonstrated lower discomfort after their volunteer experience, as measured by the Attitudes Toward Intellectual Disability Questionnaire (ATTID). Volunteers also demonstrated higher knowledge of causes and preference for interaction with people with ID than nonvolunteers. This demonstrates that volunteer involvement in IPSE positively impacts attitudes toward people with ID among typically matriculating college students.

Pre- and In-Service Teachers' Attitudes Toward Students With Learning Difficulties and Challenging Behavior

The implementation of inclusive policies is largely dependent on teachers' willingness to accommodate students with special educational needs (SEN) in mainstream classrooms, which is affected by their perceived competence and attitudes. This study investigated attitudes of pre- and in-service teachers toward students with two types of SEN: challenging behavior and learning difficulties. The three components of attitudes (affective, cognitive, and behavioral) were assessed using indirect and direct measures. Results revealed that teachers held negative implicit attitudes toward challenging behavior and learning difficulties, however, implicit attitudes did not vary as a function of the type of SEN. Ratings of the stereotypical dimensions warmth and competence and overall ratings of scholastic achievement were affected by professional status and type of SEN. Professional status, implicit attitudes, and stereotypical knowledge together explained 52 and 43% of the variance in teachers' ratings of academic proficiency for students with challenging behavior and learning difficulties, respectively. Results are interpreted within the theoretical framework and implications for teacher training are discussed.

Explicit and implicit attitudes towards people with intellectual disabilities: The role of contact and participant demographics

BACKGROUND

Intellectual disability research has concentrated on self-reported explicit attitudes with little focus on implicit attitudes. Such attitudes are evaluations which occur with or without conscious awareness, respectively. This investigation examined participants' (N = 234) attitudes towards individuals with intellectual disabilities with reference to participants' gender, age, level of education, frequency of contact and closeness.

METHOD

UK adults completed explicit (ATTID) and implicit attitude (ST-IAT) measures, and provided demographics via an online survey.

RESULTS

Participant demographics predicted explicit attitudes-with differing cognitive, affective and behavioural associations. Contact frequency was most significant. Implicit attitudes were not predicted, evidencing implicit-explicit attitude differences.

CONCLUSIONS

The results encourage more implicit-explicit attitude relationship research regarding disability. The associations between demographics, contact and implicit attitudes should be explored further. Research should question whether implicit attitudes reflect participants' true beliefs-denoting less importance to demographics-or whether they reflect wider societal values rather than individuals' attitudes.

Implicit theories concerning the intelligence of individuals with Down syndrome

Studies over the past three decades have shown that learning difficulties are not only determined by neurological disorders, but also by motivational and/or socio-cognitive factors Among these factors, implicit theories of intelligence (also referred to as conceptions, mindsets or beliefs about intelligence) are key elements. The belief that intelligence is fixed (entity theory), as opposed to malleable (incremental theory), is generally associated with negative teaching practices and poorer student outcomes, yet beliefs about the intelligence of individuals with intellectual disabilities have not received much attention. We propose the first study on conceptions of intelligence of persons with intellectual disabilities, here people with Down syndrome. Participants were 55 professionally qualified people working with individuals with intellectual disabilities and 81 adults from the community. We compared what both groups of participants believe about intelligence of typical people and what they believe about the intelligence of individuals with Down syndrome. We also investigated implicit theories of intelligence as predictors of explicit judgments about intelligence and implicit attitudes toward people with Down syndrome. Whatever the work experience in the field of intellectual disability, implicit theories of intelligence were found to be less incremental when considering people with Down syndrome than when considering typical people; and the stronger the belief in entity theory, the more negative (and less positive) the judgments expressed explicitly. Implicit theories of intelligence were also found to be predictors of negative implicit attitude but only in adults from the community. These findings offer prospects for improving practices by people working in the field of intellectual disability. They might interest a wide range of people caring for people with intellectual disabilities, such as teachers, but also other professional caregivers, and other scientists focusing on intellectual disabilities or social cognition.

Implicit stereotyping against people with disability

Focusing on the two fundamental dimensions underlying stereotype content (warmth/competence), the major aim of the present research was to test implicit stereotyping toward persons with disability. We hypothesized that persons with disability are associated with less warmth than persons without disability and with less competence, especially when a competence-relevant context is activated (work context). Three experimental studies were conducted using two different priming paradigms: conceptual priming (Study 1) and evaluative priming (Studies 2 and 3). In Study 3, context (work vs. control) was introduced as an additional factor. Our results showed that persons with disability were systematically associated with less warmth than persons without disability, and with less competence when priming a work context. These results provide a more comprehensive understanding of discriminatory behaviors toward people with disability, despite legislation promoting equal rights.

"This lifetime commitment": Public conceptions of disability and noninvasive prenatal genetic screening

Recently, new noninvasive prenatal genetic screening technologies for Down syndrome and other genetic conditions have become commercially available. Unique characteristics of these screening tests have reignited long-standing concerns about prenatal testing for intellectual and developmental disabilities. We conducted a web-based survey of a sample of the US public to examine how attitudes towards disability inform views of prenatal testing in the context of these rapidly advancing prenatal genetic screening technologies. Regardless of opinion toward disability, the majority of respondents supported both the availability of screening and the decision to continue a pregnancy positive for aneuploidy. Individuals rationalized their support with various conceptions of disability; complications of the expressivist argument and other concerns from the disability literature were manifested in many responses analyzed.

Oral and craniofacial clinical signs associated to genetic conditions in human identification part I: a review

BACKGROUND

Forensic dentistry is one of the most reliable methods used in human identification when other technique as fingerprint, DNA, visual identification cannot be used. Genetic disorders have several manifestations that can target the intra-oral cavity, the cranio-facial area or any location in the human body.

MATERIALS AND METHODS

A literature search of the scientific database (Medline and Science Direct) for the years 1990 to 2014 was carried out to find out all the available papers that indicate oral, cranio-facial signs, genetic and human identification.

RESULTS

A table with 10 genetic conditions was described with oral and cranio-facial signs that can help forensic specialist in human identification.

CONCLUSION

This review showed a correlation between genetics, facial and intra-oral signs that would help forensic ondontologist in the identification procedures.

Misleading face-based judgment of cognitive level in intellectual disability: the case of trisomy 21 (Down syndrome)

People spontaneously use faces to make inferences about other's personality traits or abilities, which generally lead to invalid conclusions. Here, we show first evidence that perceived variations in the facial appearance of 20 children with trisomy 21 (t21) influence how they are perceived in terms of intelligence (or intellectual disability), the more "trisomic" faces being rated as less intelligent (or more intellectually disabled). Despite high degrees of inter-rater agreement (80 raters), these inferences were unrelated to individuals' actual test scores which were also unrelated to perceived facial appearance. All these findings indicate that social inferences about intelligence based on facial appearance are unreliable even in groups characterized by a genetic disorder such as t21.

Attitudes towards individuals with disabilities as measured by the implicit association test: a literature review

Research investigating attitudes towards individuals with disabilities has largely focused on self-reported explicit attitudes. Given that factors such as social desirability may influence explicit attitudes, researchers have developed tools which instead assess less consciously controllable implicit attitudes. Considering research on implicit attitudes thus seems pertinent. A review of studies measuring implicit attitudes towards individuals with physical disabilities (visual, motor or hearing) or intellectual disabilities via the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998) was carried out. Systematic searches of PsycINFO, CINAHL, EMBASE, ERIC, MEDLINE, PUBMED, Scopus and Web of Science databases identified relevant articles published between January 2000 and September 2012. Seventeen articles (reporting on 18 studies that employed the IAT) were identified. These investigated implicit attitudes towards individuals with; physical disabilities (N=13), intellectual disabilities (N=3), both physical and intellectual disabilities (N=1), and 'unspecified disabilities' (N=1). Across all studies, moderate to strong negative implicit attitudes were found and there was little to no association between explicit and implicit attitudes. Individuals' beliefs about the controllability of their future, sensitivity to the concept of disease, and contact with individuals with disabilities appear to be associated with implicit attitudes. A consistent pattern of moderate to strong negative implicit attitudes towards individuals with disabilities was evident. These studies provide a starting point, but methodological issues related to sampling and the employed IATs limit the generalizability of these results. Further research investigating implicit attitudes towards specific disability types, with a wider subject pool are necessary as well as further investigation of factors that contribute to these attitudes.