Academic literature on the topic 'Intellectually handicapped'

The view is put that the least restrictive environment and the most appropriate climate for intellectually handicapped adolescents and young adults can be found or created in Colleges of Technical and Further Education in New South Wales and indeed across Australia. Such provision may also be the most appropriate for other categories of handicap, disability or disadvantage.There is still a tendency for the community at large to underestimate the potential of handicapped young people for development. Research, not generally well known and therefore not acted upon, shows that despite poor initial performance, many intellectually handicapped people show substantial improvement with learning.

It is now generally agreed that the words ‘handicapped individual’ need to be considered as having a social rather than a medical or educational meaning. To arrive at such a conclusion, however, it is necessary briefly to consider the words ‘impairment’, ‘disability’ and ‘handicap’ (Figure 1).

Four adult, moderately intellectually handicapped persons who lived independently in the community were trained in safe exiting from their bedrooms in the event of fire. Baseline levels of competence were low, typically less than 20% of steps correct. Training was introduced to each trainee following a multiple probe across subjects design. Failures to complete a step were followed by video prompting in which the trainee watched a video of a model (an intellectually handicapped male) demonstrate the correct performance of the step. Acquisition required at most 10 sessions, the skills transferred to another residence and to the trainee's bedroom, and were maintained at 5 weeks.

The purpose of this investigation was to examine the transparency and recall of symbols representing three parts of speech (nouns, verbs, descriptors) from three different graphic symbol systems (Blissymbols, Picture Communication System, and Picsyms) among adults with intellectual handicaps. Results suggested that the Picture Communication System (PCS) and Picsyms were more transparent and easier to learn than Blissymbols. Subjects correctly identified significantly fewer Blissymbols representing nouns than either PCS or Picsyms representing nouns. In early stages of recall for nouns, PCS and Picsyms were significantly easier to recall than Blissymbols. Implications of the data for symbol system selection use for persons with severe speech impairments are discussed.

This study addressed the question of whether there is a specific reaction time deficit in individuals with Down syndrome. To investigate this question, the manual and vocal reaction times of 18 Down syndrome and 2 control groups were compared. One control group consisted of intellectually handicapped children matched on intellectual ability, the other consisted of younger nonhandicapped children also of similar mental age. The results confirmed that a specific RT deficit does indeed exist and is present for both manual and vocal responses.

In 1980 Jackson and Knowles presented a paper at the Australian Group for the Study of Mental Deficiency [A.G.S.O.M.D.] conference in Launceston, Tasmania. The paper, titled "Primary School Children's Perceptions and Understandings of Mental Retardation", reported in detail responses on twenty questions from the sixty-three item questionnaire instrument used in their study. These twenty questions reflected stereotyped responses of an alarming nature. If these responses were a reflection of how Australian children generally thought, then integration of the intellectually handicapped child into mainstream classes would be counter productive. The current study was initiated to help assess the attitudes of Australian Capital Territory children to the Intellectually Handicapped. The twenty significant questions from the Tasmanian study were formed into a questionnaire and administered to 769 children in Years 3 and 6 from six Government and two Catholic schools in the Australian Capital Territory. In most cases the results were in direct contrast to those obtained in Tasmania. At first glance this meant that the attitudes of Australian Capital Territory children towards the Intellectually Handicapped were much less stereotyped than those of Tasmanian children. Further investigation, however, led to the discovery that the results from the Tasmanian study were spurious. The date had not been accurately computerized, giving a result that was probably the reverse of what Tasmanian children actually thought. Four supplementary hypotheses, comparing the responses of Years 3 and 6 girls and boys, Government and Private schools, exposed and unexposed schools, were tested. The analysis of the data for these hypotheses supported, to some degree, past findings that older children and girls have less stereotyped attitudes towards the Intellectually Handicapped than younger children and boys. The responses of Government schools versus Private schools were varied. Three of the five significantly different responses indicated a less stereotyped view was held by Government school children, while two of these significant questions indicated a less stereotyped view was held by Private school children. With regard to exposed and unexposed schools, the two significantly different responses indicated less stereotyped views were held by the nonexposed children. Future directions are indicated in the sections dealing with Limitations and Future Directions.

The main purpose of this study was to investigate the range of beliefs that a certain group of South African parents held about the appropriate educational placement of their children with mild to moderate intellectual handicaps. The sample consisted of 14 parents of children with mild to moderate intellectual handicaps attending at a special school for intellectually handicapped children in a disadvantaged context in the Western Cape. In line with the qualitative approach, semi-structured interviews with open elided questions were used to collect the data. Interviews were used rather than questionnaires because parents were illiterate and they felt more comfortable and confident with a personal interview and were able to use their own language. The data were analyzed according to Glaser and Strauss' Constant Comparative method as described by Maykut and Morehouse (1994). As has been found in other research studies, the parents in this study were not in principle against mainstreaming or inclusion of their children. Rather, they were at present not supportive of it as they perceive the conditions at the ordinary school to be unstable for their children. The qualitative analysis outcome revealed that parents were concerned about· teacher qualities, acceptance of their children by the ordinary school children and the ordinary school curriculum which they felt was only focusing on academic subjects. Parent involvement and inclusion are central concepts in the reconstruction of education in South Africa. Inclusion of intellectually handicapped learners is being considered by policy makers but it is not likely to be successful without parent support. This study is a small contribution to the debate.

The general aim of the thesis is to show how The Situational Language Intervention Programme (SLIP) was formulated in order to include the critical factors of: the cognitive abilities and linguistic characteristics of the intellectually handicapped; pragmatics, semantics and syntax and the four models of language acquisition; the criteria that guide language intervention programme development; the use of precise and systematic teaching methods that stimulate the use of language in the students' environment. The general objective of both SLIP and this thesis is to show how to increase moderately to severely intellectually handicapped adolescents' language-communication through the appropriate use of the forms of language applied to its functions in a specific range of situations. Chapter Two of the thesis is concerned with the cognitive abilities of intellectually handicapped people and the implications of intellectual handicap on communication and language development. In addition it discusses, stage by stage, the positive and negative markers of language acquisition. These markers illustrate to the teacher the signs of linguistic retardation at each stage of language learning. The contents of Chapter Three provide an outline of the four models of language acquisition, i.e. Pragmatic, Semantic/Cognitive, Psycholinguistic/Syntactic and Behavioural. Those models contribute to our understanding of how language develops and illustrate to us the complex nature of language acquisition. In addition, this discussion documents the past and current research viewpoints and draws our attention to the limitations that existing theories have in providing a "full�blown" model of language acquisition. Furthermore, Chapter Three is stating that the recent analysis of language-training for communication disordered and intellectually handicapped students has shown that a more balanced study of the semantic and pragmatic factors in language acquisition is emerging. This chapter is urging teachers to re-analyze, re-evaluate and modify their language intervention programmes by integrating the syntactic, semantic and pragmatic factors. Both the contents of Chapters Two and Three are demonstrating that it is necessary to address the theoretical viewpoint and academic findings both of which are important aspects of the role of the interventionist. They have to be addressed if the teacher is to make judgments concerning the efficacy of different models in attaining certain goals. Such factors govern the utilization and integration of certain approaches and procedures. The contents of Chapters Four and Five discuss how the language interventionist can lead the intellectually handicapped student into increased language usage and communicative competence. Chapter Four is concerned with the current critical issues and developments in: curriculum and programme design for the moderately/severely intellectually handicapped adolescent; criteria to guide programme development and direction of language intervention; direct instruction techniques; augmentative communication systems and their basic programme guidelines. Chapter Five outlines the framework of the Situational Language Intervention Programme (SLIP) which was designed and implemented by the author. The content and procedures utilized by SLIP are greatly influenced by the contents of Chapters Two, Three and Four. This influence is demonstrated in the discussion concerning SLIP's: aims and objectives; content and design decisions; selection of forms to be taught; sequencing; teaching procedures and methods of instruction. Chapter Five also discusses the implementation of SLIP.

Thesen 1. Die vorliegende Arbeit beschäftigt sich mit der Enthospitalisierung geistig behinderter Langzeitpatienten aus dem Sächsischen Krankenhaus für Psychiatrie und Neurologie Altscherbitz. Inhaltliche Schwerpunkte der Untersuchung sind die Lebensqualität, die soziale Integration und die Rehospitalisierungen nach der Entlassung. 2. Es wurden 65 ehemalige Patienten auf der Grundlage der Krankenakte zum Enthospitalisierungszeitpunkt (zwischen 1991 und 1999) und anhand eines persönlichen Interviews und einer Aktenanalyse zum Erhebungszeitpunkt (2003) untersucht. Zur Kerndatenerfassung wurde ein standardisierter zweiteiliger Erhebungsbogen erarbeitet. Dabei wurden neben soziodemografischen und krankheitsbezogenen Daten das Geschlecht, das Alter und die Hospitalisierungsdauer einbezogen. Darüber hinaus kam das Berliner Lebensqualitätsprofil, ein daraus abgeleiteter Score für soziale Integration, die Nurses Observation Scale for Inpatients (NOSIE) und der Fragebogen zur Erfassung des individuellen Hilfebedarfs im Bereich Wohnen (HMBW) zur Anwendung. 3. Obwohl sie einen großen Anteil der Populationen von Langzeitpatienten ausmachten, fanden die geistig Behinderten in der psychiatrischen Forschung bisher nur wenig Beachtung. Es wurden deshalb auch Erkenntnisse aus anderen Fachgebieten, wie der Geistigbehindertenpädagogik, berücksichtigt. 4. Die hier untersuchten ehemaligen Patienten unterscheiden sich bezüglich soziodemografischer, biografischer und medizinischer Daten von der sonst in psychiatrischen Enthospitalisierungsstudien erfassten Klientel mit überwiegend schizophrenen Erkrankungen. Die geistig Behinderten wurden sehr früh, 72% vor dem 20. Lebensjahr, hospitalisiert. Die durchschnittliche Verweildauer betrug 28 Jahre (Range sechs bis 67 Jahre). Über die Hälfte der Patienten verblieben beim ersten stationären Aufenthalt dauerhaft in der Klinik. 19 Patienten hatten eine leichte, 46 eine mittelgradige geistige Behinderung. In 19 Fällen bestand eine neurologisch-psychiatrische Komorbidität, darunter acht Schizophrenien und acht Epilepsien. 62 Personen befanden sich zum Erhebungszeitpunkt in stationären Heimeinrichtungen mit 24-Stunden-Betreuung, zwei lebten in einer Außenwohngruppe eines Wohnheims und ein Patient war im Maßregelvollzug untergebracht. 5. Sie wiesen in der individuellen Lebensgestaltung (Bereich Wohnen) überwiegend einen sehr geringen bis geringen Hilfebedarf auf. Unterstützung war vor allem bei der Regelung finanzieller und rechtlicher Angelegenheiten erforderlich sowie beim Umgang mit fremden Personen und der Organisation von Terminen. 6. In dieser Arbeit wurden die geistig Behinderten selbst zu ihrer Lebensqualität befragt. Dazu liegen bisher nur wenige Erfahrungen vor. Es zeigten sich überwiegend sehr hohe Zufriedenheitswerte, die im Vergleich zu anderen psychiatrischen Enthospitalisierungsstudien noch höher lagen. Niedrigere Zufriedenheitswerte wurden nur im Bereich der finanziellen Situation geäußert und einige Probanden wünschten sich mehr Kontakt zu den Angehörigen. Bezüglich der objektiven Daten fällt auf, dass ein hoher Anteil (72%) einer Beschäftigung, meist in einer WfB, nachging. Die Freizeit wurde von vielen Bewohnern aktiv verbracht, z.B. verließen 95% regelmäßig die Wohnung und waren im Jahr vor der Erhebung 91% verreist gewesen. Über die Hälfte war in Einzelzimmern untergebracht, nur noch eine Bewohnerin in einem Mehrbettzimmer. 70% bejahten die Frage nach einem guten Freund. Kontakte zu „Normalbürgern“ wurden nur von 9% angegeben. 7. Es wurden verschiedene Einflußfaktoren auf die Lebensqualität analysiert, wobei sich jeweils nur wenige signifikante Unterschiede fanden. A) Alter zum Enthospitalisierungszeitpunkt: Die unter 50jährigen Bewohner hatten häufiger Kontakt zur Familie und einem Freund. Nur in dieser Gruppe gab es Kontakte zu „Normalbürgern“. B) Zeitdauer, die nach der Enthospitalisierung vergangen ist: Die länger Enthospitalisierten (>4 Jahre) gingen häufiger einer Arbeit nach und waren in der Freizeit aktiver. Sie hatten häufiger einen Freund. In der am längsten enthospitalisierten Gruppe war die Zufriedenheit mit der finanziellen Lage und der Aussicht, noch lange in der Einrichtung zu verbleiben, geringer. C) Hospitalisierungsdauer: Die kürzer Hospitalisierten (bis 40 Jahre kumulative Dauer) unterschieden sich von den länger Hospitalisierten darin, dass sie häufiger einer Arbeit nachgingen und in der Freizeit aktiver waren, sie hatten häufiger einen Freund. 8. Anhand des Scores für soziale Integration konnte eine Gruppe besser Integrierter und ein Gruppe schlechter Integrierter gebildet werden. Sie unterschieden sich signifikant hinsichtlich folgender Parameter: Die besser Integrierten waren jünger und kürzer hospitalisiert. Sie erreichten in der NOSIE höhere Werte für soziales Interesse und niedrigere Werte für Retardierung. Der Anteil mittelgradiger Intelligenzminderungen war höher. Sie waren länger enthospitalisiert. 9. 18 Bewohner mussten nach der Enthospitalisierung erneut stationär psychiatrisch behandelt werden, konnten aber nach Krisenintervention wieder entlassen werden. Die Rehospitalisierten unterschieden sich von den übrigen Bewohnern in folgenden Merkmalen: Die kumulative Dauer der Hospitalisierung war kürzer (23 Jahre vs. 31 Jahre). In der NOSIE wiesen sie höhere Werte betreffend das Item „Reizbarkeit“ auf. 10. Die Ergebnisse belegen, dass die Enthospitalisierung der hier untersuchten leicht und mittelgradig geistig Behinderten überwiegend erfolgreich war. Sowohl aus den hier gewonnenen Erkenntnissen, als auch in Übereinstimmung mit der psychiatrischen und sonderpädagogischen Literatur läßt sich weiterer Handlungsbedarf für Praxis und Forschung ableiten. Der Prozess der Ent-Institutionalisierung sollte zukünftig fortgesetzt und wissenschaftlich begleitet werden. Psychiatrische und sonderpädagogische Fachleute sollten hierbei im Interesse der geistig Behinderten kooperieren.

Le propos de la thèse est d’étudier le traitement social de la sexualité des personnes désignées comme « handicapées mentales » en Suisse et en France, par le biais d’une enquête qualitative réalisée par entretiens avec des personnes considérées comme « handicapées mentales », des parents, des éducateurs spécialisés et des assistants sexuels.Une première partie étudie les représentations des personnes désignées comme « handicapées mentales » au sujet de la sexualité et met en lumière des formes de leur vie sexuelle, souvent commentée mais qui restait inexplorée. Puis, la deuxième partie porte sur l’analyse des représentations et des pratiques institutionnelles et parentales relatives à l’accompagnement de la sexualité des personnes « handicapées mentales » dans le contexte actuel de la « santé sexuelle ». Enfin, la troisième partie de la thèse est consacrée à l’étude de l’assistance sexuelle telle que cette activité est récemment apparue en Suisse.En mobilisant le handicap mental et la sexualité comme des révélateurs mutuels, cette recherche se donne ainsi pour objectif d’analyser comment les différentes catégories d’acteurs impliqués dans l’accompagnement de la sexualité des personnes « handicapées mentales » co-construisent les normes qui régissent la vie sexuelle de ces dernières. Elle vise à offrir une étude la plus complète possible du traitement social de leur sexualité et des logiques qui le sous-tendent<br>The subject of this dissertation is to study the social construction of the sexuality of people labelled as « intellectually disabled » in Switzerland and in France by means of a qualitative survey realized through interviews with persons considered as « intellectually disabled », parents, specialized educators and sexual assistants.A first part deals with the analysis of the representations of persons labelled as « intellectually disabled » regarding sexuality and with bringing to light the forms of their sexual life, often commented but still unexplored. The second part aims at analyzing the institutional and parental representations and practices towards the sexuality of people considered as « intellectually disabled » in the current context of « sexual health ». Finally, the third part of this dissertation studies the recent activity of sexual assistance in Switzerland.By mobilizing intellectual disability and sexuality together, this research aims at analyzing how the different categories of actors implied in accompanying « intellectually disabled» people in their sexuality co-build the norms that govern their sexual life. It aims at proposing a complete study of the social treatment of their sexuality and the logics that underlie them

Little information is available on future vocational preparation for intellectually disabled learners in South African schools. Currently teachers adapt the Revised National Curriculum Statement (RNCS) to educate these learners. A literature study was conducted to investigate relevant models in the United States of America in order to develop a framework for a South African vocational training and transition planning programme in the school. Various South African vocational training programmes designed for disabled learners with good literacy and numeracy skills, the role of employment agencies and the local employment possibilities for intellectually disabled people were investigated to assess their suitability for intellectually disabled learners. An Individualised Vocational Programme that involves the parents and their child(ren) was developed to suit the needs of intellectually disabled learners. The RNCS was adapted by means of curriculum straddling and designing down to make the learning material suitable for intellectually disabled learners. The full programme consisted of an adapted interest test, curriculum training, the placement of learners in school jobs/tasks and a home independence programme, The programme was implemented and a mixed method research design facilitated the case study done in a school for severely intellectually disabled learners. Findings revealed that a vocational training and transition planning programme in the school can be managed successfully to the benefit of the parents, learners and the Department of Education. Based on the findings recommendations were made to improve the various sections of the comprehensive programme.<br>Educational Studies<br>D. Ed. (Educational Management)

Thesen 1. Die vorliegende Arbeit beschäftigt sich mit der Enthospitalisierung geistig behinderter Langzeitpatienten aus dem Sächsischen Krankenhaus für Psychiatrie und Neurologie Altscherbitz. Inhaltliche Schwerpunkte der Untersuchung sind die Lebensqualität, die soziale Integration und die Rehospitalisierungen nach der Entlassung. 2. Es wurden 65 ehemalige Patienten auf der Grundlage der Krankenakte zum Enthospitalisierungszeitpunkt (zwischen 1991 und 1999) und anhand eines persönlichen Interviews und einer Aktenanalyse zum Erhebungszeitpunkt (2003) untersucht. Zur Kerndatenerfassung wurde ein standardisierter zweiteiliger Erhebungsbogen erarbeitet. Dabei wurden neben soziodemografischen und krankheitsbezogenen Daten das Geschlecht, das Alter und die Hospitalisierungsdauer einbezogen. Darüber hinaus kam das Berliner Lebensqualitätsprofil, ein daraus abgeleiteter Score für soziale Integration, die Nurses Observation Scale for Inpatients (NOSIE) und der Fragebogen zur Erfassung des individuellen Hilfebedarfs im Bereich Wohnen (HMBW) zur Anwendung. 3. Obwohl sie einen großen Anteil der Populationen von Langzeitpatienten ausmachten, fanden die geistig Behinderten in der psychiatrischen Forschung bisher nur wenig Beachtung. Es wurden deshalb auch Erkenntnisse aus anderen Fachgebieten, wie der Geistigbehindertenpädagogik, berücksichtigt. 4. Die hier untersuchten ehemaligen Patienten unterscheiden sich bezüglich soziodemografischer, biografischer und medizinischer Daten von der sonst in psychiatrischen Enthospitalisierungsstudien erfassten Klientel mit überwiegend schizophrenen Erkrankungen. Die geistig Behinderten wurden sehr früh, 72% vor dem 20. Lebensjahr, hospitalisiert. Die durchschnittliche Verweildauer betrug 28 Jahre (Range sechs bis 67 Jahre). Über die Hälfte der Patienten verblieben beim ersten stationären Aufenthalt dauerhaft in der Klinik. 19 Patienten hatten eine leichte, 46 eine mittelgradige geistige Behinderung. In 19 Fällen bestand eine neurologisch-psychiatrische Komorbidität, darunter acht Schizophrenien und acht Epilepsien. 62 Personen befanden sich zum Erhebungszeitpunkt in stationären Heimeinrichtungen mit 24-Stunden-Betreuung, zwei lebten in einer Außenwohngruppe eines Wohnheims und ein Patient war im Maßregelvollzug untergebracht. 5. Sie wiesen in der individuellen Lebensgestaltung (Bereich Wohnen) überwiegend einen sehr geringen bis geringen Hilfebedarf auf. Unterstützung war vor allem bei der Regelung finanzieller und rechtlicher Angelegenheiten erforderlich sowie beim Umgang mit fremden Personen und der Organisation von Terminen. 6. In dieser Arbeit wurden die geistig Behinderten selbst zu ihrer Lebensqualität befragt. Dazu liegen bisher nur wenige Erfahrungen vor. Es zeigten sich überwiegend sehr hohe Zufriedenheitswerte, die im Vergleich zu anderen psychiatrischen Enthospitalisierungsstudien noch höher lagen. Niedrigere Zufriedenheitswerte wurden nur im Bereich der finanziellen Situation geäußert und einige Probanden wünschten sich mehr Kontakt zu den Angehörigen. Bezüglich der objektiven Daten fällt auf, dass ein hoher Anteil (72%) einer Beschäftigung, meist in einer WfB, nachging. Die Freizeit wurde von vielen Bewohnern aktiv verbracht, z.B. verließen 95% regelmäßig die Wohnung und waren im Jahr vor der Erhebung 91% verreist gewesen. Über die Hälfte war in Einzelzimmern untergebracht, nur noch eine Bewohnerin in einem Mehrbettzimmer. 70% bejahten die Frage nach einem guten Freund. Kontakte zu „Normalbürgern“ wurden nur von 9% angegeben. 7. Es wurden verschiedene Einflußfaktoren auf die Lebensqualität analysiert, wobei sich jeweils nur wenige signifikante Unterschiede fanden. A) Alter zum Enthospitalisierungszeitpunkt: Die unter 50jährigen Bewohner hatten häufiger Kontakt zur Familie und einem Freund. Nur in dieser Gruppe gab es Kontakte zu „Normalbürgern“. B) Zeitdauer, die nach der Enthospitalisierung vergangen ist: Die länger Enthospitalisierten (>4 Jahre) gingen häufiger einer Arbeit nach und waren in der Freizeit aktiver. Sie hatten häufiger einen Freund. In der am längsten enthospitalisierten Gruppe war die Zufriedenheit mit der finanziellen Lage und der Aussicht, noch lange in der Einrichtung zu verbleiben, geringer. C) Hospitalisierungsdauer: Die kürzer Hospitalisierten (bis 40 Jahre kumulative Dauer) unterschieden sich von den länger Hospitalisierten darin, dass sie häufiger einer Arbeit nachgingen und in der Freizeit aktiver waren, sie hatten häufiger einen Freund. 8. Anhand des Scores für soziale Integration konnte eine Gruppe besser Integrierter und ein Gruppe schlechter Integrierter gebildet werden. Sie unterschieden sich signifikant hinsichtlich folgender Parameter: Die besser Integrierten waren jünger und kürzer hospitalisiert. Sie erreichten in der NOSIE höhere Werte für soziales Interesse und niedrigere Werte für Retardierung. Der Anteil mittelgradiger Intelligenzminderungen war höher. Sie waren länger enthospitalisiert. 9. 18 Bewohner mussten nach der Enthospitalisierung erneut stationär psychiatrisch behandelt werden, konnten aber nach Krisenintervention wieder entlassen werden. Die Rehospitalisierten unterschieden sich von den übrigen Bewohnern in folgenden Merkmalen: Die kumulative Dauer der Hospitalisierung war kürzer (23 Jahre vs. 31 Jahre). In der NOSIE wiesen sie höhere Werte betreffend das Item „Reizbarkeit“ auf. 10. Die Ergebnisse belegen, dass die Enthospitalisierung der hier untersuchten leicht und mittelgradig geistig Behinderten überwiegend erfolgreich war. Sowohl aus den hier gewonnenen Erkenntnissen, als auch in Übereinstimmung mit der psychiatrischen und sonderpädagogischen Literatur läßt sich weiterer Handlungsbedarf für Praxis und Forschung ableiten. Der Prozess der Ent-Institutionalisierung sollte zukünftig fortgesetzt und wissenschaftlich begleitet werden. Psychiatrische und sonderpädagogische Fachleute sollten hierbei im Interesse der geistig Behinderten kooperieren.:1. Einleitung 1 1.1. Geistig Behinderte in der Psychiatrie 2 1.1.1. Definition und Klassifikation der Intelligenzminderungen 2 1.1.2. Die psychiatrische Versorgung von Menschen mit Intelligenzminderungen 5 1.2. Begriffsklärung Enthospitalisierung 7 1.3. Zur Geschichte der Enthospitalisierung 8 1.3.1. Historische Entwicklung in Deutschland 8 1.3.2. Zur Situation im Bundesland Sachsen 9 1.3.3. Das Sächsische Krankenhaus für Psychiatrie und Neurologie Altscherbitz 11 1.4. Enthospitalisierungsstudien in Deutschland 12 1.4.1. Enthospitalisierungsstudien unter Berücksichtigung der Diagnose Intelligenzminderung 15 1.4.2. Untersuchungen zur Enthospitalisierung geistig Behinderter in anderen Fachgebieten: Beispiele aus der sonderpädagogischen und philosophischen Forschung 18 1.5. Schwerpunkt der Studie und Fragestellung 22 2. Methodik 24 2.1. Ein- und Ausschlusskriterien 24 2.2. Die aufnehmenden Einrichtungen 26 2.3. Beschreibung der Studienteilnehmer: Soziodemografische und medizinische Merkmale der Langzeitpatienten zum Enthospitalisierungszeitpunkt 30 2.4. Untersuchungsinstrumente 33 2.4.1. Kerndatenerfassung 33 2.4.2. Berliner Lebensqualitätsprofil 34 2.4.3. Score für soziale Integration 34 2.4.4. Nurses Observation Scale for Inpatients (NOSIE) 35 2.4.5. Hilfebedarf in der individuellen Lebensgestaltung (Bereich Wohnen) 36 2.4.6. Datenschutz 37 2.4.7. Statistische Methodik 37 3. Ergebnisse 39 3.1. Soziodemografische Daten 39 3.1.1. Alter bei Enthospitalisierung und Patientenmerkmale 39 3.1.2. Alter zum Erhebungszeitpunkt und Patientenmerkmale 39 3.1.3. Kumulative Dauer des stationären Aufenthaltes und Patientenmerkmale 40 3.1.4. Zeitdauer, die nach der Enthospitalisierung vergangen ist und Patientenmerkmale 40 3.1.5. Vergleich soziodemografischer Daten vor und nach der Enthospitalisierung 41 3.2. Lebensqualität der enthospitalisierten Patienten 44 3.2.1. Auswertung des Berliner Lebensqualitätsprofils 44 3.2.2. Lebensqualität und Alter zum Enthospitalisierungszeitpunkt 46 3.2.3. Lebensqualität und Alter zum Erhebungszeitpunkt 49 3.2.4. Lebensqualität und kumulative Dauer des stationären Aufenthaltes 50 3.2.5. Lebensqualität und Zeitspanne, die seit der Enthospitalisierung vergangen ist 51 3.3. Soziale Integration 52 3.3.1. Soziale Integration und Hilfebedarf in der individuellen Lebensgestaltung (HMBW) 53 3.3.2. Soziale Integration und Fremdeinschätzung durch das Heimpersonal (NOSIE) 53 3.3.3. Soziale Integration in Abhängigkeit von Patientenmerkmalen 53 3.4. Hilfebedarf in der individuellen Lebensgestaltung (HMBW) 54 3.4.1. Eingruppierung der Patienten 54 3.4.2. Hilfebedarf und soziodemografische Daten 55 3.4.3. Hilfebedarf und Lebensqualität 56 3.4.4. Hilfebedarf und Zeit, die nach der Enthospitalisierung vergangen ist 56 3.4.5. Hilfebedarf, Alter bei Enthospitalisierung und kumulative Dauer des stationären Aufenthaltes 57 3.5. Fremdeinschätzung durch das Heimpersonal (NOSIE) 57 3.5.1. Darstellung der einzelnen Items 57 3.5.2. NOSIE und Zeit, die nach der Enthospitalisierung vergangen ist 57 3.5.3. NOSIE, Alter bei Enthospitalisierung und kumulative Dauer des stationären Aufenthalts 58 3.6. Merkmale der rehospitalisierten Patienten 58 3.6.1. Soziodemografische Daten 58 3.6.2. Fremdeinschätzung durch das Heimpersonal (NOSIE) 59 3.6.3. Score für soziale Integration 60 3.6.4. Vergleich der rehospitalisierten mit den nicht rehospitalisierten Patienten 60 4. Diskussion 61 4.1. Limitierung des eigenen Untersuchungsansatzes und methodische Probleme bei der Befragung geistig Behinderter 61 4.2. Diskussion der Ergebnisse 62 4.2.1. Soziodemografische und medizinische Daten 62 4.2.2. Lebensqualität als „Erfolgsparameter“ der Enthospitalisierung 66 4.2.2.1. Einfluss des Alters bei Enthospitalisierung auf die Lebensqualität 70 4.2.2.2. Einfluss der Hospitalisierungsdauer auf die Lebensqualität 70 4.2.2.3. Einfluss der Zeitdauer, die nach Enthospitalisierung vergangen ist, auf die Lebensqualität 71 4.2.2.4. Zusammenfassung 74 4.2.3. Soziale Integration der enthospitalisierten geistig Behinderten 75 4.2.4. Hilfebedarf in der individuellen Lebensgestaltung (HMBW) 77 4.2.5. Rehospitalisierungen 79 4.3. Schlussfolgerungen für die Praxis und Forschung 81 Literaturverzeichnis 84 Anhang Danksagung Eidesstattliche Erklärung Thesen

碩士<br>中原大學<br>心理學研究所<br>99<br>In the last ten years, Western countries gradually noticed that people with intellectual disabilities have the needs of mental health. They were thought to have the same emotional disturbance of normal individuals. People with intellectual disabilities seem to be more vulnerable for developing psychiatric disorders. Since people with severe and profound intellectual disabilities have limited verbal communication, they cannot express their personal emotions, thoughts, and beliefs for clinicians to diagnose. Several assessment tools in foreign countries have been developed for screening possible psychiatric disorders in individuals with different levels of intellectual disabilities, and clinicians can use assessment tools to help those who are experiencing psychiatric disorders receive mental health services. However, in Taiwan, clinicians working with people with intellectual disabilities face the situation that those individuals may have comorbid psychiatric disorders. The clinicians need an assessment tool to assess psychopathology in people with intellectual disabilities. In addition, diagnosing mental illness in people with severe and profound intellectual disabilities can be difficult. Among the numerous assessment tools in foreign countries, this study selected the Diagnostic Assessment for the Severely Handicapped Revised (DASH-II) and evaluated its psychometric properties in Taiwan. We hope DASH-II can provide useful information to assist people with intellectual disabilities in receiving mental health services. This was a cross-sectional study. The participants (N=100) were recruited purposefully by interviewing the caregivers of individuals with severe and profound intellectual disabilities in institutions located north of Miaoli. They were administered the Diagnostic Assessment for the Severely Handicapped Revised (DASH-II) and Psychiatric Assessment Schedule for Adults with Developmental Disabilities Checklist Revised (PAS-ADD Checklist Revised). The statistical methods of Cronbach’s alpha coefficient, Pearson correlation, and logistic regression were applied in this study. The internal consistency of the DASH-II Chinese version subscales was similar to the original English version. Cronbach’s alphas ranged from .473 to .823. The interrater reliability of the three dimensions was almost perfect. The Kappa coefficients of the interrater reliability were .982 for frequency, .952 for duration, and .983 for severity rating. The DASH-II Chinese version had good criterion validity. Every subscale of the DASH-II Chinese version correlated moderately with each of the subscales of the PAS-ADD Checklist Revised Chinese version. Furthermore, the DASH-II Chinese version had good construct validity. The results of the Hosmer-Lemeshow test confirmed the regression model fit of the logical regression, which supported the explanatory and predictive abilities of the DASH-II Chinese version. The results of this study showed that the DASH-II Chinese version appeared to have adequate reliability and validity. It can be used in Taiwan to screen people with severe and profound intellectual disabilities for latent psychiatric disorders. Except for the pervasive developmental disorders/autism subscale, the other subscales of the DASH-II Chinese version still lack specific validation. So clinicians using the DASH-II Chinese version to screen for latent psychiatric disorders in people with severe and profound intellectual disabilities were recommended to rely on having at least two subscales with scores above the cutoff scores.

碩士<br>開南大學<br>資訊及電子商務學系<br>98<br>This study examines the behavior of children with intellectual disabilities. This case study employs Case-Based Reasoning with database to construct a system of analysis and diagnosis. The database record cases of behavioral problems and each case records information on characteristics, possible reasons for the case and the corresponding counseling strategies. By choosing the relevant characteristics from diagnostic system on the internet and computing the weighting values and indexes of attributes may get the most suitable case. With the help of the system, knowledge sharing mechanism can be established. It also provides a virtual community platform to help users to ask and discuss relevant issues. However, the number of cases is still limited and likely to affect the reasoning process. Future research direction may include the continual expansion of number of cases and increase the number of categories of disabilities.

This chapter considers ethical and spiritual issues related to intellectual disability. Consideration of the meaning of life of an intellectually disabled person must take into account how society defines and responds to individual differences. There are ethical and religious concerns regarding prenatal diagnosis and questions of how to teach ethical behavior to persons with intellectual disability. Participation in religious practices in the community and in group home settings is important for families and persons with intellectual disability. This chapter reviews these issues in detail. In biblical times, there were edicts about disability that offer insight into attitudes toward disabled people. There is an Old Testament injunction: “Thou shalt not curse the deaf, put a stumbling block before the blind, nor maketh the blind wander out of a path” (Leviticus 19:14). This may be the first Western command to legislate for the protection of the deaf and handicapped. Moreover, deaf persons without speech were viewed as children and provided the same protections as children. Yet, the threat of disability was also an element in biblical injunctions: “If you do not follow his commandments and decrees . . . all these curses will become upon you and overtake you: The Lord will afflict you with madness, blindness, and confusion of mind. At midday, you will grope around like a man in the dark” (Deuteronomy 28:15). Although help for those with disabilities was seen as a charitable obligation, disability was perceived potentially as a punishment from God. Ancient people often believed that illness was inflicted by a deity or supernatural power (Rosen, 1968). In records dating back before 2000 B.C., the birth of children with congenital impairments were used to predict the future of the community. In Babylonia, those who prophesized about the future kept a list of birth deformities and the specific meaning and prophecy that these disabilities foretold. Although a disability was viewed as a portent of things to come (Braddock and Parish, 2002) or punishment for immorality, there also existed the attitude that the disabled should be treated with compassion. The New Testament provides insight into how attitudes about disability evolved.

The capacity to adapt to disability and assist others with disability may have an evolutionary origin. De Waal (1996) describes assistance to an injured group member among primates as evidence of altruistic behavior. Mother monkeys will provide additional care to compensate for injuries, and other members of the group may “babysit” injured infants, as do other young of the group. If the risk of predation is low and food is adequate, handicapped animals may live to adulthood. In human evolution, Berkson (1993) described an adult Neanderthal male with severe arm and head injuries that occurred at an early age. Apparently, this individual adapted to the injury by using his teeth to hold objects. Other conditions, such as disabling arthritis, were found in Neanderthals as well. Thus, individuals with minor or even significant impairments in primate and human societies before the evolution of modern humans, in some instances, received adaptive assistance from other members of the group. Drawing on these possible evolutionary origins of assistance to others in need, this chapter reviews the historical background of care for persons with intellectual disability and discusses environmental provisions and supports, education and skill development, normalization and self-determination, and interventions for those with co-occurring mental and behavioral disorders (psychotherapy, behavioral interventions, and psychopharmacologic treatments). The modern developmental approach to understanding learning and development began with Jean Itard, at the end of the eighteenth century. As a member of the medical staff at the Institute for Deaf Mutes in Paris, he considered the link between deafness and learning. Because of this background, he was asked to study a feral child discovered living alone in the wild in southern France. It was thought that this boy might approximate “man in the state of nature.” Because the child was mute, he entered a school for the deaf in Paris although he was not deaf. Pinel (1809), the leading psychiatrist of the time, proposed that the boy, named Victor, was not teachable. Yet Itard, during the next five years, sought to instruct Victor, using approaches established for deaf persons.

This chapter focuses on multiple disability (MD) or multiple handicapped (MH) students. Being considered equal to their grade- and age-level peers is essential for MD/MH students. Thus, in this chapter, use of the adaptive academic service delivery model with MD/MH students is examined through a case study within a junior and high school setting. This chapter includes a discussion about the causes and characteristics, the educational placement and instructional strategies, and the eligibility criteria for students with multiple disabilities or multiple handicaps. The chapter concludes with a discussion about future trends for MD/MH students and service providers.

The teaching of programming and its basic concepts even to young children has a crucial influence on the development of their cognitive functions and blends the lessons in the class with real life. In this chapter, school activities with educational robotics performed at both the special-needs education school and general public school were described. The students with mild intellectual disabilities and physically handicapped at the special needs school could build the robots nicely using small blocks and move them as they wanted through coding. The intellectual disabled students usually do not have enough long-term memory and are weak in abstraction but could develop the ability to actually understand logical thinking through hands-on learning with educational robotics. Through the present activities, the students including the public school could become aware of various goods around them programmed with coding and connect the learning in class to the real world.

This chapter begins with George Kerscher, who launched Computerized Books for the Blind and Print Disabled in 1988. “I was trying to reach people who were blind and physically handicapped,” Kerscher explains, “but also include people who could not read standard print because of dyslexia or some other learning disability.” The enterprise was never formally incorporated as either a for-profit or non-profit organization. The chapter talks about how market for solutions specific to readers with disabilities was too small to lure profit-minded entities, even with strong intellectual property protection. Rather, university scientists and nonprofits serving people with disabilities, and individual inventors with disabilities, did the difficult and unprofitable work of pioneering innovation.

Having a child with intellectual disability is a major and usually totally unexpected blow to any family. However, most families show great resourcefulness and adapt to give their normal child as well as themselves a happy, rewarding life. Parents strongly resent being treated as potential psychiatric patients and have vigorously thrown out the concept of ‘the handicapped family’. They do suffer understandable grief. From the point of discharge, the encouragement of informal support is more useful than providing hospital-based services. Children with all sorts of disability go to school early and the provision of unobtrusive familiar services is helpful. Unfortunately, there is often a gap in services between children's services and those for older adolescents and adults. The gap occurs at the worst time for parents who of all times require a familiar knowledgeable person who can offer a service throughout the transition period. The services required by the parents are practical help, such as appropriate equipment, respite care, advice about behaviour, and the ability to find emergency or specialized help at short notice. Parents also require some notice to be taken of their increasing age and/or infirmity, the financial difficulties arising out of the disability, and their anxiety that a humane plan can be made for their son or daughter when they die.

The continuous growth in the development of interactive technologies has lighted up the game-based learning applications. The game-based learning applications motivate the students to enhance their knowledge and improve the overall student learning experience. Learning with fun and entertainment is the prime aspect of any interactive platform. The skills and knowledge learned by game-based learning are kept longer than traditional learning methods. In addition, an efficient learning method involves students completely in what they are doing. The game-based learning application is very helpful for the physically handicapped students to reveal their intellectual ability. This chapter discusses how the game-based learning applications impacts the Indian education system, national and international status of game-based learning, challenges of game-based learning, existing game-based learning applications, and present and future impacts of game-based learning applications on the Indian education system.