Alexander J. Tymchuk

Predicting adequacy of parenting by people with mental retardation

While there has been increased attention placed upon the inadequacy of parenting by persons with mental retardation, such attention does little to increase our understanding of the complexities of parenting. A refocusing of research and intervention efforts is needed to examine the concomitants of adequacy of parenting. What we know about both the inadequacy as well as the adequacy of parenting by persons with mental retardation and the limitations of the information upon which we base these statements is reviewed. New foci are suggested in understanding both adequacy and the inadequacy of parenting by persons with mental retardation.

Mothers with mental retardation who do or do not abuse or neglect their children

Mothers with mental retardation with or without a history of child abuse and/or neglect were compared on a number of demographic variables. The reasons why children were or were not removed also were examined. The demographic comparisons showed that while those mothers with such a history generally had higher IQs, they were similar to the mothers without such a history. Twice as many of those with a history of abuse and/or neglect were married, lived independently, and had at least two children, one of which often had problems, in comparison to those without such a history. Examination of the reasons for child removal showed that removal occurred if the mother had a problem in addition to her retardation or if she was unwilling to attend and actively participate in a training program and/or did not have someone who could provide support. If a mother was willing and did attend training and had support, children were either not removed initially or were returned upon evidence that the mother was actively participating. In comparison to those mothers with a history of abuse and/or neglect, those without such a history functioned at a lower intellectual and functional level and were living with a relative who shared child-care responsibilities.

Parents with Mental Retardation A National Strategy

The topic of parenting by people with mental retardation has a long and controversial history during which it was assumed that, as a result of that mental retardation, they were unable to provide adequate parenting. More recently, individual researchers and practitioners have attempted to demonstrate that, while some parents with mental retardation do not provide adequate child care, many currently do so and are able to improve their parenting skills. Unfortunately, there have been limited responses to systematically address this area. In this report the author presents what we do and do not know about parents with mental retardation and, based upon his experience in the mental retardation field for the past two decades, makes recommendations for a national strategy.

Decisions about enteral tube feeding among the elderly.

Objective: To determine choices about enteral tube feeding and factors associated with deciding to accept or forego this intervention in a group of ambulatory non‐demented older individuals.

Moving towards Integration of Services for Parents with Intellectual Disabilities.

Parents with intellectual disabilities, like all parents, require suitable services and support in order to ensure the health, safety, and well-being of themselves and of their children. Substantial clinical and empirical literature now exist documenting the degree to which these parents can be successful when supports and services are matched to their learning characteristics, living environments, and communities. However, despite the documentation of need and the evidence of success, suitable supports for these families continue to be limited, fragmented, and uncertain. Absent any effective personal political voice, governmental, professional, and private organizations largely have ignored the need to ensure an evenness of supports for these parents. Another major difficulty has been the absence of demonstrations for successful integration of services. Since the lack of interest by government and by others means the absence of funds to examine new integrative program models, parents have been faced with...

Informing the Elderly: A Comparison of Four Methods

Providing elderly persons with understandable information with which they can make informed health care decisions is a difficult, yet critical, task. Four methods of enhancing understanding of the Residents Bill of Rights were evaluated in residents of the board and care section of a long‐term care facility. The methods included the use of large print and simplified language, a storybook, and a videotape. There was no significant improvement for performance on the comprehension test after any of the methods of presentation of the Bill of Rights. A number of subjects were found to be very deficient in short‐term memory or in verbal knowledge. When these subjects were eliminated from the analyses, significant improvement was demonstrated with the simplified version of the Bill of Rights yielding the most improvement. These findings indicate that many elderly people can benefit from an informed consent procedure that provides information clearly and simply. Furthermore, with relatively simple cognitive screening procedures, it should be possible to identify those unable to process the information necessary to participate in common health care decisions.

Decision-making abilities of mothers with mental retardation☆

The decision-making abilities of mothers with mental retardation and contrast mothers were examined. Both groups received two high- and two low-risk vignettes in full and partial formats. Although there were no significant differences between the two groups on the appropriateness of their decisions, as expected, the mothers with mental retardation scored lower both on the recall and elicited measures. Both groups scored lower on the partial formats than on the full formats, and on the high-risk vignettes than on the low-risk ones. These results suggest that familiarity with the parenting situation as well as the degree of risk inherent in that situation is of importance when one is examining decision making for either group. The results also suggest that although mothers with mental retardation can make in vitro decisions that are similar to those of nonhandicapped mothers of the same socioeconomic background, additional research must examine in vivo decision making for both groups.

OPTIMIZING THE INFORMED CONSENT PROCESS WITH ELDERLY PEOPLE

While the avowed purpose of informed consent is to inform, this objective has been shown not to have been met in many situations, particularly with elderly people. The assumption that a single methodology for informed consent would suffice for all people may underlie this failure. The view of consent within a simplistic paradigm of how a person seeks, obtains, and assimilates information in order to make a decision needs to be expanded. This article presents a conceptualization of the informing process and adaptations of the consent process that may help to more completely fulfill the primary goal of informed consent.

Applied Research in Child Maltreatment: Practicalities and Pitfalls

Presented here is a model of applied research in child maltreatment. Applied research is defined and 3 examples from an ecobehavioral perspective are presented. The advantages of these models along with the inherent systemic, cultural, and familial difficulties of conducting applied research in this area are discussed. Particular attention is paid to problems of attrition and intervention adherence. Potential solutions are presented covering working with social service agencies, use of memoranda of understanding, and the use of focus groups.

The home inventory of dangers and safety precautions-2: addressing critical needs for prescriptive assessment devices in child maltreatment and in healthcare ☆

OBJECTIVE This paper describes the development and preliminary validation of a prescriptive home danger and safety precaution instrument containing 14 epidemiological categories to be used in the design and evaluation of family-tailored injury prevention and safety interventions. METHOD The HIDSP-2 evolved from application and revision of the previous home danger and safety precaution recognition and observation instruments. As part of this process, the suitability of the HIDSP-2 for use in a broad-based trial was evaluated with 29 low income parents exhibiting individual learning needs. Inter-rater reliability and stability of scores were examined. Internal consistency was examined for total dangers and precautions and for those categories in which there were sufficient items to do so. RESULTS Administrative time was reduced while continuing usefulness in the identification and remediation of dangers and implementation of precautions was demonstrated. Stability of observation was high. Alphas as a measure of internal consistency was satisfactory for total danger and precautions separately; however, those for most individual categories were low. There was significant reduction in the number of dangers identified initially and significant improvement in the safety precautions implemented. CONCLUSIONS The HIDSP-2 can assist healthcare, education, disability, and child protective service workers in the development of home safety plans for remediating home dangers and implementing precautions. While we see this instrument as eminently suitable for use in broad-based interventions and in epidemiological studies, further research must continue to examine the psychometric characteristics of the individual danger and precaution categories.