Alya Reeve

Conceptualizing Supports and the Support Needs of People With Intellectual Disability

This is the third in a series of perspective articles (Schalock et al., 2007; Wehmeyer et al., 2008) from the Terminology and Classification Committee of the American Association on Intellectual and Developmental Disabilities (AAIDD). The purpose of these articles is to share our thoughts on critical issues associated with terminology, definition, and classification in the field of intellectual disability and to seek input from the field as we prepare the 11th edition of AAIDD’s Diagnosis, Classification, and System of Supports Manual (the working title). In the first article (Schalock et al., 2007), we explained the reasons for shifting from the term mental retardation to intellectual disability. Although the two terms cover the same population of individuals, we concluded that intellectual disability was the better term because it

The Intellectual Disability Construct and Its Relation to Human Functioning

The American Association on Intellectual and Developmental Disabilities’ (AAIDD) Terminology and Classification Committee has two primary purposes in publishing this Perspective: (a) to share our thinking about the construct underlying the term intellectual disability (henceforth the intellectual disability construct) and its relation to human functioning and (b) to ask for input from the field because the committee is preparing a proposal for the upcoming Definition, Classification and Systems of Supports manual, to be published in 2009 or 2010. The article has three sections. In the first section, we make a distinction between an operational definition, which operationalizes the intellectual disability construct and provides the basis for diagnosis and classification, and a constitutive definition, which explains the underlying construct and provides the basis for theory– model development and planning individualized supports. In the second section, we provide an historical overview of how the construct underlying the term mental retardation (henceforth, the mental retardation construct) differs from the construct underlying intellectual disability. In the third section, we describe the parameters to the proposed AAIDD theoretical framework of human functioning that reflects our current understanding of the multidimensionality of human functioning that underlies the intellectual disability construct and the significant role that individualized supports play in human functioning. The article concludes with a brief discussion of the benefits to the field that accrue from a clear understanding of both the differences between an operational and constitutive definition and the fundamental properties of the intellectual disability construct. Operational Versus Constitutive Definitions

Naming, Defining, and Classifying in Mental Retardation

Recent discussions about changing the term mental retardation to a different term may be considered in the broader framework of three distinct but related processes: naming (terminology), defining, and classifying. The three processes are analyzed according to their purposes and functions: In naming, a term is assigned; in defining, the term is explained; and in classifying, the group is divided into subgroups according to stated principles. The current status of each process is described, especially as represented in the 1992 AAMR manual, Mental Retardation: Definition, Classification, and Systems of Supports. We suggest three sets of guiding questions that may help evaluate proposed changes in naming, defining, or classifying.

Pharmacological Management of Persistent Hostility and Aggression in Persons With Schizophrenia Spectrum Disorders: A Systematic Review

The incidence of aggressive behaviors is higher among persons with schizophrenia spectrum disorders (SSDs) than among persons without such disorders. This phenomenon represents a risk to the well-being of patients, their families, and society. The authors undertook a systematic review of the English language literature to determine the efficacy of neuropharmacological agents for the management of hostility and aggression among persons with SSDs. The search combined findings from the Medline, EMBASE, and PsycINFO databases. Ninety-two full text articles were identified that reported relevant findings. The American Academy of Neurology criteria were used to determine levels of evidence. Paliperidone-extended release is probably effective for the management of hostility among inpatients with SSDs who have not been preselected for aggression (Level B). Clozapine is possibly more effective than haloperidol for the management of overt aggression and possibly more effective than chlorpromazine for the management of hostility among inpatients with SSDs who have not been preselected for aggression (Level C). Clozapine is also possibly more effective than olanzapine or haloperidol for reducing aggression among selected physically assaultive inpatients (Level C). Adjunctive propranolol, valproic acid, and famotidine are possibly effective for reducing some aspects of hostility or aggression among inpatients with SSDs (Level C). Paliperidone-extended release currently appears to be the agent for the management of hostility among inpatients with SSDs for which there is the strongest evidence of efficacy.

Increased anterior brain activation to correct responses on high-conflict Stroop task in obsessive–compulsive disorder

OBJECTIVE An abnormally increased activation in anterior brain networks, accompanied by normal task performance, has been reported in studies on biological mechanisms of obsessive-compulsive disorder (OCD). We test a hypothesis, that this phenomenon, deemed specific to OCD, will be compromised by a very difficult task, which may lead to reduced cortical information processing and erroneous performance, as found in other disorders such as schizophrenia. METHODS We designed a new variant of high-conflict Stroop-word-color interference task (Stroop-WCIT) with each incongruent (INC) trial preceded by multiple congruent trials. Event-related potentials (ERPs) were acquired from subjects with OCD and case-matched healthy controls (C). We analyzed ERPs elicited by correct responses to conflict-related INC trials. RESULTS Our hypothesis found no support. Although the anterior ERPs N200, a negative component within 140-300 ms latency window, was significantly abnormally increased in OCD subjects, their performance accuracy remained normal. CONCLUSIONS Current findings suggest an enhanced adaptive top-down control in OCD mediated by the prefrontal lateral and dorsal anterior cingulate networks. SIGNIFICANCE Further studies are warranted to test the hypothesis that increased activity within the anterior network for top-down inhibitory control in OCD may be a part of an adaptive compensatory neural mechanism.

Anxiety: Challenges of Normal and Abnormal Responses

Anxiety is an important physiological and psychological response in humans, especially for those with intellectual and/or developmental disabilities (IDD). Anxiety contributes to improved attention, performance and survival in threatening situations. When the response becomes over-learned, habitual, or otherwise dysfunctional, increased anxiety can lead to disruptive behavior, inefficient brain patterns, and avoidance of pleasurable experiences. A brief review of the neuroanatomic underpinnings, assessment techniques and therapeutic strategies is presented. DSM-5 terminology is reviewed. Classes of medications are summarized.