Cynthia R. Ellis

Assessment and Diagnosis of Mental Illness in Persons with Mental Retardation: Methods and Measures

The assessment and diagnosis of psychiatric disorders in individuals with mental retardation has been a neglected area of research. However, current research indicates that these individuals suffer from the same range of psychiatric disorders that is evident in those who are not mentally retarded. A model of assessment and diagnosis of mental illness in this population is presented that incorporates psychiatric as well as behavioral methods. The emphasis is on the comprehensive assessment of an individuals behavior, based on family history, self and informant clinical interviews, rating scales, direct observations, and an experimental analysis of the target behaviors. The model provides the basis for making differential diagnoses in terms of related psychiatric disorders and between psychiatric disorders and behavior problems. Depression and schizophrenia are used as illustrative disorders to describe the application of this model. Given the paucity of literature on the assessment and diagnosis of mental illness in individuals with mental retardation, a number of suggestions are made regarding future research and refinement of the model.

Recognition of facial expressions of emotion by persons with mental retardation. A matched comparison study

Children and adults with mental retardation were tested on their ability to recognize facial expressions of emotion. The sample consisted of 80 children and adults with mental retardation and a control group of 80 nonhandicapped children matched on mental age and gender. Ekman and Friesens normed photographs of the six basic emotions (anger, disgust, fear, happiness, sadness, and surprise) were used in a recognition task of facial expressions. Subjects were individually read two-sentence stories identifying a specific emotion, presented with a randomized array of the six photographs of the basic facial expressions of emotion, and then asked to select the photograph that depicted the emotion identified in the story. This procedure was repeated with 24 different stories, with each of the six basic emotions being represented four times. Results showed that, as a group, individuals with mental retardation were not as proficient as their mental-age-matched nonhandicapped control subjects at recognizing facial expressions of emotion. Although adults with mild mental retardation were more proficient at this task than those with moderate mental retardation, this finding was not true for children. There was a modest difference between the children with moderate mental retardation and their nonhandicapped matched controls in their ability to recognize facial expressions of disgust.

Characteristics of Children and Adolescents with Serious Emotional Disturbance in Systems of Care. Part II: Community-based Services

This is the second in a series of investigations designed to study the characteristics of children and adolescents with serious emotional disturbance (SED) who are currently being served in various systems of care, ranging from community-based services to psychiatric hospitalization and residential placement. The sociodemographic, educational, psychological, and treatment history characteristics of children and adolescents who were provided with community-based services as an alternative to residential placement were examined. Of the 363 children and adolescents who were judged by community service providers to be at imminent risk of residential placement, complete sociodemographic data were available for only 228 (63%). These 228 children and adolescents were grouped according to their school-identified disability status at the time they were targeted to receive community-based services: (a) those identified as SED (54%); (b) those identified with other disabilities, such as mental retardation or learning disabilities (28%); and (c) those with no identified disabilities (18%). The data were analyzed for the total study sample—as well as for the three groups—on the following variables: age, gender, race, referral source, guardianship, living arrangements, special education status, psychotropic medication, criminal record, prior involvement with the service system, and history of residential placement. Significant differences among the three groups were found on a number of variables, including guardianship, medication, criminal record, prior involvement with the service system, and history of residential placement. Findings are discussed in terms of community-based service needs of children and adolescents with SED.

Fluoxetine Treatment of Severe Self-Injury in Young Adults with Mental Retardation

Dysfunction of the serotonergic system has been implicated in the development and maintenance of self-injury in some persons with mental retardation. Several preliminary reports have suggested that fluoxetine, a drug that blocks the reuptake of serotonin, may decrease self-injury in these individuals. Of the 44 cases of self-injury treated with fluoxetine and previously reported in the literature, 42 demonstrated a beneficial response to the drug. We report four additional cases of adults with mental retardation whose self-injury was treated with fluoxetine. Each of these individuals benefited from fluoxetine to some extent, with average decreases in self-injury ranging from 20% to 88% when compared with baseline levels. These findings, combined with those from previously published case studies, emphasize the need for well-controlled studies to more adequately assess the effects of fluoxetine on self-injury.

Clinical Effects of Buspirone on Intractable Self-Injury in Adults with Mental Retardation

OBJECTIVE The efficacy of buspirone in controlling self-injurious behavior was examined in five individuals with mental retardation. Buspirone was used alone in two individuals and as an adjunct to thioridazine in the other three. METHOD Standard behavioral observation methods were used to collect data on the number of self-injurious responses of the individuals during baseline and several doses of buspirone in an open trial. RESULTS When compared with baseline levels, all five individuals showed some response to buspirone, with reductions in self-injury ranging from 13% to 72%, depending on the dose. The most effective dose of buspirone was 30 mg/day for three individuals and 52.5 mg/day for the other two. These individuals were maintained for 6 to 33 weeks on their most effective dose. Coexistent symptoms of anxiety did not predict a favorable response to buspirone therapy. CONCLUSIONS Buspirone showed a mixed but generally favorable response in controlling intractable self-injury in this and four previous studies reporting similar cases. However, the drug should not be endorsed as a proved treatment for self-injury until similar results have been obtained from well-controlled studies of its efficacy.

Empowerment Status of Families Whose Children Have Serious Emotional Disturbance and Attention-Deficit/Hyperactivity Disorder.

Empowerment is a critical indicator of a familys ability to access and effectively utilize services to achieve desired outcomes for themselves and their children. The empowerment status of two groups of families, those with children who had serious emotional disturbance (SED) alone and those with children who had SED combined with attention-deficit/hyperactivity disorder (ADHD), were investigated. The Family Empowerment Scale (FES) was completed by a sample of 228 families. In addition, these families provided demographic data concerning family composition, race, education, income, membership in a parent support group, and the mental health status of their children. The demographic variables were entered into a multivariate analysis of variance model to predict the empowerment status of families across the four subscales of the FES. Statistically significant correlations were obtained between family empowerment and membership in a parent support group, mental health status of the child (SED alone versus SED with ADHD), gender of the respondent, and respondent education. The results indicated that membership in a parent support group was a strong predictor of family empowerment, particularly of the systems advocacy and knowledge dimensions of empowerment. The results of this study can be used by mental health services providers for designing services that maximize family empowerment.

Community-based instruction for independent meal preparation by adults with profound mental retardation

Three adults with profound mental retardation and very limited reading skills were transitioned to community living after spending more than 20 years in a residential facility. Community-based instruction was used to teach them to independently prepare meals. Directed rehearsal and prompting procedures were used to teach them those meal preparation skills that they were unable to perform independently. We present assessment, training and followup data on the preparation of a dessert by the three participants. Following an assessment on the steps needed to prepare the dessert, training was introduced in a multiple baseline across subjects design. Results showed that the participants were able to independently prepare the dessert in up to 21 pre-training and training sessions. Monthly followup for six months showed that they were able to independently prepare the dessert in various community settings of their choice.

Value and Address Diversity

There has been increasing concern about the academic failure and the school dropout rate of U.S. children and adolescents, particularly those with serious emotional disturbance (SED). Although the rates of identification, placement, and achievement of children and adolescents with SED are strongly correlated with gender, race, and other cultural dimensions, these are typically not addressed in our educational system. The growing diversity in students has increased the potential for misidentification and provision of inappropriate educational and related services to these children and adolescents. Target 3 of the National Agenda for Achieving Better Results for Children and Youth with Serious Emotional Disturbance deals with issues involved in providing culturally competent and linguistically appropriate services to students with SED. Within the context of this target, we define the concepts of diversity, culture, cultural competence, and cultural sensitivity before discussing historical and current approaches to multicultural education. The limitations of current approaches indicate the need for a new paradigm of multicultural education. A holistic model of multicultural education is sketched, and the applications, examples of best practices, and implications of this model for the education of diverse learners are presented.

Acute intermittent porphyria in a children's psychiatric hospital

Acute intermittent porphyria (AIP) is a rare autosomal disease that presents with gastrointestinal, psychiatric, and neurological symptoms. Bizarre behaviors are common to several illnesses present in a psychiatric setting. Most often these are manifestations of psychotic illness such as schizophrenia or manic-depressive illness, but they can also be seen in cases of organic mental dysfunction and toxic psychotic states. The author describes the disorder and reports on two cases of AIP in children who were initially diagnosed as atypical psychosis in an inpatient childrens psychiatric hospital over a 3-year period.

Homeless women and their families: Characteristics, life circumstances, and needs

This study investigated the needs of a sample of 100 women from shelters for the homeless in Richmond, Virginia. The womens responses to a 117-item interview were used to obtain information regarding their domicilary status, work history, educational background, family and health history, social support, reasons for homelessness, and social service needs. The results indicated that a significant number of the women had moved as many as six times within the past five years for various reasons, including domestic violence, interpersonal conflict, overcrowding, and eviction. Many women were high school graduates and had job skills in the health care, educational, and clerical fields. Most women were raised by their natural or extended family and the majority of them had a friend or family member who provided social support. Identified needs included housing, food, clothing, and transportation. The needs of homeless women and their children were different from the needs of the homeless chronically mentally ill and require specialized services as well as an increase in the available number of low-income housing units.