Susan M. Havercamp

Health Disparities among Adults with Developmental Disabilities, Adults with other Disabilities, and Adults Not Reporting Disability in North Carolina:

Objectives. The purposes of this study were (1) to identify disparities between adults with developmental disabilities and non-disabled adults in health and medical care, and (2) to compare this pattern of disparities to the pattern of disparities between adults with other disabilities and adults without disabilities. Methods. The authors compared data on health status, health risk behaviors, chronic health conditions, and utilization of medical care across three groups of adults: No Disability, Disability, and Developmental Disability. Data sources were the 2001 North Carolina Behavioral Risk Factor Surveillance System and the North Carolina National Core Indicators survey. Results. Adults with developmental disabilities were more likely to lead sedentary lifestyles and seven times as likely to report inadequate emotional support, compared with adults without disabilities. Adults with disabilities and developmental disabilities were significantly more likely to report being in fair or poor health than adults without disabilities. Similar rates of tobacco use and overweight/obesity were reported. Adults with developmental disabilities had a similar or greater risk of having four of five chronic health conditions compared with non-disabled adults. Significant medical care utilization disparities were found for breast and cervical cancer screening as well as for oral health care. Adults with developmental disabilities presented a unique risk for inadequate emotional support and low utilization of breast and cervical cancer screenings. Conclusions. Significant disparities in health and medical care utilization were found for adults with developmental disabilities relative to non-disabled adults. The National Core Indicators protocol offers a sound methodology to gather much-needed surveillance information on the health status, health risk behaviors, and medical care utilization of adults with developmental disabilities. Health promotion efforts must be specifically designed for this population.

Motivation in Developmental Context: A New Method for Studying Self-Actualization:

Maslow’s hierarchy implies that human growth is associated with adult maturity, a decrease in the prepotency of “lower” motives and an increase in the prepotency of “higher” motives. These hypotheses were evaluated with data from 1,712 participants who had been tested with the Reiss Profile, which is a standardized assessment of a comprehensive range of enduring (trait) strivings. The results provided some support for Maslow’s general idea of human growth: The lower motives (such as eating and exercise) were stronger for younger versus older adults, whereas the higher motives (such as honor and idealism) were stronger for older versus younger adults. The results demonstrated a new method for studying some of the issues raised by Maslow.

Distinguishing Low Levels of Social Support and Social Strain: Implications for Dual Diagnosis.

Low social support is known to be a risk factor for mental illness in the general population. Social strain, or stressful social interaction, has also been shown to correlate highly with psychopathology but has been largely ignored for individuals with mental retardation. Results based on staff ratings of 104 adults with mental retardation are presented, highlighting the relationship among support, social strain, and psychopathology. Data suggest that social strain is more strongly associated with psychopathology than are overall low levels of social support for individuals with mental retardation.

An innovative clerkship module focused on patients with disabilities.

Lack of medical training results in physicians being unprepared to provide care to people with disabilities, which, in turn, contributes to the substantial health disparities that are evident in this population. Few medical schools or primary care residencies address the care of adults with disabilities. Competencies and guidelines to assist American physicians in caring for patients with physical or intellectual disabilities have yet to be established, thus making educational goals unclear. This article describes one novel training module regarding people with disabilities that was developed at the University of South Florida Health, Morsani College of Medicine (USF) and inserted into the primary care clerkship during a major curriculum redesign in 2005. Since then, all USF third-year medical students have been required to participate in this disability-related course component. The authors describe the modules development and integration into the primary care clerkship, as well as the specific elements of their curriculum. By using a variety of teaching modalities in the classroom and community, and especially by involving people with disabilities themselves, the medical students have a very comprehensive learning experience regarding people who have physical, sensory, or intellectual disabilities. The authors have been able to show that USF medical students, on completion of this module, demonstrate improved knowledge, attitudes, and comfort in caring for people with disabilities, which the authors believe will lead to improved health and health care access for this underserved population. Suggestions for program replication, including common challenges, are also discussed.

The Role of Motivation and Psychopathology in Understanding the IQ–Adaptive Behavior Discrepancy*

Publisher Summary This chapter briefly reviews motivational research in persons with mental retardation and explores the relations among motivation, adaptive behavior, and psychopathology. The chapter presents the concept of IQ–adaptive behavior discrepancy and report on the preliminary results of a pilot study that explored this phenomenon. The IQ–adaptive behavior discrepancy refers to the phenomenon that occurs when an individual with mental retardation fails to perform up to his/her capability. The chapter operationally define the IQ–adaptive behavior discrepancy as the difference between the IQ standard score and the Adaptive Behavior standard score (IQ–AB). Relatively few motivation researchers have studied the IQ–adaptive behavior discrepancy in persons with mental retardation. The chapter presents the study on discrepancies between the performance of adaptive behavior and the individuals intellectual functioning to demonstrate the interplay of individual motivational variables in explaining the direction and magnitude of performance discrepancies.