Intellectual disability

智力残疾
  • 文章类型: Journal Article
    背景:人际暴力是一种可以在不同的人和条件下发生的现象。然而,智障人士更容易受到这个问题的影响,对他们的健康和福祉有潜在风险。这项研究的目的是确定作为人际暴力受害者的残疾人的社会人口统计学特征,肇事者的概况和受害者得到照顾后采取的措施。
    方法:这是一个探索性的,描述性,描述性使用进入巴西卫生部的应报告疾病信息系统的人际暴力通知表进行横断面研究。之所以选择圣保罗市,是因为它是拉丁美洲最大的城市,并且拥有比其他城市更快的数据处理系统。该期间涵盖2016年至2022年之间的通知。该信息是在2023年10月至11月之间收集的,并进行了单变量统计分析。使用费希尔的精确检验,显著性水平为5%(α=0.05)。
    结果:在此期间,共有4,603份针对智障人士的通知。身体暴力的形式,忽视/遗弃和心理/道德暴力在15-19岁年龄组更为频繁,而性暴力在10-14岁年龄组更频繁(p<0.001)。在所调查的所有形式中,最常攻击的性别是女性(p<0.001),受害最深的人的肤色是黑色和/或棕色,除了忽视/放弃的情况(p=0.058)。大多数受害者接受的教育很少(p=0.012)。侵略是由一个人犯下的(p<0.001),已知或与受害者有关,如母亲或父亲,除了性暴力案件,其中陌生人是主要肇事者(p<0.001)。肇事者的性别是男性,除了忽视和/或放弃的情况(p<0.001),年龄在25至29岁之间(p=0.004)。在性暴力案件中,强奸是最常见的,所进行的程序是采血,然后预防性传播感染(STIs)是卫生专业人员进行的主要程序(p=0.004)。在接受护理后,大多数转介给健康和社会援助网络,很少向人权参考中心等机构推荐,监护委员会和警察局(p<0.001)。
    结论:智障人士极易受到所研究的暴力形式的影响,尤其是儿童和青少年,黑色或棕色,教育水平低。肇事者通常是亲密的人,男性,比受害者年长。卫生专业人员的转诊没有优先考虑受害者的安全和人权保障。应实施对暴力受害者健康的照顾,考虑到特殊方面,比如智障人士,寻求帮助可能很困难。
    BACKGROUND: Interpersonal violence is a phenomenon that can occur with different people and conditions. However, people with intellectual disabilities have increased vulnerability to this problem, with potential risks to their health and well-being. The aim of this study was to identify the sociodemographic characteristics of people with disabilities who have been victims of interpersonal violence, the profile of the perpetrators and the measures taken after the victims have been cared for.
    METHODS: This is an exploratory, descriptive, cross-sectional study using the Interpersonal Violence Notification Forms entered into the Brazilian Ministry of Health\'s Notifiable Diseases Information System. The city of São Paulo was chosen as the setting because it is the largest city in Latin America and has a faster data processing system than other cities. The period covered notifications made between 2016 and 2022. The information was collected between October and November 2023 and a univariate statistical analysis was carried out. Fisher\'s exact test was used, with a significance level of 5% (α = 0.05).
    RESULTS: There were 4,603 notifications against people with intellectual disabilities in the period. The forms of physical violence, neglect/abandonment and psychological/moral violence were more frequent in the 15-19 age group, while sexual violence was more frequent in the 10-14 age group (p < 0.001). The sex most often attacked was female in all the forms investigated (p < 0.001) and the skin colors of the most victimized people were black and/or brown, except in cases of neglect/abandonment (p = 0.058). Most of the victims had little schooling (p = 0.012). The aggressions were committed by one person (p < 0.001), known or related to the victim, such as mother or father, except in cases of sexual violence, where strangers were the main perpetrators (p < 0.001). The sex of the perpetrator was male, except in cases of neglect and/or abandonment (p < 0.001), and the age was between 25 and 29 (p = 0.004). In cases of sexual violence, rape was the most frequent and the procedures carried out were blood collection followed by prophylaxis for Sexually Transmitted Infections (STIs) were the main procedures carried out by health professionals (p = 0.004). The majority of referrals made after receiving care were to the health and social assistance network, with few referrals to bodies such as the human rights reference center, guardianship council and police stations (p < 0.001).
    CONCLUSIONS: People with intellectual disabilities are highly vulnerable to the forms of violence studied, especially children and adolescents, black or brown, with low levels of education. The perpetrators are usually close people, male and older than the victims. The referrals made by health professionals did not prioritize the victim\'s safety and the guarantee of human rights. Lines of care for the health of victims of violence should be implemented, taking into account special aspects, such as people with intellectual disabilities, whose search for help can be difficult.
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  • 文章类型: Journal Article
    背景:与突触RasGTP酶激活蛋白1(SYNGAP1)相关的非特异性智力障碍是由SynGAP1水平不足引起的神经发育障碍,导致神经元突触功能障碍并呈现广泛的临床表型。造血干细胞基因治疗具有在用慢病毒载体转导造血干细胞和祖细胞后将治疗水平的功能性SynGAP1递送至受影响的神经元的潜力。
    方法:作为治疗SYNGAP1的新方法,我们已经产生了表达SynGAP1修饰形式的慢病毒载体,用于转导人CD34造血干细胞和祖细胞。然后将基因修饰的细胞移植到成年免疫缺陷的SYNGAP1+/-杂合小鼠中,并评估SYNGAP1相关临床表型的改善。还在移植小鼠的脑组织中评估了SynGAP1的表达。
    结果:在我们的概念验证研究中,我们已经证明了SYNGAP1相关表型的显著改善,包括在移植了载体转导细胞的小鼠中观察到的运动能力的改善,因为它们在开放场试验中表现出减少的多动症,在旋转杆试验中表现出增加的下降潜伏期.在这些小鼠的大脑中也检测到SynGAP1水平的增加。
    结论:这些早期研究结果突出了干细胞基因治疗方法作为SYNGAP1治疗策略的潜力。
    BACKGROUND: Synaptic Ras GTPase activating protein 1 (SYNGAP1)-related non-specific intellectual disability is a neurodevelopmental disorder caused by an insufficient level of SynGAP1 resulting in a dysfunction of neuronal synapses and presenting with a wide array of clinical phenotypes. Hematopoietic stem cell gene therapy has the potential to deliver therapeutic levels of functional SynGAP1 to affected neurons upon transduction of hematopoietic stem and progenitor cells with a lentiviral vector.
    METHODS: As a novel approach toward the treatment of SYNGAP1, we have generated a lentiviral vector expressing a modified form of SynGAP1 for transduction of human CD34+ hematopoietic stem and progenitor cells. The gene-modified cells were then transplanted into adult immunodeficient SYNGAP1+/- heterozygous mice and evaluated for improvement of SYNGAP1-related clinical phenotypes. Expression of SynGAP1 was also evaluated in the brain tissue of transplanted mice.
    RESULTS: In our proof-of-concept study, we have demonstrated significant improvement of SYNGAP1-related phenotypes including an improvement in motor abilities observed in mice transplanted with the vector transduced cells because they displayed decreased hyperactivity in an open field assay and an increased latency to fall in a rotarod assay. An increased level of SynGAP1 was also detected in the brains of these mice.
    CONCLUSIONS: These early-stage results highlight the potential of this stem cell gene therapy approach as a treatment strategy for SYNGAP1.
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  • 文章类型: Journal Article
    目的:本文解释了我们如何创建全球智力残疾护士研究实验室(GIDNRC),一个变革性的网络。GIDNRC旨在改进理解,研究,政策,临床护理,并为智障人士提供支持。
    背景:2022年,世界卫生组织(WHO)呼吁国际医疗保健领导者采取行动,促进残疾人更加平等的医疗保健。本文将GIDNRC作为专业人士共同努力的一种方式,为全世界的智障人士提供更平等的医疗保健。
    方法:我们通过回顾同行评审的文献和研究来创建这篇论文,国际政策,和护理网络倡议。
    结论:本文探讨了当前的政策,研究,和实践问题构成了GIDNRC的基础,包括COVID-19大流行如何改变护理。
    结论:护士占世界卫生劳动力的50%以上。因此,它们有可能在使智障人士的护理比目前全世界更加平等方面产生巨大影响。然而,障碍存在。形成GIDNRC,以及使用万维网,提供了解决这一目标障碍的机会。
    结论:护士可以在日常护理实践中满足智障患者的需求。GIDNRC旨在加强这些临床技能,了解世界各地的护理如何变化,分享知识,良好做法,以及为全球智障人士提供护理的新方法。
    结论:国际护理政策应积极关注智障人士的需求以及护士在满足这些健康需求方面所扮演的角色。GIDNRC可能为实现该政策的发展提供了重要途径。
    OBJECTIVE: This paper explains how we created the Global Intellectual Disability Nurse Research Collaboratory (GIDNRC), a transformative network. The GIDNRC aims to make improvements in the understanding, research, policy, clinical care, and support provided to people with an intellectual disability.
    BACKGROUND: In 2022, the World Health Organization (WHO) called upon healthcare leaders internationally to take actions to promote more equal healthcare for disabled persons. This paper promotes the GIDNRC as a way for professionals to work together to make more equal healthcare throughout the world for people with intellectual disabilities.
    METHODS: We created this paper by reviewing peer-reviewed literature and research, international policies, and nursing networking initiatives.
    CONCLUSIONS: This paper explores current policy, research, and practice issues that formed the basis of beginning the GIDNRC, including how the COVID-19 pandemic changed care.
    CONCLUSIONS: Nurses are over 50% of the world\'s health workforce. Therefore, they have the potential to make a large impact in making care for people with intellectual disability much more equal than currently exists throughout the world. However, barriers exist. Forming the GIDNRC, as well as using the World Wide Web, offers an opportunity to address barriers to this goal.
    CONCLUSIONS: Nurses can address the needs of people with intellectual disability in their daily nursing practice. The GIDNRC aims to strengthen these clinical skills, understand how care may vary throughout the world, and share knowledge, good practices, and new ways to approach care for people with an intellectual disability worldwide.
    CONCLUSIONS: International nursing policy should actively focus on the needs of people with intellectual disabilities and the role nurses play in addressing these health needs. The GIDNRC may provide an important way to achieve developments in this policy.
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  • 文章类型: Journal Article
    背景:为有智力和发育障碍的青少年量身定制性教育是至关重要的,但未被满足,需要,因为这一人群尤其面临性虐待和受害的风险。然而,没有基于证据的干预措施来具体满足这一需求.本文提出了一个干预框架的发展,以解决性教育的公平性,并支持智力和发育障碍的青少年理解和提供性同意,性教育和性健康的基础方面。
    方法:性健康公平项目团队使用基于社区的参与式研究方法,为患有智力和发育障碍的青少年开发了四模块性同意干预措施。我们利用了多样化的,中西部郊区学区的跨学科团队,并使用后向设计来创建目标和评估,这些目标和评估源于特殊教育教师的定性数据。
    结果:由此产生的性同意干预,问我第一个选择,由四个模块组成,涵盖的主题包括性同意的定义;决策策略和实践;传达同意和拒绝,确定同意和不同意的情况;以及围绕同意的法律问题。每个模块分为五个部分用于内容交付:(1)介绍,(2)讲座,(3)补充活动,(4)评估,(5)结论。我们详细说明了干预的独特方面,强调我们使用通用设计学习原则来支持教师教学和学生学习的领域。
    结论:我们创建性同意干预措施的努力直接解决了性教育公平问题。我们对我们的设计过程和决策提供评论,以及对希望在类似情况下为智力和发育障碍学生开发性健康干预措施的未来群体的建议。下一步包括进一步测试和确认性同意干预措施,以建立智力和发育障碍青少年性教育的证据基础。
    BACKGROUND: Tailored sexuality education for adolescents with intellectual and developmental disabilities is a crucial, yet unmet, need as this population is particularly at risk for sexual abuse and victimisation. However, there are no evidence-based interventions to specifically address this need. This paper presents the development of an intervention framework to address equity in sexuality education and support adolescents with intellectual and developmental disabilities to understand and provide sexual consent, a foundational aspect of sexuality education and sexual health.
    METHODS: The Sexual Health Equity Project team used a Community-Based Participatory Research approach to develop a four-module sexual consent intervention for adolescents with intellectual and developmental disabilities. We leveraged a diverse, interdisciplinary team in a suburban Midwestern school district, and used Backward Design to create objectives and assessments which were rooted in findings from qualitative data by special education teachers.
    RESULTS: The resulting sexual consent intervention, Ask Me First-Choices, is comprised of four modules covering topics including definition of sexual consent; decision-making strategies and practice; communicating consent and refusal, identifying situations of consent and non-consent; and legal issues surrounding consent. Each module is divided into five components for content delivery: (1) introduction, (2) lecture, (3) supplemental activity, (4) assessment, and (5) conclusion. We detail the intervention\'s unique aspects, emphasising areas where we used Universal Design for Learning principles to support teachers\' instruction and students\' learning.
    CONCLUSIONS: Our efforts to create a sexual consent intervention directly address sexuality education equity issues. We offer commentary on our design process and decisions, as well as recommendations for future groups who want to develop sexual health interventions in similar contexts for students with intellectual and developmental disabilities. Next steps include further testing and validation of the sexual consent intervention to build the evidence-base of sexuality education for adolescents with intellectual and developmental disabilities.
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  • 文章类型: Journal Article
    智力障碍(ID)的儿童由于运动而经常在保持适当的口腔卫生方面面临挑战,感官,和智力障碍,这可能导致口腔健康受损;因此,有必要改善这些人群的口腔健康状况,并建立有效的预防干预措施系统。这里,我们旨在评估洛雷斯坦省ID患儿中牙龈内阿米巴和毛滴虫的患病率,通过寄生虫学和分子方法在伊朗西部。
    当前的描述性调查涉及215名具有ID的儿童和215名健康儿童(非ID),他们被转介到洛雷斯坦省的医疗机构,伊朗在2022年10月至2024年3月之间。通过利用显微镜分析和常规聚合酶链反应(PCR)技术发现了口腔中原生动物的流行。
    通过显微镜和PCR方法,发现有ID的儿童中牙龈大肠杆菌和T.tenax的总患病率分别为87(40.5%)和92(42.8%),分别。在阳性样本中,57名(61.9%)和35名(38.1%)儿童的牙龈大肠杆菌和T.tenax检测呈阳性,分别。相比之下,在对照组的215名非身份证儿童中,39(18.1%)和42(19.5%)通过显微镜和PCR方法检测呈阳性,分别。在非身份证儿童的阳性样本中,23例(54.7%)和19例(45.3%)儿童牙龈大肠杆菌和T.tenax阳性,分别。多元逻辑回归分析表明,居住在城市地区,父母教育,家庭月收入,刷牙p<0.001)被确定为口腔寄生虫的独立危险因素。
    这项研究确定了洛雷斯坦省ID儿童口腔寄生虫的显着患病率,伊朗西部。必须认识到与这些寄生虫相关的主要危险因素,尤其是刷牙不足,为了加强ID儿童的公共和口腔健康策略。因此,儿科牙科专业人员应该对这些风险因素保持警惕,以有效识别和解决该人群的口腔健康问题,从而减轻口腔疾病和感染的发生。
    UNASSIGNED: Children with intellectual disability (ID) often face challenges in maintaining proper oral hygiene due to their motor, sensory, and intellectual impairments, which can lead to compromised oral health; therefore, there is a need to enhance the oral health status of these populations and establish an effective system for administering preventive interventions. Here, we aimed to evaluate the prevalence of Entamoeba gingivalis and Trichomonas tenax among children with ID in Lorestan province, in Western Iran through parasitological and molecular methods.
    UNASSIGNED: The current descriptive investigation involved 215 in children with ID and 215 healthy children (non-ID) who were referred to health facilities in Lorestan province, Iran between October 2022 and March 2024. The prevalence of protozoa in the oral cavity was found through the utilization of both microscopic analysis and conventional polymerase chain reaction (PCR) techniques.
    UNASSIGNED: The total prevalence of the E. gingivalis and T. tenax in children with ID was found to be 87 (40.5%) and 92 (42.8%) through microscopic and PCR methods, respectively. Among the positive samples, 57 (61.9%) and 35 (38.1%) children tested positive for E. gingivalis and T. tenax, respectively. In contrast, among the 215 non-ID children in the control group, 39 (18.1%) and 42 (19.5%) tested positive by microscopic and PCR methods, respectively. Among positive samples in non-ID children, 23 (54.7%) and 19 (45.3%) children were positive for E. gingivalis and T. tenax, respectively. Multiple logistic regression analysis indicated that residing in urban areas, parental education, monthly family income, and tooth brushing p<0.001) were identified as independent risk factors for oral cavity parasites.
    UNASSIGNED: This study identified a notable prevalence of oral cavity parasites in children with ID in Lorestan province, Western Iran. It is imperative to recognize the primary risk factors associated with these parasites, particularly inadequate teeth brushing, in order to enhance public and oral health strategies for children with ID. Therefore, pediatric dental professionals should remain vigilant regarding these risk factors to effectively recognize and address oral health issues in this population, thereby mitigating the occurrence of oral diseases and infections.
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  • 文章类型: Journal Article
    来自教育和临床实践的少量研究和报告表明,教学识字技能可以促进智障学生(ID)的语音产生。然而,需要进行干预研究来测试潜在的联系。这项研究旨在调查十二周的系统,数字素养干预可增强ID和沟通困难学生的语音效果。121名具有身份证的学生被分配到四个不同的组:基于语音的,基于理解,结合基于语音和理解的干预措施,以及照常教学的对照组。在干预前后评估语音产生。没有估算变量的数据的结果表明,系统,数字素养干预对语音产生的影响。然而,缺失数据的敏感性分析结果更加模糊,其中一项干预措施的效果仅接近显著性(ps=.05-.07)。尽管如此,我们初步建议,数字素养干预可以支持ID和沟通困难学生的言语发展。未来的研究应该做,以确认和进一步阐明这一环节的功能机制,这样我们就可以有更好的理解,可以提高教学和演讲和阅读的关键能力。
    A small body of research and reports from educational and clinical practice suggest that teaching literacy skills may facilitate the development of speech sound production in students with intellectual disabilities (ID). However, intervention research is needed to test the potential connection. This study aimed to investigate whether twelve weeks of systematic, digital literacy intervention enhanced speech sound production in students with ID and communication difficulties. A sample of 121 students with ID were assigned to four different groups: phonics-based, comprehension-based, a combination with both phonics- and comprehension-based intervention and a comparison group with teaching-as-usual. Speech sound production was assessed before and after the intervention. The results on the data without the imputed variable suggested a significant positive effect of systematic, digital literacy interventions on speech sound production. However, results from sensitivity analyses with imputed missing data was more ambiguous, with the effect only approaching significance (ps = .05-.07) for one of the interventions. Nonetheless, we tentatively suggest that systematic, digital literacy intervention could support speech development in students with ID and communication difficulties. Future research should be done to confirm and further elucidate the functional mechanisms of this link, so that we may have a better understanding and can improve instruction and the pivotal abilities of speech and reading.
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  • 文章类型: Case Reports
    背景:智力障碍是一种神经发育障碍,其特征是智力功能和适应性行为明显受损。认知灵活性和注意力是智力障碍儿童经常受到影响的关键认知领域。本病例报告探讨了经颅交流电刺激的新颖用途,一种无创的大脑刺激技术,来增强这些认知功能。该研究的新颖性在于其专注于针对特定Brodmann区域的α波频率经颅交流刺激,及其对智障儿童人群的认知灵活性和注意力的潜在持续影响。
    方法:案例研究涉及两名小学生,都是7岁有轻度智力障碍,一男一女,都是突厥民族,来自Khosrowshah的ShahidFahmideh特殊儿童学校,伊朗。两位参与者都接受了为期2周的干预,每天以α波频率(10Hz)进行20分钟的经颅交流电刺激,瞄准Brodmann区域F3和P3。使用威斯康星卡片分类测试和时钟测试评估认知灵活性和注意力,在四个时间点进行管理:干预前,干预后第1周、第2周和第1个月。统计分析显示,与基线相比,两位参与者的威斯康星卡片分类测试和时钟测试得分均有显着改善。随着时间的推移持续增强。
    结论:该病例报告的结果表明,经颅交流刺激可能是改善智力障碍儿童认知灵活性和注意力的有希望的干预措施。观察到的显着和持续的改善表明,经颅交流电刺激可能对该人群的认知发展产生有意义的临床影响。然而,需要进一步的研究来证实经颅交流电流刺激的功效,并探索其更广泛的适用性和长期效果,更多样化的人口。
    BACKGROUND: Intellectual disability is a neurodevelopmental disorder characterized by significant impairments in intellectual functioning and adaptive behavior. Cognitive flexibility and attention are crucial cognitive domains often affected in children with intellectual disability. This case report explores the novel use of transcranial alternating current stimulation, a noninvasive brain stimulation technique, to enhance these cognitive functions. The study\'s novelty lies in its focus on alpha-wave frequency transcranial alternating current stimulation targeting specific Brodmann areas and its potential sustained impact on cognitive flexibility and attention in the pediatric population with intellectual disability.
    METHODS: The case study involved two elementary school students, both 7 years old with mild intellectual disability, one male and one female, both with Turkic ethnicity, from Shahid Fahmideh School for Exceptional Children in Khosrowshah, Iran. Both participants underwent a 2-week intervention with daily 20-minute sessions of transcranial alternating current stimulation at an alpha-wave frequency (10 Hz), targeting Brodmann areas F3 and P3. Cognitive flexibility and attention were assessed using the Wisconsin Card Sorting Test and the Clock Test, administered at four time points: pre-intervention, week 1, week 2, and 1 month post-intervention. Statistical analysis showed significant improvements in both Wisconsin Card Sorting Test and Clock Test scores for both participants compared with baseline, with sustained enhancement over time.
    CONCLUSIONS: The findings from this case report indicate that transcranial alternating current stimulation may be a promising intervention for improving cognitive flexibility and attention in children with intellectual disability. The significant and sustained improvements observed suggest that transcranial alternating current stimulation could have a meaningful clinical impact on the cognitive development of this population. However, further research is needed to confirm the efficacy of transcranial alternating current stimulation and to explore its broader applicability and long-term effects in larger, more diverse populations.
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  • 文章类型: Journal Article
    我们对智障人士(ID)探索和导航大规模空间的能力知之甚少。在这项交叉综合征研究中,患有唐氏综合症(DS)的个体,患有威廉姆斯综合征(WS)和通常发育中的儿童(TD;5-11岁)的个体探索虚拟环境,目的是学习环境中的所有事物(实验1)或找到六颗星(实验2)。当目标只是了解没有特定目的地的环境时,WS和DS组之间几乎没有差异(实验1);两组的表现水平类似于TD儿童的子集,具有相似的非语言能力。当任务的目标是在环境中定位目标时,差异变得明显(实验2)。DS组表现最弱,在非语言能力相似的情况下,表现在或低于TD儿童子集的水平,而WS组在TD子集组的级别上执行。DS,WS和TD组也表现出不同的探索行为模式。DS的探索行为较弱,并且在所有试验中都没有改善。在WS中,所有试验中的探查行为均发生了变化,但不典型(重复试验后,再就诊次数增加).此外,诊断个体差异分析(潜在轮廓分析)揭示了探索和导航变量的五个轮廓,其中没有一个是DS或WS特有的。只有非常差的导航员的最极端特征是DS和WS参与者特有的。有趣的是,所有其他配置文件包含至少一个患有DS的个体和至少一个患有WS的个体。这凸显了调查智力残疾个体表现异质性的重要性,以及数据驱动的跨诊断方法对识别行为特征的有用性。
    We know little about the ability to explore and navigate large-scale space for people with intellectual disability (ID). In this cross-syndrome study, individuals with Down syndrome (DS), individuals with Williams syndrome (WS) and typically developing children (TD; aged 5-11 years) explored virtual environments with the goal of learning where everything was within the environment (Experiment 1) or to find six stars (Experiment 2). There was little difference between the WS and DS groups when the goal was simply to learn about the environment with no specific destination to be reached (Experiment 1); both groups performed at a level akin to a subset of TD children of a similar level of non-verbal ability. The difference became evident when the goal of the task was to locate targets in the environment (Experiment 2). The DS group showed the weakest performance, performing at or below the level of a subset of TD children at a similar level of non-verbal ability, whilst the WS group performed at the level of the TD subset group. The DS, WS and TD group also demonstrated different patterns of exploration behavior. Exploration behaviour in DS was weak and did not improve across trials. In WS, exploration behavior changed across trials but was atypical (the number of revisits increased with repeated trials). Moreover, transdiagnostic individual difference analysis (Latent Profile Analysis) revealed five profiles of exploration and navigation variables, none of which were uniquely specific to DS or to WS. Only the most extreme profile of very poor navigators was specific to participants with DS and WS. Interestingly, all other profiles contained at least one individual with DS and at least one individual with WS. This highlights the importance of investigating heterogeneity in the performance of individuals with intellectual disability and the usefulness of a data-driven transdiagnostic approach to identifying behavioral profiles.
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  • 文章类型: Journal Article
    自闭症研究中患有严重自闭症(需要全天候获得护理)的个人代表性不足,导致对其服务需求的知识有限,缺乏针对这些需求的循证实践。这项研究探讨了护理人员对服务需求的看法,获得护理的障碍,和治疗优先事项,以指导治疗发展和改善服务提供。顺序混合方法设计将定量调查数据(n=423;Mage=18.89岁;26.7%的女性)与青少年和患有严重自闭症的成年人的护理人员的定性访谈(n=20)相结合。定量调查结果表明,定期的社会化机会是最常见的未得到满足的服务需求(60.3%的护理人员),其次是初级卫生保健,有自闭症培训的工作人员(59.3%),社会技能指导(55.8%),生活技能指导(51.3%),和行为支持(47.3%)。需要社交活动团体的可能性较高与情绪反应性升高有关,更高的语言水平,少数民族化,和较低的家庭收入。对专门初级保健的需求增加与收入减少有关,而对社交和生活技能指导的需求与年龄增长和焦虑情绪升高有关。定性分析确定了10个主题,这些主题通过强调普遍缺乏个性化、以目标为导向的服务,常见的护理障碍,以及优先发展集中治疗设置,以协调整个成年期的护理。这项研究确定了美国患有严重自闭症的青少年和成年人的迫切服务需求。这些见解对于提高临床护理的可及性和质量至关重要。
    The underrepresentation of individuals with profound autism (who require 24/7 access to care) in autism research has resulted in limited knowledge about their service needs and a lack of evidence-based practices tailored to those needs. This study explored caregiver perspectives on service needs, barriers to accessing care, and treatment priorities to guide treatment development and improvement of service delivery. A sequential mixed-methods design integrated quantitative survey data (n = 423; Mage = 18.89 years; 26.7% female) with qualitative interviews (n = 20) with caregivers of adolescents and adults with profound autism. Quantitative findings indicated regular socialization opportunities were the most frequently endorsed unmet service need (60.3% of caregivers), followed by primary health care with autism-trained staff (59.3%), social skills instruction (55.8%), life skills instruction (51.3%), and behavioral support (47.3%). Higher likelihood of needing social activity groups was associated with elevated emotional reactivity, higher language level, minoritized ethnicity, and lower household income. Greater need for specialized primary health care was associated with lower income, while the need for social and life skills instruction was associated with increased age and elevated dysphoria. Qualitative analysis identified 10 themes that converged and expanded quantitative findings by highlighting a pervasive shortage of individualized, goal-oriented services, common barriers to care, and the priority of developing centralized treatment settings that coordinate care throughout adulthood. This study identified pressing service needs for adolescents and adults with profound autism in the United States. These insights are crucial for improving the accessibility and quality of clinical care.
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  • 文章类型: Journal Article
    背景:SMARCB1基因编码BRG1相关因子(BAF)复合物的一个亚基,该基因的突变与Coffin-Siris综合征(CSS)3型有关。CSS的特点是一系列的发育障碍,面部畸形特征,和喂养困难。在CSS中注意到基因型-表型相关性,涉及SMARCB1突变的病例通常表现出更严重的语言障碍和智力障碍。方法:我们对已报告的CSS3型病例进行了回顾,并提出了与SMARCB1变体相关的CSS的第一例,其中患者表现出正常的智力,而仅表现出轻度的选择性神经心理缺陷。患者接受了喂养挑战的评估,生长延迟,和第二年的畸形特征。随后,CSS诊断是由于从头杂合c.568C>T(p。Arg190Trp)在SMARCB1基因中的变异体。由于学习困难,患者接受了全面的神经心理学评估,这与她的医学和发育历史的回顾性重建有关。结果:患者表现出正常的智力和适应功能,在算术和语言学习和长期记忆方面有特定的缺陷和选择性困难。在儿童早期观察到的喂养困难和语言延迟随着时间的推移显着改善。讨论:我们将此案例与先前报告的CSS类型3案例进行讨论,强调神经心理学方面。很明显,CSS的神经心理学特征在受影响的个体之间可能有所不同,强调医疗保健专业人员针对特定认知和情感需求量身定制的个性化支持和干预措施的重要性。我们的案例为未来的研究提供了途径,以鉴定表型表达的特定修饰剂,以解释患者之间智力的变异性并确定基因治疗的潜在靶标。
    Background: The SMARCB1 gene encodes a subunit of the BRG1-Associated Factor (BAF) complex, and mutations in this gene have been linked to Coffin-Siris Syndrome (CSS) type 3. CSS is characterized by a range of developmental disabilities, facial dysmorphic features, and feeding difficulties. There\'s been noted genotype-phenotype correlation in CSS, with cases involving SMARCB1 mutations often exhibiting more severe language impairment and intellectual disability. Method: We conducted a review of reported CSS type 3 cases and presented the first instance of CSS associated with a SMARCB1 variant wherein the patient exhibited normal intelligence and only mild selective neuropsychological deficits. The patient underwent evaluation for feeding challenges, growth delay, and dysmorphic features during their second year of life. Subsequently, CSS diagnosis was confirmed due to a de novo heterozygous c.568C > T (p.Arg190Trp) variant in the SMARCB1 gene. Due to learning difficulties, the patient underwent a comprehensive neuropsychological assessment, which was related to the retrospective reconstruction of her medical and developmental history. Results: The patient demonstrated normal intelligence and adaptive functioning, with specific deficits in arithmetic and selective difficulties in verbal learning and long-term memory. Feeding difficulties and language delay observed in early childhood showed significant improvement over time. Discussion: We discuss this case in relation to previously reported CSS type 3 cases, emphasizing neuropsychological aspects. It\'s evident that neuropsychological features of CSS can vary among affected individuals, highlighting the importance of personalized support and interventions tailored to specific cognitive and emotional needs by healthcare professionals. Our case suggests avenues for future research to identify specific modifiers of phenotypic expression to explain variability in intellect among patients and pinpoint potential targets for gene therapy.
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