Salud Pública de Méxicohttps://www.scielosp.org/feed/spm/2008.v50suppl2/2021-01-13T00:10:00ZVol. 50 - 2008WerkzeugIntellectual disability and its effects on societyS0036-363420080008000012021-01-13T00:10:00Z2017-01-20T00:02:00ZLazcano-Ponce, EduardoRangel-Eudave, GuillerminaKatz, Gregorio
<em>Lazcano-Ponce, Eduardo</em>;
<em>Rangel-Eudave, Guillermina</em>;
<em>Katz, Gregorio</em>;
<br/><br/>
The challenge of mental disabilityS0036-363420080008000022021-01-13T00:10:00Z2017-01-20T00:02:00ZSotelo, Julio
<em>Sotelo, Julio</em>;
<br/><br/>
Intellectual disability: an unresolved world health challengeS0036-363420080008000032021-01-13T00:10:00Z2017-01-20T00:02:00ZSalvador-Carulla, Luis
<em>Salvador-Carulla, Luis</em>;
<br/><br/>
The present, past and future of the study of intellectual disability: challenges in developing countriesS0036-363420080008000042021-01-13T00:10:00Z2017-01-20T00:02:00ZParmenter, Trevor R
<em>Parmenter, Trevor R</em>;
<br/><br/>
There is strong evidence that socio-cultural factors largely determine what is seen as competent behaviour. Within western high income countries, driven by the values of utilitarian individualism, the construct of intellectual disability has been largely determined to meet the needs of urban, industrialised societies. In contrast, competence in non-industrialised societies may be more reflected in collaborative, interpersonal problem solving skills such as those found among Nigerian students labelled as intellectually disabled. However, people who are judged to be incompetent or "obtrusive" in countries deficient in support services, are often neglected and consigned to a life in poorly managed segregated institutions, as is the case in China, Russia and some countries in Eastern Europe. Non western countries that have a long history of a globalised economy, such as Taiwan and Japan also remain committed to segregated institutional provisions for people with an intellectual disability, despite a notional acceptance of inclusionary policies enunciated by the United Nations’ Declarations and Conventions. In this paper is concluded that it must be recognised that the population of people with an intellectual disability, regardless of how the condition is defined and classified, is quite heterogeneous. Their needs are also varied and not at all dissimilar to those of the general population. As developing countries adopt western style consumer-driven economies, there is an extreme danger that they, too, will follow the same trajectory of exclusion and impose the culture of "otherness" for a group whose contribution to that society will be devalued. Good science is futile unless it benefits all peoples.Intellectual disability: definition, etiological factors, classification, diagnosis, treatment and prognosisS0036-363420080008000052021-01-13T00:10:00Z2017-01-20T00:02:00ZKatz, GregorioLazcano-Ponce, Eduardo
<em>Katz, Gregorio</em>;
<em>Lazcano-Ponce, Eduardo</em>;
<br/><br/>
Etiology and classification: Causal factors related with cognitive disability are multiples and can be classified as follows: Genetic, acquired (congenital and developmental), environmental and sociocultural. Likewise, in relation to the classification, cognitive disability has as a common denominator a subnormal intellectual functioning level; nevertheless, the extent to which an individual is unable to face the demands established by society for the individual’s age group has brought about four degrees of severity: Mild, moderate, severe and profound. Diagnostic: The clinical history must put an emphasis on healthcare during the prenatal, perinatal and postnatal period and include the results of all previous studies, including a genealogical tree for at least three generations and an intentional search for family antecedents of mental delay, psychiatric illnesses and congenital abnormalities. The physical exam should focus on secondary abnormalities and congenital malformations, somatometric measurements and neurological and behavioral phenotype evaluations. If it is not feasible to establish a clinical diagnosis, it is necessary to conduct high-resolution cytogenetic studies in addition to metabolic clinical evaluations. In the next step, if no abnormal data are identified, submicroscopic chromosomal disorders are evaluated. Prognosis: Intellectual disability is not curable; and yet, the prognostic in general terms is good when using the emotional wellbeing of the individual as a parameter. Conclusions: Intellectual disability should be treated in a comprehensive manner. Nevertheless, currently, the fundamental task and perhaps the only one that applies is the detection of the limitation and abilities as a function of subjects’ age and expectations for the future, with the only goal being to provide the support necessary for each one of the dimensions or areas in which the person’s life is expressed and exposed.Intellectual disability: an approach from the health sciences perspectiveS0036-363420080008000062021-01-13T00:10:00Z2017-01-20T00:02:00ZSalvador-Carulla, LuisRodríguez-Blázquez, CarmenMartorell, Almudena
<em>Salvador-Carulla, Luis</em>;
<em>Rodríguez-Blázquez, Carmen</em>;
<em>Martorell, Almudena</em>;
<br/><br/>
Intellectual disability (ID) is a complex condition that has not aroused very much interest in the health sciences and medical fields. As a result, a large part of the responsibility for caring for individuals with ID has fallen in the areas of education, social services and volunteering. Nevertheless, intellectual disability is a very significant health problem, whether because of its prevalence, the costs to the public health system, the families and society in general or due to related health complications. ID should be a priority area of study and action in the health field. This article reviews the conceptual, diagnostic and etiological problems that affect intellectual disability, as well as factors related with the health of the persons who are affected. In addition, some recommendations are outlined for improving health care for this population group.The impact of stress and social support on the mental health of individuals with intellectual disabilitiesS0036-363420080008000072021-01-13T00:10:00Z2017-01-20T00:02:00ZLunsky, Yona
<em>Lunsky, Yona</em>;
<br/><br/>
People with intellectual disabilities (ID) are at increased risk for mental health problems than the general population. The reasons for this are both biological and social. Current treatment for mental health problems tends to be reactive in nature with less emphasis on how mental health problems can be prevented. A better understanding of the social contributors to mental health in individuals with ID should lead to the prevention of mental health problems in this particularly vulnerable population. Two promising areas of research when thinking about mental health promotion and ID are stress and social support, which are reviewed here.Attending to the health needs of people with intellectual disability: quality standardsS0036-363420080008000082021-01-13T00:10:00Z2017-01-20T00:02:00ZO'Hara, Jean
<em>O'hara, Jean</em>;
<br/><br/>
People with intellectual disabilities remain among the most vulnerable members of society and often face many barriers to healthcare. They experience major health problems and risks yet pay a ‘disability penalty’, the result of social exclusion, discrimination and isolation. If public health strategies are to address the physical and mental health needs of people with intellectual disabilities, attention needs to be given to their particular health profile. Health targets, quality standards and outcome measures must attend to their needs, for the measure of civilisation is how well we treat those who are deemed more vulnerable and less able in society. This article highlights how these issues are being addressed in ‘westernised’ countries and some of the dilemmas and challenges faced by health care organisations.The WHO atlas on global resources for persons with intellectual disabilities: a right to health perspectiveS0036-363420080008000092021-01-13T00:10:00Z2017-01-20T00:02:00ZLecomte, JocelinMercier, Céline
<em>Lecomte, Jocelin</em>;
<em>Mercier, Céline</em>;
<br/><br/>
This paper focuses on the links between the WHO atlas on global resources for persons with intellectual disabilities (Atlas-ID) project and the right to health in international human rights law. The WHO Atlas-ID project initiated by the Department of Mental Health and Substance Abuse of the WHO was designed to collect, compile and disseminate data on intellectual disabilities services and resources throughout the world. The right to health, as linked to all other human rights, brings a set of globally agreed upon norms and standards, and out of these norms arise governmental obligations. Even in countries which have a relatively high standard of living, persons with intellectual disabilities are very often denied the opportunity to enjoy the full range of economic, social and cultural rights. This paper aims at establishing the WHO Atlas-ID and the international human rights instruments as two parts of a holistic approach in regards to State provided services to persons with intellectual disabilities and their families.Health promotion for Latin Americans with intellectual disabilitiesS0036-363420080008000102021-01-13T00:10:00Z2017-01-20T00:02:00ZFrey, Georgia CTemple, Viviene A
<em>Frey, Georgia C</em>;
<em>Temple, Viviene A</em>;
<br/><br/>
In response to the emerging global concern regarding health and people with intellectual disabilities (ID), several developed countries have established national initiatives to address the unique health needs of this population segment. However, most people with ID reside in countries with developing economies, such as many Latin American countries, yet there is virtually no information on the health of people with ID in these regions. Countries with developing economies face distinct challenges in promoting health among this population segment that may preclude adoption or adaptation of policies and practices developed in regions with established economies. This paper will address the issue of health promotion among people with ID in Latin America, an area that is undergoing significant reforms in both health care and disability rights. Information on the social and health status of Latin Americans with ID, as well as research on health promotion best practices, will be used to develop recommendations for promoting health for these individuals.Promotion of physical activity in individuals with intellectual disabilityS0036-363420080008000112021-01-13T00:10:00Z2017-01-20T00:02:00ZStanish, Heidi IFrey, Georgia C
<em>Stanish, Heidi I</em>;
<em>Frey, Georgia C</em>;
<br/><br/>
This paper provides an overview of strategies that have been used to promote physical activity in individuals with intellectual disability. Several different approaches are discussed and the strengths and limitations of each are presented. Some determinants of physical activity for individuals with intellectual disability are also reported in an effort to better understand the factors that influence participation that could be targeted in future interventions. Recommendations for programming are provided.Physical activity and persons with intellectual disability: some considerations for Latin AmericaS0036-363420080008000122021-01-13T00:10:00Z2017-01-20T00:02:00ZTemple, Viviene AStanish, Heidi I
<em>Temple, Viviene A</em>;
<em>Stanish, Heidi I</em>;
<br/><br/>
Physical activity is a personal and societal investment in health. In Latin America, rates of non-communicable diseases are growing and there is burgeoning interest in physical activity as a preventative health measure. This paper describes physical activity among adults with intellectual disability from a public health perspective; and provides recommendations related to the need for, and measurement of, physical activity among persons with intellectual disability in Latin America.A best practice in education and support services for independent living of intellectually disabled youth and adults in MexicoS0036-363420080008000132021-01-13T00:10:00Z2017-01-20T00:02:00ZKatz, GregorioRangel-Eudave, GuillerminaAllen-Leigh, BetaniaLazcano-Ponce, Eduardo
<em>Katz, Gregorio</em>;
<em>Rangel-Eudave, Guillermina</em>;
<em>Allen-Leigh, Betania</em>;
<em>Lazcano-Ponce, Eduardo</em>;
<br/><br/>
This article describes a best practice in the field of intellectual disability, a program for independent living offered by the Center for Integral Training and Development (CADI per its abbreviation in Spanish) for people with intellectual disability in Mexico. A detailed description of an effective program that fosters autonomy, social inclusion and high quality of life in people with intellectual disability is presented. The program encompasses four areas: a) a therapeutic academic area that teaches applied living skills; b) development of social skills; c) development of vocational skills, and d) skills for independent living. The program is divided into three levels: a) initiation to independent living, where clients develop basic abilities for autonomy, b) community integration and social independence, which provides clients with the skills necessary for social inclusion and economic independence, and c) practical and psychological support, which offers counseling for resolving psychological issues and enables subjects to maintain their autonomy.Education of persons with intellectual disabilities in IndiaS0036-363420080008000142021-01-13T00:10:00Z2017-01-20T00:02:00ZRao, L Govinda
<em>Rao, L Govinda</em>;
<br/><br/>
Historically in India, persons with disabilities enjoyed co-existence, though at different times, the treatment and attitudes were at variance. Out of all the types of disabilities, an intellectual disability poses greater challenges than the other types. The families of persons with intellectual disabilities do also have needs different from others, which cannot be segregated from the needs of children with intellectual disability. Specific legislations have been put in place to ensure empowerment of persons with disabilities. Through Rehabilitation Council of India, human resource development programs are standardized. The National Institute for the Mentally Handicapped has developed many service models and contributed toward human resource development and research. Many Non-Government Organizations have started special education and vocational training programs. National Trust, a statutory body, supports the individuals and families and seeks to protect those individuals having no parents. Sarva Shiksha Abhiyan (Education for All), has special focus on education of children with disabilities. Vocational training centres have an obligation to develop eco-centric and commercially viable jobs. As per the National Policy, the Government of India envisages that every child with a disability should have access to appropriate preschool, primary and secondary level education by 2020.View of Mexican family members on the autonomy of adolescents and adults with intellectual disabilityS0036-363420080008000152021-01-13T00:10:00Z2017-01-20T00:02:00ZAllen-Leigh, BetaniaKatz, GregorioRangel-Eudave, GuillerminaLazcano-Ponce, Eduardo
<em>Allen-Leigh, Betania</em>;
<em>Katz, Gregorio</em>;
<em>Rangel-Eudave, Guillermina</em>;
<em>Lazcano-Ponce, Eduardo</em>;
<br/><br/>
This study aims to describe the ways in which Mexican adolescents and adults with intellectual disability exercise autonomy. Two focus groups were carried out with family members who are the legal guardians of people with intellectual disability who have received independent living training at the Center for Integral Training and Development (CADI, per its abbreviation in Spansh). Focus group transcripts were analyzed with codes defined a priori, based on an existing theoretical framework on autonomy and quality of life among intellectually disabled persons. Autonomy is exercised by the intellectually disabled in the personal, social, sexual and economic spheres of life. Empowered autonomy implies that the person is taught the necessary skills and then allowed to act upon his or her own interests. Negotiated autonomy includes guidance, explanation and negotiation; it constitutes a learning process. Interpreted autonomy is the most limited type described, and implies protection, interpretation and may involve decision-making by others. These types of autonomy constitute a complex phenomenon and the divisions between them are indistinct.Do persons with intellectual disability have a social life?The Israeli realityS0036-363420080008000162021-01-13T00:10:00Z2017-01-20T00:02:00ZDuvdevany, Ilana
<em>Duvdevany, Ilana</em>;
<br/><br/>
Living in the community does not, in and of itself, guarantee social integration and inclusion for persons with intellectual disability. Social life and leisure participation can indicate the beginning of such a process and its impact on the quality of life. The present study investigated the social life quality of persons with intellectual disability who live in community settings or with foster families and its impact on their quality of life. The sample consisted of 85 adults with intellectual disability, ranging in age from 18 to 55 years. Forty-five of them lived in community residential settings and 40 lived with foster families in Israel. Five questionnaires were used: 1) a demographic questionnaire; 2) Quality of Life Questionnaire;¹ 3) the Revised UCLA Loneliness Scale;² 4) Social Relationships List;³ and 5) Leisure Activities List.³ The main findings showed no significant differences between the two groups in social life or feelings of loneliness. Foster residents were more involved and more independent in their leisure activities than were those who lived in community residences. An association between social life and quality of life was partly confirmed. The need for intervention programs and leisure education programs is discussed.Sexual life in subjects with intellectual disabilityS0036-363420080008000172021-01-13T00:10:00Z2017-01-20T00:02:00ZConod, LoïseServais, Laurent
<em>Conod, Loïse</em>;
<em>Servais, Laurent</em>;
<br/><br/>
During the last decades, the expectancies towards sexual life of people with intellectual disability have been more and more recognized by researchers, clinicians, caregivers and parents. These expectancies, that largely depend on socio-cultural and personal factors, such as the level of disability, must be supported in order to help people with intellectual disability to reach the best quality of life as possible. Therefore, it is important to identify every patient’s and resident’s personal expectancies towards sexuality and which medical and educative support he/she needs according to his/her disability and co-morbidity. The aim of the present paper is to review the different research works conducted in this area.Sexuality in subjects with intellectual disability: an educational intervention proposal for parents and counselors in developing countriesS0036-363420080008000182021-01-13T00:10:00Z2017-01-20T00:02:00ZKatz, GregorioLazcano-Ponce, Eduardo
<em>Katz, Gregorio</em>;
<em>Lazcano-Ponce, Eduardo</em>;
<br/><br/>
In developing countries, the study of intellectual disability has enormous knowledge gaps, especially in the areas of intervention, utilization of services and legislation. This article provides information not only for aiding in the potential development of sexuality in individuals with intellectual disability, but also for fostering their social integration. In Mexico and the region, in order to develop educational interventions for promoting sexual health, it is necessary to consider the following priorities: a) mental health professionals should have the knowledge or receive training for carrying out a sexual education and counseling program; b) educational interventions for subjects with intellectual disability should be adapted for the different stages of life (childhood, adolescence and adulthood); c) during childhood, educational intervention should emphasize the concept of public and private conducts; d) in adolescence, intervention should consider the actual mental age and not the chronological age of the subjects receiving intervention; e) the expression of sexuality in the adult with intellectual disability depends on the early incorporation of factors for promoting social inclusion; f) for educational interventions to be successful, it is fundamental that sexual educators and counselors, in addition to working with the clients, also work with their parents and other close family members; g) intervention programs should establish development objectives for developing in persons with intellectual disability a positive attitude towards sexuality and the improvement in self-esteem; h) in subjects with intellectual disability, their linguistic comprehension level should be taken into consideration and techniques for open discussion and non-inductive education should be used; i) social integration programs should address the needs of developing countries and their individuals, since it is not feasible to import external programs due to differences in infrastructure and the absence of public policies for promoting development; j) full sexuality in subjects with intellectual disability should be fostered in a comprehensive manner within an independent living program; k) in Mexico and the region, public policies should be instituted for administering independent living programs for people with intellectual disability and should lead to social, familial and economic power for the purpose of being productive. Thus, people with mental deficiency in developing countries can aspire to being integrated into social and work life and to appropriately expressing their sexuality.Sexual health for people with intellectual disabilityS0036-363420080008000192021-01-13T00:10:00Z2017-01-20T00:02:00ZEastgate, Gillian
<em>Eastgate, Gillian</em>;
<br/><br/>
People with intellectual disability experience the same range of sexual needs and desires as other people. However, they experience many difficulties meeting their needs. They may be discouraged from relieving sexual tension by masturbating. They face a high risk of sexual abuse. They are likely not to be offered the full range of choices for contraception and sexual health screening. Poor education and social isolation may increase their risk of committing sexual offences. However, with appropriate education and good social support, people with intellectual disability are capable of safe, constructive sexual expression and healthy relationships. Providing such support is an essential part of supporting people with intellectual disability.The feasibility of vocational rehabilitation in subjects with severe mental illnessS0036-363420080008000202021-01-13T00:10:00Z2017-01-20T00:02:00ZWatzke, StefanGalvao, Anja
<em>Watzke, Stefan</em>;
<em>Galvao, Anja</em>;
<br/><br/>
Vocational rehabilitation represents an important element within the mental health care system. To ensure the success of rehabilitation, programs of varying degrees of complexity are needed in order to meet patients’ abilities and needs. Rehabilitation success must be examined multidimensionally and not be reduced to the mere integration into competitive employment. Success is also represented by progress in the level of vocational integration, strengthening of work capabilities, the improvement of the functional level, and in a better quality of life. The patient’s need for rehabilitation has to be recognized as early as possible to shorten the duration of the patient’s disintegration and to avoid stagnation periods. Rehabilitation needs to start in the clinic; with psychiatric help sustained during the rehabilitation process to prevent illness exacerbation and premature program termination. The patient’s development regarding his or her functional level, work capability, and subjective wellbeing needs to be evaluated throughout the program to consistently monitor the patient’s individual needs and abilities and to ensure appropriate support. Training for cognition and social skills should be integrated into rehabilitation programs to compensate individual deficits.European Manifesto: basic standards of healthcare for people with intellectual disabilitiesS0036-363420080008000212021-01-13T00:10:00Z2017-01-20T00:02:00ZScholte, Frans A
<em>Scholte, Frans A</em>;
<br/><br/>