Pica among Persons with Intellectual Disability: Prevalence, Correlates, and Interventions

Background: Individuals with intellectual disabilities (ID) have a higher prevalence of comorbid psychiatric disorders and challenging behaviours compared to the general population. Though less common, one area of concern among those with ID is pica (the ingestion of inedible substances). To date, there is little knowledge of pica, particularly with respect to its risk factors and social consequences. The closure of Ontario's three remaining facilities by 2009 underscores the importance of having knowledge of complex behaviours such as pica for improving supports and services in the community for these individuals. The aim of this study is to better understand the characteristics and support needs of adults with ID and pica. This study is comprised of a quantitative and qualitative component. QUANTITATIVE STUDY Objectives: To investigate the prevalence, risk factors, social and medical characteristics of pica. To determine how pica is managed in terms of hours of supervision, receipt of interventions, and psychotropic medication. Methods: Secondary data analysis was performed on two samples as part of cross-sectional study: 1008 persons with ID from Ontario's facilities and 420 community-dwelling adults with ID from southwestern Ontario. All persons had been assessed using the interRAI Intellectual Disability (interRAI ID)?a comprehensive and standardized instrument that measures a variety of domains for support planning. Bivariate and multivariate analyses were restricted to the facility sample due to the small size of persons with pica in the community. Results:The overall prevalence of pica was 22. 0% and 3. 3% in the facilities and the community, respectively. Logistic regression analysis showed that being male, cognitive functioning, autism, and being non-verbal were associated with a higher odds of having pica, whereas activities of daily living (ADL) was a protective factor. A quadratic relationship was observed between cognitive function and pica: the risk of pica increased with severity of cognitive impairment up to moderate to severe levels of impairment and then diminished among those with very severe cognitive impairment. Behaviour management, self-care skills, and 8 hours or more of one-to-one supervision were more likely to be provided to persons with pica. Compared to persons without pica, persons with pica had higher rates of being prescribed antipsychotic medication. Surprisingly, pica was not associated with higher rates of gastrointestinal health problems, with the exception of acid reflux. The negative social outcomes of pica, however, were many: pica was associated with higher odds of not having a strong and supportive relationship with family, lack of contact with family or other close relations, and absence of participation in social and recreational activities. QUALITATIVE STUDY Objective: To determine the support needs of adults with ID and pica from the perspective of direct-care staff of facility and community settings. Methods: Through two focus groups, the perspectives of four staff from Huronia Regional Centre (HRC), and six staff from community agencies from southwestern Ontario were examined. Transcripts were analyzed thematically for factors that facilitated or hindered the management of pica. Results: Qualitative data revealed three categories that underpinned reduction in pica: preventative measures (environmental controls, close supervision, and the provision of alternative activities), formal supports, and familiarity with the individual. On the other hand, inadequate staff support, lower functioning level of the individual, and lack of knowledge acted as barriers to managing and reducing pica. These barriers were associated with persons participating in fewer recreational activities and community outings, and in some cases the use of mechanical restraints. Barriers specific to each setting in the management of pica were also illuminated. Staff in both settings tended to be self-sufficient and isolated in managing this complex behaviour. Conclusions: Results suggest that attention should be equally paid to the potential social consequences of pica rather than solely to its health risks. Higher staff to client ratios, and training and education for staff to provide more active support to promote individuals' engagement in recreational activity and community integration is needed. Key recommendations also focus on educating and training staff on the risk factors and appropriate management of pica. Improving the collaboration and knowledge exchange among developmental service agencies is also recommended to enhance the management of pica among caregivers. Lastly, the community at large needs education on pica to foster more inclusive community living for those with ID

Reliability of Standardized Assessment for Adults who are Deafblind

This study assessed the reliability of the interRAI Community Health Assessment (interRAI CHA) and Deafblind Supplement (DbS). The interRAI CHA and DbS represents a multidimensional, standardized assessment instrument for use with adults (18 and older) who are deafblind. The interrater reliability of the instrument was tested through the completion of dual assessments with 44 individuals who were deafblind in the province of Ontario, Canada. Overall, nearly 50% of items had a kappa value of at least 0.60, indicating fair to substantial agreement for these items. Several items related to psychosocial well-being, mood, and sense of involvement had kappa scores of less than 0.40. However, among these items with low kappa values, most (78%) showed at least 70% agreement between the two assessors. The internal consistency of several health subscales, embedded within the assessment, was also very good and ranged from 0.63 to 0.93. The interRAI was also very good and ranged from 0.63 to 0.93. The interRAI CHA and DbS represents a reliable instrument for assessing adults with deafblindness to better understand their needs, abilities, and preferences

Pica among Persons with Intellectual Disability: Prevalence, Correlates, and Interventions

I hereby declare that I am the sole author of this thesis. This is a true copy of the thesis, including any required final revisions, as accepted by my examiners. I understand that my thesis may be made electronically available to the public. ii Background: Individuals with intellectual disabilities (ID) have a higher prevalence of comorbid psychiatric disorders and challenging behaviours compared to the general population. Though less common, one area of concern among those with ID is pica (the ingestion of inedible substances). To date, there is little knowledge of pica, particularly with respect to its risk factors and social consequences. The closure of Ontario’s three remaining facilities by 2009 underscores the importance of having knowledge of complex behaviours such as pica for improving supports and services in the community for these individuals. The aim of this study is to better understand the characteristics and support needs of adults with ID and pica. This study is comprised of a quantitative and qualitative component. Quantitative Stud

Teacher Training in a Proactive Classroom Management Approach for Students with Autism Spectrum Disorders

As the prevalence of Autism Spectrum Disorders (ASD) increases, more children with ASD present for services in public school classrooms. Due to the unique social and communication difficulties that characterize this population, these children often exhibit challenging behaviours such as non-compliance, verbal and physical aggression and high levels of off-task responses. Compounding these concerns, teachers and classroom support staff are typically inadequately trained in evidence-based behavioural intervention strategies for such children, particularly those suited for class-wide intervention that are easy to implement and fit within a school setting.The current study addressed these concerns by examining the effectiveness of Errorless Classroom Management (ECM), a proactive classroom management teacher training package, in three self-contained classrooms and a total of 7 students ranging from Grade 1 to Grade 8. In a multiple baseline across classrooms design, teachers and classroom support staff were taught a range of proactive skills that included use of moderating support strategies, reinforcement of prosocial student behaviours, and systematic fading of supports and reinforcement. Teachers and classroom support staff were also trained in how to use these classroom management strategies to build four core student skills: compliance, acquiescence, on-task behaviour, and communication skills. After training, classroom staff showed increased use of proactive classroom management strategies and reduction in use of reactive disciplinary strategies. Results also indicated moderate improvements in student compliance, on-task skills and prosocial behaviours, as well as covariant reductions in challenging behaviours. Improvements in staff and student behaviour were maintained at the 5 month follow-up. Most staff members indicated satisfaction with the training and showed an overall moderate reduction in stress levels related to classroom management. The outcomes of the current study are encouraging and suggest that ECM is suitable as a proactive classroom management approach for self-contained ASD special education classrooms and may fit well as a curriculum within a school wide positive behaviour support framework. The in-service training was completely non-aversive, inexpensive, and brief, making it a positive and cost-efficient approach to classroom management. Teacher training in ECM could potentially decrease the number of students with ASD who require intensive supports in the school system.Ph.D

Clinical Indicators For Endotracheal Suctioning In Adult Patients Receiving Mechanical Ventilation

Background Critically ill patients who need mechanical ventilation require endotracheal suctioning. Guidelines recommend coarse crackles over the trachea and/or the presence of a sawtooth pattern on the flow-volume loop of the ventilator waveform as the best indicators. Objective To determine clinical cues for endotracheal suctioning in patients who require mechanical ventilation. Methods A descriptive study of 42 adult patients receiving mechanical ventilation. After baseline endotracheal suctioning with a closed-system device, patients were assessed hourly up to 4 hours for guideline-based cues for endotracheal suctioning and lung sounds were auscultated. Endotracheal suctioning was done when cues were detected or 4 hours after baseline suctioning. Secretions were collected, measured, and weighed. Results Most patients were male (62%) and white (93%). Mean age was 51 years, and mean duration of mechanical ventilation was 7.5 days. The median time to endotracheal suctioning was 2 hours, and a mean of 4.4 mL of secretions was removed. Three patients had no cues identified but had 1.0 mL or more of secretions. The most frequent cues were crackles over the trachea (88%), sawtooth waveform (33%), coughing (29%), and visible secretions (5%). Cues resolved and physiological parameters improved after suctioning. Coarse lung sounds did not improve. Conclusions Patients receiving mechanical ventilation should be routinely assessed for coarse crackles over the trachea, the most common indicator for endotracheal suctioning. Despite common practice, assessment of lung sounds to identify the need for suctioning is not supported