Behavioral Medicine with the Developmentally Disabled, 1988

Since the late 1960s, the behavioral treatment of mentally retarded, au­ tistic, and other developmentally disabled persons has grown progres­ sively more sophisticated. The literature on behavioral treatment has produced effective and clinically significant programs for the reduction of maladaptive behaviors such as tantrums, aggression, and self-injury; skills deficits have been remediated through improved programs for language and life skills acquisition; and new environments have been opened in the creation of mainstream educational opportunities. In spite of these advances, it strikes us that this almost exclusive focus on behavior problems and skills remediation has been somewhat myopic and that much of the potential for application of behavioral science to solving problems of the developmentally disabled is as yet untapped. In the 1980s, an important revolution has taken place: the devel­ opment of the field of behavioral medicine. This field, in merging disease treatment and management with learning and behavior, has already made impressive progress toward a reconceptualization of health care that acknowledges the centrality of behavior in disease expression. Al­ though there has, as yet, been only a preliminary application of this reconceptualization to the field of developmental disabilities, we are convinced that further extension has great potential.

1. Behavioral Medicine with the Developmentally Disabled: Major Issues and Challenges.- Origins.- Current Applications.- Assessment.- Symptom Management.- Compliance with Medical Regimens.- Prevention.- Theoretical/Contextual Issues.- Learning and Illness.- Medical and Behavioral Disorders.- Effects of Cognitive Dysfunction on Medical Care.- Future Applications.- Assessment.- Symptom Management.- Compliance.- Prevention.- Conclusions.- References.- I. Symptom Management.- 2. Feeding Disorders in the Developmentally Disabled Population.- Consumption of Inappropriate Amounts and Varieties of Food.- Insufficient Consumption.- Excessive Consumption.- Inappropriate Interactions with Previously Consumed Food.- Future Directions.- Prevention and Early Identification.- Length of Treatment.- Maintenance and Generalization.- Methodological Concerns.- Conclusions.- References.- 3. The Role of Development and Learning in Feeding Disorders.- The Development of Normal Feeding Behaviors.- Learning Mechanisms in the Etiology and Maintenance of Feeding Disorders.- New Directions.- References.- 4. Behavioral Medicine and Neurological Disorders.- Cerebral Palsy.- Spina Bifida.- Conclusions.- References.- 5. Neurobehavioral Analysis of Epilepsy in Developmentally Disabled Individuals.- Differential Diagnosis of Epilepsy versus Pseudoepilepsy.- Telemetered EEG and Video Recording (TEEG-VR).- Results of TEEG-VR in Developmentally Disabled Individuals.- The Effects of the Environment on Epileptic Events.- The Effects of the Everyday Environment on Epilepsy in Developmentally Disabled Individuals.- The Question of Contingency Management of Seizurelike Behaviors.- Evaluation of the Functional Effects of Subclinical Seizures and AEDs in Developmentally Disabled Individuals.- A Visual Discrimination Procedure.- An Auditory Discrimination Procedure.- References.- 6. Assessment and Treatment of Neuromuscular Disorders.- Procedural Adaptations for Developmentally Disabled and Mentally Retarded.- EMG Biofeedback versus Contingency Management.- Social Validation and Health Outcome Measures.- Conclusions.- References.- 7. Urinary and Fecal Incontinence in the Developmentally Disabled.- General Incidence.- Incidence of Incontinence in Developmentally Disabled Populations.- Urinary Incontinence.- Review of Urinary System Functioning.- Causes of Urinary Incontinence.- Organic Problems.- Developmental Problems.- Medical Treatment for Urinary Incontinence.- Medication.- Surgical Interventions.- Medical Referral.- Comments on Behavioral Training Procedures.- Training Using Alarms.- Increasing Bladder Capacity (or Retention Training Control).- Other Behavioral Procedures.- Conclusions and Recommendations for Urinary Incontinence Remediation.- Comments Specific to Developmentally Delayed Populations.- Fecal Incontinence.- Physiology of Defecation.- Causes of Fecal Incontinence.- Medical Treatment for Fecal Incontinence.- Medication Interventions.- Surgical Interventions.- Medical Referral.- Behavioral Medicine Procedures.- Comments Specific to Developmentally Delayed Populations.- General Comments about Behavioral Medicine Intervention for Incontinence.- What To Do When It Doesn’t Work.- Summary, Conclusions, and Directions for the Future.- References.- 8. Use of Biofeedback in the Treatment of Incontinence.- Fecal Incontinence.- Urinary Incontinence.- Conclusions.- References.- II. Assessment Issues.- 9. Behavioral Assessment Technology for Pharmacotherapy in Developmental Disabilities.- Common Methodological Problems.- Design and Analysis Issues.- Pharmacological Issues.- Behavioral Issues.- Side Effects.- Theoretical Issues.- Neuropharmacologically Based Models for Behavioral Pharmacotherapy.- References.- 10. Pharmacotherapy in Developmental Disabilities: Methodological Issues.- 11. The Role of Neuropsychological Assessment in Behavioral Medicine with the Developmentally Disabled.- Neuropsychological Assessment.- Neuropsychological Assessment with the Developmentally Disabled.- Integration of Neuropsychology and Behavioral Medicine.- Conclusions.- References.- 12. The Utility of Neuropsychological Assessments of Mentally Retarded Individuals.- The Question of “Organicity”.- Qualitative versus Quantitative Approaches.- A Neuropsychological Model.- Coding Processes.- Executive Functions.- Summary.- References.- III. Educative Interventions.- 13. Behavioral Medicine Approaches to the Prevention of Mental Retardation.- Fetal Alcohol Syndrome.- Epidemiology.- Etiology.- Developmental Impact of FAS.- Identification of Drinking Status.- Preventive Approaches for FAS.- Phenylketonuria.- Epidemiology.- Developmental Outcome.- Detection.- Preventing Retardation Due to PKU.- Maternal PKU.- Other Genetic Disorders.- Lead Poisoning.- Epidemiology.- Developmental Impact.- Preventive Interventions to Reduce Lead Poisoning.- Temporary Preventive Solutions?.- Motor Vehicle Trauma.- Epidemiology.- Etiology.- Assessment.- Preventing Motor Vehicle Injuries.- Other Accidents.- Behavioral Medicine Contributions.- References.- 14. On Effective Prevention of Mental Retardation.- Fetal Alcohol Syndrome.- Phenylketonuria.- Lead Poisoning.- Accident Prevention.- References.- 15. Training Parents in Behavioral Medicine Techniques for the Chronic Care of Their Developmentally Disabled Children.- Target: Developmental Gain.- Target: Physical Therapy.- Target: Occupational Therapy.- Target: Pressure Sores.- Other Issues: Analysis of Treatment Components.- Family Effects.- Clinical Significance of Parent Training Research to Date.- Implications of Parent-Based Interventions on the Medical Components of Chronic Care.- Important Issues To Consider in Developing Parent-Based Interventions.- Future Research Directions.- Conclusions.- References.- 16. Behavioral Parent Training for Families of Developmentally Disabled Children: A Behavioral Medicine Perspective.- A Behavioral Medicine Perspective.- Recognizing and Understanding the Child’s Condition.- Providing Care of the Child’s Special Needs.- Managing Behavior Problems.- Supporting Youth’s Self-Management and Adaptation.- Coping with Medical Problems and Deterioration.- Balancing Personal and Family Priorities with Children’s Needs.- References.- 17. Obesity in the Developmentally Disabled.- Prevalence.- Social and Health Hazards of Obesity.- Clinical Significance of Research.- Etiology.- Maintenance.- Treatment.- Issues of Definition and Measurement.- Relationship between Behavioral and Medical Aspects of Obesity.- Summary and Directions for Further Research.- Medical and Behavioral Evaluation and Treatment.- Interdisciplinary Evaluation.- References.- 18. Clinical-Research Issues in the Treatment of Obesity in the Developmentally Disabled.- State of the Science.- Prader-Willi Syndrome.- Characteristics.- Treatments and Limitations.- Implications for Future Research.- Conclusions.- References.