Percepções de familiares sobre uma rede de cuidados de saúde mental infantojuvenil / Family perceptions about a children's mental health network / Percepciones familiares sobre una red de atención de salud mental infantojuvenil

Este artigo pretende conhecer como a rede de cuidados em saúde tem se operacionalizado a partir da percepção de familiares de crianças com demanda de cuidado em saúde mental (SM). Foram realizados dois grupos focais, um com familiares da Atenção Básica (AB) e outro com familiares do Centro de Atenção Psicossocial Infantojuvenil (CAPSij), totalizando 15 participantes. Seguiu-se com a análise lexical do tipo classificação hierárquica descendente, com o auxílio do software R Interface, a fim de análises multidimensionais de textos e questionários (IRaMuTeQ), resultando em cinco classes: A Pílula Mágica; Forças e Fraquezas dos serviços; Procurando por ajuda; Aceitando o diagnóstico da criança e Onde procurei ajuda. Os resultados apontam para dificuldades presentes na AB em identificar e manejar situações de Saúde Mental Infantojuvenil (SMIJ), por meio de uma lógica ainda medicalizante. Ressalta-se que a escola é apresentada como lugar de destaque na produção da demanda por cuidado e a família ainda é pouco convocada à construção das ações. Conclui-se, então, que avanços ainda são necessários para operacionalização de um cuidado pautado nas diretrizes da política de SMIJ.(AU)

This article aims to know how the healthcare network has been operationalized from the perception of family members of children with demand for mental health care (MH). Two focus groups were held, one with family members from Primary Care (PC) and the other with family members from the Child Psychosocial Care Center (CAPSij), totaling 15 participants. A lexical analysis of the descending hierarchical classification type was performed with the help of the software R Interface for multidimensional analyzes of texts and questionnaires (IRAMUTEQ), resulting in five classes: The Magic Pill; Strengths and Weaknesses of services; Looking for help; Accepting the child's diagnosis; and Where did I look for help. The results point to difficulties present in PC in identifying and managing situations of mental health in children and adolescents (MHCA), with a medicalization logic. Note that the school is presented as a prominent place in producing the demand for care, and the family is still not very much involved in the actions. It is, thus, concluded that advances are still needed for operationalization of care guided by MHCA policy guidelines.(AU)

Este artículo tuvo por objetivo conocer cómo opera una red asistencial a partir de la percepción de familiares de niños con demanda de atención en salud mental (SM). Se realizaron dos grupos focales, uno con familiares de Atención Primaria (AP) y otro con familiares del Centro de Atención Psicosocial Infantojuvenil (CAPSij), totalizando 15 participantes. Se realizó análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), lo que resultó en cinco clases: "La píldora mágica"; "Fortalezas y debilidades de los servicios"; "En busca de ayuda"; "Aceptar el diagnóstico del niño" y "¿Dónde busqué ayuda?". Los resultados apuntan las dificultades presentes en AP para identificar y manejar situaciones de salud mental infantojuvenil (SMIJ) mediante una lógica aún medicalizante. La escuela tiene un lugar destacado en la producción de la demanda de cuidados y la familia aún no está muy involucrada en la construcción de acciones. Se concluye que se necesitan avances para ofertar una atención guiada por lineamientos de la política del SMIJ.(AU)

Psicólogas(os) no sistema educacional de Boa Vista/Roraima: concepções, práticas e desafios / Psychologists in the educational system of Boa Vista/Roraima: conceptions, practices and challenges / Psicólogas(os) en el sistema educativo de Boa Vista/Roraima: concepciones, prácticas y retos

O objeto de estudo deste trabalho é a atuação de psicólogas(os) no campo da educação básica. Tivemos como objetivo investigar as práticas de atuação e os desafios enfrentados pelas(os) psicólogas(os) que trabalham na educação em Boa Vista (RR), com intuito de conhecer a inserção desses profissionais no sistema educacional. Trata-se de pesquisa qualitativa, orientada pelo referencial teórico-metodológico da Psicologia Escolar Crítica. Realizamos o processo de levantamento dos dados entre os meses de março e abril de 2018, por meio de entrevistas semiestruturadas, audiogravadas e transcritas. Encontramos 21 psicólogas e um psicólogo trabalhando em instituições educacionais e de ensino na cidade; a maioria atuava na educação básica; metade dos entrevistados ingressou por concurso público e a outra metade era contratada e comissionada; poucos(as) foram contratados(as) como psicólogos(as) escolares. Para a análise, selecionamos dez psicólogas(os) com mais tempo no cargo. Quanto às práticas de atuação, identificamos que 60% atuavam na modalidade clínica e 40% na modalidade clínica e institucional. Como desafios, encontramos melhoria das condições de trabalho; estabelecimento de relações hierárquicas e a dificuldade de fazer compreender as especificidades desse campo de trabalho; necessidade na melhoria das condições para formação continuada; atuação da(o) psicóloga(o) escolar enquanto ação institucional. Diante do exposto, compreendemos ser necessária uma mudança de paradigma na atuação das(os) psicólogas(os) que trabalham na educação na região, e a apropriação das discussões da área, principalmente, aquelas apresentadas pela Psicologia Escolar Crítica, vez que esta contribui para uma atuação que leve em conta os determinantes sociais, políticos, culturais e pedagógicos que constituem o processo de escolarização.(AU)

This work has as object of study the role of psychologists in the field of Basic Education. We aimed to investigate practices and challenges faced by psychologists who work in education in Boa Vista/RR, to know the insertion of these professionals in the educational system. This is a qualitative research, guided by the theoretical-methodological framework of Critical School Psychology. The data collection process was carried out between March and April 2018, with semi-structured, audio-recorded, and transcribed interviews. We found 21 female psychologists and one male psychologist working in educational institutions in the municipality; most worked in Basic Education; half of the interviewees had applied to work as government employee and the other half were hired and commissioned; few were hired as school psychologists. To carry out the analysis, we selected ten psychologists with more time in the position. Regarding the practices, we have identified that 60% worked in the clinical modality and 40% in the clinical and institutional modality. As challenges, we find the improvement in working conditions; the establishment of hierarchical relationships and the difficulty of making the specificities of this field of work understood; the need to improve conditions for continuing education; the practice of the school psychologist as institutional action. In view of the above, we understand that a paradigm shift in the performance of psychologists working in education in that region is necessary, and the appropriation of discussions in the area, especially those presented by Critical School Psychology, contributes to an action that considers social, political, cultural, and pedagogical determinants that constitute the schooling process.(AU)

Este trabajo tiene como objeto de estudio la actuación profesional de las(os) psicólogas(os) en la educación básica. Su objetivo es investigar las prácticas y retos que enfrentan las(os) psicólogas(os) que trabajan en la educación en Boa Vista, en Roraima (Brasil), con la intención de conocer la inserción de estos profesionales en el sistema educativo. Esta es una investigación cualitativa que se guía por el marco teórico-metodológico de la Psicología Escolar Crítica. Se recopilaron los datos entre los meses de marzo y abril de 2018, mediante entrevistas semiestructuradas, grabadas en audio y después transcritas. Las 21 psicólogas y un psicólogo trabajan en instituciones educativas de la ciudad; la mayoría trabajaba en la educación básica; la mitad de los entrevistados ingresaron mediante concurso público y la otra mitad era contratada y de puesto comisionado; pocos fueron contratados como psicólogos escolares. Para el análisis, se seleccionaron diez psicólogas(os) con más tiempo en el cargo. Con respecto a las prácticas, el 60% trabajaba en la modalidad clínica; y el 40%, en la modalidad clínica e institucional. Los retos son mejora de las condiciones laborales; establecimiento de relaciones jerárquicas y dificultad para comprender las especificidades de este campo de trabajo; necesidad de mejorar las condiciones para la educación continua; y actuación dela (del) psicóloga(o) escolar como acción institucional. En vista de lo anterior, es necesario el cambio de paradigma en la práctica profesional de las(os) psicólogas(os) que trabajan en la educación de la región y la apropiación de las discusiones del área, especialmente las presentadas por la Psicología Escolar Crítica, que contribuye a una acción que tiene en cuenta los determinantes sociales, políticos, culturales y pedagógicos que constituyen el proceso de escolarización.(AU)

Care management in a French cohort with Down syndrome from the AnDDI-Rares/CNSA study.

Down syndrome (DS) is a genetic neurodevelopmental disorder. In individuals with DS, a multidisciplinary approach to care is required to prevent multiple medical complications. The aim of this study was to describe the rehabilitation, medical care, and educational and social support provided to school-aged French DS patients with varying neuropsychological profiles. A mixed study was conducted. Quantitative data were obtained from a French multicentre study that included patients aged 4-20 years with diverse genetic syndromes. Qualitative data were collected by semi-structured face-to-face interviews and focus groups. Ninety-five DS subjects with a mean age of 10.9 years were included. Sixty-six per cent had a moderate intellectual disability (ID) and 18.9% had a severe ID. Medical supervision was generally multidisciplinary but access to medical specialists was often difficult. In terms of education, 94% of children under the age of six were in typical classes. After the age of 15, 75% were in medico-social institutions. Analysis of multidisciplinary rehabilitation conducted in the public and private sectors revealed failure to access physiotherapy, psychomotor therapy and occupational therapy, but not speech therapy. The main barrier encountered by patients was the difficulty accessing appropriate facilities due to a lack of space and long waiting lists. In conclusion, children and adolescents with DS generally received appropriate care. Though the management of children with DS has been improved considerably, access to health facilities remains inadequate.

Teaching students with intellectual and developmental disabilities to calculate cost after discounts via schematic diagrams.

BACKGROUND/AIMS/METHODS: Life skills instruction is important for students with intellectual and developmental disabilities (IDD) and an emerging research base exists in which schema instruction is used to support students with IDD. In this single-case multiple probe across participants study, researchers explored the use of a schematic diagram in conjunction with the system of least prompts (SLP) to support the acquisition, fluency, maintenance, and generalization of life skills mathematics for secondary students with IDD. PROCEDURES/OUTCOMES: Researchers collected data relative to student accuracy and independence in solving problems involving finding the cost of an item after a discount (i.e., sale or coupon). Researchers collected data across baseline, intervention, maintenance, and generalization phases. RESULTS/CONCLUSION: Researchers found a functional relation between the intervention package and accuracy for all three students. Students were successful with the schematic diagram, however, the data for generalization to when no schema was provided were more idiosyncratic. IMPLICATIONS: This research holds implications for the use of a schematic diagram to support students with IDD learning life-skills mathematical problem solving.

Loss in services precedes high school exit for teens with autism spectrum disorder: A longitudinal study.

The present longitudinal study investigated changes in service receipt and unmet service needs spanning 14 years before and after high school exit in a large community-based sample of individuals with autism spectrum disorder (ASD) (n = 204), of whom 59% had co-occurring intellectual disability (ID). Using multilevel models, potential discontinuity of service patterns at the point of high school exit was examined, as well as the rate of change in services received and needed during the high school years and into the post-high school period. Differences between those with and without ID were probed. Study findings indicated that overall, sample members experienced a reduction in receipt of services during high school, particularly for those without co-occurring ID. After high school exit, sample members experienced a decline in services received; for those without ID, there was a continuous rate of loss of services after leaving high school but for those with ID, there was a sharp decline in services received. Unmet service needs increased right after high school exit for both those with and without ID. These patterns reflect loss of entitlement for services that accompanies high school exit, and the limited availability of adult services for individuals with ASD. This study documented not only the post-high school service cliff that has been the subject of much concern, but also that the loss of services begins long before high school exit and that subgroups of the population with ASD are particularly vulnerable. Autism Res 2019, 12: 911-921. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: In this research, we studied changes in the number of services received before and after high school exit in a large sample of individuals with autism spectrum disorder (ASD). With each passing year during high school, individuals with ASD received fewer services. At the time of high school exit, there was a sharp drop in the number of services received, particularly for those with co-occurring intellectual disability. This study found not only that there is a post-high school service cliff, but also that the loss of services begins long before high school exit.

Service-Learning and Students With Severe Disabilities: Examining Participation and Curricular Goals.

The purpose of this case study was to examine how students with severe disabilities participated in service-learning at a food pantry and the curricular goals they addressed. Service-learning is a form of experiential learning that blends classroom instruction with community service. Participants included 3 high school students with severe disabilities enrolled in a private faith-based school, 5 school staff, and the food pantry coordinator. Data were collected over a 6-month period from observations, interviews, and a focus group. Findings indicate students partially participated in service-learning with supports using a strengths-based approach. Barriers to participation included unclear paraprofessionals' roles, uncertain project priorities, and insufficient supports for communication and behavior. Curricular goals addressed emphasized Jewish values and functional skills. An extension of Furco's service-learning theoretical model is proposed to conceptualize service-learning as being situated along a continuum from supported volunteering to vocational training.

Response latency as a measure of behavior in the assessment of elopement.

Elopement is a common form of problem behavior but is relatively underrepresented in the functional analysis literature. One barrier to assessing elopement experimentally is the need to retrieve the subject following an instance of elopement. This retrieval confounds programmed session contingencies when the goal is to obtain repeated measurement of free-operant behavior. The current study evaluated latency to elopement as an alternative to free-operant measurement. We first compared response latency to allocation in 5-min sessions and then measured latency alone in a trial-based format. The identified reinforcers matched across both data analysis modalities in the session-based assessments, and the trial-based functional analysis showed a significant time savings in identifying the function of behavior over a session-based assessment. Results indicated that elopement serves idiosyncratic social functions in young children with intellectual and developmental disabilities, and that a latency-based assessment saves time while yielding equally clear results.

Psychoeducational assessment of students with intellectual disability: professional-action framework analysis.

BACKGROUND: The right to educational inclusion for students with intellectual disability (SWID) requires the development of good assessment and intervention practices from holistic perspectives not exclusively focused on the academic limitations that SWID may present. These practices are settled in Spain, via regulations drawn up by each Autonomous Community (AC). The variety of existing regulations demands a critical review of the decisions taken to promote the inclusion of those students. METHOD: current regulations-in-force in each AC that regulate attention to diversity (AD) have been were analyzed by using a checklist that includes the variables that defining each stage of the AD process and the ways of providing supports that favor the development, learning and participation of SWID. RESULTS: attention to diversity measures in each AC emphasize organizational and curricular issues, with no AC following holistic approaches in both assessment and intervention, but rather neglecting self-determination and the promotion of quality of life for SWID. CONCLUSIONS: guidelines for the development of new legal frameworks and professional practices based on the latest evidence-based models of attention to SWID and on the results are discussed.

A avaliação interativa e o software alfabetização fônica: um estudo de caso / The Interactive Assessment and the Alfabetização Fônica Software: a Case Study / Evaluación Interactiva y Alfabetização Fônica Computadorizada: un Estudio de Caso

O trabalho verificou a eficácia ­ na perspectiva da avaliação interativa ­ de uma intervenção com o software Alfabetização Fônica no desenvolvimento linguístico de uma aluna com deficiência intelectual. A aluna, com 20 anos e multirrepetente, frequentava o 1º ano do ensino médio de uma escola pública; foi diagnosticada formalmente com deficiência intelectual e apresentava dificuldades linguísticas na expressão oral e escrita, na compreensão e na leitura. O método baseou-se numa análise longitudinal, a partir de uma avaliação de pré-teste do perfil cognitivo da aluna (PROLEC), seguido da realização de intervenções com o software Alfabetização Fônica e de uma avaliação de pós-teste. O PROLEC visa à avaliação dos processos de leitura e envolve as seguintes provas: a) Identificação de letras; b) Processos léxicos; c) Processos sintáticos; d) Processos semânticos. Diferenças significativas nos desempenhos entre os pré-testes e os pós-testes apontaram para a eficácia de intervenções com procedimentos computadorizados nas dimensões léxicas, sintáticas e semânticas da linguagem e na consciência fonológica.

The study aimed to verify the effectiveness - from interactive assessment approach - an intervention with the software Alfabetização Fônica in the language skills of a student with intellectual disability. The 20-year-old student after repeted the school year many times attended the first year of high school in a public school; she was diagnosed with intellectual disability and had linguistic difficulties in oral and written expression, comprehension and reading. The method was based on a longitudinal analysis based on a review of pre-test of the cognitive profile of the student through the WAIS-III, Raven, PROLEC and conducting interventions with the software and post-test evaluation. The PROLEC aims at the evaluation of reading processes and has the following proofs: a) Identification of letters; b) Lexical processes; c) Syntactic processes; d) Semantic processes. Significant differences the performances of the student between the pre and post-tests pointing to the effectiveness of interventions, especially in lexical, syntactic and semantic dimensions of language and phonological awareness indicators.

El trabajo verificó la eficacia - en la perspectiva de la evaluación interactiva - de una intervención con el software Alfabetização Fônica en el desarrollo lingüístico de una alumna con discapacidad intelectual. La alumna, con 20 años que había repetido el año muchas veces, frecuentaba el primer año de la enseñanza media de una escuela pública; fue diagnosticada formalmente con deficiencia intelectual y presentaba dificultades lingüísticas en la expresión oral y escrita, en la comprensión y en la lectura. El método se basó en un análisis longitudinal, a partir de una evaluación de pre test del perfil cognitivo de la alumna (PROLEC), seguida de la realización de intervenciones con el software Alfabetización Fónica y de una evaluación de post test. El PROLEC tiene como objetivo la evaluación de los procesos de lectura y aplica las siguientes pruebas: a) Identificación de letras; b) Procesos léxicos; c) Procesos sintácticos; d) Procesos semánticos. Diferencias significativas en los desempeños entre los pre test y las post-pruebas apuntaron a la eficacia de intervenciones con procedimientos computarizados en las dimensiones léxicas, sintácticas y semánticas del lenguaje y en la conciencia fonológica.

Parent Involvement in Meaningful Post-School Experiences for Young Adults With IDD and Pervasive Support Needs.

Despite initiatives supporting young adults with intellectual and developmental disabilities (IDD) to engage in post-secondary education and integrated employment, those with more intensive support needs are not as easily involved in these post-school experiences. In an effort to learn from positive examples, we examined parent involvement in meaningful post-school experiences by eight young adults with IDD and pervasive support needs. Secondary analysis of data from a prior interview study yielded this smaller sample of eight young adults with meaningful post-school experiences. Their parents were actively involved as fierce advocates and creative problem solvers. The active involvement of parents included: a) attitudinal facilitators, b) advocacy efforts and perceptions, and c) strategic actions. Implications for future research and practice are described.

The experiences and support needs of people with intellectual disabilities who identify as LGBT: A review of the literature.

BACKGROUND: People who identify as lesbian, gay, bisexual and transgender (LGBT) can face many challenges in society including accessing education, care and support appropriate to individual needs. However, there is a growing and evolving evidence base about the specific needs of people with intellectual disabilities (ID) in this regard. AIMS: The aim of this review was to explore the experiences of people with ID who identified as LGBT through an examination of studies that addressed their views and highlighted specific issues, concerns and service responses. METHODS AND PROCEDURES: A comprehensive search of relevant databases from February 1995 to February 2015 was conducted. Studies were identified that met specific criteria that included: empirical peer reviewed studies, the use of recognised research methods and focused on people with ID whom identified as LGBT. The search yielded 161 papers in total. The search was narrowed and 37 papers were screened using rigorous inclusion and exclusion criteria. Finally, 14 papers were considered suitable for the review. OUTCOMES AND RESULTS: The data were analysed and key themes identified that included accessing health services, gender and sexual identity, attitudes of people with ID regarding their LGBT status, and education, supports and therapeutic interventions. CONCLUSIONS AND IMPLICATIONS: There is a need for service providers and carers to be more responsive to the concerns of people with ID who identify as LGBT to improve their health and well-being by reducing stigma and discrimination and by increasing awareness of their care and support needs. The implications are discussed in terms of policy, education, research and practice developments.

Comparing a number line and audio prompts in supporting price comparison by students with intellectual disability.

BACKGROUND/AIMS/METHODS: Price comparison is an important and complex skill, but it lacks sufficient research attention in terms of educating secondary students with intellectual disability and/or autism spectrum disorder. This alternating treatment design study compared the use of a paper-based number line and audio prompts delivered via an audio recorder to support three secondary students with intellectual disability to independently and accuracy compare the price of three separate grocery items. PROCEDURES/OUTCOMES: The study consisted of 22 sessions, spread across baseline, intervention, best treatment, and two different generalization phases. Data were collected on the percent of task analysis steps completed independently, the type of prompts needed, students' accuracy selecting the lowest priced item, and task completion time. RESULTS/CONCLUSIONS: With both intervention conditions, students were able to independently complete the task analysis steps as well as accurately select the lowest priced item and decrease their task completion time. For two of the students, the audio recorder condition resulted in the greatest independence and for one the number line. For only one student was the condition with the greatest independence also the condition for the highest rate of accuracy. IMPLICATIONS: The results suggest both tools can support students with price comparison. Yet, audio recorders offer students and teachers an age-appropriate and setting-appropriate option.

Positive behavioural support in schools for children and adolescents with intellectual disabilities whose behaviour challenges: An exploration of the economic case.

Decision-makers with limited budgets want to know the economic consequences of their decisions. Is there an economic case for positive behavioural support (PBS)? A small before-after study assessing the impact of PBS on challenging behaviours and positive social and communication skills in children and adolescents with intellectual disabilities and behaviours that challenge was followed by an evaluation of costs. Results were compared with the costs of alternative packages of care currently available in England obtained from a Delphi exercise conducted alongside the study. Children and adolescents supported with PBS showed improvement in challenging behaviours and social and communication skills, at a total weekly cost of GBP 1909 (and GBP 1951 including carer-related costs). PBS in schools for children and adolescents with intellectual disabilities and behaviours that challenge may help to support them in the community with potential improvements in outcomes and also cost advantages.

Learning to Apply Algebra in the Community for Adults With Intellectual Developmental Disabilities.

Students with intellectual and developmental disabilities (IDD) are routinely excluded from algebra and other high-level mathematics courses. High school students with IDD take courses in arithmetic and life skills rather than having an opportunity to learn algebra. Yet algebra skills can support the learning of money and budgeting skills. This study explores the feasibility of algebra instruction for adults with IDD through an experimental curriculum. Ten individuals with IDD participated in a 6-week course framing mathematics concepts within the context of everyday challenges in handling money. The article explores classroom techniques, discusses student strategies, and proposes possible avenues for future research analyzing mathematics instructional design strategies for individuals with IDD.

Variation in Educational Services Receipt Among US Children With Developmental Conditions.

OBJECTIVE: To examine the relationship between ease of access to needed community-based services (ease of access) and educational services receipt, and variation in educational services receipt by sociodemographic and need factors among a nationally representative sample of children with autism spectrum disorder (ASD), developmental delay (DD), and/or intellectual disability (ID). METHODS: Data from the 2009-2010 National Survey of Children with Special Health Care Needs were linked to the 2011 Survey of Pathways to Diagnosis and Services on a sample of 3502 US children aged 6 to 17 years with ASD, DD, and/or ID. Descriptive statistics, chi-square tests, and multivariable logistic regression models were used to determine associations of educational services receipt with ease of access and sociodemographic and need factors. RESULTS: Among children with developmental conditions, nearly half (49.7%) lacked easy access to services, and 16.9% did not have an individualized education program (IEP). Among children with an IEP, those with ease of access were more likely to have an IEP that addressed parent concerns about the child's development and education than those unable to easily access services (adjusted odds ratio 2.77; 95% confidence interval 1.71-4.49). Need factors, including functional limitations status, care coordination need, developmental condition type, and early intervention receipt, were significantly associated with educational services receipt. CONCLUSIONS: Cross-systems initiatives facilitating service access remain important to ensuring the developmental needs of children with ASD, DD, and/or ID are met. Increased interprofessional collaboration promoting quality educational services receipt for children diagnosed with developmental conditions may further reduce disparities.

Need for a Comprehensive Sex and Relationship Education Programme for Adults with Learning Disability.

INTRODUCTION: Most people with learning disabilities (PWLD) have little understanding of the concept of sex and relationship. PWLD are vulnerable and more likely to be victims of sexual offending. Currently, the only formal access to sex and relationship education that PWLD have is in special need schools. BACKGROUND: The right to express their sexuality is frequently restricted or denied by restricted policies, negative attitudes and lack of awareness of their needs. AIMS: To provide a Comprehensive Sex and Relationship Education programme for PWLD. METHODOLOGY: These group/individual sessions will led by a sexuality support worker with experience in working with PWLD. They will be supported by members of the multidisciplinary team including, psychiatrist, psychologist, occupational therapists etc. CONCLUSION: Providing sex and relationship education PWLD would help them achieve a fulfilling and rewarding sexual experience and make them less vulnerable to sexual abuse. There should be greater emphasis to be placed on sex and relationship education in PWLD; preferably by qualified professionals.

Self-injurious, aggressive and destructive behaviour in children with severe intellectual disability: Prevalence, service need and service receipt in the UK.

Children with severe intellectual disabilities are at increased risk of presenting with self-injurious, aggressive and destructive behaviour. Severity of these behaviours is an important predictor of psychological and behavioural service use by people with intellectual disabilities. However, studies suggest that the needs of children with intellectual disabilities and their families are not being met. The aims of the present study were to: (1) describe the self-injurious, aggressive and destructive behaviours and subsequent support needs of children with severe intellectual disabilities attending special schools in one major city within the UK, (2) compare teacher and primary carer ratings of behaviour and service need and (3) explore the extent to which the needs of children with intellectual disabilities are being met in terms of contact with relevant specialist services. Questionnaires were completed by teachers and primary family carers of children with a severe intellectual disability. Results indicated that at least 5.3% and 4.1% of children showed at least one behaviour at a clinically significant frequency and management difficulty respectively. Primary carers identified more children with significant behaviour difficulties and support needs than teachers. The odds for children presenting with high levels of the behaviours of interest for having a service need for behavioural intervention were at least 13 times those for children not showing the behaviours, yet only doubled for contact with a specialist relevant health-care professional. These results quantify the magnitude of the substantial gap between level of need and relevant support received.

'A disease that makes criminals': encephalitis lethargica (EL) in children, mental deficiency, and the 1927 Mental Deficiency Act.

Encephalitis lethargica (EL) was an epidemic that spread throughout Europe and North America during the 1920s. Although it could affect both children and adults alike, there were a strange series of chronic symptoms that exclusively affected its younger victims: behavioural disorders which could include criminal propensities. In Britain, which had passed the Mental Deficiency Act in 1913, the concept of mental deficiency was well understood when EL appeared. However, EL defied some of the basic precepts of mental deficiency to such an extent that amendments were made to the Mental Deficiency Act in 1927. I examine how clinicians approached the sequelae of EL in children during the 1920s, and how their work and the social problem that these children posed eventually led to changes in the legal definition of mental deficiency. EL serves as an example of how diseases are not only framed by the society they emerge in, but can also help to frame and change existing concepts within that same society.

[A ''humanitarian duty and a matter of honour for German Jewry": "feeble-minded" Jewish children and the Institution in Beelitz]. / Eine "Pflicht der Humanität und Ehre der deutschen Judenheit": Die "Schwachsinnigenfürsorge" am Beispiel der Israelitischen Erziehungsanstalt für geistig zurückgebliebene Kinder Wilhelm-Auguste-Victoria-Stiftung in Beelitz e. V.

In 1908, in collaboration with the Bnei Briss, the German Association of Israelite Communities founded an institution for intellectually disabled Jewish children in Beelitz with the aim of educating 7-14-year-olds, using therapeutic pedagogy. The institution was part of the philanthropic efforts undertaken by German Jewry in that period. It was set up in the wake of the German Kaiser's call to found more philanthropic institutions, and its establishment is indicative of the efforts at integration being made by German Jewry. In their fund-raising material, the German Association of Israelite Communities stressed the "loyalty and patriotism" of German Jewry and described the establishment of the institution as "a humanitarian duty" and "a matter of honour for German Jewry". It was, therefore, demands from the non-Jewish world that led to the foundation of a Jewish institution; however, its establishment was also symbolic of the struggle against anti-Semitism and indicative both of German Jewry's dissimilation and their efforts at integration. The article investigates the struggle of Jewish parents to have their children admitted to the institution, the philosophy and teaching methods of the director Sally Bein (1881-1942) and his wife Friederike Rebeka Bein (1883-1942), the background of the students, the causes of intellectual disability, as well as the disagreements that occurred between parents, teachers and the director. The article also discusses the successes and failures of therapeutic pedagogy.