Behavioral treatment of children with autism, mental retardation, and related disabilities: ethics and efficacy

Treatment of a patient with traumatic brain injury-related severe self-injurious behavior

OBJECTIVE

Report a case of severe self-injurious behavior (SIB), paying special attention to treatment.

DESIGN

Case report.

PARTICIPANT

A 26-year-old woman (H.S.) 8 years post-traumatic brain injury with a history of severe SIB.

METHODS

H.S. was treated over a 22-week period with combined behavioral and psychopharmacological interventions.

RESULTS

Marked reduction in SIB was noted after the interventions were initiated.

CONCLUSION

Behavioral treatment and medications may be useful tools in the treatment of SIB after traumatic brain injury.

Learning disabilities: a survey of community nurses for people with prevalence of challenging behaviour and contact demands

BACKGROUND

There is scant knowledge on the contacts community nurses for people with learning disabilities have with clients who display challenging behaviours, or the numbers of such people on these nurses' caseloads. This study was undertaken in a UK region with a population of 1.68 million people. In this region it is estimated that there are 8500 people with learning disabilities who are in contact with services, this includes around 500 people remaining in hospitals awaiting resettlement.

AIMS AND OBJECTIVES

The research aims were to identify the overall caseload sizes of the nurses, the prevalence of people with learning disabilities who have challenging behaviours on the nurses' caseloads and what contact demands these people required. An additional aim was to discover courses or training that helped the nurses to fulfill their roles.

DESIGN AND METHODS

A postal survey was undertaken of the total population of community nurses for people with learning disabilities in the region. The method of data collection was a self-completion questionnaire.

RESULTS

The study found that people with challenging behaviours accounted for over a quarter of the combined caseloads, and these clients required the most frequent visits from the nurses. There was a wide range in the number of clients on the caseloads of each nurse but overall these were higher than in other parts of the UK.

CONCLUSIONS

It is concluded that community nurses for people with learning disabilities have large caseloads and people with learning disabilities who have challenging behaviours, who account for over one-quarter of the clients they visit, require much more frequent contact visits than other clients. The combination of high numbers of clients (or low numbers of these nurses) may impact on how such nurses are able to perform their role and functions.

RELEVANCE TO CLINICAL PRACTICE

An increase in the numbers of community nurses for people with learning disabilities and skill development in caring for people with challenging behaviours is recommended. If this is not performed the clinical effectiveness of this group of nurses with respect to their work with people who challenge services may be unduly hampered.

Autism and the school nurse

Until recently, treatment for children with autism involved housing them in hospitals for the developmentally disabled. Today, more states are returning children with autism to their home communities, and more parents are choosing or are being required to keep their children with autism in their homes. Laws were developed to ensure that children with autism receive some form of education, often through the local school system. School nurses, who may not have experience working with children with autism, may feel uncertain about how to provide support for the child with autism. Approximately 300,000 persons in the United States have autism or display autistic behaviors. About one-third are under age 21. People with autism come from all socioeconomic classes. Males are four times more likely to be affected by autism than females. People with autism can be expected to live a normal lifespan.