Академический Документы
Профессиональный Документы
Культура Документы
CITTÀ APERTA
© copyright 2009
Città Aperta Edizioni s.r.l.
94018 Troina (En) - via Conte Ruggero, 73
Tel. 0935 653530 - Fax 0935 650234
Persons with Multiple Disabilities Access Stimulation and Contact the Caregiver via
Microswitch and VOCA Technology
Giulio E. Lancioni, Mark F. O’Reilly, Nirbhay N. Singh, Jeff Sigafoos, Doretta Oliva,
Angela Smaldone, Maria L. La Martire, Massimo Antonucci,
Claudia De Pace, & Claudia Chiapparino 119
Abstract
1
Dept. of Psychology, University of Bari, Via Quintino Sella 268, 70100 Bari, Italy. Tel.: +39
080 5521410, E-mail:g.lancioni@psico.uniba.it
2 Dept. of Special Education, Meadows Center for Preventing Educational Risk, Universi-
oliva.d@legadelfilodoro.it
6 Research Associates, Lega F. D’Oro Research Center, Osimo, Italy. E-mail: ansmal-
done@yahoo.it
7 Research Associates, Lega F. D’Oro Research Center, Osimo, Italy. E-mail:
marialuisa.lamartire@virgilio.it
8 Dept. of Psychology, University of Bari, Bari, Italy. E-mail: m.antonucci@psico.uniba.it
10
Dept. of Psychology, University of Bari, Bari, Italy. E-mail: claudia.chiapparino@alice.it
119
Life Span and Disability Lancioni G. E. et al.
1. Introduction
120
Persons with Multiple Disabilities
2. Method
2.1 Participants
The eight participants were between 5.2 and 17.9 (M = 11) years of age
(see Table 1). They had encephalopathy due to congenital anomalies, pre-
maturity, and perinatal or postnatal hypoxia, and were rated in the severe
or profound intellectual disability range (although no standard tests or IQ
scores were applicable with them). All of them presented with visual im-
pairment (see Table 1), with diagnoses varying from functional/minimal
residual vision (which allowed them to see objects in their proximity) to to-
tal blindness (see Geruschat, 1992; Morse, Teresi, Rosenthal, Holmes, &
Yatzkan, 2004). All participants had serious motor disabilities and were
nonambulatory. They responded with alertness and smiles to a variety of
environmental stimuli (e.g., music and songs) and seemed to be alert to and
enjoy the vocal and physical attention of their caregivers (see above). Two
seemed more specifically interested in their caregivers’ intervention in pro-
viding food items or motor play (Candy and Betsy). All of them lived at
home with their parents and attended day programs. The study was ap-
proved by an ethics committee and received informed consent from the
participants’ parents.
121
Life Span and Disability Lancioni G. E. et al.
2.3 Selection of preferred stimuli to use for microswitch and VOCA responses
Stimulus preference screening (Lancioni et al., 2008b) was used to select
preferred stimuli, that is, stimuli followed by participants’ positive reactions
(e.g., alerting/orienting or smiling) in more than two-thirds of their presen-
tations. The screening covered multiple stimuli; a stimulus was presented 15
to 45 nonconsecutive times. Based on screening, four to eight environmen-
tal stimuli (e.g., songs, vibrating boxes, and lights) were selected for the mi-
croswitch response of each participant. The stimuli were placed near the
participants or fitted to their body and were operated automatically
through the electronic control system (i.e., without any external interven-
tion). The stimuli selected for the VOCA response (through the aforemen-
tioned screening) involved: (a) four to eight joyful sentences presented by
a research assistant serving as caregiver and (b) positive physical gestures
(e.g., caressing, embracing, tickling, and kissing) or, alternatively, food items
or motor play (for Candy and Betsy) provided by the same research assis-
tant. Each stimulus episode lasted 8-10 s.
122
Persons with Multiple Disabilities
123
Life Span and Disability Lancioni G. E. et al.
those intervention conditions. The rating was based on three questions con-
cerning the three conditions’ beneficial impact on contact with the outside
world, their recreational-communicative potential, and their overall cost-bene-
fit value. For each question, three scores were required (i.e., one per condition).
The scores could vary from 1 (least positive) to 5 (most positive).
3. Results
Figures 1 and 2 summarize the data for the three participants with 10-min
sessions (i.e.,Todd, Boris, and Doug) and the five participants with 5-min ses-
sions (i.e., Daisy, Candy, Alf, Kate and Betsy), respectively. The data of each
participant are shown within a single figure panel, identified by his or her
name, and are grouped into blocks of sessions. Four blocks (two per re-
sponse) are used during the first baseline and two blocks are used for each of
the subsequent phases. The number of sessions included in the blocks is indi-
cated by the numerals above them. During the first baseline for the three par-
ticipants included in Figure 1, the mean frequencies of microswitch and VO-
CA responses ranged between 4 and 12 per session. During the first Inter-
vention I phase, the mean frequencies of microswitch responses were be-
tween 25 and 33 per session During the second baseline, the mean frequen-
cies of VOCA responses were between 6 and 10 per session. During the sec-
ond Intervention I phase, the mean frequencies of VOCA responses were be-
tween 21 and 27 per session.The Kolmogorov-Smirnov test (Siegel & Castel-
lan, 1988) showed that the increase from baseline to Intervention I was sta-
tistically significant (p < .01) for each of the two responses for all three stu-
dents. During Intervention II, the participants’ mean cumulative (mi-
croswitch plus VOCA) response frequencies were between 32 and 40 per ses-
sion. The VOCA responses represented between 27% and 43% of the total.
The data for the five participants included in Figure 2 also showed sta-
tistically significant increases from baseline to Intervention I for each of the
two responses. Candy’s Intervention II was interrupted after a relatively
small number of sessions, due to her health problems and hospitalization.
ANOVAs carried out with the scores of each of the two groups of raters
separately showed that the differences among conditions were statistically
significant on each of the three questions, with F(2, 189) ranging from 14.31
to 142.25 (p < .01) (Hays, 1988). Post-hoc paired t-tests showed that the
scores for the microswitch-VOCA combination (which averaged between
4.1 and 4.5 across the three questions for the two groups of raters) differed
significantly from (were more positive than) those available for the mi-
croswitch and the VOCA alone conditions on each of the three questions
for both groups. The t(63) values ranged from 4.98 to 19.84 (p < .01)
(Bourke, Daly, & McGilvray, 1985).
124
Persons with Multiple Disabilities
Figure 1 - The three panels show the data for Todd, Boris, and Doug, respectively.
Within each panel, the striped and gray bars represent the mean frequen-
cies of microswitch and VOCA responses, respectively, per blocks of ses-
sions. The number of sessions included in the blocks (bars) is indicated by
the numerals above them.The striped and gray sections of the stacked bars
appearing in Intervention II represent the relative mean frequencies for the
two responses within the blocks
Microswitch Responses
VOCA Respons es
45
30
TODD
15
45
30
BORIS
15
45
30
DOUG
15
0
1 2 3 4 5 6 7 8 9 10 11 12
Blocks of Sessions
125
Life Span and Disability Lancioni G. E. et al.
Figure 1 - The five panels show the data for Daisy, Candy, Alf, Kate, and Betsy, re-
spectively. The data are plotted as in Figure 1
Microswitch Responses
VOCA Responses
10 3 4 4 4 3
Mean Frequencies of Microswitch and VOCA Responses
4 DAISY
5
0
20 24
10
15 23 9
14 14
10 3 4 4
4 2 3 CANDY
5
0
15 59
20 19 60
19
14
15
10
4 3 2
2 4 2 ALF
5
0
73 74
20
21 21
21 21
15
10
4 2 4 4 KATE
5 2 5
53 53
20 45 31
15 44 30
10 4
3 2 4 2 4 BETSY
5
0
1 2 3 4 5 6 7 8 9 10 11 12
Blocks of
Blocks ofSessions
Sessions
126
Persons with Multiple Disabilities
4. Discussion
In line with previous data (Lancioni et al., 2008a; 2008b; 2009), these par-
ticipants generally showed consistent microswitch responses as well as VO-
CA responses. The fact that the participants’ VOCA responses were aimed
at different objectives (i.e., social contact or caregiver mediation for other
forms of stimulation) reflected differences in personal interests. Even so,
VOCA responses were for all participants a means to enrich their input in
a relevant way through a functional interaction with their caregivers.
The reasons why the frequency of VOCA responses tended to be lower
than the frequency of microswitch responses were not investigated. One
might hypothesize that (a) the social attention/contact or the caregiver-me-
diated stimulation had a lower reinforcing power than the stimuli available
for microswitch responses at least for some participants, and (b) those par-
ticipants’ response choice reflected such a difference of stimulus impact
(Kazdin, 2001).
In spite of the fact that careful balance between microswitch-related
stimuli and VOCA consequences needs to be found for some students, the
combination of microswitch and VOCA can still be considered a valuable
strategy with clearly positive implications. This view seemed to be widely
supported by the social validation data, which provided a strong endorse-
ment for such a strategy from both groups of raters.
In conclusion, the results of this study (a) provide new evidence of the
applicability of microswitch-VOCA combinations with persons with multi-
ple disabilities, (b) indicate that the consequences of the VOCA can include
caregiver-mediated stimulation opportunities (as an option for participants
with modest reactions to social attention only), and (c) show a clear en-
dorsement of the microswitch-VOCA combination by university psycholo-
gy students and post-graduate clinical trainees. Building on the outcome of
this study and the previous ones on this topic, new research could extend
the evaluation of microswitch-VOCA combinations with the use of new de-
vices (i.e., suitable also for persons with very serious response restrictions)
as well as with larger combinations of devices (e.g., two or three mi-
croswitches and one VOCA).
References
Barlow, D. H., Nock, M., & Hersen, M. (2009). Single-case experimental designs (3rd
ed.). New York: Allyn & Bacon.
Bourke, G. J., Daly, L. E., & McGilvray, J. (1985). Interpretation and uses of medical
statistics (3rd ed.). London: Blackwell.
Cunningham, J., McDonnell, A., Easton, A., & Sturmey, P. (2003). Social validation
127
Life Span and Disability Lancioni G. E. et al.
data on three methods of physical restraint: Views of consumers, staff and students.
Research in Developmental Disabilities, 24, 307-316.
Geruschat, D. R. (1992). Using the acuity card procedure to assess visual acuity in
children with severe multiple impairments. Journal of Visual Impairment and
Blindness, 86, 25-27.
Hays, W. L. (1988). Statistics (4th ed.). New York: Holt, Rinehart and Winston.
Holburn, S., Nguyen, D., & Vietze, P. M. (2004). Computer-assisted learning for
adults with profound multiple disabilities. Behavioral Interventions, 19, 25-37.
Kazdin, A. E. (2001). Behavior modification in applied settings (6th ed.). New York:
Wadsworth.
Lancioni, G. E., O’Reilly, M. F., Singh, N. N., Sigafoos, J., Didden, R., Oliva, D., Cam-
podonico, F., De Pace, C., Chiapparino, C., & Groeneweg, J. (2009). Persons with
multiple disabilities accessing stimulation and requesting social contact via mi-
croswitch and VOCA: A new research evaluation and social validation. Research in
Developmental Disabilities, 30, 1084-1094.
Lancioni, G. E., O’Reilly, M. F., Singh, N. N., Sigafoos, J., Oliva, D., & Severini, L.
(2008a). Enabling two persons with multiple disabilities to access environmental
stimuli and ask for social contact through microswitches and a VOCA. Research in
Developmental Disabilities, 29, 21-28.
Lancioni, G. E., O’Reilly, M. F., Singh, N. N., Sigafoos, J., Oliva, D., & Severini, L.
(2008b). Three persons with multiple disabilities accessing environmental stimuli
and asking for social contact through microswitch and VOCA technology. Journal
of Intellectual Disability Research, 52, 327-336.
Morse, A. R., Teresi, J., Rosenthal, B., Holmes, D., & Yatzkan, E. S. (2004). Visual
acuity assessment in persons with dementia. Journal of Visual Impairment and
Blindness, 98, 560-566.
Siegel, S., & Castellan, N. J. (1988). Nonparametric statistics (2nd ed.). New York:
McGraw-Hill.
128
Life Span and Disability / XII, 2 (2009), 129-139
Michael F. Giangreco1
Abstract
This article is a reply to the debate invited by Vianello & Lanfranchi (this Journal, issue
1/2009).
1
University of Vermont, Center on Disability and Community Inclusion. E-mail:
Michael.Giangreco@uvm.edu
129
Life Span and Disability Giangreco M. F.
130
Opportunities for Children and Youth with Intellectual Developmental Disabilities
131
Life Span and Disability Giangreco M. F.
132
Opportunities for Children and Youth with Intellectual Developmental Disabilities
133
Life Span and Disability Giangreco M. F.
134
Opportunities for Children and Youth with Intellectual Developmental Disabilities
135
Life Span and Disability Giangreco M. F.
5. Conclusion
136
Opportunities for Children and Youth with Intellectual Developmental Disabilities
References
Baer, D. (1981). A hung jury and a Scottish verdict: “Not proven”. Analysis and In-
tervention in Developmental Disabilities, 1(1), 91-98.
Baumgart, D., Brown, L., Pumpian, I., Nisbet, J., Ford, A., Sweet, M., Messina, R., &
Schroeder, J. (1982). Principle of partial participation and individualized adapta-
tions in educational programs for severely handicapped students. Journal of the As-
sociation for the Severely Handicapped, 7, 17-27.
Browder, D. M., & Spooner, F. (Eds.). (2006). Teaching language arts, math, & sci-
ence to students with significant cognitive disabilities. Baltimore: Paul H. Brookes.
Cole, C. M., Waldron, N., & Majd, M. (2004). Academic progress of students across
inclusive and traditional settings. Mental Retardation, 42, 136-144.
Downing, J. E. (2008). Including students with severe and multiple disabilities in typ-
ical classrooms: Practical strategies for teachers (3rd ed.). Baltimore: Paul H.
Brookes.
Doyle, M. B. (2003). “We want to go to college too”: Supporting students with sig-
nificant disabilities in higher education. In D. L. Ryndak & S. Alper. (Ed.), Curricu-
lum development for students with disabilities in inclusive settings (pp. 307-322).
Boston: Allyn & Bacon.
Dymond, S. K., Renzaglia, A., Gilson, C. L., & Slagor, M. T. (2007). Defining access
to the general curriculum for high school students with significant cognitive dis-
abilities. Research and Practice for Persons with Severe Disabilities, 32, 1-15.
Fisher, M., & Meyer, L. H. (2002). Development and social competence after two
years for students enrolled in inclusive and self-contained educational programs.
Research and Practice for Persons with Severe Disabilities, 27, 165-174.
137
Life Span and Disability Giangreco M. F.
Giangreco, M. F. (2002). Values, logical practices, and research: The three muske-
teers of effective education. In J. Downing (Ed.), Including students with severe and
multiple disabilities in typical classrooms (2nd ed., pp. 9-13). Baltimore: Paul H.
Brookes.
Giangreco, M. F., Carter, E. W., Doyle, M. B., & Suter, J. C. (in press). Supporting
students with disabilities in inclusive classrooms: Personnel and peers. In R. Rose
(Ed.), Confronting obstacles to inclusion: International responses to developing in-
clusive schools. London: Routledge.
Giangreco, M. F., Dennis, R., Cloninger, C., Edelman, S., & Schattman, R. (1993).
“I’ve counted Jon:” Transformational experiences of teachers educating students
with disabilities. Exceptional Children, 59, 359-372.
Giangreco, M. F., Edelman, S., Luiselli, T. E., & MacFarland, S. Z. (1997). Helping or
hovering? Effects of instructional assistant proximity on students with disabilities.
Exceptional Children, 64, 7-18.
Grigal, M., & Hart, D. (2009). Think college: Postsecondary education options for
students with intellectual disabilities. Baltimore: Paul H. Brookes.
Hunt, P., & Goetz, L. (1997). Research on inclusive educational programs, practices,
and outcomes for students with severe disabilities. Journal of Special Education, 31,
3-29.
Logan, K. R., Jacobs, H.A., Gast, D. L., Murray, A. S., Daino, K., & Skala, C. (1998).
The impact of typical peers on the perceived happiness of students with profound
multiple disabilities. Journal of the Association for Persons with Severe Handicaps,
23, 309-318.
Logan, K., & Keefe, E. (1997). A comparison of instructional context, teacher be-
havior, and engaged behavior for students with severe disabilities in general edu-
cation and self-contained elementary classrooms. Journal of the Association for
Persons with Severe Handicaps, 22, 16-27.
138
Opportunities for Children and Youth with Intellectual Developmental Disabilities
cal and research foundations: A synthesis of the literature that informs best practices
about inclusive schooling. Baltimore: Paul H. Brookes.
Peterson, J. M., & Hittie, M. M. (2010). Inclusive teaching: the journey towards ef-
fective schools for all learners. (2nd edition). Boston: Pearson.
Rose, D. H., Meyer, A., & Hitchcock, C. (2005). The universally designed classroom:
Accessible curriculum and digital technologies. Cambridge, MA: Harvard Press.
UNESCO (1994). The Salamanca statement and framework for action on special
needs education, Retrieved on August 20, 2009 from: www.unesco.org/education-
/pdf/SALAMA_E.PDF .
Vianello, R., & Lanfranchi, S. (2009). Genetic syndromes causing mental retarda-
tion: Deficit surplus in school performance and social adaptability compared to
cognitive capacity. Life Span and Disability, 12 (1), 41-52.
Wehman, P., Inge, K. J., Revell, W. G., & Brooke, V. A. (2007). Real work for real
pay : Inclusive employment for people with disabilities. Baltimore: Paul H. Brookes.
Wolfensberger, W. (1975). The origin and nature of our institutional models. Syra-
cuse, NY: Human Policy Press.
139
Life Span and Disability / XII, 2 (2009), 141-149
Abstract
This article is a reply to the debate invited by Vianello & Lanfranchi (this Journal, issue
1/2009).
1George Mason UniversityM. Address: College of Education and Human Development,
MSN 1D5, George Mason University, Fairfax, VA, USA, 22030. E-mail: tscruggs@gmu.edu
2
George Mason UniversityM. E-mail: kmichaud@gmu.edu
141
Life Span and Disability Scruggs T. E. / Michaud K.
142
The “Surplus” Effect in Developmental Disability: A Function of Setting or Training (or Both)?
143
Life Span and Disability Scruggs T. E. / Michaud K.
ties over a school year when placed in inclusive elementary grade class-
rooms. They reported that over the year, all students except one exhibited
growth on a measure of overall adaptive behavior. However, this level of
growth (although on a normative score) was trivial, amounting to only
about .07 standard deviation units. Nevertheless, the mean adaptive behav-
ior scores of this sample, similar to those of Vianello and Lanfranchi, was
much higher than expected from the IQ scores. Achievement of nondis-
abled students in inclusive and traditional classrooms was the same, sug-
gesting the presence of students with developmental disabilities did not im-
pact the achievement of nondisabled students.
A similar investigation in Ireland (Hardiman, Guerin, & Fitzsimons,
2009) revealed that social competence ratings did not differ between stu-
dents with moderate intellectual disability in inclusive and segregated set-
tings. In this investigation also, both groups of students (in inclusive and
segregated settings) exhibited levels of adaptive behavior above that pre-
dicted by their degree of disability.
Hatton, Wheeler, Skinner, Bailey, Sullivan, Roberts et al. (2003) investi-
gated adaptive behavior scores of individuals with Fragile X Syndrome be-
tween the ages of 1 and 12 years, and a mean of 4.4 assessments over time.
They reported that adaptive behavior skills increased steadily, but gradual-
ly, over time. These students were identified through genetics clinics, devel-
opmental evaluation centers, and early intervention programs, so there is
reason to believe that many, if not most of them were not being served in in-
clusive placements. It was also reported that students displayed IQs superi-
or to adaptive behavior below the age of 10, but that these scores appeared
to converge in later years. Such data suggest that some individuals with de-
velopmental disabilities may make progress on adaptive behavior, regard-
less of academic setting.
Even when individuals with developmental disabilities in inclusive set-
tings are compared across Italian and American samples, however, these
comparisons may not be entirely equivalent. It is possible, for example, that
students with mental retardation in inclusive Italian schools receive more
teacher attention than those in American schools. Palladino, Cornoldi,
Vianello, Scruggs and Mastropieri (1999), for example, provided evidence
that Italian schools relied more on teachers, and less on paraprofessionals,
to implement direct service delivery in inclusive classrooms than was the
case in many American schools.
Overall, then, data from America and other countries suggest that stu-
dents with developmental disabilities in inclusive placements often exhibit
an academic and behavioral “surplus” relative to mental age. However,
there is some evidence that individuals in other placements may also
progress in these areas.
144
The “Surplus” Effect in Developmental Disability: A Function of Setting or Training (or Both)?
3. Teacher Attitudes
4. Self-Help Skills
145
Life Span and Disability Scruggs T. E. / Michaud K.
146
The “Surplus” Effect in Developmental Disability: A Function of Setting or Training (or Both)?
5. Summary
References
Alwell, M., & Cobb, B. (2006a). Teaching functional life skills to youth with disabil-
ities: Executive summary. National Secondary Technical Assistance Center. Re-
trieved October 25, 2009, from http://www.nsttac.org/pdf/life_skills_executive_-
summary.pdf
Alwell, M., & Cobb, B. (2006b). A systematic review of the effects of curricular in-
terventions on acquisition of functional life skills by youth with disabilities.
What Works in Transition: Systematic Review Project. Colorado: Colorado State Univer-
sity and National Secondary Transition Technical Assistance Center. Retrieved Oc-
tober 25, 2009, from http://www.nsttac.org/pdf/life_skills.pdf
Arnold-Reid, G. S., Schloss, P. J., & Alper, S. (1997). Teaching meal planning to
youth with mental retardation in natural settings. Remedial & Special Education,
18, 166-173.
Carlberg, C., & Kavale, K. (1980). The efficacy of special versus regular class place-
ment for exceptional children: A meta-analysis. Journal of Special Education, 14,
295-309.
Cole, C. M., Waldron, N., & Majd, M. (2004). Academic progress of students across
inclusive and traditional settings. Mental Retardation, 42, 136-144.
147
Life Span and Disability Scruggs T. E. / Michaud K.
Cornoldi, C., Terreni, A., Scruggs, T. E., & Mastropieri, M. A. (1998). Teacher atti-
tudes in Italy after twenty years of inclusion. Remedial and Special Education, 19,
350-356.
Cuvo, A. J., Davis, P. K., & Gluck, M. S. (1991). Cumulative and interspersal task se-
quencing in self-paced training for persons with mild handicaps. Mental Retarda-
tion, 29, 335-342.
Denny, P., & Test, D. (1995). Using the one-more-than technique to teach money
counting to individuals with moderate mental retardation: A systematic replica-
tion. Education & Treatment of Children, 18, 422-32.
Domaracki, J. W., & Lyon, S. R. (1992). A comparative analysis of general case sim-
ulation instruction and naturalistic instruction. Research in Developmental Disabil-
ities, 13, 363-379.
Felce, D., & Perry, J. (2009). Living with support in the community: Factors associ-
ated with quality of life outcome. In S. L. Odom, R. H. Horner, & M. E. Snell (Eds.)
Handbook of developmental disabilities (pp. 410-428). New York: Guilford.
Hardiman, S., Guerin, S., & Fitzsimons, E. (2009). A comparison of the social com-
petence of children with moderate intellectual disability in inclusive versus segre-
gated school settings. Research in Developmental Disabilities, 30, 397-407.
Hatton, D. D., Wheeler, A. C., Skinner, M. L., Bailey, D. B., Sullivan, K. M., Roberts,
J. E., Mirrett, P., & Clark, R. D. (2003). Adaptive behavior in children with
Fragile X syndrome. American Journal on Mental Retardation, 108, 373-390.
Hoge, G., Dattilo, J., & Williams, R. (1999). Effects of leisure education on per-
ceived freedom in leisure of adolescents with mental retardation. Therapeutic
Recreation Journal, 33, 320-332.
Kim, S., Larson, S. A., & Lakin, K. C. (2001). Behavioral outcomes of deinstitution-
alization for people with intellectual disability: A review of US studies conducted
between 1980 and 1999. Journal of Intellectual and Developmental Disability, 26,
35-50.
McDonnell, J., Thorson, N., Disher, S., Mathot-Buckner, C., Mendel, J., & Ray, L.
(2003). The achievement of students with developmental disabilities and their
148
The “Surplus” Effect in Developmental Disability: A Function of Setting or Training (or Both)?
Mechling, L. C., Gast, D. L., & Langone, J. (2002). Computer-based video instruc-
tion to teach persons with moderate intellectual disabilities to read grocery aisle
signs and locate items. Journal of Special Education, 35, 224-240.
Palladino, P., Cornoldi, C., Vianello, R., Scruggs, T.E., & Mastropieri, M.A. (1999).
Paraprofessionals in Italy: Perspectives from an inclusive country. The Journal of
the Association for Persons with Severe Handicaps, 24 (4) , 254-258.
Vianello, R. (1996). Inclusive schools for pupils with handicap and learning diffi-
culties in Italy. In R. Vianello (Ed.), Learning difficulties in Europe: Assessment and
treatment (pp. 49-56). Bergamo, Italy: Edizioni Junior.
Vianello, R., & Lanfranchi, S. (2009). Genetic syndromes causing mental retarda-
tion: Deficit and surplus in school performance and social adaptability compared to
cognitive functioning. Life Span and Disability, 12 (1), 41-52.
Williamson, P., McLeskey, J., Hoppey, D., & Rentz, T. (2006). Educating students
with mental retardation in general education classrooms. Exceptional Children, 72,
347-361.
149
Life Span and Disability XII, 2 (2009), 151-159
Abstract
151
Life Span and Disability Di Nuovo S. / Buono S.
diagnosis largely overlapping with that based on the clinical evaluation, but
with differences justifying the comparative use of the different approaches.
1. Introduction
152
Diagnosis of Intellectual Disability: comparison between clinical criteria and automatized procedures
tests3) and the scaled scores obtained in the Vineland Adaptive Behavior
Scale (VABS), with reference to communication and socialization areas.
The algorithm is based therefore exclusively on psychometric tests
scores (one of these based on observation), integrating them in a rigorous-
ly standardized way and avoiding ‘subjective’ evaluations on the part of the
personnel.
The schema used for the diagnosis through the computerized algorithm
may be synthesized as follows (table 1).
1
The criteria to locate the diagnosis with respect to the normative range are based on the
standardization for the Intellectual Disability of the Vineland Adaptive Behavior Scale. As cut-
off was used the subdivision in three levels presented in the VABS Manual (Sparrow, Balla, &
Cicchetti,1984, Italian edition 2003).
2 According to DSM-IV-TR (A.P.A., 2000) diagnostic criteria, it is possible to make diag-
nosis of Mental Retardation in persons “with IQ between 70 and 75, who exhibit significant
deficits in adaptive behavior. Conversely, Mental Retardation would not be diagnosed in an in-
dividual with an IQ lower than 70 if there are no significant deficits or impairments in adaptive
functioning.” (p. 42).
3 The tests chosen to change scores in equivalent IQ, when Wechsler Scale is not applicable, are:
Coloured Progressive Matrices test (CPM), Leiter International Performance Scale (LIPS), Griffiths’
Mental Development Scale (MDS), Psycho Educational Profile Revised (PEP) for autism.The tests,
and the reasons of the choice, are described in detail in the previously quoted article (Aa.Vv., 2007).
153
Life Span and Disability Di Nuovo S. / Buono S.
2. Sample
The cases included in the study were 100, randomly chosen among those
diagnosed in one-year period in the IRCCS ‘Oasi’ Institute.
The cases with Intellectual Disability was divided in the following
groups on the basis of the diagnosis included in the clinical record:
- Mild Mental Retardation: n=34
- Moderate Mental Retardation: n= 21
- Severe Mental Retardation n=1 (in this only case a test of intelligence
was applicable; other cases of this level, or cases of Profound Mental
Retardation, have not been included, due to the unavailability of cog-
nitive tests useful for the computerized diagnosis)
- Borderline Intellectual Functioning: n=25
N=19 cases without any disability were added. They had been submitted
to the équipe for learning disabilities but they did not fit the criteria for the
diagnosis of Borderline Intellectual Functioning.
The diagnoses had been made independently by the équipe according
with the usual criteria, and have been reformulated by means of the soft-
ware applying the specific algorithm.
3. Analysis of data
154
Diagnosis of Intellectual Disability: comparison between clinical criteria and automatized procedures
We may conclude that substantially the clinical diagnosis and that based on
the computerized algorithm agree with respect to the principal dimensions
explaining the evaluation criteria.
Clin Softw Clin Softw Clin Softw Clin Softw Clin Softw
Normals 0.19 0.19 1.00 1.00 0.61 0.62 1.73 1.74 -0.40 -0.40
BIF 0.26 0.27 0.86 0.86 0.18 0.18 -0.04 -0.05 0.78 0.76
Mild 0.35 0.32 0.77 0.76 0.14 0.13 -0.45 -0.44 0.31 0.36
Moderate 0.20 0.22 0.99 0.99 0.40 0.41 -0.83 -0.82 -1.12 -1.06
Clinical Evaluation
Software Evaluation
1
B.I.F.
Mild
0
Normal
-1 Moderate
-2
-2 -1 0 1 2
155
Life Span and Disability Di Nuovo S. / Buono S.
Table 3 - Contingency table between clinical evaluations (rows) and software (co-
lumns). Percent of congruent classifications by rows and columns
BIF 2 15 8 0 0 25 60 .00
Mild MR 0 9 19 6 0 34 55 .88
Moderate MR 0 0 4 16 1 21 76 .19
Severe MR 0 0 0 0 1 1 100.00
Total 19 26 31 22 2 100
156
Diagnosis of Intellectual Disability: comparison between clinical criteria and automatized procedures
157
Life Span and Disability Di Nuovo S. / Buono S.
158
Diagnosis of Intellectual Disability: comparison between clinical criteria and automatized procedures
References
Aa. Vv. (2007). Misure diverse di intelligenza e di adattamento nella diagnosi del
grado di ritardo mentale: un tentativo di sintesi. Ciclo Evolutivo e Disabilità / Life
Span & Disability, 10 (2), 195-214
Shalock, R. L., & Luckasson, R. (2005). Clinical judgment. Washington, DC: Amer-
ican Association of Mental Retardation.
Luckasson, R., Borthwick-Duffy, S., Buntx, W. H. E., Coulter, D. L., Craig, E. M.,
Reeve, A., Schalock, R. L., Snell, M. E. Spitalnik, D. M. Spreta, S., & Tasse, M. J.
(2002). Mental Retardation: Definition, classification, and system of supports (10th
ed.). Washington, DC: American Association of Mental Retardation.
Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (1984). Vineland Adaptive Behavior
Scales. Circle Pines: American Guidance Service. Tr. it. della Forma completa – In-
tervista, a cura di G. Balboni & L. Pedrabissi, Firenze: O.S., 2003.
W.H.O. (1992). The ICD-10 Classification of mental and behavioural disorders: clin-
ical description and diagnostic guidelines. Geneva: World Health Organization.
Wechsler, D. (1991). Wechsler Intelligence Scale for Children – Third Edition. San
Antonio: The Psychological Corporation, TX.
159
Life Span and Disability / XII, 2 (2009), 161-173
Abstract
1. Introduction
For all people the goal of the developmental process is to reach the high-
er level of autonomy in relation to one’s individual capacity and to the lifes-
pan moment; and to the same – even greater – extent, this is especially the
case with persons with intellectual disabilities. Educational support for de-
veloping individual abilities that aid social interaction or obtaining good re-
sults in differing environmental contexts (at home and outside, at school, in
161
Life Span and Disability Muñoz R. C. / Barbero F. L.
the free time) must be a fundamental value for schools or other education-
al context where people with intellectual disabilities are involved.
The main aims of the American Association on Health and Disability
(AAHD) are to advance health promotion and wellness initiatives for peo-
ple with disabilities (Blankenbaker & Carlin, 2008), and education is fun-
damental for this promotion.
In this article we establish the bases for the creation of didactic material
for young people with intellectual disabilities, and successively we will pre-
sent an Integral Program of Health Education planned for this group. How-
ever, this program could be also adapted for other groups with social learn-
ing difficulties, people affected with psychic diseases, persons with difficul-
ties in social adjustment, and immigrants from other countries.
162
A project of education for health and autonomy of persons with intellectual disabilities
163
Life Span and Disability Muñoz R. C. / Barbero F. L.
Table 2 - Relation between areas and contents of adaptive competencies and basic
themes related to health: Source: Casado Muñoz (1999, 2001)
Areas of Adaptive Contents of th e areas Basic themes
Competence and related competencies related to health
Communication Comprehension and All themes, especially
expression of messages mental hea lth
Food and n utriti on,
Food and nutrition, hygiene illness
Personal Care
hygiene prevention
Sexual health
Food and nutriti on
Food, hygiene, security,
Home life accident prevention
social interaction, etc.
Mental hea lth
164
A project of education for health and autonomy of persons with intellectual disabilities
3. Methodology
To deal with methodological aspects that give direction to and guide the
process of elaborating guidelines for educational materials, we will follow
some basic principles (De La Fuente Fernández, 1999):
- Individualization: Students’ different work rhythms and rates of learn-
ing have to be respected. In the same way, the process of learning must
be gradual and sequential. We must encourage approaches that im-
prove a student’s self-esteem.
- Globalization and integration: Content integration must be reinforced;
placing in sequence learning processes to reach objectives more easily,
avoiding fragmentation that inhibits a unified learning process.
- Functionality: Learning must be directly related to aspects of daily life.
- Comprehensiveness: All students must adhere to learning processes
considered fundamental for intellectual development and improved
socialization.
- Diversity: Respect for differences in interests, motivations and capaci-
ties of each student.
- Cooperative work: Both students and teachers must work together to
achieve practically useful results of education.
165
Life Span and Disability Muñoz R. C. / Barbero F. L.
166
A project of education for health and autonomy of persons with intellectual disabilities
A basic premise is the fact that the contents - that is, the illustrations that
accompany the text - must take into account students’ age. It is also impor-
tant to work with colored materials. For this reason, the program has more
than 500 original color designs in the schedules suitable for student’s work.
To summarize, we have tried to plan some didactic materials adapted to
the needs and interests of young people with learning difficulties; materials
that deal with practical realities of daily life with the greatest possible sim-
plicity; educational resources where the scarce or null reading-writing abil-
ities are not an obstacle in following the student’s formative path, and
where students (who think, feel, experiment, comment...) are principal and
active participants in all aspects of the whole program.
6.2 Structure
The program is composed of 8 didactic units: Food and Nutrition, Per-
sonal Hygiene, Injury Prevention, Drugs, Environmental health, Mental
health, Prevention of Illness, Sexual Health, in the following format:
- A pamphlet including health questionnaire to determine student’s ini-
tial level.
- A CD with didactic material including all units.
Each Didactic Unit consists of a “Teacher Manual” and work schedules.
The Teacher Manual is subdivided into the following parts:
- Introduction.
- Relation to other program issues, to introduce teacher to aspects in
common between each Didactic Unit and the others.
- Educational objectives, planned for the Didactic Unit.
- Contents: summary of the elements contained in the Unit: concepts,
comparisons, thinking, procedures, attitudes.
- Activities report: organizing a group of activities that the teacher can
directly integrate or adapt according to student’s characteristics. Their
development can be mainly achieved through oral communication,
since this form of communication permits students to analyze and
167
Life Span and Disability Muñoz R. C. / Barbero F. L.
deepen understanding more easily. But also activities related with read-
ing writing and computing are implemented.
6.5 Music
Music is a relevant aid for strengthening motivation, an excellent tech-
nique for improving expression and positive dynamics (Serrano Gonzàlez,
l998). Our students have welcomed it.
If, as we have previously said, it is important to adapt materials taking in-
to account different countries and cultures, in music this becomes funda-
168
A project of education for health and autonomy of persons with intellectual disabilities
mental for showing that simply transferring a musical piece from one coun-
try to another does not have the same educative result.
Once our program has been planned with the characteristics we have
described, it is essential that it get applied and evaluated. In the following
section we will indicate the procedure followed for validation of the pro-
gram, and the results obtained.
7.2 Measures
As measurement instrument we used the Health Questionnaire devel-
oped and validated by Casado Muñoz in 1994, whose reliability was verified
finding in particular an high Cronbach’s alpha coefficient (0.92) (Casado
Muñoz & Lezcano Barbero, 2006). The Questionnaire was previously vali-
169
Life Span and Disability Muñoz R. C. / Barbero F. L.
7.3 Sample
The experimental pilot group, for the preliminary evaluation of the Pro-
gram, was composed of 9 participants to a Social Guarantee Program as stu-
dents with special educative needs.
The control group was composed of the same number of age-matched
students of an Occupational Formation Course.
The age range was 16 - 20 in the experimental group (mean age 18.0), 20
- 24 in the control group (mean age 21.9).
The small number of participants in the sample was due to a policy of
adopting in the Program group classes of between 8-10 students.
To avoid spurious influences and to enhance the reliability of the re-
search process, the two groups were selected from the same center: in our
case the “El Arca” Center that belongs to the “Asprodes” Center of Sala-
manca (Spain), that works with young people with intellective disabilities
over the age of 16.
7.5 Results
To verify if the changes in each of the two groups were statistically sig-
nificant or not, the pre-post differences have been analyzed by means of
paired samples t-test. We considered the variations obtained through the
application of the Health Questionnaire in each of the dependent variables
(didactic unities) at the beginning and end of the experience for each of the
two groups.
The analysis was performed using the statistical package SPSS.
Results have shown in the experimental group a significant pre-post dif-
170
A project of education for health and autonomy of persons with intellectual disabilities
8. Conclusions
171
Life Span and Disability Muñoz R. C. / Barbero F. L.
References
American Association on Mental Retardation (2002). Mental Retardation. Defini-
tion, classification and systems of supports (10th ed.). Washington, DC: American
Association on Mental Retardation.
Casado Muñoz, R. (1999). The education for the Mental Health of the young with
mental retardation. Paper presented at the 2nd European Congress of Mental
Health in Mental Retardation. Brunel University, Uxbridge. 8-10 september 1999.
Casado Muñoz, R. (2001). Educación para la salud de jóvenes con discapacidad in-
telectual. Burgos: Servicio de Publicaciones de la Universidad de Burgos.
Casado Muñoz, R., & Lezcano Barbero, F. (2001): El Programa Integral de Edu-
cación para la Salud (PIEpS): innovación didáctica para jóvenes con discapacidad
mental. In J.J. Bueno Aguilar, et al. (Eds). Atención Educativa a la diversidad en el
nuevo milenio. Actas de las XVIII Jornadas Nacionales de Universidades y Edu-
cación Especial. La Coruña: Universidade da Coruña.
Casado Muñoz, R., & Lezcano Barbero, F. (2006). Programa Integral de Educación
para la Salud de jóvenes con discapacidad Intelectual. Madrid: Comunidad de
Madrid. Dirección General de Promoción Educativa.
172
A project of education for health and autonomy of persons with intellectual disabilities
Fuente Fernández, M.A., De la (1999). Los Programas de Garantía Social como re-
spuesta a las Necesidades Educativas Especiales. In: Educación e inserción socio-
laboral de personas discapacitadas. Santiago de Compostela: Universidad de Santi-
ago de Compostela.
Ruiz, J. M. (1999). Cómo hacer una evaluación de centros educativos. Madrid: Narcea.
173
Life Span and Disability / XII, 2 (2009), 175-185
Abstract
This article reviews studies that compare different groups (about culture,
national, racial) in order to propose a summary of results about the role
played by caregivers’ cultural influences in the management of patients.
The paper, after a brief introduction, illustrates the research conducted
about mental representations concerning the body, health, illness and
practices of care. The focus, finally, is on recent studies about caring pro-
fessions. The Authors also indicate future lines of research.
1. Introduction
175
Life Span and Disability Velotti P. / Zavattini G. C.
176
Caring professions in multi-ethnic society
Over the last thirty years, the representations of health and illness have
been the topic of several studies; following the papers of Moscovici
(1961/1976) on the different representations of psychoanalysis in the vari-
ous social groups, new research had explored how the existing knowledge
systems could change (Flick, 1998). Herzlich (1973), in the French context,
identified three different conceptions of health and illness that have stimu-
lated further investigation. Jodelet (1991) analyzed the existence of a link
between the representation of mental illness and behavior towards patients
in a small French village; he showed how a naive theory (fear of contagion,
proximity, etc.) of mental illness constituted the key point of the social rep-
resentation of illness and explained the behavior implemented by the vil-
lagers who did not seek integration with the patients. Research has also
documented how changes in these representations determine modifications
in subjects’ behavior.
These early works are followed both by studies on the social representa-
tion of the disease - which focused on a variety of illness - and by studies on
health that, on the basis of the work of Herzlich (Herzlich, & Graham,
1973), have attempted to identify different conceptions belonging to differ-
ent cultures. Flick (2000) found different representations in samples of Ger-
man and Portuguese women and in samples of professional nurses of East
and West Germany and he has connected the differences observed to the
dissimilar contexts where the subjects belonged.
In other studies the focus of these investigations - that have identified a
direct or indirect involvement of specific factors on individuals’ behaviors –
regarded topics such as how to ask for help, the medical services availabili-
ty, the compliance of patients, the correct behavior related to health, etc.;
and results showed that aspects such as socio-demographic characteristics,
social and cultural factors, seems to be related to health- behaviors imple-
mented by the people (Radley, & Billig, 1996; Galli, 1998; Jovchelovitch, &
Gervais, 1999; Fasanelli, Galli, & Sommella, 2005, Dixit, Mishra, & Sharma,
2008). These data have subsequently oriented scholars to develop appro-
priate programs of intervention.
Each study has attempted to examine how the possible differences be-
tween individuals are related to the different cultures and how recent
changes in cross-culture might give reason for the variations in health sta-
tus and for the modifications in the subjects’ care behavior (Fox, Hinton, &
Levkoff, 1999). At the same time, it showed that the diseases’ representa-
tions also have strong implications in the type of answers that people, in
general, give to patients (Barrowclough, Lobban, & Hatton, Quinn, 2001).
Among the theories most used there is the self-regulation model of Lev-
enthal (Leventhal, & Diefenbach, 1991; Leventhal, Musumeci, & Contrada,
2007) for which the answer of subjects to the disease is considered the re-
177
Life Span and Disability Velotti P. / Zavattini G. C.
178
Caring professions in multi-ethnic society
4. Conclusions
179
Life Span and Disability Velotti P. / Zavattini G. C.
The literature has, in fact, emphasized that in the ‘care relationship’ fur-
ther aspects of the caregiver personality are involved, such as empathy, ac-
ceptance, warmth, willingness to learn and to understand the different cul-
tures, etc; these aspects – such as “cultural congruence” – seem to have a role
in the formation of the relationship of care (Proctor & Davis, 1994; Balk,
1997; Burman, 1999). In the first exploratory phase, research (Stephenson,
2000) analyzing different variables (nationality, place of birth, race, region of
residence, history of migration, language membership, years lived in the new
country, religion, occupation, etc), with the purpose of understanding the dif-
ferences in the ways of perceiving and/or in the behavior of individuals.
Thus, to assess the effect of “culture” in the jobs related to health.
Finally, emerges in literature, the necessity of greater awareness of di-
versity within groups of different populations. For example, samples that
are generally classified in research as “Latin”, really includes people from
different places of origin such as Central America, Caribbean, Spain.
(Aranda & Knight, 1997; Connell & Gibson, 1997; Delgado & Tennstedt,
1997; Gallagher-Thompson, 2000; Morano & Bravo, 2002). In the future, on-
ly a greater characterization of the target population on respect to the
country of origin, residence (urban or rural area), period of migration will
allow more detailed conclusions.
Now, the challenge is to integrate this knowledge in appropriate theo-
retical models that take into account the cultural changes resulting from
migration and also the constant ‘contact’ of the individuals (healthcare
workers and patients) to different models than their own.
Acknowledgment
The study was funded by Italian Ministry of Research, PRIN 2006, Re-
search Unit, coordinated by Prof. Zavattini (University of Rome – ‘La
Sapienza’).
References
Aranda, M. P., & Knight, B. G. (1997).The influence of ethnicity and culture on the
caregiving and coping process: A socio-cultural review and analysis. The Gerontol-
ogist, 37, 342–354.
Balk, D. (1997). Caring that empowers: meeting the needs of overwhelmed pa-
tients. Death Studies, 21, 203-207.
180
Caring professions in multi-ethnic society
Barrowclough, C., Lobban, F., Hatton, C., & Quinn, J. (2001). An investigation of
model of illness in care of schizophrenia patients using the Illness Perception
Questionnaire. British Journal of Clinical Psychology, 40, 371-385.
Bruce, J., Beard, K., Tedford, S., Harmon, M., & Tedford, K. (1997).African Ameri-
cans’ and Caucasian Americans’ recognition and like-ability responses to African
American and Caucasian American races. Journal of General Psychology, 124, 143-
155.
Connell, C., & Gibson, G. (1997). Race, Ethnicity and Culture in Dementia Care-
giving: Review and Analysis. The Gerontologist, 37 (3), 355-364.
Delgado, M., & Tennstedt, S. (1997). Making the Case for Culturally Appropriate
Community Services: Puerto Rican Elders and Their Caregivers. Health and Social
Work, 22.
Dilworth-Anderson, P., Williams, I. C., & Gibson, B. E. (2002). Issues of Race, Eth-
nicity, and Culture in Caregiving Research: A 20-Year Review (1980–2000).The
Gerontologist, 42, 237-272.
Dixit, S., Mishra, M., & Sharma, A. K. (2008). Conceptualisation of Health and Ill-
ness. A Study of Social Representations among Bondos of Orissa. Psychology &
Developing Societies, 20 (1), 1-26.
Fasanelli, R., Galli, I., & Sommella, D. (2005). Professione caregiver. Studio delle re-
lazioni tra pratiche assistenziali e rappresentazioni sociali della malattia di
Alzheimer. Napoli: Liguori.
Ford, M.E., & Kelly, P.A. (2005). Conceptualizing and categorizing race and ethnic-
ity in health service research. Health Service Research, 40, 1658-1675.
Fortier, J. P., & Bishop, D. (2003). Setting the agenda for research on cultural com-
petence in health care. In C. Brach (ed.), Final report: Setting the agenda for re-
search on cultural competence in health care. Washington, DC: U.S. Department of
Health and Human Services.
Fox, K., Hinton, W. L., & Levkoff, S. (1999). Take up the caregiver’s burden: stories
of care for urban African American elders with dementia. Culture, Medicine and
Psychiatry, 23, 501-529.
181
Life Span and Disability Velotti P. / Zavattini G. C.
Hannum, R. J., Bowman, K. F., O’Toole, E. E., Abbott, K., Love, T. E., Thomas, C., &
Dawson, N. V. (2007). Caregiver Objective Burden and Assessments of Patient-
Centered, Family-Focused Care for Frail Elderly Veterans. Gerontologist, 47 (1), 21
- 33.
Herzlich C., & Graham, D. (1973). Health and Illness. A social Psychological Analy-
sis. London: Academic Press Inc.
Ikels, C. (2002). Constructing and deconstructing the self: Dementia in China. Jour-
nal of Cross-Cultural Gerontology, 17, 233-251.
Janevic M. R., & Connell, C. M. (2001). Racial, ethnic, and cultural differences in
the dementia caregiving experience: Recent findings. The Gerontologist, 41, 334-
347.
Jovchelovitch, S., & Gervais, M.C. (1999). Social Representations of Health and Ill-
ness: The Case of the Chinese Community in England. Journal of Community &
Applied Social Psychology, 9 (4), 247-260.
Kiviniemi, M. T., & Rothman, A. J. (2008). What do people think about changes in
health behaviors? Differential perceptions of consequences of increases and de-
creases in health behaviours. Psychology & Health, 23 (7), 867- 885.
182
Caring professions in multi-ethnic society
Lawton, M. P., Rajagopal, D., Brody, E., & Kleban, M. (1992). The Dynamics of
Caregiving for a Demented Elder Among Black and White Families. Journal of
Gerontology: Social Sciences, 47, 156-164.
Leventhal, H., & Diefenbach, M. (1991). The active side of illness cognition. In J.A.
Skelton, R.T. Croyle (Eds.), Mental Representation in Health and Illness (pp. 517-
555). New York: Springer-Verlag Inc.
Leventhal, H., Musumeci, T. J., & Contrada, R. J. (2007). Current issues and new di-
rections in Psychology and Health: Theory, translation, and evidence-based prac-
tice. Psychology and Health, 22, 381-385.
Li, L.W., & Fries, B. E. (2005). Elder Disability as an Explanation for Racial Differ-
ences in Informal Home Care. Gerontologist, 45 (2), 206-215.
Mahoney, D. F., Cloutterbuck, J., Neary, S., & Zhan, L. (2005). African American,
Chinese, and Latino Family Caregivers’ Impressions of the Onset and Diagnosis of
Dementia: Cross-Cultural Similarities and Differences. The Gerontologist, 45 (6),
783–792.
Miller, B., Campbell, C., Farran, C., Kaufman, J., & Davis, L. (1995). Race, Control,
Mastery and caregiver distress. Journal of Gerontology: Social Sciences, 50B (6), 374-
382.
Navaie-Waliser, M., Feldman, P. H., Gould, D. A., Levine, C., Kuerbis, A. N., &
Donelan, K. (2001). The Experiences and Challenges of Informal Caregivers. Com-
mon Themes and Differences Among Whites, Blacks, and Hispanics. The Gerontol-
ogist, 41, 733-741.
183
Life Span and Disability Velotti P. / Zavattini G. C.
Petrillo, G. (Ed.). (1996). Psicologia sociale della salute. Napoli: Liguori Editore
Pinquart, M., & Sörensen, S. (2005). Ethnic Differences in Stressors, Resources, and
Psychological Outcomes of Family Caregiving: A Meta-Analysis. Gerontologist, 45,
90-106.
Proctor, E., & Davis, L. (1994). The challenge of racial difference: skills for clinical
practice. Social Worker, 39, 314-323.
Radley, A., & Billig, M. (1996). Accounts of health and illness: Dilemmas and rep-
resentations. Sociology of Health & Illness, 18 (2), 220-240.
Rüdell, K., & Diefenbach, M. A. (2008). Current Issue and new directions in psy-
chology and health: Culture and health psychology. Why health psychologists
should care about culture. Psychology and Health, 23 (4), 387-390.
Sheikh, S., & Furnham, A. (2000). A cross-cultural study of mental health beliefs
and attitudes towards seeking professional help. Social Psychiatry and Psychiatric
Epidemiology, 35, 326-334.
Sokolovsky, J. (1990). Bringing Culture Back Home: Aging, Ethnicity and Family
Support. In J. Sokolovsky (ed.), The Cultural Context of Aging: Worldwide Perspec-
tive (Cap. 10). NY: Bergin and Garvey Publishers.
Sondik, E., Lucas, J., Madans, J., & Smith, S. (2000). Race/ethnicity and the 2000
census: implications for public health. American Journal of Public Health, 90, 1709
-1713.
Tang, M. X, Cross, P., Andrews, H., Jacobs, D. M, Small, S., & Bell, K. (2001). Inci-
dence of Alzheimer’s disease in African Americans, Caribbean Hispanics, and Cau-
casians in northern Manhattan. Neurology, 56, 49-56.
Valle, R. (1998). Caregiving across cultures: Working with dementing illness and eth-
nically diverse populations. Washington, DC: Taylor & Francis.
Wallace, D., & Wallace, R. (1998). A plague on your Houses: the war on the urban
poor. London: Verso Press.
184
Caring professions in multi-ethnic society
Wells, J. N., Cagle, C. S., Bradley, P., & Barnes, D. M. (2008). Voices of Mexican
American Caregivers for Family Members With Cancer: On Becoming Stronger.
Journal of Transcultural Nursing, 19 (3), 223-233.
Yaffe, M. J., Orzeck, P., & Barylak, L. (2008). Family physicians’ perspectives on
care of dementia patients and family caregivers. Canadian Family Physician, 54 (7),
1008-1015.
Zavattini, G. C., Pace, C. S., & Velotti, P. (2008). I concetti di salute, malattia e
pratiche di cura in operatori socio-sanitari appartenenti a culture differenti. Atti del
Congresso Nazionale di Psicologia, Sezione di Psicologia Clinica, Padova.
185