Psychological and Behavioral Aspects of Physical Disability

A relationship between the disciplines of psychology and medicine is evident in writings from the beginnings of recorded history. This inter­ action was characterized in some epochs by mutual interest and support, only to be followed by periods of relative disinterest. During the past century there have been several formal attempts to acknowledge this interdependence and to revive and codify on a more permanent basis the working relationships between practitioners and scientists from both psychology and medicine. These twentieth-century waves of interest, which have also come and gone, have been identified by such names as psychosomatic medicine and rehabilitation psychology. For a variety of reasons, notably the lack of a sufficient knowledge base in either disci­ pline, the desired partnership has not come to full flower. This state of affairs seems to be changing as we enter the last two decades of the twentieth century. In the American Psychologist in September, 1980, I reviewed recent developments in psychology and in medicine and in federal and private funding patterns, which give evidence of revitalizing this partnership between these two disciplines and their relevant subspecialties. For ex­ ample, after six decades of spectacular biomedical scientific advances which have all but eradicated such life-threatening diseases as polio­ myelitis and tuberculosis, leaders in medicine, the behavioral sciences, and other segments of society reached a consensus during the 1970s that the behavior of the individual is one of today's unexplored frontiers for modern medical practice and related good health care.

1 General Considerations for Evaluating and Counseling the Physically Handicapped.- The Stigma of Disability.- The Process of Adjustment to Disability.- Psychological Characteristics and Problems Commonly Associated with Disability.- Helping Relationships with the Physically Disabled.- Suggestions about Process.- Labeling, Normalization, and Mainstreaming.- Milestones.- References.- 2 Hemophilia.- The Physical Disability.- Definition and Incidence.- Manifestations.- Treatment.- Common Psychological Characteristics and Problems.- The Family.- Intelligence—Schooling.- Emotional Adjustment.- Vocation.- Evaluating Persons with Hemophilia.- Intervention Methods.- Trends and Needs.- Appendix: Sources of Information.- References.- 3 Diabetes Mellitus.- The Physical Disability.- Classification.- Prevalence.- Genetic Factors.- Clinical Characteristics.- Treatment.- General Effect on Physical Development.- Common Psychological Characteristics and Problems.- General Consequences of Chronic Conditions.- Psychological Characteristics Unique to Diabetes.- Evaluating Diabetic Patients.- Evaluating the General Level of Cognitive Functioning.- Evaluating the Patient’s Emotional Status.- Evaluating the Patient’s Adaptive Behavior.- Intervention Methods.- Trends and Needs.- Management and Self-Care.- Clinical and Laboratory Research.- Appendix: Sources of Information.- References.- 4 Other Genetic Disorders.- Genetic Disorders.- Mechanisms of Inheritance.- Autosomal and X-Linked Recessive Disorders.- Autosomal Dominant Disorders.- Chromosomal Abnormalities.- Genetic Counseling.- Phenylketonuria.- The Physical Disability.- Common Psychological Characteristics and Problems.- Evaluating Persons with Phenylketonuria.- Intervention Methods.- Turner’s Syndrome.- The Physical Disability.- Common Psychological Characteristics and Problems.- Evaluating Persons with Turner’s Syndrome.- Intervention Methods.- Klinefelter’s Syndrome.- The Physical Disability.- Common Psychological Characteristics and Problems.- Evaluating Persons with Klinefelter’s Syndrome.- Intervention Methods.- Huntington’s Disease.- The Physical Disability.- Common Psychological Characteristics and Problems.- Evaluating Persons with Huntington’s Disease.- Intervention Methods.- Trends and Needs.- Appendix: Sources of Information.- References.- 5 Cerebral Palsy.- The Physical Disability.- Definition.- Incidence.- Motor.- Speech.- Hearing.- Vision.- Intelligence.- Seizures.- Common Psychological Characteristics and Problems.- Family.- Intellectual and Emotional Functioning.- Speech.- Self-Concept.- Social and Work Adjustment.- Evaluating Persons with Cerebral Palsy.- Interview.- Psychological Testing.- Intervention Methods.- The Family.- Realistic Expectations, Self-Appraisal, Self-Concept.- Identity and Competence.- Employment and Vocational Counseling.- Behavior Modification.- Trends and Needs.- Appendix: Sources of Information.- References.- 6 Epilepsy.- The Physical Disability.- Classification of Epileptic Seizures.- Prevalence.- Etiology.- Current Treatment Procedures.- Common Psychological Characteristics and Problems.- Impact of Seizures.- Misperceptions or Fears Associated with the Diagnosis of Epilepsy.- Epilepsy and Predicaments.- Employment.- Epilepsy and Intellectual Impairment.- Epilepsy and Personality Disorders.- Evaluation of Individuals with Epilepsy.- Impact of Epilepsy on the Adjustment of a Child.- Specialized Assessment for Evaluation of Seizure-Related Transient Mental Deficits.- Intellectual and Cognitive Assessment of Individuals with Epilepsy.- Specialized Neuropsychological Assessment.- Assessment of Issues Pertaining to Epilepsy and Employment.- Intervention Methods.- Trends and Needs.- Appendix: Sources of Information.- References.- 7 Mental Retardation.- The Physical Disability.- Definition.- Levels of Mental Retardation.- Mental Retardation as “Reversible”.- Prevalence.- Etiology.- Common Psychological Characteristics and Problems.- Impact of Diagnosis.- Altered Feedback.- Peer Relations.- Adult Adjustment.- Evaluating Persons with Mental Retardation.- Recurring Assessment Questions. Infancy, School Years, Adult Years.- Types of Assessment Instruments.- Selection of Assessment Procedure.- Special Considerations.- Intervention Methods.- Intervention: A Framework.- Interdisciplinary Care.- Residential Treatment.- Trends and Needs.- Appendix: Sources of Information.- References.- 8 Spinal Cord Injury.- The Physical Disability.- Incidence.- Acute Care.- Rehabilitation Care.- Common Psychological Characteristics and Problems.- Stages of Reaction.- Personality Patterns.- Social and Sexual Adjustment.- Evaluating Persons with Spinal Cord Injury.- Interview.- Psychological Testing.- Intervention Methods.- Early Stages.- The Family.- Independence.- Psychotherapy.- Sex and Marital Counseling.- Vocation.- Trends and Needs.- Appendix: Sources of Information.- References.- 9 Myelomeningocele (Spina Bifida).- The Physical Disability.- Definition.- Incidence and Etiology.- The Decision to Treat.- Associated Problems.- Common Psychological Characteristics and Problems.- Family Impact.- Intelligence and Schooling.- Emotional Adjustment.- Vocation.- Evaluating Persons with Myelomeningocele.- Evaluation of the Environment.- Evaluation of the Person.- Intervention Methods.- Intervention Goals.- Intervention with Parents.- Intervention with School Personnel.- Direct Intervention with the Myelomeningocele Patient.- Trends and Needs.- Training of Professional Care Personnel.- Appendix: Sources of Information.- References.- 10 Progressive Muscle Disorders.- The Physical Disability.- Diagnostic Methods.- The Anterior Horn Cell or Lower Motor Neuron.- Common Psychological Characteristics and Problems.- Childhood Onset.- Adolescent and Early Adult Onset.- Adult Onset.- Evaluation of Patients with Progressive Muscle Disorder.- Interview.- Psychological Testing.- Intervention Methods.- Trends and Needs.- Appendix: Sources of Information.- References.- 11 Congenital Heart Defects.- The Physical Disability.- Definition and Incidence.- Associated Conditions.- Manifestations.- Diagnosis and Treatment.- Common Psychological Characteristics and Problems.- Emotional.- Cognitive.- Evaluating Persons with Congenital Heart Defect.- Intervention Methods.- Trends and Needs.- Appendix: Sources of Information.- References.- 12 Coronary Heart Disease.- The Physical Disability.- Definition and Incidence.- Risk Factors.- Diagnosis.- Treatment.- Common Psychological Characteristics and Problems.- Type A Personality.- Post-Coronary.- Evaluating Persons with Coronary Heart Disease.- Intervention Methods.- Trends and Needs.- Appendix: Sources of Information.- References.- 13 Visual Handicaps.- Physical Disability.- Overview.- Incidence and Causation.- Definition of Blindness.- Common Psychological Characteristics and Problems.- Parent-Child Interactions.- Early Development and Learning.- Development of Communication Skills.- Psychological and Behavioral Reactions to Blindness.- Evaluating the Blind.- Parental and Environmental Evaluation.- Evaluation of Development and Intelligence.- Evaluation of Personality.- Intervention Methods.- Medical Intervention.- Parent Training and Child Training.- Training the Blind Person.- Rehabilitative and Therapeutic Intervention.- Trends and Needs.- Appendix: Sources of Information.- References.- 14 Hearing Disorders.- The Physical Disability.- Definition and Incidence.- Principal Causes and Medical Treatments for Hearing Loss.- Problems in Identifying Hearing Impairment.- Hearing Aid Amplification.- Common Psychological Characteristics and Problems.- Overview.- Family Effects.- Individual Effects.- Evaluating the Hearing-Impaired Person.- General Problem: Communication.- Evaluating Cognitive Ability.- Measurement of Personality.- Evaluation Interview.- Intervention Methods.- The Multidiscipline Approach.- Intervention with the Family.- Educational Methods.- Personal Counseling.- Trends and Needs.- Electrical Stimulation of the Auditory Nerve.- Electrophysiological Audiometry.- Regional Resource Centers.- Public Attitude.- Preventive Procedures.- Appendix: Sources of Information.- References.