In a group of 23 hospital patients aged over 50 with Down's syndrome, psychological testing indicated that significant intellectual deterioration, which was un-related to chronological age, sex, length of hospitalisation, or earlier mental age, had occurred in nine. Clinically, there was no evidence in any patient of active physical illness, focal neurological signs, or dementia, but significant associations were found between intellectual deterioration and decreased visual acuity, hearing loss, and macrocytosis.

ABSTRACT. Previous cross–sectional studies of Down's syndrome have suggested thatdeficits in cognitive and neurological functioning after the age of 35 years are symptomatic of Alzheimer's disease. It has been claimed that this pattern corresponds to post‐mortem neuropathological findings of Alzheimer's disease in all Down's syndrome patients who die aged over 35 years. In the present study of Down's syndrome patients aged between 19 and 49 years, results showed that, for those over 35 years, intellectual deterioration had occurred in less than a third. No relationship was found between chronological age and the level of self care skills or the presence of disturbed behaviour. Results are discussed in terms of the interpretation of the existing neuropathological literature, the methodology of future studies and clinicaldecisions regarding hospitalized patients with Down's syndrome.

This study surveys firstly, using a modified semantic differential technique, how a sample of health visitors in the County of South Glamorgan perceived different behavioural problems in pre-school children. A selection of visiting records, covering a 1-year period, is also studied. Results from the semantic-differential indicate that health visitors perceive eating and sleeping as the most common problem areas. Hyperactivity and sleeping problems are seen as being the most difficult to deal with and the most disruptive to family life. Although health visitors generally feel it is necessary to follow up children with behaviour problems, they find these difficult to resolve. About one third of children are referred to other agencies. Visiting records reveal that children with hyperactivity and sleeping problems receive the highest number of visits from health visitors and that there is little improvement in these children over a period of 1 year. An extension of the health visitor's role and training to include behavioural treatments for pre-school children is discussed.

Thirty-eight pre-school developmentally delayed children receiving the South Glamorgan Home Advisory Service were included in the study. The children were grouped according to developmental ability and manifesting problems. The effectiveness of three methods of teaching (activity charts, target setting, suggestion) were assessed under a balanced design. Weekly skill gain and increments on checklists were measured at the start and at the end of the study period. Parents' opinions on the different methods of teaching were requested and time samples of duration of home visiting were taken. On weekly skill gain, suggestion proved less effective than activity charts or target setting. Severely delayed children made least progress on weekly skill gains. Progress on checklists was independent of teaching method. However, group differences were observed in that severely delayed children (DQ range 22-61) and older (greater than 17 months) Down's syndrome children made least gains on the checklists. Activity charts were preferred by parents although they were also rated as being the most time consuming. Duration of home visits tended to be greater when activity charts were used. Implications of the findings are discussed with reference to ways of improving advice given to parents and alternative ways of evaluating pre-school educational programmes for particular groups of children.

SynopsisRelatives of 39 schizophrenic patients attending a day hospital in South Glamorgan assessed the patients‘ behaviour at home covering a period of one week. The results pointed to the existence of a sub-group of patients with severe behavioural problems. These patients had had more psychiatric admissions, and had spent a longer total time in hospital. The proportion of forms of behaviour regarded as problems by the relatives themselves was lower than that suggested by their assessments, except in the families where the patient exhibited severe behavioural difficulties. The findings are discussed in terms of the practical difficulties regarding home-management by relatives of the schizophrenic.