Urine metabolic screening is an important part of the evaluation of children with DD/ID as it can enable families to make reproductive decisions and children to receive appropriate therapy early.

Two hundred persons over 80 in two urban communities were interviewed. Of those interviewed, 21% evidenced psychological impairment as defined by the presence of at least one of the following self-report symptoms: 1) depression; 2) periods of inability to function; 3) suicidal ideation; 4) alcohol problems and 5) use of psychotropic medication. A profile of the psychologically impaired group compared to the psychologically healthy showed that accidents (mostly falls), eye problems and few social contacts were significantly associated with impairment. Approximately 75% had some restrictions on activity due to physical health problems. Social isolation was marked: 54% either had no children or saw them less than once a month; 38% visited with close friends or relatives less than once a month; 19% were rated as having very little or no social support; and 23% socialized beyond the household less than once a week. Social interaction was the strongest predictor of psychological wellbeing (Affect Balance Scale) in a multiple regression analysis that included physical health and socioeconomic variables. Questions about service needs and utilization indicated unmet needs in the areas of transportation, house maintenance, medical services, and a regular visiting service.

Interviews were conducted in the homes of 200 persons aged 80 years or older; 100 lived in Vancouver and 100 in Victoria, B. C. Between 15 and 27 per cent showed psychologic impairment, as measured by self-reporting of symptoms, including use of prescribed psychotropic drugs. A comparison of those who were psychologically impaired with those who were psychologically healthy demonstrated that accidents, eye problems, and dearth of social contacts were significantly associated with the former group. In 74 per cent of the sample, activities were restricted in varying degrees because of health problems, and there was a surprising degree of social isolation. On the Social Interaction Index, low scores were significantly more common among the psychologically impaired, and a similar relationship between poor physical health and social isolation was demonstrated with a multiple regression analysis. The findings suggest that poor social interaction, particularly, and poor health may be predictors of psychologic distress. Extended family support is weakening, and planned programs are needed to improve the lifestyles of the aged and to prevent loneliness and alienation.

Considerable attention has been paid during the past twenty years, mainly by research workers in the U.S.A., to the employment of rating scales for the assessment and recording of those characteristics of psychiatric patients which are generally classed as signs and symptoms. As well as being used in the practical problems of diagnostic evaluation of patients, the rating scales are often employed in research endeavours in the area of psychiatric nosology. Their employment and the methodological approach which they represent might well be regarded as complementary to other sorts of activities and interpretative philosophies which might be encountered in any particular psychiatric facility, including those in which comparatively less emphasis may be laid upon considerations of diagnostic differentiation. Rating scales are relatively objective methods of appraisal at least of certain observable aspects of personality, such as overt situational behaviour and appearance, as well as some aspects of the patients' verbal communication. In employing these scales, such personal characteristics are systematically reviewed; usually quantitatively graded; and are recorded in recoverable form. Immediate interpretation of the observed phenomena is not called for. The observations are made in a more or less standardized fashion, and more than one rater may participate in order to minimize subjective differences of appraisal. In this way, then, real life behaviour in a particular situation is assessed, in contrast to the approach involved in some of the more traditional ‘test’ methods, in which the rationale entails that certain aspects of personality are implied symbolically in the test scores or protocol. However, in so far, as certain of the scales may involve some self-report on the part of patients regarding subjective feelings and symptoms, there is clearly some affinity with certain of the older personality inventories, questionnaires, symtom check-lists and the like. The factor analytic treatment of data derived from the use of psychiatric rating scales to assess some of the phenomena of psychopathology has led to fresh suggestive principles of classifying these. From various studies a number of dimensions have emerged in distinction from the usual disease entities though it is possible to make assimilatory links between these two sets, as, for example, Lorr (26) has done. While the nature and number of the ‘factors’ produced are dependent upon the particular patient population studied, several surveys have resulted in some measure of concordance as may be seen in the three lists of factors shown in Table 1. The various scales themselves may be typed according to the extent of involvement of the patient; the areas covered by the particular scale; and the sort of patients for whom it is intended. In this way, the reader will be able to select scales which are appropriate for any particular purpose, such as routine observation and assessment, or research connected with changes of signs and symptoms.