Vocational Guidance and Employment of Persons with a Diagnosis of Prader-Willi Syndrome. (Vocational Guidance & Prader-Willi Syndrome)

By Wadsworth, John S.; McBrien, Dianne M. et al. | The Journal of Rehabilitation, January-March 2003 | Go to article overview

Vocational Guidance and Employment of Persons with a Diagnosis of Prader-Willi Syndrome. (Vocational Guidance & Prader-Willi Syndrome)


Wadsworth, John S., McBrien, Dianne M., Harper, Dennis C., The Journal of Rehabilitation


Prader-Willi syndrome is an infrequent, but distinctive, genetic disorder that is expressed as cognitive and adaptive deficits, sexual immaturity, poor gross motor skills, emotional lability, sleep difficulties, and behavioral disturbances (Alexander, VanDyke, & Hanson, 1995; Akefeldt, Gillberg, & Larsson, 1991). This constellation was first described by Down (1887) and at a later date by Prader, Labhart, and Willi (1956). The most striking and easily identified behavioral manifestations of the chromosomal disorder are an intense preoccupation with food and marked abnormalities in satiety (Dykens, Leckman, & Cassidy, 1996; Zellweger, 1984). Serious behavioral difficulties, such as aggression, may often be related to food seeking.

In addition, persons with Prader-Willi syndrome typically also display severe behavioral difficulties not related to food seeking that include: irritability, lethargy, impulsiveness, obsessive behavior, temper tantrums, stubbornness, argumentativeness, and self-injurious behavior (Clarke, Boer, Chung, Sturmey, & Webb, 1996; Dykens et al., 1996; Greenswag, 1987). There is some evidence of a higher incidence of acute reoccurring psychotic symptoms not entirely accounted for by intellectual disability (Beardsmore, Dorman, Cooper, & Webb, 1998; Clarke, 1998). Despite severe behavioral outbursts, persons with a diagnosis of Prader-Willi syndrome are often described as generally good natured (Greenswag).

Individuals with the diagnosis of Prader-Willi syndrome present a challenge to vocational rehabilitation programs. Dykens et al. (1997) note that the supervision necessary to assist individuals with Prader-Willi syndrome in maintaining a quality lifestyle and preventing a premature death may be in conflict with the philosophical and ethical standards that promote consumer independence, choice making, and personal responsibility. To be vocationally successful, and to avoid the life threatening complications associated with morbid obesity, persons with the diagnosis of Prader-Willi benefit from vocational services that recognize the strong genetic component of behaviors characteristic of the syndrome (Saporito, 1995). These behavioral characteristics may limit the consumer's vocational choices. Many of these behaviors that have an organic basis are not easily modified by typical environmental supports or therapeutic interventions.

Understanding the genotype-phenotype relationship of the syndrome is critical in recognizing that emotional and behavioral disturbances, especially those that center on food, are not driven by cognitive processes, but rather are a behavioral manifestation of a chromosomal disorder (Alexander et al., 1995). These behaviors are extremely difficult to change through behavioral, cognitive, or other interventions that focus on self-awareness and self-control (Whitman & Greenswag, 1995). A clear understanding of this syndrome can help vocational counselors design more effective strategies for vocational guidance and placement of persons with the diagnosis of Prader-Willi syndrome.

The purpose of this paper is to review the incidence and diagnostic criteria of Prader-Willi syndrome. The functional features of the syndrome are presented and illustrated by several composite case examples that feature typical expressions of the syndrome and functional difficulties that arise from those expressions. Finally, vocational strategies are reviewed. This discussion focuses on strategies to assist rehabilitation counselors in the vocational assessment and counseling of persons with Prader-Willi syndrome.

Etiology and Diagnostic Criteria

Prader-Willi syndrome is a chromosomal disorder that results from the deletion or inactivation of information that codes for the organization of sub cellular organelles called nucleoli (Cassidy, 1995). Males and females appear to be equally affected (Alexander et al., 1995). In 60 to 70% of clinically typical individuals, the syndrome is caused by the deletion of the father's contribution to chromosome 15q (Butler, 1990). …

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