TheInfoList

Developmental disability is a diverse group of chronic conditions that are due to mental or physical impairments that arise before adulthood. Developmental disabilities cause individuals living with them many difficulties in certain areas of life, especially in "language, mobility, learning, self-help, and independent living".Center for Disease Control and Prevention. (2013)
Developmental disabilities.
Retrieved October 18, 2013
Developmental disabilities can be detected early on and persist throughout an individual's lifespan. Developmental disability that affects all areas of a child's development is sometimes referred to as
global developmental delay Global developmental delay is an umbrella term used when children are significantly delayed in their cognitive and physical development. It can be diagnosed when a child is delayed in one or more milestones, categorised into motor skills, speech, co ...

. The most common developmental disabilities are: * Motor disorders, and learning difficulties such as
dyslexia Dyslexia, also known as reading disorder, is characterized by trouble with reading despite normal intelligence. Different people are affected to different degrees. Problems may include difficulties in spelling words, reading quickly, writing w ...

, , ,
dysgraphia Dysgraphia is a deficiency in the ability to write, primarily handwriting, but also coherence. Dysgraphia is a specific learning disability''(SLD)'' as well as a transcription disability, meaning that it is a writing disorder associated with impair ...

, and
dyscalculia Dyscalculia () is a disability resulting in difficulty learning or comprehending arithmetic, such as difficulty in understanding numbers, learning how to manipulate numbers, performing mathematical calculations and learning facts in mathematics. I ...

. *
Autism Autism is a developmental disorder characterized by difficulties with social interaction and communication, and by restricted and repetitive behavior. Parents often notice signs during the first three years of their child's life. These sig ...

is a spectrum disorder that causes difficulties in communications. ASD affects speech, understanding body language, social interactions, difficulty in understanding others in things like sarcasm and other’s feelings, and causes stims like hand flapping. *
Down syndrome Down syndrome or Down's syndrome, also known as trisomy 21, is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. It is usually associated with physical growth delays, mild to moderate intellectual disabi ...

is a condition in which people are born with an extra copy of chromosome 21. Normally, a person is born with two copies of chromosome 21. However, if they are born with Down syndrome, they have an extra copy of this chromosome. This extra copy affects the development of the body and brain, causing physical and mental challenges for the individual. *
Fragile X syndrome Fragile X syndrome (FXS) is a genetic disorder characterized by mild-to-moderate intellectual disability. The average IQ in males is under 55, while about two thirds of affected females are intellectually disabled. Physical features may include a ...

(FXS) is thought to cause
autism Autism is a developmental disorder characterized by difficulties with social interaction and communication, and by restricted and repetitive behavior. Parents often notice signs during the first three years of their child's life. These sig ...

and intellectual disability, usually among boys. *
Pervasive developmental disorders The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), is a group of disorders characterized by delays in the development of multiple basic functions including socialization and comm ...

(PDD) are a group of developmental disabilities that can cause significant social, communication and behavioral challenges. *
Fetal alcohol spectrum disorder Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. Symptoms can include an abnormal appearance, short height, low body weight, small head size, poor coordi ...

s (FASD) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. *
Cerebral palsy Cerebral palsy (CP) is a group of permanent movement disorders that appear in early childhood. Signs and symptoms vary among people and over time. Often, symptoms include poor coordination, stiff muscles, weak muscles, and tremors. There may be p ...

(CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture. CP is the most common motor disability in childhood. *
Intellectual disability Intellectual disability (ID), also known as general learning disability and formerly mental retardation (MR),Rosa's Law, Pub. L. 111-256124 Stat. 2643(2010). is a generalized neurodevelopmental disorder characterized by significantly impaired inte ...

, also (sometimes proscriptively) known as mental retardation, is defined as an IQ below 70 along with limitations in adaptive functioning and onset before the age of 18 years. *
Attention Deficit Hyperactivity Disorder Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, or excessive activity and impulsivity, which are otherwise not appropriate for a person's age. Some individuals with ADHD also displ ...

or simply known as ADHD is a genetic neurodevelopmental disorder characterized by executive dysfunction. Primarily in attention span, cognition, self-control, and emotional regulation.

# Causes

The causes of developmental disabilities are varied and remain unknown in a large proportion of cases. Even in cases of known etiology the line between "cause" and "effect" is not always clear, leading to difficulty in categorizing causes. Genetic factors have long been implicated in the causation of developmental disabilities. There is also a large environmental component to these conditions, and the relative contributions of
nature versus nurture The nature versus nurture debate involves whether human behavior is determined by the environment, either prenatal or during a person's life, or by a person's genes. The alliterative expression "nature and nurture" in English has been in use since ...

Preterm birth Preterm birth (PTB), also known as premature birth, is the birth of a baby at fewer than 37 weeks' gestational age, as opposed to full-term delivery at approximately 40 weeks. PTB is defined as birth before 37 weeks' gestation, very early PTB is ...

is known to be a predictor for potential developmental disabilities later in childhood, which further complicates the question of nature versus nurture, as Current theories on causation focus on genetic factors, and over 1,000 known genetic conditions include developmental disabilities as a symptom. Developmental disabilities affect between 1 and 2% of the population in most western countries, although many government sources acknowledge that statistics are flawed in this area. The worldwide proportion of people with developmental disabilities is believed to be approximately 1.4%. It is twice as common in males as in females, and some researchers have found that the prevalence of mild developmental disabilities is likely to be higher in areas of poverty and deprivation, and among people of certain ethnicities.

# Diagnosis and quantification

Developmental disabilities can be initially suspected when a child does not reach expected
child development stages Child development stages are the theoretical milestones of child development, some of which are asserted in nativist theories. This article discusses the most widely accepted developmental stages in children. There exists a wide variation in ...

. Subsequently, a
differential diagnosis In healthcare, a differential diagnosis is the distinguishing of a particular disease or condition from others that present similar clinical features. Differential diagnostic procedures are used by clinicians to diagnose the specific disease in a ...

may be used to diagnose an underlying disease, which may include a
physical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the patient' ...

and
genetic test Genetic may refer to: *Genetics, in biology, the science of genes, heredity, and the variation of organisms **Genetic, used as an adjective, refers to genes ***Genetic disorder, any disorder caused by a genetic mutation, whether inherited or de novo ...

s. The degree of disability can be quantified by assigning a ''developmental age'' to a person, which is age of the group into which test scores place the person. This, in turn, can be used to calculate a ' (DQ) as follows: $DQ = \frac * 100$

# Associated issues

## Physical health issues

There are many physical health factors associated with developmental disabilities. For some specific syndromes and diagnoses, these are inherent, such as poor heart function in people with Down syndrome. People with severe communication difficulties find it difficult to articulate their health needs, and without adequate support and education might not recognize ill health.
Epilepsy Epilepsy is a group of neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures are episodes that can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical ...

, sensory problems (such as poor vision and hearing),
obesity Obesity is a medical condition in which excess body fat has accumulated to an extent that it may have a negative effect on health. People are generally considered obese when their body mass index (BMI), a measurement obtained by dividing a pe ...

and poor
dental healthDental Public Health (DPH) is a para-clinical specialty of dentistry that deals with the prevention of oral disease and promotion of oral health. Dental public health is involved in the assessment of key dental health needs and coming up with effect ...

are over-represented in this population.
Life expectancy Life expectancy is a statistical measure of the average (see below) time an organism is expected to live, based on the year of its birth, its current age, and other demographic factors including biological sex. The most commonly used measure ...

among people with developmental disabilities as a group is estimated at 20 years below average, although this is improving with advancements in adaptive and medical technologies, and as people are leading healthier, more fulfilling lives, and some conditions (such as
Freeman–Sheldon syndrome Freeman–Sheldon syndrome (FSS) is a very rare form of multiple congenital contracture (MCC) syndromes (arthrogryposes) and is the most severe form of distal arthrogryposis (DA). It was originally described by Ernest Arthur Freeman and Joseph Haro ...

) do not impact life expectancy.

## Mental health issues (dual diagnoses)

Mental health Mental health, defined by the World Health Organization (WHO), is "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to ma ...

issues, and , are more likely to occur in people with developmental disabilities than in the general population. A number of factors are attributed to the high incidence rate of dual diagnoses: * The high likelihood of encountering events throughout their lifetime (such as abandonment by loved ones,
abuse Abuse is the improper usage or treatment of a thing, often to unfairly or improperly gain benefit. Abuse can come in many forms, such as: physical or verbal maltreatment, injury, assault, violation, rape, unjust practices, crimes, or other typ ...

,
bullying upright=1.3|Banner in a campaign against bullying Cefet-MG Bullying is the use of force, coercion, hurtful teasing or threat, to abuse, aggressively dominate or intimidate. The behavior is often repeated and habitual. One essential prerequisi ...

and
harassment Harassment covers a wide range of behaviors of an offensive nature. It is commonly understood as behavior that demeans, humiliates or embarrasses a person, and it is characteristically identified by its unlikelihood in terms of social and moral re ...

) * The social and developmental restrictions placed upon people with developmental disabilities (such as lack of
education Education is the process of facilitating learning, or the acquisition of knowledge, skills, values, morals, beliefs, and habits. Educational methods include teaching, training, storytelling, discussion and directed research. Education fr ...

,
poverty Poverty is the state of not having enough material possessions or income for a person's basic needs. Poverty may include social, economic, and political elements. ''Absolute poverty'' is the complete lack of the means necessary to meet basic pe ...

, limited
employment Employment is a relationship between two parties, usually based on contract where work is paid for, where one party, which may be a corporation, for profit, not-for-profit organization, co-operative or other entity is the employer and the other ...

opportunities, limited opportunities for fulfilling relationships, boredom) * Biological factors (such as brain injury,
epilepsy Epilepsy is a group of neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures are episodes that can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical ...

, illicit and prescribed drug and alcohol misuse) * Developmental factors (such as lack of understanding of
social norms Social norms are regarded as collective representations of acceptable group conduct as well as individual perceptions of particular group conduct. They can be viewed as cultural products (including values, customs, and traditions)Sherif, M. (1936 ...

and appropriate behavior, inability of those around to allow/understand expressions of grief and other human
emotions Emotions are biological states associated with all of the nerve systems brought on by neurophysiological changes variously associated with thoughts, feelings, behavioural responses, and a degree of pleasure or displeasure. There is currently no ...

) * External monitoring factor: all federal- or state-funded residences are required to have some form of behavioral monitoring for each person with developmental disability at the residence. With this information psychological diagnoses are more easily given than with the general population that has less consistent monitoring. * Access to health care providers: in the United States, all federal- or state-funded residences require the residents to have annual visits to various health care providers. With consistent visits to health care providers more people with developmental disabilities are likely to receive appropriate treatment than the general population that is not required to visit various health care providers. These problems are exacerbated by difficulties in diagnosis of mental health issues, and in appropriate treatment and medication, as for physical health issues.

## Abuse and vulnerability

Abuse Abuse is the improper usage or treatment of a thing, often to unfairly or improperly gain benefit. Abuse can come in many forms, such as: physical or verbal maltreatment, injury, assault, violation, rape, unjust practices, crimes, or other typ ...

is a significant issue for people with developmental disabilities, and as a group they are regarded as people in most jurisdictions. Common types of abuse include: *
Physical abuse Physical abuse is any intentional act causing injury or trauma to another person or animal by way of bodily contact. In most cases, children are the victims of physical abuse, but adults can also be victims, as in cases of domestic violence or work ...

(withholding food, hitting, punching, pushing, etc.) *
Neglect In the context of caregiving, neglect is a form of abuse where the perpetrator, who is responsible for caring for someone who is unable to care for themselves, fails to do so. It can be a result of carelessness, indifference, or unwillingness and a ...

(withholding help when required, e.g., assistance with personal hygiene) *
Sexual abuse Sexual abuse, also referred to as molestation, is abusive sexual behavior by one person upon another. It is often perpetrated using force or by taking advantage of another. When force is immediate, of short duration, or infrequent, it is called ...

is associated with psychological disturbance. Sequeira, Howlin & Hollins found that sexual abuse was associated with increased rates of mental illness and behavioural problems, including symptoms of post-traumatic stress. Psychological reactions to abuse were similar to those observed in the general population, but with the addition of stereotypical behaviour. The more serious the abuse, the more severe the symptoms that were reported. * Psychological or
emotional abuse Emotions are biological states associated with all of the nerve systems brought on by neurophysiological changes variously associated with thoughts, feelings, behavioural responses, and a degree of pleasure or displeasure. There is currently no ...

(
verbal abuse Verbal abuse (also verbal attack or verbal violence or verbal assault; often referred to as psychic violence) is an act of violence in the form of speech that decreases self-confidence and adds to feelings of helplessness. It is "an act that ...

,
shaming Shame is an unpleasant self-conscious emotion typically associated with a negative evaluation of the self; withdrawal motivations; and feelings of distress, exposure, mistrust, powerlessness, and worthlessness. Definition Shame is a discret ...

and belittling) * Constraint and restrictive practices (turning off an electric wheelchair so a person cannot move) *
Financial abuse Finance is the study of financial institutions, financial markets and how they operate within the financial system. It is concerned with the creation and management of money and investments. Savers and investors have money available which could ...

(charging unnecessary fees, holding onto pensions, wages, etc.) *
Legal Law is a system of rules created and enforced through social or governmental institutions to regulate behavior,Robertson, ''Crimes against humanity'', 90. with its precise definition a matter of longstanding debate. It has been variously descr ...

or civil abuse (restricted access to services) * Systemic abuse (denied access to an appropriate service due to perceived support needs) * Passive neglect (a caregiver's failure to provide adequate food, shelter) Lack of education, lack of
self-esteem Self-esteem is an individual's subjective evaluation of their own worth. Self-esteem encompasses beliefs about oneself (for example, "I am unloved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and ...

and self-advocacy skills, lack of understanding of
social norms Social norms are regarded as collective representations of acceptable group conduct as well as individual perceptions of particular group conduct. They can be viewed as cultural products (including values, customs, and traditions)Sherif, M. (1936 ...

and appropriate behavior and communication difficulties are strong contributing factors to the high incidence of abuse among this population. In addition to abuse from people in positions of power, is recognized as a significant, if misunderstood, problem. Rates of criminal offense among people with developmental disabilities are also disproportionately high, and it is widely acknowledged that criminal justice systems throughout the world are ill-equipped for the needs of people with developmental disabilities—as both perpetrators and victims of crime. Failings in care have been identified in one in eight deaths of people with learning difficulties under NHS England.

## Challenging behavior

Some people with developmental disabilities (particularly Autism) exhibit challenging behavior, defined as "culturally abnormal behaviour(s) of such intensity, frequency or duration that the physical safety of the person or others is placed in serious jeopardy, or behaviour which is likely to seriously limit or deny access to the use of ordinary community facilities". Common types of challenging behavior include self-injurious behavior (such as hitting, headbutting, biting), aggressive behavior (such as hitting others, shouting, screaming, spitting, kicking, swearing, hairpulling), inappropriate sexualized behavior (such as public masturbation or groping), behavior directed at property (such as throwing objects and stealing) and stereotyped behaviors (such as repetitive rocking, [[echolalia or elective incontinence). Such behaviors can be assessed to suggest areas of further improvement, using assessment tools such as the [[Nisonger Child Behavior Rating Form (NCBRF). Challenging behavior in people with developmental disabilities may be caused by a number of factors, including biological (pain, medication, the need for sensory stimulation), social (boredom, seeking social interaction, the need for an element of control, lack of knowledge of community norms, insensitivity of staff and services to the person's wishes and needs), environmental (physical aspects such as noise and lighting, or gaining access to preferred objects or activities), psychological (feeling excluded, lonely, devalued, labelled, disempowered, living up to people's negative expectations) or simply a means of communication. A lot of the time, challenging behavior is learned and brings rewards and it is very often possible to teach people new behaviors to achieve the same aims. Challenging behavior in people with developmental disabilities can often be associated with specific mental health problems. Experience and research suggests that what professionals call "challenging behavior" is often a reaction to the challenging environments that those providing services create around people with developmental disabilities. "Challenging behavior" in this context is a method of communicating dissatisfaction with the failure of those providing services to focus on what kind of life makes most sense to the person, and is often the only recourse a developmentally disabled person has against unsatisfactory services or treatment and the lack of opportunities made available to the person. This is especially the case where the services deliver lifestyles and ways of working that are centered on what suits the service provider and its staff, rather than what best suits the person. In general, behavioral interventions or what has been termed [[applied behavior analysis has been found to be effective in reducing specific challenging behavior. Recently, efforts have been placed on developing a developmental pathway model in the behavior analysis literature to prevent challenging behavior from occurring. This method is controversial according to the [[Autistic Self Advocacy Network, saying that this type of therapy can lead to the development of [[Post-traumatic stress disorder|Post Traumatic Stress Disorder and worsening of symptoms later in life.

# Services and support

Today, support services are provided by government agencies, [[non-governmental organizations and by [[private sector providers. Support services address most aspects of life for people with developmental disabilities, and are usually theoretically based in community inclusion, using concepts such as [[social role valorization and increased self-determination (using models such as [[Person Centred Planning). Support services are funded through government block funding (paid directly to service providers by the government), through individualized funding packages (paid directly to the individual by the government, specifically for the purchase of services) or privately by the individual (although they may receive certain subsidies or discounts, paid by the government). There also are a number of non-profit agencies dedicated to enriching the lives of people living with developmental disabilities and erasing the barriers they have to being included in their community.

## Education and training

Education and training opportunities for people with developmental disabilities have expanded greatly in recent times, with many governments mandating universal access to educational facilities, and more students moving out of [[special schools and into [[mainstreaming in education|mainstream classrooms with support. [[Post-secondary education and [[vocational education|vocational training is also increasing for people with these types of disabilities, although many programs offer only segregated "access" courses in areas such as [[literacy, [[numeracy and other basic skills. Legislation (such as the UK's [[Disability Discrimination Act 1995) requires educational institutions and training providers to make "reasonable adjustments" to curriculum and teaching methods in order to accommodate the learning needs of students with disabilities, wherever possible. There are also some vocational training centers that cater specifically to people with disabilities, providing the skills necessary to work in integrated settings, one of the largest being [[Dale Rogers Training Center in [[Oklahoma City. (See also [[Intensive interaction)

## At-home and community support

Many people with developmental disabilities live in the general community, either with family members, in supervised-group homes or in their own homes (that they rent or own, living alone or with [[flatmates). At-home and community supports range from one-to-one assistance from a support worker with identified aspects of daily living (such as [[budgeting, [[shopping or paying bills) to full 24-hour support (including assistance with household tasks, such as [[cooking and [[Housekeeping|cleaning, and personal care such as showering, dressing and the administration of medication). The need for full 24-hour support is usually associated with difficulties recognizing safety issues (such as responding to a fire or using a telephone) or for people with potentially dangerous medical conditions (such as asthma or diabetes) who are unable to manage their conditions without assistance. In the [[United States, a support worker is known as a [[Direct Support Professional (DSP). The DSP works in assisting the individual with their ADLs and also acts as an [[advocate for the individual with a developmental disability, in communicating their needs, self-expression and [[objective (goal)|goals. Supports of this type also include assistance to identify and undertake new hobbies or to access community services (such as education), learning appropriate behavior or recognition of community norms, or with relationships and expanding circles of friends. Most programs offering at-home and community support are designed with the goal of increasing the individual's independence, although it is recognized that people with more severe disabilities may never be able to achieve full independence in some areas of daily life.

## Residential accommodation

Some people with developmental disabilities live in residential accommodation (also known as group homes) with other people with similar assessed needs. These homes are usually staffed around the clock, and usually house between 3 and 15 residents. The prevalence of this type of support is gradually decreasing, however, as residential accommodation is replaced by at-home and community support, which can offer increased choice and self-determination for individuals. Some U.S. states still provide institutional care, such as the [[Texas State Schools. The type of residential accommodation is usually determined by the level of developmental disability and mental health needs.

## Day services

Non-vocational day services are usually known as day centers, and are traditionally segregated services offering training in life skills (such as meal preparation and basic literacy), center-based activities (such as crafts, games and music classes) and external activities (such as day trips). Some more progressive day centers also support people to access vocational training opportunities (such as college courses), and offer individualized outreach services (planning and undertaking activities with the individual, with support offered one-to-one or in small groups). Traditional day centers were based on the principles of [[occupational therapy, and were created as [[respite care|respite for family members caring for their loved ones with disabilities. This is slowly changing, however, as programs offered become more skills-based and focused on increasing independence.

[[Advocacy is a burgeoning support field for people with developmental disabilities. Advocacy groups now exist in most jurisdictions, working collaboratively with people with disabilities for systemic change (such as changes in policy and legislation) and for changes for individuals (such as claiming welfare benefits or when responding to abuse). Most advocacy groups also work to support people, throughout the world, to increase their capacity for [[self-advocacy, teaching the skills necessary for people to advocate for their own needs.

## Other types of support

Other types of support for people with developmental disabilities may include: * Therapeutic services, such as speech therapy, occupational therapy, physical therapy, massage, aromatherapy, art, dance/movement or music therapy * Supported holidays * Short-stay respite services (for people who live with family members or other unpaid carers) * Transport services, such as dial-a-ride or free bus passes * Specialist behavior support services, such as high-security services for people with high-level, high-risk challenging behaviors * Specialist relationships and sex education. Programs are set up around the country in hopes to educate individuals with and without developmental disabilities. Studies have been done testing specific scenarios on how what is the most beneficial way to educate people. Interventions are a great way to educate people, but also the most time consuming. With the busy schedules that everybody has, it is found to be difficult to go about the intervention approach. Another scenario that was found to be not as beneficial, but more realistic in the time sense was Psychoeducational approach. They focus on informing people on what abuse is, how to spot abuse, and what to do when spotted. Individuals with developmental disabilities don't only need the support programs to keep them safe, but everybody in society needs to be aware of what is happening and how to help everybody prosper.Lund, Emily. Hammond, Marilyn. “Single-Session Intervention for Abuse Awareness Among People with Developmental Disabilities.” Sexuality and Disability 32.1 (n.d.): 99-105. Proquest Central. Web. 24 April 2014.

* [[American Coalition of Citizens with Disabilities * [[Behavioral cusp * [[Disability abuse * [[List of disability rights activists * [[List of disability rights organizations

# References

Developmental-Behavioral Pediatrics, 4th Edition
- Expert Consult — Online and Print By William B. Carey, MD, Allen C. Crocker, MD, Ellen Roy Elias, MD, Heidi M. Feldman, MD, PhD and William L. Coleman, MD

Barry Gray and Robin Jackson (Eds) London: Jessica Kingsley Publishers, 2002

''A Short History of the Treatment of Persons with Mental Retardation''

''Real Lives: Contemporary supports to people with mental retardation''
(1998)
''Rights of People with Intellectual Disabilities: Access to Education and Employment'', bilingual reports on 14 European countries

* [https://web.archive.org/web/20131113152733/http://www2.stats.govt.nz/domino/external/pasfull/pasfull.nsf/web/Media+Release+2001+New+Zealand+Disability+Survey:+Snapshot+8+Intellectual+Disabilities?open 2001 New Zealand Snapshot of Intellectual Disability]
''People with Intellectual Disabilities: from Invisible to Visible Citizens of the EU Accession Countries''

Policy brief: ''Education and Employment in the UK''

* [https://web.archive.org/web/20071207224956/http://www.csc-scc.gc.ca/text/rsrch/reports/r14/r14e_e.shtml ''Persons With Intellectual Disability Who Are Incarcerated For Criminal Offences''] (Canadian paper)
'Fighting to keep 'em in'
''Ragged Edge magazine'' January 1998 * Wishart, G.D. (2003) The Sexual Abuse of People with Learning Difficulties: Do We Need A Social Model Approach To Vulnerability? Journal of Adult Protection, Volume 5 (Issue 3) * Piper, Julia (2007). "The Case of the Pillow Angel". The Triple Helix Cambridge Michaelmas