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Biomedical subjects

R P Hastings

Publications and source records attributed to R P Hastings.

At least 19 recordsLinked to original sources
PubMed2006

Medical, surgical, and health outcomes of gastrostomy feeding.

A prospective controlled study with repeated measures before and after surgery examined the medical, surgical, and health outcomes of gastrostomy for children with disabilities at a tertiary paediatric referral centre in the North Thames area, UK. Anthropometric measures included weight, mid-upper-arm and head circumference. Five-day prospective food diaries were completed and data on physical health and surgical outcomes recorded. Seventy-six children participated and underwent gastrostomy (44 males, 32 females; median age 3 y 4 mo, range 4 mo-17 y 5 mo), and 35/76 required an anti-reflux procedure. Categories of disability were: cerebral palsy (32/76), syndrome of chromosomal or other genetic origin (25/76), slowly progressive degenerative disease (11/76), and unconfirmed diagnosis (8/76). Most children had gross motor difficulties (99%) and were non-ambulant (83%). Oromotor problems were identified in 78% of children, 69% aspirated, and 65% were fed nasogastrically before surgery. The mean weight before surgery was -2.84 standard deviation score (SDS; SD 2.21, range -9.8 to 3.4). Two-thirds of children achieved catch-up growth postoperatively: weight-for-age (mean difference 0.51 SDS, 95% CI 0.23-0.79, p=0.001) and mid-upper arm circumference (mean difference 1.12 cm, 95% confidence interval 0.50-1.75, p=0.001). Health gains included a reduction in drooling, secretions, vomiting, and constipation. Major surgical complications were found in 13/74 children. The study provides evidence that catch-up growth and health gains are possible following gastrostomy.

Adolescent↗
PubMed2004

Burnout in direct care staff in intellectual disability services: a factor analytic study of the Maslach Burnout Inventory.

BACKGROUND: There is gathering research interest in the well-being of staff working in services for people with intellectual disability (ID), including the assessment of burnout and its correlates. However, no previous studies have considered the applicability of the main three dimensions of burnout to staff in ID services. METHODS: Data were analysed from two samples of staff (total n=184) who participated in research studies that included completion of the Maslach Burnout Inventory (MBI). RESULTS: Nineteen of the MBI items loaded clearly onto factors closely resembling the three original subscales: emotional exhaustion, depersonalization and personal accomplishment. Internal consistency for the three MBI subscales was fair to good (range 0.68-0.87). CONCLUSIONS: The original three MBI dimensions were found to be highly relevant to the present sample of staff. The analyses support the construct validity and reliability of the MBI for staff in ID services.

Adult↗
PubMed2004

Mothers' expressed emotion towards children with and without intellectual disabilities.

OBJECTIVES: To identify factors associated with maternal expressed emotion (EE) towards their child with intellectual disability (ID). DESIGN AND METHOD: A total of 33 mothers who had a child with ID and at least one child without disabilities between the ages of 4 and 14 years participated in the study. Mothers completed self-assessment questionnaires which addressed their sense of parenting competence, beliefs about child-rearing practices, and their reports of behavioural and emotional problems of their child with ID. Telephone interviews were conducted to assess maternal EE towards the child with ID and towards a sibling using the Five Minute Speech Sample (FMSS; Magana et al. 1986), and also to assess the adaptive behaviour of the child with ID using the Vineland Adaptive Behaviour Scale (VABS; Sparrow et al. 1984). RESULTS: Mothers with high EE towards their child with ID were more satisfied with their parenting ability, and their children had more behaviour problems. Analysis of differential maternal parenting, through comparisons of EE towards their two children, showed that mothers were more negative towards their child with ID for all domains of the FMSS except dissatisfaction. CONCLUSIONS: A small number of factors associated with maternal EE towards children with ID were identified. Differences in maternal EE towards their child with ID and their other child suggest that EE is child-driven rather than a general maternal characteristic. Implications of the data for future research are discussed.

Adolescent↗
PubMed2004

Life events and psychiatric symptoms in adults with intellectual disabilities.

BACKGROUND: Previous research has indicated that children and adults with intellectual disabilities (ID) may respond to traumatic and other life events in a similar way to the general population. However, few studies have charted the extent of exposure to recent life events in samples of adults with ID and the association of such exposure with general psychiatric problems. METHODS: Adults with ID (n = 1155) in community and residential services in a county district in North-east England were assessed using the Psychiatric Assessment for Adults with Developmental Disabilities Checklist (PAS-ADD Checklist), which includes a checklist of recent life events. Data were provided by informants who knew the index client well. RESULTS: Within the 12 months before data collection, the five most frequently experienced life events were: moving residence (15.5% of sample), serious illness of close relative or friend (9.0%), serious problem with close friend, neighbour or relative (8.8%), serious illness or injury to self (8.5%), and death of close family friend or other relative (8.3%). Overall, 46.3% had experienced one or more significant life events in the previous 12 months and 17.4% had experienced two or more. Logistic regression analysis revealed that the presence of one or more life events in the previous 12 months added significantly to the classification of psychiatric caseness predicted by demographic variables (age, sex, residence in community or hospital) on the PAS-ADD Affective Disorder scale. Overall, the odds ratio for affective disorder given exposure to one or more life events was 2.23 [95% confidence interval (CI) = 1.56, 3.18]. CONCLUSIONS: Small, but potentially significant relationships were found between life events exposure and psychiatric problems in adults with ID. Further research is needed to explore the causal direction of this relationship and also to develop more sensitive measures of life events relevant to the situation of adults in residential and community service environments.

Adolescent↗
PubMed2003

Determinants of negative emotional reactions and causal beliefs about self-injurious behaviour: an experimental study.

BACKGROUND: Caregivers' emotional and cognitive reactions to challenging behaviours have been identified as potential determinants of their reinforcing responses towards such behaviours. However, few studies have explored factors affecting caregivers' emotional and cognitive responses to challenging behaviours. METHODS: Sixty students inexperienced in work with people with challenging behaviours and 60 experienced staff watched one of two carefully matched, acted videotapes depicting self-injury maintained by attention or escape-from-task demands. The participants were also told whether the self-injury depicted typically led to mild or severe consequences for the person filmed. The subjects completed measures of their negative emotional reactions to the self-injury and their behavioural causal beliefs about the behaviour depicted. RESULTS: Analyses of variance revealed that students reported more negative emotional reactions and were less likely to endorse behavioural causal hypotheses. Those who watched the severe self-injury videotape also reported more negative emotional reactions. Two effects of the behavioural function of the depicted self-injury were also found: (1) attention-maintained self-injury was associated with higher levels of endorsement of behavioural causal hypotheses; and (2) severe attention-maintained self-injury led to the strongest negative emotional reactions, but only from students. CONCLUSIONS: The effects of experience and behavioural function on emotional reactions and behavioural causal beliefs need to be explored in more detail in future research. If replicated, the present results have significant implications for theory and practice in the remediation of challenging behaviours and the support of care staff.

Adolescent↗
PubMed2002

Psychological adjustment in children with end stage renal disease: the impact of maternal stress and coping.

OBJECTIVE: To explore maternal and child perspectives on children's adjustment in the context of paediatric renal disease, and maternal psychological variables that may account for variance in child and maternal ratings. METHODS: Forty-three children with end stage renal disease and their maternal caregivers completed the Strengths and Difficulties Questionnaire (SDQ). Mothers also reported on their own mental health, and the strategies they used to cope with their child's illness. The severity of the child's condition was rated independently by a renal clinician. RESULTS: Compared with normative data for the SDQ mothers reported their children to be at increased risk of psychological problems. However, the children themselves reported no more problems than a normative sample. Mothers' coping and mental health explained some of the variance in their ratings of the child's adjustment but were not predictive of the children's self-ratings. CONCLUSIONS: The results suggest that maternal factors may not explain the variability in children's adjustment to chronic illness, perhaps especially within the age range studied here. Practical implications of the data are also discussed. In particular, a systemic approach to paediatric liaison by psychologists is emphasized.

Adaptation, Psychological↗
PubMed2002

Behavioural knowledge, causal beliefs and self-efficacy as predictors of special educators' emotional reactions to challenging behaviours.

Theoretical models and emerging empirical data suggest that the emotional reactions of staff to challenging behaviours may affect their responses to challenging behaviours and their psychological well-being. However, there have been few studies focusing on factors related to staff emotional reactions. Seventy staff working in educational environments with children with intellectual disability and/or autism completed a self-report questionnaire that measured demographic factors, behavioural causal beliefs, behavioural knowledge, perceived self-efficacy, and emotional reactions to challenging behaviours. Regression analyses revealed that behavioural causal beliefs were a positive predictor, and self-efficacy and behavioural knowledge were negative predictors of negative emotional reactions to challenging behaviours. Staff with formal qualifications also reported more negative emotional reactions. No other demographic factors emerged as significant predictors. The results suggest that behavioural causal beliefs, low self-efficacy and low behavioural knowledge may make staff vulnerable to experiencing negative emotional reactions to challenging behaviours. Researchers and clinicians need to address these issues in staff who work with people with challenging behaviours.

Adolescent↗
PubMed2002

Behaviour problems in adult women with Rett syndrome.

BACKGROUND: Despite considerable interest in the genetic, physical and neurological aspects of Rett syndrome (RS), there have been few studies of associated behavioural and emotional features. Furthermore, few case studies or surveys have included adult women with RS. The main aim of the present study was to compare behaviour problems in a sample of women with RS against data from normative samples. METHODS: The primary carers of 50 women with RS completed the community version of the Aberrant Behavior Checklist. RESULTS: Women with RS were rated as having lower levels of irritability, hyperactivity and inappropriate speech behaviours than normative samples of adults with intellectual disability. CONCLUSIONS: A number of factors may affect the presentation of behaviour problems in women with RS (e.g. cognitive impairments or physical disabilities). Therefore, more research is needed in order to generate information about the behavioural phenotype of RS. The implications of the present data for future research are also discussed.

Adult↗
PubMed2001

Exploration of psychometric properties of the developmental behavior checklist.

The Developmental Behavior Checklist (DBC; Einfeld & Tonge, 1995) is one of a very small number of psychopathology assessment instruments designed specifically for use with children and adolescents with mental retardation. In the present study, a factor analysis of the DBC was performed using a sample of 531 children and adolescents. This analysis revealed a factor structure sharing a good deal of overlap with the factor analyses of the DBC's developers. Furthermore, the high levels of internal consistency of the DBC subscales were replicated. Further research and development is needed on the DBC and other instruments for children and adolescents with mental retardation.

Adolescent↗
PubMed2001

Stress in UK families conducting intensive home-based behavioral intervention for their young child with autism.

There is increasing international interest in intensive home-based behavioral intervention for children with autism. In the present study, 141 UK parents conducting such interventions completed a questionnaire addressing issues of stress, coping, and support. Regression analyses showed that parents' stress levels were predicted mainly by psychological rather than demographic variables. In particular, adaptive coping strategies, informal social support sources, and beliefs about the efficacy of the intervention were associated with lower reported stress and higher levels of autism symptomatology were associated with higher reported stress. There was also evidence that the use of Passive Appraisal coping and beliefs about the efficacy of the interventions moderated the effects of autism symptomatology on parents' pessimism. Implications of these findings for future research and for the support of families engaged in intensive home-based behavioral intervention are discussed.

Adaptation, Psychological↗
PubMed2001

Coping, burnout, and emotion in staff working in community services for people with challenging behaviors.

Staff in mental retardation services identify challenging behavior as a significant source of work-related stress. However, there has been little examination of the psychological processes that may explain an association between challenging behavior and staff stress. In the present study, direct-care staff (N = 83) from five community services completed a questionnaire on their emotional reactions to aggressive behavior, the coping strategies that they employ, and their experience of burnout. Staff more frequently reported using adaptive strategies than maladaptive ones to cope with aggressive behavior. Regression analyses showed that staff disengagement and adaptive coping strategies and their emotional reactions to aggressive behavior predicted burnout scores. Implications of these results for future research and for staff mental health are discussed.

Adaptation, Psychological↗
PubMed2000

Behavioural and emotional difficulties in students attending schools for children and adolescents with severe intellectual disability.

BACKGROUND: For several decades, researchers and clinicians have been aware of an increased prevalence of psychiatric disorder in children with intellectual disability. However, there are few research studies exploring this issue. METHODS: The parents of 123 children attending schools for children with 'severe learning difficulties' completed the Developmental Behaviour Checklist (DBC) in order to identify those children with clinically significant behavioural and emotional problems. Comparisons were made with norms for the DBC and a range of child variables were investigated as possible correlates of disorder. RESULTS: Some 50.4% of the children scored above the cut-off on the DBC for psychiatric disorder. The child's severity of physical disability was related most strongly to parental ratings of behavioural and emotional problems. There were also effects for the child's age and the absence of Down's syndrome. CONCLUSIONS: The present study confirms previous research findings of a high prevalence of behavioural and emotional difficulties amongst children with intellectual disability, and identifies a number of correlates of disorder which require further investigation.

Adolescent↗
PubMed1998

Swedish and English adolescents' attitudes toward the community presence of people with disabilities.

Predictions derived from North American formulations of normalization suggest that contemporary care policies for people with intellectual disabilities will have a positive impact on societal perceptions of this group. To test this, adolescents' attitudes towards the community presence of people with disabilities in a normalization-advanced country (Sweden) and a relatively less normalization-advanced country (England) were compared. It was expected that Swedish and English participants would hold equally positive views of people with a non-intellectual disability, whereas English participants would hold less positive views than Swedish participants of people with an intellectual disability. The results gave limited support to this expectation when dimensions of participants' attitudes derived from a factor analysis were analysed. These results are discussed with reference to other factors that may influence attitudes in the two countries. In addition, implications for future research and practice are outlined.

Adolescent↗
PubMed1998

Learning disability care staff's emotional reactions to aggressive challenging behaviours: development of a measurement tool.

OBJECTIVES: To describe the development of a rating scale measure of caregivers' emotional reactions to aggressive challenging behaviour, and to report preliminary psychometric data for the scale. DESIGN: Using previous research on staff working with people with learning disabilities, a range of likely emotional reactions to challenging behaviours were selected for possible inclusion in a rating scale measure. METHODS: A total of 83 care staff from 23 community residences for people with learning disabilities rated their recent emotional reactions to aggressive challenging behaviour using 18 emotion items. A further sample of 18 care staff participated in a test-retest study after the initial stages of scale development. RESULTS: A rating scale was developed on the basis of a factor analysis and further item analysis. The measure has two subscales: feelings of depression/anger (10 items), and feelings of fear/anxiety (5 items). The subscales have a high internal consistency, good test-retest reliability and are relatively unaffected by social desirability biases. CONCLUSIONS: The emotional reactions to aggressive challenging behaviour scale has excellent face and construct validity, and other preliminary psychometric data are promising. The scale has a number of potential research and clinical applications.

Activities of Daily Living↗
PubMed1997

Staff beliefs about the challenging behaviors of children and adults with mental retardation.

From both theoretical and practical perspectives, staff beliefs are likely to have a significant impact on the process of care for children and adults with mental retardation who engage in challenging behaviors. This paper reviews research addressing three domains of staff beliefs: definitions of challenging behavior, causal attributions, and beliefs about appropriate intervention. In general, staff definitions were found to be at odds with formal definitions. According to care staff, challenging behaviors are actions that are difficult to manage. Staff causal attributions appear congruent with current theory, when measured with little specificity. However, when staff are asked to suggest causes of challenging behavior with clearly described functions they often fail to make appropriate attributions. Beliefs about appropriate short-term interventions suggest responses likely to develop and/or maintain challenging behavior, but beliefs about longer-term planned intervention appear to be more closely matched to contemporary practice. Reasons for this long-term/short-term distinction, based on the demands of the immediate situation, are proposed. Suggestions for future research on staff beliefs are discussed in detail. Finally, implications for staff training, referral practice, and for analysis and intervention with challenging behavior, are outlined.

Adult↗
PubMed1997

Measuring staff perceptions of challenging behaviour: the Challenging Behaviour Attributions Scale (CHABA).

Causal attributions may interact with other variables to determine staff responses to challenging behaviour. Furthermore, staff perceptions of the causes of challenging behaviour are likely to change as a result of theoretical and practical training. However, there is no established simple method for measuring staff attributions that could facilitate research in these areas. The present paper describes the development and preliminary psychometric analysis of the Challenging Behaviour Attributions Scale (CHABA).

Adult↗
PubMed1997

Staff strategies and explanations for intervening with challenging behaviours: a replication in a community sample.

Carers' beliefs about challenging behaviours may partially determine their behavioural responses to them. The present study replicated previous work on the beliefs of institution staff and their explanations about interventions for challenging behaviours (Hastings 1996) with a sample of 56 community staff. Many immediate intervention strategies, and the staff motivation for these choices, were in conflict with behavioural approaches to challenging behaviour and would be considered counter-habilitative from this perspective. Staff were able to describe appropriate longer-term interventions. These basic findings confirmed those of previous research with institution staff. However, tentative comparisons suggested that community staff were more likely than institution staff (from previous research) to describe interventions involving the building of relationships with service users and the identification of the underlying causes of the behaviours.

Activities of Daily Living↗