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PubMed2006

Functional behavioural assessment in people with intellectual disabilities.

PURPOSE OF REVIEW: The presence of problem behaviours often impede an individual's quality of life and ability to be fully included in the environments of his or her choice. Functional behavioural assessment has been gaining widespread use in all settings in which people with intellectual disabilities might present problem behaviours. Understanding the function of these problem behaviours is a critical component to developing an effective intervention plan. This paper presents a review of the current knowledge and findings regarding functional behavioural assessments. RECENT FINDINGS: The recent studies on functional behavioural assessment have supported the well established fact that success in reducing behaviour problems is closely linked to understanding the function of the problem behaviour. Implementing functional behavioural assessment in school settings has been met with some challenges. Although a complex process, recent research has shown promise in training nonprofessionals in learning to carry out a functional behavioural assessment and implementing the information gained from the functional behavioural assessment into an effective behavioural intervention. SUMMARY: The necessity of conducting a functional behavioural assessment is uncontested. Developing a behavioural intervention on the information obtained from a thorough functional behavioural assessment is part of best practice in the field of intellectual disabilities. We have the tools to conduct, and train others to conduct, a comprehensive functional behavioural assessment.

Comorbidity↗

PubMedDate not supplied

Assessing same/different judgments in individuals with severe intellectual disabilities: a status report.

This report summarizes state-of-the-art approaches for assessing visual stimulus same/different judgments in individuals with severe intellectual disabilities. Methods are described that permit one to conduct assessments on a population-wide basis, excluding few if any participants due to failure to acquire necessary baseline performances. Methodological investigations summarized here indicate that one can obtain reliable same/different judgments with a variety of stimuli in virtually anyone for whom a basal score on the Peabody Picture Vocabulary Test can be obtained. This approach includes judgments involving not only familiar, readily nameable stimuli, but also abstract two-dimensional forms of the type commonly used to minimize extraexperimental influences on performance. Taken together, recent findings lead to the conclusion that past studies have significantly under-estimated the capacity of participants with low MA scores to make same/different judgments. They also suggest a more general methodological approach that can potentially lead to more sensitive assessment of other behavioral capacities in this difficult-to-test population.

Attention↗

PubMed1999

Stress and residential staff who work with people who have an intellectual disability: a factor analytic study.

The present study describes the development of a questionnaire, and the subsequent collection of data, to gather information on the demands and supports which influence stress (as measured by anxiety and depression scales) in direct care staff who work with people with intellectual disability. The results from the questionnaire were also used to explore the relationships between the factors derived from the questionnaire and to consider how these may be influential in building organizational models. The questionnaire was specifically constructed to measure the demands and supports experienced by direct care staff. The participants included 216 staff working in community residential services for people with intellectual disability. These individuals included staff working for two British health trusts and similar staff working for one local authority. The questionnaire consisted of 33 demands items and 23 supports items. Separate factor analyses were conducted on the demands and supports scales. Analyses of the reliability and validity of the resulting factors were conducted. Stepwise multiple regressions were conducted to further explore the relationship of factors with the measures of anxiety and depression. Four factors were extracted from the demands scale and three factors from the support scale. There was some concern over levels of reliability and validity for individual factors; however, the reliability of the main scales appeared to be satisfactory. All but one support factor correlated significantly with levels of anxiety and depression. The factors explained a modest amount of the variance in the regressions. While there are some concerns about the psychometric properties of the questionnaire, it is argued that the scales and factors can be used to confirm and further understanding of the relationship between groups of demands, supports and stress in staff. The usefulness of the questionnaire as a means of diagnosing specific sources of demand and support is considered. It is suggested that the questionnaire could form the basis for assessment and subsequent intervention in houses where staff are reporting relatively high levels of anxiety and depression.

Adult↗

PubMed1993

Communicating with people who have intellectual disabilities.

Much of the art of general practice lies in the ability to communicate. For this reason, successful general practitioners tend to have highly developed skills in listening and talking to their patients. The process, however, becomes more difficult when patients do not share these verbal skills. The worldwide move towards the reintegration of previously institutionalised people means that most Australian general practitioners will encounter more intellectually disabled people in their practices. This accessing of mainstream health services appears to result in better quality care being available to this previously neglected group, although many people with intellectual disabilities report frustration in communicating effectively with their general practitioners.

Adult↗

PubMed2001

Assessing the need for reactive behaviour management strategies in children with intellectual disability and severe challenging behaviour.

The need for reactive behavioural management strategies for aggressive behaviours in adults with intellectual disability has been clearly established, but equivalent information concerning children with challenging behaviour is lacking by comparison. The present study was conducted in order to assess this need. A retrospective study was conducted to ascertain the nature of aggressive behaviours amongst a cohort children referred to a specialist support service. Aggressive behaviours were found to occur at high rates within the study group. Almost 60% of the children displayed aggression that occurred at least daily, and the behaviours resulted in serious consequences for carers in almost one-third of the group. Physical interventions were already in use in 56% of cases, but were largely improvised by carers. The need to include reactive behavioural training as part of an overall intervention package for carers of children with challenging behaviour appeared to be supported by the present results. The implications for training design are discussed.

Adolescent↗

PubMed2002

Healthcare costs of intellectual disability in the Netherlands: a cost-of-illness perspective.

Healthcare costs are continuously increasing, and impose a strong responsibility on governments for an adequate allocation of resources among healthcare provisions and patients. The aims of the present study were to describe the healthcare costs of intellectual disability (ID) and other mental disorders in the context of the total costs of all other diseases, and to determinate the future need of healthcare resources, especially for ID and mental disorders. The present authors performed a top-down cost-of-illness study comprising all healthcare costs of the Netherlands in 1994. Data on healthcare use were obtained for all 22 healthcare sectors, and used to ascribe costs to disease groups, age and sex. Costs of mental disorders are by far the largest in the Dutch healthcare system. Some 25.8% of total disease-specific costs could be ascribed to mental disorders: psychiatric conditions, 10.6%; ID, 9.0%; and dementia, 6.2%. There are large differences between age and sex groups. The costs of ID and schizophrenia are higher among men, and the costs of dementia and depression are higher among women. The age pattern shows two peaks: the first occurs at 25-35 years of age (ID and psychiatric conditions); and the second at 75-85 years of age (dementia). Time trends between 1988 and 1994 show an average annual growth rate of 5.2% for total healthcare costs: psychiatric conditions, 4.8%; ID, 5.4%; and dementia, 9.4%. Demographic projections suggest a less-than-average cost increase for ID and psychiatric disorders (with annual growth rates of 0.2% and 0.4%, respectively) compared to the costs of dementia and total healthcare (with annual growth rates of 1.6% and 0.9%, respectively). Intellectual disability and mental disorders represent a large part of healthcare use in the Netherlands. The costs will inevitably increase because of the ageing of the population and increasing life expectancy among people with disabilities. Non-specific cost containment measures may endanger the quality of care for vulnerable people at younger and older ages.

Adult↗

PubMed1998

Balancing restriction and freedom in the care of people with intellectual disability.

The case of a 50-year-old man with severe intellectual disability is described. After 20 years of institutional care, the subject was moved to a newly opened community group home. His physical and mental health deteriorated at this location after unproven allegations of sexual abuse which had taken place whilst he had been living in the institution. Although the subject's health continued to deteriorate, there was resistance to his readmission to the same hospital for assessment. He had always needed to be cajoled into eating, but this approach had not been followed by the home which had contributed towards his weight loss. The situation the subject, the carers and the health personnel found themselves in illustrates how problematic it is to find the right balance between restrictive practices and respect for an individual's choice.

Activities of Daily Living↗

PubMed2003

Impulsiveness as a factor in sexual offending by people with mild intellectual disability.

BACKGROUND: It has been suggested that sexual offending by people with intellectual disability (ID) results from a pattern of impulsive behaviour that is consistent with psychosocial disadvantage, rather than sexual deviancy. This study aimed to explore this hypothesis by assessing levels of impulsiveness in sexual offenders, non-sexual offenders and non-offenders with mild ID. METHOD: Impulsiveness was assessed using a modified version of the Barratt Impulsiveness Scale (11th edition). Total impulsivity scores were compared between sexual offenders, non-sexual offenders and non-offenders, all with mild ID. RESULTS: There was a significant difference in the levels of impulsiveness between sexual offenders and non-sexual offenders with ID (t=2.83, P<0.01). The sexual offenders were less impulsive than non-sexual offenders. CONCLUSIONS: This study did not support the hypothesis that sexual offending by people with ID is better explained by impulsive behaviour rather than sexual deviancy. It supports recent findings that among the general population, sexual offenders are less impulsive than controls and violent offenders.

Adult↗

PubMed2002

Offenders with intellectual disability: the size of the problem and therapeutic outcomes.

BACKGROUND: People with intellectual disability (ID) who offend may be subject to a variety of dispositions within the criminal justice system, or via diversion to health and social services in inpatient units or in community ID teams. Offenders with ID are a group with complex needs who may pose a recurrent risk to the public. Despite the significant number of offenders with ID, there is limited evidence on treatment effectiveness and outcomes. METHODS: A literature search of all electronic databases was undertaken, and journals were hand-searched for clinical trials or case studies of interventions for offenders with ID. The main outcome was recidivism rates. RESULTS: There were no published clinical trials of offenders with ID. A series of small-scale group cognitive-behavioural treatments for sex offenders offers the most persuasive evidence of success in reducing recidivism. CONCLUSION: Offenders with ID often receive inadequate services as a result of poor identification through the criminal justice system and research into effective treatments is rudimentary. Further studies are necessary in order to improve treatment efficacy and service provision for a complex group of individuals.

Behavior Therapy↗

PubMed2007

Trends in residential policies and services for people with intellectual disabilities in Taiwan.

BACKGROUND: In Taiwan, 92-95% of people with an intellectual disability (ID) live with their families, with the remaining residing in residential facilities. Instead of funding community-living alternatives, the Taiwanese Government funds only registered facilities as part of its residential policies and services. The purpose of this study was to evaluate current policies and services trends regarding people with an ID in Taiwan. METHODS: Both documentary research, such as an analysis of policies, services programmes, official statistics, surveys, reports and funding provision reports, and a mail survey, were conducted to examine current trends and characteristics of the 96 residential settings available for people with an ID in Taiwan. RESULTS: During the 1990s in Taiwan, residential programmes for people with an ID showed the biggest growth since 1952. Since the first 'Community Home' was launched in 1990, the number of smaller scale residential settings with a unit size of less than 30 has grown significantly, particularly since 2000. However, the rate of institutionalization of people with an ID and who live in the institutions has also risen. CONCLUSIONS: In Taiwan, unlike in Western societies, residential services for people with an ID provided by formal care systems are tending to grow in number, and these include both large and smaller residential settings.

Adolescent↗

PubMed2005

Beating the barriers: recruitment of people with intellectual disability to participate in research.

BACKGROUND: The health status of people with intellectual disability (ID) is poor, yet very little research has been done on their health needs. There are several barriers to performing this research. The aim of our research was to examine the significant barriers encountered in recruiting adults with ID to participate in research. METHODS: Our project was a randomized controlled trial aiming to improve health advocacy of people with ID. We approached many organizations to recruit participants and kept records of our results. Recruitment was very low for the first 4 months. Then we adopted two new recruitment strategies--in-service telephone recruitment and meetings with prospective participants. We then monitored the subsequent recruitment rates. We also questioned participants about the difficulties they encountered when considering recruitment. RESULTS: Initial recruitment of participants yielded less than one-third of the expected number. Additional strategies implemented were partially successful. Significant barriers to recruitment included several sectoral issues and the challenges arising from the research process. CONCLUSIONS: While this population is a difficult one to reach for research, attempts to do so should not be abandoned, because the potential health benefits for this underserved group far outweigh the recruitment barriers experienced.

Adult↗

PubMed2001

Factors associated with intended staff turnover and job search behaviour in services for people with intellectual disability.

Staff turnover is a major problem in services for people with intellectual disability (ID). Therefore, understanding the reasons for staff turnover is vital for organizations seeking to improve their performance. The present study investigates the factors directly and indirectly associated with an intention to leave an organization and actual job search behaviour amongst staff in services for people with ID. As part of a large-scale survey of staff in services for people with ID, information was collected from 450 staff concerning intended turnover, job search behaviour and a wide range of factors potentially associated with these outcomes. Path analyses revealed that work satisfaction, job strain, younger staff age and easier subjective labour conditions were directly associated with intended turnover. The same factors, with the exception of younger staff age, were also directly associated with job search behaviour. Factors indirectly associated with these outcomes included wishful thinking, alienative commitment to the organization, lack of staff support, role ambiguity, working longer contracted hours, having a low-status job, a lack of influence over decisions at work and less orientation to working in community settings with people with ID. The models of staff turnover empirically derived in the present study confirm and extend previous research in this area. The implications for organizations are discussed.

Adult↗

PubMed2007

An evaluation of Beck's cognitive theory of depression in adults with intellectual disability.

BACKGROUND: The theories supporting cognitive treatment for depression among individuals with intellectual disability (ID) have not been formally tested with this population. The current study evaluated Beck's cognitive theory of depression to determine its appropriateness for adults with ID. METHODS: Forty-eight adults with primarily mild or moderate ID participated in semi-structured interviews, twice approximately 16 weeks apart, as did an additional 12 adults diagnosed with depression. Participants reported on depressed mood, the cognitive triad, as measured by views of the self, the world and the future, hopelessness and self-esteem. RESULTS: The Cognitive Triad Inventory for Children (CTI-C) displayed adequate psychometric properties in this sample. In addition, it was correlated with depressed mood, and individuals diagnosed with depression had significantly higher scores on the CTI-C than those with no psychiatric diagnoses. Contrary to hypotheses, a negative cognitive triad did not predict depressed mood 4 months later, but the inverse relationship where depressed mood predicted a later negative cognitive triad approached statistical significance. CONCLUSIONS: The findings indicate that the cognitive triad can be measured among individuals with mild or moderate ID and is related to depression and depressed mood. However, the role of the cognitive triad in the development of depression is still unknown. The findings provide some support for Beck's cognitive theory of depression among individuals with ID and provide suggestions for further testing the theory. Implications for the treatment of depression among individuals with ID are discussed.

Adult↗

PubMed2003

Assessment and diagnosis of depression in people with intellectual disability.

BACKGROUND: Despite widespread acceptance that depression can occur in adults with intellectual disability (ID), the difficulties encountered in its assessment and diagnosis have hampered the individual clinician, and meant that questions of prevalence, treatment choice and outcome remain problematic. METHOD: The present paper reviews the progress in this field since three reviews, all published in the mid-1990s, recommended further attention to three interlinked issues: diagnostic criteria, the symptoms of depression in this group and the lack of rating scales. RESULTS: Despite a further 11 published papers and other studies in progress, the method of diagnosis for people with severe and profound ID remains debatable, with some authors advocating adherence to standard criteria, others suggesting adding criteria to the standard ones and yet others believing that substitute criteria are called for. However, for those with mild to moderate ID, a consensus is emerging that standard diagnostic criteria are appropriate. There has been progress in examining some of the symptoms which might constitute depression in people with ID. New diagnostic criteria issued by the Royal College of Psychiatrists are to be welcomed. There is an assumption in much of the research that symptoms of behaviour commonly termed challenging or maladaptive must be atypical symptoms of depression, but none of the studies reviewed demonstrate this effectively. This is compounded by methodological flaws in the way that depressed samples are arrived at for further study. Although new rating scales have emerged, there is as yet no gold standard diagnostic tool for depression amongst people with ID. CONCLUSIONS: It is suggested that, given these difficulties, the validity of the conceptual frameworks for depression is still in doubt. It remains the case that large-scale, collaborative, prospective studies are called for.

Depression↗

PubMed2006

Temperament and social behaviour at home and school among typically developing children and children with an intellectually disability.

BACKGROUND: There has been limited research on differences in temperament between typically developing children and children with an intellectual disability (ID). Individual differences have generally been neglected in previous investigations of children with an ID. The present research investigated differences in temperament and social behaviour between typically developing children and children with an ID, in both home and school settings. METHODS: Participants were 100 children (M = 10.7 years, SD = 0.88) from both regular and special education schools. Temperament was measured using the Emotionality, Activity, Sociability (EAS) Temperament Survey for Children (parental and teacher ratings), while social behaviour was measured using the School Social Behaviour Scales, Second Edition (SSBS-2) and the Home and Community Social Behaviour Scales (HCSBS). RESULTS: There were minimal significant differences in temperament between the regular and special education groups. Children who attended regular schools had a significantly higher level of social competence and significantly lower level of antisocial behaviour both at home and school, when compared with children who attended special schools. CONCLUSIONS: The difference in social behaviour between children attending regular and special schools was attributed to the difference in intellectual ability of the two groups, as well as contextual influences of regular or special school environments.

Antisocial Personality Disorder↗

PubMed2003

Obesity in people with intellectual disabilities: the impact of nurse-led health screenings and health promotion activities.

BACKGROUND: Obesity appears to be more common among people with intellectual disabilities, with few studies focusing on achieving weight reduction. AIM: Firstly, to follow-up people identified as overweight and obese following special health screening clinics and to determine the actions taken. Secondly, to evaluate the impact of health promotion classes on participants' weight loss. METHODS: A clinic led by two learning disability nurses was held for all people aged 10 years and over (n = 464) who attended special services within the area of one Health and Social Services Trust in Northern Ireland. In a second study, the nurses organized health promotion classes for 20 people over a 6- or 8-week period. FINDINGS: The health screen identified 64% of adults and 26% of 10-19-year olds as being overweight or obese. Moreover, those aged 40-49 years who were obese had significantly higher levels of blood pressure. However, information obtained from a follow-up questionnaire sent after 3 months suggested that of the 122 people identified for weight reduction, action had been taken for only 34% of them and only three were reported to have lost weight. The health promotion classes, however, led to a significant reduction in weight and body mass index scores. CONCLUSIONS: Health screening per se has limited impact on reducing obesity levels in this client group. Rather, health personnel such as general practitioners, nurses and health promotion staff need to work in partnership with service staff, carers and people with intellectual disabilities to create more active lifestyles.

Adolescent↗

PubMed2007

Prevention of clozapine-induced granulocytopenia/agranulocytosis with granulocyte-colony stimulating factor (G-CSF) in an intellectually disabled patient with schizophrenia.

BACKGROUND: While clozapine is an effective treatment for refractory schizophrenia, its use is limited by haematological side effects. Treatment options that allow continued prescription of clozapine by tackling these side effects will greatly aid patients for whom this medication is all too often their only hope of recovery. METHOD: In this case report, we describe what we believe are two 'firsts' in the clozapine literature: the use of granulocyte-colony stimulating factor on a prophylactic basis in an intellectually disabled patient receiving clozapine for refractory schizophrenia. RESULT: Treatment with granulocyte-colony stimulating factor prevented discontinuation of clozapine, enabling our intellectually disabled patient's recovery from a schizophrenic illness.

Adult↗

PubMed2005

Psychiatric diagnoses and behaviour problems from childhood to early adolescence in young people with severe intellectual disabilities.

BACKGROUND: While general population studies indicate an increase in the rate of psychiatric disorder in adolescence, little is known about the course of mental health and behaviour problems between childhood and adolescence in young people with severe intellectual disabilities. METHOD: From a sample of 111 children with severe intellectual disability who had been identified from the registers of six special schools at 4-11 years of age, 82 were traced and reassessed 5 years later at the age of 11-17 years. Behaviour problems were assessed by means of parental interviews conducted in the family home and parent and teacher questionnaires. Parental reports of psychiatric diagnoses were checked against health records. RESULTS: With most behaviour problems, including aggression, destructive behaviour and self-injury, there was little difference in rates between the two assessment occasions. However, in spite of this overall pattern of stability, the rates of some behaviour problems, including overactivity, showed significant reductions between childhood and early adolescence. Persistence rates for most behaviour problems appeared comparable to those reported for similar behaviours in general population studies of children. There was no significant difference in the proportion of cases with psychiatric diagnoses between the two assessment occasions, although brief psychotic episodes emerged in three cases in adolescence. CONCLUSIONS: The findings suggest that the prevalence of mental health and behavioural problems in young people with severe learning disabilities remains relatively stable between childhood and adolescence, although some specific behaviour problems diminish. However, a small minority of children may develop severe psychiatric disorders in adolescence.

Adolescent↗