Intellectual Disability Population Research Articles

Using the children’s accelerated trauma technique with adults with intellectual disabilities

Purpose This paper aims to explore using the children’s accelerated trauma technique (CATT) in an adult intellectual disability population, with the aim of reducing symptoms of post-traumatic stress disorder (PTSD). Design/methodology/approach A service evaluation was completed to investigate differences between pre- and post-CATT trauma scores. Findings Scores on a measure of PTSD decreased significantly following CATT. Practical implications The findings support continued use of CATT in adults with intellectual disabilities, and they highlight the need to evaluate effectiveness in a larger sample. Originality/value This paper evaluates the novel application of a trauma treatment – developed for use with children – in an adult intellectual disability population and adds to the existing evidence base.

Understanding Sexual Dysfunctions in Individuals with Intellectual Disabilities from A Psychological Perspective

Background: This article delves into the complex world of sexual dysfunctions in individuals with intellectual disabilities (ID), a topic that has been relatively underexplored in the realm of psychological research. Intending to shed light on the unique challenges faced by this population, the article meticulously examines the barriers to effective communication, cognitive differences, and the social dynamics that impact both the experiences and treatment outcomes for individuals with ID. Methods: The study utilized a blend of empirical methods, including questionnaires, psychodiagnostic tests, and graphical representations of data, and was conducted among a substantial sample of 1450 individuals with ID in Kyiv, Ukraine. It offers a comprehensive overview of the sexual health landscape within this community. Results: The research findings highlight a notable prevalence of sexual dysfunctions among the ID population, exacerbated by a lack of accessible sexual education, the prevalence of unsafe sexual practices, and a high rate of self-reported sexual abuse. Conclusions: The article emphasizes the importance of a nuanced understanding and approach to sexual health care and education for individuals with ID. It calls for policies, practices, and further research that honor the dignity, autonomy, and sexual rights of individuals with ID, aiming to bridge the current gaps in care and understanding. By doing so, it contributes significantly to the discourse on sexual health in the ID population, offering valuable insights and directions for future work in this vital area of study.

PHYSICAL FITNESS AND BALANCE PERFORMANCE IN TABLE TENNIS PLAYERS WITH INTELLECTUAL DISABILITIES: A COMPARISON BETWEEN THE YEARS 2016 AND 2022

Training routine is beneficial for people with intellectual disabilities, increasing their physical fitness, improving the balance and consequently reducing the risk of falls. However, during the COVID-19 breakdown, training restrictions could impair these benefits. This is a two-fold study aimed to compare the physical fitness performance and balance in table tennis athletes with intellectual disability (ID) during 2016 and 2022; and to analyse the association between the fitness and balance parameters. Table tennis athletes with ID, from both sexes and members of the Special Olympics Czech Republic, were assessed in 2016 (n=33) or 2022 (n=32). The FUNfitness protocol was used to measure the physical fitness parameters and balance (e.g., functional shoulder rotation, timed sit-to-stand test, partial sit-up test, handgrip test, single leg stance eyes open, single leg stance eyes closed). Comparison and correlation statistical tests were used (p<0.05). The physical fitness parameters and balance presented no statistically significant between the years (2016 vs 2022) or better results in 2022 (single leg stance, partial sit-up test). The correlation of physical fitness parameters and balance demonstrated that balance is positively related to flexibility (single leg stance eyes closed: r=0.32 and 0.58 for males and females, respectively) and lower limb strength (single leg stance eyes open: r=-0.31 and -0.52 for males and females, respectively). In conclusion, the development of flexibility and low limb strength in ID population can help improve the balance, and consequently minimize the risk of falls.

Expanding and developing the workforce to serve autistic people and people with intellectual disability

This paper considers current workforce issues facing psychological professionals working in NHS services, examining the challenges, and identifying opportunities to better meet the needs of autistic people and people with an intellectual disability (PwID) across the lifespan. The aim of this paper is to identify and publicly articulate the need for a coherent approach to guide the practice of psychological professionals when helping autistic people and/or PwID. It should be noted that the scope of the paper is limited to autism and intellectual disability. In addressing these broad groups and their co-occurring conditions and needs, we anticipate that many principles could be applied to other neurodevelopmental conditions. We also note the significant potential challenges in linking intellectual disability and autistic populations, hence have attempted – in drawing together a working group to write this paper – to ensure representation from a range of psychological professionals including those in policy, leadership, and training roles, those working in specialist or generic mental health services and undertaking clinical research across the lifespan.Objectives:■To help define and support clear action so that all sectors welcome and adequately support people with neurodevelopmental differences, including autistic people and/or PwID.■To play a role in the development, planning and evaluation of new psychological professions roles such as the Clinical Associates in Psychology (CAPS) and Education Mental Health Practitioners (EMHPs).■To reflect on the obstacles to recruiting to autism and learning disability services and to propose approaches to developing a sustainable psychological workforce in these areas.■To recognise where good examples of education and training programmes exist to address training, confidence and competence for all psychological professionals working with those who may be autistic and/or have an ID, and consider how to establish a more consistent approach to education, training and CPD across the workforce.■To engage in policy discussions around the current gaps, such as the demand for diagnostic assessments and support which significantly outstrips capacity, whilst highlighting unrealised opportunities, through for example, a systematic approach to training.■To advocate for the need for the voice of autistic people and PwID and their families/carers which is often absent from the design and offer of help.

Rehabilitation for adults with an intellectual disability and mental health and behavioural complexities: A scoping review

AbstractBackgroundThere has been significant focus in the past decade on reducing admissions to assessment and treatment units for people with intellectual disabilities experiencing mental health or behavioural concerns. This has included the development of intensive support functions of National Health Service Learning Disability services to bolster community support and treatment for people at risk of admission. However, in recent years, there has been increased consideration of service development to include rehabilitation functions which would aim to proactively provide medium‐term additional input to individuals with a complexity of need. This input would aim to improve future trajectories and support the individuals to remain living a good life in their own community. This review focuses on community and in‐patient approaches to meeting a complexity of need.MethodA scoping review was carried out according to established best practice guidelines. Papers returned from the search were screened by the following inclusion criteria (a) Models or Outcomes of Rehabilitation; (b) Intellectual Disability Population; (c) Sample being 18 or above and (d) longer than short‐term stay/treatment, defined as 6 months or longer; and (e) Mental health and/or behaviour complexities. The search was conducted in electronic databases CINAHL, PsycInfo, Medline, Embase and Social Policy & Practice. Here, 3790 articles were initially identified and 27 were ultimately included in the review.FindingsThere are few studies evaluating rehabilitation for people with intellectual disabilities and mental health or behavioural concerns. There was some evidence that accessing assessment and treatment inpatient provision resulted in clinical improvements. Some studies demonstrated initial evidence that longer term rehabilitation was beneficial as a step‐down from inpatient care. Some key principles were identified in terms of rehabilitation approaches: the need for person‐centred creative approaches, suitable staff training, focus on building skills, and a focus on increasing quality of life.ConclusionThere are some indicators of what good rehabilitation services might comprise for people with an intellectual disability, who have rehabilitation needs. However, far more research and guidance are required in this area. In particular, it is unclear whether rehabilitation is best provided within an inpatient or community model, and further detail is required about optimal components of such rehabilitation.

Differentiation of the body build and posture in the population of people with intellectual disabilities and Down Syndrome: a systematic review

BackgroundThe aim of the study was to identify the variables of the internal compensatory mechanisms that differentiate the body build and posture of people with Down syndrome (DS) from the intellectual disability (ID) population. It was assumed that gaining knowledge in the abovementioned aspect will allow for a better understanding of the limitation of the kinesthetic abilities of people with ID and DS and simultaneously enable to optimize the process of planning and interventions to improve physical activity in this population with the adequate use of theirs strengths in the biomechanical and morphofunctional systems.MethodsThe methodology of this systematic review was developed according to the PRISMA guidelines. A search of PubMed, EBSCO, Scopus databases was conducted to identify all studies on DS/ID and the body build and posture from 2003 to 2023.Results395 articles were assessed to determine eligibility, while 22 studies met the inclusion criteria and were subjected to detailed analysis and assessment of their methodological quality. The differentiation of the body build and posture in DS population can be induced by both internal and external compensatory mechanisms. It is difficult to confirm the direct effect of the intrinsic variables that impact the body build and posture in the ID population, excluding people with DS.ConclusionsCompared to other ID, the intrinsic differences in the body build and posture in DS individuals were induced by gender, age, and level of ID. The tendency for diversity between DS and other ID populations in body build and posture may be determined by the presence of the third copy of chromosome 21 in DS group. Internal compensatory processes may be induced mainly by abnormalities in the structure of the cervical vertebrae and feet. IQ should not be used as the only variable that identifies the population of people with ID.

A longitudinal exploration of self-reported TV behaviours as a surrogate for sedentary behaviour in older adults with an intellectual disability from the intellectual disability supplement to the Irish longitudinal study on aging (IDS-TILDA) study.

This study presents the findings of an investigation into the self-reported TV habits of adults with an intellectual disability, where time watching TV was used as a proxy for sedentary behaviour (SB). Risk factors identified for the general and intellectual disability populations and standard covariates of age, sex, level of intellectual disability, living circumstances and BMI were explored to determine their viability as contributors to increased TV viewing and SB. Missing data was imputed using Multiple Imputation Chained Equation (MICE). Multinomial logistic regression and Chi-squared Automatic Interaction Detector Analysis (CHAID) analyses of risk factors for increased TV viewing were explored and compared. The Systems of Sedentary Behaviour (SOS) framework was used to structure results. Novel risk factors for increased TV viewing were identified.

Profiles of Peer-Rejected Individuals: Their Attitudes toward the Intellectual Disability Population and the Mediating Role of Resilience

Literature shows that public perceptions toward people with intellectual disability (ID) tend to be negative, perhaps more so than toward any other population with disabilities, causing severe consequences on the quality of life of these people. Understanding factors associated with these attitudes may contribute to better integration of the ID population into society. This study focuses on the predictive role of school-age peer rejection and contemporaneous familial support on attitudes toward people with ID. Specifically, it aims to identify distinct profiles of people who experienced peer rejection during their school years and who experienced various levels of familial support during the rejection period, and to examine the disparities between these profiles regarding attitudes toward people with ID. An additional goal is to examine whether resilience can mediate the association between profiles of peer-rejected individuals and their attitudes toward individuals with ID. The research sample comprised 1063 Israeli adults reporting various levels of peer rejection during school years. Cluster analysis revealed two profiles of peer-rejected individuals that significantly differ in the level of familial support provided in the face of peer rejection. In accordance with the hypotheses, attitudes of peer-rejected individuals with poor familial support were more negative than those with high familial support and the mediating effect of resilience was significant. Findings emphasize the protective role of familial support in the face of peer rejection, contributing to the emerging literature that deals with the long-term effects of peer rejection and poor resiliency resources on negative attitudes toward out-groups.

Adaptations to research within the intellectual disability population during the COVID-19 pandemic: Lessons learned from the CAREVIS study.

The COVID-19 pandemic resulted in changes in all areas of clinical practice, including clinical research and within the intellectual disability population. While there have been some benefits from this rapid adoption of change, those involved in research have had to overcome a number of additional challenges. These adaptive changes, which have included the use of technology, closure of social spaces, working with specific groups who are more vulnerable to COVID-19, and mask use impairing communication, have had both positive and negative impacts on research. As the pandemic and related restrictions evolve, it is important to examine the changes that have occurred. In the future, the adoption of a hybrid model in research is likely to be a common approach, establishing a balance between technology and in-person interaction.

Housing in Delaware for the Intellectual and Developmental Disabilities Population.

Individuals with intellectual and developmental disabilities (IDD) encounter numerous barriers in attempting to access housing. Those barriers - financial, physical, and cultural in nature - have been exacerbated by the COVID-19 public health emergency and the related, or co-occurring, shifts that have characterized the housing market in the United States, and Delaware specifically, over these last three years. In this brief introductory research report, we examine the system of housing supports and their availability to individuals with IDD through a subset of those served by the state's Division of Developmental Disabilities Services through interviews with representatives across the housing support system. Our findings fall into four areas of work: scale and scope; housing availability; housing assistance; and housing supports. We find that: the estimated scale of the housing crisis (in terms of homelessness and insecurity) affecting this population is much greater than the general population, but in line with other national estimates for individuals with IDD; there is limited available housing that is accessible to individuals with IDD available in the state; there is limited assistance available for navigating the housing that might be available; and that there are too few options for providing more supports for individuals living, or trying to live, independently. We conclude with a few suggested recommendations that could provide more reliable data and tracking of need and a call for research that connects housing for individuals with IDD into the growing body of research looking at the relationship between access to housing and health.

Development and initial psychometric properties of the Warwick-Edinburgh Mental Wellbeing Scale-Intellectual Disability version.

The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS; Tennant et al., 2007) is yet to be validated in the intellectual disability (ID) population. The aim of this study was to report the development process and assess the psychometric properties of a newly adapted version of the WEMWBS and the Short WEMWBS for individuals with mild to moderate IDs (WEMWBS-ID/SWEMWBS-ID). The WEMWBS item wordings and response options were revised by clinicians and researchers expert in the field of ID, and a visual aid was added to the scale. The adapted version was reviewed by 10 individuals with IDs. The measure was administered by researchers online using screenshare, to individuals aged 16+years with mild to moderate IDs. Data from three UK samples were collated to evaluate the WEMWBS-ID (n=96). A subsample (n=22) completed the measure again 1 to 2weeks later to assess test-retest reliability, and 95 participants additionally completed an adapted version of the adapted Rosenberg Self-Esteem Scale to examine convergent validity. Additional data from a Canadian sample (n=27) were used to evaluate the SWEMWBS-ID (n=123). The WEMWBS-ID demonstrated good internal consistency (ω=0.77-0.87), excellent test-retest reliability [intraclass correlation coefficient (ICC)=.88] and good convergent validity with the self-esteem scale (r=.48-.60) across samples. A confirmatory factor analysis for a single factor model demonstrated an adequate fit. The SWEMWBS-ID showed poor to good internal consistency (ω=0.36-0.74), moderate test-retest reliability (ICC=.67) and good convergent validity (r=.48-.60) across samples, and a confirmatory factor analysis indicated good model fit for a single factor structure. The WEMWBS-ID and short version demonstrated promising psychometric properties, when administered virtually by a researcher. Further exploration of the scales with larger, representative samples is warranted.

Compassion-Focused Therapy and People with Intellectual Disabilities: A Renewed Focus

Compassion-Focused Therapy is an integrative therapeutic model with a wealth of evidence behind its efficacy. Its accessibility leads it to be a helpful therapeutic modality for the intellectual disability population. Its ability to aid the understanding of the person, us as clinicians, and the wider context around us give a depth of understanding not prioritised across all therapeutic models. This article explores Compassion-Focused Therapy in the context of working alongside people with intellectual disabilities. It focuses on how understanding archetypal and social mentality processes can aid understanding in people with intellectual disabilities as well as exploring some of the clinical implications and practical applications. It ends with a call to consider more readily, the use of Compassion-Focused Therapy in people with intellectual disabilities.

Video-Based Behaviorally Coded Movement Assessment for Adolescents with Intellectual Disabilities: Application in Leg Dribbling Performance

Measuring motor performance in individuals with intellectual disabilities (ID) is quite challenging. The objective of this study was to compare the motor performances of individuals with ID and those with typical development (TD) during soccer dribbling through video-based behavior-coded movement assessment along with a wearable sensor. A cross-sectional research design was adopted. Adolescents with TD (N = 25) and ID (N = 29) participated in the straight-line and zigzag soccer dribbling tests. The dribbling performance was videotaped, and the footage was then analyzed with customized behavior-coding software. The coded parameters were the time for movement completion, the number of kicks, blocks, steps, the number of times the ball went out of bounds, the number of missed cones, and the trunk tilt angle. Participants with ID exhibited significantly poorer performance and demonstrated greater variances in many time and frequency domain parameters. It also revealed that participants with ID kicked with both feet while dribbling, whereas those with TD mainly used the dominant foot. The present findings demonstrated how the ID population differed from their peers in lower-extremity strategic control. The customized video-based behavior-coded approach provides an efficient and effective way to gather behavioral data and calculate performance parameter statistics in populations with intellectual disabilities.

A STOMP-focused evaluation of prescribing practices in one assessment and treatment unit for people with intellectual disabilities

PurposeThis study aims to understand whether psychotropic prescribing practices for people with intellectual disabilities are in keeping with best practice guidelines.Design/methodology/approachThis service evaluation project was a retrospective analysis of routinely collected data from the care records of all 36 people with intellectual disability discharged from an intellectual disability assessment and treatment unit during the first five years of the Stop Over medicating People with Intellectual Disabilities and/or autistic people (STOMP) initiative. Data were gathered at four time points (pre-admission, discharge, 6- and 12-month follow-up) before being analysed to understand whether psychotropic prescribing differed among people with different clinical characteristics/traits/diagnoses. Changes over time were also explored to ascertain whether and how prescribing altered from admission to discharge, and over the subsequent year of community living.FindingsMost people with intellectual disabilities left the assessment and treatment unit on fewer regular psychotropic medications and at lower doses than at admission. These optimised regimes were still apparent 12 months post-discharge, suggesting effective discharge planning and community care packages. Inpatients with severe intellectual disabilities generally received more anxiolytics and hypnotics, at higher doses. Autistic people tended to receive more psychotropics in total and at higher cumulative doses, a pattern that persisted post discharge. A third of the sample were admitted on regular anti-psychotic medications despite having no corresponding psychotic diagnosis, a proportion that remained relatively stable through discharge and into the community.Originality/valueThis study highlights subsets of the intellectual disability population at particular risk of receiving high doses of psychotropics and a feasible template for providers intending to undertake STOMP-focused evaluations.

Ignorance is bliss? Are body image issues and eating disorders being ignored in intellectual disability populations?

The topics of body image issues and eating disorders among people with intellectual disabilities are significantly understudied and underrepresented in psychological literature. This is despite eating disorders, with which body image issues go hand-in-hand, being among the most common, and the deadliest mental health disorders in neurotypical populations. This piece will look at possible reasons for this, including therapeutic and research disdain. On top of this, the possible consequences, such as death by indifference, will be discussed.Easy read summaryThere is very little research about how and if people with intellectual disabilities are affected by issues about their body image and eating disorders, despite these things being very common in people who do not have intellectual disabilities.This paper suggests some reasons why this may be, such as it being assumed that people with intellectual disabilities are not able to have body image issues or be affected by eating disorders because of their disability.Another reason suggested is that people doing research also are not looking at these things and because of this the guidelines for treating body image issues and eating disorders may not be suitable for people with intellectual disabilities.This is important as serious mental health conditions may be missed and people with intellectual disabilities may not be receiving the care that they need or deserve.

Divergent presentation of anxiety in high-risk groups within the intellectual disability population

BackgroundAnxiety symptomatology is common in individuals with intellectual disability (ID). Symptomatology includes both traditional Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) anxiety disorders and autism spectrum disorder (ASD)-related anxiety traits. Some genetic disorders such as Cornelia de Lange (CdLS) and fragile X syndromes (FXS) are at very high risk of anxiety and afford the opportunity to examine prevalence, profiles and associated person characteristics. However, prevalence and associated characteristics of anxiety in these high-risk groups remain poorly described and understood. The aim of the current study was to examine the prevalence and profile of DSM-5 and ASD-related anxiety symptomatology in individuals with CdLS and FXS and associated behavioural and cognitive characteristics.MethodsQuestionnaires and interviews assessing DSM-5 and ASD-related anxiety were conducted with caregivers of individuals with CdLS (n = 49) and FXS (n = 36).ResultsDSM-5 anxiety symptomatology was present in both groups with high co-morbidity across anxiety diagnoses. ASD-related anxiety was also prevalent with specific difficulties related to intolerance of uncertainty identified in both groups. Symptomatology was persistent over the lifespan for both groups. Anxiety type was partially associated with repetitive behaviour but not measures of overall ASD phenomenology in CdLS.ConclusionsDSM-5 and ASD-related anxiety are common in these high-risk syndromes associated with ID. Prospective syndrome specific presentations and associations, which may implicate specific underlying mechanisms, are discussed. Clinicians should be aware of the risk and difficulties involved in assessment of anxiety in individuals with ID, including atypical types, to ensure these individuals do not “miss” diagnoses and support in general clinical practice.

Risk for intellectual disability populations in inpatient forensic settings in the United Kingdom: A literature review.

People with an intellectual disability who commit a criminal offence can be detained, by a court, in a forensic inpatient facility. There is limited understanding of how inpatients with an intellectual disability and their nurses navigate risk in U.K. forensic services. A traditional literature review design was followed to map evidence (2000-2021) around the forensic and health and wellbeing risks faced by inpatients with an intellectual disability, nurses' perceptions of managing risk, and patient experiences of informing risk assessment and management. Papers were analysed thematically. Findings suggest that restrictive measures to mitigate forensic risks (e.g., violence) can exacerbate the risk of poor health and wellbeing outcomes. There was some limited evidence of direct patient involvement in risk assessment and management. Further research is required to explore how forensic inpatients with an intellectual disability can have input in care planning, risk assessment and management.

An exploration of the consequences of, and coping with loneliness in an ageing intellectual disability population

Background: Loneliness has been associated with increased hypervigilance and sad passivity. The physiological and psychological reactions of people with an intellectual disability to loneliness have never been investigated. Therefore, this research aims to explore the outcomes of loneliness for an ageing intellectual disability population. Methods: In Ireland, data from a nationally representative data set of people aged over 40 years with an intellectual disability (N=317) was applied to a social environment model that describes the effects of loneliness in five pre-disease pathways which are: health behaviours, exposure to stressful life events, coping, health and recuperation. The data was tested through chi-squared, ANCOVA and binary logistic regression. Results: Being lonely predicted raised systolic blood pressure (A.O.R=2.051, p=0.039), sleeping difficulties (AOR=2.526, p=0.002) and confiding in staff (AOR=0.464 p=0.008). Additionally, participants who did 10 to 20 minutes of exercise daily (moderate activity) had significantly higher loneliness scores than those who did not (F=4.171, p<0.05). Conclusions: The analysis supports the concept of hypervigilance in older people with an intellectual disability but finds that the health behaviours of the lonely do not differ from the not lonely. Future research needs to investigate the longitudinal relationships between loneliness and health.

An exploration of the consequences of, and coping with loneliness in an ageing intellectual disability population

Background: Loneliness has been associated with increased hypervigilance and sad passivity. The physiological and psychological reactions of people with an intellectual disability to loneliness have never been investigated. Therefore, this research aims to explore the outcomes of loneliness for an ageing intellectual disability population. Methods: In Ireland, data from a nationally representative data set of people aged over 40 years with an intellectual disability (N=317) was applied to a social environment model that describes the effects of loneliness in five pre-disease pathways which are: health behaviours, exposure to stressful life events, coping, health and recuperation. The data was tested through chi-squared, ANCOVA and binary logistic regression. Results: Being lonely predicted raised systolic blood pressure (A.O.R=2.051, p=0.039), sleeping difficulties (AOR=2.526, p=0.002) and confiding in staff (AOR=0.464 p=0.008). Additionally, participants who did 10 to 20 minutes of exercise daily (moderate activity) had significantly higher loneliness scores than those who did not (F=4.171, p<0.05). Conclusions: The analysis supports the concept of hypervigilance in older people with an intellectual disability but finds that the health behaviours of the lonely do not differ from the not lonely. Future research needs to investigate the longitudinal relationships between loneliness and health

Egocentric norm in health-based decision making of patients on the autistic spectrum.

Individuals diagnosed with autism spectrum disorder (ASD) without intellectual disability (ID) may have advanced mental reasoning; however, symptomology may vary within the population. Possible symptomology includes communication problems, difficulty relating to people, things, and events, and sensory sensitivity. Current concepts in determining health behavior are not applicable to the ASD without ID population. The aim of this analysis is to define the concept of egocentric norm in the context of health-based decisions of adults diagnosed with ASD without ID and to support improved nursing practice with this population. The Walker and Avant approach was used. Model, borderline, and contrary cases are offered. Literature search yielded 47 peer reviewed papers that were included in the analysis. Uses of the concept were reviewed, following the Walker and Avant approach. Egocentric norm is defined as an individual's ability to perceive, adapt, and respond to information and potential consequences of personal health behavior based on self-evaluation and the immediate environment with limited regard to peer and family influence. The new concept of egocentric norm may account for the unique dynamics presented by adults with ASD without ID, which may impact health behaviors and actions.