Methodological issues in interviewing and using self-report questionnaires with people with mental retardation

The use of proxy measurement of internal states in people with intellectual disability: A scoping review

BACKGROUND

The measurement of internal states of people with an intellectual disability is challenging. Given these difficulties, proxy respondents are sometimes used. However, the literature provides some caution about the validity of the use of proxy respondents.

AIMS

This review aims to identify the available evidence regarding the use of proxy respondents in the measurement of internal states of people with intellectual disabilities.

METHOD

The Arksey and O'Malley scoping review framework was used for this review, refined with the Joanna Briggs Institute Methodology.

RESULTS

Results indicate there are some differences in the findings reported with respect to the efficacy of the use of proxy respondents. These may be due to a number of inconsistencies and weaknesses in examinations of their utility.

CONCLUSIONS

If proxy-reports are to be useful in understanding the internal states of people with intellectual disability, researchers need to address the shortcomings revealed by this review.

Translation and validation of prolonged grief disorder (PG-13) scale in Urdu among bereaved adolescents with intellectual disability

BACKGROUND

The study aimed to translate and validate the Prolonged Grief Disorder (PG-13) scale from English into Urdu language. This involved examining its psychometric properties, evaluating its factor structure and assessing both convergent and discriminant validity. The study was conducted within the cultural context of Pakistan and focused on the assessment of manifestations of grief, including symptoms of prolonged grief, in adolescents with mild-to-moderate intellectual disability (ID). The PG-13 scale was selected for this study due to its demonstrated accuracy in measuring prolonged grieving symptoms in bereaved population.

METHOD

A total of 140 adolescents, aged 10-19 years according to the World Health Organization (WHO) 2018 criteria, were selected from 14 cities in Pakistan. These participants had lost loved ones within the time span of the last 4 years. The WHO (2018) guidelines for translation, adaptation, and validation were followed.

RESULTS

The findings suggest that the translated and validated PG-13 scale has adequate psychometric properties, with Cronbach alpha coefficient of .97. Confirmatory factor analysis supports a single-factor structure for the scale, with factor loadings ranging from .80 to .95.

CONCLUSION

The PG-13 Urdu version is a reliable and validated scale available for assessing grieving symptoms in the Pakistani context.

An Accessible Web-Based Survey to Monitor the Mental Health of People With Mild Intellectual Disability or Low Literacy Skills During the COVID-19 Pandemic: Comparative Data Analysis

BACKGROUND

The COVID-19 pandemic and related control measures affected the mental health of all populations. Particular subgroups are underrepresented in mainstream surveys because they are hard to reach, and study measurements are not adapted to their skills. These subgroups include people with lower cognitive and literacy skills, such as people with mild intellectual disability (MID), who were considered vulnerable during the COVID-19 pandemic given their low socioeconomic status, small social networks, increased risks of health problems, and difficulties understanding health-related information.

OBJECTIVE

This study examines the impact of the COVID-19 pandemic on mental health among people with MID or low literacy skills compared with those predominantly represented in national surveys.

METHODS

A repeated cross-sectional study of people with MID or low literacy skills and a general population sample was conducted in the Netherlands. An easy-read web-based survey was co-designed with, and tested among, people with MID or low literacy skills and conducted in 3 rounds within 1 year of the COVID-19 pandemic (T1: November to December 2020, T2: March to April 2021, and T3: September to October 2021). The survey contained questions about demographics and 6 aspects of mental health: feeling happy, feeling energized, feeling stressed, worry, feeling lonely, and sleeping problems.

RESULTS

Our adapted survey and recruitment procedure enabled 1059 persons with MID or low literacy skills to participate (T1: n=412, 38.9%; T2: n=351, 33.1%; and T3: n=296, 28%). They were significantly younger, had a lower level of education, and more often than not were born outside the Netherlands compared to the general population sample (P<.001). Approximately half of them (604/1059, 57.03%) received professional care. They displayed poorer mental health scores than the general population sample. The percentages of people with MID or low literacy skills who reported more negative feelings in T1 ranged from 20.6% (85/412) reporting feeling lonely often or almost always to 57.8% (238/412) reporting feeling happy almost never or sometimes. The general population sample's percentages were 5.4% (160/2930) and 32.2% (941/2918), respectively. Although scores improved over time in both populations, the disproportional effects remained.

CONCLUSIONS

General COVID-19-related restrictions for the entire Dutch population affected people with MID or low literacy skills more negatively than the general population. Our study underscores the relevance of including these subpopulations in public health research because they are often overlooked in regular health data. An accessible web-based survey particularly targeted at this population enabled us to do so, and we reached a group of respondents significantly different from regular survey participants. This survey's results provided insights into the health of people with MID or low literacy skills and gained knowledge to be used by care organizations and policy makers to reduce health disparities during a pandemic and in general.

Measuring empathy in youth and young adults with mild intellectual disabilities or borderline intelligence in residential care - The validation of an adapted basic empathy scale: The BES-MID

Youths with mild intellectual disability (MID) are assumed to show impaired cognitive and affective empathy. However, the use of linguistic and conceptual complex empathy measures set limits to the valid and reliable assessment of empathy in youth with MID or borderline intelligence (BI). The objective of the present study was to evaluate the validity and reliability of the adapted BES-MID as an instrument for assessing cognitive and affective empathy in youth and young adults (12-24years) with MID/BI. The current study was conducted in a sample of N = 146 youth and young adults with MID or BI Results from Confirmatory Factor Analyses confirm the two-factor structure of affective and cognitive empathy for the BES-MID. While the original BES cannot be used to assess empathy in youth and young adults with MID or borderline intelligence, the BES-MID showed satisfactory validity and reliability in youth and young adults with MID or borderline intelligence. Despite some limitations and the need for further research, the current study has resulted in a valid and reliable empathy scale (BES-MID) for assessing cognitive and empathic abilities in youth and young adults with MID or borderline intelligence, which is important for future empathy research in youth and young adults with MID or borderline intelligence.

The design and methodology for a pilot study of home and community-based services outcome measures

BACKGROUND

The Research and Training Center on HCBS Outcome Measurement (RTC/OM) developed and piloted measures in six domains to assess the outcomes experienced by HCBS recipients. These measures were based upon the revised National Quality Forum's HCBS Outcome Measurement framework.

OBJECTIVE

The background and rationale for the pilot study are outlined along with the research design, sampling frame, and psychometric and statistical methods used. In addition, administration feasibility for all measures are described. Finally, a summary of results across all measures is provided. Detailed results for individual outcome measure domains are left to forthcoming publications.

METHODS

Measure construct under study were piloted on a sample of 107 participants identified as receiving HCBS or HCBS-like services and experiencing one of five disabilities: intellectual and developmental, age-related, or physical disabilities as well as Traumatic/Acquired Brain Injury and Serious Mental Health Conditions. Participants were interviewed either in-person or through HIPAA compliant online video conferencing over one to two sessions. Psychometric evidence was evaluated with internal consistency and test-retest reliability, as well as inter-observer agreement. Nonparametric methods were used to test for group comparisons.

RESULTS

Initial reliability and validity results of outcomes on five measures were good to excellent. No significant group differences between disability groups were found.

CONCLUSIONS

The psychometric evidence for the tested measures is very promising. Only two of the six measures required significant changes prior to their use in an upcoming field study. Details on results and revisions for individual measures will appear in later publications.

Bereavement among Adolescents with Intellectual Disability: A Qualitative Study

The current study was conducted to explore the bereavement (experienced loss of a loved one through death within time frame of 0-3 years span). Seven adolescents (10-19 years old) with intellectual disability were included in the study. Semi-structured interviews were conducted through interview guide which was prepared with the help of Piaget's theory of cognitive development concept related to death. Data was analyzed with content analysis and six major themes were derived, that is, meaning of death, death rituals, religious concepts related to death, reasons of death, grieving perception, and coping with grief. Mostly, concepts were explained under the light of religious preaching and their introjection in the lives of adolescents with intellectual disability. Current study helped in exploration of experiential phenomenon of loss in adolescents with intellectual disability.

Examining cognitive accessibility of the VIA Inventory of Strengths for adults with intellectual disability

BACKGROUND

We evaluated cognitive accessibility of the VIA Inventory of Strengths Youth short form with adults with intellectual disability for use in strengths-based practice.

METHODS

We conducted cognitive testing with adults with intellectual disability (n = 33; M age = 36.2; range: 20.4-64.2). Data were coded for the extent to which (1) items were interpreted correctly; (2) participants endorsed items as describing themselves. We calculated descriptive statistics to evaluate item interpretation and response scale use.

RESULTS

On average, 59% of participants interpreted items correctly, 20% misinterpreted items, 14% had mixed interpretations. Positive item endorsement was most associated with the response 'Very much like me' (77%); mixed endorsement was most associated with 'Somewhat like me' (39%); and negative endorsement of items was most associated with 'Not at all like me' (54%).

CONCLUSIONS

Revisions are necessary for several items to improve accessibility for adults with intellectual disability and should be made in collaboration with this population.

Adaptive interviewing for the inclusion of people with intellectual disability in qualitative research

BACKGROUND

Historically the voices of people with intellectual disability have been occluded by barriers imposed by research practice. More recently, adaptive research approaches have been proposed to enhance the inclusion of people with intellectual disability in qualitative research.

METHOD

This article presents an adaptive interviewing approach employed with five people ageing with intellectual disabilities in rural South Australia. The interviews were conducted within a broader participatory action research project in which tools and resources were co-designed for post-parental care planning.

RESULTS

We describe our adaptive interviewing approach incorporating multiple methods: (i) responsive communication techniques; (ii) the inclusion and support of family carers; (iii) visual tools; (iv) walking interviews.

CONCLUSION

Findings contribute knowledge about how an adaptive interview approach supports the participation of people with an intellectual disability in qualitative research.

Effectiveness of the mentalisation-based serious game 'You & I' for adults with mild to borderline intellectual disabilities: A randomised controlled trial

BACKGROUND

Mentalising and stress regulation pose challenges for adults with mild to borderline intellectual disabilities (MBID), emphasising the importance of an intervention program. The study examined the effectiveness and social validity of the serious game 'You & I' in enhancing mentalising and stress regulation among adults with MBID.

METHOD

A randomised controlled superiority trial with experimental and waitlist-control groups was conducted with 159 adults with MBID (Mage  = 36) at baseline, post-test, and follow-up. Analyses investigated the effects on aspects of mentalising, stress regulation, and social validity.

RESULTS

The experimental group showed decreased stress from negative interpersonal relations, while the control group experienced increased stress (d = 0.26). There were no significant effects on mentalising, but positive user expectations and experiences were reported.

CONCLUSIONS

This initial study on 'You & I' provides limited evidence of its effectiveness for people with MBID, warranting further examination of the potential of serious games.

Adoption of new transportation assistive technologies by people with mild intellectual disabilities

PURPOSE

Although numerous technology-based assistive devices are available for use by people with intellectual disabilities, device adoption rates of are often low. The current research examined reasons for non-adoption among two samples of people with mild intellectual disabilities focusing on transportation: an area of great concern for individuals with intellectual disabilities. The influences on adoption or non-adoption of the perceived benefits of assistive devices were assessed together with the effects of device complexity, transportation self-efficacy, desire for self-determination regarding transport, technophobia, and the desire to be seen to "fit in" with wider society when wearing a device.

MATERIALS AND METHODS

Interviews were conducted with 44 people attending a support venue in southwest London. Outcomes to the interviews were employed in the formation of a questionnaire distributed to a wider national sample of people with mild intellectual disabilities. Interview and survey questions were created using Tourangeau's investigation method. Responses to the survey were subjected to a logistic regression analysis.

RESULTS AND CONCLUSION

Technophobia, transportation self-efficacy and desires for self-determination and to "fit-in" exerted powerful impacts on device adoption. Campaigns and activities designed to increase adoption rates need to recognise these important influences.

Digital health technologies and major depressive disorder

There is an urgent need to improve the clinical management of major depressive disorder (MDD), which has become increasingly prevalent over the past two decades. Several gaps and challenges in the awareness, detection, treatment, and monitoring of MDD remain to be addressed. Digital health technologies have demonstrated utility in relation to various health conditions, including MDD. Factors related to the COVID-19 pandemic have accelerated the development of telemedicine, mobile medical apps, and virtual reality apps and have continued to introduce new possibilities across mental health care. Growing access to and acceptance of digital health technologies present opportunities to expand the scope of care and to close gaps in the management of MDD. Digital health technology is rapidly evolving the options for nonclinical support and clinical care for patients with MDD. Iterative efforts to validate and optimize such digital health technologies, including digital therapeutics and digital biomarkers, continue to improve access to and quality of personalized detection, treatment, and monitoring of MDD. The aim of this review is to highlight the existing gaps and challenges in depression management and discuss the current and future landscape of digital health technology as it applies to the challenges faced by patients with MDD and their healthcare providers.

Lessons learned from the adaptation of the Reflective Functioning Questionnaire (RFQ) for Dutch people with mild to borderline intellectual disabilities

BACKGROUND

People with mild to borderline intellectual disabilities (MBIDs) face challenges in social functioning, possibly as a result of limited mentalising abilities such as reflecting on the behaviour of themselves and others. Reflective functioning in people with MBIDs has not yet been investigated due to a lack of instruments. The Reflective Functioning Questionnaire (RFQ) is a seemingly easy adaptable, short self-report questionnaire. The aim of the present, explorative study was to adapt the RFQ for people with MBIDs and investigate the psychometric properties and correlations with other mentalising related constructs. The formulation of the items was adapted to the target group and items were added to broaden the scope towards reflection on both the self and other.

METHOD

Participants were 159 adults with MBIDs who completed a Dutch-translated and easy-to-read RFQ with five supplemental items, a questionnaire for autistic traits, a self-report questionnaire assessing perspective taking and two performance-based measures assessing emotion recognition and Theory of Mind.

RESULTS

Confirmatory factor analysis confirmed the factor structure of the RFQ and revealed a two-factor structure with a Self and Other subscale. Generally satisfactory internal consistency and test-retest reliability were found. Explorative results showed correlations of the RFQ-8 and RFQ subscales with autistic traits and between the RFQ Other and perspective taking.

CONCLUSIONS

This explorative study is the first testing psychometric properties of the RFQ as a self-report questionnaire for assessing reflective functioning in adults with MBIDs. This step is relevant in gaining more scientific knowledge on assessing mentalising in people with MBIDs.

Quality of Life in Individuals with Intellectual and Developmental Disabilities: The Congruency Effect between Reports

Assessing quality of life (QoL) is important to provide personalized and individualized support plans with the purpose of improving personal outcomes. Based on the conceptual model of QoL, the aim of this study was to assess the congruence between the perceptions of institutionalized individuals with intellectual and developmental disabilities (IDD) and the perception of a third party, regarding QoL. Forty-two individuals participated in this study, including twenty-one with mild to severe IDD and their family members/caregiver/reference technician, who responded to the Personal Outcomes Scale (Portuguese version). Significant differences (p < 0.05) were found between reports in the personal development (t = -2.26; p = 0.024), emotional well-being (t = -2.263; p = 0.024), physical well-being (t = -2.491; p = 0.013) and total QoL (t = -2.331; p = 0.02). The results further show that most third-party reports tend to undervalue the QoL of the individual with IDD, and that there is no congruence in any of the QoL domains. The inclusion of self-reports in the QoL assessment is important. In addition to the assessment of third-party reports, the process of making decisions appropriate to the context and individual characteristics is equally important. On the other hand, the inclusion of third-party reports is an opportunity to promote communication among all stakeholders, recognize and discuss differences, and promote QoL, not only of individuals with IDD, but also of families.

Capabilities, Opportunities, and Motivation: Exploring Fitness Program Experiences of Adults with Intellectual and Developmental Disabilities

Although there are many benefits to regular engagement in physical activity, adults with intellectual and developmental disabilities often do not engage in or near the recommended amount of physical activity. Barriers, such as lack of perceived capability, accessible environments, transportation, social support, and or knowledgeable support staff, may limit participation in physical activity. The present study used qualitative methods to explore the experiences of adults with intellectual and developmental disabilities enrolled in a fitness program. We used field observations and photo-elicited semi-structured interviews to explore what capabilities, opportunities, and motivations facilitate or hinder engagement in fitness classes and their experiences in the program. We used the COM-B model to deductively interpret and analyze the data through thematic analysis. Major themes were identified around types of support and preferences for physical over sedentary activities. Instructor, client, and family support were identified as important in facilitating interest, engagement, and skill. Dependency on others for financial and transportation support was also reported as important for participants to access the fitness program. This study provides valuable insight into the interactions and experiences of adults with intellectual and developmental disabilities, including what keeps them engaged in a fitness program as it relates to capabilities, opportunities, and motivation.

A person-centered approach to home and community-based services outcome measurement

In the United States, over 2.5 million people with disabilities are recipients of supports through the Center for Medicare and Medicaid Services (CMS) Home and Community-Based Services (HCBS) program. Recent decades have seen a growing focus on providing HCBS in a person-centered manner thereby supporting outcomes that are both important for and to the person. HCBS outcome measurement, however, has not kept pace with advancements in person-centered thinking as it relates to providing supports to people with disabilities. The concept of person-centered outcome measurement has been inadequately defined and is frequently misunderstood including by those in the measurement field. The authors first operationally define person-centered measurement and establish its importance within the context of HCBS and the recent CMS's Final Settings Rule. The important role that person-centered measurement has to play in quality improvement efforts in this area is then explored. A discussion is subsequently provided as to the challenges that are faced in person-centered measurement specific to the disability field. In addition to further conceptualizing and defining this form of measurement, recommendations are provided for moving the field forward.

Web search to access health information by adults with intellectual disability

Purpose

This study explored the current and desired use of web-search, particularly for health information, by adults with intellectual disability.

Design/methodology/approach

The authors surveyed 39 participants who were in supported employment or attending day centers in Australia. The survey, delivered through structured interviews, increased participation with data in a form of the participants' narratives. The responses were analyzed through a form of thematic analysis.

Findings

This study's results present the participants' daily health information interests, approaches to finding information and expectations for self-sufficiency. Participants' interest was in information to stay healthy rather than purely clinical information. The participants were keen to use online information in, accessible as well as entertaining and engaging formats. Supporting others close to the participants was the prominent intention of participants' health information access. Participants showed aspirations for an autonomous life by wanting to learn how to search.

Research limitations/implications

The findings of this study provide some avenues for consumer health information access to be respectful and inclusive of users with intellectual disability, both from an accessible design perspective as well as from a learning and support standpoint.

Originality/value

This study complements other human–computer interaction (HCI) studies which observe how adults with intellectual disability can be supported to engage with web search; this study offers the adults' verbalized perspectives on how adults wish to interact with web searching for health information, nuanced by adults' existing abilities and support needs.

Autism spectrum disorder symptom expression in individuals with 3q29 deletion syndrome

BACKGROUND

The 1.6 Mb 3q29 deletion is associated with neurodevelopmental and neuropsychiatric phenotypes, including a 19-fold increased risk for autism spectrum disorder (ASD). Previous work by our team identified elevated social disability in this population via parent-report questionnaires. However, clinical features of ASD in this population have not been explored in detail.

METHODS

Thirty-one individuals with 3q29 deletion syndrome (3q29del, 61.3% male) were evaluated using two gold-standard clinical ASD evaluations: the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), and the Autism Diagnostic Interview, Revised (ADI-R). Four matched comparators for each subject were ascertained from the National Database for Autism Research. Item-level scores on the ADOS-2 and ADI-R were compared between subjects with 3q29del and matched comparators.

RESULTS

Subjects with 3q29del and no ASD (3q29del-ASD) had greater evidence of social disability compared to typically developing (TD) comparison subjects across the ADOS-2. Subjects with 3q29del and ASD (3q29del + ASD) were largely indistinguishable from non-syndromic ASD (nsASD) subjects on the ADOS-2. 3q29del + ASD performed significantly better on social communication on the ADI-R than nsASD (3q29 + ASD mean = 11.36; nsASD mean = 15.70; p = 0.01), and this was driven by reduced deficits in nonverbal communication (3q29 + ASD mean = 1.73; nsASD mean = 3.63; p = 0.03). 3q29del + ASD reported significantly later age at the first two-word phrase compared to nsASD (3q29del + ASD mean = 43.89 months; nsASD mean = 37.86 months; p = 0.01). However, speech delay was not related to improved nonverbal communication in 3q29del + ASD.

LIMITATIONS

There were not enough TD comparators with ADI-R data in NDAR to include in the present analysis. Additionally, our relatively small sample size made it difficult to assess race and ethnicity effects.

CONCLUSIONS

3q29del is associated with significant social disability, irrespective of ASD diagnosis. 3q29del + ASD have similar levels of social disability to nsASD, while 3q29del-ASD have significantly increased social disability compared to TD individuals. However, social communication is reasonably well preserved in 3q29del + ASD relative to nsASD. It is critical that verbal ability and social disability be examined separately in this population to ensure equal access to ASD and social skills evaluations and services.

The perspective of emerging adults with Down syndrome - On quality of life and well-being

This study explored the thoughts of emerging adults with Down syndrome on quality of life and subjective well-being. Eight 22-year-olds participated in interviews. Data was analysed with content analysis. Four themes were revealed: Work based on interest and capability, having an active and social leisure life, a safe place to live and the use of information and communication technology. Two context related patterns were identified showing that quality of life and subjective well-being were related to individualised support to enhance independency in work, social leisure and place of living. Knowledge of their perception of independency and their awareness of needing customised help and support is valuable. This study supports the proposed emerging Quality of Life Supports Paradigm in the field of intellectual disabilities, which integrates key concepts of quality of life and supports.

Effect of Indoor Climbing on Occupational Self-Efficacy and Employability: Results of a 10-Month Randomised Controlled Study of Persons with Intellectual Disability

(1) Background: Indoor climbing has different effects at various levels, including physical, psychological, and social ones. It is of high interest to assess whether social skills developed through climbing can be transferred to another environment, such as the working environment. This study investigates the effects of indoor climbing on employability and occupational self-efficacy of people with intellectual disability, who possess lower levels of social competences in general. (2) Methods: A randomised controlled study (RCT) experimental study design with three groups was formed-one intervention (IG) and two control groups (CGI&II). For 10 months, the IG went climbing (two times per week), whereas the first CG followed a sports programme and the second CG served as controls. (3) Results: IG participants showed significant improvement in mental and somatic health over time. Regarding occupational self-efficacy, females had a significantly lower mean. Nevertheless, only the IG's female participants mean increased significantly over time. (4) Conclusions: Indoor climbing can be effective for improving occupational health and can be beneficial for specific groups; however, additional research is needed to further specify the influence of indoor climbing on a wider variety of aspects of the life of people with intellectual disability.

Access, understanding, promotion and maintenance of good health: Evaluation of knowledge transfer of people with intellectual disabilities to bridge the health information and disease prevention in public health

The importance of patient empowerment among people with intellectual disabilities (ID) is steadily growing, yet multiple health and health literacy challenges still make this population more vulnerable to health disparities. Inadequate access to essential health and other basic services and the lack of involvement in health and educational research are some of the most crucial factors contributing to this inequality. A greater effort must be made to include people with ID in health literacy and communication research, preliminary focusing on language, including pictorial language. This community case study aimed to document the experiences of answering a pilot questionnaire to evaluate the problems of people with mild to moderate ID, 6A00.0 and 6A00.1 according to ICD-11. Our results show that most patients acquire health information from their physician or a medical professional. In preparing appropriate questionnaires, special education teachers can give valuable insight. However, participants were easily distracted and needed support in focusing on the questionnaire. Easy-to-read language, a simple format, big fonts and the presence of confidential caretakers are needed. This indicates, that semi-structured interviews with a trained interviewer might be most suitable for measuring the knowledge transfer of people with ID. The results of this case study highlight the need to develop an appropriate questionnaire and emphasize the need for a continued dialogue between people with ID and healthcare providers.

Exploring the social care-related quality of life outcomes of adults with intellectual disabilities through the use of Talking Mats®

BACKGROUND

Views on social care related quality of life (SCRQol) are typically gathered directly from individuals or from proxy informants. Easy-read options are available, although such methods may not be accessible to those with greater communication challenges.

METHODS

Fifteen people with intellectual disabilities were interviewed about their SCRQoL using Talking Mats® (TM). A descriptive approach was taken to exploring what people had to say.

RESULTS

Participants reported high levels of satisfaction with living conditions and personal care routines. They were mostly satisfied with the level of choice and control they had and with their carers.

CONCLUSIONS

People with intellectual disabilities who have greater communication challenges can make meaningful contributions to the assessment of the care they receive. Talking Mats is one tool which can be used to support people with intellectual disabilities to give their views.

Is health a priority? Examining health-related support needs in adults with intellectual disability through a self-determination framework

BACKGROUND

People with intellectual disabilities experience inequities in healthcare. Those are maintained by individual limitations as well as environmental factors. In this context, health needs are less likely to be expressed, identified and met.

METHOD

We led a survey in 832 adults with intellectual disabilities to identify if health was set as a priority and if so, what were their major health-related support needs (in terms of physical, social and psychological health).

RESULTS

67.1% of participants reported at least one need. Most frequently, two or more types of needs were reported with gender and living facility having an effect on whether participants would report these needs, but these did not affect which type of needs were reported.

CONCLUSIONS

Health-related support needs are highly prevalent and diversified in people with intellectual disabilities. This study emphasizes the importance to consider health as a global concept as well as the relationships between health and self-determination.

Social individuation: Extending the scale of emotional development - Short (SED-S) for adolescent reference ages

BACKGROUND

The SED-S is a standardized diagnostic instrument for assessing emotional development (ED) in people with a disorder of intellectual development. The SED-S defines five ED stages covering emotional reference ages up to 12 years in eight domains (5 items per domain). Stage 6 will extend the scale for early adolescent reference ages.

AIMS

The aim of this study is to define the SED-S items for stage 6 ('Social Individuation').

METHODS AND PROCEDURES

Experts in developmental psychology phrased 56 items (7 items/domain) describing typical behaviors for emotional reference ages 13th-18th year (145th-216th month) in English, German and Dutch. Twenty-eight independent experts assessed the items' content validity and observability on a Likert scale (0 = good to 3 = unacceptable). Two items/domain with the lowest ratings were excluded to finally select 5 items/domain for SED-S stage 6.

OUTCOMES AND RESULTS

The ratings were good with results ranging from 0.06 to 0.78 for validity and 0.06-1.78 for observability. After exclusion of the 2 lowest ranking items/domain, a set of 40 items was selected.

CONCLUSIONS AND IMPLICATIONS

The SED-S is extended to allow the assessment of emotional reference ages up to 18 years. Further research should evaluate the scale's psychometric properties. WHAT THIS PAPER ADDS?: The current version of the SED-S covers emotional reference ages up to 12 years (144 months). Extending the SED-S for emotional reference ages up to 18 years (145th-216th months of life) in Dutch, German and English allows better differentiation in the higher ED range and expands the applicability of the scale. Specifically, it makes it possible to apply the SED-S in people with borderline intellectual functioning. Accounting for the level of ED may provide valuable information about the behaviors and needs of individuals with higher reference ages and may support targeted treatment options in a population highly vulnerable to behavioral or mental disorders.

Considerations for measuring individual outcomes across contexts in Down syndrome: Implications for research and clinical trials

Individuals with Down syndrome (DS) are increasingly involved in clinical trials that target developmental outcomes, like cognition and behavior. The increased focus on treatment in DS has led to ongoing discussions regarding the selection of outcome measures using syndrome-informed criteria. This discourse is warranted as clinical trials can fail if the outcome measures selected are inappropriate for individuals with DS or do not take into account the behavioral phenotype commonly associated with DS. This review focuses on the challenges present in the measurement of outcomes in DS, with a specific focus on considerations made in evaluating cognitive, language, and behavioral/psychopathology outcomes. This review also provides a summary of recommendations for assessment of outcomes in these domains as well as recommendations for future research. The impact of physical health and assessment psychometrics on the measurement of outcomes is also reviewed.

Treatment Satisfaction in a Civil Commitment Facility for Sexually Violent Persons

Evaluating patient satisfaction in therapeutic settings is consistent with a Risk-Needs-Responsivity (RNR) model. This study provides results from a program improvement initiative in a sexually violent person (SVP) civil commitment facility that queried patients and treatment providers about their satisfaction with therapeutic processes and assessment methods. Overall, patients reported high levels of satisfaction with treatment at the facility, with the highest levels of satisfaction on items about being treated with kindness and respect and staff acting professionally. Providers rated current assessment methods such as the Penile Plethysmography (PPG) assessment, polygraph testing, and neuropsychological testing as most helpful for patients in treatment progress; however, patients rated PPG assessment and polygraph testing as the least helpful of the assessments conducted. Soliciting patient feedback periodically could be important for maintaining treatment engagement and discovering opportunities to enhance patient satisfaction to treatment in a SVP civil commitment setting.

Symptoms of Pediatric Feeding Disorders Among Individuals with 3q29 Deletion Syndrome: A Case-Control Study

OBJECTIVE

The goal of this study was to evaluate symptoms of pediatric feeding disorder in a sample of individuals with 3q29 deletion syndrome (3q29Del). Previous research has found that individuals with 3q29Del may experience elevated feeding concerns in early childhood; however, the specificity of these feeding concerns is not well understood.

METHODS

We compared individuals with 3q29Del (N = 83) with controls (N = 59) using an 11-item survey that assessed commonly reported symptoms associated with pediatric feeding disorders. An exploratory analysis also examined individuals with 3q29Del with and without a comorbid global developmental delay (GDD) or an autism spectrum disorder diagnosis.

RESULTS

Caregivers of 3q29Del cases reported higher incidences of feeding concerns on 10 of the 11 items included in the survey. This included statistically significant differences in food refusal behaviors, rejection of 1 or more food groups, and a history of failure to thrive. Parents of children with comorbid GDD were more likely to report concerns regarding food selectivity and problem behaviors during mealtime.

CONCLUSION

The results suggest individuals with 3q29Del experience increased symptoms of pediatric feeding disorder that may require targeted evaluation and intervention for optimal outcomes. Future research should include a more thorough multidisciplinary evaluation to further elucidate symptom severity and optimal treatment strategies.

Development and psychometric assessment of a psychological well-being instrument for adults with mild intellectual disability or borderline intellectual functioning

BACKGROUND

Measuring eudaimonic well-being is important to gain a complete picture of the well-being of individuals with mild intellectual disabilities or borderline intellectual functioning (MID-BIF), but there is no measurement instrument available for this population coding for multiple dimensions of eudaimonic well-being.

AIMS

The current study developed and piloted a new instrument coding for eudaimonic well-being in individuals with MID-BIF.

METHODS AND PROCEDURES

The instrument (SPWB-ID) was adapted from Ryff's scales of psychological well-being, including subscales addressing purpose in life, environmental mastery, positive relationships, self-acceptance, personal growth, and autonomy. Adaptations were based on the literature and interviews with people with MID-BIF and experts in the field. The SPWB-ID was piloted among 103 adults with MID-BIF.

OUTCOMES AND RESULTS

The trimmed version of the SPWB-ID showed sufficient to good internal consistency and test-retest reliability. Hypothesis testing for construct validity suggested the subscales of the SPWB-ID measured well-being, showing moderate to high correlations with quality of life, and differences in eudaimonic well-being between participants with and without clinically relevant depression scores.

CONCLUSIONS AND IMPLICATIONS

The SPWB-ID reliably measures eudaimonic well-being in individuals with MID-BIF. This enables support providers to collect information on eudaimonic well-being, providing input for person-centred care and support for individuals with MID-BIF.

Diminished culpability in fetal alcohol spectrum disorders (FASD)

There is a biological basis for diminished criminal responsibility in offenders with fetal alcohol spectrum disorders (FASD) just as there is in those with intellectual disability. Functional limitations affecting cognition in both neurodevelopmental conditions stem directly from structural brain damage at a gross and molecular level, which usually impairs executive functioning among other cognitive skills. Executive functioning, which includes reasoning and impulse control, is the only neural system in the brain that involves conscious thought. With respect to the law, impaired reasoning or rationality is an aspect of mens rea ("guilty mind"). When rationality is impaired by prenatal alcohol exposure, acts driven by strong emotion and urges can occur, which has obvious implications regarding criminal responsibility. The Atkins decision by the U.S. Supreme Court reflects the rationale that organically based brain dysfunction in executive skills reduces criminal culpability. We argue that people with FASD who have similar brain dysfunction likewise have reduced criminal responsibility.

Psychometric Properties of Self-Determination Inventory: Student Report Among Chinese Students With and Without Intellectual and Developmental Disabilities

This study explores the psychometric properties of Self-Determination Inventory: Student Report (SDI:SR) in students with intellectual and developmental disabilities (IDD) and without disabilities in China. The paper-and-pencil version of SDI:SR Chinese Translation (SDI:SR Chinese) was used to explore self-determination across students with IDD (n = 245) and students without disabilities (n = 315) from 16 schools across six cities in China. We examined the factor structure of the measure, conducted analysis of measurement invariance, and compared the latent means across students with IDD and without disabilities. Findings suggest that the data fit a one-factor model better than a three-factor model. We found greater variability in self-determination among students with IDD than students without disabilities. However, the two groups did not differ in latent means.

Wearable Sensing Systems for Monitoring Mental Health

Wearable systems for monitoring biological signals have opened the door to personalized healthcare and have advanced a great deal over the past decade with the development of flexible electronics, efficient energy storage, wireless data transmission, and information processing technologies. As there are cumulative understanding of mechanisms underlying the mental processes and increasing desire for lifetime mental wellbeing, various wearable sensors have been devised to monitor the mental status from physiological activities, physical movements, and biochemical profiles in body fluids. This review summarizes the recent progress in wearable healthcare monitoring systems that can be utilized in mental healthcare, especially focusing on the biochemical sensors (i.e., biomarkers associated with mental status, sensing modalities, and device materials) and discussing their promises and challenges.

The Integration of Wheelchair Users in Team Handball

Thus far, there are only a few sports activities in which people with and without intellectual disabilities can participate together and on an equal footing. The situation is even more complicated when people who are dependent on a wheelchair want to take part. The sports project Freiwurf Hamburg aims to make team handball playable for everyone. This case study documents how this can be achieved with a modified version of the handball game for runners and wheelchair users. Qualitative and quantitative data are collected and evaluated. The results show that players tend to distinguish between the roles of runner and wheelchair user rather than between disabled and non-disabled.

Straight from the horse's mouth: Increasing self-report in mental health assessment in individuals with intellectual disability

BACKGROUND

Mental health conditions are common among individuals with intellectual disability. Under recognition of mental health disorders leading to unmet treatment needs is common in this population. This article addresses one major contributing factor, the lack of cognitively accessible self-report measures for individuals with intellectual disability.

METHOD

In this literature-informed overview of the state of the field, we discuss the need for, and complexities of, including individuals with intellectual disability in mental health assessments.

RESULTS

With appropriate supports, many individuals with intellectual disability can respond to mental health questions. We discuss evidence-based strategies to make mental health assessments more accessible.

CONCLUSION

We highlight the need to engage individuals with intellectual disability to provide first-hand information about their health and well-being. New instruments and research procedures should be developed in partnership with individuals with intellectual disability. Self-report may be essential to advancing the science of mental health research.

Self-Report Stress Measures to Assess Stress in Adults With Mild Intellectual Disabilities-A Scoping Review

Stress has a major negative impact on the development of psychopathology and contributes to the onset of adverse physical conditions. Timely recognition and monitoring of stress-related problems are therefore important, especially in client populations that are more vulnerable to stress, such as people with mild intellectual disabilities (MID). Recent research on the use of physiological measures to assess stress levels emphasize that, in addition to these measures, self-report instruments are necessary to gain insight into the individual perception and impact of stress on daily life. However, there is no current overview of self-report stress measures that focus on the experience of stress in the present moment or in daily life. To provide an overview of the existing self-report stress measures for clinicians and researchers, a scoping review was conducted. In addition, to advise clinical professionals on the use of self-report measures of stress for people with MID, the results of an expert consultation were used to refine the preliminary findings. A systematic scoping literature search resulted in a total of 13 self-reported stress measures that met the final inclusion criteria, of which three were developed specifically for assessing stress in adults with MID (GAS-ID, LI, and SAS-ID). For each included self-report stress measure, the psychometric quality, assessment procedure, and suitability for adults with MID were reported. These were supplemented by the findings from the expert consultation. Implications for clinical practice on the use of self-report stress measures, particularly for people with MID, are discussed. Recommendations for future research and development are given.

Machine Learning-Based Behavioral Diagnostic Tools for Depression: Advances, Challenges, and Future Directions

The psychiatric diagnostic procedure is currently based on self-reports that are subject to personal biases. Therefore, the diagnostic process would benefit greatly from data-driven tools that can enhance accuracy and specificity. In recent years, many studies have achieved promising results in detecting and diagnosing depression based on machine learning (ML) analysis. Despite these favorable results in depression diagnosis, which are primarily based on ML analysis of neuroimaging data, most patients do not have access to neuroimaging tools. Hence, objective assessment tools are needed that can be easily integrated into the routine psychiatric diagnostic process. One solution is to use behavioral data, which can be easily collected while still maintaining objectivity. The current paper summarizes the main ML-based approaches that use behavioral data in diagnosing depression and other psychiatric disorders. We classified these studies into two main categories: (a) laboratory-based assessments and (b) data mining, the latter of which we further divided into two sub-groups: (i) social media usage and movement sensors data and (ii) demographic and clinical information. The paper discusses the advantages and challenges in this field and suggests future research directions and implementations. The paper's overarching aim is to serve as a first step in synthetizing existing knowledge about ML-based behavioral diagnosis studies in order to develop interventions and individually tailored treatments in the future.

Experiences of ward atmosphere in inpatients with intellectual disability and mental illness: clinical implications for mental health nursing

Background: Patients with intellectual disability in psychiatric services are rarely asked about their experiences when admitted to inpatient units. Aim: To enhance the understanding of ward atmosphere for inpatients with co-occurring intellectual disabilities (ID) and mental illness by exploring patients' experiences from a specialised mental health inpatient unit. Methods: A selected sample of 10 adults with comorbid mental illness and ID were recruited for a qualitative interview study based on Gunderson's conceptualisation of therapeutic components in mental health wards. The patients were interviewed by two experienced clinicians and interviews were analysed using directed content analysis. Results: Patients' experience of their relationships with ward staff seemed central to their experiences of several aspects of mental health nursing. Feeling safe, contained, and validated, were further important aspects. However, the patients seemed to have little influence on treatment choices and did not report participating in shared decision-making. Conclusions: The patients' answers in this study are in line with previous research on ward atmosphere for patients in the general population. However, more research is necessary to inform future mental health nursing for patients with ID, both in inpatient and ambulatory services.

The reporters' agreement in assessing the quality of life of young people with intellectual disabilities

A good evaluation of the quality of life (QoL) of young people with disability is essential to detect, monitor and report their support needs in research, and individual, institutional and policy planning. The aim of this study is to evaluate the reporters' agreement in the assessment of the QoL of young people with Intellectual Disabilities in transition to adulthood. Self and proxy-report version of INICO-FEAPS quality of life scale was used to assess 119 students of a post-compulsory educational program, being the proxy-report informed by one of their relatives. Results show poor intraclass correlations between informants. No discrepancies were found in the global QoL. However, small discrepancies were found for some dimensions. Young people's reports were higher for self-determination, personal development and interpersonal relationships. On the contrary, relatives' reports were higher for rights, material and physical wellbeing. The discrepancies in global QoL assessment were not related to student's severity, IQ, diagnosis or parent's gender. These findings underline the importance of young people's participation in the assessment of their QoL as well as the convenience of using both kind of informants when taking appropriate decisions in educational contexts during transition to adulthood.

Development and psychometric properties of a self-report instrument for the assessment of sexual behaviour and concerns of people with mild intellectual disabilities (SEBECOMID-S)

BACKGROUND

This paper presents a description of the development and psychometric properties of a self-report instrument for the assessment of sexual behaviour and concerns of people with mild intellectual disabilities (SEBECOMID-S).

METHODS AND PROCEDURES

The study included 281 people with mild intellectual disabilities. The psychometric properties were examined through exploratory factorial analysis, descriptive statistics, and reliability indices.

RESULTS

The exploratory factor analyses offered a structure with three factors: concern about the appropriateness of their sexual behaviour, sexual practices performed, and safe sex practices. The model presents an excellent fit (χ² /df = 1.10, RMSEA = 0.019, CFI = 0.997, TLI = 0.995, and SRMR = 0.065). General test reliability was good (α = 0.77, Ω = 0.76).

CONCLUSIONS

SEBECOMID-S is a valid and reliable tool to obtain objective information about the sexual behaviour and concerns of people with mild intellectual disabilities. The use of this instrument will make it possible to adjust their training to their real experiences, making it more effective.

Needs of older people with intellectual disabilities: variables influencing inter-respondent (client vs staff) agreement

Background: The importance of understanding the needs of older people with intellectual disabilities (IDs) is obvious, but the research available is limited. This study identifies the self-reported needs of older adults with IDs and compares them with staff reported needs regarding the same older adults with ID, therefore specifying and explaining agreements and disagreements. Method: The needs of 96 older adults with IDs were assessed through the Inventory of Identification of Needs (informant and self-report versions). Results: Both older people with IDs and staff reported quite diverse needs related to all the domains assessed by the IIN: physical health, literacy, information, meaningful activity, participation in the community, mental health, basics needs and accommodation. All the mean scores of the informant version of the IIN were higher than the ones of the self-report version. Agreement amongst informants was influenced by the prominence of needs, the accessibility to and the subjectivity of the information, and social desirability. Conclusions: A consumer-driven approach implies that services should be based on the needs identified.

Influence of Teacher-Student Relationships and Special Educational Needs on Student Engagement and Disengagement: A Correlational study

Contemporary educational research has found that student engagement and disengagement have a relevant influence on learning outcomes. However, research on the influence of teacher–student relationships in the engagement of students with special educational needs (SEN) is scarce. The purpose of this study is to analyze the impact of teacher–student relationships, peer support at school, family support for learning, opportunities to participate at school, and SEN on engagement and disengagement of students using a sample of secondary students with SEN and typical development (TD). Through a non-experimental, correlational, and cross-sectional design, we evaluated 1,020 high school students (340 with SEN and 680 with TD) in the 9th grade (13–19 years old, M = 14.8; SD = 0.89). Teacher–student relationships, peer support at school, and family support for learning were assessed via subscales from the Student Engagement Inventory (SEI), opportunities to participate at school were measured with a subscale of the School Participation Questionnaire (SP), whereas engagement and disengagement were measured using the Multidimensional Scale of School Engagement (MSSE). Results show significant statistical differences between SEN and TD students in both student engagement and disengagement indicators. Engagement of SEN students is higher in the cognitive, emotional, and social dimensions than that of TD students. However, they also have higher disengagement in the cognitive and behavioral dimensions. Furthermore, SEN students rate their relationships with teachers more highly and perceive more opportunities for school participation than their peers. Further analyses show that teacher–student relationships are positively associated with all dimensions of student engagement and inversely with behavioral and cognitive disengagement. Although correlational, the findings suggest teacher–student relationships and school participation opportunities could be important variables for diminishing disengagement and its negative consequences for both SEN and TD students, while improving student engagement. We discuss these results considering possible implications for educational policies, practices, and research.

Toward a Comprehensive Assessment of Relationships with Teachers and Parents for Youth with Intellectual Disabilities

This study proposes a multi-informant (youth, teachers, and parents) measure of relationship quality with adults for youth with intellectual disabilities (ID). A sample of 395 youth with mild (49.15%) and moderate (50.85%) ID, aged 11-22 (M = 15.82) was recruited in Canada (French-speaking, N = 142), and Australia (English-speaking, N = 253). Results support the reliability, factor validity, discriminant validity (in relation to sex, ID level, country, and comorbidity), convergent validity (depression, anxiety, aggressiveness, and prosocial behaviors), and one-year longitudinal stability of the measure. Youth self-reports provide a complementary perspective on relationship quality with adults relative to teachers' or parents' reports, whereas teachers and parents seem unable to differentiate their own perspective from that of the target youth.

Evaluating the self-determination continuum towards seeking support among people with mild to borderline intellectual disabilities

BACKGROUND

Providing professional support for people with mild to borderline intellectual disabilities (IDs) is supposed to support their autonomous participation in society and, in turn, enhance their well-being and quality of life. However, the motivation for seeking support may differ for people with mild to borderline IDs, varying in the extent to which the person's autonomy is self-determined. The present study tested the association between different types of motivation for seeking support and well-being.

METHOD

Adults with mild to borderline IDs (N = 154) participated in a cross-sectional survey. Researchers administered the Self-Regulation Questionnaire - Support - II (SRQ-S-II) and a life satisfaction questionnaire. To determine the test-retest reliability of the SRQ-S-II, 30 participants completed a follow-up questionnaire.

RESULTS

The motivations cited by people with mild to borderline IDs for seeking support ranged from amotivation to intrinsic motivation. Multiple regression analysis indicated that the model explained 56.6% of the variance, with intrinsic motivation (β = 0.361, P < 0.001) and identified motivation (β = 0.381, P = 0.001) proving to be significant predictors in terms of explaining the highest percentage of variance in well-being. Amotivation (β = -0.247, P = 0.004) and introjected motivation (β = -0.145, P = 0.03) contributed significantly to the model with negative beta coefficients. Finally, reliability measures (Cronbach's alphas, MacDonald's omegas and test-retest reliabilities) indicated that all types of motivation for seeking support could be reliably assessed.

CONCLUSIONS

The results of the present study showed that people with mild to borderline IDs displayed the full range of types of motivations for seeking support and, moreover, that it was associated with well-being. Studying these motivational states, and increasing our awareness of what motivates this population to seek support, can aid the design of more effective support that respects self-determination and well-being. The SRQ-S-II is thus an important instrument for understanding the role of support in promoting well-being.

Psychometric properties of a brief self-reported health-related quality of life measure (HRQoL-IDD) for persons with intellectual and developmental disabilities

Background

To encourage self‐determination and address health disparities among persons with intellectual and developmental disabilities, clinicians and researchers rely on self‐reported measures like health‐related quality of life (HRQoL). This study evaluated the psychometric properties of a theory‐driven self‐reported HRQoL measure for adults requiring mild to moderate support related to intellectual and developmental disabilities.

Method

224 volunteers completed 42 quality of life items developed with extensive input from persons with intellectual and developmental disabilities, family members/caregivers, and providers. The 5‐point Likert scale format with visual images of fluid‐filled cups represented the range of responses.

Results

Exploratory and Unrestricted Factor Analyses yielded 16 HRQoL items with 4 subscales: Functional Well‐Being, Emotional Well‐Being, Social Well‐Being, and Healthy Decision‐making. The HRQoL‐IDD explained 62.8% of variance, had satisfactory internal consistency (0.73–0.83), stability of reponses, and reading level (2nd grade, ages 7‐8).

Conclusions

The HRQoL‐IDD is a promising measure of self‐reported HRQoL for use in community‐based settings for persons requiring mild to moderate support related to intellectual and developmental disabilities.

Emotion regulation and angry mood among adolescents with externalizing problems and intellectual disabilities

BACKGROUND AND AIMS

Cognitive behavior therapy targeting emotion regulation is found to be effective in decreasing externalizing problems, but little is known about the emotion regulation capacities of adolescents with externalizing problems and Mild Intellectual Disabilities or Borderline Intellectual Functioning (MID-BIF). Therefore, the aim of this study was to compare emotion (i.e., anger) regulation capacities, angry mood level and angry mood variability between two groups: adolescents with externalizing problems and MID-BIF and adolescents with externalizing problems and average intelligence (AIQ).

METHODS AND PROCEDURES

Participants in the MID-BIF (n = 42, M_age = 15.52, SD = 1.43) and AIQ (n = 39, M_age = 13.67, SD = 1.06) group completed questionnaires about emotion regulation difficulties, emotion regulation strategies, and angry mood.

OUTCOMES AND RESULTS

Adolescents in the MID-BIF group reported fewer emotion regulation difficulties, fewer maladaptive regulation strategies, and lower levels of angry mood than adolescents in the AIQ group. No between-group differences in angry mood variability were found. Lastly, adolescents in the MID-BIF group reported to use more behavioral than cognitive regulation strategies.

CONCLUSIONS AND IMPLICATIONS

These findings provide a starting point in understanding emotion regulation and angry mood of adolescents with externalizing problems and MID-BIF and show that it is important to consider differences between cognitive and behavioral regulation processes.

Validity and reliability of the 'Leisure Participation Observation' among adults with intellectual disabilities: A pilot study

BACKGROUND

Individuals with intellectual disabilities have decreased leisure participation, affecting their health and well-being. Existing measures of leisure participation are primarily based on self- or proxy reports. This study describes the initial validity and reliability of Leisure Participation Observation (LPO), developed for individuals with ID.

METHOD

Two judge panels (N = 10 each) completed a table of specifications for content validity. Reliability of the LPO was established on 38 individuals with moderate ID 25-45 years old.

RESULTS

This study established the content validity of the LPO. Additionally, weighted kappa showed moderate-high statistically significant inter-rater reliability (.667-.859, p < .01) and low-moderate, significant test-retest reliability, based on intraclass correlations (.226-.474, p < .05). Finally, results yielded moderate-high internal consistency (α = .74).

CONCLUSIONS

The LPO shows promise as an observation tool for assessing leisure participation in the moderate ID population that may serve as the basis for developing intervention programmes.

Family-based social capital of emerging adults with and without mild intellectual disability

BACKGROUND

Family is recognised as an important context for the self-development of young adults in emerging adulthood, although very little research has addressed the perspective of young people with intellectual disability about their families by using self-report. This study examined how emerging adults with mild intellectual disability define their family support networks, compared with definitions of students without intellectual disability, within a social capital theoretical framework.

METHODS

Fifty-three participants with mild intellectual disability and 53 students without intellectual disability were interviewed individually using the Family Network Method - Intellectual Disability (FNM-ID). Data from the FNM-ID relate to key social network measures on how individuals define their family groups, and how they perceive existing supportive relationships within their families. Participants with mild intellectual disability and students were compared on the FNM-ID social network measures.

RESULTS

Participants with mild intellectual disability reported fewer family members who they considered significant to them than students without intellectual disability. They were less likely to include peers (i.e. friends and partners) and siblings in their significant family networks, had fewer relationships with family members in which they received or gave support, had fewer reciprocal support relationships and had a less central position in their family network.

DISCUSSION

The family-based social capital of emerging adults with mild intellectual disability differed from that of students without intellectual disability. They may remain more dependent on their natural family for emotional support as their supportive networks have not necessarily made the transition to networks with emotionally close peer relationships.

Comparison of Sport Competitive Anxiety Levels of Flemish athletes with and without intellectual disability

BACKGROUND

High anxiety levels are common in people with intellectual disabilities (ID) and anxiety can affect sport performance, but sport competitive anxiety profiles in athletes with ID are unknown.

METHODS

A total of 303 athletes; 116 with ID (33% female, M age = 22.64, SD = 3.94), and 187 without ID (54% female, M age = 21.81, SD = 3.23), completed the modified questionnaire Sport Anxiety Scale-2-FLemish-ID (SAS-2-FL-ID).

RESULTS

The SAS-2-FL-ID was a valid tool to use in a population of athletes with ID. They had higher trait anxiety (9.36 ± 2.62) than peers without ID (7.58 ± 2.44), F = 26.95, p<.001. With respect to sport anxiety, they only scored higher on the "concentration disruption" subscale. Their overall level of competitive anxiety across all subscales (24.14 ± 7.73) was significantly lower compared to athletes without ID (26.51 ± 7.49), F = 27.10, p<.001.

CONCLUSION

On the sporting field, athletes with ID worry less and feel less somatic anxiety compared to athletes without ID.

Measuring Health-Related Quality of Life in Pediatric Neurology

Health-related quality of life (HRQOL) is central to how clinicians and parents make choices about medical care for pediatric neurology patients. To provide parents with the information they need to make these decisions and plan for the future, it is necessary for parents and clinicians to understand how HRQOL is defined and measured in the setting of pediatric neurodevelopmental impairment. We review challenges that exist in measuring HRQOL in pediatric neurology, examine existing measures, and outline key principles to guide selection and interpretation of HRQOL measures in children with neurologic conditions.