Self-reported anti-social behaviour: prevalence and risk factors amongst adolescents with and without intellectual disability

Social Capital and the Reciprocal Nature of Family Relationships: The Perspective of Individuals With Mild Intellectual Disability

Even though family plays a significant role in the lives of people with intellectual disability, little research has included their own views about their families. This study examined how 138 people with mild intellectual disability describe their family group, with a focus on the reciprocal nature of the emotional support in relationships with family members. Participants reported "significant" family members beyond the nuclear family, and parents were seen as the main provider of support. Only half of participants had a support relationship with siblings and just 13% of participants reported partners. About 30% of support was reciprocal, and reciprocity varied greatly with the types of family connection (e.g., siblings, peers). Implications for future research as well as practice are discussed.

Characteristics of prisoners with intellectual disabilities

BACKGROUND

Previous studies have found high rates of intellectual disabilities (ID) in prison. However, little is understood about prisoners with ID. This study aimed to identify prisoners with ID and compare their characteristics with prisoners without neurodevelopmental disorders with regard to demographic profile, mental health, suicide risk and offences.

METHOD

This was a descriptive, cross-sectional study carried out using face-to-face interviews with 240 participants in a London Category C prison. Standardised tools were used to assess prisoners for ID and mental disorder.

RESULTS

The study identified 18 prisoners as having ID. Participants with ID were less likely to be from a black or minority ethnic background, be over 35 years of age or have any qualifications. They were more likely to have been single, homeless or unemployed before coming into prison. Prisoners with ID were significantly more likely to have mental health problems and 25% had thought about suicide in the last month and 63% had attempted suicide in the past. Prisoners with ID were also more likely to be housed in the vulnerable prisoners' wing and significantly more likely to have committed robbery than other prisoners.

CONCLUSIONS

The findings confirm the presence of significant numbers of people with ID with high levels of mental illness in a male prison. Services across the CJS are required for this group, specifically, there is a need for raised awareness among those working in prison about ID and improved skills to recognise offenders with ID and address major gaps in current healthcare provision in prison.

The mental health of adolescents with and without mild/moderate intellectual disabilities in England: Secondary analysis of a longitudinal cohort study

BACKGROUND

Children with mild/moderate intellectual disabilities are at greater risk for mental health problems, with socio-economic factors and adversity partly accounting for this. Fewer data are available for adolescents.

METHODS

Secondary analysis was undertaken of the Next Steps annual panel study following a cohort through adolescence into adulthood containing self-report mental health data up to age 16/17. Participants with mild/moderate intellectual disabilities were identified through data linkage with educational records.

RESULTS

Adolescents with mild/moderate intellectual disabilities were more likely than non-disabled peers to experience socio-economic disadvantage and bullying. Incidence rates of mental health problems were generally not significantly different between adolescents with and without intellectual disabilities.

CONCLUSIONS

These findings are consistent with higher rates of persistent mental health problems beginning earlier among children with intellectual disabilities. Greater attention needs to be paid to the timecourse of mental health problems, and the impact of socio-economic factors, family and peers on mental health.

Predictors of Risky Behavior and Offending for Adolescents With Mild Intellectual Disability

Adolescents with intellectual disability (ID) engage in risky behavior and offending. However, little is known on the impact school-related predictors have on engagement in risky behaviors for adolescents with ID. This study analyzed secondary data from the National Longitudinal Transition Study-2 (NLTS2) to determine levels of engagement in risky behaviors and offending for adolescents with mild and moderate/severe ID. School-related predictors of engagement for adolescents with mild ID were also explored. Results indicated adolescents with mild ID engage in risky behaviors and offending at significantly higher rates as compared to adolescents with moderate/severe ID. Participation in a social skills or life skills class was a significant predictor of less engagement in risky behaviors for individuals with mild ID.

Autism spectrum disorder and criminal responsibility: historical perspectives, clinical challenges and broader considerations within the criminal justice system

There has been relatively limited research focus on autism in the context of the criminal justice system. The relationship between autism spectrum disorder (ASD) and criminal responsibility is complex. Furthermore, the features inherent to ASD can have a significant bearing on a wide array of other issues in this context including police interviewing, fitness to be tried, culpability and the appropriateness of custodial disposal. This review explores the background to our understanding of ASD, patterns of offending behaviour and the nature of the relationship between this and characteristic ASD deficits. The clinical and legal challenges posed by ASD defendants in terms of identification, assessment and on a broader service level as they negotiate the criminal justice system are highlighted to illustrate the varied difficulties they may encounter and to draw attention to this field as a worthy area of research and training for the medical, legal and law enforcement professions.

A systematic review of community-based parenting interventions for adolescents with challenging behaviours

Parenting skills training is an established means of treating challenging behaviours among young children, but there has been limited research on its efficacy when used to treat challenging adolescent behaviour. The aim of this systematic review was to evaluate the efficacy and effectiveness of community-based parenting interventions designed for families with adolescents, as judged in terms of increased knowledge and skills among parents, improvements in adolescent behaviour, and program feasibility within community settings. Results indicated that intervention group parents typically made greater gains than did control group parents on measures of good parenting, with positive flow-on effects to some aspects of challenging adolescent behaviours. Limited evidence suggests that group and individual intervention formats may be equally effective and that there is no advantage to the participation of the target adolescent in the intervention.

Crime and Legal Issues among Intellectually Disabled Individuals

Intellectual Disability (ID) can be caused by a variety of factors, which may lead to a variety of signs and symptoms. Individuals with ID are living in societies where during the past decade there is a steady increase in the amount of research focused on civil law, criminal law and mental health. In this chapter, there will be a theoretical presentation of the research on ID regarding criminal law and the different forms of aggressive behavior such as sexual violence, homicide, theft, arson and alcohol-drug abuse. There will be information on research regarding civil law and the most common problems for individuals with ID, such as financial capacity and capacity for medical consent. Finally, there will be a section for the most important issues regarding the trial and conviction for individuals with ID and a presentation of a recent research on attitudes toward ID and legal issues. The above will be examined through the prism of current neuropsychological data, while cross-cultural restrictions will be discussed.

Disabling chronic conditions in childhood and socioeconomic disadvantage: a systematic review and meta-analyses of observational studies

OBJECTIVE

To determine the association of socioeconomic disadvantage with the prevalence of childhood disabling chronic conditions in high-income countries.

STUDY DESIGN

Systematic review and meta-analyses.

DATA SOURCES

6 electronic databases, relevant websites, reference lists and experts in the field.

STUDY SELECTION

160 observational studies conducted in high-income countries with data on socioeconomic status and disabling chronic conditions in childhood, published between 1 January 1991 and 31 December 2013.

DATA EXTRACTION AND SYNTHESIS

Abstracts were reviewed, full papers obtained, and papers identified for inclusion by 2 independent reviewers. Inclusion decisions were checked by a third reviewer. Where reported, ORs were extracted for low versus high socioeconomic status. For studies reporting raw data but not ORs, ORs were calculated. Narrative analysis was undertaken for studies without data suitable for meta-analysis.

RESULTS

126 studies had data suitable for meta-analysis. ORs for risk estimates were: all-cause disabling chronic conditions 1.72 (95% CI 1.48 to 2.01); psychological disorders 1.88 (95% CI 1.68 to 2.10); intellectual disability 2.41 (95% CI 2.03 to 2.86); activity-limiting asthma 2.20 (95% CI 1.87 to 2.85); cerebral palsy 1.42 (95% CI 1.26 to 1.61); congenital abnormalities 1.41 (95% CI 1.24 to 1.61); epilepsy 1.38 (95% CI 1.20 to 1.59); sensory impairment 1.70 (95% CI 1.39 to 2.07). Heterogeneity was high across most estimates (I(2)>75%). Of the 34 studies without data suitable for meta-analysis, 26 reported results consistent with increased risk associated with low socioeconomic status.

CONCLUSIONS

The findings indicate that, in high-income countries, childhood disabling chronic conditions are associated with social disadvantage. Although evidence of an association is consistent across different countries, the review provides limited evidence to explain the association; future research, using longitudinal data, will be required to distinguish low socioeconomic status as the cause or consequence of childhood disabling chronic conditions and the aetiological pathways and mechanisms.

Anti-social behaviour and police contact among 13- to 15-year-old English adolescents with and without mild/moderate intellectual disability

OBJECTIVES

To describe the rates of anti-social behaviour (ASB) among adolescents with/without mild/moderate intellectual disability (MMID). To estimate whether any differences could be attributable to differences in exposure to extraneous risk factors.

DESIGN

Secondary analysis of the Longitudinal Study of Young People in England.

METHODS

Participants with MMID were identified through data linkage with educational records.

RESULTS

Parents of children with MMID were more likely to report police contact, children with MMID were more likely to self-report fighting/public disturbance, shoplifting and graffiti. When controlling for differences in exposure to extraneous risk factors, MMID was associated with increased rates of police contact and self-reported graffiti, no difference in self-reported shoplifting, reduced rates of self-reported fighting/public disturbance and vandalism.

CONCLUSIONS

Differences in the rates of exposure to extraneous risk factors play an important role in accounting for the differences in the prevalence of self-reported ASB among adolescents with and without MMID.

Students' and teachers' perceptions of aggressive behaviour in adolescents with intellectual disability and typically developing adolescents

This study investigated aggressive behaviour in Serbian adolescents with intellectual disability (ID) compared to typically developing peers. The sample consisted of both male and female adolescents aged 12-18 years. One hundred of the adolescents had ID, and 348 adolescents did not have ID. The adolescents were asked to complete the Reactive-Proactive Aggression Questionnaire (RPQ), and their teachers provided ratings of aggression for the adolescents using the Children's Scale of Hostility and Aggression: Reactive-Proactive (C-SHARP). Results indicated that adolescents reported a higher prevalence of aggressive behaviour than their teachers. Reactive aggression was more prevalent than proactive aggression in both subsamples. In the subsample of adolescents with ID, there were no sex or age differences for aggression. However, in the normative subsample, boys and older adolescents scored significantly higher on aggression. According to adolescent self-reports the prevalence of aggression was higher in adolescents without ID, while teachers perceived aggressive behaviour to be more prevalent in adolescents with ID. Scientific and practical implications are discussed.

Stepping Stones Triple P seminars for parents of a child with a disability: a randomized controlled trial

Parents of children with a developmental disability require tailored parenting support, as their families have special needs and are at risk of increased burden. The aim of this study was to evaluate the efficacy of the Stepping Stones Triple P seminars, a brief group intervention for parents of a child with a disability. There were two seminars that presented parenting strategies to improve both child behavior and parenting variables implicated in the development and maintenance of child problem behavior. Fifty-three parents participated in this randomized controlled trial. Each had a child, aged two to ten, with a disability. The results indicated significant reductions in child behavior problems, the use of dysfunctional parenting styles, and parental conflict reported by parents in the intervention group compared to a waitlist group. The results were maintained at 3-month follow-up and there was evidence of a sleeper effect for parenting confidence. This study demonstrated that the seminars provide a promising intervention for parents of children with a disability. Limitations and implications for future research are also discussed.

Predictors of the persistence of conduct difficulties in children with cognitive delay

BACKGROUND

High rates of conduct difficulties have been reported among children with borderline intellectual disabilities or intellectual disabilities. Little is known about predictors of the persistence of conduct difficulties in the pre-adolescent period in this high-risk group.

METHODS

Secondary analysis of data from the first three waves of the Longitudinal Study of Australian Children.

RESULTS

The prevalence of conduct difficulties at age 4/5 years among children with cognitive delay was independently associated with: living in an income poor household; living in a more deprived neighbourhood; having co-morbid emotional difficulties; having poorer pro-social behaviours; poorer maternal health; greater exposure to angry/harsh parenting; and greater exposure to more inconsistent parenting. The persistence of conduct difficulties at ages 6/7 years and 8/9 years was independently associated with: male child gender; living in material hardship; child expressive communication difficulties; living in a single parent headed household; and greater exposure to angry/harsh and inconsistent parenting. When compared to their more intellectually able peers, children with borderline or intellectual disability were significantly more likely to exhibit persistent conduct difficulties, but only when exposed to multiple environmental risks. These results were consistent across different thresholds for measuring conduct difficulties and different thresholds for measuring cognitive delay.

CONCLUSIONS

The persistence and high levels of conduct difficulties among this high risk group appears to be associated with a combination of increased risk of exposure to environmental adversity and decreased resilience when so exposed.

Concurrent and prospective associations between facial affect recognition accuracy and childhood antisocial behavior

This study examined the concurrent and prospective associations between children's ability to accurately recognize facial affect at age 8.5 and antisocial behavior at age 8.5 and 10.5 years in a sub sample of the Avon Longitudinal Study of Parents and Children cohort (5,396 children; 2,644, 49% males). All observed effects were small. It was found that at age 8.5 years, in contrast to nonantisocial children; antisocial children were less accurate at decoding happy and sad expressions when presented at low intensity. In addition, concurrent antisocial behavior was associated with misidentifying expressions of fear as expressions of sadness. In longitudinal analyses, children who misidentified fear as anger exhibited a decreased risk of antisocial behavior 2 years later. The study suggests that concurrent rather than future antisocial behavior is associated with facial affect recognition accuracy.

Suicidal ideation in adolescents aged 11 to 15 years: prevalence and associated factors

OBJECTIVE

To verify the prevalence and associated factors of suicidal ideation among adolescents aged 11 to 15 years.

METHOD

Cross-sectional population-based study. Adolescents completed a self-report that contained the Children's Depression Inventory. Suicidal ideation was measured according to item 9 of the Children's Depression Inventory. Multivariate logistic regression analysis was applied using a hierarchical model.

RESULTS

1145 adolescents were invited to participate, and 1039 were interviewed (refusal rate: 9.26%). The prevalence of suicidal ideation was 14.1%. Factors associated to suicidal ideation: female gender, current alcohol consumption, use of illicit drugs, symptoms indicating conduct disorders and high Children's Depression Inventory scores for depressive symptoms.

CONCLUSION

Prevention strategies should focus on female adolescents, especially those sexually active with probable mental health problems and substance use.

Forensic psychiatric perspective on criminality associated with intellectual disability: a nationwide register-based study

BACKGROUND

Contrasting views exist over the association of intellectual disability (ID) and criminal offending. This nationwide study attempts to shed further light to expand understanding to substantiate the relation between socio-demographic characteristics, psychiatric co-morbidity and criminal behaviour among the Finnish forensic population with ID.

METHOD

We reviewed all forensic psychiatric examination reports of individuals with ID who underwent a pre-trial forensic psychiatric evaluation in Finland during an 11-year period (1996-2006).

RESULTS

One-third of the offenders had been regularly and sufficiently treated as outpatients. Half of the offenders had previous criminality, and the single most common crime was arson. Almost half of the offenders were diagnosed with alcohol abuse/dependence and two-thirds with any substance abuse/dependence. Furthermore, almost half were intoxicated during the index crime. Antisocial personality disorder was diagnosed in 25% of the offenders. Almost half of the offenders were placed in involuntary special care for the ID, which lasted ca 2 years. Among the last-mentioned, two-thirds of the nursing care plans lacked recommended structure.

CONCLUSIONS

The offenders with so-called triple diagnosis - substance abuse, mental illness and ID - form a small subgroup of criminal offenders with complex needs. The results of the present study underline the importance of close, long-term cooperation among specialists in the field of ID, addiction service, mental health services and forensic psychiatry.

Young people with intellectual disabilities and mental health needs

PURPOSE OF REVIEW

This review focuses on the risk factors for increased mental health problems, and the types of psychopathology and their therapeutic management, in young people with intellectual disabilities.

RECENT FINDINGS

Recent studies indicate that this population presents significantly more emotional and behavioural problems than their peers without intellectual disabilities. These problems are not adequately detected and treated by mental health professionals; the children's families are overburdened, psychosocially and economically disadvantaged and in need of specialist support and counselling.

SUMMARY

The mental health needs of children and adolescents with intellectual disabilities are multiple, complex, persistent and costly, and for various reasons they are not adequately met. Prevention of mental health problems or early recognition through better screening followed by appropriate treatment are essential, in order to ensure better psychosocial adaptation of young people with intellectual disabilities. Inequalities in the provision of services must be addressed, and families helped through support and counselling, along with psychotherapeutic and psychopharmacological interventions for the children, as appropriate.

Poverty and people with intellectual disabilities

Epidemiological studies have consistently reported a significant association between poverty and the prevalence of intellectual disabilities. The available evidence suggests that this association reflects two distinct processes. First, poverty causes intellectual disabilities, an effect mediated through the association between poverty and exposure to a range of environmental and psychosocial hazards. Second, families supporting a child with intellectual disabilities and adults with intellectual disabilities are at increased risk of experiencing poverty due to the financial and social impact of caring and the exclusion of people with intellectual disabilities from the workforce. It is likely that the association between poverty and intellectual disabilities accounts in part for the health and social inequalities experienced by people with intellectual disabilities and their families. Implications for policy and practice are discussed in relation to the funding of services for people with intellectual disabilities and preventative approaches to addressing the health and social inequalities experienced by people with intellectual disabilities and their families.