Acquiescence in interviews with people who have mental retardation

Qualitative methodological approaches involving participants with intellectual disabilities: Scoping review of literature exploring death and dying

BACKGROUND

A paucity of qualitative research on sensitive topics that focuses on participants with intellectual disabilities leaves their views unexplored. This scoping review mainly aimed to provide an overview of qualitative data collection methods used in research involving participants with intellectual disabilities to explore death and dying.

METHOD

A scoping review of primary research and methodological papers published between January 2008 and March 2022 was conducted. The PRISMA-ScR checklist was followed.

RESULTS

We identified 25 articles utilising four data collection methods: interviews, focus groups, the Nominal Group Technique, and participant observation. Data collection trends were identified, including accommodations for participants with intellectual disabilities, visual media used as a facilitator, and reporting of distress protocols. Most participants had mild to moderate intellectual disabilities.

CONCLUSIONS

The included studies demonstrate a flexible approach that relies on the use of multiple methods. Future research must adequately report study characteristics to ensure transparency and reliability.

The physician's role in reducing health disparities for persons with epilepsy and intellectual disability: "it's not just epilepsy…you really have to take a deeper dive."

Epilepsy affects approximately 25 % of people with intellectual disability (ID). Despite this high prevalence, evidence of health disparity exists in healthcare access and health outcomes for this population. Patients with ID experience additional challenges in accessing appropriate epilepsy care, and are at greater risk of experiencing inappropriate prescribing, polypharmacy and misdiagnosis compared with the general population. The expectations, attitudes and actions of physicians are key in addressing health inequalities, particularly those which disproportionately impact a specific group of patients, such as patients with ID and epilepsy. This qualitative study aimed to explore the views of specialist physicians as to why they believe this patient group are at a disadvantage when it comes to accessing appropriate epilepsy care, and how physicians can intervene to ensure that patients with ID are given equal access to suitable epilepsy care, and equal opportunity to achieve the best possible treatment outcomes. Semi-structured interviews were carried out with six physicians, located in six countries, who specialise in the care of persons with ID who have epilepsy. Interviews sought views on prognostic expectations, experiences of disparities in epilepsy care, and suggestions for advocacy interventions. Interviews were analysed using reflexive thematic analysis. Three core themes and nine subthemes were identified. Core themes included (1) 'Nervousness in care and treatment,' which reflected participants' descriptions of a nervousness by colleagues when treating epilepsy in patients with ID. (2) 'Taking a deeper dive' captured the harmful effects of accepting "common dogma," as well as the issue of a lack of clarity around treatment pathways for patients with epilepsy and ID. (3) 'Teach me' illustrated the importance of shared expertise, reflective practice and continued research and advocacy. Findings reflected participants' recommendations to address disparities in epilepsy care for patients with ID. These recommendations highlighted education and training, taking time to learn how to communicate in different ways, and regular reflection on personal assumptions and biases as important contributors to addressing inequalities in epilepsy care for patients with ID. It is hoped that findings will prompt those providing epilepsy care to reflect on their own practice and identify ways in which they might intervene to minimise inadvertent harm and reduce health disparities in epilepsy care for patients with ID.

Exploring spirituality and quality of life in individuals who are deaf and have intellectual disabilities

PURPOSE

While positive contributions of religion and spirituality (R/S) to quality of life (QOL) are confirmed by a growing body of evidence, only limited research has involved people with intellectual disabilities and so far, no studies included prelingually deaf individuals with intellectual disabilities. This study explores the role of R/S in people with intellectual disabilities and deafness living in three therapeutic living communities specifically adapted to their needs.

METHODS

Forty-one individuals (mean age: 46.93 years, 43.9% female) with prelingual deafness and mild to moderate intellectual disability participated in structured sign language interviews adapted to their cognitive-developmental level, regarding their QOL, individual spirituality and participation in spiritual practices in the community. Participants' QOL was assessed with an established short measure for QOL (EUROHIS-QOL) adapted to easy-to-understand sign language. With 21 participants, qualitative interviews were conducted. In addition, proxy ratings from caregivers were obtained.

RESULTS

The participants' ratings of their individual spirituality (r = 0.334; p = 0.03) and spiritual practices-in-community (r = 0.514; p = 0.00) correlated positively with their self-reported QOL. Qualitative findings illustrate the importance of R/S and give insights into R/S concepts and practices.

CONCLUSIONS

Personal spirituality and participating in spiritual practices are positively related to self-reported quality of life in deaf individuals with intellectual disability (ID). As a consequence, access to spiritual and religious services should be included in comprehensive programs and society at large.

The role of familiarity with the experimenter on cognitive performance, metacognition, pro-social behaviors, and the well-being of adults with moderate to severe intellectual disabilities

BACKGROUND

Few studies have evaluated the explanatory factors of poor performance and the effects of context in adults with intellectual disabilities. The aim of this study is to assess the role of a familiar experimenter on their cognitive performance, well-being, metacognitive experiences, and social behaviors.

METHOD

Participants with moderate to severe intellectual disability were recruited into two groups, one with a familiar and one with an unfamiliar experimenter. They carried out a categorization task. Before and after they reported their metacognitive experiences and level of well-being. The experimenter observed their pro-social behavior.

RESULTS

Performance and some social behaviors were better when the participant knew the experimenter. However, he did not affect the level of well-being. The participants' metacognitive experiences were poor, whether or not they knew the experimenter.

CONCLUSIONS

The familiarity of the experimenter plays a determining role, both on the participants' performance, and on their compliance with certain pro-social behavior.

Catatonia and Neuroleptic Malignant Syndrome in Patients With Cerebral Palsy: Two Case Reports and a Systematic Review of the Literature

BACKGROUND

Patients with cerebral palsy, a group of movement disorders with motor, communication, and behavioral features that can mimic catatonic signs, could benefit from efforts to improve the detection and treatment of comorbid catatonia. Given that cerebral palsy frequently co-occurs with conditions associated with catatonia, such as autism spectrum disorder, epilepsy, intellectual disability, and mood and psychotic disorders, lifetime prevalence of catatonia in this population may be high.

OBJECTIVE

This study aimed to systematically review the literature on catatonia and the related condition of neuroleptic malignant syndrome (NMS) in patients with cerebral palsy while presenting 2 additional cases of catatonia.

METHODS

We used the terms "cerebral palsy" in combination with "catatoni∗," related terms for catatonia, and "neuroleptic malignant syndrome" to query Ovid MEDLINE (1948 to November 28, 2022), PsycINFO, Cumulative Index to Nursing, and Allied Health Literature, and Embase for applicable case reports. The Neuroleptic Malignant Syndrome Information Service database was also manually searched.

RESULTS

In addition to our 2 catatonia reports, we identified 10 reports of catatonia in patients with cerebral palsy, as well as 8 reports of NMS. Patients with both conditions responded well, and sometimes rapidly, to treatment. Notably, of the 5 patients with catatonia and cerebral palsy who received electroconvulsive therapy, 2 developed recurrent self-limited hyperthermia posttreatment. We also identified several cases of baclofen withdrawal, which can be life threatening because of seizure risk, presenting with NMS-like features in patients with cerebral palsy who had malfunctioning intrathecal baclofen pumps for spasticity management.

CONCLUSIONS

Given frequent comorbidity of conditions associated with catatonia in patients with cerebral palsy, as well as routine treatment with medications that can induce NMS, such as metoclopramide and anticholinergics, catatonia and NMS may be underreported in the cerebral palsy patient population, despite being highly treatable. Possible underdiagnosis of catatonia in patients with cerebral palsy may be because of misattribution of overlapping features between the 2 conditions to cerebral palsy. Clinicians should be aware of possible recurrent self-limited fever when using electroconvulsive therapy to treat patients with catatonia and cerebral palsy while also being vigilant for intrathecal baclofen withdrawal when encountering NMS-like features in patients with cerebral palsy.

Are autistic people disadvantaged by the criminal justice system? A case comparison

LAY ABSTRACT

Most autistic people will never experience being arrested or charged with a crime, however for those who do tend to be less satisfied with the way they were treated. The purpose of this study was to find out if autistic people are being disadvantaged by the criminal justice system if they are arrested. Previous research has shown that autistic people may have difficulties communicating with the police. This study builds on this knowledge by uncovering why autistic people may not feel able to communicate with the police and whether the police made any adjustments to help them. This study also measures the impact of being involved with the criminal justice system on autistic people's mental health, such as stress, meltdowns and shutdowns. The results show that autistic people were not always given the support they felt they needed. For example, not all autistic people had an appropriate adult with them at the police station who could help to make sure they understood what was happening around them. Autistic people were also more likely to feel less able to cope with the stress and more likely to suffer meltdowns and shutdowns because of their involvement with the criminal justice system. We hope this study will help police officers and lawyers to better support autistic people if they become involved with the criminal justice system.

Examining Phenotypic Differences in Gaze Avoidance Between Autism Spectrum Disorder and Fragile X Syndrome

We examined potential phenotypic differences in eye gaze avoidance exhibited by boys with autism spectrum disorder (ASD) and boys with fragile X syndrome (FXS). In Study 1, the Eye Contact Avoidance Scale (ECAS) was administered to caregivers of boys aged 7-18 years with FXS (n = 148), ASD (n = 168), and mixed developmental disabilities (MDD; n = 128). In Study 2, subsets of boys with FXS (n = 31) and boys with ASD (n = 25) received a brief behavioral treatment probe to improve eye contact. Results showed that boys with FXS obtained significantly higher scores on the ECAS compared to boys with ASD and MDD. Exposure to the brief behavioral treatment probe resulted in significant decreases in scores for boys with FXS, but not for boys with ASD.

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.

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.

Formal and Informal Supports for Women With Intellectual and Developmental Disabilities During Pregnancy

This article explores the role of formal and informal supports for women with intellectual and developmental disabilities (IDD) throughout their pregnancy, childbirth, and postpartum experiences. Data from qualitative interviews with women with IDD (n = 16) were analyzed. Results showed that formal supports aided in planning, transportation, advocacy, and providing emotional support throughout pregnancy. Informal supports helped with errands, comfort, and emotional encouragement. The community surrounding these women facilitated communication with providers, self-empowerment regarding health choices, and increased preparedness for parenthood. Findings indicate the importance of encouraging and sustaining both formal and informal supports during pregnancy, childbirth, and postpartum to improve pregnancy and parenting experiences for women with IDD.

The development of the Adapted Firesetting Assessment Scale

BACKGROUND

Treatment for adults who set fires relies upon valid and reliable assessment. Research is needed to ensure self-report measures are available for adults with neurodevelopmental disabilities and that they are robust.

METHOD

Qualitative and quantitative data from three rounds of a Delphi exercise with practitioners and a focus group discussion with adults with neurodevelopmental disabilities were used to generate consensus about the accessibility of item adaptations made to the Fire Interest Rating Scale, Fire Attitudes Scale, and the Identification with Fire Questionnaire.

RESULTS

Findings suggested the accessibility of current measures could be improved to better meet the needs of adults with neurodevelopmental disabilities and adaptations to all questionnaire items were needed.

CONCLUSION

Following feedback, revisions to current measures were implemented leading to the development of the Adapted Firesetting Assessment Scale with improved accessibility for adults with neurodevelopmental disabilities.

Optical Coherence Tomography for Patients with Developmental Disabilities: A Preliminary Study

Dental radiographs are essential for diagnosis and treatment planning, but are sometimes difficult to acquire for patients with developmental disabilities (PDD). Optical Coherence Tomography (OCT) is a non-ionizing imaging modality that has the potential application as an alternative to dental radiographs for PDD. This study aimed to determine the feasibility of intraoral OCT imaging for PDD. Ten participants were recruited in the Dental Education in the Care of Persons with Disabilities (DECOD) Clinic to explore the utility of dental OCT. The prototype system (Yoshida Dental) creates in-depth and three-dimensional images of teeth. The participants indicated their degree of pain during imaging on the Wong-Baker FACES Pain Rating Scale, and the degree of discomfort after imaging on a visual analog scale. OCT can be used for patients with developmental disabilities with minimal levels of pain and discomfort, without ionizing radiation.

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.

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.

The intellectual ableism of leisure research: Original considerations towards understanding well-being with and for people with intellectual disabilities

People with intellectual disabilities (IDs) are considered to be one of the most marginalized, isolated and disenfranchised groups in society. However, recent social prescription intervention programmes are being introduced to enhance the physical and mental well-being of these individuals through participation in leisure activities, thus increasing academic interest in research within the area. This article introduces the theoretical and methodological tensions in applying mainstream scholarly thinking of leisure and well-being to people with IDs and argues that by failing to acknowledge and address such tensions scholars are at risk of demonstrating intellectual ableism. Layering Kleiber's components of leisure over Seligman's Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment concept of well-being, this article poses critical questions of how each contributing element of well-being could be reconceptualized for people with neurological diversities. The intersection of leisure, well-being and ID is ripe for research development; however, many studies in the domain are falling short of suitable theoretical discussion and methodological rigour. This article concludes with suggestions on how scholars can reduce intellectual ableism through inclusive design, methodological reporting, acknowledging bias and grappling theoretical dissonance.

Quality of life and vocational education service quality in students with intellectual disability

The aim of the study was to investigate the relation between subjective quality of life and quality of vocational education services from the view of students with intellectual disability who participate in public special vocational education schools in Greece. The level of quality of life and quality of special vocational education services was explored. The article presents a functional description of service quality in special vocational education and operationalizes quality of life for students with disability. Instruments were developed and adapted in line with the participatory research paradigm. Convenience sampling was used. Data was gathered from 131 students with intellectual disability. All measures showed good evidence of internal consistency and construct validity. The findings suggest relationship between quality of life and quality of special vocational education services received by students with intellectual disability. Low levels of self-determination are highlighted. Practical implications concerning the application of the instruments in special education settings as measures for the quality assessment and the evaluation of educational interventions are discussed.

Assessment of Occupational Health and Job Satisfaction in Workers with Intellectual Disability: A Job Demands-Resources Perspective

In the contexts where people with intellectual disability work, there are factors that determine their job satisfaction. The objective of this study was to test the adequacy of the central assumptions of the Job Demands–Resources (JD-R) theory in workers with intellectual disability employed in different work alternatives. Data from 362 workers in sheltered workshops and 192 workers in supported employment were utilized. The model was contrasted using a structural equation model and a multi-group analysis. The results supported the suitability of the model and confirmed that job demands and job resources evoke two relatively independent processes such as health impairment and motivational process. The multi-group analysis confirmed the invariance of the model between the two work alternatives. Thus, the JD-R model offers a useful framework to explain the job satisfaction of workers with intellectual disability. Implications for the improvement of personal and job results are discussed.

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.

Is it feasible to assess self-reported quality of life in individuals who are deaf and have intellectual disabilities?

PURPOSE

There is consensus that Quality of Life (QOL) should be obtained through self-reports from people with intellectual Disability (ID). Thus far, there have been no attempts to collect self-reported QOL from people who are deaf and have ID.

METHODS

Based on an established short measure for QOL (EUROHIS-QOL), an adapted easy-to-understand sign language interview was developed and applied in a population (n = 61) with severe-to-profound hearing loss and mild-to-profound ID. Self-reports were conducted at two time points (t₁ and t₂), 6 months apart. The Stark QOL, an established picture-based questionnaire, was also obtained at t₂ and three Proxy ratings of QOL (from caregivers) were conducted for each participant at t₁.

RESULTS

Self-reported QOL was successfully administered at both time points for 44 individuals with mild and moderate ID (IQ reference age between 3.3 and 11.8 years). The self-reports showed sufficient test-retest reliability and significant correlations with the Stark QOL. As anticipated, self-reported QOL was higher than proxy-reported QOL. Test-retest reliability and internal consistency were good for self-reported QOL.

CONCLUSION

Reliable and valid self-reports of QOL can be obtained from deaf adults with mild-moderate ID using standard inventories adapted to the linguistic and cognitive level of these individuals.

Interviewing alleged victims with mild and moderate intellectual disabilities and autism: A field study of police-investigated cases of physical and sexual abuse in a Norwegian national sample

BACKGROUND

People with intellectual disabilities (IDs) or autism are at great risk of being victims of physical and sexual abuse. This study uses transcriptions of real-life investigative interviews to examine the interview techniques (e.g. question type) used in investigative interviews of these groups of alleged victims.

METHODS

A national sample of transcribed investigative interviews (N = 96) of alleged victims with mild ID (n = 48, age 5-70 years old), moderate ID (n = 18, age 14-43 years old) and autism (n = 16, age 5-50 years old) was analysed.

RESULTS

The study shows a preponderance of alleged sexual offences (70.7%) and reveals that open-ended questions account for only 2.6% of the total number of questions asked. The interviewers relied heavily on yes/no (53.4%) and directive questions (32.2%). Suggestive questions (8.6%) were frequently used.

CONCLUSIONS

The use of question type varied considerably within and across the diagnostic group. The study reveals the need for a more in-depth analysis of variables that influence investigative interviews of people with cognitive impairments.

Information and communication technology use in daily life among young adults with mild-to-moderate intellectual disability

BACKGROUND

Information and communication technology (ICT) increases participation in life activities, and young adults are frequent users. Young adults with intellectual disability (ID) do not use ICT as much as their peers, and little is known about how ICT is used by young adults with ID. This study describes the use of ICT from the perspective of young adults with mild to moderate ID in a municipal social care context.

METHOD

Semi-structured interviews were used to collect information from 11 young adults with mild-to-moderate ID living in residential care and analysed using a content analysis.

RESULTS

ICT was used for family relationships, daily support, interactions based on interests and amusement, and as support for offline activities. Family members were important providers of support for ICT use.

CONCLUSION

Young adults with mild-to-moderate ID use ICT in their daily life. The social care context needs to be further investigated due to its influence on the young adults' access to ICT and need of support.

The Scottish police caution: do individuals with intellectual disabilities understand a verbally presented police caution, and can comprehension be improved?

This study considers comprehension of the Scottish police caution amongst people with an intellectual disability (n = 30). It applies techniques to the caution that are suggested to increase its 'listenability', to examine whether this could be a successful method of improving understanding. These techniques include providing instructions, further explanations and listing information. Half of the participants were assessed using the original version and half the modified version. Participants were assessed using an abbreviated IQ assessment, a measure of working memory and measure of state anxiety to consider potential predictors of performance. The modified version did not improve performance, with no participants judged to have adequate understanding in either version.

Experience sampling method and the everyday experiences of adults with intellectual disability: A feasibility study

BACKGROUND

Experiences of people with intellectual disability are often reported by proxy, excluding the person's own perception. To assist people with intellectual disabilities ability to communicate their own experiences, the current study explored the feasibility, reliability and validity of experience sampling methods (ESMs) for people with intellectual disability.

METHOD

After a training session, 19 participants carried a mobile device for 7 consecutive days, answering a survey when prompted 7 times daily. Participants were interviewed at the end of data collection.

RESULTS

Excluding incomplete entries, the response rate was 33.8%, varying by living arrangement and employment. Split-half reliability and correlations among logically linked internal experiences demonstrated strong reliability and validity. Illustration of the context of responses supported face validity. Technological and content difficulties were discussed in interviews.

CONCLUSIONS

Experience sampling methods is feasible for some people with intellectual disability, providing valid and reliable information. Future research is needed to further improve feasibility.

Examining the questionnaire on attitudes consistent with sexual offending

BACKGROUND

The Questionnaire on Attitudes Consistent with Sexual Offending (QACSO) is an assessment developed by Lindsay, Whitefield, Carson, Broxholme and Steptoe (2004). The QACSO was designed to assess cognitive distortions relating to sexual offending in males with intellectual disabilities (ID). Cognitive distortions form part of the offence chain in sexual offending and as such require effective assessment and treatment.

METHOD

The QACSO manual and studies utilizing the QACSO were examined.

RESULTS

An overview of characteristics of the QACSO is outlined. The strengths and limitations of the measure are discussed, including validity and reliability of the measure and normative samples.

CONCLUSIONS

The QACSO is a valuable tool in assessing cognitive distortions in intellectual disability sexual offenders. Whilst there are some concerns about validity and reliability which it would be beneficial to address, overall the measure has utility in forensic practice and research, and is unique for being developed specifically for intellectual disability offenders.

Differences in Youth and Parent Postsecondary Expectations for Youth with Disabilities

BACKGROUND

Parent expectations are known to be significant predictors of postsecondary outcomes among youth with disabilities. However, little is known about the relationship between parent and youth expectations and their differential prediction of postsecondary outcomes among youth with disabilities.

OBJECTIVE

To determine the relationship between parent and youth expectations among students with disabilities in the United States.

METHODS

Through analysis of the National Longitudinal Transition Study-2 (NLTS2), we compared wave two parent and youth expectations across disability categories (N=1,940) and explored the extent to which they predicted youth postsecondary outcomes.

RESULTS

We identified that parent and youth expectations are related but significantly different, with parents consistently holding less independent expectations than youth. Both parent and youth expectations were identified as significant predictors of postsecondary outcomes, with youth expectations more strongly predicting education and independent living outcomes, and parent expectations more strongly predicting employment and Social Security benefit outcomes.

CONCLUSIONS

Transition providers should work with parents and youth to develop collaborative goals and expectations to best support youth with disabilities for independent activities in adulthood.

Neighbourhood social inclusion from the perspective of people with intellectual disabilities: Relevant themes identified with the use of photovoice

BACKGROUND

Earlier studies show that to gain more understanding of the concept of social inclusion, the views and experiences of people with intellectual disabilities are needed. The aim of this study was to investigate their perspective on neighbourhood social inclusion from an ecological point of view.

METHOD

We carried out a photovoice study with 18 people with intellectual disabilities in three neighbourhoods in the Netherlands. Participants took photographs in their neighbourhood they considered relevant, and these photographs were discussed during an interview.

RESULTS

Six themes emerged from qualitative analysis: attractiveness of the neighbourhood, social contacts in the neighbourhood, activities in the neighbourhood, social roles in the neighbourhood, independence and public familiarity.

CONCLUSIONS

As regards neighbourhood social inclusion, participants were often focused on small and informal activities and situations. Public familiarity proved very important. Framing the concept of neighbourhood social inclusion within an ecological approach may help to better understand processes of social inclusion.

An investigation of the determinants of quality of life in adolescents and young adults with Down syndrome

BACKGROUND

Young people with Down syndrome experience varying abilities in activities of daily living, cognitive functioning, behaviour and social skills. The aim of this research was to investigate, from a carer's perspective, the factors that influenced the quality of life of these young people.

METHODS

Families of young people with Down syndrome (n = 197), aged 16-31 years, living in Western Australia, took part in a questionnaire study regarding young person daily functioning, family characteristics, medical background and quality of life measured by the Kidscreen 27-item scale. Kidscreen-10 total score was used as an outcome in the investigation of determinants with higher scores indicating better quality of life.

RESULTS

After adjustment for confounders including carer's mental health measured by the Depression and Anxiety Scale (DASS), global impact of illness as well as impact of mental health and bowel conditions were all negatively associated with the young person's quality of life. Young people who had three or more friends had better quality of life than those with no friends. Scores were lower (reflecting poor quality of life) in individuals who had more behavioural problems but these relationships were attenuated after adjustment for confounders and DASS.

CONCLUSIONS

Overall, our findings revealed that quality of life of young people with Down syndrome was most negatively associated with burden of medical conditions, but also with lack of friendships. We were somewhat surprised to find the effect of medical problems on quality of life persisting into adolescence and adulthood where in general the burden of medical comorbidities is much less than in childhood.

Patient-reported outcome measures for young people with developmental disabilities: incorporation of design features to reduce cognitive demands

Use of patient-reported outcome measures (PROMs) may increase the involvement of young people with developmental disabilities in their healthcare decisions and healthcare-related research. Young people with developmental disabilities may have difficulty completing PROMs because of extraneous assessment demands that require additional cognitive processes. However, PROM design features may mitigate the impact of these demands. We identified and evaluated six pediatric PROMs of self-care and domestic life tasks for the incorporation of suggested design features that can reduce cognitive demands. PROMs incorporated an average of 6 out of 11 content, 7 out of 14 layout, and 2 out of 9 administration features. This critical review identified two primary gaps in PROM design: (1) examples and visuals were not optimized to reduce cognitive demands; and (2) administration features that support young people's motivation and self-efficacy and reduce frustration were underutilized. Because assessment demands impact the validity of PROMs, clinicians should prospectively consider the impact of these demands when selecting PROMs and interpreting scores.

WHAT THIS PAPER ADDS

Patient-reported outcome measure (PROM) design features can reduce assessment demands related to cognitive processes. Pediatric PROMs underutilize design features that decrease cognitive demands of self-reporting.

Assessment of job satisfaction in people with intellectual disabilities: Towards best-practice recommendations

BACKGROUND

The current body of research on job satisfaction of people with intellectual disability is based on highly diverse measures, originating both from the general population and people with intellectual disability. This heterogeneity represents a possible confounder. Best-practice approaches for the assessment of job satisfaction are hence needed.

METHOD

Using systematic literature review, job satisfaction measures were identified and analyzed with regard to their applicability for people with intellectual disability. Identified best-practice measures (JDI/JIGS as well as RSM-WS) were subsequently applied in the course of a pilot study with 129 employees of sheltered workshops. Comprehension, reliability and validity were assessed.

RESULTS

The three identified instruments exhibit high reliability and validity. Comprehension was sufficient for JDI and JIGS but better for RSM-WS.

CONCLUSIONS

The JDI/JIGS represent a feasible measures of job satisfaction allowing for comparisons with the general population. In samples with more severe intellectual disabilities, the RSM-WS is preferable.

Item response theory analysis applied to the Spanish version of the Personal Outcomes Scale

BACKGROUND

The study of measurements of quality of life (QoL) is one of the great challenges of modern psychology and psychometric approaches. This issue has greater importance when examining QoL in populations that were historically treated on the basis of their deficiency, and recently, the focus has shifted to what each person values and desires in their life, as in cases of people with intellectual disability (ID). Many studies of QoL scales applied in this area have attempted to improve the validity and reliability of their components by incorporating various sources of information to achieve consistency in the data obtained. The adaptation of the Personal Outcomes Scale (POS) in Spanish has shown excellent psychometric attributes, and its administration has three sources of information: self-assessment, practitioner and family. The study of possible congruence or incongruence of observed distributions of each item between sources is therefore essential to ensure a correct interpretation of the measure. The aim of this paper was to analyse the observed distribution of items and dimensions from the three Spanish POS information sources cited earlier, using the item response theory.

METHOD

We studied a sample of 529 people with ID and their respective practitioners and family member, and in each case, we analysed items and factors using Samejima's model of polytomic ordinal scales.

RESULTS

The results indicated an important number of items with differential effects regarding sources, and in some cases, they indicated significant differences in the distribution of items, factors and sources of information.

CONCLUSIONS

As a result of this analysis, we must affirm that the administration of the POS, considering three sources of information, was adequate overall, but a correct interpretation of the results requires that it obtain much more information to consider, as well as some specific items in specific dimensions. The overall ratings, if these comments are considered, could result in bias.

Pain and Cognitive Functioning in Adults with Down Syndrome

Objective

The aim of the present study was to examine whether cognitive functioning (i.e., memory and executive functioning) is related to self-reported presence of pain (i.e., affirmative answer to the question whether the individual feels pain) and experience of pain (i.e., intensity and affect) in adults with Down syndrome (DS).

Design, Setting, and Subjects

Cross-sectional study of 224 adults with DS (mean age = 38.1 years, mild-severe intellectual disabilities) in the Netherlands.

Methods

File-based medical information was evaluated. Self-reported presence and experience of pain were assessed during a test session, both in rest and after movement (affect with the facial affective scale [FAS], intensity with the numeric rating scale [NRS]). Neuropsychological tests for memory and executive functioning were used.

Results

Participants with lower memory scores were more likely to report the presence of pain, while controlling for age, gender, physical conditions that may cause pain, language comprehension, and vocabulary ( p  = .030, 58.4% classification rate, N  = 154). No statistically significant associations were found between executive functioning and self-reported presence of pain or between cognitive functioning and self-reported pain experience.

Conclusions

Memory seems to be related to the self-reported presence of pain in adults with DS after explicit inquiry, although the clinical use of this model is yet limited. Therefore, further research is needed for insight into the role of cognitive processes in self-report (e.g., involving aspects such as acquiescence and repeated measurements) to evaluate whether neuropsychological examination could contribute to pain assessment in DS.

Developing a Health-Related Quality-of-Life Measure for People With Intellectual Disability

Using principles of community-based participatory research we developed a new theory-based measure of health-related quality of life (HRQOL) for individuals with intellectual disability (ID). We recruited adults with ID (n = 129) to take part in interviews and review successive versions of HRQOL items. Critical input about content and understandability shaped the items, as did input from four focus groups of parents/caregivers (n = 16) and representative stakeholders from community-based agencies (n = 7). The resulting HRQOL measure, called the HRQOL-IDD, contains 42 items. The response format depicts a gradient of fluid-filled cups ("none" to "full") to represent frequency of experience of each item on a 5-point scale.

False confessions

As illustrated by numerous cases in recent years, DNA exonerations of innocent individuals have cast a spotlight on the counterintuitive problem of false confessions. Studying the underlying psychology scientists have found that (1) innocent people are often targeted for interrogation because police make erroneous but confident judgments of deception; (2) certain interrogation techniques-namely, lengthy sessions, presentations of false evidence, and minimization themes that imply leniency-increase the risk that innocent people will confess; (3) certain individuals are particularly vulnerable to influence-notably, those with mental health problems or intellectual impairments, which render them overly compliant or suggestible, and children and adolescents, who exhibit 'immaturity of judgment'; (4) confession evidence is highly persuasive in court as a matter of common sense, increasing perceptions of guilt, even among judges and juries who see the confession as coerced, and even at times when the confession is contradicted by exculpatory information; (5) Miranda rights to silence and to counsel are not sufficiently protective, so proposals for reform have centered on the mandatory recording of interrogations, from start to finish, and a shift toward using investigative interviewing-a less confrontational, less deceptive means of questioning suspects. WIREs Cogn Sci 2017, 8:e1439. doi: 10.1002/wcs.1439 For further resources related to this article, please visit the WIREs website.

Reducing Barriers to Patient-Reported Outcome Measures for People With Cognitive Impairments

The field of rehabilitation has increasingly called for the use of patient-reported outcome measures (PROMs) in research and practice. Given that many rehabilitation patients present with conditions associated with cognitive impairments, it is imperative to reduce barriers to PROM use for this population. The purpose of this article is to develop a comprehensive understanding of cognitive accessibility that can prospectively inform the design of PROMs. We put forth the following definition of cognitive accessibility for PROMs: cognitive accessibility is present when assessment design anticipates respondent variability in cognitive abilities and, to the greatest extent possible, reduces cognitive demands and/or supports cognitive processes to enable respondents with a range of cognitive abilities to interpret and respond to assessment items as intended. Our operationalization of cognitive accessibility in measurement in the field of rehabilitation is informed by 2 assumptions: (1) cognitive accessibility results from an interaction between the individual's capacities and the demands of the assessment and assessment context, and (2) individuals with cognitive impairments have the right to be involved in decisions about their lives, including health care decisions. This article proposes 3 design features that can be optimized for cognitive accessibility: content, layout, and administration procedures. We end with a discussion of next steps that the field of rehabilitation measurement can undertake to advance our understanding of cognitive accessibility.

Alcohol, tobacco and cannabis use: Do students with mild-intellectual disability mimic students in the general population?

Education policies encourage inclusion of students with mild-intellectual disability (mild-ID) in community/school life. However, such policies potentially increase exposure to substance use. This article examines tobacco, alcohol and cannabis use among French students enrolled in special units for students with disabilities (ULIS) at mainstream junior high schools compared to those of general population of the equivalent age; and explores factors associated with substance use among ULIS students, known to present mostly mild-ID. In 2014, a questionnaire adapted from the international HBSC/WHO study was administered to 700 ULIS students (mean-age 14.2). Comparative data were gathered from 7023 junior high-school students (mean-age 13.6) in the general population. Among students <14 years-old, tobacco and alcohol use rates were similar between ULIS and general population. For students ≥14, alcohol use remained comparable, while tobacco and cannabis use were higher in general population. Among ULIS students, low perceived health/life satisfaction, divorced/separated parents and high perceived academic demands were associated with tobacco use. Bullying, not liking school very much and attending schools outside a deprived area were associated with alcohol use. Having had sexual intercourse and not perceiving one's health as excellent were associated with cannabis use. Having dated was associated with using all three substances.

Substance use among individuals with intellectual disabilities living independently in Flanders

BACKGROUND

Over the past decades, there has been increased scientific and clinical interest in substance use among individuals with intellectual disabilities (ID). Despite raised interest and awareness in the topic, lack of supportive data on prevalence and risk factors highlights the need for ongoing research. The aims of this cross-sectional multicenter study were to examine the nature and extent of substance use in individuals with ID living independently, to investigate group differences in substance use and related problems, and to explore the role of substance-related knowledge and attitudes in substance use behaviors.

METHOD

Participants were 123 individuals with mild to moderate ID receiving support from independent living services. Data were gathered by means of a structured interview strategy (i.e. the Substance Use and Misuse in Intellectual Disability-Questionnaire; SumID-Q).

RESULTS

Findings revealed that rates of lifetime use of licit and illicit substances were higher than those found in earlier studies among individuals with ID and the general population. While cannabis use was the only illicit substance reported, current tobacco and alcohol use were shown to be highly prevalent (48%-45.5%). Rates for the latter were similar to earlier studies among community samples of individuals with ID. In contrast to our hypotheses, few group differences in substance use behaviors were observed. Male gender was associated with age of onset of alcohol and tobacco use and tobacco use-related problems, while younger age was found to be associated with lifetime use of cannabis. No evidence was found regarding the role of knowledge; however, smokers and alcohol users rated tobacco and alcohol use more positively.

CONCLUSION

This study demonstrated that individuals with ID living independently use a wide range of licit and illicit substances and present divergent levels and patterns of substance use. Notwithstanding the role of personal choice in substance use, more research is needed to better understand the nature and extent of substance use and related problems, as well as the role of substance-related knowledge and attitudes in individuals with ID.

A systematic literature review of the physical and psychosocial correlates of Special Olympics participation among individuals with intellectual disability

BACKGROUND

Special Olympics (SO) is commonly cited to play an important role in the lives of individuals with intellectual disabilities (ID). The purpose of the current review was to (a) synthesise key findings regarding the physical, psychological/emotional, social and/or intellectual/cognitive correlates of SO participation for individuals with ID and (b) highlight limitations in the extant research as well as directions for future research.

METHOD

A systematic review of electronic databases was undertaken. A total of 46 articles were confirmed to meet study criteria. Quality assessments of included studies were conducted using checklists from the Scottish Intercollegiate Guidelines Network methodology checklists (SIGN 50; SIGN 2008).

RESULTS

There was a larger amount of support for physical, psychological/emotional and social outcomes as compared with cognitive/intellectual outcomes; however, many studies were confounded by measurement difficulties, sampling procedures and a lack of replicable methods, which hinder generalisation of results.

CONCLUSIONS

This review highlights the need for a continued critical focus on SO programme evaluation research with more rigorous and replicable methods.

Job Satisfaction, Quality of Work Life and Work Motivation in Employees with Intellectual Disability: A Systematic Review

BACKGROUND

Current research on employment options for people with Intellectual Disability emphasizes the importance of employee needs and satisfaction. The study aims at systematically reviewing the literature on job satisfaction and related constructs.

METHODS

A systematic literature search was conducted. Studies were included if (i) they are specific to effects of work, (ii) assessed variables are related to job satisfaction, QoWL, attitudes towards work or work motivation and if (iii) studies reported intellectual disability-specific results. Twenty-three studies met the inclusion criteria. Findings were classified according to the socio-cognitive model of job satisfaction.

RESULTS

Current literature suggests high job satisfaction in people with intellectual disability. Predictors of job satisfaction are similar to people without disabilities, albeit the importance of factors differs.

CONCLUSIONS

Stronger consideration of well-established theories and measures from organizational psychology would enhance future research. Findings indicate that high satisfaction ratings might result from lack of control over vocational decisions.

Developing an Easy Read Version of the Adult Social Care Outcomes Toolkit (ASCOT)

BACKGROUND

This study reports the experiences of developing and pre-testing an Easy Read version of the Adult Social Care Outcomes Toolkit (ASCOT) for self-report by people with intellectual disabilities.

METHODS

The study has combined survey development and pre-testing methods with approaches to create accessible information for people with intellectual disabilities. A working group assisted researchers in identifying appropriate question formats, pictures and wording. Focus groups and cognitive interviews were conducted to test various iterations of the instrument.

RESULTS

Substantial changes were made to the questionnaire, which included changes to illustrations, the wording of question stems and response options.

CONCLUSIONS

The process demonstrated the benefits of involving people with intellectual disabilities in the design and testing of data collection instruments. Adequately adapted questionnaires can be useful tools to collect information from people with intellectual disabilities in survey research; however, its limitations must be recognized.

Experiences of patients with intellectual disabilities and carers in GP health information exchanges: a qualitative study

BACKGROUND

Accurate health information exchange (HIE) is pivotal for good quality of care. However, patients with intellectual disabilities (ID) face challenges in processing and exchanging health information around GP consultations. Knowledge of HIE barriers and facilitators, including the roles of carers, may help to improve GP care for people with ID.

OBJECTIVE

To gain more insight into HIE barriers and facilitators for ID patients in GP care.

METHODS

A qualitative study exploring GP consultation experiences of people with ID (n = 35), professional carers (n = 20) and relatives (n = 15). Transcripts from interviews and focus groups were analyzed using a framework analysis approach.

RESULTS

Analyses resulted in four themes: (i) Recognizing patient health needs; (ii) Impaired doctor-patient communication; (iii) Carers' mediating roles during consultations; and (iv) Patients' autonomy and self-determination. Barriers related to communication skills, lack of time, continuity of carers and physicians, information alignment between relative or professional carer and the GP, and information transfer and recording within the patient network. Facilitating factors related mainly to carer interventions, personal connections with patients and GP communication with patients and carers outside the consultation.

CONCLUSION

There is considerable HIE potential in patients themselves, as well as in their network, although many barriers have to be overcome to profit from this. GP practices are recommended to adjust consultations and communication practices and to facilitate deployment of the patient's network, while still considering patient autonomy.

Effect of Type of Survey Administrator on Consumer Assessment of Care

This study evaluated the possible effects of peer, unit staff, and quality management staff survey administrators on item means of the inpatient version of the Consumer Assessment of Care, a 14-item mental health service satisfaction survey developed by the New York State Office of Mental Health and administered at South Beach Psychiatric Center. Of 511 inpatients who completed the survey, 215 were administered by unit staff, 156 by consumers, and 140 by quality management staff. Each subgroup used a mixed-mode administration method for consecutive 6-mo. periods. Reliability and factor analysis indicated the survey was psychometrically robust. Item means for the types of administrator were significantly different. Tukey HSD multiple-comparisons indicated that item means were significantly higher for unit staff administrators than peer and quality management staff administrators, which did not differ from each other. Response set, acquiescence, or socially desirable responding may elicit higher item means for unit staff administrators.

"Teaches People That I'm More Than a Disability": Using Nominal Group Technique in Patient-Oriented Research for People With Intellectual and Developmental Disabilities

Individuals with intellectual and developmental disabilities (IDD) have complex healthcare needs, which are often unmet. Nominal group technique (NGT) uses a mixed-methods approach, which may engage the IDD population in the research process in a person-centered manner and address the shortcomings of traditional research methods with this population. NGT was used with a group of 10 self-advocates to evaluate a series of healthcare tools created by and for individuals with IDD. Participants provided helpful input about the strengths of these tools and suggestions to improve them. NGT was found to be an effective way to engage all participants in the research process.

Communicating with Patients with Special Health Care Needs

People with special health care needs (PSHCN) often have difficulty communicating with providers in health care settings, including dental practices. This difficulty can affect access to care as well as the quality of care received. This article provides practical tips and tools dental professionals can use to facilitate communication for a diverse population of PSHCNs. The article discusses communication needs of patients with communication disorders; augmentative and alternative communication; and communication for patients with intellectual disability, psychiatric conditions; and dental fears. Examples are given of communication breakdowns, and descriptions of how communication challenges can be resolved.

The Diagnostic Guideline for Anxiety and Challenging Behaviour for Persons with Intellectual Disabilities: Preliminary Outcomes on Internalizing Problems, Challenging Behaviours, Quality of Life and Clients' Satisfaction

BACKGROUND

People with intellectual disabilities are vulnerable to develop psychopathology (in particular anxiety) and related challenging behaviour. A diagnostic guideline was developed to support professionals to better diagnose and thus treat psychopathology and related CB. This study examined preliminary outcomes from the application of this guideline.

METHOD

A comparative multiple case study with an experimental and a control condition.

RESULTS

The application of the guideline showed a trend of decreases of internalizing problems (P = 0.07) and anxiety/depressed problems (P = 0.09). We found no statistically significant decreases of externalizing problems and no increases in perceived quality of life as compared with care as usual. Clients were not more satisfied with the support they received for coping with their emotional and behaviour problems.

CONCLUSION

The application of the Diagnostic Guideline for Anxiety and Challenging Behaviour did not show statistically significant changes in externalizing problems and Quality of Life. Despite the small sample size of n = 59, we did find a trend in decreasing internalizing problems and anxiety/depressed problems. Further research into either or not confirming these trends is recommended.