Suchergebnisse

Background  Work is an aspiration for many people with intellectual disability and is regarded as a vital goal by policy‐makers in pursuit of social inclusion. The aim of this study was to consider the impact of supported employment on the socio‐emotional well‐being of people with intellectual disabilities.Method  A systematic search was conducted. The review included case‐controlled and longitudinal studies measuring outcomes for: (1) quality of life (QOL), (2) social life and (3) autonomy.Results  While results for QOL, well‐being and autonomy were largely positive, there was a lack of perceived social acceptance. The findings are interpreted in the light of methodological strengths and weaknesses.Conclusions  Implications for the socio‐emotional support required by some individuals in employment, and directions for future research are discussed.

Background  It is striking that although cognitive behavioural therapy was developed to treat depression in the general population, there remains a paucity of research concerning its application to people with intellectual disabilities. Recent research points to the importance of understanding people's distress in the context of their particular life experience.Areas to be addressed  This paper examines how the life experience of people with intellectual disabilities may influence the nature of their self‐perceptions and their vulnerability to depression. In addition to considering the impact of experience on the content of participants' self‐perceptions, evidence concerning the mediating role played by cognitive factors in the genesis and maintenance of depression is also reviewed.Conclusions  These strands of research are discussed in the light of existing CBT models of depression, along with potential adaptations of interventions for people with intellectual disabilities.

AbstractBackgroundEvidence and awareness of the importance of culturally adapting psychosocial interventions is growing. The aim of this paper is to systematically review studies on cultural adaptations of psychosocial interventions for parents and their children with intellectual disabilities, in low‐ and middle‐income countries.MethodsStudies were identified through electronic databases and searching bibliographies. The quality and cultural adaptations of thirteen studies focusing on parental trainings were analysed using standardised tools and frameworks.ResultsFindings suggest interventions reduce the risk of depression and stress and increase coping strategies and positive perceptions of family functioning. Parenting skills training may improve parent–child interactions and child development. However, these benefits should be interpreted cautiously due to methodological shortcomings. Most studies described efforts to make appropriate cultural adaptations to the interventions, but these adaptations were not comprehensive.ConclusionHigh‐quality cultural adaptations are crucial to providing meaningful interventions in different parts of the world.

Background  This paper focuses on the transition to supported employment for people with intellectual disabilities paying particular attention to the impact of job breakdown on psychological well‐being; an issue often omitted from studies.Materials and Methods  Forty‐nine people with intellectual disabilities were interviewed within 3 months of entering supported employment and 9–12 months later. Data collection involved in‐depth interviews with people with intellectual disabilities, their carers and employers and completion of a self‐report measure of depression and anxiety (an adapted form of the Hospital Anxiety and Depression Scale), and a self‐report measure of quality of life (the ComQol).Results  By time of the follow‐up interviews, 13 of the 49 jobs had broken down. Analysis of scores measuring quality of life, anxiety and depression showed no effect for loss of employment. However, interviews with participants indicated that job loss had a considerable impact on those affected.Conclusions  There were a wide range of reasons for job breakdown, many of which were particular to the circumstances of people with intellectual disabilities. Although job breakdown does not have an impact of anxiety or depression many participants found job loss traumatic.

Background  Recent studies have suggested that cognitive biases may play an important mediating role in aggressive outbursts from people with mild intellectual disabilities (IDs). Essentially, some individuals may frequently perceive other people as acting towards them in a hostile fashion. This biased perception may develop through repeated adverse experiences, and may make them more likely to respond, likewise, in an aggressive manner. These studies have led to the development of a cognitive behavioural model of aggression, incorporating factors both intrinsic and extrinsic to the individual. This study aimed to explore one facet of this model: a putative relationship between anger‐arousal level, problem‐solving ability and perception of hostile intent in others.Method  Single‐case methodology was utilized, and a 44‐year‐old man with a mild ID and a history of difficulties with aggression participated. A series of vignettes, containing potentially provocative social interactions, were read to the participant. His perception of hostile intent, and suggestions of possible behavioural responses were recorded as dependent variables. Anger‐arousal was manipulated, through autobiographical recall, as a dependent variable.Results  Although not conclusive, results indicate that anger‐arousal may act in an interactive fashion to increase perception of hostile intent. No effect of anger‐arousal was observed on problem‐solving ability; however, floor‐effects in the task used may provide an explanation for this.Conclusions  A high level of anger‐arousal may exacerbate the probability of a frequently aggressive individual perceiving others as acting in a hostile manner. However, future research should take the limitations of this study into account, and continue development of a cognitive model of frequent aggression in those with a mild ID.

AbstractPrior to the start of the pandemic, adults with intellectual disability (ID) were more likely to experience mental health difficulties and face barriers obtaining mental health care. COVID‐related public health restrictions, combined with heightened challenges to obtain timely mental health care, have served to worsen this situation internationally, with a combination of new onset conditions and worsening mental health for those already struggling. In this narrative review, we summarize literature on the mental health of adults with ID during the COVID‐19 pandemic to describe what is known based on clinician perceptions, existing administrative health data, family and staff perceptions, and self‐report. In addition to noting similarities and differences in findings based on the source of information, we also explored how experiences differed depending on where and when the research was conducted. Based primarily on research conducted during the first six months of the pandemic, there is a consistent finding across sources of increased anxiety, stress, and isolation. This review also explored the delivery of virtual mental health care and the impact of pandemic‐based mental health interventions. There have been very few research studies evaluating clinical care during this time but clinicians have managed to provide supports virtually, which has been evaluated positively by some individuals. This narrative review concludes by identifying gaps in the literature and suggests key directions for future mental health research, policy, and practice efforts. Any mental health efforts now and during pandemic recovery need to have an understanding of how the mental health needs and services for adults with ID have evolved over the course of the pandemic. Further research is needed on the impact of both clinical interventions and other nonclinical efforts on the mental health of people with ID.

Background  Employment is viewed by policy makers as both a human right and as a means of changing the marginalized status of people with intellectual disabilities, with important social and emotional benefits. However, there has been little longitudinal research examining the experience of people with intellectual disabilities in the workplace.Methods  Thirty‐five individuals with mild to borderline intellectual disabilities participated in this study. They were recruited from supported employment agencies in Scotland. A longitudinal approach was adopted, with the participants being interviewed around the time of starting their jobs, and again 9–12 months later.Results  The content analyses of the semi‐structured interviews indicated that the participants perceived continuing benefits from entering mainstream employment, including more purposeful lives and increased social status. However, over the follow‐up period the participants reported few social opportunities that extended beyond the workplace, and an anxiety about their competence to meet employers' demands remained a concern for some.Conclusions  The discussion addresses the importance of understanding work in relation to the participants' wider lives, along with the longer‐term role for supported employment agencies to help people achieve their social and emotional goals in a vocational context.

AbstractBackgroundAt the start of the COVID‐19 pandemic, some parents in the Netherlands decided to bring their offspring with intellectual disabilities, who normally live in residential care, home. The present study explored why the mothers decided to bring their offspring home.MethodInterviews were carried out with seven mothers of adults with intellectual disabilities. An interpretative phenomenological approach was used to establish in‐depth accounts of the mothers' experiences.ResultsThe analysis yielded three overarching themes: (a) Families are indispensable; (b) the complex role of being a mother of a child with intellectual disabilities; and (c) Who is looking out for our offspring during COVID‐19?ConclusionsThe mothers experienced a strong sense of wanting to do what was best for their offspring with intellectual disabilities during COVID‐19. The study provides insight into why mothers remain involved in the care for their offspring and the complexity of navigating lifelong care responsibilities.

BackgroundThe role of support workers and other professionals in the psychotherapeutic process has been commented upon but not as yet been systematically investigated.MethodTo explore their views and expectations of cognitive behaviour therapy (CBT) for adults with intellectual disabilities, eleven paid support workers and professionals were recruited and interviewed before the CBT sessions commenced for their service users and nine took part in the second interview that took place after nine sessions.ResultsThematic Analysis of the interview transcripts indicates that staff members do not perceive CBT as a long‐term solution for psychological problems have little knowledge of CBT and do not feel included in the process. Nevertheless, after nine sessions, most participants reported improved psychological well‐being for their service users and expressed a wish for longer‐term involvement of the therapist.ConclusionsThe results suggest that for CBT to be effective in the longer term, the therapist is required to consider a wider systemic approach including staff training and supervision, staff and management consultancy and creating a delicate balance between confidentiality and sharing the psychological formulation with 'significant others' to ensure maintenance and generalisation of improved psychological well‐being.

AbstractBackgroundPeople with severe to profound intellectual disabilities experience similar or higher levels of depression than those with more mild intellectual disabilities. Yet, there is an absence of evidence about how to adapt existing psychological therapies for this population.MethodA behavioural activation intervention (BeatIt) for people with mild to moderate intellectual disabilities was adapted for people with severe to profound intellectual disabilities and depression. Key considerations include: (i) beginning with a more in‐depth assessment process; (ii) including the person in session activities and developing a relationship with them; (iii) formulation and the use of film to document the link between activity and mood; and (iv) addressing barriers to change at an individual and inter‐personal level and considering how the carer could support the person's engagement in activity.ResultsSuccessfully adapting BeatIt represents a first step towards gathering evidence about the effectiveness of behavioural activation for people with severe to profound intellectual disabilities.

AbstractBackgroundIn the general population, the transition from adolescence to adulthood has been identified as a "high‐risk" period for weight gain. There has been no research examining health behaviours over this transition in adults with intellectual disabilities.Methods/designThe feasibility of recruitment, retention and relevant health behaviours were measured in 31 adolescents with mild‐moderate intellectual disabilities. Anthropometric, objective physical activity, dietary and self‐determination measures were collected over a 12‐month transitional period from school to adulthood.ResultsKey results suggest weight and BMI increased significantly from month 6 to month 12 (p = 0.044 and p = 0.043). Waist circumference increased significantly from baseline to month 12 (p = 0.049), and from month 6 to month 12 (p = 0.03).DiscussionRecruiting and retaining young adults with intellectual disabilities over a 12‐month health behaviour study is feasible. The data indicate the transition from school to adulthood may be the start of a high‐risk period for weight gain.

BackgroundThe prevalence of obesity is higher in those with intellectual disabilities than the general population. The aim of the study was to understand the determinants of physical activity and dietary patterns in this population during their final year of school.MethodQualitative data were generated from 10 interviews with adolescents with mild–moderate intellectual disabilities. Data were analysed using deductive thematic analysis, employing Self‐Determination Theory as a theoretical framework.ResultsAdolescents' environment and social interactions play a pivotal role in influencing physical activity and dietary patterns. Three themes emerged from the analysis: situatedness, motivation and wider environmental influences.ConclusionsSchool structure, high self‐efficacy and social connectedness facilitate increased physical activity and healthier diet in adolescents with intellectual disabilities. Home life, low self‐efficacy and a lack of social connectedness can serve as a barrier to PA and a healthy diet.

AbstractPartly due to a lack of evidence‐based methods to support people with intellectual disability (ID) and challenging behavior, their needs are often poorly met. One way to generate rapid evidence is to systematically describe and monitor interventions that are considered to be "good practice"—to develop evidence based on practical knowledge. This study describes the Dutch practice‐based intervention Triple‐C (Client, Coach, Competence). The intervention was developed in practice to support people with severe ID to borderline functioning and challenging behavior. The practice‐based nature of Triple‐C means that many of the professionals' actions or activities are often underpinned by their implicit knowledge about the intervention they are delivering. Consequently, as the emphasis is on practice, the professionals can find it difficult to articulate how the intervention is operationalized and positive change achieved. This study aimed to assess the practical knowledge of Triple‐C professionals and to develop an understanding of the mechanisms of change for Triple‐C to improve understanding and to inform future research about the intervention. Through an iterative process, a logic model was developed to describe the intervention and its underlying assumptions. The development of the logic model was shaped using interviews with the founders, focus groups with support staff, psychologists, managers and members of the board of a service provider, and the analysis of published accounts of the Triple‐C intervention. Data gathered from these sources were analyzed using content analysis. The logic model of the Triple‐C intervention provides insight into the key elements of the approach, such as the need for unconditional supportive relationship and carrying out meaningful activities. Moreover, the potential relationship with existing evidence‐based interventions such as Positive Behavioral Support and Active Support are described. Defining the underlying logic of a practice‐based intervention like Triple‐C is an important first step toward producing an evidence base for interventions developed from clinical practice.

AbstractBackgroundTo enhance social inclusion of people with intellectual disability, policy is aimed at increasing informal support networks. Nevertheless, staff continue to play a vital role in their support networks.MethodSix individuals with mild intellectual disability, living in community‐based settings, were interviewed following a semi‐structured format. In‐depth accounts of participants' support experiences were established using Interpretative Phenomenological Analysis.ResultsThree main themes were identified: relationships with staff placed within a personal history, relationships with staff within an organisational context, and staff support and interviewees' place in the world.ConclusionsRelationships with staff were often one of the closest and most significant social relationships participants had. As living in the community had not necessarily led to meaningful inclusion for participants, the findings point at the important role of staff in supporting and facilitating friendships and close relationships of people with intellectual disability.

AbstractBackgroundInformal supportive networks of individuals with intellectual disability have become increasingly important. The aim of this paper is to describe how the Family Network Method – Intellectual Disability (FNM‐ID) offers a way to gather the perspective of people with mild intellectual disability on their family support.MethodThe FNM is designed to explore how individuals define their family contexts, and more specifically how they perceive existing supportive relationships in these contexts.ResultsBy carefully piloting ways of questioning people with mild intellectual disability, systematic adaptations were made to the original FNM. Data obtained by the FNM‐ID can be analysed using social network analysis. Thereby, the FNM‐ID provides rich, theoretically significant information on emotional support in the family networks of individuals with mild intellectual disability.ConclusionsThe FNM‐ID is a useful and successfully adapted tool for other researchers and professionals to systematically explore the family support experiences of individuals with mild intellectual disability.