Journal of Intellectual Disability Research最新文献

Background

Stigma towards persons with intellectual disabilities remains a significant barrier to their inclusion and access to healthcare. Mental health professionals (MHPs) play a crucial role in providing appropriate support for people with intellectual disabilities, and their attitudes can influence the quality of care and access to mental health services for this population. This study aims to evaluate the attitudes of Chilean MHPs towards individuals with intellectual disabilities.

Methods

A cross-sectional study was conducted with 121 MHPs in Chile. Participants completed the Attitudes Toward Intellectual Disability Questionnaire–Short Form (ATTID-SF), assessing five dimensions: discomfort, knowledge of capacity and rights, interaction, sensitivity/tenderness and knowledge of causes. Descriptive statistics, correlation analyses and ANOVAs were used to examine differences in attitudes based on sociodemographic variables and prior experience with individuals with intellectual disability.

Results

Overall, participants exhibited positive attitudes towards individuals with intellectual disability. However, certain concerns persisted, particularly regarding their capacity to handle finances and parenthood. Psychiatrists demonstrated greater knowledge of causes than psychologists. Women reported higher levels of sensitivity/tenderness than men. Previous contact with individuals with intellectual disability was associated with more positive attitudes. Participants expressed more negative attitudes towards individuals with higher support needs.

Conclusions

While Chilean MHPs generally exhibit positive attitudes towards individuals with intellectual disability, gaps in knowledge and lingering biases highlight the need for enhanced training. Increasing direct contact in clinical practice and promoting interdisciplinary education may help reduce stigma and improve mental health service accessibility for this population.

Background

The use of instruments developed for people with autism spectrum disorder (ASD) and intellectual and developmental disabilities (IDDs) is recommended for assessing mental health in these groups. This is the first study to investigate the structural validity and internal consistency of the Psychopathology in Autism Checklist (PAC) among autistic children and adolescents with IDDs.

Methods

A total of 600 children aged 2–19 years (M = 9.2 years, SD = 4.5 years, 66% male) with IDDs (full-scale IQ M = 81.29, SD = 18.65) participated, including 194 individuals with ASD. Parents completed the PAC, Strengths and Difficulties Questionnaire (SDQ) and Vineland Adaptive Behaviour Scales (VABS). Full-scale IQ was assessed using an individualised intelligence test, and the extent of autism characteristics was assessed using the Autism Diagnostic Observation Schedule-2.

Results

Confirmatory factor analyses revealed acceptable fit indices for a three-factor solution. The internal consistency was adequate for most of the PAC subscales. The PAC showed meaningful overlap and differentiation with the SDQ, VABS, measures of intellectual functioning and a measure of autism symptoms.

Conclusions

Overall, satisfactory internal consistency and validity were found for the PAC (with the exception of the psychosis subscale). These findings provide preliminary support for the use of the PAC in children and adolescents with ASD and IDDs.

Background

This paper examines clinical outcomes of an approach to referrals for concerns about severe behavioural distress in people with intellectual disabilities (ID) that is based on the concepts of emotional development (EDev) and attachment. Due to research and clinical experiences suggesting that positive behaviour support (PBS) may have limited long-term impact, an alternative approach is proposed, which focuses on relational factors and emotional skills already held by carers.

Methodology

We report the process and outcomes of a brief standardised assessment using the Scale of Emotional Development–Short (SED-S) which then informed an attachment-based workshop. Outcomes were measured by way of the Health of the Nation Outcome Scales–Learning Disabilities (HoNOS-LD) administered at (a) assessment, (b) following 1–2 intervention workshops and (c) at 6-month follow-up.

Results

Significantly fewer sessions and hours of clinical time were required for the EDev intervention than the prior PBS interventions. Results demonstrated significant improvements from assessment to post-intervention, which were maintained 6 months later. Almost half (48%) of the participants were referred while in unsettled accommodation arrangements.

Conclusions

This study provides initial evidence supporting an approach that shows promise as an alternative to existing models of care based upon applied behaviour analysis. Future well-controlled studies across multiple sites are needed, but if these findings are replicated, the priority for intervention may shift from reduction in behavioural risks to robust care relationships which meet the person's emotional needs.

Introduction

People with intellectual disability (ID) face increased vulnerability to addictive behaviours, yet effective interventions are under-researched. This study aimed to systematically review existing interventions for substance use and problem gambling in this population.

Methods

Following PRISMA guidelines, we searched Web of Science, PsycINFO and CENTRAL for studies on substance use or gambling tailored for people with ID. Two independent reviewers synthesised the data and assessed the methodological quality using established tools.

Results

Sixteen studies were included: three randomised controlled trials (RCTs), six non-randomised trials and seven case studies. Most studies involved small samples of male adults with mild ID, focusing on tobacco (n = 6), polydrug use (n = 5), alcohol (n = 3), opioids (n = 1) or gambling (n = 1). Mindfulness-based therapy and cognitive behavioural therapy combined with motivational interviewing showed promising results for reducing tobacco and alcohol use in people with ID. Short-term benefits were observed for alcohol and cannabis use, though impacts on severity were unclear. Psychoeducation was frequently integrated with behavioural techniques, contributing to reduced substance use through enhanced awareness and knowledge.

Conclusions

The evidence for interventions targeting substance use and gambling in individuals with ID remains limited. A meta-analysis was not possible due to insufficient data, though single-case designs provided valuable insights. More rigorous and comprehensive research is needed to better understand and improve intervention strategies for addressing substance use and gambling problems in people with ID.

Trial Registration: PROSPERO CRD42023477296

Background

Previous research has shown that older adults with intellectual disabilities are at increased risk of cardiovascular diseases (CVD). However, longitudinal studies investigating the actual incidence of CVD and its associated risk factors in this population are limited. Such research is essential for optimising healthcare delivery and informing effective resource allocation. Therefore, this study aimed to examine CVD incidence in older adults with intellectual disabilities and explore its associations with participant characteristics and risk factors.

Method

A prospective longitudinal study was conducted in older adults (≥ 50 years) with intellectual disabilities as part of the Healthy Ageing and Intellectual Disabilities study. Baseline measurements were performed in 2009–2010, with follow-up assessments, including medical record reviews, in 2020–2023. Incidence rates for myocardial infarction (MI), heart failure (HF) and stroke were calculated by sex and 10-year age categories. Competing risk analysis was performed to examine the associations between CVD diagnoses during follow-up and baseline participant characteristics/CVD risk factors, accounting for mortality as a competing risk.

Results

Among 598 participants (62.0 ± 8.5 year; 49.3% female), with a mean follow-up of 8.6 years, incidence rates were 2.3 per 1000 person years for MI, 7.2 for HF, and 5.3 for stroke. Hypertension (HR 3.17; p < 0.001), Down syndrome (HR 2.66; p < 0.01) and antipsychotic use (HR 1.98; p = 0.04) were associated with an increased CVD risk during follow-up.

Conclusions

A lower incidence of MI and similar to higher incidence of HF and stroke were found in older adults with intellectual disabilities than in the general population. Further research, including a focus on the association of CVD incidence with Down syndrome, is needed. Meanwhile, proactive assessment and management of CVD risk factors, such as hypertension and antipsychotic use, are important for improving cardiovascular health in older adults with intellectual disabilities.

Background

In 2015, the Building the Right Support programme was launched for England in an attempt to reduce the number of psychiatric inpatients with intellectual disabilities and/or autism by 35%–50%. This target, and subsequent targets, were missed, and for 2025–2026, the government further committed to reducing numbers by 10%. Considering these continued targets, we aimed to investigate psychiatric bed utilisation over time, and to further understand factors that may influence psychiatric admissions and discharges of people with intellectual disabilities and/or autism, by utilising time series modelling with national English data to explore the relationship between a set of chosen sociodemographic, clinical and service-related predictor variables and the following outcome variables: (1) total monthly number of hospital spells, (2) total monthly number of discharges, (3) total monthly number of admissions, (4) ratio of community to non-community discharges, (5) number of inpatients with a length of stay under 2 years, (6) number of patients with a length of stay over 2 years and (7) total number of distinct individuals who had been subjected to restraints.

Methods

Using data from the publicly available Mental Health Services Data set, we utilised linear regression (with moving average or auto-regressive errors) to examine the relationships between variables over time, from February 2013 to January 2024.

Results

Over time, the number of inpatients decreased by an average of 4.55 patients per month. The number of inpatients with a length of stay greater than 2 years reduced over time. Periods of time when the number of inpatients was greater were associated with more inpatients under the age of 18 years. Periods of time when hospital stays, admissions and discharges were higher were associated with fewer White inpatients relative to non-White inpatients. Periods of time with more patients detained under Part II of the Mental Health Act were associated with more admissions and the increased use of restraint.

Conclusions

Over the last 11 years, the planned closure of psychiatric inpatient beds has been unsuccessful. Our findings indicated that periods of increased psychiatric bed utilisation were associated with more admissions of younger people, non-White inpatients and those likely to be experiencing a crisis. Future research should explore how psychiatric beds can be utilised more effectively alongside co