Tizard Learning Disability Review最新文献

Purpose

Autistic children, particularly those with an intellectual disability, often face difficulties with early verbal development and social interaction. The science of behaviour analysis has developed procedures shown through research to help support and teach these skills. Interventions focusing solely on manipulating the antecedent stimuli in the environment are presented less frequently in the literature than those concerned with response consequences. This study aims to evaluate if changes to the classroom environment would evoke prosocial behaviours during play sessions.

Design/methodology/approach

A multiple treatment reversal design was used to compare the presence of anthropomorphic toys, pet animals and toys themed upon preferred interests, introduced on a central table within the existing play area. Data were collected on the social behaviour of peers in two primary classrooms.

Findings

For five of the six participants, all three conditions resulted in increased social behaviour compared to baseline conditions.

Originality/value

At the time of the study, social interaction opportunities were limited due to the COVID-19 pandemic restrictions, placing greater emphasis on safely encouraging opportunities within the classroom to ensure skill maintenance. Due to the reported outcomes, educators, particularly in specialised settings, should focus on evaluating their classroom environment to ensure the contents and layout support children in maintaining and generalising their social skills. Further research on the benefits of class pets is also encouraged.

Purpose

This paper aims to explore using the children’s accelerated trauma technique (CATT) in an adult intellectual disability population, with the aim of reducing symptoms of post-traumatic stress disorder (PTSD).

Design/methodology/approach

A service evaluation was completed to investigate differences between pre- and post-CATT trauma scores.

Findings

Scores on a measure of PTSD decreased significantly following CATT.

Practical implications

The findings support continued use of CATT in adults with intellectual disabilities, and they highlight the need to evaluate effectiveness in a larger sample.

Originality/value

This paper evaluates the novel application of a trauma treatment – developed for use with children – in an adult intellectual disability population and adds to the existing evidence base.

Purpose

This paper aims to explore the challenges and themes discussed in the associated article “The Effects of Changing the Classroom Play Environment on the Peer Interactions of Autistic Children with an Intellectual Disability.” It expands on the research's context, foundation and potential impact, critically analysing the evidence on this topic.

Design/methodology/approach

This commentary evaluates the perceptions and effectiveness of different classroom play environments for autistic children with intellectual disabilities, using a multiple treatment reversal design (ABACADA) to investigate how various play conditions impact prosocial behaviours.

Findings

The inclusion of toys related to preferred interests, such as anthropomorphic toys and small animals, promotes engagement and social interactions. The commentary highlights common barriers, but the study’s results are encouraging. Further investigation could benefit clinicians and educators in optimising classroom setups for applied practice. Potential solutions to barriers are considered.

Originality/value

The value and design of classroom play environments for autistic children with intellectual disabilities remain debated. This commentary provides a balanced, evidence-based perspective on how specific stimuli can enhance prosocial behaviours, contributing to ongoing discussions on inclusive and supportive educational practices.

Purpose

This study aims to investigate the experiences of frontline managers supervising and developing staff to support autistic adults living in two types of residential housing in the community.

Design/methodology/approach

A qualitative approach used semi-structured interviews with 14 frontline managers. Audio-taped material was transcribed and analysed using thematic analysis.

Findings

Two main themes emerged. Theme 1 “autism in practice” illustrates commonalities observed to affect autistic adults with learning disabilities receiving staff support; whilst one sub-theme illustrated the diversity in how these commonalities may be experienced and expressed, another focused on participants’ experiences of staff concerns regarding behaviours described as challenging. Theme two, “what’s important in autism-informed support” reflected participants’ perceptions of the features of successful person-centred staff support for autistic service users.

Research limitations/implications

The “rich” experiences of these managers may not be readily generalised.

Practical implications

Features of good staff support for autistic adults who may show behaviours of concern included attending to individuals’ specific communication and sensory needs and for predictability within their environments. Developing staff skills and confidence to implement skilled approaches in the context of often high risk behaviour of concern took time and frontline managers “on site” to observe, coach, mentor and demonstrate good practice. More intellectually (verbally) able service-users were perceived as more “difficult” to support.

Social implications

Staff supporting autistic adults in ordinary housing need frontline managers to act as practice leaders rather than administrators.

Originality/value

This study is the first to report, to the best of the authors’ knowledge, on management for staff supporting autistic adults living in community housing.

Purpose

This paper aims to provide a commentary response to “Stakeholder experiences of deprescribing psychotropic medicines for challenging behaviour in people with intellectual disabilities”.

Design/methodology/approach

The commentary provides some evidence-based perspectives on the risks and challenges of psychiatric drug-withdrawal, emphasising the importance of the patient experience in deprescribing decisions. It also makes the case for clinical clarity and carer-engagement in optimising deprescribing outcomes for individuals. Some clinical reflections are provided.

Findings

Whilst efforts to reduce the overmedication of people with learning disabilities are welcomed, there is lacking evidence around this population’s experience of adverse effects from psychiatric deprescribing decisions, including differentiating between withdrawal and relapse effects. Clinical clarity and carer engagement are key to safe and effective prescribing, although in reality, this can be challenging.

Originality/value

This paper will be of value to all professionals with a role in the effective deprescribing of psychiatric medications with and/or for people with intellectual disability. It provides perspectives on aspects of stakeholder experience that warrant further consideration and research.

Purpose

The purpose of this paper is to expand upon some of the issues raised in “An evaluation of a speech and language therapy eating, drinking and swallowing service for adults with intellectual disability” (Crocker et al., 2024).

Design/methodology/approach

This commentary outlines considerations for multidisciplinary team working and professional roles both within and beyond the community learning disability team. It discusses models of service delivery and competency frameworks relating to eating, drinking and swallowing services.

Findings

Services should be integrated, include a broad multidisciplinary team and aim to increase competency in all contexts supporting people with eating, drinking and swallowing needs. Outcomes of service provision need to be measured outside of individualised care.

Originality/value

This paper broadens the discussion of quality of eating, drinking and swallowing services beyond speech and language therapy and considers a whole systems approach.

Purpose

There is a sparsity of research that considers how to overcome implementation challenges for interventions in special school settings where specialist teaching methods are involved. Successful implementation has often relied on considerable researcher involvement, making them inaccessible and not sustainable for the majority of special schools. The purpose of this study was to implementa train-the-trainer approach to train teaching staff to use the Teaching Early Numeracy to Children with Developmental Disabilities (TEN-DD) programme in a large special school in the UK, thereby significantly reducing researcher involvement in its implementation.

Design/methodology/approach

One staff member was trained to become the school lead for TEN-DD and trained other teaching staff in the school on implementation. This study recruited 13 students aged between 12 and 16 years of age with developmental disabilities to receive TEN-DD. Pre- and post-intervention tests on a standardised numeracy measure were conducted.

Findings

A train-the-trainer model was developed and successfully delivered to train teaching staff in TEN-DD. A standardised outcome measure indicated that ten students made improvements to their numeracy skills after teachers trained using this approach delivered TEN-DD for between 3 and 10 months.

Originality/value

Very little research has been carried out to better understand methods for overcoming implementation challenges for delivering evidence-based teaching programmes at scale to students with developmental disabilities who attend special schools. To the best of the authors’ knowledge, this study reports the results of the first evaluation of using a train-the-trainer model for the delivery of a numeracy intervention (TEN-DD), whereby there was no involvement of researchers in implementation beyond the initial training of the school lead. This model of training for interventions may be more sustainable for special schools and help improve the uptake of evidence-based interventions.

Purpose

With a historic lack of attention to synthesis methods such as systematic review and meta-analysis and a lack of randomised controlled trials, the evidence base for behavioural interventions for children and adults who are autistic or are diagnosed with developmental disabilities is patchy. The Sharland Foundation Developmental Disabilities Applied Behavioural Research and Impact Network (SF-DDARIN), a network of like-minded researchers and practitioners across the UK, aims to address this. The purpose of this paper is to describe the network’s work and provide the context for the remaining articles in the special issue that exemplify network projects.

Design/methodology/approach

In this case study paper, the authors describe how the SF-DDARIN works and is resourced, detailing the process used to maximise research opportunities by facilitating network members working together. The authors outline the progressive research steps that the SF-DDARIN has identified are needed to develop and improve the evidence base for behavioural interventions systematically and, with examples, describe how the network delivers these steps.

Findings

Since its establishment in 2016, the SF-DDARIN network members have collectively worked on more than 53 projects involving over 50 researchers, had over 120 special schools contribute to projects and have recruited over 500 participants. This has been achieved through funding from the Sharland Foundation, primarily to cover the staffing costs of a small support team and internship partnerships with external organisations. Some projects have attracted external funding.

Originality/value

SF-DDARIN may provide an innovative, effective and resource-efficient model for other groups seeking to develop and extend their evidence base in developmental disability research.

Purpose

This study aims to investigate the prevalence and characteristics of dysphagia among adults with intellectual disabilities (ID) referred to speech and language therapy for swallow assessment, providing information on the demographic characteristics, referral trends, co-occurring health conditions and reasons for referrals highlighting the complex health-care needs of this population.

Design/methodology/approach

This study used a standardised patient data extraction method over a six-month period involving 74 adults with ID referred to speech and language therapy for swallow assessment.

Findings

This study revealed a high prevalence of dysphagia among adults with ID referred to speech and language therapy for swallow assessment. Increasing age and severity of ID were associated with an increased likelihood of swallowing difficulties. Co-occurring health conditions such as mobility difficulties, epilepsy and gastrointestinal conditions were prevalent, suggesting that adults with ID and swallowing difficulties are often living with complex health conditions. Choking incidents and hospital admissions were primary reasons for referral.

Research limitations/implications

This study stresses the pressing need for strategies to mitigate risks associated with choking incidents and hospital admission among this vulnerable population. Possible limitations include a reliance on referral and the focus being on a single service over a short period which may limit generalisation to the wider ID population.

Practical implications

This study emphasises the need to understand each person’s unique profile of health needs and the value of a specialised speech and language therapy service.

Social implications

The importance of increasing awareness among caregivers and medical experts is highlighted.

Originality/value

The findings underscore the importance of tailored assessment, caregiver involvement and heightened interdisciplinary awareness to effectively manage dysphagia in individuals with ID.