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Persons with intellectual disabilities (ID) may have difficulties providing reliable and valid accounts of their personal experiences through self-report measures. The aim of the current study was to systematically review the peer-reviewed research literature on the adaptations needed to develop “ID-inclusive” self-report measures. A search of PsycINFO, PubMed, Web of Science, and Google Scholar identified 49 studies that met inclusion criteria. A GRADE-CERQual assessment was performed to determine the level of confidence in the review findings. One hundred sixty-one recommendations for the development of “ID-inclusive” self-report measures were extracted from 49 included studies. Recommendations were presented in a GRADE-CERQual Summary of Findings table, according to a five-stage model of instrument development. This review offers much-needed practical guidance for clinicians and researchers on how to develop “ID-inclusive” self-report measures. Recommendations for future research about selfreport instrument development for use with people with ID are presented.

BackgroundPersons with intellectual disabilities (ID) may have difficulties providing reliable and valid accounts of their personal experiences through self-report measures. The aim of the current study was to systematically review the peer-reviewed research literature on the adaptations needed to develop ‘ID-inclusive’ self-report measures. MethodA search of PsycINFO, PubMed, Web of Science and Google Scholar identified 49 studies that met inclusion criteria. A GRADE-CERQual assessment was performed to determine the level of confidence in the review findings. Results161 recommendations for the development of ‘ID-inclusive’ self-report measures were extracted from 49 included studies. Recommendations were presented in a GRADE-CERQual Summary of Findings table, according to a 5-stage model of instrument development. ConclusionsThis review offers much-needed practical guidance for clinicians and researchers on how to develop ‘ID-inclusive’ self-report measures. Recommendations for future research about self-report instrument development for use with people with ID are presented.

BackgroundSexual health remains at risk for people with an intellectual disability. Attitudes towards sexuality, its support and education have an important role in promoting sexual health. The current review aims to provide an overview of the current research on supportive and restrictive attitudes towards sexuality and its support of people with intellectual disabilities themselves.MethodA systematic review was conducted, searching across eight databases. The quality of the studies was assessed with the Mixed-Method Appraisal Tool.ResultsSix themes emerged from the data: sexual behaviour, sexual identity, intimate relationships, barriers to sexual expression, sex education and support by caregivers. Supportive and restrictive attitudes were reported throughout.ConclusionsAttitudes regarding sexuality of people with intellectual disabilities are heterogeneous and people with intellectual disabilities seem to be able to express their sexual desires, needs and attitudes. Findings allow for improved individual support and in-depth research questions.

Background:The life expectancy of people with intellectual disabilities has increased. The implications of ageing have resulted in changes in their support needs and challenges to support staff. Access to evidence based strategies for support staff providing care to elderly with intellectual disabilities remains scarce. A systematic review was conducted to provide an overview of available psychosocial interventions.Methods:Four databases were searched and assessed according to the PRISMA guidelines. A narrative, integrative method of analysis was conducted to synthesise quantitative and qualitative data.Results:The 36 studies included in the review reported on interventions aimed at either identifying and meeting the needs or perceptions of older individuals or at improving their behaviour and skills. Furthermore, the role of support staff in the implementation of interventions was either active, assisting or undefined.Conclusions:This overview of studies could contribute to the existing body of knowledge and help to optimise psychosocial support for a growing population.

Background: Efforts to synthesise existing knowledge concerning the effects of exercise interventions on obesity (i.e. changes in body weight and composition) have been made, but scientific evidence in this matter is still limited. This systematic review and meta-analysis aims to identify and critically analyse the best available evidence regarding the use of physical exercise as a strategy to attenuate obesity through its effects on adiposity-related anthropometric parameters in people with intellectual disability (ID). Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was performed using PubMed, Scopus, SPORTDiscus, CINAHL and the Cochrane Library through specific keywords up to July 2020. The search adhered to the population, intervention, comparison and outcome strategy. Randomised controlled trials addressing the effects of the exercise intervention on adiposity-related anthropometric parameters (body mass index, waist circumference, waist–hip ratio, fat percentage or body weight) in children, adolescents and adults with ID were included. The methodological quality of the studies found was evaluated through the PEDro scale. Results: A total of nine investigations with children and/or adolescents (10–19 years) and 10 investigations with adults (18–70 years) were selected, mostly experiencing mild and moderate ID. Methodological quality was fair in 13 of these publications, good in five and excellent in one. Seventeen trials reported comparable baseline and post-intervention data for the intervention and control groups and were included in the meta-analysis. In nine studies, the intervention group performed a cardiovascular training programme. Five papers described a combined training programme. Two trials executed whole-body vibration training programmes, and one publication proposed balance training as the primary intervention. According to the meta-analysis results, the reviewed studies proposed exercise modalities that, in comparison with the activities performed by the participants' in the respective control groups, did not have a greater impact on the variables assessed. Conclusions: While physical exercise can contribute to adiposity-related anthropometric parameters in people with mild and moderate ID, these findings show that exercise alone is not sufficient to manage obesity in this population. Multicomponent interventions appear to be the best choice when they incorporate dietary deficit, physical activity increase and behaviour change strategies. Finding the most effective modality of physical exercise can only aid weight loss interventions. Future research would benefit from comparing the effects of different exercise modalities within the framework of a multicomponent weight management intervention. SI Publicación en abierto financiada por el Consorcio de Bibliotecas Universitarias de Castilla y León (BUCLE), con cargo al Programa Operativo 2014ES16RFOP009 FEDER 2014-2020 DE CASTILLA Y LEÓN, Actuación:20007-CL - Apoyo Consorcio BUCLE

Policies limit the use of coercive measures as a measure of last resort to protect people from danger. Success of policies can only be determined by registering the use of coercive measures. The reliability of 57 standardized coercive measures was tested. In addition, implementation was investigated of improved registration in a residential care setting. This mixed methods study within a residential care organization for people with intellectual disabilities in the Netherlands included 55 living units and 269 residents. Reliability of 57 standardized coercive measures was tested against other informants (colleague staff, trained outside observer) and results were validated by a panel of stakeholders. Second, the implementation of a mandatory routine registration system was investigated by comparing registration of coercive measures to personal files of 30 residents. Registration of coercive measures yielded reliable data for at least 25 out of 57 types of coercive measures. The second part of the study showed widely varying explanations of unreliable data by stakeholders, including knowledge and awareness of coercive measures of support staff and the influence of contextual factors on the encoding of coercive measures. After implementation, 46% of the coercive measures were registered in the registration system. Comprehensive registration of coercive measures by staff neither appeared feasible nor yielded reliable data. Clearly, multidisciplinary discussion among support staff and professionals is needed to decide whether care practices are restrictive or not. Further research should focus on how these considerations can lead to a reliable and meaningful registration.

BackgroundIn studies involving people with intellectual disabilities, photovoice is increasingly used to include the voice of participants. Analysing existing literature, the present authors found that photovoice was used in various forms with different outcomes. These studies describe both obstructing and facilitating factors. The present authors designed a more standardized approach of photovoice and developed an alternative strategy: “guided photovoice.”MethodThe “guided photovoice” approach was tested on fourteen participants with intellectual disabilities. The outcomes of the approach were evaluated.ResultsThe effectiveness of the approach varied with the participants’ capabilities and needs. Some participants were talked more while taking photographs, others told their story easily during the interviews. The use of follow‐up questions was helpful to deepen the interview.ConclusionsA more standardized, guided photovoice approach is a helpful addition to the various options for using photovoice; it is important to decide which approach best fits the needs and capabilities of the participants.

Background:To optimise care and support for people with intellectual disabilities (ID), sharing and application of knowledge is a precondition. In healthcare in general, there is a body of knowledge on bridging the 'know-do-gap'. However, it is not known to what extent the identified barriers and facilitators to knowledge sharing and application also hold for the care and support of people with ID, due to its specific characteristics including long-term care. Therefore, we conducted a systematic review to identify which organisational factors are enabling and/or disabling in stimulating the sharing and application of knowledge in the care and support of people with ID.Method:A systematic review was conducted using five electronic databases of relevant articles published in English between January 2000 and December 2015. During each phase of selection and analysis a minimum of two independent reviewers assessed all articles according to PRISMA guidelines.Results:In total 2,256 articles were retrieved, of which 19 articles met our inclusion criteria. All organisational factors retrieved from these articles were categorised into three main clusters: (1) characteristics of the intervention (factors related to the tools and processes by which the method was implemented); (2) factors related to people (both at an individual and group level); and, (3) factors related to the organisational context (both material factors (office arrangements and ICT system, resources, time and organisation) and immaterial factors (training, staff, size of team).Conclusion:Overall analyses of the retrieved factors suggest that they are related to each other through the preconditional role of management (i.e., practice leadership) and the key role of professionals (i.e. (in)ability to fulfill new roles).

Direct support professionals (DSPs) play an important role in the process of integration of people with intellectual disabilities. Nevertheless, little is currently known about what determines the level of effort exerted by DSPs to enable the social integration of their clients. The aim of this study was to investigate three different psychological determinants (attitudes, social norms, and meta-evaluations) of the behavioral intentions of DSPs to facilitate the social integration of their clients. Semistructured interviews were conducted with 28 DSPs working in a setting of reversed integration, as well as 25 family members and 25 neighbors. The DSPs' perceived social norms and meta-evaluations of neighbors and family members were compared with their actual social norms and evaluations. The authors found that half of the DSPs interviewed were positive about integration, whereas the other half were negative or neutral. Concerning social norms, the DSPs expect neighbors to have neutral attitudes toward the integration of people with intellectual disabilities, while in reality the neighbors are very positive. More than half of the DSPs were uncertain about the family members' opinions about integration. Asking the family members themselves, there was some variation in their attitudes toward integration. Regarding the meta-evaluation, DSPs had a realistic idea about how their work would be evaluated by family members and neighbors; both groups were positive. It is evident that this group of DSPs had an overly negative idea of neighbors' opinions about integration and contact with people with intellectual disabilities. Creating awareness of a supportive social norm in the neighborhood could help and encourage DSPs to strive for social contact between their clients and neighbors.

BackgroundEqual access to mainstream healthcare services for people with intellectual disabilities (ID) still requires attention. Although recent studies suggest that health professionals hold positive attitudes towards people with ID, stigmatising attitudes may influence their efforts to serve people with ID in community healthcare practice. To stimulate inclusion in mainstream healthcare services, this systematic review focussed on barriers in attitudes of mainstream health professionals towards people with ID.MethodFive electronic databases were systematically searched and references in full text articles were checked for studies published in the English language between January 1994 and January 2016. A social–psychological triad of cognitive, affective and behavioural dimensions of stigmatising attitudes is used to structure and discuss the results.ResultsThe literature search generated 2190 records with 30 studies that passed our exclusion criteria. Studies were mostly cross-sectional and of moderate quality. With respect to stigma, a lack of familiarity with and knowledge about people with ID was found. ID was considered as a stable condition not under personal control. Moreover, mainstream health professionals had either low or high expectations of the capabilities of people with ID. Professionals reported stress, lack of confidence, fear and anxiety, a tendency to treat people with ID differently and a lack of supporting autonomy.ConclusionsStigmatising attitudes towards people with ID appeared to be present among mainstream health professionals. This might affect the ongoing challenges regarding inclusion in mainstream healthcare services. To facilitate inclusion in mainstream healthcare services, it is recommended to include contact and collaboration with experts-by-experience in education programs of health professionals. Future research should progress beyond descriptive accounts of stigma towards exploring relationships between cognitive, affective and behavioural dimensions as pointers for intervention. Finally, inclusion would benefit from an understanding of ‘equal’ treatment that means reasonable adjustments instead of undifferentiated treatment.

Background: There is a growing evidence base about the effectiveness of positive behavioural support (PBS) in relation to behaviours that challenge (CB). There is, however, limited research from the perspective of individuals receiving this support. The objective of this qualitative study was to obtain the views of participants with an intellectual disability about what was important to them in relation to receiving PBS.\ud \ud Materials and methods: Seven participants with an intellectual disability, recruited via support organisations in the North East of England, gave their views about their support through interviews (n = 3) and a focus group (n = 4). Data were collected between April and June 2016 and were analysed using thematic analysis.\ud \ud Results: Four themes were identified: the importance of being treated as a human being; the wider impact of PBS; the contrast of PBS with previous experiences of support; and the beneficial impact of positive support. PBS was valued for its wide impact on quality of life, with a reduction in CB being just one of many important aspects.\ud \ud Conclusion: This study highlights the importance of including service user perspectives and quality of life indicators in research which evaluates service provision and support.

Background: Despite a lack of consensus regarding prevalence rates of substance abuse, people with intellectual disabilities (ID) on average use substances slightly less often than their non-disabled peers. However, their use of substances is more often problematic. Avoidance of treatment is a crucial problem among substance-abusing people with ID. This study tested a motivational intervention to facilitate autonomous motivation (i.e. wanting to change substance abuse because of a sense of free choice and volition) for engaging with a subsequent addiction treatment. Method: A multiple-case experimental design (N=6) was conducted to measure day-to-day motivation to change substance abuse among individuals with mild ID (N=3) and borderline level of intellectual functioning (N=3) in the Netherlands. The participants (five men, one woman) lived in the community (except one, he lived in a residential facility) and abused cannabis, alcohol or hashish. During the intervention phase, the 10-session treatment programme 'Beat the kick' was delivered by an experienced psychologist, based on motivational interviewing techniques adapted for people with mild to borderline ID. Participants completed an adaptive self-reported inventory based on self-determination theory (SDT) two to three times a week during baseline, intervention and 1-month follow-up. Results: The results of five of the six participants (one dropped out) showed that the type of motivation changed from more controlled types of motivation (i.e. external motivation and introjected motivation) at baseline to more autonomous types of motivation after completion of the intervention. In addition, the participants reported a significant increase in overall need satisfaction and autonomy satisfaction and a significant decrease of overall need frustration. Conclusions: The implementation of SDT and motivational interviewing principles in the treatment programme 'Beat the kick' reliably changed the type of motivation. In addition, the experimental effects provide initial proof of the use and applicability of SDT among people with ID.

BackgroundDespite a lack of consensus regarding prevalence rates of substance abuse, people with intellectual disabilities (ID) on average use substances slightly less often than their non-disabled peers. However, their use of substances is more often problematic. Avoidance of treatment is a crucial problem among substance-abusing people with ID. This study tested a motivational intervention to facilitate autonomous motivation (i.e. wanting to change substance abuse because of a sense of free choice and volition) for engaging with a subsequent addiction treatment.MethodA multiple-case experimental design (N = 6) was conducted to measure day-to-day motivation to change substance abuse among individuals with mild ID (N = 3) and borderline level of intellectual functioning (N = 3) in the Netherlands. The participants (five men, one woman) lived in the community (except one, he lived in a residential facility) and abused cannabis, alcohol or hashish. During the intervention phase, the 10-session treatment programme ‘Beat the kick’ was delivered by an experienced psychologist, based on motivational interviewing techniques adapted for people with mild to borderline ID. Participants completed an adaptive self-reported inventory based on self-determination theory (SDT) two to three times a week during baseline, intervention and 1-month follow-up.ResultsThe results of five of the six participants (one dropped out) showed that the type of motivation changed from more controlled types of motivation (i.e. external motivation and introjected motivation) at baseline to more autonomous types of motivation after completion of the intervention. In addition, the participants reported a significant increase in overall need satisfaction and autonomy satisfaction and a significant decrease of overall need frustration.ConclusionsThe implementation of SDT and motivational interviewing principles in the treatment programme ‘Beat the kick’ reliably changed the type of motivation. In addition, the experimental effects provide initial proof of the use and applicability of SDT among people with ID.

Aim: It is generally acknowledged that being physically active is important for people with intellectual disabilities (ID) because of the positive effects on physical and mental health. However, physical activity seems to be a minor part of the support provided to people with ID, especially in those with severe or profound intellectual disabilities. The aim of this study was to overview the facilitators and barriers to physical activity in people with ID. In addition, differences between direct and proxy reports were explored. Method: A systematic review was conducted using three databases (PsychINFO, ERIC, MEDLINE). All research papers were subjected to narrative analyses.Results: 22 papers investigating facilitators and barriers to physical activity in people with ID were included. Facilitators and barriers were identified in the physical activity itself, the individual with ID, the support offered and in the organization, resources and environment. Too, a discrepancy between direct and proxy reports was found.Conclusion: Gaps were identified in the literature suggesting the need to identify the facilitators and barriers to physical activity for people with the more severe ID and their direct support persons.

BackgroundIncreasing the societal participation of people with intellectual disabilities via competitive employment requires a full understanding of what this means to them. This paper aims to provide an in‐depth examination of the lived experiences of people with intellectual disabilities in competitive employment.MethodInterviews were conducted with six participants with mild intellectual disability or borderline functioning and good verbal communication skills. Interviews were analysed according to the guidelines of interpretative phenomenological analysis (IPA). Member checks were conducted.ResultsAnalysis yielded three main themes: (a) Building on my life experiences, (b) My place at work and (c) Being a valuable member of society, like everyone else.ConclusionsCompetitive employment could make a substantial contribution to the sense of belonging to society and quality of life of people with intellectual disabilities. Nevertheless, they must cope with stigma‐related obstacles and feelings of being dependent on others in the work environment.

Background:Chronic stress responses can lead to physical and behavioural health problems, often experienced and observed in the care of people with intellectual disabilities or people with dementia. Electrodermal activity (EDA) is a bio-signal for stress, which can be measured by wearables and thereby support stress management. However, the how, when and to what extent patients and healthcare providers can benefit is unclear. This study aims to create an overview of available wearables enabling the detection of perceived stress by using EDA.Methods:Following the PRISMA-SCR protocol for scoping reviews, four databases were included in the search of peer-reviewed studies published between 2012 and 2022, reporting detection of EDA in relation to self-reported stress or stress-related behaviours. Type of wearable, bodily location, research population, context, stressor type and the reported relationship between EDA and perceived stress were extracted.Results:Of the 74 included studies, the majority included healthy subjects in laboratory situations. Field studies and studies using machine learning (ML) to predict stress have increased in the last years. EDA is most often measured on the wrist, with offline data processing. Studies predicting perceived stress or stress-related behaviour using EDA features, reported accuracies between 42% and 100% with an average of 82.6%. Of these studies, the majority used ML.Conclusion:Wearable EDA sensors are promising in detecting perceived stress. Field studies with relevant populations in a health or care context are lacking. Future studies should focus on the application of EDA-measuring wearables in real-life situations to support stress management.

Research suggests that restrictive measures are widely used on adolescents with mild intellectual disabilities. In the Netherlands, restrictive measures are defined as all measures that limit the freedom of a person. In most countries, legislation and policies that seek to reduce the use of restrictive measures focus on seclusion and mechanical and physical restraints. The study aimed to investigate the extent to which restrictive practices are used in the care of adolescents with mild intellectual disabilities while also exploring the attitudes of support staff toward these interventions. A survey study was done among a nationally representative Dutch research sample consisting of support staff. A structured questionnaire was completed by 195 staff members (response of 68.7%) working in settings providing care for people with intellectual disabilities. The measures generally used by staff members who work with adolescents with mild intellectual disabilities involved restricting the freedom of movement and so‐called social restrictions (such as limiting the use of mobile phones). Nearly all respondents considered restrictive measures to be justified in the case of danger, physical aggression, or sexually abusive behavior (87.8–96.8%). Frequently mentioned reasons for using restrictive measures were averting or avoiding danger (90.4 and 83.0%, respectively) and calming the adolescent (63.8%). Although seclusion and mechanical and physical restraints were generally considered most intrusive, staff members were aware that social restrictions could also be instrusive. The fact that current policies do not address these measures makes support staff question the lawfulness of their actions. As well as staff training to reduce the use of restrictive measures, rules, and legislation are also needed to clarify the options and limits to using such measures in the professional care of adolescents with mild intellectual disabilities.

Background The aim of this study is to explore the prevalence and influencing factors of metabolic syndrome (MetS) in people with intellectual disabilities (IDs) and behavioural problems in a Dutch special healthcare institution.Methods This observational study was conducted from medical records of physical examinations, laboratory results, medication (history), ethnicity and length of stay, as well as from questionnaires about lifestyle and smoking habits. MetS was defined by using the criteria of the 2009 consensus guidelines. The questions in this study were about the prevalence of MetS over a 1-year period and exploration of the differences between the people with and without MetS to determine the factors associated with it.Results The overall prevalence of MetS in the selected population of people with IDs and behavioural problems was 46%. The factors 'use of conventional antipsychotics', 'age', and a 'low nutrition score' increased the risk of developing MetS. Together, these variables determine 19% of the variance in the incidence of MetS.Conclusions The study indicates a firm prevalence of MetS in a vulnerable population, whereby a minority of contributing factors was determined. Professionals should be particularly alert during the provision of antipsychotics, diet and exercise habits to prevent MetS when treating people with IDs and behavioural problems, and further studies are needed to explore the factors that contribute to the nascence and prevalence of MetS.

BACKGROUND: Several factors that correlate with the onset or continuation of challenging behaviour are mentioned in research. These are factors related to persons with ID, but also to direct support professionals and the context. Although many of these factors seem to affect the onset or continuation of challenging behaviour in people with ID in general, results are often inconclusive and have little focus on people with profound intellectual and multiple disabilities (PIMD). The present study aimed to assess the extent to which known factors related to challenging behaviour are also applicable to a group of 198 people with PIMD.METHOD: To determine which factors were associated with challenging behaviour, univariate analyses on associations between known risk factors and challenging behaviour were conducted. The associated factors were then subject to a regression analysis to determine the extent to which they explain the prevalence of challenging behaviour and can thus be seen as factors associated with challenging behaviour.RESULTS: The results show that, in particular, factors concerning the personal characteristics of people with PIMD, such as sleeping problems and auditory problems, were related to the variance in mean frequency of challenging behaviour. Only one factor related to the direct support professionals was found: when these professionals had been offered training on the subject of challenging behaviour in people with intellectual disabilities in general, they identified significantly more withdrawn behaviour. We found no contextual factors related to challenging behaviour.CONCLUSION: These findings are generally consistent with findings reported in other studies, especially concerning the personal characteristics of people with PIMD. Further research should focus on the effects of providing safe auditory environments and appropriate sleep schedules for people with PIMD on the occurrence of challenging behaviour.

Objectives/Introduction: Sleep is crucial for both mental and physical health, and sleep disorders can pose a severe burden on health‐related quality of life. Importantly, family members may be affected by each other's sleep and wake behavior. Finally, there may be differences in sleep perception between family members. As a tool for future studies, we designed a concept for ‘By‐Proxy Sleep Assessment’, namely, the rating of one's partner's or children's sleep quality. This might provide a useful additional sleep quality measure, especially when assessing people with difficulties reporting their own sleep, such as children and people with intellectual disabilities or dementia.Methods: We used data from the FieldLab study, created to collect data on sleep and sleep related behaviors in five households, using an IoT ecosystem to combine subjective and objective information from connected objects measuring variables such as sleep, physical activity and environmental factors. A chat application enabled communication between researchers and participants and qualitative data was obtained through means of questionnaires and scheduled chatbot messages. Participants were asked to rate subjective sleep quality as well as the sleep quality of their partners and children on a scale of 0 to 10 each morning.Results: A total of 143 nights of partner By‐Proxy Sleep Assessment were collected from three couples and 40 nights of By‐Proxy Sleep Assessment for children from two couples. Subject‐proxy differences were averaged over the study period and varied between −0.38 ± 1.32 (−3 ‐ +2) and 1.23 ± 1.30 (−1 ‐ +3) for partners and −0.11 ± 0.97 (−3 ‐ +2) and 0.61 ± 1.50 (−1 ‐ +4) for children/parents. Preliminary analysis of IoT data and qualitative measurements through the chatbot revealed that both internal (e.g. migraines) and external factors (e.g. room temperature) contribute to discrepancies in sleep quality assessment by a proxy.Conclusions: Experience sampling studies can offer a new perspective on sleep quality and sleep perception. Although the By‐Proxy Sleep Assessment ratings already correlated rather well with the subjects’ own ratings, the IoT data may aid in improving the reliability of this approach.

BackgroundVarious studies have found that direct support professionals (DSPs) play an important role in determining the degree to which people with intellectual disabilities (ID) are included in society. However, less research has been conducted on the psychological processes that may influence the behavioural intentions of DSPs to actually engage with and invest effort in supporting their clients' inclusion. Five possible psychological variables are identified in the literature: attitudes, social norms, experienced competencies, identity and meta‐evaluation. In our research, we tested whether these processes influence the (intended) efforts DSPs make to facilitate their clients' inclusion.MethodA structured questionnaire was sent to 927 DSPs working in one of three different locations (an ordinary non‐segregated setting, a reversed non‐segregated setting and a residential facility). Of these, 336 DSPs completed the questionnaire.ResultsSeveral variables revealed differences between the three locations, specifically in efforts to facilitate inclusion, attitudes, social norms, experienced competencies and professional identity. Looking at the overall means, we found (relatively) high scores for the experienced competencies, role identity and meta‐evaluation. In contrast, the means were relatively negative regarding the DSPs' attitudes to inclusion and their assumed social norms.ConclusionsDirect support professionals' efforts to facilitate inclusion depend on their attitude towards inclusion, the experienced competencies, their role identity, the DSPs' meta‐evaluation and, indirectly through attitudes, also on the assumed social norms of the relevant stakeholders. Organizations responsible for supporting people with ID and which may want their DSPs to make greater efforts to facilitate inclusion should pay attention to these psychological variables.

Background - The utility of the theory of planned behaviour (TPB) in predicting the intentions of care staff to encourage healthy eating behaviour in those they supported was examined.\ud \ud Method - A quantitative, within-participant, questionnaire based design was used with 112 carers to assess the performance of two TPB models. The first contained the variables: attitude, subjective norm and perceived behavioural control. The second had additional variables of self efficacy and self identity.\ud \ud Results - Model 1 accounted for 31% of the variance with all three variables being significant predictors. Adding variables increased the overall predictive power of the model by 4%, but resulted in a reduction in the predictive power of the individual variables.\ud \ud Conclusion - The results suggests the TPB is a useful model for predicting carer intentions in relation to the diet of those they support, with their perceptions of the attitudes of others towards healthy eating being a key influential factor. Ways in which this may inform interventions to improve the overall health of people with intellectual disabilities are discussed.

Background: The present study examines understanding of challenging behaviour among a sample of children and adolescents with a moderate intellectual disability, and investigates their behavioural intentions towards peers with challenging behaviour. Methods: The study involved the collection of quantitative and qualitative data. In the quantitative part of the study participants (N=39) completed a modified Friendship Activity Scale following the presentation of vignettes depicting individuals with challenging and non-challenging behaviour. In the qualitative part of the study, participants (N=31) took part in a semi-structured interview that sought their views on the causes of the challenging behaviour described in one of the vignettes. Results: Analysis of the data from the Friendship Activity Scale indicates that participants have significantly more positive intentions towards a vignette character that does not engage in challenging behaviour. Content analysis of the qualitative data indicates that participants hold a variety of beliefs about the causes of challenging behaviour. Suggestions include that possibility that it is a response to transient emotional states and to external events. Conclusions: The findings are consistent with the findings of other studies on young people’s understanding of and attitudes towards peers with atypical behaviour. The theoretical and clinical implications for young people with intellectual disabilities are discussed. Not applicable ti, da, ke OR 15/11/10

BackgroundA supportive social network is crucial for facilitating social inclusion, which can, in turn, contribute to the quality of life (QOL) for people with intellectual disabilities (ID). In this study, we investigate how people with mild ID perceive their social networks and which network characteristics relate to satisfaction with the network and perceived QOL.MethodData were gathered from 33 young adults with a mild to borderline ID using structured questionnaires: the MSNA to map the social network, the IDQOL‐16 to assess QOL, and a questionnaire to determine satisfaction and wishes with regard to the social network.ResultsThe majority of the participants (73.1%) were satisfied with their social networks. Improvement in the area of strengthening existing ties (e.g. more frequent contact, better contact) was desired as opposed to expansion of the network. Affection – especially towards family and professionals – was most strongly related to perceived QOL. It appears to be essential that relatives live in the same town, can frequently meet up and provide both emotional and practical support.ConclusionsThe significance of family and the importance of high‐quality interpersonal relationships between professional and client in the lives of young adults with ID cannot be overestimated. Although measures of satisfaction and wishes can have limitations, in actual practice it is considered useful to assess the opinions of clients with respect to their social networks. Interventions can then be tailored to the needs and wishes of the persons themselves.