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Mindfulness helps people focus on what is happening right now. It can help people to have good mental health.A group of researchers from the USA created a mindfulness-based therapy for people with intellectual disabilities, called Soles of the Feet.Soles of the Feet teaches people with intellectual disabilities to focus on the soles of their feet, instead of focusing on difficult thoughts and feelings.This paper thinks about how Soles of the Feet works for people with intellectual disabilities.

We heard about the abuse and bad treatment of people with intellectual disabilities which had happened at an inpatient unit called Whorlton Hall in 2019.We were upset and angry that abuse keeps happening even though people have been trying to make sure support is better and safer.We wanted to write something to tell people that we thought the abuse was terrible and should not be happening.We hoped that we could write something that would tell people how important it is to:–help people to get better at spotting signs of emotional and physical abuse–report any abuse or poor support and make a plan to follow up to make sure this stops–share ideas of how we can better work together to stop abuse from happeningWe set up a small group of clinical psychologists to write a ‘position statement’ which would include all these things.We shared what we had written with a bigger group of psychologists and health professionals in our Attachment and Intellectual Disabilities Special Interest Group and they said what they thought was good and how to make it better.

People with an intellectual disability are more likely to have dementia and we wanted to see if there was a way of helping this groupWe ran an eleven-week Cognitive Stimulation Therapy CST) group for people with an intellectual disability and their carers to see if this would help. This has helped other people without an intellectual disability with dementia.We wanted to see if the group was helpful, so we asked people that went what they thought about it and we also did some assessments with them before and after.All the information we collected showed us that people enjoyed the group and that this was helpful.We need to collect some more information about CST groups for people with an intellectual disability and dementia to check they really are helpful

• Research into the understanding of medication in staff that support people with intellectual disabilities (ID) and Autism Spectrum Disorder (ASD) is very limited.• Existing research suggests that staff require more training around medication and need more involvement in medication decisions.• Training staff and involving them in medication decisions would help to improve the quality of life of people with ID and ASD, with side effects of medication identified and addressed more quickly.

• Sometimes people commit crimes called sex offences. This is when someone does something sexual to someone who did not want it to happen or were not able to agree to it. A small number of sex offenders have an intellectual disability.• We interviewed five men with intellectual disabilities who had committed sex offences. These men had completed group treatment to stop them from committing sex offences in the future. All of the men were living in the community.• The men we interviewed talked about joining and being part of group treatment.• Most said that they did not feel like they had a choice about starting group treatment. Others said that group treatment reminded them of school. Some told us they felt anxious about talking to other members about their sex offences. When they overcame their anxiety and shared their sex offences with other group members, they felt relieved.• The findings of this study are important because they will help professionals make sure the treatment is as good as possible.

‘There is no greater agony than bearing an untold story inside you’ (Maya Angelou)This brief paper considers how trauma and attachment can be present in the lives of people with intellectual disabilities (ID). Trauma of a serious nature in childhood is both a heightened likelihood, and strong predictor, of negative outcomes for people with ID. However, it can also be addressed through psychological assessment and interventions, and is mediated through attachment bonds with others.

Antisocial behaviour in young people is a widespread issue. Young people with borderlinemild Intellectual Disabilities (ID) are often not recognised or provided with support for their learning and are more likely to engage in antisocial behaviour than young people without ID (Hall, 2000). Research has indicated that these young people benefit from systemic psychological interventions which target the systems around them (Tausendfreund et al., 2016). Whilst the literature base for interventions that reduce behaviour problems is vast, there has been limited research for young people with borderline-mild ID and there have been no previous systematic reviews focused on this group. The objective was to discover which systemic psychological interventions are effective for young people with borderline-mild ID and significant behaviour problems. PsychINFO and Web of Science databases were searched and after duplicates removal, 4018 articles were screened via titles and abstracts. 3862 records were excluded at that stage, and a further 150 were excluded at the full text screening stage. One additional paper was identified, resulting in seven studies included in this review. The Quality Appraisal Checklist for Quantitative Intervention Studies (QACQIS) (NICE, 2012) was used to analyse methodological quality. Methodological quality varied in accordance with study design. Six different systemic psychological interventions were identified, and even though the research indicated positive results for all interventions, it was concluded that Parent Management Training, Mindfulness Based Positive Behaviour Support, Non-Violent Resistance-Intellectual Disabilities, and Multisystemic Therapy-ID showed most promise as equitable systemic psychological interventions for reducing behaviour problems in young people with borderline-mild ID. It was difficult to draw direct comparisons between studies due to variation in study design and outcome measurements. Multi-site, multi-informant randomised research should be carried out in the future.

Sometimes, it can be really hard to put our problems into words – especially if we are thinking or talking about upsetting things.What did we do and why?We wanted to know if taking photos of things that are really important and talking about them with people helped people with learning disabilities to understand ‘values’ and maybe feel better.How did we do this?We gave six people a mobile phone (with a camera). Every three days we sent them text messages to ask:▪ How happy are you today?▪ How worried are you today?▪ How scared are you today?▪ Do you like your life today?Then we asked people to take photos of things that are really important to them in life, and talk about them with one of our ‘catching what matters’ therapists.What did we find out?Taking photos of things that are really important in life helped people to understand what ‘values’ means.Did people feel better?We asked people how they felt at the start and end of the research. We found that taking photos of important things helped some people feel:▪ Less worried.▪ Less scared.▪ More happy.▪ And that they liked their life more.So, what does this mean?▪ Taking photos of things that are important might help people with learning disabilities to understand what ‘values’ means.▪ Some people felt better, and some people didn’t.▪ It would be good to find out more about what helped people feel better.▪ More research might help us to find out more in the future.Could we improve this research in the future?Next time, we could maybe ask more people to take part so that we have more information.

Clinical psychologists are often involved in attempts to change attitudes towards people with intellectual disabilities. Sometimes this is with groups of carers and staff and sometimes with students (trainees or undergraduates). This study examined whether exposure to publicly available videos can change students’ attitudes towards people with intellectual disabilities (ID), and whether the content of videos (positive or negative) was associated with differential attitude change. Overall, 153 psychology undergraduates participated in the study, with 102 watching a negative content video (Winterbourne View) and 51 watching a positive content video. A quasi-experimental design compared two equal-sized groups matched on initial levels of attitudes (N = 29 in each group). Results indicated that the content of each video was associated with a different course of change: the positive video related to improvement in empowerment, similarity and proximal living attitudes, while the negative was associated with a worsening in attitudes. These findings are directly relevant to the training environments familiar to clinical psychologists. Videos can be useful means of changing attitudes where direct contact with people with ID is not possible. To achieve positive change in attitudes, videos need to bring out the strengths of people with ID by emphasising their achievements.

The evidence base for psychodynamic psychotherapy for people with intellectual disabilities (ID) is mainly made up of case studies with a small number of open trials without control (Beail, 2016) and the development of the evidence base for psychological therapies is a priority. In this service evaluation, we estimated the significance and effect size of psychodynamic intervention in 66 cases from the time of assessment to case closure, using the Health of the Nation Outcome Scales for Learning Disability (HoNOS-LD). A significant and sizeable effect from assessment to case closure was detected on HoNOS-LD Total Score, with similar effects on subscale Factor Scores. A waiting list control condition for a smaller subset did not find significant overall change, and cases remaining within the service following intervention showed no deterioration after therapy. A relatively low number of sessions was required on average (13.7; median=8) but a dose-effect relationship was observed with more change associated with more sessions. We consider the shortcomings of this study and make recommendations for improved design of further studies.

Despite the popularity of person-centred planning, few quantitative studies have evaluated its effectiveness. This service evaluation examined the effectiveness of ‘Planning Live’, a person-centred planning intervention, in two assessment and treatment units (ATUs) for people with intellectual disabilities (ID), using routinely collected Health of The Nation Outcome Scales-Learning Disability (HoNOS-LD) data. Although previous qualitative research found that Planning Live was seen as helpful by individuals, families and professionals, we found that Planning Live was not associated with additional improvements in HoNOS-LD outcomes. We discuss these results, reflect on the inherent difficulties of evaluating person-centred planning interventions quantitatively, and make suggestions for future research.

Very few measures to help clinicians with attachment difficulties exist that are practical, reliable, and valid. The Quality of Early Relationships Rating Scale (QuERRS) (Skelly & Reay, 2013) is a 20-item rating scale that was intended to help clinicians formulate the attachment representations in the narratives of clients with mild to moderate intellectual disability, during psychotherapy assessment sessions. The current study is a preliminary examination of the factor structure of the QuERRS, suggesting that a larger study and further refinement of the scale is warranted.

An individual’s internal model of attachment security or insecurity can be judged by clinicians during assessment. When clinicians judge clients’ style to be characterised by security, there may be lower case severity (Skelly & Reay, 2013).This study is an examination of the relationship of clinicians’ attachment classification to outcome of psychodynamic psychotherapy in people with intellectual disabilities, measured through change in HoNOS-LD scores over time. We examined 44 cases of psychodynamic psychotherapy provided within two specialist community psychology services in the Tyne area over a two-year period.Results suggest that preoccupied or unresolved attachment was indicative of high case severity at assessment, but also predicted greater gain during therapy. A dose effect was observed, with more sessions given to clients rated as preoccupied or unresolved. Although some clients required more than 20 sessions, the average session number was markedly lower than that. There was no effect of age or gender, but higher IQ was associated with more change on one of the HoNOS-LD Factor Scores (Loss of Adaptive Functioning).This study provides preliminary evidence that psychodynamic psychotherapy for distress and personality conditions may be differentially effective for people with secure and insecure attachment ratings. Preoccupied or unresolved attachment styles may have resource implications in requiring longer psychological interventions, at least with this therapy orientation.

The process of psychoanalytic change can seem intangible. One way that psychoanalytic therapists from the Object-Relations school conceptualise the desired change in therapy is a change from the predomination of the infantile Paranoid-Schizoid Position to the predomination of the Depressive Position in the thoughts and feelings of their client. We used the Personal Relatedness Profile (Hobson et al., 1998) to rate whether six people with mild to moderate intellectual disabilities presented with lower ratings of paranoid-schizoid functioning over the course of their treatment. We found that the ratings for co-therapists were surprisingly reliable, with a measureable and significant reduction in ‘paranoid-schizoid’ functioning observed across the year of therapy. We contend that psychoanalytic processes are quantifiable and central to lasting personal change for the better.

Objectives:In a study concerning empathy in offenders who have intellectual disabilities (ID) we adapted a measure designed for use with the general population. In this paper we describe how we did this and the pitfalls we encountered. We were looking at empathy because it is seen as a significant factor in treatment and treatment outcomes with sex offenders. This has been inducted into treatment programmes and evaluations with sex offenders who have ID. The aim of our study was to explore general and victim empathy in sex-offenders and non-offenders with ID. The original aim was to explore differences between these groups on adapted measures of general and victim empathy, and if there was any relationship between the sex-offenders’ scores on empathy towards non-specific victims of sexual assault and their empathy towards their own victim.Methods:A measure of general and victim specific empathy developed for use with sex offenders in the general population (the Empat) was adapted for use with adults who have ID. Twenty-one sex-offenders and 21 non-offenders with ID, matched by age, gender and IQ, completed the adapted version of the Empat and the offender group also completed a previously adapted version of the Victim Empathy Scale.Results:Psychometric evaluation of the adapted scale produced marginal and poor reliabilities. In view of this further analysis to examine comparisons between the two groups would most likely produce spurious results. Thus the introduction of measures from the general population to populations of people who have ID are not always successful. However, such outcomes are not always reported. Further research is needed to develop better approaches to the assessment of victim specific and general empathy in offenders who have ID.Conclusion:Despite following guidelines on measure adaptation for people who have ID, the measures did not achieve satisfactory psychometric properties and, therefore, any findings could be spurious. This study clearly shows that researchers need to establish that any general population measures they employ or adapt for use with people who have ID need to be evaluated psychometrically first.

This research project was completed as part of the requirements for the degree of Doctor in Clinical Psychology (DClinPsy) at Royal Holloway, University of London.