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Background: There is growing evidence that people with intellectual disabilities have greater healthcare needs than the general population and that these needs are often unmet. Recently, increasing attention has been drawn to poor care received by people with intellectual disabilities when admitted to hospital. Method: A literature search was conducted to identify studies on experiences of secondary healthcare for people with intellectual disabilities. Studies were published between January 1990 and March 2008. Results: Thirteen studies were identified. Important influences on the experience of hospital care were: individual factors; the carer's role; the attitudes, knowledge and communicative style of health staff; and the physical environment. A range of recommendations and initiatives have been developed to improve hospital care. Conclusion: More research is needed, given that so few studies are published in this area. Initiatives to improve access to secondary healthcare need to be evaluated to inform the development of services.

Background: As patterns of morbidity and mortality are changing, more people with intellectual disabilities develop cancer or other life-limiting illness. This paper reviews the literature around the need of people with intellectual disabilities for palliative care. Methods: A range of databases and the World Wide Web were searched for relevant papers, book chapters, training and information materials, unpublished materials and policy guidelines. Publications from 1995 to 2005 are included. Findings: Although there has been a steady increase in published materials in recent years, research data around the palliative care needs of people with intellectual disabilities remain scarce. Case reports are the most prevalent method of exploring pertinent issues. The paper presents an overview of issues identified in the literature, with a particular focus on pain and symptom assessment, ethical issues, service planning and training needs. Conclusion: There are significant gaps in current knowledge. The authors make recommendations for future areas of research and development.

Background: It has often been stated that the prevalence of psychiatric disorders in people with intellectual disabilities is greater than it is in the population as a whole. Method: The epidemiological studies on psychiatric disorders in people with intellectual disabilities were reviewed. Results: There is evidence that the prevalence of psychiatric disorder is greater in children with intellectual disabilities, compared with children with normal IQs, that it is higher in both adults and children with severe intellectual disabilities compared with people with mild or no intellectual disability and that the rate of problematic behaviour is higher in both adults and children having intellectual disabilities, than in their non-disabled peers. Conclusions: There is no sound evidence that the prevalence of psychiatric disorders in adults with mild intellectual disability is greater than in the population as a whole.

Background: The health needs of people with intellectual disabilities have recently received increasing attention. Method: Based on a review of the 2003 literature, this paper presents an overview of our knowledge on physical, mental and social well-being in this group. Results: Physical well-being is threatened by handicap-related conditions, syndrome-related health problems and lifestyle characteristics. Conclusion: Gaps in knowledge include insufficient evidence on health disparities, the lack of comparability of data on the prevalence of ill heath, lack of expertise in relation to communication problems and the fact that all knowledge is based on research in developed countries, while people with intellectual disabilities in developing countries face the same or even greater health problems. Recommendations concerning evidence, education and empowerment are formulated.

Objectives: This review aims to show how people who are categorized as having intellectual disabilities view their social identity, and the impact that this identity has on them. It is felt that research in this area gives valuable insights that are directly applicable to, and raise important questions about, clinical work with people with intellectual disabilities. Methods: The diagnostic criteria for and the process of gaining the identity of intellectual disabilities are considered. The literature on stigma and social identity is reviewed and methodological difficulties within these studies are highlighted. Results: It is argued that having intellectual disabilities is a powerful and stigmatizing identity. There is a consistent finding in the literature that many people with intellectual disabilities appear unaware of this identity. The possible reasons put forward for this finding are considered, and the clinical implications of the studies reviewed are discussed. Conclusions: The few studies that have been undertaken offer useful insights into the effects that having an identity of intellectual disabilities has on an individual. It is argued that further research is needed and that this will be particularly applicable to intellectual disabilities services, where many questions concerning the possible impact of an intellectual disabilities identity remain unanswered.

Introduction: Attribution theory posits that helping behaviour is determined in part by the potential helper's attributions and emotions regarding the behaviour that requires help. Specifically, helping is considered to be more likely if stability is perceived as low, generating optimism for change, and if controllability is perceived as low, engendering high levels of sympathy and low levels of anger. Method: We conducted a systematic literature search to identify studies that have tested these predictions in relation to carers' propensity to help people with intellectual disabilities who display challenging behaviour. Results: The literature is inconsistent and provides at best partial support for the theory. This situation differs from that seen in the general population, where the predictions of attribution theory are broadly supported. Discussion: We consider three potential explanations for this discrepancy: the reliability of the largely vignette-based methodology, the fact that most studies fail to define "helping" explicitly and the possibility that attribution theory might apply only to low-frequency behaviours.

Background: Community-based rehabilitation (CBR) is being implemented in more than 90 countries. Concerns have been voiced about the adequacy of the evidence base regarding the efficacy, effectiveness and efficiency of CBR. This review summarizes evidence on the efficacy of CBR for children with intellectual disabilities. Materials and method: Electronic literature database searches were conducted to identify articles in the English language published since 1980 relating to the efficacy of CBR for children with intellectual disabilities. Requests for information were also sent to membership of International Association for the Scientific Study of Intellectual Disabilities and relevant organizations in selected low- and middle-income countries. Results: Thirteen studies were identified for inclusion in the review. The quality of evidence for the efficacy of CBR for children with intellectual disabilities was "very low". Conclusion: Improving the evidence base will require greater investment in evaluation and addressing the marginalization of people with intellectual disabilities in CBR.