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Background: Access to information and communication technologies (ICTs) is often thought to enhance the lives of people with intellectual disabilities (ID) and is considered an important aspect of digital inclusion. However, inclusion practices often fail to address societal inequalities that lead to and sustain exclusion. The aim of this research was to enhance understandings of the relationships people with ID form with technology by critically analysing the underlying assumptions of inclusion practices. Method: We employed a post‐qualitative approach to reanalyse previously collected data from face‐to‐face interviews with 10 Australian adults with ID who attended a community literacy programme about their technology use in their daily lives. Two of social theorist Sara Ahmed's key concepts were used to analyse these data: (1) 'stickiness' of emotions, where certain (socially dominant) emotions are considered to attach to objects over time (e.g. mobile phone use is normal/good) and (2) 'fit' between people and objects, where there is a sense of comfort when objects are designed for people like you – those outside the 'norm' experience discomfort and a sense of being 'othered' in their interactions with such objects which do not fit them. Results: Our analysis identified how people with ID often attributed positive feelings to technology even when they had seemingly negative interactions with their devices (e.g. they could not use certain features, caregivers acted as gatekeepers to access). The positive associations were likely the outcome of implicitly held understandings that society highly values technology (Ahmed's stickiness of emotions). Although some participants accessed technology without difficulty, others experienced discomfort due to difficulties using devices that were not designed for them (Ahmed's fit between people and objects). Importantly, some participants had access to technology and the technical skill to use ICTs, but other factors, such as not having many friends, impacted their ability to use their devices in meaningful ways. Conclusion: Our analysis suggests that digital inclusion practices focused on providing access to technology may unintentionally harm in ways that are not immediately apparent when working with people with ID. Harms might include further marginalisation or 'othering' of people with ID. It is important to recognise that well‐meaning attempts to encourage use of ICTs may be counterproductive if they lead to experiences of marginalisation. To avoid this, inclusion practices could focus beyond access to devices, and the ability to use them, to include considerations of the multiple socio‐emotional effects. What is a good fit is not entirely predeterminable, exploration of the possibilities for what will work well for any individual requires experimentation and creativity, and a careful attention to unintended effects. Beyond this, the development of new technology should consider how to diversify devices that often fail to fit people with disabilities. [ABSTRACT FROM AUTHOR]

Abstract: Background: There are different instruments to measure energy expenditure in general population, but we do not know whether these instruments can be used in people with intellectual disability. Methods: A sample of 33 participants was invited to wear a triaxial accelerometer during seven consecutive days. Energy expenditure was measured with the International Physical Activity Questionnaire Short Version (IPAQ‐S) to gather data regarding the participant's descriptions of the physical activity performed. Results: Agreement between the accelerometers and IPAQ‐S in terms of energy expenditure measurements was not reached (P > 0.05). A significant correlation was found between moderate metabolic equivalent of tasks measured with accelerometers and vigorous metabolic equivalent of tasks measured with the IPAQ‐S (r = −0.351 [P = 0.045]). Conclusion: The main conclusion of this study was a level of discrepancy between measurements taken using the IPAQ‐S and the accelerometers in people with intellectual disability. [ABSTRACT FROM AUTHOR]

Background Solution- Focused Brief Therapy ( SFBT) is a form of behaviour therapy that focuses on evoking desired behaviour rather than on diminishing existing problem behaviour. SFBT has a number of advantages that makes it attractive for use with people who have intellectual disabilities ( ID). These advantages include: focus on empowerment for the person, unique intervention strategies for each person based on their particular skills, and recognition of the expert status of the individual identified as the patient resulting in a sense of self-efficacy. Methods To investigate the effects of SFBT, we conducted a controlled pre- and post-test and follow-up study with 20 people with mild ID ( MID) receiving SFBT and 18 people with MID receiving care as usual ( CAU). We expected that SFBT could help people with MID with (1) reaching treatment goals; (2) improving quality of life (i.e. psychological and social functioning); (3) reducing maladaptive behaviour; and (4) increasing resilience (autonomy and social optimism). Results Two of the 20 clients terminated SFBT prematurely. Most clients receiving SFBT (13 of 18 clients) showed clinically relevant progressions (more than two points on a 1 to 10 scale) towards their treatment goals after SFBT and at follow-up, an additional client showed clinically relevant progress (total of 14 of 18 clients). Directly after therapy, the SFBT group performed statistically significantly better than the CAU group on psychological functioning, social functioning, maladaptive behaviour, autonomy and social optimism. The effect sizes of these improvements were medium to large. At 6-week follow-up, the improvements in psychological functioning, social functioning and maladaptive behaviour in the treatment group were still statistically significant compared with CAU, with medium to large effect sizes. Conclusions Although the study had limitations because of the short follow-up period and the non-random selection of participants, the statistically significant differences between the SFBT and CAU groups and the medium to large effect sizes, indicate the potential effectiveness of SFBT for people with MID. [ABSTRACT FROM AUTHOR]

Background: Data on the development of Covid‐19 among people with intellectual disabilities (IDs) are scarce and it is uncertain to what extent general population data applies to people with ID. To give an indication of possible implications, this study investigated excess mortality patterns during a previous influenza epidemic. Methods: Using Dutch population and mortality registers, a historical cohort study was designed to compare mortality during the 2017–2018 influenza epidemic with mortality in the same period in the three previous years. People with ID were identified by entitlements to residential ID‐care services as retrieved from a national database. Results: Data covered the entire adult Dutch population (12.6 million; GenPop), of which 91 064 individuals were identified with an ID. During the influenza epidemic, mortality among people with ID increased almost three times as much than in the GenPop (15.2% vs. 5.4%), and more among male individuals with ID (+19.5%) than among female individuals with ID (+10.6%), as compared with baseline. In both cohorts, comparable increases in mortality within older age groups and due to respiratory causes were seen. Particularly in the ID‐cohort, excess deaths also occurred in younger age groups, due to endocrine diseases and ID‐specific causes. Conclusions: During the 2017–2018 influenza epidemic, excess mortality among people with ID was three times higher than in the general Dutch population, appeared more often at young age and with a broader range of underlying causes. These findings suggest that a pandemic may disproportionally affect people with ID while population data may not immediately raise warnings. Early detection of diverging patterns and faster implementation of tailored strategies therefore require collection of good quality data. [ABSTRACT FROM AUTHOR]

Background: Advance care planning (ACP) is a process in which professionals, patients and their relatives discuss wishes and options for future care. ACP in the palliative phase reduces the chance that decisions have to be taken suddenly and can therefore improve the quality of life and death. The primary aim of this study is to explore how ACP takes place in cases of people with intellectual disabilities (ID). Method: Medical files were analysed, and interviews were held in six care organisations for people with mild to severe ID. The data concerned people with ID (n = 30), 15 in the palliative phase, identified using the 'surprise question', and 15 who had died after an identifiable period of illness. Additional pre‐structured telephone interviews were conducted with their relatives (n = 30) and professionals (n = 33). Results: For half of the people with ID who had died, the first report in their file about palliative care (needs) was less than 1 month before their death. Professionals stated that ACP was started in response to the person's deteriorating health situation. A do‐not‐attempt‐resuscitation order was recorded for nearly all people with ID (93%). A smaller group also had other agreements between professionals and relatives documented in their files, mainly about potentially life‐sustaining treatments (43%) and/or hospitalisation admissions (47%). Relatives and professionals are satisfied with the mutual cooperation in ACP in the palliative phase. Cognitive and communication disabilities were most frequently mentioned by relatives and professionals as reasons for not involving people with ID in ACP. Conclusions: Advance care planning in the palliative phase of people with ID focuses mainly on medical issues at the end of life. Specific challenges concern a proactive identification of changing needs, fear to initiate ACP discussions, documentation of ACP in medical files and the involvement of people with ID in ACP. It is recommended that relatives and professionals should be informed about the content of ACP and professionals should be trained in communicating in advance about wishes for future care. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disabilities (IDs) have very high rates of osteoporosis and fractures, to which their widespread vitamin D deficiency and other factors could contribute. We aimed to assess in people with IDs previously treated for vitamin D deficiency (1) long‐term adherence to vitamin D supplementation and (2) bone mineral density (BMD), as an indicator for risk of fractures, according to vitamin D supplementation and other factors. Method: We recorded height, weight, medical, pharmacological, dietary and lifestyle assessment. Blood sample were taken for vitamin D and related analytes. dual‐energy X‐ray absorptiometry for BMD was performed. Results: Of 51 study participants (mean [standard deviation, SD] age 51.5 [13.6] years, 57% male), 41 (80.4%) were taking vitamin D and 10 were not. Mean [SD] serum vitamin D was 81.3 [21.3] vs. 25.2 [10.2] nmol/L (P < 0.0001), respectively. Thirty‐six participants underwent a dual‐energy X‐ray absorptiometry scan, which showed osteoporosis in 23.7% and osteopenia in 52.6%. Participants on vitamin D had higher BMD than those who were not, a statistically significant difference when confounders (lack of mobility and hypogonadism) were removed. BMD was significantly different according to mobility, particularly in wheelchair users, in whom hip BMD was 33% lower (P < 0.0001) than in participants with normal mobility. Participants still taking vitamin D showed a 6.1% increase in BMD at the spine (P = 0.003) after mean [SD] 7.4 [1.5] years vitamin D treatment. Conclusions: In people with IDs and previous vitamin D deficiency, BMD increases on long‐term vitamin D supplementation. However, additional strategies must be considered for osteoporosis and fracture prevention in this population. [ABSTRACT FROM AUTHOR]

Background: We aimed to validate the Italian version of the two parallel short forms of the Prudhoe Cognitive Function Test (s‐PCFT‐I) in adults and seniors with intellectual disabilities (ID) of any aetiology and level of severity. Methods: Our validation is a multicentre study attended by 211 subjects with ID, 125 male and 86 female, aged 40 years and above for people with Down syndrome and aged 50 years for people with other forms of disabilities. Results: The s‐PCFT‐I shows a wide range of scores in the absence of floor effects with minimal ceiling effects. A Cronbach's α coefficient of 0.85 and a mean inter‐item correlation of 0.21 indicate high internal consistency. The tool demonstrates good agreement between testers and near excellent temporal stability with intraclass correlation coefficients respectively of 0.85 and 0.90. s‐PCFT‐I total scores do not differ by sex or age, while statistically significant differences are observed between people with different levels of severity of ID. Moderate to good and highly significant correlations (−0.40 to −0.66) among the s‐PCFT‐I total scores and subscores and the Sum of Cognitive Score of the informant‐based Dementia Questionnaire for Persons with Intellectual Disabilities suggest an acceptable level of concurrent criterion validity. Cognitive decliners according to Prasher's Dementia Questionnaire for Persons with Intellectual Disabilities cut‐off scores perform significantly lower on s‐PCFT‐I than non‐decliners. Conclusions: The s‐PCFT‐I has good psychometric properties and user friendliness and may therefore be a valuable addition to the current informant‐rated tools for screening and assessment of cognition in aging people with ID. [ABSTRACT FROM AUTHOR]

Background: Direct support professionals play an important role in facilitating physical activity support for people with intellectual disabilities (ID). This study examined how the characteristics of people with ID and the characteristics of direct support professionals are related to the professionals' behaviour when supporting people with ID in physical activity. Methods: A cross‐sectional approach was used. Direct support professionals (n = 217) who support people with ID completed a self‐report questionnaire, which aimed to measure the components that produced behaviour when providing physical activity support for people with ID. Associations with the characteristics of people with ID and the characteristics of the professionals were analysed using multivariate linear regression models. Results: The results demonstrate that the professionals' characteristics – such as age, workplace and training – were related to the variance in the components that theoretically produced the direct support professionals' behaviour. The characteristics of the people with ID did not contribute to the variance in the direct support professionals' behaviour. Conclusions: The findings suggest that professional characteristics are the dominant reasons for the differences observed in the capability, opportunity and motivation of direct support professionals to provide physical activity support. This study also underscores the need for integrated training programmes to help direct support professionals promote physical activity in people with ID. [ABSTRACT FROM AUTHOR]

Objective: The risk for the development of severe behaviour problems by individuals with intellectual disability (ID) is a well‐known concern. However, there are currently no reliable instruments for assessing these behaviours in French. The Behaviour Problems Inventory – Short Form (BPI‐S) assesses these three types of behaviour in people with ID: self‐injurious behaviour (eight items), aggressive/destructive behaviours (10 items) and stereotypic behaviours (12 items). The purpose of this study was to conduct a psychometric study of a French version of the BPI‐S. Method: Data were collected on 305 children, adolescents and young adults with ID 50 care workers in seven specialised institutions in France as informants. We examined the scale's factorial structure (using confirmatory factor analysis), internal consistency and inter‐rater reliability. We also established preliminary French norms. Results: Our results show that the French BPI‐S has a factorial structure similar to that of the English version. It has good internal consistency. The internal consistency of the frequency ratings was 0.91 and 0.62 for the severity ratings. The BPI‐S has a good inter‐rater reliability with acceptable coefficients for the frequency ratings (Self Injurious Behaviour (SIB) = 0.81; Aggressive–Destructive behaviour = 0.66; Stereotyped behaviours = 0.75) and for the severity ratings (SIB = 0.92; Aggressive–Destructive behaviour = 0.54). The data also show that the frequency and severity of behaviours differ based on the level of ID. Conclusions: The French version of the BPI‐S has good psychometric properties for assessing problem behaviours in children, adolescents and young adults. This scale can be used for research and clinical evaluation of disorders associated with ID. [ABSTRACT FROM AUTHOR]

Abstract Background The Specialist Mental Health Service for people with an intellectual disability (ID) and psychiatric disorder (referred to throughout this paper as ‘the Service’) has been in operation in south-east London for the last 18 years, during which time two local, long-stay institutions have closed. Aims To measure the number of referrals to the Service from 1983 to 2001 and identify trends. Methods Data were recorded on 752 new referrals using the assessment and information rating profile. Diagnoses according to the International Classification of Diseases (10th edition) were made by two psychiatrists. Referrals for a one off consultation or assessment, or with an IQ > 70 were excluded from analysis. Results Over time more non-white clients and more clients with mild ID were referred. More referrals were made in later years, and a greater proportion came from primary care. Later referrals were also more likely to have a psychiatric diagnosis than those in earlier years. Conclusion Significant trends in referrals were identified, which may be explained by various external factors. [ABSTRACT FROM AUTHOR]

Abstract A meta-analysis of prevalence and cohort studies conducted over the last 30 years was carried out to identify risk markers for challenging behaviour shown by individuals with intellectual disabilities (IDs). A total of 86 potential studies was identified from the review, with 22 (25.6%) containing sufficient data to enable a statistical analysis to be conducted. Results indicated that males were significantly more likely to show aggression than females, and that individuals with a severe/profound degree of ID were significantly more likely to show self-injury and stereotypy than individuals with a mild/moderate degree of ID. Individuals with a diagnosis of autism were significantly more likely to show self-injury, aggression and disruption to the environment whilst individuals with deficits in receptive and expressive communication were significantly more likely to show self-injury. In most cases, tests for heterogeneity were statistically significant, as expected. The meta-analysis highlighted the paucity of methodologically robust studies of risk markers for challenging behaviours and the lack of data on incidence, prevalence and chronicity of challenging behaviour in this population. [ABSTRACT FROM AUTHOR]