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Background: Participation is often defined as taking part and being included in different areas of life. Leisure represents an important area of life for all people. People with disabilities have the right to experience leisure time in a self-determined manner. They have the right to participate in leisure activities on an equal basis with others. Due to various influencing factors, people with intellectual disabilities, especially those with severe to profound intellectual disabilities, are at risk of decreased participation. This is alarming because participation in leisure activities reflects quality of life. Purpose: The present study aims to review the empirical findings on leisure participation and its influencing factors in people with mild to moderate disabilities as compared to people with severe to profound intellectual disabilities. Method: A scoping review following the PRISMA-ScR checklist by Cochrane and the Joanna Briggs Institute (JBI) was conducted to examine research studies published in peer-reviewed journals between 2000 and 2022. The studies that were included relate to activities within the everyday leisure time of people with intellectual disabilities, regardless of age, gender, or severity of their cognitive disability. The categories of vacation and tourism were excluded so as to focus on everyday leisure. The sample was screened by two reviewers independently. In total, 27 articles met the inclusion criteria, with 21 articles referring to people with a mild to moderate intellectual disability and only six articles referring to people with a severe to profound intellectual disability. The evidence was summarized with a predefined standardized charting form, which was used by the two reviewers. Results: The results show that participation in leisure activities by people with intellectual disabilities can be limited, especially for those with severe to profound intellectual disabilities. This contradicts the guiding principle and human rights of inclusion and self-determination. Their participation in leisure time is extremely dependent on external factors, such as support people, leisure time availability, and form of living. Passive activities at home are often provided for people with severe to profound intellectual disabilities in particular; therefore, the need for interactive and self-determined leisure opportunities in the community is enormous. Various factors influencing leisure participation can be identified. Implications: The findings of this scoping review can be used to consider intervention, support, and barriers to enhancing leisure participation among people with disabilities as an important area of life.

The article considers the problem of social rehabilitation of people with intellectual disabilities: analyzes the category of «disability» as a social phenomenon, summarizes the current approaches and social practices of foreign and Russian scientific schools in the context of the problem being studied, theoretically reveals the potential of art–therapeutic methods in organizing social rehabilitation of people with disabilities in accordance with the specifics of disabilities.The article describes an empirical study, in the course of which the features of social orientation of people with intellectual disabilities, their adaptive mechanisms and creative potential are revealed. The material of the article includes a description of the author's project “Art without Borders”, aimed at the socio–cultural rehabilitation of people with intellectual disabilities and the development of their creative potential using art therapy methods. The results of the study can be the basis for designing a system of social rehabilitation of people with intellectual disabilities.

Background Overmedication of people with intellectual disabilities, particularly when psychotropic medications are used for challenging behavior (CB) in the absence of a psychiatric disorder, is a significant public health concern. Support staff play a pivotal role in influencing the prescribing process. Staff views and attitudes toward medication use for CB are therefore of paramount importance. Method We have conducted four focus groups involving support staff (n = 8), home managers (n = 5) and trainers (n = 3), two of which primarily explored participants’ experiences and views on using medication for CB and medication withdrawal. Results Some participants felt medication use was justified, but others saw that as a form of chemical restraint. Most agreed that polypharmacy of psychotropics might lead to side effects. Some acknowledged the lack of shared decision-making involving people with intellectual disabilities and their families. There was universal anxiety about withdrawing the medication. Conclusions All agreed on the need for more medication-related information.

Caregivers of people with intellectual disabilities may feel overburdened in their work and experience negative psychological consequences. The purpose of this instrumental study was to determine the evidence of internal structure and reliability of the Zarit Caregiver Burden Interview scale. A total of 398 family caregivers, including women and men, participated (M = 47.33, SD = 10.44). The structure of the scale was evaluated by factor analysis and the McDonald Omega coefficient was used to estimate reliability. Sixteen models of the scale were tested, differing in number of items and factor structures. A model of 15 items and 4 dimensions (overload, competence, social relationship, and interpersonal relationship) obtained acceptable fit (χ2 = 184.72; p < 0.001; CFI = 0.95; TLI = 0.94; RMSEA = 0.055; SRMR = 0.05) and reliability coefficients above 0.70 in their dimensions. It is concluded that the Zarit scale is valid and reliable for use in caregivers of people with intellectual disabilities.

Background People with intellectual disabilities (IDs) may be at increased risk of developing periodontal diseases and dental caries due to poor oral hygiene. Our aim was to investigate motor proficiency factors associated with presence of visible plaque and gingival bleeding in people with IDs. We were particularly interested in the level of dependence, manual coordination and fine manual control of people with ID, as well as the level of exhaustion of the primary caregiver. Methods In this cross-sectional study, 299 people with ID were evaluated for oral hygiene using the simplified Visible Plaque Index and for gum inflammation using the Gingival Bleeding Index. The Bruininks-Oseretsky Motor Proficiency Test assessed motor proficiency through fine manual control (fine motor integration and fine motor precision) and manual coordination (manual dexterity and upper limb coordination). The level of dependence was assessed by the Katz dependency index, and the caregiver was tested for exhaustion using the fatigue severity scale. Prevalence ratios [and 95% confidence intervals (CI)] were calculated using crude and adjusted Poisson regression with robust variance. Results The exhaustion of the caregiver was associated positively to visible plaque [prevalence ratio (PR) = 1.36; 95% CI 1.06-1.65]. For gingival bleeding, people with IDs that had better fine motor integration (PR = 0.49; 95% CI 0.33-0.75) and precision (PR = 0.50; 95% CI 0.26-0.94), as well as manual dexterity (PR = 0.62, 95% CI 0.49-0.77), presented better results. Conclusion Poor oral hygiene and gum inflammation were associated with motor proficiency of people with IDs and caregivers' exhaustion. Interventions to improve the oral health of people with IDs should take into account such conditions.

Background There is evidence that psychotropic medications are overprescribed and overused to manage behaviours of concern for people with intellectual disabilities. Disability support workers and support staff lack education and training on the administration and safety of psychotropic medication use. This study aimed to test the applicability and preliminary efficacy of SPECTROM, an education programme developed in the UK, in an Australian context. Methods The training comprises two parts: Module 1 encompasses psychotropic medications, their use and side effects. Module 2 focuses on non-pharmacological interventions for supporting people with behaviours of concern. Thirty-three participants attended the training course and completed pre-training and post-training surveys on the Psychotropic Knowledge Questionnaire and Management of Aggression and Violence Attitude Scale-Revised at four time points: pre-training, 2 weeks, 3 months and 5 months post-training. Results Psychotropic Knowledge Questionnaire scores showed statistically significant post-training improvement at all post-training time points (P < 0.05). Management of Aggression and Violence Attitude Scale-Revised scores were high at pre-training and did not change significantly at any of the post-training survey time points. A 2-week post-training feedback questionnaire reported 80% agreement that the training programme was appropriate, useful and valid. Only 36% of participants completed questionnaires at all time points. Conclusions SPECTROM training increased staff knowledge of psychotropic medications, yet loss of participants was high. Further refinement of the applicability of the training for the Australian context and evaluation of the feasibility of implementation, clinical and cost-effectiveness of the programme are required.

COST Actions are grants provided by the European Union to support the establishment of networks of expertise to explore and address a scientific or social issue that impacts across Europe. This article introduces and describes one such action that started in October 2022 - CUPID - will address issues of policy and equity of access to cancer prevention initiatives by people with intellectual disabilities compared to the general population in Europe. With 82 individual members drawn from 30 countries CUPID will establish an interdisciplinary network of stakeholders representing carers, service providers, advocacy groups, educators, healthcare professionals, researchers and people with intellectual disabilities. The CUPID COST Action will be implemented over four years and will identify what needs to be addressed by the European Union and health and social services to improve cancer prevention among people with intellectual disabilities.

BACKGROUND: People with intellectual disabilities experience persistent marginalization in relation to work and employment. The concept of work inclusion provides a way of generating a more specific understanding of the meaning of employment participation. Work inclusion of people with intellectual disabilities focuses not on mere presence, but instead emphasizes relational aspects and potential for meaningful participation. OBJECTIVE: In this paper we report on an empirical study into the experiences of people with intellectual disabilities of employment participation in the Icelandic labor market. We considered their experiences in relation to four key components of work inclusion, placing emphasis on how they perceived opportunities for inclusion related to social relations, belonging, valued contributions and trust. METHODS: This study used a qualitative research design. Data was collected with semi-structured interviews with 9 participants with intellectual disabilities who all had experience of being employed in the Icelandic labour market. RESULTS: Our findings show the role of the work environment in participants’ experiences of opportunities for having good relations at work, having a sense of belonging to the organization, being able to make a contribution to the goals of the organization, and receiving trust in one’s professional role and responsibility. When participants experienced opportunities in relation to these basic components of work inclusion, they felt more positively about their employment participation. Lack of opportunities was reported as a reason for segregation and withdrawal. CONCLUSION: This study shows the importance for work organizations and other actors in the labor market of paying attention to components of work inclusion and their relation with corporate culture.

Compassion-Focused Therapy is an integrative therapeutic model with a wealth of evidence behind its efficacy. Its accessibility leads it to be a helpful therapeutic modality for the intellectual disability population. Its ability to aid the understanding of the person, us as clinicians, and the wider context around us give a depth of understanding not prioritised across all therapeutic models. This article explores Compassion-Focused Therapy in the context of working alongside people with intellectual disabilities. It focuses on how understanding archetypal and social mentality processes can aid understanding in people with intellectual disabilities as well as exploring some of the clinical implications and practical applications. It ends with a call to consider more readily, the use of Compassion-Focused Therapy in people with intellectual disabilities.

Contains fulltext : 283542.pdf (Publisher’s version ) (Open Access) Background: Aggressive incidents are common in people with intellectual disabilities. Therefore, we aimed to assess whether supplementation of multivitamins, minerals, and omega-3 fatty acids (FA) reduces aggressive incidents. Methods: We conducted a randomised, triple blind, placebo controlled, single crossover intervention trial. People with intellectual disabilities or borderline intellectual functioning, between 12 and 40 years of age, and showing aggressive behaviour were included. Participants received either a daily dose of dietary supplements, or placebo. Primary outcome was the number of aggressive incidents, measured using the Modified Overt Aggression Scale (MOAS). Results: There were 113 participants (placebo, n = 56), of whom 24 (placebo, n = 10) participated in the crossover phase of the trial. All 137 trajectories were included in the analyses. There was no significant difference in mean number of aggressive incidents per day between those assigned to supplements and those who received placebo (rate ratio = 0.93: 95% Confidence Interval [CI] = 0.59–1.45). Conclusion: In this pragmatic trial, we did not find significant differences in the outcomes between the supplement and placebo arms. The COVID-19 pandemic started midway through our trial, this may have affected the results. 10 p.

People with intellectual disabilities often face discriminatory behaviour in everyday life. The aim of this qualitative study was to gain insight into experiences of discrimination of people with intellectual disabilities. The research participants were 25 people with mild intellectual disabilities who live in Zagreb, Croatia. Their experiences indicate that they have experienced direct and indirect discrimination by people from their immediate social environment with whom they interact almost daily. Four themes about experienced discrimination emerged from the analysis: disability harassment, economic disadvantages, denial of the right to form or maintain intimate relationships, and peer rejection and exclusion. Discrimination is manifested in different treatment in fields of education, employment, participation in society and opportunities for realisation of certain social roles. It affects the quality of life and inclusion of people with intellectual disabilities.

The dominant idea in debates on social inclusion of people with intellectual disabilities is that social inclusion requires recognition of their ‘sameness’. As a result, most care providers try to enable people with intellectual disabilities to live and participate in ‘normal’ society, ‘in the community’. In this paper, we draw on (Pols, Medicine Health Care and Philosophy 18:81–90, 2015) empirical ethics of care approach to give an in-depth picture of places that have a radically different take on what social inclusion for people with intellectual disabilities looks like: places known as ‘sheltered living institutions’. We argue these places can be seen as ‘communities of difference’ catered to the specific needs and capacities of the residents. We then contend that these communities raise questions about what a good life for people with intellectual disabilities looks like and where and how it ought to be realised; questions not posed very often, as they get muzzled by the dominant rhetoric of normalisation and the emphasis on sameness.

Mainstream economic evaluations methods may not be appropriate to capture the range of effects triggered by interventions for people with intellectual disabilities. In this systematic review, we aimed to identify, assess and synthesise the arguments in the literature on how the effects of interventions for people with intellectual disabilities could be measured in economic evaluations.We searched for studies providing relevant arguments by running multi-database, backward, forward citation and grey literature searches. Following title/abstract and full-text screening, the arguments extracted from the included studies were summarised and qualitatively assessed in a narrative synthesis.Our final analysis included three studies, with their arguments summarised in different methodological areas.Based on the evidence, we suggest the use of techniques more attuned to the population with intellectual disabilities, such sensitive preference-based instruments to collect health states data, and mapping algorithms to obtain utility values.

People with intellectual disabilities and behaviours that challenge others are living longer. This review aimed to explore what is known about the health and social care needs, experiences, service interventions and resources of and for this population as they transition to different care contexts in the UK.A rapid scoping review of published and unpublished literature was conducted based on collaborative working with key stakeholders and using systematic methods of data searching, extraction and analysis.Consistent social work support, skilled staff, suitable accommodation, creative engagement with individuals and families to plan ahead, and timely access to quality healthcare are all required to promote successful transitions as people age, and to avoid unwanted/inappropriate transitions at points of crisis.More research is needed to assess the types of services that this population can and do access as they age, the quality of those services, and the extent to which local commissioners are planning ahead for people with intellectual disabilities and behaviours that challenge others.

Background People with intellectual disabilities can be exposed to sexual abuse and they can display harmful sexual behaviour. This study aimed to identify barriers to preventing harmful sexual behaviour in people with intellectual disabilities within the support sector and the justice system. Method We conducted focus group interviews with 20 participants from hospital-based habilitation centres, community residences, schools and the criminal justice system. Results The interviews identified a lack of education and guidelines for stakeholders or carers on regulating the sexual behaviour of people with intellectual disabilities. The criminal justice system faces challenges related to prioritising, understanding and communicating. People with intellectual disabilities may lack an understanding of the concepts of sexual consent and acceptable sexual behaviour. Conclusion There is a need to improve knowledge about intellectual disability and how to prevent harmful sexual behaviour for professional caregivers in the support sector and the criminal justice system.

Purpose This study provides further insight into the experiences of five men who have committed sexual offences, with intellectual disabilities and have been recalled back to prison. The purpose of this paper is to increase professional knowledge to assist with improving working practices that support the reintegration of individuals convicted of sexual offences and with intellectual disabilities, back into the community. Design/methodology/approach Interview data was analysed using interpretative phenomenological analysis, to identify the key issues associated with criminal justice services. Findings The following superordinate themes were identified: “The label that sticks” and “Probation officer dependency”. Research limitations/implications The key implications of the findings were the high level of dependency individuals had on their probation officers and the impact that this relationship had on the overall experience of recall. The stigma of the label “sex offender” was also found to have a profound impact on individuals’ feelings of safety and their future progression. Originality/value Research exploring the experiences of individuals convicted for sexual offences and with intellectual disabilities, being recalled back to prison, is limited. Future recommendations of how practice could be improved to better support responsivity needs of this group and to create a more positive self-identity are discussed.

Purpose Although it is recommended that reflective practice groups (RPGs) are used to support staff in inpatient intellectual disability (ID) services, there is to date no research on their effectiveness or how staff perceive RPGs in these settings. This paper aims to evaluate staff perceptions of the RPGs in an assessment and treatment unit for people with ID and to ascertain the nature of any barriers for staff in attending the group. Design/methodology/approach Thirteen staff completed questionnaires ascertaining their views on the purpose, process and impact of the RPG run within the service. Questionnaires included a version of the clinical supervision evaluation questionnaire (CSEQ; Horton et al., 2008) adapted for this context and a questionnaire designed by the authors examining barriers to attending the group. Findings Staff responses indicated that they valued the group and perceived it as improving their clinical practice and their self-awareness. Staff did not always perceive group sessions as having clear aims and did not perceive the group as enhancing their well-being or their awareness of gaps in their skills. RPGs may be most effective if they form part of a service-wide approach to staff support and development. Originality/value To the best of the authors’ knowledge, this is the first evaluation of RPGs in inpatient ID services. The adapted CSEQ was found to be an easily implemented method of evaluating RPGs in an inpatient ID setting.

The purpose of this study was to draw consensus among an expert panel regarding essential elements of an accessible fitness center guide for people with intellectual disabilities that will enable them to engage in physical activity fully and effectively. The study was situated in the socioecological model of disability. Researchers drew expert consensus regarding the essential features of accessible guides in fitness environments. A three-round Delphi procedure was used, involving repeated circulation of the questionnaire to an expert panel (N = 33). The panel was asked to rate the importance and adequacy of 66 items regarding the accessible fitness guide. A consensus was reached regarding 43 items after three rounds. The items include 7 body-weight exercises, 2 machine exercises, 12 environment-related items, 15 exercise preparations, 4 social etiquettes, and 3 emergencies.

SUMMARY Almost a quarter of people with intellectual disabilities have epilepsy. This life-long condition adversely affects their health, safety and well-being and carries an increased risk of sudden unexpected death in epilepsy (SUDEP) in this population. This commentary considers what not only health and social services but also communities and people with intellectual disabilities themselves can do to improve outcomes.

SUMMARY On average, 49–63% of people with intellectual disabilities and/or autism spectrum disorder (ASD) are prescribed psychotropic medications to treat psychopathology, including psychiatric illness, behaviours that challenge and the core symptoms and associated behaviours of these developmental disorders. In many cases, psychotropics, particularly antipsychotics, are used off-label without a proper indication, particularly to manage behaviours that challenge. The RCTs show moderate evidence supporting the efficacy of low-dose risperidone and some preliminary evidence for aripiprazole in treating behaviours that challenge among children with ASD and/or intellectual disabilities. The RCT-based evidence for the other psychotropics is equivocal, so no definitive conclusions can be made on their efficacy. Polypharmacy and the use of high doses of antipsychotics are prevalent in this population, leading to the risk of adverse events and drug–drug interactions. Despite various national and international guidelines, and government initiatives encouraging reduced psychotropic use, there is little evidence of this happening; on the contrary, the use of antidepressants, mood stabilisers and benzodiazepines may be increasing. A concerted multi-agency effort is urgently needed to address this significant public health concern of the overmedication of people with intellectual disabilities and/or ASD.

The paper intends to do a scoping review of people with intellectual disabilities in emergency care where this group seems to face access barriers and discrimination. It analyses the conceptual and methodological framework for studies examining the former.A scoping review is conducted. The studies' quality is assessed via a checklist developed by the authors drawing on a compilation of common assessment tools for study quality.Fourteen quantitative studies fulfil the inclusion criteria for further analysis. Summary measures are extracted. Results are synthesized with Andersen's Behavioral Model of Health Service Use. Studies employ a combination of variables attributable to different aspects of population characteristics and health behavior.Most studies seek to quantify or predict emergency care overuse by people with intellectual disabilities. Future studies should also take patients' poor health or treatment outcomes and their perspectives into account.

Background: Previous research has shown that people with intellectual disabilities have limited sexual knowledge, which can be essential for developing positive sexuality. This study aimed to check the validity and reliability of an assessment tool (SexKunn) for measuring the sexual knowledge of people with intellectual disabilities in Norway. Further, we aimed to identify potential knowledge gaps among the participants and highlight their potential impact. Methods: 37 people with intellectual disabilities completed one assessment. 20 participants then completed a retest. Clinicians’ (n=23) views on the assessment tool were measured to obtain face validity. Results: A weighted Cohen’s kappa for the test and retest of the overall scores was considered to be substantial. The clinicians described an acceptable face validity regarding high positive value scores and low negative burden scores. They also suggested improvements. The study identified that the participants lacked knowledge about female genitals, hygiene, appropriate touching/sexual acts with friends/ intimate partners, and contraception. Conclusions: The SexKunn is a feasible assessment tool to measure sexual knowledge in people with intellectual disabilities. A lack of sexual knowledge of people with intellectual disabilities may violate their sexual rights.

COVID-19 pandemic is a public health issue. From 2019 to 2022, 4.5 million people died from the COVID-19 epidemic. Consequently, COVID-19 has put a significant strain on every single creature in this world. COVID-19 has been associated with lockdown, thus resulting in lockdown related inequities towards most people in this world, with unanticipated consequences for people with disabilities. Building in this debate, this paper aimed to discuss on the impacts of COVID-19 on the physical health of People with Intellectual Disabilities. Based on the Prisma protocol, this systematic literature review examined 28 publications from Web Sources of Science and Scopus.The study identified three themes regarding the impact of COVID-19 on the physical environment of people with intellectual disabilities namely mental health, social isolation, severe health problems, socioeconomic and psychology. This study has significant implications in understanding how PWID are impacted by COVID 19 and urged that early preventative measures should be taken since People with Intellectual Disabilities are considered a vulnerable population, therefore it is crucial to ensure that their health status are sustained.

Spanish universities still face many barriers to the training of people with disabilities, especially with intellectual disabilities (ID). In general, continuing higher education courses are the main training response for the latter. Knowing the impact that confinement by COVID-19 has had on the students of these courses is a relevant element. The present investigation focused on analyzing the case of the confinement experience of 12 young students with ID who attended the continuing training program called Unidiversidad at the University of Alcalá (Spain). In particular, the implications on their emotional well-being, interpersonal relationships, and individual training were analyzed. Information was collected through a semi-structured interview with the students and a questionnaire with their relatives. The results reflect changes in emotional well-being linked to the increased concern of students for the health of their families. Interpersonal relationships were also affected, although participants tried to compensate for the lack of face-to-face interaction with instant messaging applications and video calls. The change in training to the online modality generated concern and uncertainty in students, although it also provided learning opportunities, which have been supported by peer tutoring and support from teachers. This work has been supported by the University Teaching Research Network Program of the Institute of Educational Sciences of the University of Alicante (2020-21 call). Ref. 5100.

Emotions influence processes of learning and thinking in all people. However, there is a lack of studies in the field of emotion research including people with intellectual disabilities (ID) addressing the existing diversity. The present study investigates the emotional competence of people with ID (N = 32). The first aim was to assess the emotional development using the Scale of Emotional Development (SEED). Based on these insights, the second objective was to replicate existing findings, validating the emotional reaction of people with ID to pictures of the International Affective Picture System (IAPS) based on self-reports. In an additional pilot-like analysis, the third aim was to investigate if these self-reported emotional reactions match the emotions expressed in their faces using the automated and video-based facial expression analysis software ‘Affectiva (Affdex SDK)’. In the present study, the self-reported emotional reactions of participants with ID were in line with previous research. In addition, the present study shows the general potential of this innovative approach of using and applying commercially available automated emotion recognition software for the field of special needs and social science.

Long-COVID (also known as post-coronavirus-19 syndrome) is a term used to describe symptoms that people experience following their recovery from the COVID-19 virus. The severity of long-COVID is well recognised, with healthcare providers commissioning services to diagnose and treat those affected, as well as funded research into the condition.We performed a systematic search for relevant articles but were unable to find any research on long-COVID in people with intellectual disabilities. Due to the lack of data, we have only been able to make extrapolations from what is known about the condition within the general population.We provide an overview of long-COVID and its potential relevance to people with an intellectual disability. We have focused specifically on symptoms or signs, prevalence, risk factors and treatments of the condition in this group, highlighting areas for clinical practice and future research from a psychosocial perspective. We raise serious questions about our current understanding and the availability of the evidence-based to inform treatments tailored towards this population.This is the first report that we are aware of on the topic of long-COVID in people with an intellectual disability. The lack of research is preventing us from gaining a greater understanding of how the condition impacts people with an intellectual disability.

The current study highlights the attitude of students toward the use of film sequences, as educational resources used in the course of Psychopedagogy of people with intellectual disabilities, in the online learning environment. The participants in the study were students (N = 28) in the 2nd year, who follow the Special Psycho-pedagogy study program. The research method was a questionnaire-based survey. The working tool contains 23 questions, which were developed by the authors for this research. In the introductory part, in addition to the synthesis of the specialized literature, we briefly presented the aspects related to the management of the university course, in a pandemic context, by presenting the ways in which the film sequences were used to achieve the objectives of the discipline. The results of the descriptive study show that students show a positive attitude towards the use of film sequences in teaching, learning, and final assessment activities. Thus, the students consider that the film sequences used in the course activities facilitate the understanding of the theoretical information from the course support, about the particularities in the development of people with intellectual disabilities. Additionally, the film sequences used for assessing knowledge in the final exam took students out of their comfort zone of passively taking the theoretical information and giving an answer during the online assessment tests. The research findings highlight the practical implications and future directions of research to ensure good management of course activities in the online learning environment.

Background: \ud The promotion of physical activity and the decrease of inactivity and sedentary behaviour are crucial for a healthy lifestyle and positive quality of life. People with intellectual disabilities are at increased risk of inactivity and sedentary behaviour. Therefore, it is important to increase their physical activity by implementing physical activity guidelines in their daily life. Professional direct care providers can play a decisive role in supporting people with intellectual disabilities to participate in physical activity, but the engagement of direct care providers with this role may be reflective of their own attitudes and beliefs towards physical activity. Therefore, the link between the implementation of current physical activity guidelines for people with intellectual disabilities and direct care providers' own beliefs and behaviour with regard to physical activity is investigated.\ud \ud Method: \ud A total of 104 direct care providers completed self‐reported questionnaires about their own physical activity behaviour (IPAQ‐SF), recommendations for people with intellectual disabilities (adaption of EMIQ‐HP) and questions regarding global physical activity guidelines. They were also asked about potential barriers and facilitators for the recommendation of physical activity in open‐ended questions. \ud \ud Results: \ud Personal physical activity behaviour is related to the recommended physical activity for people with intellectual disabilities (moderate‐to‐vigorous physical activity: r s = 0.408, P = 0.005). However, recommended physical activity behaviour for people with intellectual disabilities is significantly lower than direct care providers' own physical activity behaviour (P < 0.001). 47.1% of the respondents recommended people with intellectual disabilities to participate in less than the 150 min of moderate intensity physical activity per week for that is recommended in global physical activity guidelines. \ud \ud Conclusion: \ud Direct care providers may hold stereotypical views and insecurities about the potential harms associated with people with intellectual disabilities participating in physical activity. Therefore, the dissemination of physical activity recommendations for people with intellectual disabilities should be a major target for health professionals, social workers and scientists to address direct care providers' concerns. Furthermore, we need to emphasise the benefits of regular physical activity to professional direct care providers and directly to people with intellectual disabilities.

Purpose The assessment for and diagnosis of personality disorder (PD) continue to be contentious, with many prominent practitioner psychologists arguing against this specific label and providing a credible alternative framework to psychiatric diagnosis more generally. This paper aims to summarise the literature and support practitioners identifying PD in people with intellectual disabilities (ID). Design/methodology/approach Relevant National Institute for Health and Care Excellence (NICE) guidance and literature were reviewed to provide a service position on the assessment and diagnosis of PD in people with ID. Findings For people with intellectual disabilities, the PD label can be even less robustly applied and may be even more pejorative and obstructive. That said, there are people for whom a PD diagnosis has clear clinical utility and opens access to suitable specialist services. Practical implications Evidence suggests that a diagnosis of PD can be both facilitative and obstructive, and the assessment and diagnosis process should, therefore, be undertaken with caution. Originality/value This paper presents an account of NICE guidance and evidence on the assessment and diagnosis of PD in people with intellectual disabilities.

Access to equal healthcare is a priority for people with intellectual disabilities. Most studies have focused on primary care providers; however, the administration of inclusive healthcare also relies on medical specialists, who should be considered a specific group because their practice varies significantly in this regard. Semi-directive interviews were conducted with 12 medical specialists to explore their representations regarding the care of people with intellectual disabilities. An inductive thematic analysis was applied to the data. The results highlighted a significant heterogeneity between practitioners’ representations of people with intellectual disabilities in healthcare, current practices, and their perceptions and expectations in the process of ensuring quality care. This study highlights the importance of considering medical specialists’ awareness raising and training to handle consultations with people with intellectual disabilities. From a broader perspective, a clear political framework to guide healthcare practices at the national level should be developed.

Background: People with intellectual disabilities increasingly live in smaller community settings rather than institutional settings. Home- and community-based services (HCBS) are a type of long-term care in which services and supports are provided in people’s homes and communities. HCBS are essential for people with disabilities to remain in the community. Method: The 2015-2016 National Core Indicators survey data, along with other datasets, were used to determine how factors impacted service utilization and additional services needed for adults with intellectual and development disabilities (I/DD) in the US. Three groups of factors were used: individual, interpersonal, and public policy factors. Results: Variables within each of the three groups of factors affected access to HCBS. Of significant note within individual factors, older adults received more services and had fewer additional services needed. Black respondents received fewer services and had more additional services needed. A higher problem behaviors score and use of mobility aids were associated with greater utilization and more additional services needed. Better health was associated with significantly fewer additional services needed. Within interpersonal factors, results indicated that people who lived in group homes received more services than people living in their own or family homes. Additionally, individuals with community jobs received more services. A notable public policy finding indicated people who lived in a state with a Balancing Incentive Program (BIP) got more services but also had additional services needed. Conclusion: This study examined factors not studied previously and indicates that future research should look at different factors to better understand their impacts on access to HCBS for people with I/DD.

Background:The multi-disciplinarity of long-term care for people with intellectual disabilities makes organisations seek stability and predictability, complicating implementing innovations. Interventions to implement a method for reducing restrictive measures were analysed through the lens of Normalisation Process Theory to understand the social mechanisms at play.Methods:Process notes, collected during a trial in which a method to reduce restrictive measures was implemented, were analysed guided by implementation interventions defined by Cochrane Effective Practice and Organisation of Care Review Group. These interventions were mapped to social mechanisms of Normalisation Process Theory.Results:Implementation interventions were widely used in which clients’ perspectives were expressed (client-related-interventions), and consensus processes were held with care professionals. These interventions initiated NPT’s social mechanisms’ Coherence, Cognitive Participation and Collective Action.Conclusions:The emphasis on consensus and clients’ perspectives when methodically reducing restrictive measures reflects some unique implementation challenges in long-term intellectual disability care.