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AbstractPeople with intellectual disabilities can be abused in all settings: homes, communities, and services. Reducing this abuse requires attention be paid to people who are engaged with people with intellectual disabilities, who were largely overlooked by a neoliberal inquiry focused on individuals. Displacing neoliberalism has been further impeded by its recent combination with social media, which has engendered “cultural homogenisation”: the further spread and sustenance of the same ideas. This article aims to offer a fundamental critique of the Disability Royal Commission’s (the Commission) inquiry by revealing the way neoliberal ideology has shaped its recommendations; and to identify positive alternatives. Arguments: (1) Neoliberal individualism is a powerful but invisible doctrine. Its focus on choice and autonomy has generated concern to provide accessible information, irrespective of its feasibility; and concern to eliminate restrictive practices, irrespective of equally important needs of staff and parents. (2) “Datafication” intended to monitor and improve otherwise unregulated markets is expensive, ineffective, and impedes engagement. (3) The only meaningful adult life envisaged is paid work, despite a meagre and shrinking number of people with intellectual disabilities obtaining jobs. (4) The limitations of a legal inquiry are identified. (5) Alternatives to the promotion of voice, choice, and work are explored. Exhausted neoliberal ideology led the Commission astray. Rather than continuing to enact neoliberal solutions, two different initiatives that are more likely to disrupt the status quo are proposed: replacing legal intervention with public health approaches to reducing violence in all settings; and developing new “counter-publics” of fun and belonging that connect people and their consociates.

AbstractIn Anglophone countries, the 40% of people with intellectual disabilities who show challenging behaviour, mental health problems, or both, are usually offered behavioural rather than emotional interventions. Yet much of their distress has originated in emotionally damaging personal histories, since children with intellectual disabilities are much more likely to experience adverse childhood experiences that predict significant mental health problems in adults. This clinical research review addresses that. It raises two issues: first, provision of effective support to parents (considered elsewhere); and second (the focus of this article), how services for distressed adults can address the untapped potential for development and growth in their emotional lives. A key finding in favour of an attachment perspective is that the emotional development of people with intellectual disabilities lags significantly behind their cognitive development, and their level of emotional rather than cognitive development predicts challenging behaviour. Two attachment assessments that can frame intervention have been considered: the Scale of Emotional Development–Short; and the Adult Attachment Projective Picture System. Related system changes necessary for services to implement attachment-informed interventions were then identified: specialisation rather than eclecticism, ensuring that trauma-informed care is applied with fidelity, and staff stability.

ABSTRACTDedifferentiationdescribes a shift away from regarding cognitive impairments as the origin of difficulties experienced by people with intellectual disabilities and, instead, regarding their difficulties as socially produced and common to all people with disabilities. This article reviews research evidence concerning the advantages and disadvantages of dedifferentiated policy and service systems for people with intellectual disabilities, the bulk of which addresses education and health service systems. Advantages of dedifferentiation include its avoidance of assumptions about homogeneity, and the stigma of being labelled intellectually disabled; and its support for strong collectives and advocacy that enable people with all types of disabilities to live in the presence of others. For young children, dedifferentiated school and mental health services have positive outcomes not found in similar services for older children and adults. Disadvantages of dedifferentiation include inaccurate or absent representations of unique needs arising from intellectual disability, failure to reduce marginalisation, poor-quality non-specialist mainstream secondary education and health services, and deteriorations in social care. Arguments that dichotomies such as dedifferentiation/differentiation encourage simplification and misconception are reviewed: instead, twenty-first-century thinking negotiates between diverse parties and perspectives. The article makes the case for treating people with intellectual disabilities as members of the broad disability group wherever possible, and for protecting and developing differentiated opportunities, services and research whenever necessary. This requires policymakers and practitioners to balance conflicting ideas more effectively, but it also requires reflection and debate that allow new conceptual tools to emerge. The article concludes by posing three questions intended to encourage reconceptualisation.

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Current revision of the two major psychiatric classification systems has elicited particular comment on neurodevelopmental disorders, which have seen increased provision of specialist clinical services, user group activity, fictional and biographical accounts, and research. Philosophical scrutiny of autism research and literature provides an additional perspective.

Mourning exists at the nexus between individual experience, professional discourses, research, and culture, making it a complex issue for health services that has shown vibrant change in recent years. By contrast, bereavement discourse in intellectual disability is suffused by dogmatic assertions about correct intervention: we describe four vignettes to illustrate bereavement issues in intellectual disability. Suggestions concerning issues and management are made, but the article focuses primarily on the conceptual issues that underpin clinical intervention. The analysis shows how challenges to the meaning of the disabled life, and to the understandings carers and staff draw on, tend to be resisted. We hypothesize this is most likely to surround issues that evoke cultural uncertainty, such as bereavement. The thesis is that the field of intellectual disability tends to be isolationist because meaning is difficult to create and easily dissolved, especially when addressing culturally contested topics. Dialogue with other disciplines is necessary to stop the field from atrophying, but needs to be carried out in ways that enable carers and clinicians to continue providing the support that people with intellectual disability require.

A shift in accepted practice regarding sharing research led one editor to discuss adopting a legal rather than a moral stance to enforce ethical standards. Familiar ethical concerns regarding consent and balancing individual rights against those of others are considered, alongside lacunae in the field, by drawing on virtue ethics. Reappraisals of quality of life, person-centred planning and normalization are discussed, concluding that developing ethical relationships with people who have intellectual disability takes precedence over client competency.