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BackgroundMethodResultsConclusionsOpportunities for students with intellectual disability to attend postsecondary education have increased with the rise of inclusive post-secondary education (IPSE) supports, bringing the need to examine the experiences of students and their instructors.This qualitative study used semi-structured interviews with 12 university instructors of IPSE students and 10 IPSE students to examine experiences with course adaptations.Results indicate that instructors desired greater institutional support, training, and information as they felt unsure about their abilities to support students with intellectual disability and had varied understanding of accommodations and modifications. Students wanted to be seen as capable university students, utilised peer mentor supports, and were able to provide information about how they learned in a university setting.The study found that students were valuable but often underutilised sources of information about their own access needs and sometimes worked through and around university systems. Implications for practice are provided. [ABSTRACT FROM AUTHOR]

\nLAY SUMMARYAcademic writing is a complex task involving microstructure (linguistic-level) and macrostructure (coherence structure) indices. Our goal was to examine the contribution of an academic writing intervention programme among students with intellectual disability at the microstructure and macrostructure levels while characterising the learning curves. Six students with mild intellectual disability studying for a BA (MCA = 30.43, MIQ = 69.17) participated in a spiral intervention programme of 32 lessons focusing on improving paragraph complexity and text structure measured at five time-points. Microstructure improvement in number of words, sentences, paragraphs, words per paragraph, lexical density, adjectives along with macrostructure improvement in text-paragraph structure, global-local linkage were found. A rapid increase in macrostructure indices was observed between the first and second testing points, after which a ceiling effect was reached. Concurrently, microstructure indices demonstrated a slower, more gradual learning curve throughout the intervention period. The discussion will focus on the improvement patterns in microstructure–macrostructure indices and the various learning curves observed. It explores the implications of these findings for cognitive modifiability in adults with intellectual disability and the potential of tailored academic writing interventions in post-secondary education programmes. A long-term, spiral intervention programme was effective at improving academic writing skills that require high cognitive involvement among individuals with intellectual disabilities in microstructure and macrostructure indices.Different types of linear learning curves showed a rapid increase in macrostructure indices, alongside a mixed rate of improvement in microstructure indices.The participants' thinking skills improved from focused thinking to transcendental thinking following the Structural Cognitive Modifiability (Feuerstein, 2003).The results can be explained via the Compensatory Trajectory theory (Lifshitz, 2020; 2015) which claims that chronological age plays an important role in determining the cognitive level and ability in adults with intellectual disabilities.A long-term, spiral intervention programme was effective at improving academic writing skills that require high cognitive involvement among individuals with intellectual disabilities in microstructure and macrostructure indices.Different types of linear learning curves showed a rapid increase in macrostructure indices, alongside a mixed rate of improvement in microstructure indices.The participants' thinking skills improved from focused thinking to transcendental thinking following the Structural Cognitive Modifiability (Feuerstein, 2003).The results can be explained via the Compensatory Trajectory theory (Lifshitz, 2020; 2015) which claims that chronological age plays an important role in determining the cognitive level and ability in adults with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Spivakovsky et al. (2023) questioned the effectiveness of Positive Behaviour Support as an intervention for reducing challenging behaviour and the use of restrictive practices as a behaviour management approach. This article responds to their critique. We argue that the literature supports the effectiveness of Positive Behaviour Support when it is properly implemented. As employees of a Positive Behaviour Support service provider, our position is also supported by our experience of the use of Positive Behaviour Support and its beneficial outcomes. To ensure a high level of fidelity in the implementation of Positive Behaviour Support, it needs to align with the elements that underpin Positive Behaviour Support (i.e., elements of applied behaviour analysis, person-centred practice, human rights, system change) rather than simply implementing Positive Behaviour Support to meet existing legislative requirements. In conclusion, when Positive Behaviour Support service provision and implementation in Australia is correctly aligned with the core components of Positive Behaviour Support, positive outcomes for people with disabilities, including a reduction in the use of restrictive practices, can be achieved. [ABSTRACT FROM AUTHOR]

One of the most contentious outcomes of the Disability Royal Commission (the Commission) is the divided recommendations regarding special schools. This is an outcome that is particularly relevant to students with intellectual disabilities who are more likely than other students with disabilities to be enrolled in special schools. The place of special schools in an inclusive education system has long been debated among educators, policymakers, and parents of students with disabilities, and this debate was no less prominent in the investigations of the Commission, as it grappled with the question of what safe, quality, inclusive schools look like for students with disabilities. The Commissioners sought unsuccessfully to avoid polarised discussions about special schools and arrived at a split conclusion about the role of special schools going forward. Understanding and critiquing the Commission's divided recommendations on special schools is the focus of this article. [ABSTRACT FROM AUTHOR]

This article considers the response of the Disability Royal Commission (the Commission) to the experiences of the estimated 21,000 Australian parents with intellectual disabilities and their children. Research shows that interlocking complex social disadvantage and ableist professional attitudes toward parenting by people with intellectual disabilities persist, leading to very high rates of child protection and child removal. The approach taken by the Commission to examination of violence, abuse, neglect, and exploitation against parents with disabilities as a group led to the invisibility of parents with intellectual disabilities within the Final Report. The life course approach was narrowly conceived and did not fully capture reproductive justice across the life course. The issue of parenting and child protection contact was primarily considered in relation to First Nations families, which brought critical attention to some aspects of systemic violence and abuse, but issues and experiences of non-Indigenous parents with intellectual disabilities were absent. We argue that these and other flaws prevented the Commission from making important recommendations in relation to legal and policy reform to uphold the rights of people with intellectual disabilities to become parents and to receive the support they need for parenting over the life course. [ABSTRACT FROM AUTHOR]

Many people with intellectual disabilities have complex health needs that are not met by the Australian healthcare system. The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (the Commission) looked at the failings of the healthcare system and the improvements needed. Services provided by allied health professionals are one part of the healthcare system. This article describes the evidence the Commission heard about the unmet allied health needs of people with intellectual disabilities, the resulting harms caused, and the recommendations to address these. Despite identifying unmet allied health needs, the Commission heard evidence predominantly about nursing and medical care, although many of its recommendations were applied to the entire health workforce, including allied health professionals. The article reflects on the challenges of implementing the Commission's recommendations and the risk that positive change in health outcomes for people with intellectual disabilities may not be achieved. [ABSTRACT FROM AUTHOR]

The Disability Royal Commission received evidence of educational exclusion of school students with disabilities, occurring in both overt and covert forms, and of students' experiences of violence and abuse. According to this evidence and prior research and reports, exclusionary and abusive practices appear to be entrenched in school education in both mainstream and special settings. The relationship between the evidence presented to the Commission and prior inquiries and research is presented with the aim of providing a critique of its approach and recommendations. Highlighted are the contrasting recommendations to either abolish or retain special schools and other segregated school settings. Other recommendations are reviewed to demonstrate how the final recommendations were part of a comprehensive suite of strategies to address long-standing exclusionary practices. Particular attention is given to students with severe-profound intellectual disabilities, who are most likely to be enrolled in or diverted to special schools and segregated units located in mainstream schools. Although the recommendations were comprehensive in addressing key contributors to exclusion, they showed a failure to consider in greater depth prior research and current positive practices of authentic inclusive education. It is argued that the Commission missed the opportunity to draw on research based on models of supports, shared understanding of inclusion, and making use of professionals beyond educators to provide complementary expertise. [ABSTRACT FROM AUTHOR]

The Disability Royal Commission (the Commission) investigated many issues, one of which was whether people with cognitive disabilities, including people with intellectual disabilities, faced systemic neglect in the Australian health system. Using a method of co-design with people with intellectual disabilities, we analysed the Commission's approach and recommendations about preventive health care. We identified how the Commission's recommendations can inform the achievement of the National Preventive Health Strategy (the Strategy) for people with intellectual disabilities. We found that a strength of the Commission's process was the multiple ways it inquired about the experience of accessing preventive health care. However, the inclusiveness of the invitations to participate in the Commission's work and the location of the public hearings were limitations for key stakeholders. Our analysis also noted that the Commission's public hearings focused on the supply side of healthcare access (health services) compared to the demand side of access (health users). This was a missed opportunity to learn from health users about their experiences. Two challenges to the implementation of the recommendations include the focus on cognitive disability instead of intellectual disability, and the focus on health care in general, rather than specifically on preventive health care. We also found that the Commission's recommendations mainly relate to the leadership, governance and funding elements in the Strategy, with a few actions relevant to prevention, partnerships, information, research, surveillance and preparedness. It is important that all the elements required to mobilise prevention systems are considered and actioned to achieve the Strategy. [ABSTRACT FROM AUTHOR]

This study investigates South African teachers' attitudes in schools for learners with special educational needs specifically learners with severe intellectual disability (SID) using a quantitative and descriptive online survey. The questionnaire includes the Modified Teachers' Attitudes Scale. The theory of planned behaviour is used as an explanatory model to explore why teachers may have difficulty with their role in supporting the educational needs of learners with SID. Purposive sampling was employed to recruit teachers which are on Facebook support groups. The results based on the feedback from 221 teachers, reveal that teachers possess negative attitudes regarding the communication, socialisation, and future outcomes of learners with SID. Teachers revealed positive attitudes towards inclusion and their capabilities when teaching learners with SID. A neutral attitude was obtained towards these learners' participation needs. The article concludes with the importance of teacher education on the nature and manifestations of the disorder to provide realistic expectations within the classroom. An additional recommendation is made addressing the management of schools requesting to fortify the use of inclusive practice and place value on input from teachers. [ABSTRACT FROM AUTHOR]

Egypt has recently undergone significant educational reforms, granting children with disabilities the right to inclusive education and well-being as stipulated in the Arab Republic of Egypt's Constitution and Ministerial Degrees. This qualitative study aimed to capture the current situation of inclusion in Egypt's educational landscape and gather insights from school leaders (n = 2) and parents (n = 4) regarding the services provided to children with intellectual disabilities (ID) in two international schools in Egypt. Through semi-structured interviews, this study aimed to assess recent changes and efforts made in education reform to support inclusive practices for ID in international schools in Egypt. The study employed ecological systems theory (EST) to incorporate the framework into the thematic analysis of qualitative data, categorizing the school leaders' and parents' responses into four societal layers. The results revealed several challenges facing ID in Egypt, including inclusive leadership, teachers' qualifications, support systems, and a sense of solidarity. The findings suggest that tailored interventions should be implemented to improve the educational outcomes of children with disabilities in inclusive settings. [ABSTRACT FROM AUTHOR]

This comprehensive study delves into the family quality of life (FQOL) of caregivers in Saudi Arabia, focusing on those caring for individuals with autism, intellectual disabilities, and other disabilities and those without any disabilities. Employing the Arabic version of the Beach Center FQOL Scale, the research encompasses a diverse group of 1065 family members. It reveals that caregivers of individuals without disabilities experience notably higher FQOL, especially in domains such as family interaction, parenting, emotional, and physical/material well-being. The study also identifies unique FQOL challenges encountered by caregivers of individuals with autism. These insights underscore the necessity for specific support mechanisms catering to the distinct needs of caregivers, particularly those handling autism-related challenges, highlighting a critical area for targeted interventions and policy formulation. [ABSTRACT FROM AUTHOR]

Introduction: There is increased focus on the negative impact of the overprescribing of medication, specifically psychotropic medication, including anti-seizure medications (ASM), in people with Intellectual Disability (ID). This is particularly important for the older adult population, where multi-morbidity and polypharmacy are more common. ASMs are associated with psychiatric and behavioral adverse effects. Furthermore, there is growing awareness of the anticholinergic burden for older adults with epilepsy and ID and the relationship with behaviors that challenge (BtC). Areas covered: This review defines the older adult population and outlines the relationship between epilepsy and ID. BtC is outlined in the context of the population and the relationship with ASMs. The evidence base to guide prescribing and de-prescribing for newer ASMs is also presented, including pragmatic data. Expert opinion: Polypharmacy, particularly psychotropics, are a mortality risk factor for older adults with epilepsy and ID. Therefore, any BtC requires a holistic assessment with a multi-disciplinary approach. This includes specific consideration of all prescribed medicines in the context of polypharmacy. There should be routine reviews, at least annually, for those aged 40 years and over particularly focused on anticholinergic burden and/or polypharmacy. [ABSTRACT FROM AUTHOR]

BackgroundMethodResultsConclusionIndividuals with intellectual disability have deficits in postural balance and mobility. This study aimed to explore the effect of listening to music on postural balance and mobility in individuals with intellectual disability.Ten participants with intellectual disability and 10 participants with typical development performed postural balance and mobility tests [Time Up and Go (TUGT)/Ten Metre Walking (TMWT)] in three music conditions: no music, preferred music, and Mozart’s Jupiter music.Results revealed that listening to Mozart’s Jupiter decreased (p < 0.001) the center of pressure mean velocity values for both groups. In individuals with intellectual disability, the TUGT and the TMWT time to execution increased (p < 0.001) in the preferred music compared to the no music condition whereas the Mozart music has no significant effect (p ≥ 0.05).Listening to Mozart’s Jupiter enhanced static postural balance, whereas listening to the preferred music impaired mobility in individuals with intellectual disability. [ABSTRACT FROM AUTHOR]

BackgroundMethodResultsConclusionParental intellectual disability is considered a risk factor for child removal internationally. In New South Wales, Australia, authorised clinicians are court appointed experts who assess parenting and cognitive capacity in child protection matters.This study examined a sample of 20 assessment orders requesting parenting capacity and cognitive capacity assessments and corresponding authorised clinician reports.Authorised clinicians were requested to assess whether parental intellectual disability and cognitive impairment posed the risk of harm to children. Clinicians assessed parents as either “able with support” or “unable” to provide adequate care to their child.Our findings highlight the law’s conceptualisation of risk, parenting capacity, and cognitive impairment in binary terms (i.e., risk or no risk, able or unable), which in turn limits casework planning and clinicians’ framing of parents’ abilities. We provide recommendations to improve fair and equitable assessment processes for parents with cognitive difficulties, as well as access to timely and appropriate services. [ABSTRACT FROM AUTHOR]

AbstractContextPurposeMethods and resultsConclusion and implications\nIMPLICATIONS FOR REHABILITATIONContemporary technologies, such as mainstream and specialised Assistive Technologies (ATs), are seen as effective. However, there is a noticeable gap between technological progress and the ability to customise these technologies to meet the unique needs and characteristics of neurodivergent individuals, particularly those on the Autism Spectrum and people with Intellectual Disability (pwID).The goal of this study is to investigate the present requirements and future priorities acknowledged by specialists in the field regarding the progress of social inclusion for this population, making use of ATs.A qualitative survey involving 24 international experts, and its respective thematic analysis reveals challenges in social inclusion, emphasizing communication and physical accessibility, awareness gaps, and stigma. Concurrently, issues surrounding ATs include limited access, insufficient training, and a lack of awareness and skills, with individuals, and families being inadequately involved.The study proposes strategies for overcoming these challenges, with a focus on accessibility, awareness, skills, family involvement, and customization. Identified research needs encompass scientific development, inclusive approaches, and changes in technological development paradigms.Customization and Accessibility of Assistive Technologies (ATs): The research emphasizes the critical gap between existing ATs and their alignment with the needs of people with Intellectual Disability (pwID) and those on the autism spectrum. This is crucial for rehabilitation since its effectiveness is based on the consideration of individual requirements. In this sense, the present study involves enhancing the adaptability of technologies to support varied communication styles and learning abilities, thereby promoting greater independence and participation in daily activities, also through rehabilitation.Policy and Infrastructure Development: In an innovative manner, the study points out the systemic challenges, including inadequate policies and lack of support infrastructure, that hinder the effective use of ATs. For rehabilitation practices to be impactful, there is a need for policy reform and infrastructure development that prioritizes the provision and integration of ATs into education, employment, and community living. This includes ensuring funding for AT acquisition, creating inclusive educational and work environments, and improving public spaces to accommodate the needs of pwID and on the autism spectrum.Involvement of Individuals and Families in the AT Development Process: The paper highlights the limited involvement of individuals with ID and on the autism spectrum, and their families, in the process of developing and selecting ATs. Therefore, an important implication for rehabilitation is the need to adopt a person-centred approach that actively involves these individuals and their families in decision-making processes and, whenever possible, in co-creation processes. This approach ensures that AT solutions are better suited to the users’ preferences, challenges, and daily life contexts, thereby enhancing the effectiveness of technological aids in supporting social inclusion and autonomy.Adoption of Qualitative, In-Depth Methods in AT Research: The adoption of qualitative research methods in disability and health research significantly contributes to the development of human-centred, context-driven, and personalized technologies and rehabilitation strategies.Customization and Accessibility of Assistive Technologies (ATs): The research emphasizes the critical gap between existing ATs and their alignment with the needs of people with Intellectual Disability (pwID) and those on the autism spectrum. This is crucial for rehabilitation since its effectiveness is based on the consideration of individual requirements. In this sense, the present study involves enhancing the adaptability of technologies to support varied communication styles and learning abilities, thereby promoting greater independence and participation in daily activities, also through rehabilitation.Policy and Infrastructure Development: In an innovative manner, the study points out the systemic challenges, including inadequate policies and lack of support infrastructure, that hinder the effective use of ATs. For rehabilitation practices to be impactful, there is a need for policy reform and infrastructure development that prioritizes the provision and integration of ATs into education, employment, and community living. This includes ensuring funding for AT acquisition, creating inclusive educational and work environments, and improving public spaces to accommodate the needs of pwID and on the autism spectrum.Involvement of Individuals and Families in the AT Development Process: The paper highlights the limited involvement of individuals with ID and on the autism spectrum, and their families, in the process of developing and selecting ATs. Therefore, an important implication for rehabilitation is the need to adopt a person-centred approach that actively involves these individuals and their families in decision-making processes and, whenever possible, in co-creation processes. This approach ensures that AT solutions are better suited to the users’ preferences, challenges, and daily life contexts, thereby enhancing the effectiveness of technological aids in supporting social inclusion and autonomy.Adoption of Qualitative, In-Depth Methods in AT Research: The adoption of qualitative research methods in disability and health research significantly contributes to the development of human-centred, context-driven, and personalized technologies and rehabilitation strategies. [ABSTRACT FROM AUTHOR]

Abstract\nPoints of interestThe online learning resource ‘Every Moment has Potential’ (2015) aimed to teach direct support professionals about the values underlying active support, especially choice and control. This is unsurprising: these values anchor disability rights activism and policies. However, accompanying videos meant to illustrate choice and control offer a more nuanced story. My qualitative analysis brings in Lori Marso’s concept of freedom in the encounter to theorize four kinds of encounters in active support relationships: encounters that treat people as people; encounters that encourage surprise and spontaneity; encounters of mutual and safe touch; and challenging encounters. I aim to question critically the explicit values alongside the practices of active support. Plus, by using online YouTube videos as analysis, I hope to encourage more creative ways to include people with severe and profound intellectual disabilities in academic work, especially theoretical and philosophical work about intellectual disability.Support workers help people do things, like cook, clean, shop, and have fun.Some people say that support workers should help people with disabilities make choices.I watched videos that showed support workers helping people with intellectual disabilities to see if this was true.Helping people make choices is good, but good support workers help in other ways, too.Good support workers treat people with intellectual disabilities like people. They help people with intellectual disabilities have fun. They try new things together. And support workers and people with intellectual disabilities can use physical touch with each other in good and safe ways. [ABSTRACT FROM AUTHOR]

Creating meaningful interaction can be challenging for communication partners of persons with intellectual disabilities and hearing impairment (IDHI). To elicit moments of interaction and communication, the sensory-enhanced interactive storytelling technique (SEIS-T) has been developed within clinical and educational practice for people with IDHI and their communication partners. SEIS-T uses custom-made storybooks, referential objects and augmentative and alternative communication (AAC). Although many positive communicative moments with SEIS-T have been mentioned by practitioners, scientific research regarding this approach is limited. The present study aimed to alleviate this by examining changes in communication patterns and engagement of children with IDHI over the course of 10 repeated SEIS-T sessions and comparing the results to regular storytelling sessions. Six children participated in a multiple-baseline study. An event-sampling method was applied to analyse videos of the reading sessions, with respect to the children’s verbal and nonverbal communicative acts (role, form and complexity), and their attention to the storytelling. Non-overlap of all pairs (NAP)-analysis was used to test differences between the baseline and intervention phase for each participant. Promising improvements were seen in the frequency and variety of communicative acts by the children and in their focused attention during storytelling, when employing the SEIS-T. [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATIONS FOR REHABILITATIONA lack of multistep requesting among children with intellectual disability can be an indicator of complex communication and social challenges. This study aims to determine the effect of a systematic instruction (differential reinforcement, progressive time delay, and least-to-most prompting) using an iPad with the “GoTalk Now” app on the acquisition and maintenance of multistep requesting. Using a multiple-probe across-participants design, three children between the ages of nine and 10 diagnosed with intellectual disability participated in this study. The findings revealed that the intervention was effective in both the intervention and maintenance phases. In two participants, the change in performance occurred immediately, while in the other participant, it took more sessions to reach the acquisition criteria. Social validity data were obtained from participants’ teachers. Implications and future directions are discussed according to the findings.The use of iPads, evidence-based practices, and systematic instruction can enhance communication skills, specifically multistep requesting, among children with moderate intellectual disability.The intervention package (GoTalk Now app on iPad and systematic instruction) was effective and help the three children gain and maintain multistep requesting skills.The positive change in children’s performance may encourage more usage of the iPad and systematic instruction for enhancing different skills among children with intellectual disability.This study may prove useful to teachers and specialists who teach or work with children with intellectual disability.The use of iPads, evidence-based practices, and systematic instruction can enhance communication skills, specifically multistep requesting, among children with moderate intellectual disability.The intervention package (GoTalk Now app on iPad and systematic instruction) was effective and help the three children gain and maintain multistep requesting skills.The positive change in children’s performance may encourage more usage of the iPad and systematic instruction for enhancing different skills among children with intellectual disability.This study may prove useful to teachers and specialists who teach or work with children with intellectual disability. [ABSTRACT FROM AUTHOR]

Background: Children and adolescents with intellectual disabilities commonly experience emotion regulation difficulties. To better understand emotion regulation in this population, the views of their teachers were considered. Methods: Twenty-nine teachers participated in two focus groups. This study utilized qualitative methods to determine if the emotion regulation experiences of this population, as perceived by their teachers, map onto the five domains of the process model of emotion regulation: situation selection, situation modification, attentional deployment, cognitive change, and response modulation. Results: A thematic analysis indicated the data from both focus groups was consistent and mapped onto the five domains of the process model; with several additional themes and sub-themes identified. Conclusions: Perspectives provided by teachers affirmed that the process model of emotion regulation is relevant to children and adolescents with intellectual disabilities. Future research might consider developing the themes identified in this qualitative study into quantitative questionnaire items and validating that measure. [ABSTRACT FROM AUTHOR]

Introduction: Social knowledge is an important aspect of social cognition that pertains to broader knowledge of social concepts and norms. People with intellectual disabilities are more likely to experience mental health challenges, and it's important to pay special attention to how comorbid conditions can affect their social cognition skills, potentially weakening these skills. Consequently, the present study seeks to compare social knowledge between two groups of adults in Bosnia and Herzegovina: those with intellectual disabilities and those diagnosed with a dual diagnosis encompassing intellectual disability and psychiatric conditions. An additional goal was to identify the factors contributing to social knowledge in these groups. Methods: The study sample included 62 adults with mild intellectual disability, divided into two groups based on their comorbid psychiatric condition. We used a demographic questionnaire, Raven's Progressive Matrices, Peabody Picture Vocabulary Test (PPVT), MINI PAS – ADD scale, and The Social Knowledge Test to assess social knowledge and intellectual functioning. We compared the social knowledge scores between the two groups and identified the predictors of social knowledge in each group. Results: The results indicated that adult participants with dual diagnoses had lower social knowledge scores than those with intellectual disabilities only, even after controlling for intellectual functioning and verbal abilities. The predictors of social knowledge differed between the two groups, with age being the only statistically significant predictor in both groups. In individuals with intellectual disabilities, age and the presence of obsessive-compulsive disorder symptoms were important predictors of social knowledge, while in the group of participants with dual diagnoses, age and PPVT were significant predictors of social knowledge. Conclusion: This study highlights the importance of social knowledge in individuals with intellectual disabilities and dual diagnoses. The findings suggest that individuals with dual diagnoses may have a specific deficit in social knowledge that is not fully explained by their intellectual functioning or verbal abilities. Clinicians and educators should focus on identifying and addressing social knowledge deficits in individuals with dual diagnoses to improve their overall social functioning. [ABSTRACT FROM AUTHOR]

Purpose: Meaningful interactions with significant others are crucial for children's well-being, including those with severe to profound intellectual and multiple disabilities. This study aimed to gain more insight into the potential of an ICT-Toolkit in enhancing or contributing to the interaction between parents and their children with complex care needs. Methods: A multiple case study with an AB experimental design was conducted. Four mother-child dyads were observed during eight two-and-a-half-hour home visits. Children between 6 and 16 years with severe to profound intellectual and multiple disabilities were included. A participatory research observation approach was used. Results: Using the ICT-Toolkit compared to the baseline phase stimulated a decrease in the repetitive activities of two of the four dyads. Overall, the activity repertoire of the children and the length of time being engaged in individual activities increased, and the activities together increased in three of the dyads. There were more turn-taking interactions; the children took more initiative to engage their mother in their activity, and the children exhibited more affection when engaging with the ICT-Toolkit items. Three mothers followed their children more in their play, and all mothers were more verbally and physically active in instructing and/or motivating their children. Discussion: All mothers noticed their child's "new" behaviour when interacting with an ICT-Toolkit item. The mothers followed the child's lead when engaged with the ICT-Toolkit. The ICT-Toolkit's added effect may be due to the predictability, uncomplicated and highly perceivable stimuli it provides with minimal effort and maximum effect. IMPLICATION OF REHABILITATION: A technology toolkit contributes to activities and mother-child interactions for children with intensive care needs. The ICT-Toolkit contributes to more turn-taking interactions and more initiative taking by the children to engage their mother in their activity. Children exhibited more affection towards their mothers when engaging with the ICT-Toolkit items. The participation in this study led mothers of children with intensive care needs to mentalise about the needs of their child and how their behaviour may influence the behaviour of their child. The ICT-Toolkit's added effect may be due to the predictability, uncomplicated and highly perceivable stimuli it provides with minimal effort and maximum effect. [ABSTRACT FROM AUTHOR]

This study aimed to determine the effects of the print-referencing Shared Reading Programme (SRP) on print awareness (PA), vocabulary and listening comprehension of children with mild intellectual disability (ID) and their peers with low print awareness (LPA). Multiple probe design across subjects was employed. Three children with mild ID and their fifteen classmates with LPA participated in the study. Results showed that print awareness, vocabulary and listening comprehension of all children had increased at the end of the implementation compared to baseline. To determine the social validity of the intervention, semi-structured interviews were held with children and their parents and teachers after the implementation. Results indicated that children had positive attitudes to the intervention and parents and teachers explained that children’s early literacy skills improved because of the intervention. Results of the study were discussed and considered along with other studies in the literature and suggestions for future studies were presented. [ABSTRACT FROM AUTHOR]

Individuals with ID often struggle with decoding and reading comprehension, and some studies indicate that these students do not progress beyond the early stages of decoding development. The aim of this study was to investigate the developmental trajectories of reading abilities in relation to mental age in a sample of 136 adolescents with mild, non-specific ID. Decoding and reading comprehension, together with their predictors of phonological awareness, RAN, phonological working memory, and vocabulary, were fitted against mental age. The results showed that, after 105 months, there was an unexpected plateau in the development of decoding, phonological awareness, rapid automatised naming (RAN), and phonological working memory in this sample, while reading comprehension and vocabulary continued to show growth in relation to mental age. The implications of these different trajectories are discussed in relation to developmental models of disability, and possible reasons for the plateau in decoding are suggested. [ABSTRACT FROM AUTHOR]

Children and adolescents with Intellectual Disability (ID) experience a worse Quality-of-Life (QoL) relative to typically developing peers. Thus, QoL evaluation is important for identifying support needs and improving rehabilitation effectiveness. Nevertheless, currently in Italy there are not tools with this scope. This study aims to translate and cross-culturally adapt the Quality-of-Life Inventory-Disability (QI-Disability) into Italian. The process consisted in forward-backward translation, cross-cultural adaptation and cognitive debriefing. Eventually, QI-Disability was conceptually and semantically equivalent to the original one. A validation study is necessary to make the tool available in Italian clinical practice and educational contexts to improve these children's QoL. [ABSTRACT FROM AUTHOR]

This study investigated the differences between the mathematical profiles of primary school pupils with intellectual disabilities (ID) enrolled in inclusive classrooms and those enrolled in special schools. It also considered whether the instructional setting has an impact on mathematical achievement gain. The mathematical achievement of 100 pupils with ID in inclusive classrooms (groupINCLUSIVE, n = 44) and special schools (groupSPECIAL, n = 56) was assessed at the beginning and the end of one school year. The results show that pupils with ID have a different mathematical profile in each setting. More of the pupils with very low mathematical achievement were enrolled in special schools and they made little progress over the course of the year. More of the pupils with ID who had computational skills were in inclusive classrooms. Due to large differences in age, IQ, and prior mathematical achievement between the two groups, a sample of matched pairs with one pupil from each setting was selected (n = 44). Regression analysis showed that the inclusive setting had a small positive effect on mathematical achievement gain after nine months. The study provides evidence that inclusive education is beneficial for the mathematical achievement gain of pupils with ID. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to synthesize the information on the risks and benefits of clozapine prescription for resistant challenging behavior in persons with neurodevelopmental disorders. Methods: Articles were identified with MEDLINE, Web of Sciences, and PsycINFO search from inception through January 2024. The review was restricted to persons with intellectual disability (ID) and/or autism spectrum disorder (ASD) without comorbid psychotic or affective disorder. Data were synthesized narratively. Results: We identified 24 articles (13 case reports, eight chart studies, two controlled studies, one pharmaco-epidemiological study) including 296 patients with ID (n = 222) or ASD (n = 74) (10% aged ≤ 18 years). After clozapine initiation, a decreased frequency of challenging behavior persisting over time was reported in most participants included in clinical studies, and a significant reduction in the number of admissions in the population-based two-year mirror-image study. Adverse drug reactions were those commonly observed with clozapine, i.e. constipation, sedation, and weight gain. Conclusions: Since only four participants were included in the controlled studies, the benefits of clozapine in neurodevelopmental disorders are supported by a body of evidence exclusively drawn from observational studies. Further studies are required to clarify the indications of clozapine with respect to the unmet need induced by resistant challenging behavior. Registration: PROSPERO database registration number CRD42024522343 [ABSTRACT FROM AUTHOR]

Abstract\nPoints of interestSociety is progressing to a paradigm where the valued contributions of people with intellectual disability are being recognised and supported. However, existing assessment tools fail to measure contribution as a key factor in achieving wellbeing and a valued life. To form the conceptual basis for assessment development, we elicited what constitutes contribution from the perspective of people with intellectual disability. Using photovoice and grounded theory, eleven artists with intellectual disability co-produced the Contribution Gallery. Activities associated with three workshops and the gallery opening night were videorecorded for analysis. Findings suggest people with intellectual disability make valued contributions to their family and friends, their community, our society and planet. Making these contributions give meaning and enhance wellbeing, but the value of the contributions to self and others are often unrecognised. This work challenges deficit-based paradigms and is pivotal in debates regarding assessment and support provision for people with disability.Society is changing. People with intellectual disability are getting more support. People with intellectual disability are being valued.People with intellectual disability make important contributions to society. No assessment tool has been made that measures these contributions.We used photovoice to understand what artists with intellectual disability think about contribution. Together we made the Contribution Gallery.We found that people with intellectual disability make valued contributions to their family and friends, their community, our society and planet. Making these contributions made people feel good.We have started making a contribution assessment tool. What artists with intellectual disability told us helps to design the assessment tool. [ABSTRACT FROM AUTHOR]

BackgroundMethodResultsConclusionDespite progress in implementing the rights outlined in the UN Convention on the Rights of Persons with Disabilities, individuals with intellectual disability encounter challenges in participating in daily life autonomously. Exclusion and stereotypes persist, impacting education, employment, and social participation. Inclusive sports programs, particularly the Special Olympics Unified Sports® program, aim to enhance social inclusion for these persons.This quantitative cross-sectional study compares attitudes across three groups: Unified Sports® partners, volunteers, and general population. Attitudes were measured using the Attitudes Toward Intellectual Disability Questionnaire.Results reveal that both Unified Sports® partners and volunteers exhibit more positive attitudes compared to the general population. More frequent contact with individuals with intellectual disability is associated with more positive attitudes.While limitations exist, this study provides insights into the relationship between inclusive sports programs and attitudes toward individuals with intellectual disability, laying the groundwork for further research and practical applications. [ABSTRACT FROM AUTHOR]

Background:Method:Results:Conclusions:Support from staff plays an important role in quality of life for people with intellectual disability. This study focuses on service users' views of Active Support as good support and whether Active Support increases the quality of everyday support in group homes.Nine service users were interviewed at baseline and at follow-up one year after staff received Active Support training. Thematic analyses were used to develop themes.Three main themes were created: (1) Home is more than just a place, it is a feeling; (2) Good care is caring with accessible communication; and (3) Time is precious. Participants were more satisfied with most of the support at follow-up, particularly choice-making, control in everyday life, relationships, and emotional support.Active Support corresponds well with service users’ perceptions of good support. In future studies of Active Support service users' voices should be a part of the follow-up. [ABSTRACT FROM AUTHOR]

IntroductionMethodResultsConclusionMental health concerns have been noted to be highly prevalent for youth with intellectual disability (ID), with or without autism spectrum disorder (ASD). The purpose of the current study was to examine a Canadian sample of youth with ID, with or without ASD, to explore caregiver-reported percentages, predictors, and treatment methods for mental health concerns.The sample included 358 caregivers who completed the GO4KIDDS survey on behalf of their child between the ages of 4 and 20 years (M = 11.36; SD = 3.82).In total, 56% of youth with ID (with or without ASD) were reported to experience mental health concerns. Adaptive functioning and diagnosis were significant predictors of mental health concerns. Of the youth who were reported to experience mental health concerns, 80% received some type of treatment, most commonly informal therapies (52%).More than half of the samples were reported to experience mental health concerns and while the majority received some type of treatment, many of the treatments utilized are not evidence-based. [ABSTRACT FROM AUTHOR]

BackgroundMethodResultsConclusionA peer-led self-advocacy group, Our Voice SA, is used as a case study to explore how the social engagement of people with intellectual disability contributed to their self-advocacy about things that are important to them.Secondary analyses of data (interviews, observations and program data) were thematically analysed using Clifford Simplican’s analytical lens of “freedom through encounter”.Social engagement encounters in peer-led self-advocacy led to individual and group agency for freedom. The findings explore becoming known, seen, and heard; freedom to express what matters; and unfreedom: silencing self-advocacy.A “freedom through encounter” lens is a useful perspective on how people navigate social inclusion to participate and challenge expectations. Allies were critical for overcoming structural, interdependent barriers, and supporting capacity for leadership and rights awareness that helped elevate the confidence and skills of people with intellectual disability to speak up. [ABSTRACT FROM AUTHOR]

Mary Main played a key role for this study, in which we used an idiographic approach to examine discourse about abuse, trauma, and maltreatment (ATM) among eight mothers with a mild intellectual disability (ID), whose children had been assigned a secure (the “B-group”) or disorganized (the “D-group”) attachment classification. Thematic analysis yielded six ATM discourse themes: openness; coherence; presence of trauma in consciousness; support; agency in response to crisis; and self-concept and caregiving self-efficacy. Mothers in the B-group provided coherent narratives, were open with the interviewer, had memories of seeking and receiving support, and reflected freely and autonomously on their experiences. Contrastingly, the mothers in the D-group expressed a guarded, closed-off stance towards ATM, difficulties seeking support, helplessness in response to crisis, and poor self-concept and -efficacy. Their adverse experiences were nonetheless highly present in consciousness, albeit in unintegrated forms. Our findings suggest that the D-group mothers may be unresolved with respect to loss/abuse [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONIn an increasingly technology-driven world, this study explores the accessibility of assistive technology for individuals with intellectual disabilities through assistive technology loan libraries. Assistive technology refers to devices or systems that enhance the ability of individuals with and without disabilities to function and undertake activities of daily living.The study, grounded in the Social Determinants of Health framework, employed multiple methods including both qualitative (interviews) and quantitative (questionnaire) methods, involving 19 participants comprising assistive technology professionals and users.Key findings from the study underscore the pivotal role of assistive technology loan libraries, which lend various assistive devices to individuals, enabling them to try these technologies before making a long-term commitment. However, challenges, such as a restricted variety of devices and extended waiting periods for access were highlighted. The research points to a need for improved training for both staff at the loan libraries and the users of the technology. It also suggests that policy enhancements are required to better align with rapid technological advancements and address the uneven regional distribution of these technologies.Participants in the study highlighted the importance of expanding the range of assistive devices available in these libraries and improving the efficiency of the service they provide. The study advocates for targeted efforts to enhance the effectiveness and accessibility of assistive technology loan libraries, highlighting their critical role in empowering individuals with intellectual disabilities.Assistive Technology (AT) loan libraries significantly enhance access to vital technologies for individuals with intellectual disabilities, enabling trials before purchase.Challenges like limited device variety, extended wait times, and a need for improved staff training must be addressed to optimize loan libraries’ effectiveness.Enhancements in policy, funding, and device availability are crucial to ensure equitable AT access and support rehabilitation goals.Collaboration between AT professionals, users, and policymakers is essential for developing responsive, user-centered AT loan library services.Strengthening awareness and education about AT options can empower users and caregivers, fostering greater independence and participation in daily activities.Assistive Technology (AT) loan libraries significantly enhance access to vital technologies for individuals with intellectual disabilities, enabling trials before purchase.Challenges like limited device variety, extended wait times, and a need for improved staff training must be addressed to optimize loan libraries’ effectiveness.Enhancements in policy, funding, and device availability are crucial to ensure equitable AT access and support rehabilitation goals.Collaboration between AT professionals, users, and policymakers is essential for developing responsive, user-centered AT loan library services.Strengthening awareness and education about AT options can empower users and caregivers, fostering greater independence and participation in daily activities. [ABSTRACT FROM AUTHOR]

BackgroundMethodsResultsConclusionsSuicidality in individuals with intellectual disability is a critical but under-researched area. This systematic review aims to synthesize existing literature on the prevalence, risk factors, and interventions for suicidality among individuals with intellectual disability.Adhering to the PRISMA guidelines, a comprehensive review of databases was conducted for empirical studies on suicidality in intellectual disability. Data were extracted on sample characteristics, methodologies, and key findings.Nineteen studies met the inclusion criteria. Consistent risk factors, notably comorbid psychiatric disorders, emerged. Passive suicide methods predominated with a positive correlation between higher intellectual functioning and increased suicidal behaviors.The increased vulnerability to suicide in this population highlights the need for targeted interventions and comprehensive risk assessments. Much future research is required in the face of paucity of data with the priority on developing specific suicide prevention tools while addressing cultural stigmas to enhance support for this population. [ABSTRACT FROM AUTHOR]

While mental disorders have been broadly researched in people with intellectual disabilities (ID), comparatively less attention has been given to the conceptualisation of good mental health for this population. To capture existing concepts, definitions and measurement approaches of good mental health a systematic literature review was conducted following PRISMA guidelines. The search was carried out in eleven databases, using various synonyms of (i) intellectual disability, (ii) mental health, (iii) wellbeing, (iv) definition, and (v) assessment. A total of 2,046 datasets were identified, of which 37 met the inclusion criteria and were analysed using reflexive thematic analysis and content analysis. Results show four main themes: (1) environment, (2) absence of mental illness, (3) physical health, and (4) psychosocial functioning. The fourth was the most dominant theme and was further divided into five sub-themes: (1) emotionality, (2) interpersonal relations, (3) realise own potential, (4) personal resources, and (5) overall appraisal of life. Our findings reveal different conceptualisations of wellbeing, which is a vital part of good mental health, but highlight a notable research gap in the actual definition and conceptualisation of good mental health for people with ID. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONPost-pandemic, use of digital technologies (e.g., mobile app, Zoom, virtual reality, and videogaming) to promote physical activity (PA) in populations with intellectual and developmental disabilities (IDD) has increased. The efficacy of various digital technologies in promoting PA in individuals with IDD varies. We conducted a systematic review to examine current literature findings on the efficacy of digital PA interventions on PA outcomes in individuals with IDD.Articles published between 1900 and 2024 that examined effects of technology-based PA interventions on PA levels/fitness of individuals with IDD using experimental or quasi-experimental study designs were included. Sixteen articles were retrieved from four health databases PubMed (914), PsycInfo (1201), SCOPUS (1910), and CINAHL (948).Findings based on 604 participants (Autism: 383; Down Syndrome: 106; Developmental Disability: 83, Developmental Coordination Disorder: 37) provide the most support for exergaming/digital PA intervention benefits for populations with ID, Down Syndrome, and Autism; however, there was limited support for its use in those without ID (e.g., DCD).Digital technology is an effective tool to promote improvements in PA/fitness, motor, cardiovascular performance in individuals with ID. Future studies need to build on this evidence to support the use of PA outcomes in individuals with different IDD diagnoses.Individuals with intellectual and developmental disabilities (IDD) are more physically inactive compared to peers without IDD.Exercise and physical activity are effective modalities to improve health and well-being of individuals with IDD.Exergaming/digital technologies are a promising option to promote physical activity in individuals with IDD, specifically, in children with Down Syndrome and Autism Spectrum Disorder.This is the first review comparing effects of exergaming/digital technologies on physical activity outcomes of individuals with and without intellectual disabilities.Individuals with intellectual and developmental disabilities (IDD) are more physically inactive compared to peers without IDD.Exercise and physical activity are effective modalities to improve health and well-being of individuals with IDD.Exergaming/digital technologies are a promising option to promote physical activity in individuals with IDD, specifically, in children with Down Syndrome and Autism Spectrum Disorder.This is the first review comparing effects of exergaming/digital technologies on physical activity outcomes of individuals with and without intellectual disabilities. [ABSTRACT FROM AUTHOR]

Quality of life (QoL) has been extensively studied within the field of intellectual disability, with various theoretical frameworks being developed to guide the provision of appropriate supports in daily life. However, the role that self-determination can play in the QoL of adolescents with intellectual disability has received little attention. This study explores the impact of personal characteristics (age, gender, intellectual disability level, and diagnosis of autism spectrum disorder) and the context-related variable of self-determination on QoL, overall and at domain level, in 100 adolescents with intellectual disability in a single school. The KidsLife scale of QoL and the AUTODDIS scale of self-determination were applied, with the participants' teachers acting as respondents. The variable of self-determination had the highest influence on QoL, being positively related to all the domains under investigation. A diagnosis of autism spectrum disorder was positively related with Personal Development, Material Well-being, and Social Inclusion domains. Intellectual disability severity only had a negative relationship with QoL total level when not considered simultaneously with self-determination. We discuss the role that self-determination plays in the quality of life of youth with intellectual disability. [ABSTRACT FROM AUTHOR]

This article examines the gap between the theory and practice of person-centered services for adults with intellectual disabilities in the United States. It explores the rhetoric of personalized services—it gives a history of social care, rehearses the logic of person-centered planning and outlines the tension of conflicting disability policies. Then it defines the nature of choice and explains how limited alternatives undermine choice. Next the article describes the reality of restricted service options, summarizing the conclusions of a survey of American families and a meta-review of the effectiveness of person-centered planning. After recapping the contrast between rhetoric and reality, objections to the analysis are addressed. Finally, the article offers solutions for service system transformation. While the thesis pertains to the United States, its lessons are applicable to other nations. Points of interest: In recent years, supports for adults with intellectual disabilities have been shifting from a system based on what is available from service agencies to an approach that is tailored to individual needs and wants. Choice in services requires having multiple options from which to choose. There is a gap between theory and practice in the United States. Laws and regulations require services based on individual needs and wants, yet in many cases this is not reality. Because of many social factors, people with intellectual disabilities are fit into standard service packages rather than having supports matched to their individual needs and wants. Change in multiple social systems is necessary to create personal supports and choice in services. [ABSTRACT FROM AUTHOR]

Information and communication technology (ICT) and digital media are less accessible for persons with intellectual disability (ID) but are important for citizenship. The aim was to conceptualize officials understanding of ICT usage among people with ID, and to analyze the possible influence of this understanding on the provision of services for people with ID. A qualitative study was conducted, using semi-structured interviews with municipal officials and politicians in the disability service area. Thematic analyses were conducted. ICT use is understood as an arena for democratization. Findings also illustrate the tension between integrity and protection as well as between legal and moral aspects of digital transformation in service provision. This understanding of digitalization is permeated by an individualized approach but conditioned by organizational issues. Disability services can be understood as undergoing digital transformation where regulative and normative elements in this area need to be harmonized to facilitate digitalization successfully. Points of interest: This study examines politicians' and officials' perceptions of the digitalization of intellectual disability services. This is important as it influences the possibility for persons with ID to be online. Digitalization is understood to enable democratization in terms of participation in decision-making, and social activities, and to 'be a part of society' but the support and structure to be online are under construction. The article suggests that the process of digitalization is also about the responsibility of its provision and use, laws, and of morals, and integrity. [ABSTRACT FROM AUTHOR]

Background: One of the main challenges facing individuals with an intellectual disability is the stigma associated with the various obstacles that hinder their process of full integration. Despite the efforts made, more research is called for to explore the reference environments and reveal how public and self-stigma are perceived in higher education. This scientific paper's overriding aim is to analyse how different university stakeholders (students, lecturers, and admin and service staff) perceive the presence of young people with intellectual disability. Method: An ex post facto design has been used with a sample of 306 participants and a validated instrument for measuring the perception of individuals with an intellectual disability. Results: Our findings reveal that women perceive less stigma than men, and when the analysis is broken down into the collectives involved, students with disability are clearly more conscious of public or self-stigma than their peers without any disability. Conlcusion: The disparity between gender and roles underscores the need for socioeducational interventions to promote inclusion in higher education and address self-stigma, thereby fostering self-sufficiency and emotional wellbeing among young individuals with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Background: The Canadian fetal alcohol spectrum disorder (FASD) diagnostic guideline provides clinicians with the process and procedure to reach an accurate diagnosis. However, organisational structure, culture, and resource utilisation vary. The objectives of this study were to identify the key challenges and strengths of successful FASD diagnostic clinics. Method: Qualitative interviews were conducted with 12 key informants from 10 clinics representing different regions, populations served, and clinic structures. Data analysis was performed using iterative thematic inquiry. Results: Three themes related to challenges and four themes related to strengths were identified. Human resources were identified as both a challenge and strength. Additional challenges were diagnostic capacity and system level support. Additional strengths were clinic adaptability, relational connections, and culturally responsive approaches. Conclusions: FASD clinics are more alike than not in their approach to assessment and diagnosis. Some clinics are facing similar challenges that others have overcome, supporting the need for mentorship and consistent operating standards. [ABSTRACT FROM AUTHOR]

Background: In this study, agents working in positions of authority within health sector organisations shared their perspectives concerning both the involvement of experts by experience with intellectual disabilities within their own organisations and their recommendations as to how best to involve experts by experience in policy and practice. Method: Using purposive sampling, eight agents were selected for semi-structured interviews. The interviews were analysed using thematic analysis. Results: The results indicated the importance of involving experts by experience. However, they also highlighted several barriers such as a lack of emphasis on genuine attention, insufficient visibility and recognition of expertise, and a lack of support for sustainable inclusion. Conclusions: Agents are willing to involve experts by experience in health sector organisations, but practical challenges hindered them from actually doing so. This study emphasises the importance to find solutions for better inclusion in policies. [ABSTRACT FROM AUTHOR]

Background: Moving out of the family home is a key transition for people with intellectual disabilities and their families. Yet there has been little research about parents' experiences of planning the move of their young adult offspring to residential settings offering 24-hour support. Method: Interviews were conducted with eleven parents whose offspring moved to residential settings within the past 5 years (five fathers; six mothers). They consisted of structured questions about planning their offsprings' moves and semi-structured questions about parents' experiences. Results: Content analysis of the structured questions revealed reasons parents began thinking about the moves and routes to finding information. The thematic analysis highlighted the emotional challenges parents faced. Conclusions: The findings highlight the need to address this neglected topic and ensure that practical and emotional support is put in place to plan positive futures, rather than relying on families to use their own initiative or waiting until a crisis occurs. [ABSTRACT FROM AUTHOR]

Background: Constipation impacts health-related quality of life with a burden similar to other chronic conditions. This study characterises the prevalence of constipation and its associated factors in older adults with intellectual disability. Methods: Data from the Intellectual Disability Supplement of The Irish Longitudinal Study on Ageing was analysed using bivariate and multivariate approaches. Results: Constipation affected 43.5% of this cohort and was more common in females, those in residential settings, and those with a severe/profound level of intellectual disability. The type of residence, level of intellectual disability, a low fat diet, high cholesterol, multimorbidity and, physical activity predicted constipation status with 67.7% accuracy. Physical activity was associated with lower constipation prevalence, where minimal activity was sufficient to observe this effect. Conclusions: Constipation is a common health concern in older people with intellectual disability. This analysis reveals characteristics that should inform the careful monitoring of bowel health in this population. [ABSTRACT FROM AUTHOR]

Background: Intellectual disability organisations in the Netherlands are seeking to improve clients' quality of care by implementing methods that reduce involuntary care. This study described insights gained from sharing tacit and experiential implementation knowledge in Communities of Practice (CoP). Method: In a participatory research, managers, policymakers, experts-by-experience, support staff, and researchers participated in two CoP. Transcripts of the first meetings, focusing on tacit implementation knowledge and experiences in intellectual disability care, were analysed qualitatively. Results: Six themes and nine subthemes were found. One related to implementing methods in line with the Care and Coercion Act. Other themes were the quality of care dilemma, implementation determinants, organisational context, change in organisational culture, and implementation plans and strategies. Discussions: Findings reveal insights regarding the impact of implementing methods that reduce involuntary care on care professionals, management, and organisations. Through thinking together, CoP participants collectively learned about implementing methods in intellectual disability care. [ABSTRACT FROM AUTHOR]

Background: Productivity-based wage systems are intended to enhance the labour market participation of people with disabilities. Limited scholarship exists regarding the impact of such policies in practice. This qualitative study explored stakeholder perspectives on the Australian Supported Wage System (SWS), including perceptions of fairness and equity. Methods: Document review provided context and background for the study. 14 semi-structured interviews were subsequently conducted with a range of stakeholders with knowledge of the SWS. Results: Four primary themes were identified, related to assessment processes, value contributions of the system, practice risks and challenges, and ethical tensions. Conclusions: The SWS appears to enhance worker choice and inclusion. A variety of factors may reduce the quality of these outcomes, however, and employment systems should support a range of evidence-informed approaches to ensure equitable employment outcomes. [ABSTRACT FROM AUTHOR]

Background: Older people (i.e. ≥40 years) with intellectual disability have unique medication needs and may experience high levels of potentially inappropriate prescribing. Despite the availability of tools to optimize older adults' prescriptions, there is no comprehensive tool specifically for use in older adults with intellectual disability. We aimed to develop a tool for this purpose: Optimizing Pharmaco-Therapy and Improving Medication for Ageing with Intellectual Disability (OPTIMA-ID). Research design and methods: A draft tool was developed based on literature review and clinical expertise. Focus groups with healthcare professionals and people with intellectual disability were conducted to refine the tool. The tool was presented electronically to an expert panel for Delphi validation. Median level of agreement and 75th percentile values were used to establish if consensus was reached. Criteria were accepted, rejected, revised or removed to develop the final tool. Results: Following two Delphi rounds, consensus on the content of OPTIMA-ID was reached for 67 prescribing criteria, 63 of which were agreed upon after Round 1 and a further 4 criteria accepted after Round 2. Conclusions: OPTIMA-ID contains 67 criteria that can optimize medications for older people with intellectual disability. Its effectiveness, feasibility and impact on patient outcomes need to be established. [ABSTRACT FROM AUTHOR]

BackgroundMethodResultsConclusionsA growing number of services are focused on people with intellectual disabilities. Our study investigates interpersonal justice (interpersonal treatment families receive from service professionals) perceived by family members as a heuristic (cognitive shortcut) they can use to evaluate service performance directed towards improving the quality of life of their relatives with intellectual disability.Using a sample of 86 family members, we tested a within-person model. Interpersonal justice and service performance were measured four times (T1–T4).Over time, changes in interpersonal justice were positively related to changes in service performance. Family members use the treatment they receive from professionals to superficially draw inferences (heuristic) about service performance.Our study warns about the use of superficial justice information based on a heuristic to evaluate service performance. More active participation of families in the organizational life is suggested to avoid the use of these types of cognitive shortcuts. [ABSTRACT FROM AUTHOR]

BackgroundMethodResultsConclusionsAfter decades of planning, nurses played a pivotal role in achieving the closure of large residential institutions for people with intellectual disability by 2018. This paper describes the experiences of nurses facilitating the closure of these institutions in New South Wales and Victoria, Australia.An interview-based, qualitative study was conducted with twenty-four registered nurses from Australia who had more than twelve months’ experience of caring for people with intellectual disability any time between 1960 and 2016.Nurses facilitated transition for residents and their families during devolution. However, nurses’ personal experiences of transition to work in community settings was complicated by inconsistent preparation, uncertainty of employment, and changes in professional status.Extensive experience and detailed knowledge of their clients enabled nurses to maximise opportunities for smooth transition out of institutions into community care for people with intellectual disability. Devolution was personally and professionally costly for some nurses. [ABSTRACT FROM AUTHOR]

Abstract\nPoints of interestLesbian, Gay, Bisexual, Transgender, Intersex, Queer and Asexual (LGBTIQA+) people with intellectual disability face unique challenges in asserting their identities. We aim to understand how Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) individuals with intellectual disability exercise self-determination within disability services. Eight LGBTQ adults with intellectual disability who used disability services participated in qualitative interviews. Fifteen key informants, representing government policy makers, disability service organisations, gender and sexuality educators, and senior leaders of LGBTQ organisations were also interviewed. We found that LGBTQ people with intellectual disability navigate barriers to self-determination: making autonomous decisions about their sexualities or gender identities; coming out and being recognised as LGBTQ; and gaining a sense of belonging in both disability and LGBTQ spaces. We suggest organisational-level actions including: (1) building organisational awareness; (2) including sexuality and gender identities in person centred support planning; and (3) increasing access to positive visual representations and experiences of pride.This research is important because it highlights the need for disability organisations to support LGBTQ people intellectual disability to live self-determined lives.LGBTQ people with intellectual disability do not have access to LGBTQ peers and education. This makes it difficult to develop LGBTQ identity.Disability service organisations generally do not encourage people with intellectual disability come out to the people around them including support workers.Disability service organisations should think about people’s sexuality and gender identities when choosing how to support them.Experiences of pride events can help people feel like they belong.LGBTQ people with intellectual disability can be reliant on disability service organisations for information and support services.This research is important because it highlights the need for disability organisations to support LGBTQ people intellectual disability to live self-determined lives.LGBTQ people with intellectual disability do not have access to LGBTQ peers and education. This makes it difficult to develop LGBTQ identity.Disability service organisations generally do not encourage people with intellectual disability come out to the people around them including support workers.Disability service organisations should think about people’s sexuality and gender identities when choosing how to support them.Experiences of pride events can help people feel like they belong.LGBTQ people with intellectual disability can be reliant on disability service organisations for information and support services. [ABSTRACT FROM AUTHOR]