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Background: People with severe to profound intellectual disabilities experience similar or higher levels of depression than those with more mild intellectual disabilities. Yet, there is an absence of evidence about how to adapt existing psychological therapies for this population. Method: A behavioural activation intervention (BeatIt) for people with mild to moderate intellectual disabilities was adapted for people with severe to profound intellectual disabilities and depression. Key considerations include: (i) beginning with a more in‐depth assessment process; (ii) including the person in session activities and developing a relationship with them; (iii) formulation and the use of film to document the link between activity and mood; and (iv) addressing barriers to change at an individual and inter‐personal level and considering how the carer could support the person's engagement in activity. Results: Successfully adapting BeatIt represents a first step towards gathering evidence about the effectiveness of behavioural activation for people with severe to profound intellectual disabilities. [ABSTRACT FROM AUTHOR]

Prior to the start of the pandemic, adults with intellectual disability (ID) were more likely to experience mental health difficulties and face barriers obtaining mental health care. COVID‐related public health restrictions, combined with heightened challenges to obtain timely mental health care, have served to worsen this situation internationally, with a combination of new onset conditions and worsening mental health for those already struggling. In this narrative review, we summarize literature on the mental health of adults with ID during the COVID‐19 pandemic to describe what is known based on clinician perceptions, existing administrative health data, family and staff perceptions, and self‐report. In addition to noting similarities and differences in findings based on the source of information, we also explored how experiences differed depending on where and when the research was conducted. Based primarily on research conducted during the first six months of the pandemic, there is a consistent finding across sources of increased anxiety, stress, and isolation. This review also explored the delivery of virtual mental health care and the impact of pandemic‐based mental health interventions. There have been very few research studies evaluating clinical care during this time but clinicians have managed to provide supports virtually, which has been evaluated positively by some individuals. This narrative review concludes by identifying gaps in the literature and suggests key directions for future mental health research, policy, and practice efforts. Any mental health efforts now and during pandemic recovery need to have an understanding of how the mental health needs and services for adults with ID have evolved over the course of the pandemic. Further research is needed on the impact of both clinical interventions and other nonclinical efforts on the mental health of people with ID. [ABSTRACT FROM AUTHOR]

Background: As life expectancy for people with an intellectual disability increases, there is a growing cohort of older father carers. This study aimed to gain a more in‐depth understanding of older father carers' experiences of parenting. Methods: Semi‐structured interviews were conducted with 7 older fathers (M = 63.9 years) and analysed using constructivist grounded theory. Results: Three conceptual categories were identified. "Wearing different hats: how fathers' sense of identity had altered over the years. "Family comes first": importance placed on the family unit. "Getting on in years": the challenges faced by ageing fathers parenting their son/daughter. Conclusions: Fathers re‐evaluated their priorities and found a new identity in their parenting role, although they continued to see themselves as secondary carers. Fathers worried about the future as their health declined but drew strength from the benefits they had derived and the challenges that they had overcome to do their best for their son/daughter and their family. [ABSTRACT FROM AUTHOR]

Background: Young people with Down syndrome and their families often contend with social stigma. The present study examined this issue from their mothers' perspective. Methods: An interpretative phenomenological approach (IPA) was used to explore mothers' perceptions of their child's developing awareness of their disability and associated social stigma. Interviews were carried out with nine mothers of young people with Down syndrome aged 9–16 years old. Results: All mothers were sensitive to the stigmatized status of Down syndrome and were at pains to protect their child from becoming aware of it. Some mothers had talked about Down syndrome with their child. Other mothers carefully monitored their child for signs that they were ready to talk about it. On the surface, all mothers believed that their child had a limited insight into Down syndrome and stigma but detailed discussion revealed more complex insights. Conclusion: Mothers expressed uncertainty and anxiety about when and how to talk to their child about Down syndrome. [ABSTRACT FROM AUTHOR]

Aim: This study was undertaken to investigate how young people with and without mild intellectual disabilities experience and perceive their own behavioural autonomy. Method: Fifty‐six young people with mild intellectual disabilities and 49 young people without disabilities aged 16–19 participated in a novel picture card sorting task to investigate their participation in a range of activities, and the obstacles preventing them from doing so. Results: School pupils with intellectual disabilities engaged in significantly fewer activities than their typically developing peers and were more likely to state not to be allowed to. In contrast, the college students with and without disabilities were equally as likely to undertake each activity, and those with intellectual disabilities were more likely to express lack of interest in doing so. Conclusions: The move from school to college may represent an opportunity for young people with intellectual disabilities to "catch‐up" with their typically developing peers. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to outline what is known about the prevalence, causes and treatment of depression for people with learning disabilities, with a focus on psychosocial interventions. Design/methodology/approach: This is a narrative review, and will provide evidence-based guidance for practitioners and those managing service delivery. Findings: Depression is just as prevalent among people with learning disabilities as it is in the wider population and they are frequently exposed to known vulnerability factors for low mood such as lack of social support and purposeful activity. Yet there remains a paucity of evidence about effective interventions for depression. Originality/value: Growing evidence about the effectiveness of psychological interventions for people with learning disabilities and depression is promising but insufficient. To make meaningful change, there also needs to be an implementation strategy that encompasses the broader context of people's lives, including family, care and work settings. [ABSTRACT FROM AUTHOR]

Background: No studies have explored the acceptability of Behavioural Activation and Guided Self‐Help interventions for depression with people who have intellectual disabilities. Method: Twenty‐five participants were purposively sampled from participants taking part in a trial comparing Behavioural Activation with a Guided Self‐Help intervention. A framework analysis was used to analyse interviews covering participants' expectations and views of therapy. Results: Participants were largely positive about both interventions. However, they identified specific aspects of each intervention which they had found helpful. All participants valued the therapeutic relationship. The participants also had a number of criticisms and suggestions for improving the therapies. A common concern was the time‐limited nature of the interventions and a wish for longer‐term help. Overall, both sets of participants felt the interventions had relevance for their wider lives. Conclusions: The participants reported having positive engagement with the therapies but expressed a wish for longer‐term supportive relationships. [ABSTRACT FROM AUTHOR]

This editorial highlights the contributions of Gustav Jahoda to cross-cultural and cultural psychology. Gustav’s broad and deep scholarship, focusing on culture, mind and history, crossed disciplinary boundaries of psychology, anthropology and sociology in his attempts to understand human psyche and concrete activities in various situations and locations. Gustav’s legacy is inspirational for human and social scientists who search for ‘the establishment of general psychology of a new kind’. [ABSTRACT FROM AUTHOR]

BackgroundMethodResultsConclusionsMoving 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.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.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.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: The prevalence of obesity is higher in those with intellectual disabilities than the general population. The aim of the study was to understand the determinants of physical activity and dietary patterns in this population during their final year of school. Method: Qualitative data were generated from 10 interviews with adolescents with mild–moderate intellectual disabilities. Data were analysed using deductive thematic analysis, employing Self‐Determination Theory as a theoretical framework. Results: Adolescents’ environment and social interactions play a pivotal role in influencing physical activity and dietary patterns. Three themes emerged from the analysis: situatedness, motivation and wider environmental influences. Conclusions: School structure, high self‐efficacy and social connectedness facilitate increased physical activity and healthier diet in adolescents with intellectual disabilities. Home life, low self‐efficacy and a lack of social connectedness can serve as a barrier to PA and a healthy diet. [ABSTRACT FROM AUTHOR]

Background: Depression appears to be more enduring amongst people with intellectual disabilities, suggesting that it is a more chronic problem or more poorly managed in this population. This is not helped by a lack of evidence about the effectiveness of psychological therapies for people who have intellectual disabilities and depression. Behavioural activation, which aims to counteract depression by increasing individuals' level of meaningful activity and their exposure to positive reinforcers, has proven to be as effective as cognitive behavioural therapy in the general population. Given that this therapy makes fewer communicative demands and focuses on activity, it was thought that behavioural activation would be both accessible and apt for people with intellectual disabilities, who are often socially marginalised.Methods/design: This study is a multi-centre single-blind randomised controlled trial of behavioural activation versus a self-help attention control intervention for depression in adults with mild/moderate intellectual disabilities. The study has an internal pilot in one centre, to establish that recruitment can be built up and sustained at the required level, before being rolled out across the other sites. One hundred sixty-six participants will be randomly assigned to the behavioural activation or self-help interventions, which will be delivered to individuals with mild to moderate intellectual disabilities, accompanied by someone who provides them with regular support. Both interventions are manualised and will be delivered over a period of approximately 4 months. The primary outcome measure will be the Glasgow Depression Scale, a self-report measure which is completed at baseline and 4 and 12 months post-randomisation. Secondary outcomes include measures of participants' activity levels, proxy reports of depressive symptoms, and cost-effectiveness.Discussion: The study will provide evidence about the effectiveness of behavioural activation for depression, adapted for people who have mild/moderate intellectual disabilities, and will inform the delivery of psychological therapies to people with intellectual disabilities in practice.Trial Registration: Date trial registered: Nov. 13, 2012; trial registration number: ISRCTN 09753005. [ABSTRACT FROM AUTHOR]

The prevalence of anxiety is higher in autistic young people, compared to neurotypical youths. However, the nature of worry in autistic young people is under-researched. Transition from secondary school is a time of change and can be challenging for autistic adolescents. This project explored the content and emotional impact of worries in neurotypical and autistic young people during transition. Twenty-two autistic people and 22 neurotypical people, aged 16–18, were recruited from mainstream schools. Participants completed a novel task to identify and explore the nature of their main worries. The participants' worry frequency and distress levels in relation to their most salient concerns, and their anxiety levels, were measured. Content analysis highlighted similarities and differences between the two groups' worries. Both groups worried about failure and their prospects of further education. Autistic people were more concerned about change and friendship, whereas more salient worries for neurotypical individuals were about work and money. Autistic people were more distressed by their worries than neurotypical individuals. Findings regarding the nature of autistic young people's worries may help inform interventions. Moreover, asking autistic people about their worries as they leave school may help to address their concerns, ease their transition and reduce distress. Autistic young people experience higher levels of anxiety than neurotypical young people. Having worries is part of feeling anxious. This makes it surprising that very little research has looked at the kind of worries autistic young people have. Leaving school, in particular, can be a worrying time for young people. Twenty-two autistic young people and 22 neurotypical young people who were at mainstream secondary schools agreed to take part in the study. They were between 16 and 18 years of age. They were asked to sort through a series of pictures, showing the different types of worries that young people might experience. They were then asked to pick out their four main worries and say how much they thought about each worry and how upset the worry made them. They also completed a questionnaire about their level of anxiety. There were similarities and differences between the autistic and neurotypical young people's worries. Both groups worried about failing and how they might get on in further education. The autistic young people were more worried about change and friendships. Work and money were particular concerns for the neurotypical young people. The autistic young people said that they found their worries more upsetting than the neurotypical young people. Having a better understanding of autistic young people's worries at important points in their lives might mean that more timely help and support can be given to them. Simply knowing what to ask young autistic school leavers about may help them to express unspoken concerns. [ABSTRACT FROM AUTHOR]

Background The role of support workers and other professionals in the psychotherapeutic process has been commented upon but not as yet been systematically investigated. Method To explore their views and expectations of cognitive behaviour therapy ( CBT) for adults with intellectual disabilities, eleven paid support workers and professionals were recruited and interviewed before the CBT sessions commenced for their service users and nine took part in the second interview that took place after nine sessions. Results Thematic Analysis of the interview transcripts indicates that staff members do not perceive CBT as a long-term solution for psychological problems have little knowledge of CBT and do not feel included in the process. Nevertheless, after nine sessions, most participants reported improved psychological well-being for their service users and expressed a wish for longer-term involvement of the therapist. Conclusions The results suggest that for CBT to be effective in the longer term, the therapist is required to consider a wider systemic approach including staff training and supervision, staff and management consultancy and creating a delicate balance between confidentiality and sharing the psychological formulation with 'significant others' to ensure maintenance and generalisation of improved psychological well-being. [ABSTRACT FROM AUTHOR]

Highlights: [•] We describe a fidelity-monitoring instrument, the MAnualized Group Intervention Check (MAGIC). [•] The MAGIC is designed to monitor manualized group-based CBT for people with IDs. [•] The MAGIC is easy to use and evidence is presented for its reliability and validity. [•] It is designed for completion by direct observation, so does not require sessions to be recorded. [•] The MAGIC may also be usable for other client groups with cognitive limitations. [Copyright &y& Elsevier]

Background There is an established evidence base con-cerning the use of anger management interventions with violent offenders who have intellectual disabilities. However, there has been limited research investigating the role of social cognitive factors underpinning problems of aggression. Psychosocial sources of agg-ression in the non-disabled population are generally discussed using Social Information Processing ( SIP) models. Method A systematic review of the available evidence was carried out to establish whether SIP offers a useful explanatory model for understanding the contribution of social cognitive factors to problems of aggression presented by people with intellectual disabilities. Results and conclusions Whilst research relating to the SIP model remains sparse for this population, there was evidence for different patterns of processing between aggressive and non-aggressive individuals. Group diff-erences included interpretation of emotional cues, inter-personal attributions and beliefs about the outcomes of aggressive behaviour. The future direction of SIP research with people who have intellectual disabilities is discussed, along with the possibility of using this framework to help build on current initiatives to develop individually tailored interventions to work at a cognitive level with those who are aggressive and offend. [ABSTRACT FROM AUTHOR]

Few studies have considered families' views about adolescents' sexual development. The authors compared attitudes and behaviors of mothers of young people with (n 30) and without intellectual disability (n = 30). Both groups placed similar importance on dealing with their children's developing sexuality and were similarly confident in doing so. Mothers of young people with intellectual disability held more cautious attitudes about contraception, readiness to learn about sex, and decisions about intimate relationships. Mothers expressed concerns about their children with intellectual disability and sexual vulnerability. They had also spoken about fewer sexual topics with their children and began these discussions when their children were older. The findings can inform more sensitive supports and materials to help families deal with the sexual development of their offspring. [ABSTRACT FROM AUTHOR]

This paper reports findings from a study funded by the Foundation for People with Learning Disabilities which aimed to explore experiences of anxiety and depression among 17 young people with learning disabilities in Scotland. A series of unstructured interviews were conducted with the young people while one semi-structured interview took place with their families and/or with relevant professionals. The young people talked about their distress in various ways, including medical terms, bodily sensations, feelings and emotions, behaviours, and specific fears. Those who could identify the cause(s) of their distress referred to stressful life events, troublesome medical conditions, difficulties negotiating the transition to adulthood, and social isolation. The young people said relatively little about what helped reduce their distress: a few had good formal or informal support while others had tried to develop their own coping strategies. The findings are discussed in relation to social crisis theory. Policy and practice implications are highlighted. [ABSTRACT FROM AUTHOR]

Objectives To carry out a preliminary exploration and measurement of therapy expectancy in adults with intellectual disabilities through the development and psychometric evaluation of the therapy expectation measure (TEAM). Design The initial scale development phase combined top-down theory-driven and bottom-up data-driven processes to identify TEAM items and format. The subsequent scale evaluation phase piloted the TEAM and used correlational analyses to evaluate reliability and validity. Method Six adults with intellectual disabilities took part in semi-structured interviews about therapy expectancy and motivation to identify TEAM items. A further 22 participants piloted the measure for initial psychometric evaluation. Results Preliminary psychometric evaluation confirmed that the TEAM has acceptable test-retest reliability and internal consistency. Assessment of construct validity found a strong and positive relationship with a measure of general self-efficacy. Client expectations of therapy were largely positive and congruent with therapy as a goal-oriented process in which they will be an active participant. However, a number of individuals were unclear about the reason for referral and felt a low level of involvement in the process. Client and carer perceptions of referral understanding were significantly different. Conclusions The TEAM may help clinicians to identify potential barriers to engagement in therapy and find ways of enhancing the therapeutic experience of adults with an intellectual disability. Further psychometric evaluation of the TEAMM with larger samples is required to confirm the factorial structure of the scale and enhance its clinical utility. [ABSTRACT FROM AUTHOR]

Background This study compares how people with and without intellectual disabilities talk about events, beliefs and emotions in dialogues about real-life, emotive events and in a structured task assessing understanding of cognitive mediation. Materials and Methods A cognitive-emotive interview was used to assist 19 adults with intellectual disabilities and 19 adults without disabilities in generating an account of an emotive, interpersonal event. Participants also completed a cognitive mediation task and an assessment of intellectual and verbal ability. Results Between-group analyses indicated that participants with intellectual disabilities scored significantly lower than those without disabilities on the cognitive-emotive interview and the cognitive mediation task. Participants with intellectual disabilities generated fewer beliefs within their dialogues and were less likely to provide alternative perspectives on events. Within-group comparisons showed no significant association between the ability to talk about events, beliefs and emotions within a dialogue and performance on a cognitive mediation task, or with Full Scale or Verbal IQ scores. Conclusions Participants with intellectual disabilities had more difficulties than those without disabilities in talking about events, beliefs and emotions. Within a therapeutic context, they are likely to require assistance to reflect on events and consider alternative interpretations, which take into account individual and environmental factors. Future therapeutic developments may benefit from placing greater emphasis on emotional understanding and the intuitive links that people make between events and emotions. [ABSTRACT FROM AUTHOR]

Objectives. Transition to adulthood can be a challenging time for all young people. However, this period of change is likely to be more difficult for those with mild intellectual disabilities (IDs) because they are often more socially marginalized, remain more dependent upon their family, and have fewer options for future careers than their typically developing peers. Therefore, this study examines the content and salience of worries experienced by young people with mild ID during transition to adulthood, and whether the above disadvantages are associated with the level of reported anxiety and their sense of self-efficacy. Design and Methods. Fifty-two participants (17-20 years) took part; 26 with mild ID and 26 typically developing adults. Of interest were potential differences between groups in (1) worries described; (2) salience of worries; and (3) associations between self-efficacy, anxiety, and worry within groups. Participants completed a 'worry' interview, the General Self Efficacy Scale-12 and the Glasgow Anxiety Scale-LD. Results. It was found that the ID group's most salient worries (being bullied, losing someone they are dependent upon, failing in life, followed by making and keeping friends) were largely different from their non-disabled peers (getting a job, followed by not having enough surplus money, failing, and having to make decisions about their future choices) at this stage of transition. Not only was there a difference in the nature of worries expressed, but the intellectually disabled group also reported ruminating significantly more about their worries and being more distressed by them. Conclusion. Obtaining insight into worries at transition may help to target efforts at increasing these young people's resilience. Clinical applications of the findings are discussed. [ABSTRACT FROM AUTHOR]

Background: Cognitive behaviour therapy (CBT) is the treatment of choice for common mental health problems, but this approach has only recently been adapted for people with learning disabilities, and there is a limited evidence base for the use of CBT with this client group. Anger treatment is the one area where there exists a reasonable number of small controlled trials. This study will evaluate the effectiveness of a manualized 12-week CBT intervention for anger. The intervention will be delivered by staff working in the day services that the participants attend, following training to act as 'lay therapists' by a Clinical Psychologist, who will also provide supervision. Methods/Design: This is a multi-centre cluster randomized controlled trial of a group intervention versus a 'support as usual' waiting-list control group, with randomization at the level of the group. Outcomes will be assessed at the end of the intervention and again 6-months later. After completion of the 6-month follow-up assessments, the intervention will also be delivered to the waiting-list groups. The study will include a range of anger/aggression and mental health measures, some of which will be completed by service users and also by their day service key-workers and by home carers. Qualitative data will be collected to assess the impact of the intervention on participants, lay therapists, and services, and the study will also include a service-utilization cost and consequences analysis. Discussion: This will be the first trial to investigate formally how effectively staff working in services providing day activities for people with learning disabilities are able to use a therapy manual to deliver a CBT based anger management intervention, following brief training by a Clinical Psychologist. The demonstration that service staff can successfully deliver anger management to people with learning disabilities, by widening the pool of potential therapists, would have very significant benefits in relation to the current policy of improving access to psychological therapies, in addition to addressing more effectively an important and often unmet need of this vulnerable client group. The economic analysis will identify the direct and indirect costs (and/or savings) of the intervention and consider these in relation to the range of observed effects. The qualitative analyses will enhance the interpretation of the quantitative data, and if the study shows positive results, will inform the roll-out of the intervention to the wider community. Trial registration: ISRCTN: ISRCTN37509773 [ABSTRACT FROM AUTHOR]

There is now overwhelming evidence concerning the awareness people with moderate to mild intellectual disabilities have about the stigma they experience in their lives. However, there is still controversy about the potential impact of stigma on their self-perceptions. This article will draw on findings from an ethnographic study to show that even when individuals have difficulty expressing their views verbally, their actions can provide evidence of how they struggle to establish or maintain positive social identities—sometimes at the cost of their mental health. The implications of these and other findings will be discussed in relation to social constructionist theories of self-perception. This in turn will be linked to a discussion about the kind of support that might be required by people with intellectual disabilities, and how stigma might increase vulnerability to emotional and interpersonal problems. [ABSTRACT FROM AUTHOR]

Background This paper focuses on the transition to supported employment for people with intellectual disabilities paying particular attention to the impact of job breakdown on psychological well-being; an issue often omitted from studies. Materials and Methods Forty-nine people with intellectual disabilities were interviewed within 3 months of entering supported employment and 9–12 months later. Data collection involved in-depth interviews with people with intellectual disabilities, their carers and employers and completion of a self-report measure of depression and anxiety (an adapted form of the Hospital Anxiety and Depression Scale), and a self-report measure of quality of life (the ComQol). Results By time of the follow-up interviews, 13 of the 49 jobs had broken down. Analysis of scores measuring quality of life, anxiety and depression showed no effect for loss of employment. However, interviews with participants indicated that job loss had a considerable impact on those affected. Conclusions There were a wide range of reasons for job breakdown, many of which were particular to the circumstances of people with intellectual disabilities. Although job breakdown does not have an impact of anxiety or depression many participants found job loss traumatic. [ABSTRACT FROM AUTHOR]

Accessible summary • Mothers had many different explanations of why their children with intellectual disabilities hurt themselves and often weren’t hopeful that it would stop. • Some of the mothers felt they could sometimes help with their children’s behaviour and this helped with feelings of stress. • Professionals helping people with intellectual disabilities who hurt themselves need to listen more to what their families think and feel. Mothers’ attributions of self injurious behaviour (SIB) in their children with intellectual disability have been largely ignored. However, attributions may predict maternal well-being and engagement in treatment. Thirteen mothers of people who self-injured were recruited. A qualitative design was employed, the data being subjected to thematic analysis according to Braun & Clarke’s (2006) guidelines. Weiner’s (1980) attributional model informed development of semi-structured interviews, to explore the nature and content of their views about SIB. The mothers’ attributions were consistent with dimensions of locus of cause, stability and controllability. They held different, sometimes contradictory views about causes of SIB. Although pessimistic regarding long-term improvement and often uncomfortable with interventions suggested by professionals, some felt able to exercise limited control over their offsprings’ SIB. Control was also linked to stress, and a sense of responsibility when there was inadequate support. Sensitive, effective professional support for individuals engaging in SIB requires collaboration with carers, and understanding carers’ views and feelings. [ABSTRACT FROM AUTHOR]

Background Employment is viewed by policy makers as both a human right and as a means of changing the marginalized status of people with intellectual disabilities, with important social and emotional benefits. However, there has been little longitudinal research examining the experience of people with intellectual disabilities in the workplace. Methods Thirty-five individuals with mild to borderline intellectual disabilities participated in this study. They were recruited from supported employment agencies in Scotland. A longitudinal approach was adopted, with the participants being interviewed around the time of starting their jobs, and again 9–12 months later. Results The content analyses of the semi-structured interviews indicated that the participants perceived continuing benefits from entering mainstream employment, including more purposeful lives and increased social status. However, over the follow-up period the participants reported few social opportunities that extended beyond the workplace, and an anxiety about their competence to meet employers’ demands remained a concern for some. Conclusions The discussion addresses the importance of understanding work in relation to the participants’ wider lives, along with the longer-term role for supported employment agencies to help people achieve their social and emotional goals in a vocational context. [ABSTRACT FROM AUTHOR]

Objectives. Establishing a collaborative relationship is a cornerstone of cognitive behavioural therapy (CBT). Increasingly CBT is being offered to people with intellectual disabilities who may have problems with receptive and expressive communication, and a history of disadvantage or discrimination in their relationships with those in positions of power. Consequently, they may have difficulty establishing a collaborative interaction with their therapist. This paper uses a novel method of interactional analysis to examine if collaboration increases as therapy progresses. Design and methods. Fifteen participants with borderline to mild intellectual disabilities and significant problems of depression, anxiety and anger were recruited from specialist clinical services to participate in this study. Verbatim transcripts of therapy sessions 4 and 9 were coded using an initiative-response method of analysing power distribution in dialogue, to investigate collaboration at the level of therapeutic interaction. Results. The initiative-response scores indicated that power was relatively equally distributed between clients and therapists. On this measure there was no significant increase in collaboration as therapy progressed, as the dialogues were relatively equal from session 4. Analyses of the pattern of interaction showed that whilst the therapists asked most questions, the clients contributed to the flow of the analysis and played an active part in dialogues. Conclusions. The implications of these findings are discussed, along with the possible uses of such interactional analyses in identifying barriers to communication and ways of establishing effective therapeutic dialogue. [ABSTRACT FROM AUTHOR]

Recent research has examined the relevance of the social information processing model of aggression to individuals with intellectual disability (ID). This study investigated the “response access” and “response decision” steps of this model. Photo stories were used to compare aggressive and nonaggressive individuals' beliefs about the outcomes of responding aggressively and submissively in situations of interpersonal conflict. Coding of participants' open-ended answers indicated that aggressive individuals anticipated that aggressive responses would result in more favorable outcomes than their nonaggressive peers. The aggressive participants also made more negative evaluations of submissive responses. These findings have important implications for the assessment and treatment of aggression with people who have mild ID. [ABSTRACT FROM AUTHOR]

This feasibility study was conducted to evaluate design features of the novel intraurethral valved catheter, Surinate (Urovalve, Inc; Newark, New Jersey). The device extends from the bladder neck to just beyond the external sphincter and contains a valve that can be activated by an external magnet for bladder emptying. Five patients were recruited from the Edward Hines Jr Department of Veterans Affairs Hospital spinal cord injury population. We conducted cystometry and cystoscopy to evaluate the lower urinary tract. Then, the device was inserted for 24 hours with careful monitoring. The catheter was removed from the first patient because he developed autonomic dysreflexia during implantation. The next four patients used the catheter overnight and tolerated it well: one with independent use and two with increased abdominal pressure. Emptying time was 208 +/- 99 s, residual was 42 +/- 33 mL, and the first-stream flow rate was 1.8 +/- 0.7 mL/s. The safety tether was used in three patients because the extraction device did not work. Results showed effective implantation and stability of the device in the urethra. However, objectives for use and extraction were not met. This feasibility study provided important information that will help guide design improvements for the intraurethral valved catheter. [ABSTRACT FROM AUTHOR]

Background Work is an aspiration for many people with intellectual disability and is regarded as a vital goal by policy-makers in pursuit of social inclusion. The aim of this study was to consider the impact of supported employment on the socio-emotional well-being of people with intellectual disabilities. Method A systematic search was conducted. The review included case-controlled and longitudinal studies measuring outcomes for: (1) quality of life (QOL), (2) social life and (3) autonomy. Results While results for QOL, well-being and autonomy were largely positive, there was a lack of perceived social acceptance. The findings are interpreted in the light of methodological strengths and weaknesses. Conclusions Implications for the socio-emotional support required by some individuals in employment, and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Although the impact of autism spectrum disorders (ASDs) on the family is well recognized, the way mothers attempt to make sense of the diagnosis is largely unexplored. However, in other disabilities, attributions have been shown to predict a variety of outcomes including maternal wellbeing and engagement in treatment. Using Weiner's (1985) three-dimensional model, 16 mothers were interviewed to examine the nature and impact of their beliefs about their child's ASD using semi-structured interviews and measures of depression, parenting stress and expectations for their child's future. The findings suggested that mothers made a diverse and complex range of attributions that were consistent with Weiner's dimensions of locus of cause, stability and controllability. The nature of their attributions reflected particular difficulties associated with ASDs, such as uncertainties regarding cause and prognosis. Taking account of mothers' search for meaning will better enable professionals to support families following diagnosis. [ABSTRACT FROM AUTHOR]

Background Recent studies have suggested that cognitive biases may play an important mediating role in aggressive outbursts from people with mild intellectual disabilities (IDs). Essentially, some individuals may frequently perceive other people as acting towards them in a hostile fashion. This biased perception may develop through repeated adverse experiences, and may make them more likely to respond, likewise, in an aggressive manner. These studies have led to the development of a cognitive behavioural model of aggression, incorporating factors both intrinsic and extrinsic to the individual. This study aimed to explore one facet of this model: a putative relationship between anger-arousal level, problem-solving ability and perception of hostile intent in others. Method Single-case methodology was utilized, and a 44-year-old man with a mild ID and a history of difficulties with aggression participated. A series of vignettes, containing potentially provocative social interactions, were read to the participant. His perception of hostile intent, and suggestions of possible behavioural responses were recorded as dependent variables. Anger-arousal was manipulated, through autobiographical recall, as a dependent variable. Results Although not conclusive, results indicate that anger-arousal may act in an interactive fashion to increase perception of hostile intent. No effect of anger-arousal was observed on problem-solving ability; however, floor-effects in the task used may provide an explanation for this. Conclusions A high level of anger-arousal may exacerbate the probability of a frequently aggressive individual perceiving others as acting in a hostile manner. However, future research should take the limitations of this study into account, and continue development of a cognitive model of frequent aggression in those with a mild ID. [ABSTRACT FROM AUTHOR]

Background It is striking that although cognitive behavioural therapy was developed to treat depression in the general population, there remains a paucity of research concerning its application to people with intellectual disabilities. Recent research points to the importance of understanding people's distress in the context of their particular life experience. Areas to be addressed This paper examines how the life experience of people with intellectual disabilities may influence the nature of their self-perceptions and their vulnerability to depression. In addition to considering the impact of experience on the content of participants’ self-perceptions, evidence concerning the mediating role played by cognitive factors in the genesis and maintenance of depression is also reviewed. Conclusions These strands of research are discussed in the light of existing CBT models of depression, along with potential adaptations of interventions for people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Background Distinct cognitive models and treatments have been developed for people without intellectual disability with a wide range of anxiety disorders. However, these have not been reported as applied to people with intellectual disabilities. In fact, much of the cognitive therapy literature for people with intellectual disabilities does not distinguish between different presentations of anxiety. Methods We take the particular example of social phobia and describe the specific cognitive model and associated intervention developed for people without intellectual disabilities. We then consider research on the social context of people with intellectual disability and research on developmental factors predictive of anxiety and make suggestions for adaptation of treatment approaches. Conclusion We suggest that such an approach would be useful to apply to other anxiety presentations and to identify areas for further clinical and research development. [ABSTRACT FROM AUTHOR]

This paper describes the development of the Glasgow Social Self-Efficacy Scale (GSSES) and reports preliminary details of its psychometric properties. The scale was found to have a test–retest reliability correlation coefficient of 0.90 in a sample of participants with intellectual disability. This represents strong test–retest reliability. Cronbach's α for internal reliability of GSSES was 0.78 for the 38 participants with intellectual disability and 0.90 for the 19 participants in the non-disabled group, representing acceptable internal reliability. Significant but low concurrent validity (r = 0.42) was found for non-disabled participants between the GSSES and a previous measure of social self-efficacy. Although both communication skill and scores on the GSSES were associated with depression, they were not significantly correlated with each other. This suggests that the belief of a person with an intellectual disability in their social ability is distinct from their social ability as rated by others and provides support for the construct validity of social self-efficacy in this client group. The results of these tests of reliability and validity suggest the GSSES is a useful addition to cognitive measures in people with intellectual disability. Given the small sample size, verification of its psychometric properties in larger scale studies would be beneficial. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Comments on the article about Hayes Ability Screening Index (HASI) for offenders with intellectual disabilities. Importance of HASI; Degree on the moral responsibility of mentally handicapped offenders; Role of HASI in the theory and practice of research in intellectual disabilities.

Examines the changing approaches to working with people with a moderate to mild learning disability. Role of the assumption on the lack of interpersonal understanding and impulsiveness in clinical assessment; Behavioral approach towards cognitive-behavioral therapy; Incorporation of self concept and individual cognitive processes and behavior in social context.

Family members are often the main provider of informal support to people with mild intellectual disabilities. In the current study, we explored whether their family-based social capital is prospectively associated with their wellbeing and emotional and behavioral problems. Sixty-nine participants with mild intellectual disabilities and key (proxy reporting) staff members participated in two waves of data collection (T1, T2). Data were collected about family-based social capital (FNM-ID), subjective wellbeing (PWI-ID), and emotional and behavioral problems (ABCL, BPI-01). People who reported less support provision to family members and more reciprocal family support relationships at T1 experienced higher levels of internalizing behavior problems at T2, after accounting for T1 levels of internalizing behavior problems. No other associations were found between earlier family-based social capital dimensions and psychological outcomes at T2. Our study provides initial insights regarding the prospective associations between the family-based social capital of people with mild intellectual disabilities and their wellbeing and emotional and behavioral problems. Future studies should include larger samples to investigate if our preliminary results are replicated. [ABSTRACT FROM AUTHOR]

Background: During the COVID‐19 pandemic in the United Kingdom, many health services were withdrawn from people with learning disabilities, with negative impacts on people's health. What has happened to people's health and healthcare as we move beyond the pandemic? Methods: Access to health services and health status were tracked for 550 UK adults with learning disabilities, using structured online interviews with people with learning disabilities and online surveys with family members or paid carers. Information was provided four times, from Wave 1 (in the winter 2020/2021 'lockdown') to Wave 4 (autumn 2022, over a year after public health protections stopped). Findings: By Wave 4, most people with learning disabilities had had COVID‐19, although high vaccination rates limited the number of people hospitalised. There was little evidence that use of GP services, community nurses, other therapists or annual health checks had increased over time, and at Wave 4 more people were having difficulty getting their medicines. People's health did not substantially improve over time. People with profound and multiple learning disabilities had poorer health and were less likely to be accessing health services. Conclusions: Improvements in access to health services for people with learning disabilities after the pandemic have not yet happened. Accessible Summaries: Many health services stopped for people with learning disabilities in the COVID‐19 pandemic, with a bad impact on people's health. What has happened to people's health and how they use health services through the COVID‐19 pandemic and beyond?People and families told us about the health of over 500 people with learning disabilities living in the United Kingdom four times, from the national lockdown in winter 2020/2021 through to autumn 2022.A lot of people were still not getting the health services they needed after the end of the pandemic, and people's health was not getting better.People with profound and multiple learning disabilities had worse health but were not in contact with health services as much as other people with learning disabilities. [ABSTRACT FROM AUTHOR]

To enhance social inclusion of people with (mild) intellectual disabilities, policy tends to focus on increasing their informal supportive networks. Family members, mostly parents, are often the main providers of informal support to people with mild intellectual disabilities. Previous research has shown the utility of social capital as a theoretical framework to examine support in the family relationships of people with mild intellectual disabilities, and has shown that several features of the family‐based social capital of people with mild intellectual disabilities are dependent on support and living arrangements. However, existing research on support and living arrangements does not take the key features of family‐based social capital (i.e., bonding and bridging social capital, reciprocity) into account. Therefore, the aim of the current study is to examine the family‐based social capital of people with mild intellectual disabilities supported in 24‐h residential settings (n = 29) versus outreach support settings (n = 45). All participants were individually interviewed about their family support relationships using the Family Network Method‐Intellectual Disability (FNM‐ID). Data were analyzed quantitatively using social network analyses and group comparisons. No significant differences between the two subgroups were found in the social network measures: the two subgroups did not differ in their experience of bonding and bridging social capital, nor in terms of the experienced reciprocity in their family relationships. However, a few differences in the composition of the family network were found. While people with mild intellectual disabilities in outreach support settings were more likely to include children in their significant family network and to provide support to parents, participants in 24‐h care settings were more likely to report extended family as significant family network members. [ABSTRACT FROM AUTHOR]

Having a disability, in particular, an intellectual disability, is associated with Internet non-use. This article explores how people with intellectual disabilities used the Internet across the United Kingdom during the COVID-19 pandemic. In April to May 2021, 571 adults with intellectual disabilities were interviewed. Participants most commonly used the Internet for being with family and friends, social media or doing online activities with other people. People who lived with family were the most likely to use social media; people who lived with other people with intellectual disabilities were the least likely. People who self-reported as not lonely were more likely to use the Internet for online activities with others and play video games with others. Social connections were identified as the best thing about the Internet. Many participants chose not to identify a worst thing about Internet use, while others reported issues with technology, online harm and threats to well-being. [ABSTRACT FROM AUTHOR]

Research concerning people with learning difficulties who have left institutions has typically investigated how well people 'adapt' to life in the community, and has often ignored users' own perceptions of the changes in their quality of life resulting from the move. In this study, eight people with learning difficulties who moved from a hospital and seven people who moved from parental homes to live in staffed homes in the community were interviewed. Choke, privacy, social life and relationships with their parents and staff emerged as important factors in participants' perception of their quality of life. Their relationships with their parents were found to be close, and in some cases their parents were over protective. Staff were perceived in some cases as too controlling and in others as providing too little support. The findings indicate that people with learning difficulties moving to community residences have aspirations which encompass far more than a wish to adapt to life in the community, and their relationships with family and staff are a central factor in achieving such aspirations. [ABSTRACT FROM AUTHOR]

In this study, intensive observational methods were used to examine the daily flow of activity of 12 people with moderate to severe learning difficulties living in long-stay hospital, and 12 people living in community based hostels. This covered the participants' full waking day and included weekend observations. The qualitative findings demonstrated how the participants played an active pan in determining their own lifestyles. A number of more active hospital participants dealt with the unstimulating functional regime by attempting to create a social niche for themselves. A number of less active participants coped with the hospital environment by withdrawing into themselves and engaging in stereotypical behaviour to mark the passing of time. While the hostels provided a more homely and supportive environment, the participants tended to occupy a peripheral status as the least able people in the hostels and day centres. Consequently, they often had to seek staff support for activity or turned inwards. The quantitative findings followed a similar pattern of results to previous research in this area. [ABSTRACT FROM AUTHOR]

The Family Network Method – Intellectual Disability (FNM-ID) was used to compare perspectives of people with mild intellectual disability and their support workers on family networks of people with intellectual disability. 138 participants with mild intellectual disability and support workers were interviewed, using the FNM-ID. Paired t-tests were used to examine differences in perspectives. Multiple regression analyses were used to examine divergence in perspectives. People with mild intellectual disability perceived their family networks to be larger and to provide more support than support workers did. Living in a residential setting and having higher levels of externalising behaviour were associated with differences in perspectives, whereas a higher level of internalising behaviour was associated with more similar views. Individuals with intellectual disability and support workers are unlikely to provide the same information about family networks of people with mild intellectual disability. Behavioural and emotional problems were associated with divergence in perspectives. [ABSTRACT FROM AUTHOR]

Background: At the start of the COVID‐19 pandemic, some parents in the Netherlands decided to bring their offspring with intellectual disabilities, who normally live in residential care, home. The present study explored why the mothers decided to bring their offspring home. Method: Interviews were carried out with seven mothers of adults with intellectual disabilities. An interpretative phenomenological approach was used to establish in‐depth accounts of the mothers' experiences. Results: The analysis yielded three overarching themes: (a) Families are indispensable; (b) the complex role of being a mother of a child with intellectual disabilities; and (c) Who is looking out for our offspring during COVID‐19? Conclusions: The mothers experienced a strong sense of wanting to do what was best for their offspring with intellectual disabilities during COVID‐19. The study provides insight into why mothers remain involved in the care for their offspring and the complexity of navigating lifelong care responsibilities. [ABSTRACT FROM AUTHOR]

Background: Almost no research has been published reporting on evaluations of the effectiveness of psychological interventions for people with severe to profound intellectual disabilities and depression. This paper describes the development and initial feasibility testing of an adapted Behavioural Activation therapy (BeatIt2) for this population. Method: Phase 1 of the study examined participant recruitment and willingness to be randomised in the context of a planned Randomised Controlled Trial (RCT). Phase 2 examined the feasibility of delivering the intervention. Results: Twenty adults with a severe or profound intellectual disability and clinically significant depression were recruited to Phase 1 of the study. In Phase 2, there was 100% participant retention for those recruited to the study at 6‐month follow‐up. The BeatIt2 therapy was reported to be acceptable for participants. Conclusion: COVID disruption meant that it was not possible to complete the planned feasibility RCT. The positive findings suggest that additional evaluation of BeatIt2 is warranted. [ABSTRACT FROM AUTHOR]

Background: Social inclusion has been explored using a wide range of theories and methods. Belonging and reciprocity have been identified as key components of social inclusion. This systematic methodological review identifies and evaluates the theoretical frameworks and qualitative approaches adopted to explore belonging and reciprocity in the lives of adults with intellectual disabilities. Method: A systematic search was conducted across ten databases. Screening and quality appraisal were carried out independently by two researchers, and data were extracted to provide detailed accounts of the theories and methods employed. Results: Seventeen papers met inclusion criteria. Clear conceptualisations of belonging and reciprocity were lacking, and these concepts were rarely the focus of the research. Theoretical and methodological shortcomings across this literature were identified and discussed. Conclusions: More nuanced conceptualisations of belonging and reciprocity may be helpful in future research, to better capture the context and meaning of individual lives and relationships. [ABSTRACT FROM AUTHOR]

Differences in perceived emotional support in family networks of people with mild intellectual disability with and without challenging behaviour were explored by using a self-report measure. One hundred and thirty-eight participants (78 men and 60 women, average age 28.2 years old) with mild intellectual disability were interviewed using the Family Network Method -- Intellectual Disability to assess their emotionally supportive family relationships. The instrument maps the perceived emotional support among all the family members in the family networks of people with mild intellectual disability, with and without challenging behaviour. The results suggest that challenging behaviour may not be strongly associated with the family network characteristics and emotional support in family networks of people with mild intellectual disability. A few, and generally small, differences were found between the family networks of people with or without challenging behaviour. However, one moderate sized group difference was found: those with challenging behaviour reported less mutual support in their whole family network. [ABSTRACT FROM AUTHOR]

Background: Based on self‐reported social capital, different typologies of family networks of people with intellectual disabilities were examined. Associations between behavioural and emotional problems or well‐being and typologies were investigated. Method: 137 participants with mild intellectual disability were interviewed using the Family Network Method‐Intellectual Disability to assess their emotionally supportive family relationships. Data on participants' well‐being and behavioural and emotional problems were also gathered. Latent class analysis was used to identify family typologies based on social network measures. Results: Four distinguishable typologies were identified, two supportive and two less supportive. A small association was found with behavioural and emotional problems and one of the supportive typologies. Associations with constructs of well‐being were found for both supportive and less supportive typologies. Conclusions: A variety of family types were found, with implications for sensitive professional support. [ABSTRACT FROM AUTHOR]

Partly due to a lack of evidence‐based methods to support people with intellectual disability (ID) and challenging behavior, their needs are often poorly met. One way to generate rapid evidence is to systematically describe and monitor interventions that are considered to be "good practice"—to develop evidence based on practical knowledge. This study describes the Dutch practice‐based intervention Triple‐C (Client, Coach, Competence). The intervention was developed in practice to support people with severe ID to borderline functioning and challenging behavior. The practice‐based nature of Triple‐C means that many of the professionals' actions or activities are often underpinned by their implicit knowledge about the intervention they are delivering. Consequently, as the emphasis is on practice, the professionals can find it difficult to articulate how the intervention is operationalized and positive change achieved. This study aimed to assess the practical knowledge of Triple‐C professionals and to develop an understanding of the mechanisms of change for Triple‐C to improve understanding and to inform future research about the intervention. Through an iterative process, a logic model was developed to describe the intervention and its underlying assumptions. The development of the logic model was shaped using interviews with the founders, focus groups with support staff, psychologists, managers and members of the board of a service provider, and the analysis of published accounts of the Triple‐C intervention. Data gathered from these sources were analyzed using content analysis. The logic model of the Triple‐C intervention provides insight into the key elements of the approach, such as the need for unconditional supportive relationship and carrying out meaningful activities. Moreover, the potential relationship with existing evidence‐based interventions such as Positive Behavioral Support and Active Support are described. Defining the underlying logic of a practice‐based intervention like Triple‐C is an important first step toward producing an evidence base for interventions developed from clinical practice. [ABSTRACT FROM AUTHOR]