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Introduction: COVID-19 has adversely impacted the health and wellbeing of people with intellectual and developmental disabilities (IDD). While there is emerging research examining how to support th...

Purpose The majority of adults with intellectual disabilities (ID) are prescribed at least one, if not multiple medications, with psychotropic medications being the most commonly prescribed. Direct care staff play an important role in psychotropic medication administration and monitoring, yet little is known about their knowledge and comfort with medication. The paper aims to discuss this issue. Design/methodology/approach A 15-item survey, focusing on self-reported knowledge and comfort with psychotropic medication, was completed by 152 direct care staff employed at three agencies providing residential services for individuals with ID across Ontario. Findings In total, 62 per cent of staff respondents reported that psychotropic medications were among the top medications regularly taken by the individuals they support, with behaviour listed as the most commonly reported reason for taking this medication. The majority of staff reported monitoring medication, however, the frequency of monitoring varied considerably. Generally, staff reported feeling comfortable and knowledgeable about medication use, but, most reported a desire for additional medication training. Originality/value This is the first Canadian study to examine staff knowledge and comfort regarding medication use, and the first study to assess PRN (“as needed”) as well as regularly administered medications.

Cognitive behavioral therapy is a widely studied and commonly used psychosocial intervention for treating emotional problems in individuals with autism. To date, most studies of cognitive behavioral therapy and autism have focused on efficacy. Effectiveness trials, by contrast, measure whether an intervention produces particular results under “real-world” clinical conditions. We conducted a systematic review of cognitive behavioral therapy interventions targeting affective disorders among youth with autism and (a) classified studies as either efficacy or effectiveness trials and (b) coded how the effectiveness trials reflect the implementation characteristics outlined in the Framework of Dissemination in Health Services Intervention Research. The systematic search yielded 2959 articles, with 33 studies meeting inclusion criteria. Thirteen studies were categorized as effectiveness and 20 as efficacy. We discuss how the effectiveness studies considered elements of the implementation framework and provide recommendations for future studies, including greater consideration and measurement of adoption and sustainability processes, as well as organizational- and system-level outcomes. Results shed light on our understanding of the effectiveness of cognitive behavioral therapy in routine clinical practice, how an implementation framework can be used to guide and improve effectiveness studies, and identify barriers, facilitators, and gaps in the implementation process. Lay abstract Cognitive behavioral therapy is a common treatment for emotional problems in people with autism. Most studies of cognitive behavioral therapy and autism have focused on efficacy, meaning whether a treatment produces results under “ideal” conditions, like a lab or research setting. Effectiveness trials, by contrast, investigate whether a treatment produces results under “real-world” conditions, like a community setting (e.g. hospital, community mental health center, school). There can be challenges in bringing a cognitive behavioral therapy treatment out of a lab or research setting into the community, and the field of implementation science uses frameworks to help guide researchers in this process. In this study, we reviewed efficacy and effectiveness studies of cognitive behavioral therapy treatments for emotional problems (e.g. anxiety, depression) in children and youth with autism. Our search found 2959 articles, with 33 studies meeting our criteria. In total, 13 studies were labelled as effectiveness and 20 as efficacy. We discuss how the effectiveness studies used characteristics of an implementation science framework, such as studying how individuals learn about the treatment, accept or reject it, how it is used in the community over time, and any changes that happened to the individual or the organization (e.g. hospital, school, community mental health center) because of it. Results help us better understand the use of cognitive behavioral therapy in the community, including how a framework can be used to improve effectiveness studies.

Mothers of children with autism spectrum disorder (ASD) often face high levels of stress. While there have been interventions for parents of children with ASD targeting their parenting skills, there have been fewer studies that aim to target the psychological or physical well-being of the mothers themselves. This study included mothers of children with ASD to cofacilitate acceptance and commitment therapy (ACT) to other mothers of children with ASD. The intervention consisted of one evening session and a full-day workshop, followed by a refresher session 1 month later. Of the 33 mothers that enrolled in the study, 29 attended all three sessions and completed the outcome measures. Significant changes were observed over time in terms of depression, stress, social isolation and physical health scores. Post hoc analyses showed reductions in stress and depression and improvements in physical health which were maintained at follow-up. Results suggest that a brief parent-facilitated ACT group intervention may be effective in improving the mental and physical health of mothers of children with ASD.

This article aims to explore the attitudes and behaviors of persons with intellectual and developmental disabilities (IDD) related to their information privacy when using information technology (IT). Six persons with IDD were recruited to participate to a series of 3 semistructured focus groups. Data were analyzed following a hybrid thematic analysis approach. Only 2 participants reported using IT every day. However, they all perceived IT use benefits, such as an increased autonomy. Participants demonstrated awareness of privacy concerns, but not in situations involving the use of technology; their awareness is not transferred to the abstract context of IT use. Privacy breaches were revealed to be a major risk for persons with IDD, who did not seem to understand how their personal information was used. Most protection mechanisms and tools reported were those suggested and implemented by caregivers and close relatives who had a great influence on the participants’ attitudes and behaviors toward IT and priv...

Background Adults with Autism Spectrum Disorder (ASD) encounter many difficulties finding and accessing health care services. Despite this, few studies have considered the health service use patterns of adults with ASD without intellectual disability (ID). Objectives The current study examines a diverse range of medical and mental health services and supports, as well as adults' personal experiences accessing and using these services, barriers to service use, and reported unmet service needs. Methods Forty adults (ages 18–61 years) with ASD without ID completed surveys every two months about their health service use for a total of 12–18 months. Bivariate analyses were conducted to understand the individual demographic and clinical factors associated with rate of service use, satisfaction with services, and barriers to health care. Results Results indicated that, beyond a family doctor, the most commonly used services were dentistry, individual counseling, and psychiatry. Individuals who had medical problems experienced significantly more barriers to service use than those who did not, and those who had medical and mental health problems were less satisfied with services. Conclusions Findings highlight the challenges adults with ASD without ID face accessing appropriate, quality services to meet their needs, particularly those with complex medical and mental health issues. Service providers must strive to provide adequate health care to this population who may become distressed if their needs are left unmet.

This study aimed to describe rates of antipsychotic medication use and the association between their use and demographics, clinical variables, and the use of behavioral/education services among children with ASD. For children with ASD ages 2-11 (n = 4749) and those 12-17 (n = 401), 5.4 and 17.7% were prescribed at least one atypical antipsychotic medication respectively. In the multivariable model of young children, older age, use of multiple psychotropic medications, prior ASD diagnosis, non-white Hispanic race/ethnicity, and oppositional defiant problems were associated with antipsychotic use. Among older children, only older age was associated with antipsychotic use. In at least one age group, antipsychotic medication use was also related to behaviour, family and occupational therapy, public insurance, site region, externalizing problems, body mass index, and sleep and gastrointestinal problems.

Background Cerebral palsy (CP) is one of the most common neurological conditions in childhood. Individuals with CP often experience various secondary conditions, including intellectual disability (ID), medical conditions, and psychiatric issues. A large number of youth with CP have psychiatric disorders; however, few studies have examined the prevalence of psychiatric issues in adults with CP at the population-level. Aims To investigate the prevalence and co-occurrence of psychiatric disorders at the population-level in adults with CP only, and adults with CP and ID. Method and procedures Using clinical information from seven Canadian data sources, we conducted a retrospective cross-sectional analysis of adults with CP, with and without ID. Outcomes and results Adults with CP were more likely than the general population to have a psychiatric diagnosis, independent of ID status. All psychiatric disorders were more common in individuals with CP than the general population, with the exception of addiction related disorders. In most cases, having an ID substantially increased the risk of having a psychiatric disorder. Conclusions Adults with CP are at heightened risk for experiencing psychiatric disorders. Current findings highlight the important role health care providers play in screening for psychiatric issues in individuals with CP.

Few studies have examined interventions or therapeutic processes that may help parents of children with Autism Spectrum Disorder (ASD) manage their stress. This study examines the impact of a brief Acceptance and Commitment Therapy (ACT) group intervention, led by parents, among a cohort of 33 mothers of children with ASD. Changes in ACT process measures (psychological flexibility, cognitive fusion, values) were evaluated at pre, post, and 3 months following the intervention. Mothers reported significant improvement post-intervention in psychological flexibility, cognitive fusion, and value-consistent activities in multiple life domains, including parenting, relationships, and self-care. These improvements were maintained at follow-up. The results provide preliminary evidence that improvements observed in depression and stress may be mediated by cognitive fusion and action-values consistency.

Psychotropic medications are frequently used to treat mental health and behavioral issues in adolescents and adults with an autism spectrum disorder (ASD). Although parents of individuals with ASD frequently take on medication management for their child, there is limited literature on parent perspectives of their child's medication use or their views about the healthcare services they receive, particularly in adulthood. The current study examined and compared parents of adolescents and of young adults with ASD regarding their child's psychotropic medication use and their views about healthcare services.One hundred parents of adolescents and young adults with ASD (ages 12-30 years) completed an online survey about their experience with their child's healthcare services and medication use.Parents of young adults were less likely to use nonpharmacological services before using a psychotropic medication than were parents of adolescents. Parents of young adults were also less likely to believe that their prescribing healthcare provider had adequate expertise in ASD, and were less satisfied with how their prescriber monitored their child's medication use.Findings highlight the need to build capacity among healthcare providers supporting individuals with ASD as they transition into adulthood. There is also a need for improved medication monitoring and increased awareness of the different mental health challenges that individuals with ASD encounter as they age.

Adolescents and young adults with an autism spectrum disorder (ASD) are often prescribed psychotropic medications to treat mental health and behavioral issues, and parents of these individuals play a crucial role in overseeing this care. Despite this, little is known about parents’ experiences managing and monitoring their child’s medication treatment, or their experience interacting with prescribing health care providers. To learn more about parents’ perspectives on psychotropic medication use in their adolescent or young adult with ASD, a focus group was conducted with seven mothers whose adolescent or adult child with ASD was prescribed one or more psychotropic medications. Results are summarized according to emergent themes including parent perception of child experience with medication, side effects, medication efficacy, medication monitoring, expertise issues, and service issues. Parents also provided medication recommendations, including a desire for health care providers with greater expertise in ASD, information on medication, and tools for medication monitoring.

Approximately 1 in 88 individuals have an autism spectrum disorder (ASD), and the pro- portion of children diagnosed is on the rise (Centers for Disease Control and Prevention [CDC], 2012). ASD is a neurodevelopmental disorder characterized by social deficits, com- municative difficulties, and repetitive behaviors, with evidence of cognitive dysfunction (American Psychiatric Association [APA], 2013). Although ASD is most widely known as a childhood disability, symptoms persist into adolescence and adulthood, where individuals continue to experience social difficulties, com- municative impairments, stereotyped behavior (Ballaban-Gil, Rapin, Ruchman, & Shinnar, 1991; Fecteau, Mottron, Berthiaume, & Burack, 2003; Howlin, Goode, Hutton, & Rutter, 2004; Matson & Horovitz, 2010; see Seltzer, Shattuck, Abbeduto, & Greenburg, 2004, for a review), and comorbid mental health issues (Davis et al., 2011; Palucka & Lunsky, 2007; Seltzer et al., 2004). Adolescents and adults with ASD also have sustained impairments in academic per- formance, employment, social relationships (Howlin et al., 2004; Mao, 2012), and adap- tive functioning (Chadwick, Cuddy, Kusel, & Taylor, 2005). Despite these significant impair- ments, access to health services and supports become increasingly difficult as individuals with ASD age out of the pediatric system (Autism Ontario, 2008). After age 21, young adults are no longer integrated in public school and child health systems, and identification and coordination of appropriate structured daytime activities can become particularly challenging (Mao, 2012). Consequently, many young adults remain highly dependent on their families for support (Ballaban-Gil et al. 1991; Howlin et al., 2004; Levy & Perry, 2011; Mao, 2012). In a recent review of outcomes for adults with ASD, the number of adolescents and adults living with families ranged from approximately 22% to 70% (Howlin & Moss, 2012), leaving many parents with the responsibility of health care and social service provision for their adult child in addition to behavior management and assistance with daily living.Caring for an individual with ASD is associ- ated with high levels of caregiver burden-"the perception of psychological distress, anxiety, depression, demoralization, and generalized loss of personal freedom attributed directly to caregiving" (Lawton, Moss, Kleban, Glicks- man, & Rovine, 1991, p. 182)-from the time of diagnosis (Stuart & McGrew, 2008), and throughout childhood (Lee, Harrington, Louie, & Newschaffer, 2008; Rodrigue, Morgan, & Geffken, 1990), adolescence, and young adult- hood (Cadman et al., 2012; Kring, Greenberg, & Seltzer, 2008; Lee et al., 2008; Lin, 2011). Health care costs are substantially higher for children with ASD (Croen, Najjar, Ray, Lot- spiech, & Bernal, 2006), and parents report greater financial burden compared to care- givers of children with physical and intellectual disabilities (Xiong et al., 2011). Additionally, parents of individuals with ASD report lower personal well-being compared to parents of those with Fragile X syndrome (Abbedutto et al., 2004), Down syndrome (Abbedutto et al., 2004; Blacher & McIntyre, 2006), cerebral palsy (Blacher & McIntyre, 2006), attention-deficit/hyperactivity disorder (ADHD; Cadman et al., 2012), and undifferentiated intellectual disabilities (Blacher & McIntyre, 2006). Caregiver burden is also associated with parent depression, anxiety (Gallagher, Philips, Oliver, & Caroll, Gallagher et al., 2008; Kim, Greenberg, Seltzer, & Krauss, 2003; Luescher, Dede, Glitten, Fennell & Maria, 1999; Magana, Seltzer, Krauss, Rubert, & Szapocznick, 2002), and reduced caregiver satisfaction (Pruncho, 2003). In addition, evidence exists to suggest that psychological distress among families increases as children with ASD become older (Koegel et al., 1992; Marcus, 1984), yet the majority of literature focuses on the experiences of families in childhood. …

Introduction Autism is a neurodevelopmental disorder with a high co-occurrence with intellectual disability. Adults with Autism and intellectual disability have a high incidence of challenging behaviour, defined as repetitive self injurious or aggressive behaviour. We underwent a systemic review of the evidence for treating challenging behaviours in adults with Autism and intellectual disability. Methods A literature search was conducted using three large databases to extract studies on the treatment of challenging behaviour among adults with Autism and intellectual disability. Papers, which met this criterion, were reviewed and analysed to assess study evidence and quality. Results Seven articles were selected which included five agents: fluvoxamine, sertraline, clomipramine, risperidone, and ziprasidone. Randomized control studies of fluvoxamine and risperidone, provided efficacy for the treatment of challenging behaviour in adults with Autism and intellectual disability. Open label trials of sertraline, clomipramine and ziprasidone were also effective in treating challenging behaviours for this population. Discussion Risperidone and fluvoxamine provided the best evidence for treating challenging behaviour, and risperidone was the only medication with multiple trials showing its efficacy. Further studies are required to demonstrate the efficacy of psychopharmacology in treating challenging behaviours among adults with Autism and intellectual disability.

Adolescents and adults with an autism spectrum disorder (ASD) who do not have an intellectual impairment or disability (ID), described here as individuals with high-functioning autism spectrum disorder (HFASD), represent a complex and underserved psychiatric population. While there is an emerging literature on the mental health needs of children with ASD with normal intelligence, we know less about these issues in adults. Of the few studies of adolescents and adults with HFASD completed to date, findings suggest that they face a multitude of cooccurring psychiatric (e.g., anxiety, depression), psychosocial, and functional issues, all of which occur in addition to their ASD symptomatology. Despite this, traditional mental health services and supports are falling short of meeting the needs of these adults. This review highlights the service needs and the corresponding gaps in care for this population. It also provides an overview of the literature on psychiatric risk factors, identifies areas requiring further study, and makes recommendations for how existing mental health services could include adults with HFASD.

This article summarizes Canadian research in “dual diagnosis” spanning the past 20 years and places this research within a historical and policy context. Canadian researchers have made important contributions with regard to understanding inpatient and outpatient mental health services, families, autism, specific disorders and behaviors, aboriginal mental health, forensics, and emergencies. In this article, we aim to summarize several of these contributions. Following a summary of recent research findings, we offer some suggestions and directions for future research in our country.

Pharmacological interventions are frequently used to treat commonly associated mental health and behavioural issues in individuals with autism spectrum disorders (ASD). Despite high rates of psychotropic drug use documented in children with ASD, very few studies have examined medication profiles, side effects, and rates of polypharmacy in adolescents and adults with ASD. To address this, we examined medication profiles and predictors of polypharmacy among 142 adults with ASD who had experienced a psychiatric crisis. Of the 142 adults sampled, 91 (64.1%) were prescribed at least 1 psychotropic medication and 41 (28.9%) were taking 3 or more psychotropic medications. Variables associated with and predictive of polypharmacy included history of aggression, residence, and psychiatric support. Adults with ASD are a highly medicated population and polypharmacy is a significant concern in this vulnerable group of individuals.

This study investigates the role of disfluencies such as "um" or "uh" in conversation to discern whether these features of speech serve listener- or speaker-oriented functions by looking at their occurrence (or lack of occurrence) in the speech of participants with autism. Since the characteristic egocentricity of individuals with autism means they should engage in minimal listener-oriented behavior, they are a useful group to differentiate these functions. Transcription, analysis and categorization of 26 spontaneous language samples were derived from age-matched native English-speaking controls and high-functioning individuals with Autism Spectrum Disorders (ASDs). Results showed that individuals with ASD produced fewer filled-pause words (ums and uhs) and revisions than controls, but more silent pauses and disfluent repetitions. Filled-pause words therefore appear to be listener-oriented features of speech.

Three experiments elicited phonological speech errors using the SLIP procedure to investigate whether there is a tendency for speech errors on specific words to reoccur, and whether this effect can be attributed to implicit learning of an incorrect mapping from lemma to phonology for that word. In Experiment 1, when speakers made a phonological speech error in the study phase of the experiment (e.g. saying "beg pet" in place of "peg bet") they were over four times as likely to make an error on that same item several minutes later at test. A pseudo-error condition demonstrated that the effect is not simply due to a propensity for speakers to repeat phonological forms, regardless of whether or not they have been made in error. That is, saying "beg pet" correctly at study did not induce speakers to say "beg pet" in error instead of "peg bet" at test. Instead, the effect appeared to be due to learning of the error pathway. Experiment 2 replicated this finding, but also showed that after 48 h, errors made at study were no longer more likely to reoccur. As well as providing constraints on the longevity of the effect, this provides strong evidence that the error reoccurrences observed are not due to item-specific difficulty that leads individual speakers to make habitual mistakes on certain items. Experiment 3 showed that the diminishment of the effect 48 h later is not due to specific extra practice at the task. We discuss how these results fit in with a larger view of language as a dynamic system that is constantly adapting in response to experience.

Individuals with autism or autism spectrum disorders (ASDs) are known to have difficulties discriminating animacy and are less likely to attend to animate stimuli, which may underlie the social deficits of autism. For individuals without ASD, animacy also affects word order choices: speakers choose syntactic structures (active vs. passive) that place animate entities as the grammatical subject, as a result of their conceptual salience. This study tested whether highly verbal adults with ASD would show sensitivity to animacy in a picture description task. Results showed that individuals with ASD were as sensitive to animacy as controls, and overwhelmingly placed animate entities as the grammatical subject. One stimulus proved an exception, where only individuals with ASD placed an inanimate entity (a clock) in subject position in preference to an animate one (a boy), which coincides with previous observations that individuals with autism find clocks highly salient. This study provides converging evidence of the role of conceptual salience in word order choices, and furthermore shows animate entities to be highly salient for individuals with ASD, at least as it pertains to these word order choices.

Children with cerebral palsy (CP) experience high rates of comorbid physical and mental health issues. As individuals with CP age and become adults, the risk for physical and mental health issues persists, and the need for health care support also increases. Despite this, compared to children with CP, the health needs of adults with CP are poorly understood. To better appreciate these issues, we conducted a comprehensive literature review of the physical and mental health issues, and health service use patterns among adults with CP, with and without an intellectual disability. In total, 18 articles were reviewed; seven related to physical health, three mental health, and eight health service use. Overall, our review showed that adults with CP frequently suffer from a variety of chronic physical and mental health issues, such as bladder issues, musculoskeletal problems, chronic pain, depression, and self-injurious behavior. Despite these chronic health problems, research to date fails to demonstrate a consistent pattern of health service use among adults with CP. These results highlight the significant physical and mental health issues experienced by this population, as well as considerable gaps in the literature. Our review also highlights disparities related to health and health service issues experienced by the following groups: (1) children compared to adults with CP; (2) individuals with CP compared to other clinical populations; and (3) adults with CP compared to the general population. Lastly, we discuss clinical implications of this review as it pertains to health care professionals supporting adults with CP.

This study examined the child, parent, and service factors associated with polypharmacy in adolescents and young adults with autism spectrum disorders (ASD).As part of an online survey examining health service utilization patterns among individuals with ASD, parents provided demographic and clinical information pertaining to their child. This included information on current medication use, as well as information on clinical services received, clinical history, and parent well-being. Analyses examined the bivariate association between individual child, parent, and service variables and polypharmacy. Variables significantly associated with polypharmacy were included in a multiple variable logistic regression.Of the 363 participants sampled, ∼25% were receiving two or more psychotropic drugs concurrently. The patient's psychiatric comorbidity, history of hurting others, therapy use, and parent burden were predictors of polypharmacy.Adolescents and young adults with ASD are a highly medicated population with multiple factors associated with psychotropic polypharmacy. Although there may be circumstances in which polypharmacy is necessary, a richer understanding of what predicts polypharmacy may lead to targeted interventions to better support these individuals and their families. Findings also highlight the need to support families of children with ASD prescribed multiple psychotropic medications.

Polypharmacy is the concurrent use of multiple medications, including both psychotropic and non-psychotropic drugs. Although it may sometimes be clinically indicated, polypharmacy can have a number of negative consequences, including medication nonadherence, adverse drug reactions, and undesirable drug–drug interactions. The objective of this paper was to gain a better understanding of how to study polypharmacy among people with intellectual and developmental disabilities (IDD). To do this, we reviewed literature on polypharmacy among the elderly and people with IDD to inform future research approaches and methods on polypharmacy in people with IDD. Results identified significant variability in methods used to study polypharmacy, including definitions of polypharmacy, samples studied, analytic strategies, and variables included in the analyses. Four valuable methodological lessons to strengthen future polypharmacy research in individuals with IDD emerged. These included the use of consistent definitions of polypharmacy, the implementation of population-based sampling strategies, the development of clinical guidelines, and the importance of studying associated variables.

Aims To describe and compare population-level aspects of diabetes and diabetes primary care among people with and without intellectual and developmental disabilities. Methods Administrative health data accessed from the Institute for Clinical Evaluative Sciences was used to identify a cohort of Ontarians with and without intellectual and developmental disabilities between the ages of 30 and 69 years (n = 28 567). These people were compared with a random sample of people without intellectual and developmental disabilities (n = 2 261 919) according to diabetes prevalence, incidence, age, sex, rurality, neighbourhood income and morbidity. To measure diabetes primary care, we also studied hospitalizations for diabetes-related ambulatory care-sensitive conditions. Results Adults with intellectual and developmental disabilities had a consistently higher prevalence and incidence of diabetes than those without intellectual and developmental disabilities. Disparities in prevalence between those with and without intellectual and developmental disabilities were most notable among women, younger adults and those residing in rural or high income neighbourhoods. In terms of hospitalizations for diabetes-related ambulatory care-sensitive conditions, people with intellectual and developmental disabilities were 2.6 times more likely to be hospitalized. Conclusions Adults with intellectual and developmental disabilities are at high risk of developing and being hospitalized for diabetes. The findings of the present study have a number of important implications related to the early detection, prevention and proper management of diabetes among adults with intellectual and developmental disabilities.

Individuals with intellectual and developmental disabilities (IDD) represent one of the most complex, poorly understood, and under-researched patient populations. The objectives of this review are threefold: (1) first, we provide an overview of existing research on patterns and predictors of emergency department (ED) use among persons with IDD. Population-based studies suggest that individuals with IDD are more likely to visit EDs and to visit more frequently for both physical and mental health issues. We also discuss the predisposing, enabling, and clinical need factors that contribute to emergency service utilization in this population. (2) The second objective is to summarize what is known about the care received by individuals with IDD in the ED. Qualitative research suggests that the care provided is suboptimal from the perspective of patients, their families, and ED health-care providers, with multiple barriers. (3) The final objective is to describe interventions to improve emergency care for persons with IDD, including a pilot evidence-informed approach to implementing practice change in the ED. Our ongoing work is revealing important barriers and enablers to practice change including a discomfort of staff to identify patients with suspected IDD, challenges in developing a system to flag patients with IDD in the ED, the need for educational resources to help adapt their communications and general approach to patients with IDD, and the need to develop and embed tools within the ED care pathway to assist in providing discharge instructions. Crowding and resource limitations within the ED setting may further exacerbate these care challenges and heighten the importance of facilitation in achieving practice changes.

This chapter provides a review of key issues concerning inpatient psychiatric services for individuals with intellectual disabilities (ID). Such a review is very much impacted by the time in which it is written. A similar chapter written 20–30 years prior would focus on long-stay hospitals for individuals with ID. However, with the deinstitutionalisation movement impacting many parts of the developed world, the purpose of hospitalisation has shifted to short-term treatment of acute psychiatric issues. This chapter focuses on papers published within the past 10–20 years. Section “Profiles of Inpatients with ID” describes what we know about the profile of individuals with ID that are hospitalised for mental health or behavioural concerns. We review in some detail the two main models of inpatient care: mainstream or general services and specialist units. We will describe what is known about how the two models differ as well as the risks and benefits of each. Section “Issues Pertaining to Hospitalization” focuses on clinical considerations and challenges with inpatient care. Finally, the chapter concludes with new directions for models of inpatient care and areas requiring further research.

Individuals with autism or autism spectrum disorders (ASDs) are known to have difficulties discriminating animacy and are less likely to attend to animate stimuli, which may underlie the social deficits of autism. For individuals without ASD, animacy also affects word order choices: speakers choose syntactic structures (active vs. passive) that place animate entities as the grammatical subject, as a result of their conceptual salience. This study tested whether highly verbal adults with ASD would show sensitivity to animacy in a picture description task. Results showed that individuals with ASD were as sensitive to animacy as controls, and overwhelmingly placed animate entities as the grammatical subject. One stimulus proved an exception, where only individuals with ASD placed an inanimate entity (a clock) in subject position in preference to an animate one (a boy), which coincides with previous observations that individuals with autism find clocks highly salient. This study provides converging evidence of the role of conceptual salience in word order choices, and furthermore shows animate entities to be highly salient for individuals with ASD, at least as it pertains to these word order choices.