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Drawing conclusions from the literature regarding the moral development of people with intellectual disabilities (IDs) is difficult because of the use of unstandardised and idiosyncratic measures. In order to address this short-coming, a moral reasoning production measure (the Socio-Moral Reflection Measure--Short Form; SRM-SF) and a recognition measure (the Moral Theme Inventory; MTI) were presented to men with and without IDs who had no known history of engaging in illegal behaviour. The instruments were completed on two occasions, separated by a two-week interval, in order to investigate their basic psychometric properties. The results indicated that there was a strong relationship between the MTI and the SRM-SF, suggesting that the MTI has convergent validity. The internal consistency of the MTI and the SRM-SF ranged from moderate to substantial for both men with and without IDs. However, the test-retest reliability of the MTI was poor for men with IDs, while it was good for men without IDs. The test-retest reliability of the SRM-SF was good for both men with and without IDs. Comparison of the moral reasoning abilities of men with and without IDs suggested that many of the differences between the two groups could be accounted for by general intellectual functioning. The exception was overall score on the SRM-SF and moral reasoning in relation to the law, where men with IDs scored at stage 2(1), when intelligence was controlled. The results were interpreted by suggesting that the relationship between moral reasoning and illegal behaviour may take an inverted U curve shape, moderated by intelligence. [ABSTRACT FROM AUTHOR]

Background: We examined whether staff attributions, emotions and helping behaviours in reaction to 'real' incidents of challenging behaviour (CB) exhibited by children with intellectual disabilities were different from reactions to 'vignettes'. We also examined whether these reactions are congruent with that predicted by attribution theory. Methods: Using a repeated measures design, 60 staff working with children who have severe intellectual disabilities completed measures of cognition, emotion and helping behaviour in reaction to a 'real' incident of CB, and then completed the same measures in reaction to reading a 'vignette', that was matched to the 'real' incident of CB. There was a 2-week interval between the completion of measures in response to the 'real' incident of CB and the 'vignette'. Results: Correlational support was found for Weiner's (1980) cognitive-emotional-action model of helping behaviour for measures completed in reaction to the 'real' incident of CB, regarding attributions of control only, but not for the 'vignette'. There were significant differences between the correlations detected using 'real' incidents of CB in comparison to 'vignettes'. Little evidence was found using both methods to support Weiner's (1979) model of achievement motivation. Conclusions: The results suggest that the relationships between constructs investigated using 'vignettes' is different from that detected when using 'real' incidents of CB, which has implications for psychological research that has used 'vignettes'. [ABSTRACT FROM AUTHOR]

Studies involving professional carers of people with mental health problems have investigated the relationship between burnout, job satisfaction, the coping strategies employed by carers, and expressed emotion (EE). We undertook a similar study involving carers of adults with intellectual disabilities detained within a secure hospital. Twenty-seven nursing staff completed a Five Minute Speech Sample regarding a keyworked client. EE was coded, and measures of coping strategies, burnout, attitudes to psychiatric treatment and job satisfaction were administered. Sixty-three percent of the sample were coded as having high EE. These subjects reported significantly higher levels of depersonalization and lower levels of personal accomplishment. They used coping strategies more frequently: specifically they reported trying to reorganize their work and to seek support from others. The results are discussed in light of the findings of previous studies. It is noted that the study was not causal and the sample size was small. [ABSTRACT FROM AUTHOR]

Background Men with intellectual disability (ID) and sexually abusive behaviour are a disempowered and marginalised group. Nevertheless, as service users, they can be consulted and involved in a variety of different ways, including ascertaining their views of the services they receive. Method A group of 16 men with ID and sexually abusive behaviour were interviewed to ascertain their views approximately 2 months after completing a 1-year group cognitive behavioural treatment (CBT) for sexual offending. Two raters independently reviewed interview transcripts and participant responses were summarised. Results The most salient components of treatment recalled by participants were: sex education; legal and illegal behaviours and their consequences; and discussions about specific sexual assaults. Only 3 of the 16 participants stated that they had problems with sexual offending, and only 1 identified that he had learnt about victim empathy, although this is an important component of treatment. Having support, the knowledge that they had the same problems as other group members, and talking through problems, were appreciated as some of the 'best things' about the group, while the 'worst things' were generally person-specific. Participants had mixed views on talking about their own offences during group sessions and, overall, viewed the experience as difficult but helpful. Conclusions Valuable insights into the aspects of treatment that group members found useful were explored. Such insights are often not captured by studies that assess the efficacy of treatment models using treatment-specific measures only, and these are important in defining the quality of services provided. [ABSTRACT FROM AUTHOR]

Challenging behaviours may elicit negative emotional reactions and increase stress within care staff. The Leeds Attributional Coding System (LACS) was used to elicit spontaneous causal attributions of staff toward hypothetical clients with challenging behaviours. It was hypothesized that there would be relationships (1) between staff exposure to challenging behaviours and burnout, and (2) between staff cognitions and burnout. Using a cross-sectional correlational design, 41 care staff took part in a 10 minute interview about two vignettes depicting self-injurious behaviour. Staff also completed measures of demographic information and burnout. Participants made attributions toward self-injurious behaviour that were typically internal to the client, uncontrollable, unstable and specific. There was a significant association between number of clients cared for and emotional exhaustion and personal accomplishment. Staff who made fewer stable attributions had higher levels of burnout. There were no other relationships found between staff cognition and burnout. The LACS can be successfully employed in this context, and may have some benefits over other methods. Future research is required to explore the relationship between cognition and burnout. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Expressed emotion (EE) and attributions towards challenging behaviour (CB) were explored amongst a group of staff working within a residential and day service placement for people with learning disabilities. DESIGN: Using a cross-sectional related-samples design, EE and attributions were measured amongst all staff working with one client with CB, and one client without CB. METHODS: Fifteen staff members completed the attributional questionnaire and the 5-minute speech sample (FMSS) to allow for EE ratings concerning staff relationships with two clients. One client exhibited CB, while the other did not, giving 2 samples. Attributional and EE ratings for each group were compared. This study did not employ vignette methodology. RESULTS: Staff working with a client with learning disabilities and CB attributed the CB as internal to the client and controllable by the client. Staff reported high levels of EE and made more critical comments towards the client with CB as compared with the client without CB. Furthermore, staff who reported high EE attributed CB as internal to the client and controllable by the client. CONCLUSIONS: Staff working with a client with challenging behaviour appeared to be making the 'fundamental attribution error'. The relationship between expressed emotion and attribution theory is discussed along with the methodological benefits of not relying on vignette methodology in research that examines challenging behaviour. [ABSTRACT FROM AUTHOR]

Background and Aims: We investigated whether improving the cognitive accessibility of a widely used self-report measure leads to better understanding and more accurate answers in a sample of adults with mild intellectual disability and borderline intellectual functioning., Methods and Procedures: We undertook a series of cognitive interviews before and after adaptation of the instructions and selected items of an existing self-report measure of adaptive functioning. Interview results and participant feedback were supplemented with quantitative comparisons between participant and carer scores., Outcomes and Results: Adaptation based on participant experiences and preferences combined with evidence-informed guidelines improved understanding and accuracy. Self-report and carer-report scores showed greater convergence after adaptation; this occurred because people with intellectual disabilities appeared to understand the self-report measure more effectively., Conclusions and Implications: The results show that adaptation of the self-report instrument to suit the needs and preferences of people with mild intellectual disability or borderline intellectual functioning leads to a more accessible measure and more reliable and valid results. Results also highlight the importance of complementing proxy reports with a first-person perspective in assessment as clients and informants may differ in their assessment of behavior and skills., Competing Interests: Declaration of Competing Interest The authors have no relevant financial or non-financial interests to disclose., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The current review aimed to evaluate the effectiveness of behavior-analytic procedures in increasing face mask-wearing in autistic individuals. This comes following recommended guidance during the COVID-19 pandemic. A systematic review and meta-analysis were completed of peer-reviewed and grey literature. Six databases were searched and seven studies using single-case experimental designs met the eligibility criteria which were then quality appraised. Data were extracted on participant characteristics, study design, independent and dependent variables, fidelity, generalization, maintenance, and social validity outcomes. Both the non-overlap of all pairs and Baseline Corrected TAU were used to estimate effect size. Two studies were rated strong and borderline strong quality and five were rated as adequate or below. All studies showed positive outcomes for mask-wearing, with an average of 0.92 for non-overlap of all pairs and 0.47 for Baseline Corrected Tau effect sizes. The most common and effective procedures for increasing mask-wearing were graded exposure and differential and positive reinforcement. Factors such as mode of delivery, implementer, and setting did not appear to influence study outcomes. Procedures were found to be rated as acceptable by parents and professionals in five of the studies. The existing literature on increasing face mask-wearing in autistic individuals provides promising findings to add to existing literature around increasing tolerance to medical equipment and hygiene practices in autistic populations. However, these findings are based on a small sample size, with six of the studies taking place in the United States with varying study quality., (© 2023. The Author(s).)

Background: Interventions for anxiety need to be adapted to meet the needs of autistic people with moderate to severe learning disabilities and successfully modelled before evidence about efficacy can be generated from clinical trials., Objectives: The objectives were to: (1) adapt a behavioural intervention for anxiety, develop an intervention fidelity checklist and logic model, and appraise candidate outcome measures, together with carers, autistic people, and clinicians, (2) characterise treatment-as-usual, (3) model the adapted intervention to determine the acceptability and feasibility for all stakeholders, judge the appropriateness of outcome measures, examine the feasibility and acceptability of consent and associated processes and (4) describe factors that facilitate or challenge intervention delivery., Design: This study had two phases. Phase 1a: using consensus methods, an intervention adaptation group was formed who met to adapt the intervention, appraise candidate outcome measures, and contribute to the development of the intervention fidelity checklists and logic model. Phase 1b: a national online survey was conducted with professionals to characterise treatment-as-usual. Phase 2: this was a single-group non-randomised feasibility study designed to model the intervention to test intervention feasibility and acceptability, outcome measures, and aspects of the research process., Setting: Participants were recruited from National Health Service community adult learning disabilities teams in England., Participants: Participants aged 16 and over with a diagnosis of autism, moderate to severe learning disabilities, an anxiety disorder, and a carer who was available to take part in the intervention. For those who lacked capacity to make a decision about taking part, a consultee had to provide advice that the participant should be included in the study., Interventions: The intervention comprised 12 sessions alongside treatment-as-usual., Main Outcome Measures: The feasibility and acceptability of the intervention and research processes, outcome measure completion rates, and intervention adherence., Results: The intervention was successfully adapted and modelled with 28 autistic participants with moderate to severe learning disabilities. The intervention was judged to be feasible and acceptable by autistic adults with learning disabilities, carers, and therapists. Carers and therapists suggested minor intervention revisions. Carers completed 100% of outcome measures and the missing data rate was low; however, they indicated that some of the questions were repetitive and said they had difficulty responding to some items. The use of the Mental Capacity Act, 2005, led to an average 5-week delay to participant enrolment. The accrual rate was affected by the COVID-19 pandemic and improved during the summer and early autumn of 2022., Limitations: Randomisation was not modelled within this feasibility study, although carers and therapists indicated that this would be acceptable., Conclusions: The BEAMS-ID intervention and associated study processes were judged to be feasible and acceptable. The intervention required minor revision., Future Work: The BEAMS-ID intervention should be tested further within a trial., Study Registration: This study is registered as ISRCTN12637590., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR129804) and is published in full in Health Technology Assessment ; Vol. 28, No. 72. See the NIHR Funding and Awards website for further award information.

Background: There is a lack of interventions for specific phobia in children and adolescents with moderate to severe intellectual disabilities., Objectives: The objectives were to: (a) develop an intervention for specific phobia, together with an intervention fidelity checklist and logic model, and evaluate candidate outcome measures, together with parents/carers and clinicians; (b) describe treatment as usual; (c) model the intervention to determine the acceptability and feasibility for all stakeholders, judge the appropriateness of outcome measures, explore recruitment pathways, and examine the feasibility and acceptability of consent and associated processes; and (d) describe factors that facilitate or challenge the intervention., Design: Phase 1a: using consensus methods, an Intervention Development Group was established who met to develop the intervention, review candidate outcome measures and contribute to the development of the intervention fidelity checklists and logic model. Phase 1b: a national online survey was conducted with parents and professionals to describe treatment as usual. Phase 2: a single-group non-randomised feasibility study was designed to model the intervention and to test intervention feasibility and acceptability, outcome measures and aspects of the research process., Setting: Phase 2: participants were recruited from National Health Service community child learning disabilities teams and special schools in England. Treatment was delivered in the child learning disabilities teams., Participants: Children aged 5-15 years with moderate to severe learning disability and specific phobia, and their parents/carers., Interventions: The SPIRIT intervention comprised two half-day workshops and eight support sessions plus treatment as usual., Main Outcomes: The feasibility and acceptability of the intervention and research processes, recruitment, outcome measure completion rates and acceptability, and intervention adherence. Parents completed all of the outcome measures, with very low rates of missing data. The recruitment of sites and participants was impacted by the COVID-19 pandemic., Results: The intervention was successfully developed and modelled with 15 participants with moderate to severe learning disabilities and their parents. The intervention was judged to be feasible and acceptable by parents/carers and therapists. Parents/carers and therapists suggested minor intervention revisions., Limitations: Randomisation was not modelled within this feasibility study, although the majority of parents and therapists indicated that this would be acceptable., Conclusions: The SPIRIT intervention and associated study processes were judged to be feasible and acceptable. The intervention requires minor revisions., Future Work: The SPIRIT intervention should be tested further within a clinical trial., Study Registration: Current Controlled Trials ISRCTN34766613., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR130177) and is published in full in Health Technology Assessment ; Vol. 28, No. 64. See the NIHR Funding and Awards website for further award information.

Background: Within England, children and young people entering police custody are referred to Liaison and Diversion (L&D) teams. These teams liaise with healthcare and other support services aiming to divert children and young people away from the criminal justice system. Although targeted psychological interventions are not typically offered to children and young people by L&D teams, evidence suggests that Solution Focused Brief Therapy (SFBT) leads to a reduction in internalising and externalising behaviour problems., Methods: A two-arm individually randomised controlled trial (RCT) with internal pilot and process evaluation will be conducted with approximately 448 children and young people aged 10-17 years presenting at police custody suites who are referred to the L&D team or recruited via online routes if they have previously presented at any police custody suite in England. The primary outcome is the Self-Report Delinquency Measure (SRDM) at 6 months post-randomisation. Analyses will be performed using intention-to-treat., Results: The statistical analysis plan (SAP) for the trial is described. The plan details of analyses to be undertaken which will be reported in the primary and any secondary publications. The plan was developed and published prior to locking our database and unblinding to treatment allocation., Discussion: This RCT will evaluate the effectiveness of SFBT in reducing offending behaviours in CYP presenting at police custody suites including testing of moderating factors and sensitivity of the primary analyses., Trial Registration: ClinicalTrials.gov ISRCTN14195235. Registered on June 16, 2023., (© 2024. The Author(s).)

Background: Within England, children and young people (CYP) who come into police custody are referred to Liaison and Diversion (L&D) teams. L&D teams have responsibility for liaising with healthcare and other support services while working to divert CYP away from the criminal justice system but have traditionally not provided targeted psychological interventions to CYP. Considering evidence that Solution Focused Brief Therapy (SFBT) leads to a reduction in internalising and externalising behaviour problems in CYP, the aim of this randomised controlled trial (RCT) was to determine whether there is a difference between services as usual (SAU) plus SFBT offered by trained therapists working within a L&D team, and SAU alone, in reducing offending behaviours in 10-17-year-olds presenting at police custody., Methods: Design: two-arm individually RCT with internal pilot and process evaluation., Participants: N = approximately 448 CYP aged 10-17 years presenting at one of three police custody suites in the area served by Lancashire and South Cumbria NHS Foundation Trust (LSCFT) who are referred to the L&D team. Participants will be recruited and allocated to intervention:control on a 1:1 basis. Interviews will be performed with 30-40 CYP in the intervention arm, 15 CYP in the control arm, up to 20 parents/guardians across both arms, up to 15 practitioners, and up to 10 site staff responsible for screening CYP for the trial. Intervention and control: Those allocated to the intervention will be offered SAU plus SFBT, and control participants will receive SAU only., Primary Outcome: CYP frequency of offending behaviours assessed through the Self-Report Delinquency Measure (SRDM) at 12 months post-randomisation., Secondary Outcomes: criminal offence data (national police database); emotional and behavioural difficulties (self-report and parent/guardian reported); gang affiliation (self-report). Process evaluation: evaluation of acceptability and experiences of the CYP, parents/guardians, site staff and practitioners; fidelity of SFBT delivery., Discussion: This two-arm individually RCT will evaluate the effectiveness of SFBT in reducing offending behaviours in CYP presenting at police custody suites within the area served by LSCFT. Our process evaluation will assess the fidelity of delivery of SFBT, the factors affecting implementation, the acceptability of SFBT in CYP aged 10-17 years and recruitment and reach. We will also examine systems and structures for future delivery, therefore assessing overall scalability., Trial Registration: ClinicalTrials.gov  ISRCTN14195235 . Registered on June 16, 2023., (© 2024. The Author(s).)

Background: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to manage anxiety in adults with an autism diagnosis. However, their effectiveness and adverse effect profile in the autistic population are not well known. This trial aims to determine the effectiveness and cost-effectiveness of the SSRI sertraline in reducing symptoms of anxiety and improving quality of life in adults with a diagnosis of autism compared with placebo and to quantify any adverse effects., Methods: STRATA is a two-parallel group, multi-centre, pragmatic, double-blind, randomised placebo-controlled trial with allocation at the level of the individual. It will be delivered through recruiting sites with autism services in 4 regional centres in the United Kingdom (UK) and 1 in Australia. Adults with an autism diagnosis and a Generalised Anxiety Disorder Assessment (GAD-7) score ≥ 10 at screening will be randomised 1:1 to either 25 mg sertraline or placebo, with subsequent flexible dose titration up to 200 mg. The primary outcome is GAD-7 scores at 16 weeks post-randomisation. Secondary outcomes include adverse effects, proportionate change in GAD-7 scores including 50% reduction, social anxiety, obsessive-compulsive symptoms, panic attacks, repetitive behaviours, meltdowns, depressive symptoms, composite depression and anxiety, functioning and disability and quality of life. Carer burden will be assessed in a linked carer sub-study. Outcome data will be collected using online/paper methods via video call, face-to-face or telephone according to participant preference at 16, 24 and 52 weeks post-randomisation, with brief safety checks and data collection at 1-2, 4, 8, 12 and 36 weeks. An economic evaluation to study the cost-effectiveness of sertraline vs placebo and a QuinteT Recruitment Intervention (QRI) to optimise recruitment and informed consent are embedded within the trial. Qualitative interviews at various times during the study will explore experiences of participating and taking the trial medication., Discussion: Results from this study should help autistic adults and their clinicians make evidence-based decisions on the use of sertraline for managing anxiety in this population., Trial Registration: ISRCTN, ISRCTN15984604 . Registered on 08 February 2021. EudraCT 2019-004312-66. ANZCTR ACTRN12621000801819. Registered on 07 April 2021., (© 2024. The Author(s).)

Few autism spectrum disorder (ASD) screening tools have been developed and validated in Africa. This study aimed to examine the psychometric properties of the Social Communication Questionnaire (SCQ) when used with Nigerian adolescents. Parents and caregivers of two hundred and five adolescents completed the SCQ Lifetime form while the adolescents were assessed for ASD using the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2). Factor structure and convergent and discriminative validity were examined, along with the sensitivity and specificity of the SCQ in identifying participants with an autism spectrum disorder. The confirmatory factor analysis (CFA) was used to examine the factor structure, while logistic regression and Pearson's correlation coefficient were used to examine the validities. The SCQ had good internal consistency, discriminative, and convergent validity. A cut-off score of 10 revealed sensitivity = 0.81 and specificity = 0.88 for the identification of autism spectrum disorder. AUC was 0.83, p < 0.001, 95% CI [0.77, 0.90]. The results of this study provide evidence to support the retention of the original four factors of the SCQ. The SCQ has good psychometric properties when used with Nigerian adolescents., (© 2023 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals LLC.)

Background: One in five children with an intellectual disability in the UK display behaviours that challenge. Despite associated impacts on the children themselves, their families, and services, little research has been published about how best to design, organise, and deliver health and care services to these children. The purpose of this study was to describe how services are structured and organised ("service models") in England for community-based health and care services for children with intellectual disability who display behaviours that challenge., Methods: Survey data about services were collected from 161 eligible community-based services in England. Staff from 60 of these services were also interviewed. A combination of latent class and descriptive analysis, coupled with consultation with family carers and professionals was used to identify and describe groupings of similar services (i.e., "service models")., Results: The latent class analysis, completed as a first step in the process, supported a distinction between specialist services and non-specialist services for children who display behaviours that challenge. Planned descriptive analyses incorporating additional study variables were undertaken to further refine the service models. Five service models were identified: Child and Adolescent Mental Health Services (CAMHS) (n = 69 services), Intellectual Disability CAMHS (n = 28 services), Children and Young People Disability services (n = 25 services), Specialist services for children who display behaviours that challenge (n = 27 services), and broader age range services for children and/or adolescents and adults (n= 12 services)., Conclusions: Our analysis led to a typology of five service models for community health and care services for children with intellectual disabilities and behaviours that challenge in England. Identification of a typology of service models is a first step in building evidence about the best provision of services for children with intellectual disabilities who display behaviours that challenge. The methods used in the current study may be useful in research developing service typologies in other specialist fields of health and care., Study Registration: Trial Registration: Current Controlled Trials ISRCTN88920546, Date assigned 05/07/2022., (© 2023. The Author(s).)

Background: Child criminal exploitation is a form of child abuse that poses a serious risk to the welfare, safety, and wellbeing of young people. Multisystemic therapy (MST) is an intensive family and community-based intervention for young people with anti-social behavioral problems, many of whom will be at risk of criminal exploitation. This protocol describes a pilot feasibility study and process evaluation, designed to examine MST for children at risk of criminal exploitation., Methods: This pilot feasibility study and process evaluation involves two phases with associated subphases: phase 1.1 involved the collaborative refinement of the logic model adapting MST for children at risk of criminal exploitation; phase 1.2 involved pre-pilot interviews with MST therapists, families, and young people; phase 2.1 is a pilot modeling study of MST for children at risk of criminal exploitation, and; Phase 2.2 is a process evaluation that will involve interviewing stakeholders, MST therapists and employees, families, and young people. The dataset for the process evaluation will include questionnaires completed by parents and young people at baseline, mid-treatment, end of treatment, and 6 months after treatment. We will supplement these data with participant-level data linkage from MST sites and services., Results: Accrual to the pilot stage of this project opened on 6th August 2021 and is due to close on 31st May 2022. We aim to publish the results of this feasibility study and process evaluation in 2023., Conclusions: The results of this feasibility study and process evaluation will inform the decision as to whether it is advisable to progress to a pilot clinical trial of MST for children at risk of criminal exploitation., Trial Registration: Trial registration: ISRCTN registry, ISRCTN16164816 on 25th January 2021- https://doi.org/10.1186/ISRCTN16164816 ., (© 2023. The Author(s).)

Objectives: Men with intellectual disabilities and/or autism sometimes engage in harmful sexual behaviour (HSB), but it may be harder for them to access treatment, than it is for non-disabled men. The aim of this study was to evaluate the effect of attending an adapted CBT group, known as SOTSEC-ID, on men with intellectual disabilities and/or autism who had HSB., Method: Ninety-eight men from intellectual disability services, who had ID and/or autism and a history of HSB were recruited, and they received group CBT for a year (46 of these men have been previously reported). Harmful sexual behaviour, sexual knowledge, distorted cognitions and victim empathy were measured before and after treatment, and at 6 month follow-up., Results: There were low levels of further harmful sexual behaviour: 12% of men engaged in further HSB during the 1-year period of the group, and 8% engaged in further HSB in the 6-month follow-up period. There were also significant improvements in sexual knowledge, distorted cognitions and victim empathy following treatment, maintained at 6-month follow-up. Men with autism showed significantly more non-contact HSB, were less likely to have been interviewed by police and had higher rates of further HSB, compared to men without autism., Conclusions: It is concluded that SOTSEC-ID is a promising treatment for men with ID/autism and HSB. Nevertheless, the study had a number of limitations and lacked a control group, so there is now an urgent need for a proper controlled study., (© 2023 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Background: Adults with intellectual disabilities often display behaviour that challenges that is a result of biological differences, psychological challenges, and lack of appropriate social support. Intensive Support Teams (IST) are recommended to support the care needs of this group and avoid hospitalisation. However, little attention has been paid to the perspectives of stakeholders who manage, work in, or use ISTs., Method: Interviews and focus groups were conducted with 50 stakeholders (IST service managers and professionals, adults with intellectual disabilities, and family and paid carers) of ISTs. Services operated according to one of two service models previously identified in ISTs in England (enhanced or independent)., Results: Thematic analysis identified accessible and flexible support, individualised care, and the involvement of carers and other relevant agencies in management plans and reviews as features of good IST care highlighted by all stakeholder groups. IST managers and professionals described the key challenges of current IST provision as unclear referral criteria, limited interfaces with other local services, and perceived threats associated with funding and staff retention. Findings were similar between the two IST models., Conclusions: ISTs are able to offer care and specialist support that is valued by families, service users and other care providers. However, they face several operational challenges that should be addressed if ISTs are to reach their potential along with community intellectual disability services in supporting adults with intellectual disabilities who display behaviour that challenges in the community., (© 2023 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: Using inclusive research methods with people with intellectual disabilities is increasingly common. A recent consensus statement identified key elements when conducting and reporting inclusive research with people with intellectual disabilities. This review identifies the range of health and social care research topics using inclusive research methodologies, systematically appraises the involvement of researchers with intellectual disabilities, and identifies facilitators and barriers to inclusive research. Researchers' experiences of engaging with inclusive research are synthesised., Method: Seventeen empirical studies focused upon inclusive health and social care research were identified. The associated inclusive research methodologies employed, and the stages in which researchers with intellectual disabilities were involved, along with the experiences of researchers with and without intellectual disabilities were synthesised., Results: Papers focused on a broad range of health and social care topics and largely employed qualitative or mixed-methods designs. Researchers with intellectual disabilities were frequently involved with data collection, analysis and dissemination. Facilitators of inclusive research comprised sharing power, team working, having sufficient resources and making research methodologies accessible., Conclusions: Researchers with intellectual disabilities are involved in a wide range of methodologies and research tasks. How the added value of inclusive research is measured and its impact on outcomes, require consideration., (© 2023 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: Intensive support teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost-effectiveness of IST models operating in England., Aims: To investigate the clinical and cost-effectiveness of IST models., Method: We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants ( n = 226) from 21 ISTs (ten independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months as measured by the Aberrant Behaviour Checklist-Community version 2., Results: We found no statistically significant differences between models for the primary outcome (adjusted β = 4.27; 95% CI -6.34 to 14.87; P = 0.430) or any secondary outcomes. Quality-adjusted life-years (0.0158; 95% CI: -0.0088 to 0.0508) and costs (£3409.95; 95% CI -£9957.92 to £4039.89) of the two models were comparable., Conclusions: The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated.

Aims: The International Trauma Questionnaire (ITQ) is a novel assessment instrument that is aligned to the ICD-11 diagnoses of post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). The purpose of this study was to develop and evaluate an adapted version of the ITQ suitable for use by people with intellectual disabilities., Methods: The ITQ-ID follows the original ITQ, using wording developed in collaboration with a focus group of people with intellectual disabilities The ITQ-ID was administered to 40 people with intellectual disabilities recruited from learning disability forensic and community settings, alongside a Trauma Information Form and the Impact of Event Scale-Intellectual Disabilities (IES-IDs)., Results: Most participants reported multiple traumatizing events. Around half of the participants met strict criteria for a diagnosis of PTSD, and around three quarters met looser criteria. Depending on definitions, between 66% and 93% of those who met criteria for PTSD also met criteria for a diagnosis of CPTSD. The ITQ-ID showed a single-component structure, with very good-to-excellent internal consistency, excellent test-retest reliability, and evidence of concurrent, discriminant, and content validity., Significance: The results support the potential of the ITQ-ID for assessment of PTSD and CPTSD in people with intellectual disabilities in both clinical and research contexts and highlight the need for further validation work., (© 2023 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

This study evaluated the effects of Precision Teaching in improving typically developing students' mathematical skills when delivered via teleconferencing in India. Four students received Precision Teaching, while nine acted as control participants. Precision teaching involved instruction in three mathematical skills; two prerequisite skills and the primary skill of mixed addition and subtraction facts. Instruction included untimed practice, timed practice, goal-setting, graphing, and a token economy. Participants who received Precision Teaching received ten practice sessions for the prerequisite skills and 55 sessions for the primary skill. The results demonstrated improvements in the prerequisite skills of varied magnitude and considerable improvements in the primary skill, which were maintained above baseline performance levels. In addition, those who received Precision Teaching were below the 15th percentile rank at the initial assessment and above the 65th percentile at the post-intervention assessment in the math fluency subtest of the Kaufman Test of Educational Achievement-Third Edition. Control participants did not demonstrate similar improvements. Results suggest that Precision Teaching could produce accelerated outcomes even when delivered via teleconferencing. Therefore, it could be a valuable system for helping students ameliorate potential learning losses resulting from the COVID-19 pandemic., Competing Interests: Conflict of interestWe have no conflict of interest to disclose., (© The Author(s) 2023.)

Objectives: We aimed to: (A) describe researcher decision-making when including or excluding adults with conditions that have the potential to affect capacity and/or communication in research and (B) explore the underlying values and reasoning of stakeholders in research which falls under the provisions of the Mental Capacity Act, 2005., Design: The mixed-methods design included semistructured interviews with adults with conditions that have the potential to affect capacity and/or communication, supporters, researchers, research ethics committee members and an online survey with researchers. Triangulation was used to integrate the data and examine the complementarity of the findings., Setting: England and Wales., Participants: There were 61 participants who took part in semistructured interviews, of which 39 were adults with conditions with potential to affect capacity and/or communication, 6 were in support roles for adults with conditions with potential to affect capacity and/or communication (including family members and professionals in advocacy organisations), 8 were members of research ethics committees flagged under the Mental Capacity Act to review research where there could be issues of mental capacity and 8 were researchers with experience of working with adults with conditions that have the potential to affect capacity and/or communication. The online survey had 128 participants, researchers with experience of working with adults with conditions that have the potential to affect capacity and/or communication., Results: All stakeholders were supportive of the genuine inclusion of adults with conditions that have the potential to affect capacity and/or communication in research, and exclusion was seen as a form of discrimination. Many researchers were daunted by meeting the threshold within the legislation for including participants who may lack capacity., Conclusion: Further training, expertise and resources are required to promote the successful inclusion in research of adults with conditions that have the potential to affect capacity and/or communication., Competing Interests: Competing interests: PL has funding from NIHR129804 'Behavioural interventions to treat anxiety in adults with autism and moderate to severe intellectual disabilities’. CS' post-doctoral positions have been supported by NHMRC Centre of Research Excellence grant 1153236 and through the Queensland Aphasia Research Centre. KB and AK have received funding from the Health Research Authority for training of Research Ethics Committee members in England and Wales., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The aim of this systematic review and meta-analysis (PROSPERO 2020 CRD42020169323) was to evaluate the efficacy of psychological therapy for people with intellectual disabilities., Method: A comprehensive literature search yielded 22,444 studies which were screened for eligibility. Studies were eligible for inclusion if a psychological therapy was delivered to people with intellectual disabilities compared to a group who did not receive the therapy. Thirty-three controlled trials were eligible for inclusion in the review, with 19 included within a DerSimonian-Laird random effects meta-analysis. Subgroup analysis was completed by clinical presentation, and by comparing randomised trials to non-randomised trials, and group-based to individually delivered psychotherapy., Results: Following the removal of outliers, psychological therapy for a range of mental health problems was associated with a small and significant effect size, g = 0.43, 95% CI [0.20, 0.67], N = 698. There was evidence of heterogeneity and bias due to studies with small sample sizes and a lack of randomisation. Non-randomised studies were associated with a large effect size, g = 0.90, 95% CI [0.47, 1.32], N = 174, while randomised studies were associated with a small effect size, g = 0.36, 95% CI [0.17, 0.55], N = 438, excluding outliers. Individually delivered psychological therapy was associated with a small and non-significant effect size, g = 0.32, 95% CI [-0.01, 0.65], N = 146, while group-based interventions were associated with a small and significant effect size, g = 0.37, 95% CI [0.05, 0.68], N = 361, again, excluding outliers. Psychological therapy for anger was associated with a moderate effect size, g = 0.60, 95% CI [0.26, 0.93], N = 324, while treatment for depression and anxiety was associated with a small and non-significant effect size, g = 0.38, 95% CI [-0.10, 0.85], N = 216, after outliers were removed., Conclusions: Studies are fraught with methodological weaknesses limiting the ability to make firm conclusions about the effectiveness of psychological therapy for people with intellectual disabilities. Improved reporting standards, appropriately powered and well-designed trials, and greater consideration of the nature and degree of adaptations to therapy are needed to minimise bias and increase the certainty of conclusions., Competing Interests: Declaration of Competing Interest The authors report no conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Clear evidence of overprescribing of psychotropic medicines to manage behaviours that challenges in people with intellectual disabilities has led to national programmes within the U.K. such as NHS England's STOMP to address this. The focus of the intervention in our review was deprescribing of psychotropic medicines in children and adults with intellectual disabilities. Mental health symptomatology and quality of life were main outcomes., Methods: We reviewed the evidence using databases Medline, Embase, PsycINFO, Web of Science, CINAHL and Open Grey with an initial cut-off date of 22nd August 2020 and an update on 14th March 2022. The first reviewer (DA) extracted data using a bespoke form and appraised study quality using CASP and Murad tools. The second reviewer (CS) independently assessed a random 20% of papers., Results: Database searching identified 8675 records with 54 studies included in the final analysis. The narrative synthesis suggests that psychotropic medicines can sometimes be deprescribed. Positive and negative consequences were reported. Positive effects on behaviour, mental and physical health were associated with an interdisciplinary model., Conclusions: This is the first systematic review of the effects of deprescribing psychotropic medicines in people with intellectual disabilities which is not limited to antipsychotics. Main risks of bias were underpowered studies, poor recruitment processes, not accounting for other concurrent interventions and short follow up periods. Further research is needed to understand how to address the negative effects of deprescribing interventions., Trial Registration: The protocol was registered with PROSPERO (registration number CRD42019158079)., (© 2023. The Author(s).)

Precision Teaching is a behavior measurement system that emphasizes the development of behavioral repertoires and utilizes Standard Celeration Charts as its primary tool. This system has been applied across various areas, including mainstream and special education, and has successfully improved academic, motor, communication, and other skills. While previous systematic reviews have highlighted important aspects of Precision Teaching, a more comprehensive evaluation is needed to consider all its different applications and recent developments in conceptualizing it. Therefore, this systematic review and meta-analysis will assess the effectiveness of Precision Teaching in accelerating human behavior, identify all the areas of its application, and review the technical aspects of its implementation. The review aims to provide a comprehensive understanding of the system and its potential benefits for individuals in different settings., (© 2023 The Authors. Campbell Systematic Reviews published by John Wiley & Sons Ltd on behalf of The Campbell Collaboration.)

Objectives: Mental imagery is important in the development and maintenance of psychological disorders and well-being but has been neglected in people with intellectual disabilities. A detailed idiographic analysis of the lived experience of mental imagery in this population is presented., Design: This qualitative study uses interpretative phenomenological analysis (IPA). It involved inclusive research methods with people with intellectual disabilities and other stakeholders (including family members, advocates, support workers and intellectual disability service managers)., Methods: Ten individual semi-structured interviews were conducted with people with mild-moderate intellectual disabilities. Participants were opportunistically sampled through organisations providing community services to people with intellectual disabilities in the UK. Two men and eight women (mean age 43 years) participated. Interviews were audio-recorded and analysed using IPA., Results: People with intellectual disabilities are able to experience a range of rich and detailed mental images across all sensory modalities. Participants reported changes in affect based on mental imagery, and an ability to experience both spontaneous and deliberate mental images. The emotional saliency of the object of mental imagery appeared to influence participants' ability to engage with imagery. A number of adaptations make mental imagery more accessible and easier to report. The ability of people with intellectual disabilities to experience vivid mental imagery has important clinical implications for the use of a range of mental imagery interventions with this population., Conclusions: The need to consider mental imagery interventions for this population, and how these can be adapted to ensure accessibility is a priority for people with intellectual disabilities and psychological disorders., (© 2022 The Authors. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society.)

Background: We examined whether a series of variables were related to the number of psychiatric inpatients using publicly available data about English psychiatric bed utilisation and NHS workforce., Method: Using linear regression, with auto-regressive errors, we examined relationships between variables over time using data from December 2013 to March 2021., Results: Over time, the number of inpatients reduced by either 6.58 or 8.07 per month depending upon the dataset utilised, and the number of community nurses and community nursing support staff reduced by 7.43 and 2.14 nurses per month, respectively. Increasing numbers of consultant psychiatrists were associated with fewer inpatients over time. More care and treatment reviews (CTRs) were associated with more admissions over time, while more post-admission CTRs were associated with increased discharges over time., Conclusions: Future studies should examine whether psychiatric bed utilisation elsewhere within the NHS by people with intellectual disabilities has increased., (© 2022 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Social media can lead to rejection, cyber-bullying victimisation, and cyber-aggression, and these experiences are not fully understood as experienced by autistic adults. To investigate this, 78 autistic adults completed self-report measures of social media use, cyber-bullying victimisation, cyber-aggression, and self-esteem. High levels of social media use were found to be associated with an increased risk of cyber-victimisation; whereas self-esteem was positively correlated with feelings of belonging to an online community and negatively correlated with feelings of being ignored on social network sites and chat rooms. Future studies are needed to further investigate the experience of cyber-bullying victimisation of autistic adults., (© 2021. The Author(s).)

Background: An increasing number of children, adolescents and adults with intellectual disabilities and/or autism are being admitted to general psychiatric wards and cared for by general psychiatrists., Aims: The aim of this systematic review was to consider the likely effectiveness of in-patient treatment for this population, and compare and contrast differing models of in-patient care., Method: A systematic search was completed to identify papers where authors had reported data about the effectiveness of in-patient admissions with reference to one of three domains: treatment effect (e.g. length of stay, clinical outcome, readmission), patient safety (e.g. restrictive practices) and patient experience (e.g. patient or family satisfaction). Where possible, outcomes associated with admission were considered further within the context of differing models of in-patient care (e.g. specialist in-patient services versus general mental health in-patient services)., Results: A total of 106 studies were included and there was evidence that improvements in mental health, social functioning, behaviour and forensic risk were associated with in-patient admission. There were two main models of in-patient psychiatric care described within the literature: admission to a specialist intellectual disability or general mental health in-patient service. Patients admitted to specialist intellectual disability in-patient services had greater complexity, but there were additional benefits, including fewer out-of-area discharges and lower seclusion rates., Conclusions: There was evidence that admission to in-patient services was associated with improvements in mental health for this population. There was some evidence indicating better outcomes for those admitted to specialist services.

Background: The Adapted Firesetting Assessment Scale was developed for use with adults with developmental disabilities targeting fire-related factors thought to be associated with deliberate firesetting behaviour (i.e. attitudes towards fire, fire interest, fire normalisation, identification with fire and fire safety awareness). However, the psychometric properties of the scale are yet to be evaluated., Method: The reliability, validity, comprehensibility, relevance and comprehensiveness of the Adapted Firesetting Assessment Scale were evaluated. Fifty-nine adults with developmental disabilities, some of whom had a history of firesetting, completed the Adapted Firesetting Assessment Scale on two occasions. Feedback about the questionnaire was sought from both participants and professionals., Results: The AFAS has acceptable internal consistency and excellent test-retest reliability. The attitudes towards fire, fire normalisation, poor fire safety subscales and total scores discriminated firesetters from non-firesetters. Content analysis of feedback indicated items of the AFAS were understood, relevant, accessible and comprehensible., Conclusion: A larger study is needed to examine the factor structure of the AFAS., (© 2022 The Authors. Journal of Intellectual Disability Research published by MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

Objectives: This study aimed to determine the characteristics of ethical review and recruitment processes, concerning the inclusion of adults with capacity-affecting conditions and associated communication difficulties in ethically sound research, under the provisions of the Mental Capacity Act (MCA, 2005) for England and Wales., Design: A documentary-based survey was conducted focusing on adults with capacity-affecting conditions and associated communication difficulties. The survey investigated: (1) retrospective studies during the implementation period of the MCA (2007-2017); (2) prospective applications to MCA-approved Research Ethics Committees (RECs) during a 12-month period (2018-19); (3) presentational and linguistic content of participant information sheets used with this population., Setting: Studies conducted and approved in England and Wales., Sample: Studies focused on adults with the following capacity-affecting conditions: acquired brain injury; aphasia after stroke; autism; dementia; intellectual disabilities; mental health conditions. The sample comprised: (1) 1605 studies; (2) 83 studies; (3) 25 participant information sheets., Primary and Secondary Outcome Measures: The primary outcome was the inclusion/exclusion of adults with capacity-affecting conditions from studies. The secondary outcome was the provisions deployed to support their inclusion., Results: The retrospective survey showed an incremental rise in research applications post-MCA implementation from 2 (2012) to 402 (2017). The prospective survey revealed exclusions of people on the bases of: 'lack of capacity' (n=21; 25%); 'communication difficulties' (n=5; 6%); 'lack of consultee' (n=11; 13%); and 'limited English' (n=17; 20%). REC recommendations focused mainly on participant-facing documentation. The participant information sheets were characterised by inconsistent use of images, typography and layout, volume of words and sentences; some simplified language content, but variable readability scores., Conclusions: People with capacity-affecting conditions and associated communication difficulties continue to be excluded from research, with recruitment efforts largely concentrated around participant-facing documentation. There is a need for a more nuanced approach if such individuals are to be included in ethically sound research., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Two focus groups were conducted with special needs teachers to: (a) identify barriers to learning for autistic pupils, (b) consider broad assessment domains and specific skills or behaviours which teachers consider important for these pupils, and (c) give their opinions on teacher assessments. Data analysis resulted in six main themes: (a) barriers to learning, (b) teacher priorities for autistic pupils, (c) ways of overcoming barriers, (d) the concept of 'true mastery', (e) assessing the bigger picture, and (f) practicalities of assessment. Results showed that teachers have priorities for the pupils they know well and concerns about the assessments they regularly use. To ensure face and content validity of teacher assessments, and for assessments to be useful to and valued by the teachers who use them, it is recommended that teachers have opportunities to input during various aspects of the assessment development process.

Background: Treatment for adults who set fires relies upon valid and reliable assessment. Research is needed to ensure self-report measures are available for adults with neurodevelopmental disabilities and that they are robust., Method: Qualitative and quantitative data from three rounds of a Delphi exercise with practitioners and a focus group discussion with adults with neurodevelopmental disabilities were used to generate consensus about the accessibility of item adaptations made to the Fire Interest Rating Scale, Fire Attitudes Scale, and the Identification with Fire Questionnaire., Results: Findings suggested the accessibility of current measures could be improved to better meet the needs of adults with neurodevelopmental disabilities and adaptations to all questionnaire items were needed., Conclusion: Following feedback, revisions to current measures were implemented leading to the development of the Adapted Firesetting Assessment Scale with improved accessibility for adults with neurodevelopmental disabilities., (© 2021 John Wiley & Sons Ltd.)

Background: The recent COVID-19 pandemic led to widespread international restrictions, severely impacting on health and social care services. For many individuals with an intellectual disability (ID) this meant reduced access to services and support for them and their carers., Aim: The aim of this study was to gain insight into the ways parents of adults with ID coped during the first 2020 lockdown period., Methods: Eight parents of adults with ID were interviewed. The recordings of these interviews were subjected to a thematic analysis., Results: Four main themes were identified: powerless and unappreciated; coping under lockdown; support; and the impact of lockdown on well-being., Conclusions: The parents of adults with ID who made up our sample reported that they received little support from services and experienced a sense of powerlessness. Nevertheless, they were open to accepting support from family and friends and showed remarkable resilience. These findings are discussed in the light of the Willner et al. (2020) survey results on parental mental health and coping, and suggestions for future service provision during pandemic conditions are proposed., Competing Interests: The authors declare no potential conflict of interests., (© 2021 The Authors. Journal of Policy and Practice in Intellectual Disabilities published by International Association for the Scientific Study of Intellectual and Developmental Disabilities and Wiley Periodicals LLC.)

Background: Recent COVID-19 lockdown restrictions resulted in reduced access to educational, professional and social support systems for children with intellectual disabilities and their carers., Aim: The aim of this study was to gain insight into the ways mothers of children with intellectual disabilities coped during the first 2020 lockdown period., Methods: Eight mothers of children with intellectual disabilities were interviewed. The recordings of these interviews were subjected to a thematic analysis., Results: Three main themes were identified: carrying the burden; a time of stress; and embracing change and looking to the future., Conclusions: All mothers experienced increased burden and stress. However, some also described some positive impact of lockdown conditions on them as well as on their child's well-being and behaviour. These findings are discussed in the light of the (Journal of Applied Research in Intellectual Disabilities, 33, 2020, 1523) survey results on parental coping and suggestions for future service provision during pandemic conditions are proposed., (© 2021 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: The Mental Capacity Act (MCA, 2005) and its accompanying Code of Practice (2007), govern research participation for adults with capacity and communication difficulties in England and Wales. We conducted a systematic review and narrative synthesis to investigate the application of these provisions from 2007 to 2019., Methods and Findings: We included studies with mental capacity in their criteria, involving participants aged 16 years and above, with capacity-affecting conditions and conducted in England and Wales after the implementation of the MCA. Clinical trials of medicines were excluded. We searched seven databases: Academic Search Complete, ASSIA, MEDLINE, CINAHL, PsycArticles, PsycINFO and Science Direct. We used narrative synthesis to report our results. Our review follows Preferred Reporting Items for Systematic Reviews and is registered on PROSPERO, CRD42020195652. 28 studies of various research designs met our eligibility criteria: 14 (50.0%) were quantitative, 12 (42.9%) qualitative and 2 (7.1%) mixed methods. Included participants were adults with intellectual disabilities (n = 12), dementia (n = 9), mental health disorders (n = 2), autism (n = 3) and aphasia after stroke (n = 2). We found no studies involving adults with acquired brain injury. Diverse strategies were used in the recruitment of adults with capacity and communication difficulties with seven studies excluding individuals deemed to lack capacity., Conclusions: We found relatively few studies including adults with capacity and communication difficulties with existing regulations interpreted variably. Limited use of consultees and exclusions on the basis of capacity and communication difficulties indicate that this group continue to be under-represented in research. If health and social interventions are to be effective for this population, they need to be included in primary research. The use of strategic adaptations and accommodations during the recruitment process, may serve to support their inclusion., Competing Interests: The authors have declared that no competing interests exist.

Background: Few robust autism-specific outcome assessments have been developed specifically for use by teachers in special schools. The Assessment of Barriers to Learning in Education - Autism (ABLE-Autism) is a newly developed teacher assessment to identify and show progress in barriers to learning for pupils on the autism spectrum with coexisting intellectual disabilities., Aims: This study aimed to conduct a preliminary validity and reliability evaluation of the ABLE-Autism., Methods and Procedures: Forty-eight autistic pupils attending special schools were assessed using the ABLE-Autism. Multi-level modelling was used to evaluate test-retest reliability, internal consistency and convergent validity with the Teacher Autism Progress Scale., Outcomes and Results: Results showed excellent test-retest reliability and internal consistency. A large effect size suggested that the ABLE-Autism is strongly correlated with the Teacher Autism Progress Scale. Teacher feedback was positive and suggested that the ABLE-Autism is easily understood by teachers, relevant to autistic pupils in special schools, and adequately covers the skills and behaviours that teachers believe are important to assess for these pupils., Conclusions and Implications: Although further validation is recommended, the preliminary evaluation of the ABLE-Autism suggests that it is a useful and has the potential to be an effective outcome assessment for autistic pupils in special schools., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To investigate how people with communication and understanding difficulties, associated with conditions such as dementia, autism and intellectual disability, are represented in research guidance supplementary to the Mental Capacity Act (MCA: 2005) in England and Wales., Methods: A documentary survey was conducted. The sample comprised the MCA Code of Practice (CoP: 2007) and 14 multi-authored advisory documents that were publicly available on the Health Research Authority website. Textual review of key words was conducted followed by summative content analysis., Results: Representation of people with communication and understanding difficulties was confined to procedural information and position statements that focused mainly on risk management and protection. Whilst a need to engage potential participants was recognized, guidance provided was imprecise., Conclusions: Tensions exist between the protection versus empowerment of people with communication and understanding difficulties in research. The development of structured, evidence-based guidance is indicated., Patient or Public Contribution: People with communication and understanding difficulties and carers participated in a working group to explore, discuss and interpret the findings., (© 2020 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

People with neurodevelopmental disorders often present with challenging behaviours and psychiatric illnesses. Diagnosis and treatment require patients, families and healthcare professionals to work closely together in partnership, acknowledging their respective areas of expertise. Good treatment outcomes should also be underpinned by robust research evidence. Key research priorities are highlighted.

The aims of this study were to examine: (a) whether men with intellectual disabilities who have a history of criminal offending attend to affective pictorial stimuli in a biased manner, and (b) whether there is a relationship between an affective attentional bias and offense-supportive cognitions, empathy, and moral reasoning. Forty-six men with intellectual disabilities who had a documented history of criminal offending, and 51 men who also had intellectual disabilities, but no such history, were recruited and asked to complete a computer-based dot-probe task using affective pictorial stimuli with randomization, along with measures of distorted cognitions, empathy, and moral reasoning. Those with a history of criminal offending endorsed significantly more offense-supportive cognitions, had significantly lower general empathy, and more "mature" moral reasoning, as well as a significant attentional bias toward affective pictorial stimuli. Attentional bias significantly predicted offense-supportive cognitions, and vice versa, having controlled for offense history, and Full-Scale IQ, but this was not the case for empathy or moral reasoning. While the findings require replication, interventions that aim to modify attention bias with this population should be tested., (© 2020 The Authors. Aggressive Behavior published by Wiley Periodicals LLC.)

Introduction: The measures implemented to manage the COVID-19 pandemic have been shown to impair mental health. This problem is likely to be exacerbated for carers., Method: Informal carers (mainly parents) of children and adults with intellectual disabilities, and a comparison group of parents of children without disabilities, completed an online questionnaire. Almost all the data were collected while strict lockdown conditions were in place., Results: Relative to carers of children without intellectual disability, carers of both children and adults with intellectual disability had significantly greater levels of a wish fulfilment coping style, defeat/entrapment, anxiety, and depression. Differences were 2-3 times greater than reported in earlier pre-pandemic studies. Positive correlations were found between objective stress scores and all mental health outcomes. Despite their greater mental health needs, carers of those with intellectual disability received less social support from a variety of sources., Conclusions: The greater mental health needs of carers in the context of lesser social support raises serious concerns. We consider the policy implications of these findings., (© 2020 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)