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Background: Many children experience delayed or missed identification of an intellectual disability diagnosis, meaning that key opportunities for early educational intervention may be lost. Methods: Semi-structured interviews were used to explore the views of teachers, parents, and clinicians (n = 22), about the use of the Child and Adolescent Intellectual Disability Screening Questionnaire (CAIDS-Q) and what could improve screening and identification of intellectual disability in schools. Thematic analysis was used to identify relevant themes. Results: Three themes were identified: the need for, and role of, screening in the context of limited knowledge about intellectual disability; the impact of screening and subsequent identification of intellectual disability; and the context within which participants felt screening should take place in order to maximise its benefits. Conclusions: The results confirmed the importance and benefits of timely identification of children with an intellectual disability and the positive role that screening might play in this.

Background: People with learning disabilities are at increased risk of physical health conditions and mortality compared to the general population. Initiatives to address these health inequalities include the introduction of learning disability registers, through which people with learning disabilities can be identified and offered annual health checks and reasonable adjustments in their healthcare provision. A barrier to offering such initiatives to people with learning disabilities is that practitioners/providers may be unaware of the presence of a learning disability, and people who meet criteria may not be entered onto general practice learning disability registers. Screening tools can be used to help identify people with learning disabilities in order that they can be offered appropriate health services and reasonable adjustments. This study aimed to explore the awareness and views of UK primary care staff about the existence and role of screening tools for learning disability in their services. Methods: A qualitative approach was used; semistructured online interviews were conducted with a purposive sample of primary care staff recruited via a regional professional network of primary care practitioners. Five general practitioners and one nurse practitioner, representing five primary care practices in the North-East of England, participated. Interview transcripts were analysed using thematic analysis. Findings: Two themes and associated subthemes were identified. Within Theme 1 ('I haven't had anything much to do with them') two subthemes related to reasons why screening tools were not routinely used. Theme 2 ('I think they're great that they exist') comprised two subthemes that explored the benefits of screening tools, for example, for those practitioners less experienced with people with learning disabilities, and also explored potential reluctance to use them. The study found that most practitioners had some knowledge of screening tools and the general consensus was that they are beneficial. However, the tendency of participants was not to use screening tools in a consistent and/or systematic way, instead relying on informal approaches or other services for identifying the presence of learning disabilities. Conclusions: The study findings highlight the need for changes in practice to support primary care staff to access and systematically use evidence-based effective and efficient screening tools for learning disability.

Background: We explored the accuracy of using the learning disability screening questionnaire (LDSQ) in services for people experiencing homelessness in the United Kingdom. Method: We examined the concordance between the LDSQ outcomes and assessments of intellectual disability. Seventy adults experiencing homelessness completed the LDSQ. Staff completed the LDSQ and a measure of adaptive functioning for 38 of this group. Nine participants received an intellectual assessment. Results: Sensitivity and specificity for the LDSQ when completed by staff was 83% and 96% respectively and 50% and 92% when completed by the individual. Seven people had intellectual and adaptive functioning in the intellectual disability range. Conclusion: The results suggest that the LDSQ would be an appropriate and beneficial screening tool to use within services for people experiencing homelessness. More accurate results would be likely if it were completed by staff.

Background: High staff turnover presents a challenge to the provision of good quality community-based support to people with an intellectual disability. While recent research has identified factors that are thought to be important for staff retention, their relative importance to social care staff is unknown. The aim of this study was to address this gap. Methods: 205 social care staff who worked in intellectual disability services completed an online questionnaire that asked them to: rank factors that had been previously identified as influencing staff retention in order of importance; identify the extent to which their most important factor was met by their organisation (fulfilment score); and rate their recent job-seeking intentions. Findings: The most important factor overall was the relationship of the staff member with the person they supported. This was also identified as the most important factor by the most participants, followed by pay. All of the factors, with the exception of "benefits" (such as pensions), were rated by at least one person as the most important factor. A significant negative relationship was found between fulfilment score and job-seeking score; that is, the lower the former, the more the person agreed that they had been seeking a new job. Conclusion: The results suggest that interventions to improve staff retention should take account of differences in staff views about which work-related factors are most important to them; use multi-component approaches where possible; prioritise staff pay; and help ensure that staff relationships with those they support are positive and fulfilling.

Background: Research suggests that providing staff with input in relation to Positive Behavioural Support (PBS) can have beneficial outcomes. Much of this research, however, fails to take account of systemic issues and does not include a control group. Method: We used a non-randomised, controlled group design to evaluate accredited PBS programmes, delivered as part of a systemic, regional and workforce development approach. We compared outcomes of those attending the programmes (n = 240) with a control group (n = 54), pre- and post-intervention and at 3-months follow-up. Results: The programme and its wider impact were rated positively. Significant intervention effects were found for staff practice and retention, but not for staff knowledge and attributions, or behaviours that challenge and quality of life of those being supported. Conclusions: The results are discussed in the context of the study limitations and restrictions resulting from the COVID-19 pandemic.

Background: We used a qualitative approach to explore the experiences of social care staff regarding the provision of positive behavioural support (PBS) to people with an intellectual disability at the height of the COVID-19 restrictions. Method: We conducted semi-structured interviews with 19 staff who had recently completed a PBS workforce development programme. Data were analysed using thematic analysis. Results: Three themes were identified in the context of the restrictions: The challenges to maintaining quality of life and PBS of the people being supported and staff attempts to overcome these; the ways in which PBS and behaviour support plans were implemented and the impact on behaviours that challenge; the ways in which PBS principles were applied at organisational levels to help to understand and address staff stress and distress. Conclusions: Overall, the staff identified many unexpected benefits of the restrictions. The results are discussed in the context of the study limitations.

Background: It has been suggested that COVID-19 and the associated restrictions are likely to have a negative impact on the provision of positive behavioural support (PBS) to people with an intellectual disability. Methods: Fifty-eight staff, who had recently completed an accredited positive behavioural support (PBS) programme, responded to an online questionnaire, which asked them to rate the impact of COVID-19 on factors related to PBS. Results: Participants reported a neutral or somewhat positive impact on all the areas measured, with the exception of the activities and quality of life of those they supported, which were somewhat negatively affected. The participants rated the learning from their PBS programme as helping them cope with COVID-19 to some extent. Examples of positive and negative effects and ways in which PBS helped staff to cope are presented. Conclusions: Many staff developed creative solutions that allowed them to provide PBS despite the COVID-19 restrictions. PBS learning appeared to help staff cope with the negative impact of the restrictions.

Background: Concern about the poor care of some people with an intellectual disability has highlighted the need for systemic, large-scale interventions to develop a skilled workforce. Method: We outline how an implementation science theoretical model informed the development of a region-wide Positive Behavioural Support (PBS) Workforce Development (WFD) approach. Results: We provide an example of the application of the model in practice and demonstrate how this enabled us to understand the competencies and development needs of the workforce; engage effectively with stakeholders; and develop, deliver and evaluate a PBS WFD model. Conclusion: The application of the model helped us to identify, prioritise, and address the multiple and complex factors that were relevant to the implementation of the PBS WFD approach.

There is an increasing emphasis on the importance of research having an impact on policy and practice. This can be more difficult to evidence in intellectual disability services because of the wide range of stakeholders involved. We evaluated whether an impact questionnaire covering: knowledge production, capacity building, informing policy and practice, social and economic benefits could successfully be used to evaluate the impact of research into and use of two screening questionnaires: the Learning Disability Screening Questionnaire (LDSQ) and Child and Adolescent Intellectual Disability Screening Questionnaire (CAIDS-Q). We conducted an online search for published peer reviewed and grey literature, and Internet resources that referenced LDSQ and/or CAIDS-Q. The resultant literature and resources were assessed for relevance and organized according to the categories outlined in the impact questionnaire. Evidence was found for all the areas of impact, with the largest body of evidence being in relation to informing policy and practice and social benefits and the least for economic benefits. The impact questionnaire provided the basis for a comprehensive and useful evaluative framework to assess impact, although there was some overlap between the different categories. The process of using it highlighted some wider issues to consider when attempting to evaluate impact. The results indicated that the research underpinning the LDSQ and CAIDS-Q had resulted in significant, generally positive, and wide-reaching impact on policy and practice in intellectual disability and other services, resulting in a number of positive outcomes.

Why you should read this article: • To recognise that people with intellectual disabilities are over-represented in homeless populations, but services may not recognise their intellectual disabilities • To read about the short-term impact of screening with the Learning Disability Screening Questionnaire (LDSQ) on people known to a homeless service • To be aware that use of the LDSQ to identify people with intellectual disabilities in homeless services may lead to positive healthcare outcomes, such as annual health checks. Background: Research suggests that people with intellectual disabilities are over-represented in homeless populations, but services may not recognise their intellectual disability. Aim: To explore the short-term impact of screening with the Learning Disability Screening Questionnaire (LDSQ) on seven people known to a homeless service in England. These participants had been found to have intellectual and adaptive functioning in the intellectual disability range in a larger study of the use of the LDSQ in homeless services. Method: The LDSQ impact questionnaire was used to evaluate participants’ views on the benefits and drawbacks of screening with the LDSQ. Changes in participants’ health status were also explored. Findings: There appeared to be many benefits of using the LDSQ and few drawbacks. Six of the seven participants had been placed on the GP learning disability register following participation in the larger study, of whom four had received an annual health check and two had received new treatment. Conclusion: Using the LDSQ in a homeless service appears to be beneficial for people with intellectual disabilities who are homeless and can lead to positive healthcare outcomes. [ABSTRACT FROM AUTHOR]

Aims: People with a learning disability are at increased risk of becoming homeless, but little is known about how learning disability is viewed by people accessing homeless services. This study aimed to obtain the views of people experiencing homelessness about learning disability, in the context of a project that was exploring how to increase identification of learning disability. Methods: A qualitative approach was used, and 19 adults were interviewed who were receiving support from homeless services in the North-East of England. Information from the interviews was analysed using thematic analysis. Results: Four themes were identified relating to understanding of learning disability, the role of identification, day-to-day challenges, and experiences of services. Conclusion: There is a need to: promote better understanding of learning disability; for early identification processes that involve the person in a meaningful way; and the provision of support that is non-stigmatising, practical and which addresses health concerns. [ABSTRACT FROM AUTHOR]

Background: Therapeutic untruths (TU) are used in dementia services to de-escalate distressing situations. The present authors explored the use of TU by care staff supporting people with an intellectual disability who displayed behaviours that challenged. Method: Data were collected from 126 staff (female = 72.2%; mean age = 41.9 years, SD = 10.7) via an online survey in relation to three areas: responses to three scenarios, reported use of different forms of TU and ratings of perceived effectiveness of, and level of comfort using, each type. Results: 96% of participants reported using TU themselves and observing their colleagues doing likewise. Models that included perceived effectiveness of, and level of staff comfort with using, different TU were significant, although only perceived effectiveness significantly independently contributed to the model. Conclusion: The use of TU was common, with levels consistent with those found in dementia services. The limitations and implications of the findings are discussed.

Background: Positive behavioural support (PBS) has been identified as a means of improving the quality of life and support of people with an intellectual disability. This qualitative study explored the views of service providers about a regional PBS programme, that was underpinned by a workforce development approach. Method: Semi-structured interviews were conducted with senior staff (n = 42), from organizations which provided services to people with an intellectual disability, about their views about, and perceived impact of, the PBS programme, Data were analysed using thematic analysis. Results: Two themes were identified: "It's what PBS is about, isn't it?" emphasized the importance of the programme being systemic- and evidence-based; "Macro to micro" highlighted the different points in the systems of care at which the programme was seen to impact. Conclusions: We discuss the results in the context of the study limitations.

Background: One contributor to the health inequalities that people with an intellectual disability face is failure to identify their intellectual disability. The Learning Disability Screening Questionnaire (LDSQ) can identify adults who are likely to have an intellectual disability, but little is known about its impact. Methods: A modified Delphi approach (literature search, interviews with staff and those using services [n = 28], and completion of an online survey by professionals [n = 29]) was used to develop a framework to evaluate the impact of the LDSQ. Results: Items endorsed by 60% or more of respondents (9/18) were included in the final framework. These all related to benefits of the LDSQ, including identifying people not previously known to have an intellectual disability; helping prioritize diagnostic assessment; informing support needs; and helping increase wellbeing and life chances. Conclusion: The LDSQ may offer one way of helping address the health inequalities that people with an intellectual disability face.

Response shifts can be defined as a change in the way that a respondent interprets and responds to symptom questionnaire items, over and above true changes in their symptoms. Response shifts are liable to occur as a result of psychotherapy and can undermine evaluations of the effectiveness of psychotherapy interventions by making pre- and post- intervention scores non-comparable. We evaluated whether such response shifts were in evidence in the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and how this affected the comparisons of group-level scores before and after counselling intervention. We found that response shifts were minimal, making it likely that they can be easily addressed by testing group-level change within an appropriate latent variable model, rather than relying on observed scores.

Homelessness is a worldwide health inequality. People with intellectual disability represent a relatively high proportion of homeless people, and for many their intellectual disability is not recognised. The study intended to obtain stakeholder views about how intellectual disability screening can be integrated into the support pathway for people who are homeless. A qualitative approach was taken using Thematic Analysis. Nine staff, who work with homeless people or are involved in the intellectual disability assessment pathway, were interviewed. Analysis produced three themes, each containing two subthemes. 'Current routes to support' investigates experiences of the existing pathway; 'Labels', explores views about making intellectual disability visible; 'Creating a pathway,' outlines ideas about developing and implementing a screening pathway between services. The results help inform how current practices of identifying people with intellectual disability might be improved and the role of screening in this. These results, when combined with other research around screening tools, provide insight into how intellectual disability screening can be integrated within services. [ABSTRACT FROM AUTHOR]

Background: Research suggests that having relevant contextual information can help increase the accuracy of emotion recognition in typically developing (TD) individuals and adults with an intellectual disability. The impact of context on the emotion recognition of children with intellectual disability is unknown. Method: Emotion recognition tasks, which varied in terms of contextual information, were completed by 102 children (45 with and 57 without intellectual disability). Results: There was a significant effect of age and group, with older and TD children performing better on average. There were significant group by condition interactions, whereby children with intellectual disability were more accurate at identifying emotions depicted by line drawings compared with photos with contextual information that was not directly related to the emotion being depicted. The opposite was found for TD children. Conclusions: These results have implications for socio-emotional interventions, such as universal school programmes.

Background: There is a growing evidence base about the effectiveness of positive behavioural support (PBS) in relation to behaviours that challenge (CB). There is, however, limited research from the perspective of individuals receiving this support. The objective of this qualitative study was to obtain the views of participants with an intellectual disability about what was important to them in relation to receiving PBS. Materials and methods: Seven participants with an intellectual disability, recruited via support organisations in the North East of England, gave their views about their support through interviews (n = 3) and a focus group (n = 4). Data were collected between April and June 2016 and were analysed using thematic analysis. Results: Four themes were identified: the importance of being treated as a human being; the wider impact of PBS; the contrast of PBS with previous experiences of support; and the beneficial impact of positive support. PBS was valued for its wide impact on quality of life, with a reduction in CB being just one of many important aspects. Conclusion: This study highlights the importance of including service user perspectives and quality-of-life indicators in research which evaluates service provision and support.

Background: The increasing number of individuals with an intellectual disability who are at risk of developing dementia highlights the need to use measures with strong psychometric properties as part of the screening, assessment and diagnostic process. Method: Searches were made of clinical and good practice guidelines and English language journal articles sourced from Proquest, Web of Science and Scopus databases (up to July 2017) for tools which were designed or adapted for the purpose of helping to diagnose dementia in people with intellectual disability. Results: Based on a detailed review of 81 articles and guidelines, the present authors identified 22 relevant tools (12 cognitive, 10 behaviour). These were reviewed in terms of their psychometric properties. Conclusions: A number of tools were found to be available for use with people with intellectual disability; however, few were specifically standardized for this purpose which also had comprehensive information about reliability and validity.

This study examined waiting times for diagnostic assessment of Autism Spectrum Disorder in 11 adult services, prior to and following the implementation of a 12 month change program. Methods to support change are reported and a multi-level modelling approach determined the effect of the change program on overall wait times. Results were statistically significant (b = - 0.25, t(136) = - 2.88, p = 0.005). The average time individuals waited for diagnosis across all services reduced from 149.4 days prior to the change program and 119.5 days after it, with an average reduction of 29.9 days overall. This innovative intervention provides a promising framework for service improvement to reduce the wait for diagnostic assessment of ASD in adults across the range of spectrum presentations.

Restorative practice (RP) is a behaviour management method that aims to help students develop conflict resolution and aggression management skills. This study aimed to explore the views of teaching professionals about the adoption of RP, as a whole school approach, over a five year period. Five staff (two females, three males) aged between 30 and 56, who worked within the school pastoral care team participated in individual interviews. A thematic analysis of the data identified four themes: the core of RP, restorative communication, learning opportunity, and the impact in practice. Participants' views about the core components of RP were consistent with those in the literature, with empathic, non-punitive communication being highlighted as essential. RP was seen as offering an important learning opportunity that shaped positive social relationships for both students and teachers, as well as being of benefit to behaviour and academic attainment.

Background: Neuropsychological tests of memory are believed to offer the greatest sensitivity at identifying people at the risk of developing dementia. There is a paucity of standardized and appropriate neuropsychological assessments of memory for adults with an intellectual disability. This study examines how adults with an intellectual disability perform on the Visual Association Test (VAT). Methods: Forty participants (18-45 years) with intellectual disability, without a diagnosis of dementia, completed the VAT and subtests of the CAMCOG-DS. Correlational analysis of the test variables was carried out. Results: All participants performed well on the VAT irrespective of age, gender or IQ. No significant correlations were found between the VAT and the subtests of the CAMCOG-DS. Conclusions: The VAT was found to be an easy and quick test to use with people with intellectual disability and all participants scored above "floor" level.

There has been limited research into how teachers view and respond to relational aggression in girls. The existing research is largely quantitative and questionnaire based and has indicated that gender stereotypes may influence teachers' perceptions of female aggression. The present study adopted a qualitative approach, using semi-structured interviews to explore how seven teachers (six females and one male) working in a single-sex girls' school experienced and perceived female student aggression. The results were analyzed using Interpretative Phenomenological Analysis and three themes were identified: the physicality of female aggression, aggression as the presence or absence of control, and community--aggression as a means of expressing belonging. These themes were discussed in the context of the need for a new language of female aggression, which promoted a genuine language of assertion for girls and women.

This article reports on gender ratio, age of diagnosis and the duration of assessment procedures in autism spectrum disorder diagnosis in a national study which included all types of clinical services for children and adults. Findings are reported from a retrospective case note analysis undertaken with a representative sample of 150 Scottish children and adults recently diagnosed with autism spectrum disorder. The study reports key findings that the gender ratio in this consecutively referred cohort is lower than anticipated in some age groups and reduces with increasing age. The gender ratio in children, together with the significant difference in the mean age of referral and diagnosis for girls compared to boys, adds evidence of delayed recognition of autism spectrum disorder in younger girls. There was no significant difference in duration of assessment for males and females suggesting that delays in diagnosis of females occur prior to referral for assessment. Implications for practice and research are considered.

The aim of this study was to explore the extent to which the Scottish Intercollegiate Guidelines Network 98 guidelines on the assessment and diagnosis of autism spectrum disorder were adhered to in child autism spectrum disorder diagnostic services in Scotland and whether there was a significant relationship between routine practice which more closely reflected these recommendations (increased adherence) and increased waiting times. Retrospective, cross-sectional case note analysis was applied to data from 80 case notes. Adherence ranged from a possible 0 (no adherence) to 19 (full adherence). Overall, 17/22 of the recommendations were adhered to in over 50 of the 80 cases and in 70 or more cases for 11/22 of the recommendations, with a mean adherence score of 16 (standard deviation = 1.9). No significant correlation was found between adherence and total wait time for untransformed (r = 0.15, p = 0.32) or transformed data (r = 0.12, p = 0.20). The results indicated that the assessment and diagnostic practices were consistent with the relevant Scottish Intercollegiate Guidelines Network 98 guideline recommendations. Increased adherence to the 19 included recommendations was not significantly related to increased total waiting times, indicating that the Scottish Intercollegiate Guidelines Network 98 recommendations have generally been integrated into practice, without a resultant increase in patient waits.

Background: Positive interpersonal relationships have been found to enhance an individual's quality of life. However, people with intellectual disabilities (PWID) often have restricted social networks, and little is known about their views on close social relationships. The study aimed to explore how this group perceives and experiences close relationships. Materials and Methods: Ten (6 = men 4 = women) PWID participated. Data were collected using semi-structured interviews, and analysed using interpretive phenomenological analysis. Results: The results report on three of five themes drawn from a larger qualitative study: "Relationships feeling safe and being useful"; "Who's in charge?" and "Struggling for an ordinary life." Conclusions: Close relationships are valued and desired by PWID, but a variety of barriers inhibit their development and maintenance. This includes the failure of others to value, accept and appropriately support the independence and relationships of PWID. Potential ways of addressing these issues are discussed.