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Background: People with intellectual disability may be at elevated risk of adverse consequences of substance use. This study outlines the prevalence of, and factors associated with, substance use in young people with and without intellectual disability. Method: Secondary analysis was undertaken of the Next Steps annual panel study, which follows a cohort through adolescence into adulthood and contains self-report data on smoking, alcohol and drug use. Results: Young people with mild to moderate intellectual disabilities were generally less likely to use substances than young people without intellectual disabilities. The pattern of association with socio-demographic factors was mixed. Overall, matching participants on between-group differences in exposure to extraneous risk factors did not impact on between-group differences in substance use. Conclusions: Young people with mild to moderate intellectual disability are less likely to use substances than their non-disabled peers. Prevention and intervention programs need to be adapted for those in this population who do use substances.

Background: People with from minority ethnic communities face inequalities in health and health care. This systematic review considers the question of what we know about the health and health care of children and adults with intellectual disabilities from ethnic minority communities in the UK. Method: Studies published from 1990 to 2018 were identified via electronic literature databases, email requests and cross-citations. Studies were reviewed narratively in relation to identified themes. Results: Twenty-three studies were identified, most commonly focusing on South Asian communities. Very little information was identified on physical health or physical health care, with the identified evidence tending to focus on mental health care, access to specialist intellectual disability services, and inpatient services. Conclusion: Little is known about the health status of people with intellectual disabilities from minority ethnic groups in the UK. It is clear that they may experience barriers to accessing specialist intellectual disability services and other forms of health care.

Background: There is strong evidence indicating that paid employment is generally good for the physical and mental health of the general population. This systematic review considers the association between employment and the health of people with intellectual disabilities. Methods: Studies published from 1990 to 2018 were identified via electronic literature databases, email requests and cross-citations. Identified studies were reviewed narratively. Results: Twelve studies were identified. Studies were generally consistent in reporting an association between being in paid employment and better physical or mental health status. Conclusions: This review supports the view that the well-established association between employment and better health is similar for adults with and without intellectual disabilities. However, evidence establishing causality is lacking and further research to determine specific health benefits attributable to employment for people with intellectual disabilities and the causal pathways that operate is required.

Single case studies are helpful in analyzing the details of implementation of an individualized intervention program (reference). Their exploratory nature can result in more case studies, which can be compared to allow for better understanding of an intervention's usefulness. This case study investigated the effectiveness of using brief intervention probes for two different evidence-based interventions to identify the most effective teaching strategy for a struggling elementary school reader. Following initial grade level placement, two intervention probes were tested by rapidly switching between them, then analyzing the data. The intervention that yielded the most gains in words correctly read (WCPM) was selected and implemented to increase the likelihood for success. Results were promising as WCPM increased by 37 words from baseline to intervention. The study provides a glimpse into a much-needed area of research regarding using brief intervention probes to determine the most effective specific interventions prior to implementation. This research provides recommendations for use within any intervention model, especially Response to Intervention. (Contains 1 figure.)

Background: Children with mild/moderate intellectual disabilities are at greater risk for mental health problems, with socio-economic factors and adversity partly accounting for this. Fewer data are available for adolescents. Methods: Secondary analysis was undertaken of the "Next Steps" annual panel study following a cohort through adolescence into adulthood containing self-report mental health data up to age 16/17. Participants with mild/moderate intellectual disabilities were identified through data linkage with educational records. Results: Adolescents with mild/moderate intellectual disabilities were more likely than non-disabled peers to experience socio-economic disadvantage and bullying. Incidence rates of mental health problems were generally not significantly different between adolescents with and without intellectual disabilities. Conclusions: These findings are consistent with higher rates of persistent mental health problems beginning earlier among children with intellectual disabilities. Greater attention needs to be paid to the timecourse of mental health problems, and the impact of socio-economic factors, family and peers on mental health.

Background: Constipation can lead to serious health issues and death. This systematic review summarizes international research pertaining to the management of constipation in people with intellectual disability. Method: Studies published from 1990 to 2017 were identified using Medline, Cinahl, PsycINFO, Web of Science, email requests and cross-citations. Studies were reviewed narratively in relation to identified themes. Results: Eighteen studies were reviewed in relation to three themes: laxative receipt; interventions (dietary fibre, abdominal massage and macrogol); and staff issues (knowledge and training). Laxative polypharmacy was common. Studies report positive results for dietary fibre and abdominal massage although study quality was limited. Conclusion: The main management response to constipation in people with intellectual disability is laxative use despite limited effectiveness. An improved evidence base is required to support the suggestion that an individualized, integrated bowel management programme may reduce constipation and associated health conditions in people with intellectual disability.

Background: Poor postural care can have severe and life-threatening complications. This scoping review aims to map and summarize existing evidence regarding postural care for people with intellectual disabilities and severely impaired motor function. Method: Studies were identified via electronic database searches (MEDLINE, CINAHL, PsycINFO and Web of Science) covering January 1990 to March 2016, and email requests to researcher networks. Results were collated via descriptive numerical summary of studies and thematic analysis. Results: Twenty-three studies were identified and summarized narratively in relation to three themes: characteristics and prevalence, interventions and service related issues. The evidence base is small with significant gaps. Lack of evidence for night-time positioning equipment and 24-hr postural care needs to be addressed urgently. Conclusion: Future research should be clearly directed towards ascertaining how best postural care interventions can be employed to help improve the health and quality of life of people with intellectual disabilities.

Dysphagia (feeding and swallowing disorder) is associated with serious health complications and psychosocial sequelae. This review summarizes international research relating to the prevalence of dysphagia in people with intellectual disability. Studies published from 1990 to July 2016 were identified using Medline, Cinahl, PsycINFO, Web of Science, email requests, and cross-citations. Twenty studies were identified. Dysphagia in people with intellectual disability appears to be associated with more severe levels of intellectual disability, comorbid cerebral palsy, and motor impairments. However, further research with representative samples of people with intellectual disability using adequate methods of assessment are required in order to provide more precise prevalence estimates and clarify factors that may be associated with dysphagia in this population.

Background: People with intellectual disability or borderline intellectual functioning may have poorer mental health than their peers. The present authors sought to (i) estimate the risk of poorer mental health among British adults with and without intellectual impairments and (ii) estimate the extent to which any between-group differences in mental health may reflect between-group differences in rates of exposure to common social determinants of poorer health. Materials and Methods: The present authors undertook secondary analysis of confidentialized unit records collected in Wave 3 of "Understanding Society." Results: British adults with intellectual impairments living in general households are at significantly increased risk of potential mental health problems than their non-disabled peers (e.g. GHQ Caseness OR = 1.77, 95% CI (1.25-2.52), P < 0.001). Adjusting for between-group differences in age, gender and indicators of socio-economic position eliminated this increased risk [GHQ Caseness adjusted OR = 1.06, 95% CI (0.73-1.52), n.s]. Conclusions: Our analyses are consistent with the hypothesis that the increased risk of poor mental health among people with intellectual impairments may be attributable to their poorer living conditions rather than their intellectual impairments per se. Greater attention should be given to understanding and addressing the impact of exposure to common social determinants of mental health among marginalized or vulnerable groups.

Background: Participation in sports has been linked to a range of physical, social and mental health benefits. Little is known about the extent to which people with intellectual disabilities take part in sports. This study looks at participation in sports and factors associated with participation by people with intellectual disabilities in England. Method: Data on participation in sports and measures of personal characteristics, living situation, social participation, and socioeconomic status associated with participation were analysed based on a sample of 2784 people with intellectual disabilities in England. Results: Overall, 41% of participants had taken part in sports in the past month, nearly all of whom had enjoyed it. Of those who did not take part, 34% said they would like to. Participation in sport was associated with some personal characteristics but not with support needs, and was also associated with indicators of socioeconomic status. Conclusions: Targeting interventions to increase participation in sports by people with intellectual disabilities may make a significant contribution to improving their health and well-being.

Introduction: There has been a recent increase in interest in research into the emotional and behavioural needs of children and adolescents with intellectual disability. The field has tended to focus on the association between emotional and behavioural needs and child characteristics. Little attention has been paid to the potential importance of social context. Method: Cross-sectional survey of teacher-reported emotional and behavioural needs among 386 South Asian children and 118 Black children in a deprived urban conurbation. Results: The results suggested that: (i) teachers reported higher rates of emotional and behavioural needs among Black (when compared with South Asian) children; (ii) increased rates of emotional and behavioural needs were generally associated with older child age, lower child ability, the absence of sensory impairments and male gender; and (iii) neighbourhood deprivation was associated with variation in emotional and behavioural need differently for the two ethnic groups. For Black children, increased deprivation was associated with increased need. However, for South Asian children increased deprivation was associated with decreased need. Discussion: Results are discussed in relation to "group density effects" which may reflect the potentially moderating effects of social support on the relationship between socioeconomic deprivation and mental health.

Background: Research in the US and UK has demonstrated the effectiveness of person-centred planning (PCP) for people with intellectual disabilities. However, it is important to acknowledge problems that arise when implementing PCP. This paper considers barriers to PCP reported during a longitudinal study of the impact of PCP. Methods: Person-centred planning was introduced over a 2-year period for 93 people of whom 65 had a plan developed. Information was collected regarding barriers to PCP every 3 months from key informants using self-completion questionnaires. Results: Barriers to PCP were widespread particularly in relation to: availability of trained facilitators; availability of services; lack of time and reluctance of people other than paid support staff to engage in the PCP process. Conclusions: Services need to be aware of potential barriers to PCP so that strategies can be developed to overcome them, the first of which should be the ongoing training and support of facilitators.

Person-centered planning is central to United Kingdom policies regarding the support of people with intellectual disabilities. However, little evidence exists on the impact or cost of introducing person-centered planning. We examined the efficacy, effectiveness, and costs of introducing person-centered planning for 93 people with intellectual disabilities over 2 years across four localities in England. A person-centered plan was successfully developed for 65 people. Little change was apparent prior to introducing person-centered planning. After its introduction, modest positive changes were found in the areas of social networks; contact with family; contact with friends; community-based activities; scheduled day activities; and choice. The direct training and support cost of introducing person-centered planning was $1,202 per participant; indirect costs were negligible.

Background: There are no studies that have compared outcomes for staff in different types of supported accommodation for people with intellectual disabilities and challenging behaviour. This study looked at stress, morale and intended job turnover in staff in two types of community-based residential supports: non-congregate settings where the minority of residents have challenging behaviour; and congregate settings where the majority of residents have challenging behaviour. Materials and methods: A self-completion survey questionnaire was used to collect information on the basic characteristics of staff, levels of staff stress, job satisfaction and propensity to leave their employment. Results: One hundred and fifty-seven questionnaires were returned from staff, the majority of whom were on fixed-term contracts. Congregate settings were not associated with higher levels of stress as might be assumed. Overall, over a quarter of staff reached criterion on the General Health Questionnaire-12 for experiencing emotional distress, and over a third were likely to actively seek new employment in the next year. The greatest perceived sources of stress were lack of resources and lack of staff support. The lowest level of satisfaction was with the rate of pay. Those in non-congregate settings reported greater perceived stress because of lack of procedures to deal with challenging behaviour. Conclusions: High levels of intended staff turnover may be more due to job insecurity and lack of support than service user challenging behaviour. Employers seeking to reduce turnover should pay attention to basic pay and conditions, as well as staff training in appropriate methods for dealing with challenging behaviour.