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Attachment, intellectual disabilities and mental health: research, assessment and intervention
- Authors:
- SCHUENGEL Carlo, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 26(1), 2013, pp.34-46.
- Publisher:
- Wiley
Research and practice have recently started to explore the value of attachment theory for understanding and alleviating the challenges that persons with intellectual disabilities face in mental health and social participation. The purpose of this paper is to review the current state of the art on attachment and intellectual disabilities, looking at possible clinical implications for assessment, prevention, intervention and education. The findings are discussed under the following concepts: attachment behaviours; attachment relationships; attachment bonds; attachment representations; attachment styles; and attachment disorders. Of these various attachment-related concepts, insights into attachment behaviours and relationships show the most promise for practical applications in the field of intellectual disabilities. Findings on representations, styles and disorders are inconclusive or preliminary. The paper concludes that attachment-informed research and practice can be part of emerging developmental understanding of functioning with intellectual disabilities.
Diagnosing psychiatric disorders in people with intellectual disabilities: issues and achievements
- Authors:
- BERTELLI Marco O., et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 9(5), 2015, pp.230-242.
- Publisher:
- Emerald
Purpose: Diagnosing psychiatric disorders (PD) in adults with Intellectual Disability (ID) presents several issues and need specific skills and tools. The purpose of this paper is to provide a detailed description of the current status of art through a systematic mapping of the literature. Design/methodology/approach: The authors reviewed the international literature on the basis of the following questions: what are the issues in the psychiatric diagnostic process for adults with ID? What methods and procedures have been used for psychiatric assessment in ID? To date, is it possible to identify some most effective procedures? Findings: The analysis of the literature indicates that main issues of the psychiatric diagnostic process in adults with ID are the following: identification of psychiatric symptoms, behavioural equivalents, diagnostic criteria, setting, source of information, screening, and diagnostic tools. The evidence base is only emerging and although many relevant achievements have been reached in the last two decades, no definitive guideline has been produced. Most recent acquisition also allowed to identify some assessment procedures that are currently considered the most effective. Individualised assessment remains the best way to meet the needs of this heterogeneous and variable patient group. Originality/value: This paper offers a comprehensive and updated description of current achievements and issues towards the assessment of PD in people with ID. (Publisher abstract)
A comparison of different models to meet the mental health needs of adults with intellectual disabilities
- Authors:
- SHEEHAN Rory, PASCHOS Dimitrios
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 7(3), 2013, pp.161-168.
- Publisher:
- Emerald
This paper aims to review the current knowledge on different ways of structuring psychiatric services to meet the needs of people with intellectual disability and co-morbid mental illness. It summarises the current debate and presents evidence from original research and opinion from clinical experience. It briefly at a number of different models, including: community care, community intellectual disability services, mainstream services, teritary' specialist services, in-patient care, generic vs specialist wards, specialist in-patient beds on general psychiatric wards, and emergency psychiatric services. The authors find a lack of robust research evidence to support any particular model of service provision. However, it seems to be increasingly accepted that purely generic models of care for people with intellectual disabilities and co-morbid mental illness are not appropriate. Integration of the expertise from specialist services within mainstream services is presented as potentially the most advantageous approach. (Edited publisher abstract)
The need for cognitive profiles based on neuropsychological assessments to drive individual education plans (IEPs) in forensic settings
- Authors:
- LOWINGS Graham, WICKS Beth
- Journal article citation:
- Journal of Mental Health Training Education and Practice, 7(4), 2012, pp.180-188.
- Publisher:
- Emerald
Many people in secure forensic settings are expected to take part in psycho-educational programmes as part of their treatment and rehabilitation. However many are hampered in this because of cognitive difficulties. These difficulties may result from acquired brain injury, deficits associated with substance misuse, childhood trauma, mental health problems and occasionally prescribed medication, or intellectual disability. This paper outlines the scale of the problem and offers potential solutions. The use of individual education plans based on neuropsychological profiles is proposed together with guidance on the preparation and delivery of educational materials that could improve the efficacy of psycho-educational programmes. The authors believe that understanding neuropsychological difficulties would mean that best use is made of the psycho-educational materials presented, thus speeding up and improving the efficacy of the rehabilitation process and potentially reducing the risk that the person poses to themselves and others. Currently there are resources, which offer guidance to teachers of children with neuropsychological difficulties but not for the adolescent and adult forensic population. This paper aims to address this gap.
Life events as a risk factor for psychological problems in individuals with intellectual disabilities: a critical review
- Authors:
- HULBERT-WILLIAMS L., HASTINGS R.P.
- Journal article citation:
- Journal of Intellectual Disability Research, 52(11), November 2008, pp.883-895.
- Publisher:
- Wiley
Stressful life events such as bereavement, moving house and changing jobs have repeatedly been implicated as risk factors for mental and physical ill health. Since the 1940s, researchers have demonstrated the negative effects of stressful life events, refined methods of recording such events and investigated the relative impact of different types of event. These investigations have generally not extended to include people with intellectual disabilities. A narrative review of research on life events as they occur to people with intellectual disabilities was conducted and the evidence that life events function as a risk factor for psychological problems critically assessed. Evidence was reviewed for an association between life events and a range of outcome variables, including affective disorders, challenging behaviour, psychosis and psychological problems more generally. The methodology behind the current evidence base was critiqued and a number of methodological advances that would help to strengthen it discussed. There is reasonable evidence that life events are associated with psychological problems, and that there is some tentative evidence that life events play a causal role, although to date, no relationship with psychosis in people with intellectual disabilities has been demonstrated. Life events are likely to be pertinent in clinical work with people with intellectual disabilities.
Prevalence of co‐occurring psychiatric disorders in adults and adolescents with intellectual disability: a systematic review and meta‐analysis
- Authors:
- MAZZA Mario G., et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 33(2), 2020, pp.126-138.
- Publisher:
- Wiley
Background: Subjects with intellectual disability (ID) are vulnerable to experience psychiatric disorders. The present authors performed a systematic review and meta‐analysis to estimate the prevalence of co‐occurring psychiatric disorders, excluding co‐occurring autism spectrum disorders, in subjects with intellectual disability. Method: The present authors performed a random‐effects meta‐analysis of the prevalence of psychiatric disorders in adults and adolescents with intellectual disability. Results: Twenty‐two studies were included. The pooled prevalence of any co‐occurring psychiatric disorders in intellectual disability was 33.6% (95% CI: 25.2%–43.1%) with high heterogeneity but no publication bias. Prevalence was lower in population‐based studies, in studies that used ICD criteria for the psychopathology and in studies with low risk of bias. The prevalence was higher in mild, moderate and severe intellectual disability than in profound intellectual disability. Conclusions: Psychiatric disorders are common in subjects with intellectual disability, and the present authors found that clinical and methodological moderators affect the pooled prevalence. (Edited publisher abstract)
Disability hate crime reporting
- Author:
- SMITH Lauren
- Publisher:
- IRISS
- Publication year:
- 2017
- Pagination:
- 19
- Place of publication:
- Glasgow
This literature review covers types of interventions that have been effective in increasing reporting of hate crimes motivated by perceptions of learning disabilities and mental health problems. It also looks at interventions that have been effective in supporting people through the process of reporting disability hate crimes and areas of potential areas of unmet need. It draws on academic literature, online resources and knowledge from key organisations, providing links to examples of good practice. The review identified a shortage of evidence around the efficacy of interventions designed with the explicit aim of increasing disability hate crime reporting. However, reports from several projects indicate several promising areas, which include: awareness raising; befriending links; third party reporting centres; safe places initiatives, support for reporting and disabled people's user-led organisations. The review also identifies gaps in the evidence to suggest potential areas for future interventions and research. (Edited publisher abstract)
The diagnostic boundary between autism spectrum disorder, intellectual developmental disorder and schizophrenia spectrum disorders
- Authors:
- BERTELLI Marco O., et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 9(5), 2015, pp.243-264.
- Publisher:
- Emerald
Purpose: During the last few years the prevalence of autism and Autism Spectrum Disorder (ASD) has increased greatly. A recurring issue is the overlap and boundaries between Intellectual Developmental Disorder (IDD), ASD and Schizophrenia Spectrum Disorders (SSD). In clinical practice with people with IDD, the alternative or adjunctive diagnosis of ASD or SSD is particularly challenging. The purpose of this paper is to define the boundaries and overlapping clinical characteristics of IDD, ASD and SSD; highlight the most relevant differences in clinical presentation; and provide a clinical framework within which to recognize the impact of IDD and ASD in the diagnosis of SSD. Design/methodology/approach: A systematic mapping of the international literature was conducted on the basis of the following questions: first, what are considered to be core and overlapping aspects of IDD, ASD and SSD; second, what are the main issues in clinical practice; and third, can key diagnostic flags be identified to assist in differentiating between the three diagnostic categories? Findings: Crucial clinical aspects for the differentiation resulted to be age of onset, interest towards others, main positive symptoms, and anatomical anomalies of the central nervous system. More robust diagnostic criteria and semeiological references are desirable. Originality/value: The present literature mapping provides a comprehensive description of the most relevant differences in the clinical presentation of ASD and SSD in persons with IDD. (Publisher abstract)
The diagnostic boundary between autism spectrum disorder, intellectual developmental disorder and schizophrenia spectrum disorders
- Authors:
- BERTELLI Marco O., et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 9(5), 2015, pp.243-264.
- Publisher:
- Emerald
Purpose: During the last few years the prevalence of autism and Autism Spectrum Disorder (ASD) has increased greatly. A recurring issue is the overlap and boundaries between Intellectual Developmental Disorder (IDD), ASD and Schizophrenia Spectrum Disorders (SSD). In clinical practice with people with IDD, the alternative or adjunctive diagnosis of ASD or SSD is particularly challenging. The purpose of this paper is to define the boundaries and overlapping clinical characteristics of IDD, ASD and SSD; highlight the most relevant differences in clinical presentation; and provide a clinical framework within which to recognize the impact of IDD and ASD in the diagnosis of SSD. Design/methodology/approach: A systematic mapping of the international literature was conducted on the basis of the following questions: first, what are considered to be core and overlapping aspects of IDD, ASD and SSD; second, what are the main issues in clinical practice; and third, can key diagnostic flags be identified to assist in differentiating between the three diagnostic categories? Findings: Crucial clinical aspects for the differentiation resulted to be age of onset, interest towards others, main positive symptoms, and anatomical anomalies of the central nervous system. More robust diagnostic criteria and semeiological references are desirable. Originality/value: The present literature mapping provides a comprehensive description of the most relevant differences in the clinical presentation of ASD and SSD in persons with IDD. (Publisher abstract)
Adapting to trauma: disengagement as a holding strategy
- Authors:
- BARTON David, WARD Kath, RODDAM Hazel
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(5), 2014, pp.338-347.
- Publisher:
- Emerald
Purpose: This paper draws upon a range of material to improve the understanding of disengagement with everyday life, by some individuals who have learning disabilities and mental health difficulties. Illustrative incidents from historical clinical cases are utilised, to consider whether this reframing may enhance the interpretation of presenting behaviours. Design/methodology/approach: Key recurring themes within transpersonal literature were reviewed, relevant to adults with behaviour indicating a degree of disengagement from everyday life. These were grouped into Physical Realm, Psychosocial Realm and Realm of Being. Illustrative examples of behaviour are reviewed and re-interpreted within this framework. Findings: These examples generated plausible interpretations for the presenting behaviours within this framework of the Three Realms. These interpretations support a fresh understanding of the quality of the individual's inner experience. This paper suggests a potential framework to consider the way in which some individuals may experience a different quality of consciousness than the usual. Practical implications: Use of the Three Realms for behaviour interpretation should result into a more empathetic and client-centred approach that could reduce the need for aversive approaches, lessening risk for the client and any employing organisation. The identification of behaviours that signal participation in the Realm of Being could be defined and evaluated with the potential to be used to inform the nature and content of the support provided. (Edited publisher abstract)