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Vitamin D deficiency in patients with intellectual disabilities: prevalence, risk factors and management strategies
- Authors:
- FRIGHI Valeria, et al
- Journal article citation:
- British Journal of Psychiatry, 205(6), 2014, pp.450-457.
- Publisher:
- Cambridge University Press
Background: People with intellectual disabilities have a high risk of osteoporosis and fractures, which could partly be as a result of vitamin D deficiency. Aims: To compare the serum vitamin D (25(OH)D) levels of 155 patients with intellectual disabilities under psychiatric care and 192 controls, investigate potential risk factors for vitamin D deficiency in people with intellectual disabilities and assess available treatments. Method: Cross-sectional observational study followed by treatment evaluation. Results: Almost twice as many patients with intellectual disabilities had vitamin D deficiency (25(OH)D <50 nmol/l) compared with controls (77.3% v. 39.6%, P<0.0001). In the intellectual disabilities group, winter season (P<0.0001), dark skin pigmentation (P<0.0001), impaired mobility (P = 0.002) and obesity (P = 0.001) were independently associated with lower serum 25(OH)D. In most patients, 800 IU colecalciferol daily normalised 25(OH)D levels. Conclusions: Vitamin D deficiency is highly prevalent in people with intellectual disabilities, partly because of insufficient exposure to sunlight. Screening and treatment strategies, aiming to reduce these patients' high fracture risk, should be introduced. Similar strategies may be required in other psychiatric populations at risk for fractures and with a tendency to spend excessive time indoors. (Publisher abstract)
Examining the rights of children with intellectual disability in South Africa: Children's perspectives
- Authors:
- DONOHUE Dana K., BORNMAN Juan, GRANLUND Mats
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 39(1), 2014, pp.55-64.
- Publisher:
- Taylor and Francis
Background: Human rights provide fundamental conditions for people to maintain dignity and self-determination and protect a nation's most vulnerable citizens. In South Africa, children with intellectual disability who experience socioeconomic disadvantage may be particularly vulnerable due to their cognitive impairments and inability to garner needed resources. Method: The perceptions of children with intellectual disability regarding their access to basic amenities in their home environments were examined to determine whether their positive human rights were met. Risk factors were examined in relation to these perceptions. Results: The results suggested that participants generally reported high degrees of access to basic resources. Logistic regressions suggested socioeconomic risk factors (e.g., income, education, household size, relationship status) were negatively related to children's reports of access to food and their own beds and positively related to having someone available to explain confusing concepts to them. Conclusions: The positive human rights of children living in high-risk environments should be monitored to ensure all South Africans have their rights met. (Publisher abstract)
Early intervention for children with learning disabilities: making use of what we know
- Authors:
- GORE Nick, HASTING Richard, BRADY Serena
- Journal article citation:
- Tizard Learning Disability Review, 19(4), 2014, pp.181-189.
- Publisher:
- Emerald
Drawing on existing literature regarding rates of emotional and behavioural difficulties together with risk factors, the authors present a rationale for increasing initiatives for early intervention of emotional and behaviour difficulties. The study finds rates of emotional and behavioural difficulties amongst children with learning and developmental difficulties are high. A combination of factors relating to the child, the family system, and wider social contexts is likely to account for this. Increased attempts to provide early intervention to children with learning and developmental disabilities together with their families are warranted. Recommendations are made regarding how the development of such supports might best be taken forward. (Edited publisher abstract)
Parents with intellectual disabilities seeking professional parenting support: the role of working alliance, stress and informal support
- Authors:
- MEPPELDER Marieke, et al
- Journal article citation:
- Child Abuse and Neglect, 38(9), 2014, pp.1478-1486.
- Publisher:
- Elsevier
Delaying or refraining from seeking advice and support in difficult parenting situations is identified as an important risk factor for child abuse and neglect. This study tested whether the extent of delays in support seeking is associated with working alliance for parents with mild intellectual disabilities (MID) and whether the importance of working alliance may depend on parenting stress and availability of informal support. Delays in support seeking were measured as parental latency (time waited) to approach the support worker. This latency was assessed in the intended response to hypothetical situations (vignettes) and in the reported behavioural response to real life difficult parenting situations from the preceding weeks. Multiple regression analyses were conducted for testing main and interaction effects of predictors on latency for support seeking. Better quality of the working alliance was associated with shorter intended latency to seek support for parents with MID, if parents had little access to informal support. Higher parenting stress predicted a shorter latency for intended support seeking. Parental support seeking intentions were positively associated with support seeking behaviour. A good quality of the working alliance might be important to connect needs of parents with MID to resources that professional support can offer, in particular for the most vulnerable parents. Parental reluctance to seek professional support may be the result of a combination of risk and protective factors and is not always a sign of poor working alliance. Implications for risk assessment and support practice are discussed. (Edited publisher abstract)
A review of risk factors associated with suicide in adults with intellectual disability
- Authors:
- MOLLISON Emma, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(5), 2014, pp.302-308.
- Publisher:
- Emerald
Purpose: As recently as the 1980's it was still a widely held belief that individuals with intellectual disability (ID) did not have the cognitive capacity to experience mental health problems and this acted as a “buffer” against suicidal behaviour. The literature review examines the evidence relating to risk factors for individuals with intellectual disabilities. Design/methodology/approach: The literature review covered the time period 1993-2013 and returned 117 studies, 77 of which related to individuals with ID, 37 of which related to adults. Following screening titles and abstracts 28 articles were removed. A total of nine studies were found to be eligible for inclusion in the review. A further two studies examining suicide in adolescents (up to adulthood) with ID were also considered. From the eligible studies the following information was considered: study design, sample size, strengths, limitations and the risk factors associated with an increased risk of suicide. Findings: The suicide risk factors identified during the review were found to be in keeping with the general population and included a diagnosis of clinical depression, history of self-harm, unemployment, loneliness, unemployment, an increased need for support from others, early onset mental illness and being treatment resistive. (Edited publisher abstract)
Assessing risks arising from challenging behaviours: a model and a brief review of existing resources
- Author:
- TURTON Raistrick W.
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(1), 2014, pp.32-42.
- Publisher:
- Emerald
Purpose: Challenging behaviours are defined in part by the risks of harm they present and the support of individuals who challenge would be improved with effective assessments of the risks posed by challenging behaviours. The purpose of this paper is to outline a model of risk assessment and review literature that provides relevant information. Design/methodology/approach: Literature review. Findings: Forensic risk assessment has a well worked-out and validated approach but tools used to assess challenging behaviours are not effective risk predictors. Applied Behaviour Assessment provides methods that can be more effectively used for risk assessment. Practical implications: There is a need to develop valid risk assessment procedures for assessing the risks presented by challenging behaviours. Originality/value: This is a fresh perspective on risk assessment in relation to challenging behaviours. (Publisher abstract)
Characteristics of referrals and admissions to a medium secure ASD unit
- Authors:
- O'DONOGHUE Therese, SHINE John, ORIMALADE Olufunto
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 5(3), 2014, pp.138-146.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to present preliminary data on a cohort of patients referred to a specialist forensic medium-secure autism spectrum disorder (ASD) service during its first two years of opening and to identify variables associated with admission to the service. Design/methodology/approach: Data on all referrals to the service (n=40) was obtained from clinical files on demographics, offending history, psychiatric history and levels of therapeutic engagement. The sample was divided into two groups: referred and admitted (n=23) and referred and not admitted (n=17). Statistical analysis compared the two groups on all variables. Findings: Totally, 94 per cent of all individuals assessed had a diagnosis of autism, however, structured diagnostic tools for ASD were used in a small minority of cases. About half the sample had a learning disability, almost four-fifths had at least one additional mental disorder and almost three-quarters had a history of prior supervision failure or non-compliance with treatment. The sample had a wide range of previous offences. No significant differences were found between the groups on any of the variables included in the study. Research limitations/implications: The present study presents a starting point to follow up in terms of response to treatment and characteristics associated with treatment outcome. Practical implications – The sample had a wide range of clinical and risk-related needs. Both groups shared many similarities. Originality/value: This highlights the need for comprehensive assessment looking at risk-related needs so that individuals are referred to an optimal treatment pathway. (Publisher abstract)
Intellectual disability and mental health: is psychology prepared?
- Authors:
- RAZZA Nancy J., et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(6), 2014, pp.381-389.
- Publisher:
- Emerald
Purpose: The purpose of this paper is threefold: to document the relationship between intellectual disability (ID) and psychopathology; to raise awareness of the ongoing lag in professional training for psychologists in the area of mental health treatment for people with intellectual disabilities; and, to provide recommendations for advancing professional education and, ultimately, adequate mental health treatment availability for people with intellectual disabilities. Design/methodology/approach: The paper reviews the literature on prevalence of mental health problems in people with intellectual disabilities. At the same time, the paper reviews the training of psychologists relative to the burgeoning growth in awareness of the mental health needs of people with intellectual disabilities. Findings: The paper concludes that ID is a significant risk factor for psychopathology. In addition, the paper concludes that the education of psychologists regarding the mental health needs of people with intellectual disabilities is insufficient. The authors document the need for incorporating research and treatment advances related to intellectual disabilities and mental health into to the professional training of psychologists. The paper also describe the potential this training holds for improving both the lives of people with intellectual disabilities and the overall competence of psychologists. Practical implications: This paper provides a literature-based rationale for the need to include education in the mental health needs of people with intellectual disabilities into the general training of mental health professionals. In addition, it provides specific recommendations for how such training can be incorporated into graduate psychology programmes. (Edited publisher abstract)
Developing an evidence base for violent and disablist hate crime in Britain: findings from the Life Opportunities Survey
- Authors:
- EMERSON Eric, ROULSTONE Alan
- Journal article citation:
- Journal of Interpersonal Violence, 29(17), 2014, pp.3086-3104.
- Publisher:
- Sage
The U.K.’s Life Opportunities Survey was used to examine disabled people’s self-reported exposure to violent crime, hate crime, and disablist hate crime in the UK over a 12 month period. Information was collected from a nationally representative sample of 37,513 British adults (age 16 or older). Results indicated that (a) disabled adults were significantly more likely to have been exposed over the previous 12 months to violent crime and hate crime than their non-disabled peers, (b) the differential risk of exposure to violent crime was particularly elevated among disabled adults with mental health problems, (c) the differential risk of exposure to hate crime was particularly elevated among disabled adults with mental health problems or cognitive impairments; and (d) these effects were strongly moderated by poverty status with no increase in differential risk of exposure for disabled adults among more wealthy respondents. (Edited publisher abstract)
Mothers with intellectual disability, their experiences of maltreatment, and their children’s attachment representations: a small-group matched comparison study
- Authors:
- GRANQVIST Pehr, et al
- Journal article citation:
- Attachment and Human Development, 16(5), 2014, pp.417-436.
- Publisher:
- Taylor and Francis
Maternal intellectual disability (ID) is regarded a risk factor in child development, but there is no scientific evidence on maternal ID in relation to children’s attachment. Using a matched comparison design, a small group (n = 23) of mothers diagnosed with ID was studied to help fill this gap. Besides maternal ID, the authors examined the role of abuse/trauma/maltreatment (ATM) in the mothers’ biographies, along with potential confounds. Comparison group mothers (n = 25) had normal variations in intelligence and matched mothers with ID on residential area, income, child age, and sex. History of maternal ATM was assessed using a semi-structured interview and was found to be significantly more likely in the ID group mothers’ experience than the comparison group mothers. Children’s (M age = 77 months) attachment representations were assessed with the Separation Anxiety Test. Among children of mothers with ID, a substantial minority (35%) had a secure and the vast majority (>80%) an organised attachment representation. Mothers with ID who had suffered elevated ATM were significantly more likely to have children who were scored high on disorganisation and insecurity. The authors discuss possible implications of their findings for societal considerations regarding parenting and child attachment in the context of parental ID status. (Edited publisher abstract)