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Aggression in intellectual disability - a new approach
- Authors:
- TURNER Katie, CLARKE David
- Journal article citation:
- Mental Health Review Journal, 14(2), June 2009, pp.28-36.
- Publisher:
- Emerald
Aggressive behaviour is a problem for services providing care for people with intellectual disabilities, affecting the quality of life of the individual and the quality of care provided. Current research trends, which focus on risk factors and mental health problems, are discussed. Other factors that could contribute to aggression in people with intellectual disability (PWID), such as lifestyle and environmental issues are examined. A methodology that would allow for the integration of all these factors, Behavioural Sequence Analysis, is a suitable investigative approach to this problem.
Two studies on the prevalence and validity of personality disorder in three forensic intellectual disability samples
- Authors:
- LINDSAY William R., et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 17(3), September 2006, pp.485-505.
- Publisher:
- Taylor and Francis
There is an extensive research literature on the association between personality disorder, antisocial personality disorder, and risk of future violent and sexual offences. Several studies have found an elevated prevalence of personality disorder diagnoses amongst those individuals with severe mental illness and criminal populations. While there has been some work on the prevalence of personality disorder among intellectual disability populations, it has been criticised as being unreliable and inconsistent. The present authors have taken account of these criticisms and recommendations in this comparison of 164 offenders with intellectual disability across three settings – community, medium/low secure, and high secure. In Study 1, DSM-IV diagnoses were made on the basis of four information sources: file review, interview with clinician, observations by care staff, and the Structured Assessment of Personality Interview. Across the samples, total prevalence of PD was 39.3%. The most common diagnosis was antisocial personality disorder. There was a higher rate of diagnosis in the high security setting, with no significant differences between the other two settings. There was no diagnosis of dependent PD, indicating that assessors were not overly influenced by the developmental disability itself. In Study 2 it was found that increase in severity of PD (as indicated by PCL-R scores and/or the number of PD diagnoses) showed a strong lawful relationship with instruments predicting future violence (VRAG, RM 2000/V) and a weaker relationship with instruments predicting future sexual offences (Static-99, RM 2000/S). The results indicate the utility of PD classification in this client group and that a number of individuals with PD classification are being managed successfully in community settings. These findings have considerable implications for staffing, both in terms of which individuals can be treated by these services and staff training.
Staying with people who slap us around: gender, juggling responsibilities and violence in paid (and unpaid) care work
- Author:
- BAINES Donna
- Journal article citation:
- Gender, Work and Organization, 13(2), March 2006, pp.129-151.
- Publisher:
- Blackwell
Little is actually known about women's occupational health, let alone how men and women may experience similar jobs and health risks differently. Drawing on data from a larger study of social service workers in Canada, this article examines four areas where gender is pivotal to the new ways of organizing caring labour, including the expansion of unpaid work and the use of personal resources to subsidize agency resources; gender-neutral violence; gender-specific violence and the juggling of home and work responsibilities. Collective assumptions and expectations about how men and women should perform care work result in men's partial insulation from the more intense forms of exploitation, stress and violence. This article looks at health risks, not merely as compensable occupational health concerns, but as avoidable products of forms of work organization that draw on notions of the endlessly stretchable capacity of women to provide care work in any context, including a context of violence. Indeed, the logic of women's elastic caring appear crucial to the survival of some agencies and the gender order in these workplaces.
Descriptive analysis of self-injurious behaviour and self-restraint
- Authors:
- FORMAN Debbie, HALL Scott
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 15(1), 2002, pp.1-7.
- Publisher:
- Wiley
Self-restraint often appears to be associated with self-injurious behaviour (SIB), and has been described as an attempt to prevent or escape from SIB. Research into the determinants of self-restraint is limited, and the present single case study assesses the environmental determinants of self-restraint and SIB, as well as describing the relationship between the two behaviours. Using observations in the natural environment were conducted for 16.5h and data were collected on SIB, self-restraint and environmental events. Sequential analysis showed that SIB and self-restraint were unrelated to environmental events and that the behaviours co-varied inversely. Self-injurious behaviour occurred at higher than chance levels immediately following self-restraint and also at high levels immediately prior to self-restraint. Whilst these results would appear to support the hypothesis that self-restraint was negatively reinforced by escape from SIB, the data cannot be explained solely by this theory. The implications of these findings for the behavioural theory of SIB and the conceptualisation of self-restraint are discussed.
Trauma and institutional risk in a secure developmental disorder service: does the SAVRY inflate risk in adolescents exposed to ACEs?
- Authors:
- WEBB Elanor Lucy, et al
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 13(1), 2022, pp.32-44.
- Publisher:
- Emerald
Purpose: Adverse childhood experiences (ACEs) are highly prevalent in people with developmental disorders who engage in offending behaviour. Many violence-based risk assessment tools include items pertaining to ACEs, and may inflate risk scores in trauma-exposed groups. This paper aims to explore the relationships between ACEs, risk assessment scores, incidents of risk and restrictive practices, in adolescents with developmental disorders in a forensic inpatient setting. Design/methodology/approach: Secondary analysis was conducted on clinical data for 34 adolescents detained to a developmental disorder service. Data were extracted for Structured Assessment of Violence Risk in Youth (SAVRY) risk scores and risk behaviours and restrictive practices, as measures of observed risk. Findings: Participants exposed to more ACEs had higher SAVRY risk scores (p < 0.001, two-tailed), with elevations specifically on the historical subscale (p < 0.001, two-tailed). Neither ACEs nor risk scores were associated with the frequency of risk behaviours. Nevertheless, participants exposed to four or more ACEs were secluded more frequently (p = 0.015, two-tailed), indicating a potential association between trauma and risk severity. Those with more complex developmental disorders experienced fewer ACEs (p = 0.02, two-tailed) and engaged in self-harm behaviours less frequently (p = 0.04, two-tailed). Research limitations/implications: The inclusion of ACEs in risk assessment tools may lead to the inadvertent stigmatization of trauma-exposed individuals. Further investigation is necessary to offer clarity on the impact of early adversity on risk assessment accuracy and levels of institutional risk, and the role of developmental disorders in this relationship. Originality/value: To the best of the authors’ knowledge, this study is the first to explore the relative associations between ACEs, risk assessment scores and observed institutional risk and does so in a highly marginalized population. (Edited publisher abstract)
Increased risk for mental illness, injuries, and violence in children born to mothers with intellectual disability: a register study in Sweden during 1999–2012
- Authors:
- WICKSTROM Maria, et al
- Journal article citation:
- Child Abuse and Neglect, 65, 2017, p.124–131.
- Publisher:
- Elsevier
Several studies have demonstrated that mothers with intellectual disability (ID) have a higher prevalence of mental health illness, lower socio-economic status, and a higher risk of alcohol and drug use compared to mothers without ID. The children of mothers with ID are over-represented in child protection and legal proceedings but are generally a less studied group than the mothers. The aim of this study was to investigate if children born to mothers with ID had an increased risk of being diagnosed with mental illness, injuries, and violence compared with children of mothers without ID. The study comprised a population-based cohort of children born in Sweden between 1999 and 2005. Data were collected from the Medical Birth Register and linked with two other national registers; ICD-10 codes were used for medical diagnoses, including ID. The children were followed from birth to seven years of age. In total, 478,577 children were included, of whom 2749 were born to mothers with ID. Children of mothers with ID were at a greater risk of having mental health problems (adjusted odds ratio (OR) = 2.02; 95% confidence interval (CI) = 1.74–2.35) and ID (OR = 4.14; CI = 2.95–5.82) in early childhood. They had an increased risk for injuries due to falls (OR = 1.15; Cl 1.04–1.27). The largest risk related to trauma was violence and child abuse (OR = 3.11; CI = 1.89–5.12). In conclusion, children of mothers with ID had an increased risk for injuries, violence, and child abuse. The authors suggest that parents with ID should receive evidence based support so that their children receive the best care and protection. (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)
Promoting the safety and security of disabled people
- Author:
- EQUALITY AND HUMAN RIGHTS COMMISSION
- Publisher:
- Equality and Human Rights Commission
- Publication year:
- 2009
- Pagination:
- 12p.
- Place of publication:
- Manchester
Disabled people are at greater risk of experiencing violence or hostility than the wider population. This includes violence or hostility which might be perceived as a ‘hate crime’. This report summarises research into disabled people's experiences of targeted violence and hostility. The research involved a literature review and interviews with stakeholders from key organisations and agencies, and interviews with 30 disabled people with learning disabilities and/or mental health problems form England, Wales and Scotland. Prevalence and the nature of violence, understanding risk and current interventions are covered. Quotations from disabled people interviewed are included in the report. The report concludes with the Equality and Human Rights Commission's plans to promote disabled people's safety and security over the next three years.
Clinical and actuarial prediction of physical violence in a forensic intellectual disability hospital: a longitudinal study
- Authors:
- McMILLAN Dean, HASTINGS Richard P., COLDWELL Jon
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 17(4), December 2004, pp.255-265.
- Publisher:
- Wiley
There is a high rate of physical violence in populations with intellectual disabilities, and this has been linked to problems for the victim, the assailant, members of staff and services. Despite the clinical significance of this behaviour, few studies have assessed methods of predicting its occurrence. The present study examined clinical and actuarial methods of predicting violence in a forensic intellectual disability hospital. The sample for the study consisted of people resident in the hospital during a 1-year period (n = 124). Clinical prediction used a risk rating made by members of the person's clinical team, whereas actuarial prediction used the number of violent incidents in the 6-months before the date of the clinical risk assessment. Computerized hospital records of violence in the 6 months after the assessment were used to examine the predictive accuracy of the two methods. The clinical method produced an area under the curve of 0.74 (95% CI: 0.650.83) in a receiveroperating characteristic curve analysis. The value for the actuarial method was 0.77 (95% CI: 0.690.86). Both methods performed at levels significantly above chance, but no one method was found to be superior to the other. These findings suggest that it is possible to predict who is at risk of violence in forensic populations with intellectual disabilities. Here, the authors discuss the clinical implications of these findings and the clinical application of risk prediction within clinical services.
Development of an abuse screening tool for women with disabilties
- Authors:
- CURRY Mary Ann, POWERS Laurie E., OSCHWALD Mark
- Journal article citation:
- Journal of Aggression Maltreatment and Trauma, 8(4), 2003, pp.123-141.
- Publisher:
- Taylor and Francis
Women with disabilities are at increased risk for violence, including forms of abuse that can be experienced by all women as well as forms unique to women with disabilities, such as abuse by personal assistants. The purpose of this study was to develop an abuse-screening tool unique to women with disabilities. The tool, which was based on previous research, was field-tested with 47 women who experienced physical and/or cognitive disabilities. Final refinement of the tool's wording and formatting was accomplished through focus groups and individual interviews. Women with disabilities were receptive to participating in screening, which facilitated the identification of abuse and risk factors. Recommendations for abuse screening and risk assessment with women who have disabilities are presented. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)