The impact of alleged abuse on behaviour in adults with severe intellectual disabilities

Background People with intellectual disabilities (ID) are particularly vulnerable to abuse, and most incidents come to light through victim disclosure. Those people with severe or profound ID are not able to describe what has happened to them. This project aimed to describe the consequences of abuse and changes in behaviour following alleged abuse in 18 adults with severe ID. Method Family members or other carers were interviewed to collect information about the alleged abuse. They were also asked about the person's adaptive and challenging behaviours at three time points: in the 3 months immediately prior to the abuse (time 1), in the 3 months immediately after the abuse (time 2) and in the 3 months prior to interview (time 3). Results A typical pattern emerged for both adaptive and challenging behaviours: there were few problems or difficulties at time 1, major difficulties at time 2 and some recovery by time 3. Conclusions Evidence is mounting that clinicians considering the sequelae of abuse for people with severe or profound ID need to consider changes in adaptive and challenging behaviours, as well as the typical symptoms of post‐traumatic stress disorder.     

Ecobehavioral Treatment of Challenging Behaviors

Presented here is a discussion of the ecobehavioral model in treating challenging behaviors of adults with psychiatric disorders and developmental disabilities. The history and definition of the term ecobehavioral is presented. Research, case studies, and case examples are provided to demonstrate the successful use of the ecobehavioral model in reducing challenging behaviors. Procedural variations, advantages, and limitations of an ecobehavioral approach toward treatment are discussed.     

An inpatient treatment model for adults with mild intellectual disability and challenging behaviour

Following the closure of the large mental handicap hospitals in the UK, the majority of people with intellectual disability (ID) are currently living in the community. However, people with ID who also exhibit challenging behaviour (CB) have been the most difficult-to-place group and use a large amount of service resources. A variety of service options have been proposed for the assessment and treatment of CBs, but there is little information on the effectiveness of these alternatives. The Mental Impairment Evaluation and Treatment Service (MIETS) is one of these service options and the aim of the present study is to describe and evaluate this service. The present authors studied the first 64 patients admitted to MIETS following its opening. A within-subject comparison research design was used. Demographic and clinical data were obtained from case records and the effectiveness of MIETS interventions was evaluated by comparing the number of incidents of challenging behaviour, the use of seclusion, and the place of residence before and after the MIETS intervention. Only 10 (17.5%) of the patients had been admitted from community facilities, but 48 (84.2%) of the patients were discharged to community placements (P 0.0001). The MIETS also significantly reduced the frequency and severity of challenging behaviours (P 0.0001). It is concluded that the MIETS is an effective treatment model for people with ID and CB, and that there is no place for therapeutic nihilism in this difficult-to-place group of patients.     

Aggressive behaviour by people with dementia in residential care settings: a review

This paper considers the phenomenon of aggressive behaviour perpetrated by people with dementia in residential care settings. Aggressive behaviour is defined in the context of people with dementia, and the problem of ascertaining the incidence of aggression among people with dementia is discussed. The emotional impact of assaults on nurses and other professionals is highlighted, and differing perspectives on the causation of aggressive behaviour are considered. Management strategies derived from the physical/pharmacological; environment management; behaviour modification and person-centred approaches are reviewed. Our conclusion is that while certain strategies appear to reflect good and common sense practice, in particular those deriving from the person-centred approach, there is no clear research evidence for the general effectiveness of any one management approach, and each has drawbacks of a practical or ethical nature. There is also little empirical information about how professional carers actually manage aggressive behaviour in practice.     

The drinking situations of adolescents treated for alcohol use disorders: a psychometric and alcohol-related outcomes investigation

Psychometric properties of the Inventory of Drinking Situations (IDS) were examined using a sample of adolescents with Alcohol Use Disorders (AUDs; N = 352; mean age=16.6; 65.6% boys). Relations of drinking situations to alcohol-related outcomes 1 and 3 years following treatment also were investigated. Consistent with the higher-order structure of the IDS reported in adult samples, findings indicated that a 3 factor solution provided the best fit to the data: Negative (alpha = .98), Social (alpha = .95), and Temptation (alpha = .84) Situations. With regard to convergent and discriminate validity, evidence suggested that the Negative Situations subscale was related more strongly to an indicator of negative emotionality than to an indicator behavioral undercontrol. Conversely, the Social Situations subscale was associated more strongly with an indicator of behavioral undercontrol than an indicator of negative emotionality. Social and temptation drinking situations were associated with alcohol-related outcomes 1 year following treatment, but this was generally not the case 3 years following treatment. These results indicate that the IDS is a reliable and valid measure for use with adolescents receiving treatment for alcohol-related problems.     

Assessing the need for reactive behaviour management strategies in children with intellectual disability and severe challenging behaviour

The need for reactive behavioural management strategies for aggressive behaviours in adults with intellectual disability has been clearly established, but equivalent information concerning children with challenging behaviour is lacking by comparison. The present study was conducted in order to assess this need. A retrospective study was conducted to ascertain the nature of aggressive behaviours amongst a cohort children referred to a specialist support service. Aggressive behaviours were found to occur at high rates within the study group. Almost 60% of the children displayed aggression that occurred at least daily, and the behaviours resulted in serious consequences for carers in almost one‐third of the group. Physical interventions were already in use in 56% of cases, but were largely improvised by carers. The need to include reactive behavioural training as part of an overall intervention package for carers of children with challenging behaviour appeared to be supported by the present results. The implications for training design are discussed.     

唇腭裂患儿家长的心理分析

的　评价唇腭裂患儿家长心理状态,探讨唇腭裂患儿家长负性心理状态与唇腭裂类型的关系,及改善 唇腭裂患儿家长负性心理的有效途径。方法　筛选非综合征性唇腭裂患儿家长100名作为试验组,另选择34名正 常儿童家长作为对照组。试验组按照患儿唇腭裂类型分为3个亚组:单纯性唇裂组(CL组)、单纯性腭裂组(CP组) 和唇腭裂组(CLP组)。选用生活事件量表和焦虑自评量表对试验组和对照组家长的心理状态进行定性和定量分 析。结果　试验组生活事件总刺激量、负性事件刺激量均高于对照组(P<0·05),3个亚组间生活事件总刺激量和 负性事件刺激量也有统计学差异(P<0·05),CLP组最高,CP组最低。焦虑自评量表调查结果显示,试验组焦虑自 评总分值与对照组无统计学差异(P>0·05)。结论　唇腭裂患儿家长普遍处于一种负性心理状态,少数表现出躯 体症状,唇腭裂患儿的畸形类型不同,家长的负性心理状态也不同,唇裂畸形比腭裂畸形对家长心理的影响更重, 说明唇腭裂患儿家长更在乎患儿的容貌畸形。     

Solution‐focused brief therapy with people with learning disabilities: a case study

Whilst solution‐focused brief therapy (SFBT) has become a widely used form of psychotherapy in the UK, there is little published writing on its use in services for people with learning disabilities. This article briefly discusses SFBT's potential uses with this client group, and provides by way of illustration a case example of its application with a man with mild learning disabilities referred to a learning disability clinical psychology service for ‘anger management’.     

Factors associated with the use of mechanical restraint in disability services

Background: Mechanical restraint refers to the use of materials or devices to restrict the behaviours of a person with a disability, where the restraint is neither for therapeutic purposes or required by law. The inappropriate use of mechanical restraint is recognised in legislation and policy as a violation of people’s human rights, and a risk to their health and wellbeing. Understanding who is at risk of mechanical restraint may assist service providers to better support people with a disability.

Method: State-wide data collected between July 2012 to June 2013 were sourced. Odds ratios were used to describe the associations between individual characteristics and whether an individual was subjected to mechanical restraint.

Results: Individuals with certain characteristics, such as the presence of a hearing, physical, neurological, communication or visual impairment, and autism spectrum disorder had an increased likelihood of being mechanically restrained.

Conclusion: Initiatives to reduce mechanical restraint should pay particular attention to the support needs of those with sensory impairments and complex communication support needs including those with autism spectrum disorder and those with a physical impairment.