Suchergebnisse

Background  The evidence supporting the application of Weiner's motivational model of helping to the behaviour of carers' of people with intellectual disabilities and challenging behaviour is inconsistent. One suggested reason for this is that many studies use stimuli that might generate different responses from those to actual instances of behaviour of real people.Method  Sixty‐two paid carers of people with intellectual disabilities reported attributions, emotions and intended behavioural responses to behaviour presented by an unnamed person and the same behaviour presented by a named and known person. They also completed a scale of behavioural knowledge.Results  Carers make more internal and global attributions and identify themselves as less optimistic in response to vignettes relating to named and known people than those relating to unnamed people. However, data from both unnamed and named vignettes are consistent in supporting Weiner's motivational model of helping in demonstrating a mediated model for controllability, anger and helping intention.Conclusions  Unnamed vignettes may underestimate the intensity of carers' responses to challenging behaviour; however, this study does not provide evidence that there are qualitative differences in the interrelationships between variables in data sets obtained from unnamed and named vignettes.

AbstractBackgroundThere is increasing evidence that cognitive behavioural therapy (CBT) can be effective for people with intellectual disabilities. The aim of this review was to report the nature and frequency of adaptations reported in studies of CBT for people with intellectual disabilities.MethodThis review updated and extended a previous review by (Whitehouse et al. 2006, J Appl Res Intellect Disabil, 19, 55), which used a framework of adaptations developed by (Hurley et al., 1998, J Dev Phys Disabil, 10, 365). Adaptations included simplification, language, activities, developmental level, use of directive style, flexible methods, involve caregivers, transference/countertransference and disability/rehabilitation approaches. A search identified peer‐reviewed papers that reported individual CBT informed psychological interventions for people with an Intellectual Disability.ResultsThe search identified 23 studies which met the inclusion criteria for review. Studies reported the majority of the categories of adaptation described by (Hurley et al., 1998, J Dev Phys Disabil, 10, 365).ConclusionsThe results suggest that the framework of adaptations needs further development to increase sensitivity in identifying and categorizing adaptations of CBT. Increased, systematic reporting of adaptations to studies of CBT with people with intellectual disabilities is recommended.

Background:  This study examines the relationship between the topography of challenging behaviour, subsequent attributions and emotional responses, with whether carers use physical intervention and their satisfaction with their intervention.Method:  Thirty‐seven carers described incidents where a person with an intellectual disability had exhibited verbal or physical aggression. The carer rated attributions of controllability, internality, globality and stability, global evaluations of the person's behaviour and of the persons themselves, emotions of anger and sympathy, and satisfaction with their intervention. The topography of the aggressive behaviour (verbal or physical) and the topography of the intervention (physical intervention or non‐physical intervention) were coded from accounts of the incident given by carers in the interview.Results:  Attributions of control and internality were significantly associated with less satisfaction with intervention. People who presented with physical aggression were evaluated more negatively. However, only the topography of the behaviour (whether the incident was verbal or physical aggression) was associated with the use of physical intervention.Conclusions:  This study did not find a relationship between cognitive‐emotional variables and the topography of intervention. However, relationships between cognitive variables and satisfaction with intervention were observed. Implications for research and clinical work are discussed.

Background  Distinct cognitive models and treatments have been developed for people without intellectual disability with a wide range of anxiety disorders. However, these have not been reported as applied to people with intellectual disabilities. In fact, much of the cognitive therapy literature for people with intellectual disabilities does not distinguish between different presentations of anxiety.Methods  We take the particular example of social phobia and describe the specific cognitive model and associated intervention developed for people without intellectual disabilities. We then consider research on the social context of people with intellectual disability and research on developmental factors predictive of anxiety and make suggestions for adaptation of treatment approaches.Conclusion  We suggest that such an approach would be useful to apply to other anxiety presentations and to identify areas for further clinical and research development.

AbstractBackgroundEndings in therapy are discussed widely in mainstream literature, however, there is only a small amount of research that considers endings in therapy for people with intellectual disabilities.MethodsEight therapists were interviewed about their experience of ending therapy with people with intellectual disabilities. Interviews were analysed using Interpretative Phenomenological Analysis (IPA).ResultsFour superordinate themes associated with endings that go well were identified: 'recognising', 'readying', 'reframing' and reflecting', with a fifth theme reflecting endings that were less successful. Participants worked hard to offer transformative experiences of endings and an overarching 'super‐superordinate' theme of 'facilitating transformative endings' encompassed the findings.ConclusionsEndings are a multi‐faceted component of psychological therapy with people with intellectual disabilities and are significant for both client and therapist. We discuss implications for therapy adaptations and future research.

AbstractBackgroundThis study explored understandings that service‐users with intellectual disabilities and challenging behaviour held around their behaviour, what shaped these understandings, and the relationship between how behaviours are managed and well‐being.MethodsEight participants (three female, five male) partook in individual semi‐structured qualitative interviews. Interviews were transcribed and analysed using interpretative phenomenological analysis.ResultsThree master themes emerged from this analysis: (a) challenging behaviour can be explained via an internal or external frame of reference, with each framework having different implications for how participants attempted to manage behaviour. (b) Positive relationships provide a long‐term buffer to challenging behaviour, with positive relationships with family, staff and peers operating through different mechanisms to achieve this. (c) A greater ability to exert power and control in day‐to‐day life was perceived to reduce challenging behaviour in the long term.ConclusionsImplications for practice are discussed.

ObjectivesDevelopmental literature highlights peer relationships and parental overprotection as factors implicated in the development of social anxiety. These factors are highly prevalent in the lives of people with intellectual disabilities; however research has not examined whether these factors are associated with social anxiety for this population.MethodsTwenty‐one individuals without intellectual disabilities and 21 individuals with intellectual disabilities (aged 16–24 years) completed the Social Anxiety Scale for Adolescents with follow‐up questions, the Glasgow Anxiety Scale‐Intellectual disabilities and the parental overprotection subscale of the Parental Bonding Instrument with follow‐up questions.ResultsAspects of general and social anxiety were significantly greater in the intellectual disabilities group. There were no significant differences in parental overprotection between groups, however, qualitative analyses revealed differences in experiences of social anxiety and parental overprotection.ConclusionsFurther research into factors associated with social anxiety in people with intellectual disabilities may inform adaptations to therapies and early intervention.

BackgroundResearch suggests there is a high prevalence of physical and mental ill health among individuals with intellectual disabilities and that staff working in mainstream healthcare services lack knowledge, skills and positive attitudes in supporting this client group. This review aimed to locate, extract themes from and evaluate the current literature that had assessed the training needs of mainstream health professionals within this area.MethodsThis review utilized a mixed‐methods approach, with systematic elements used to locate and evaluate the literature (n = 13) and a narrative approach used to explore patterns and themes identified. The search was completed across four databases, using the search terms felt most likely to capture the relevant literature.ResultsThree main themes of perceived training need were identified across a range of professional groups: general communication, knowledge/information and profession‐specific needs.ConclusionsThis review highlights the existing themes of training needs as identified by mainstream healthcare staff. It would appear that it may be possible to produce a core training package, suitable across professions with elements that are profession specific and therefore tailored accordingly. Limitations of the literature are explored within this review, as are recommendations for the directions of future research.

This study investigated the ability of people with an intellectual disability to consent to psychological research. The criteria employed were based on the three elements of informed consent: information, competence and voluntariness. Participants were 40 people with an intellectual disability who had agreed to take part in a larger research study investigating their ability to consent to behavioural or medical treatment. A brief questionnaire consisting of six questions was administered to each participant to discover the extent of their ability to consent to take part in the larger study. A scoring protocol was developed to determine whether participants had answered each question satisfactorily. People appeared to understand the nature of the research, but had a limited understanding of the risks and benefits involved or of their right to refuse to participate or to drop out of the study. It is concluded that researchers must carefully assess the ability of people with an intellectual disability to consent before recruiting them to research studies and must be aware of the potential for this client group to agree to participate without fully understanding the implications.

AbstractBackgroundThis article describes the development and use of the Formulation Understanding Measure to evaluate team formulation with staff supporting people with intellectual disabilities.MethodA quantitative design with an opportunistic sample was used to evaluate the psychometric properties of the Formulation Understanding Measure (FUM) including pre‐ and post‐administration at case formulation workshops. The measure was developed based upon experience of delivering case formulation workshops and was administered alongside case formulation workshops with 347 staff team members.ResultsThe measure was found to have acceptable psychometric properties with good internal reliability, a single principal component, and associations with training and demographic factors. It was also sensitive to changes resulting from case formulation workshops with the measure showing that staff increased in their understanding of the person with intellectual disability following a formulation workshop.ConclusionsThe FUM will enable routine evaluation of team formulations and further studies in the area.

BackgroundThis study aimed to develop a self‐report measure of paid caregivers' empathy towards people with intellectual disabilities.Materials and MethodsFollowing questionnaire develop‐ment, 194 staff working in services for people with intellectual disabilities completed self‐report questionnaires, including the new empathy measure. The measure's factor structure and psychometric properties were investigated.ResultsA three factor solution suggested two key processes in empathizing: experiencing commonality between one's own and people with intellectual disabilities' psychological experiences and efforts to attune to their internal worlds. The final factor represented whether carers find it challenging to empathize. Correlations with beliefs about the self and others in caregiving relationships provided initial evidence of validity, although further investigation is needed.ConclusionsThe most salient processes in empathizing with people with intellectual disabilities may be different from empathy in other contexts. Establishing determinants of carer empathy may facilitate the development of psychological interventions to promote and enhance this important quality.

BackgroundThis study examines Weiner's recent cognitive emotional model which makes a distinction between judgements of control and responsibility and emphasizes the moderation of control by 'mitigating' factors.MethodIn response to four vignettes describing two conditions of control (high or low) and mitigating factors (present or absent), questionnaires rating judgements of responsibility and emotional responses (anger and sympathy) were completed by 52 care staff.ResultsAnalysis of the data for sympathy demonstrated that attributions of control were moderated by communication ability and that the effect of control upon sympathy was mediated by the judgement of responsibility.ConclusionsThe data offer tentative support Weiner's account of the mitigation of control attributions in making responsibility judgements and their subsequent effects on emotional responses. Implications for research and clinical work are discussed.