Amanda M. Michie

A Comparison of Anxiety Treatments with Adults Who Have Moderate and Severe Mental Retardation.

Several authors have suggested that Abbreviated Progressive Relaxation may not be effective with clients who have moderate and severe mental retardation. Because of this the authors were interested in the development of behavioural relaxation which is a more simple technique and does not require a conceptual awareness of internal states of tension. These two treatments were compared in group and individual forms with four groups of subjects. Subjects were assessed using measures of rated anxiety and pulse rate before, during, and after treatment. The rated anxiety measures suggest Behavioural Relaxation Training is more effective than Abbreviated Progressive Relaxation in both group and individual formats. There were no significant differences on the pulse rate measures.

Screening for offenders with an intellectual disability: The validity of the Learning Disability Screening Questionnaire

The study assessed the validity of an intellectual disability screening tool, the Learning Disability Screening Questionnaire (LDSQ), in three forensic settings: a community intellectual disability forensic service; a forensic in-patient secure unit and a prison, using data for 94 individuals. A significant positive relationship was found between full scale IQ and LDSQ score, indicating convergent validity. Discriminative validity was indicated by, firstly, a significant difference in the LDSQ scores between those with and without an intellectual disability, with those with a diagnosis of intellectual disability, scoring significantly lower. Secondly, a ROC analysis indicated that the sensitivity and specificity of the LDSQ were both above 80%. The screening tool was found to have lower sensitivity in the forensic populations than was obtained in the original community standardisation sample, but had slightly higher specificity. Limitations and implications of the study are discussed.

The Effects of Cue Control Relaxation on Adults with Severe Mental Retardation.

This study was designed to assess two aspects of behavioural relaxation training with subjects who have severe mental retardation. The first was whether or not cue words could be linked effectively to training so that they would eventually produce a relaxation effect in the absence of a full relaxation procedure. The second was to determine the effects of relaxation training and subsequent cue control on concentration and attention to an occupational task. Five subjects participated, and individual case designs were used. Cue Control, behavioural relaxation training (BRT), and new therapists were introduced at different times for each subject to ascertain the effects of each variable. Subjects were assessed at baseline and following each training session on a behavioural relaxation scale to judge the direct effects of relaxation training and on the amount of time spent concentrating on an occupational task. BRT produced reductions in rated anxiety and improvements in concentration for all subjects. The cue control words were effective only after they had been linked to BRT. In most cases, the introduction of a new therapist had no appreciable effect on anxiety or concentration. There was some suggestion that in the final cue only phases concentration was better and more consistent than during the BRT phases of the study.

A comparison of the neuropsychological profiles of adult male sex offenders and non-offenders with a learning disability

Abstract The present study compared the neumpsychologlcal pmfiles of a group of adult male sex offenden with a laming disability (n-42) with a group of adult male non-offenders with a learning disability (n-42) using the Wechsler Adult Intelligence Scale - Revised (1986). The groups wen matched for full-scale IQ. Thc study found that the non-offender group had significantly higher Verbal 1Q scorn than the sex offender group. No significant differences wen found for Performance IQ. The non-ofinder group was also found to have significantly hlgher scores on the Vocabulary sub-test than the sex offender group and the sex offender group was found to have significantly higher scores on the ObJecr Assembly subtest than the non-ofinder group. Finally. the sex offender group was found to have a significantly lower Verbal IQ than Performance IQ. No significant Verbal-Performance discrepancy was found for the non-offender group. Possible implications of these findings are dlscusscd.

A comparison of sex offenders and other types of offenders referred to intellectual disability forensic services

This study compared 131 sex offenders with ID and 346 other types of offenders with ID using case file records. All the females in the study were non sexual offenders. Significantly more sexual offenders were referred from court and criminal justice services while significantly fewer were referred from secondary healthcare. A higher percentage of sex offenders had some form of legal status at time of referral. Greater proportions of non sexual offenders were referred for aggression, damage to property, substance abuse and fire setting while only the sex offenders had an index sex offence. For previous offending, the non sexual offenders had higher rates of aggression, cruelty and neglect of children, property damage and substance abuse while the sexual offenders had higher rates of previous sexual offending. For psychiatric disturbance and adversity in childhood, only ADHD showed a significant difference between groups with the non sexual offenders recording higher rates.

Screening with young offenders with an intellectual disability

The research suggests that young offenders with an intellectual disability (ID) may not always be identified within youth justice services. This pilot study assessed some aspects of the validity of a screening tool, the Child and Adolescent Intellectual Disability Screening Questionnaire (CAIDS-Q), in UK forensic settings, using data from 23 individuals. The CAIDS-Q had positive and negative predictive power of 100%. In addition, a significant difference was found in CAIDS-Q scores between those with and without an ID, with the latter group scoring significantly higher, indicating discriminative validity. A significant positive relationship was found between full-scale IQ and CAIDS-Q scores, indicating convergent validity. The pilot study suggested that the CAIDS-Q may represent a valid screening tool to identify those young offenders who are likely to have an ID. Limitations and implications of the pilot are discussed.

Recognition of facial expressions of emotion by adults with intellectual disability: Is there evidence for the emotion specificity hypothesis?

This study aimed to evaluate the emotion recognition abilities of adults (n=23) with an intellectual disability (ID) compared with a control group of children (n=23) without ID matched for estimated cognitive ability. The study examined the impact of: task paradigm, stimulus type and preferred processing style (global/local) on accuracy. We found that, after controlling for estimated cognitive ability, the control group performed significantly better than the individuals with ID. This provides some support for the emotion specificity hypothesis. Having a more local processing style did not significantly mediate the relation between having ID and emotion recognition, but did significantly predict emotion recognition ability after controlling for group. This suggests that processing style is related to emotion recognition independently of having ID. The availability of contextual information improved emotion recognition for people with ID when compared with line drawing stimuli, and identifying a target emotion from a choice of two was relatively easier for individuals with ID, compared with the other task paradigms. The results of the study are considered in the context of current theories of emotion recognition deficits in individuals with ID.

Diagnostic information and adversity in childhood for offenders with learning disabilities referred to and accepted into forensic services

Several studies have related diagnostic information and adversity in childhood to criminal careers and risk of recidivism. Notably, ADHD and conduct disorder in childhood, schizophrenia, sexual abuse and physical abuse have been associated with offences in adulthood. This study investigates these variables in relation to large cohorts of offenders with learning disabilities. A case note review was undertaken for 126 individuals referred but not accepted into forensic learning disability services and 197 individuals accepted for such services. Results are reported on diagnostic information and experience of adversity in childhood. ADHD/conduct disorder featured prominently in both groups. Autistic spectrum disorders were not particularly over‐represented. For adversity in childhood, general socioeconomic deprivation featured prominently in both groups. This also increased significantly for those accepted into services. Sexual abuse and non‐accidental injury were featured at around 13‐20% for both groups. These results are broadly consistent with the mainstream literature on offending, ADHD/conduct disorder and general deprivation featuring significantly in all groups and rising for those accepted into offender services. It is important to deal with these aspects during assessment and to provide appropriate psychotherapeutic services for these individuals.

Health and social care staff responses to working with people with a learning disability who display sexual offending type behaviours

Abstract This study found that 59% of social care staff were currently supporting a client with a learning disability who had offended or displayed an offending type behaviour. The range of behaviours was similar to that displayed by clients in a secure health facility and included rape, sexual assault and exposure. Only 22.9% of social care staff had received training in this area, while none of the health staff had. Both groups expressed low levels of confidence in supporting this client group. The areas of difficulty were common to both groups and included personal attitudes and attitudes of others to the behaviour, and concerns over risk, responsibility and safety. In respect of attitudes, social care staff were found to be significantly more likely to hold negative attitudes towards the persons behaviour, while health staff were significantly more likely to feel negatively towards the person. Health staff were significantly more likely to identify training as a means of further support, while social care staff identified professional input. Both groups identified the need for theoretical training about working with this client group. Despite this no significant differences were found between those who had and had not received training and confidence, attitudes and the need for further support.

Service provision in Scotland for people with an intellectual disability who have, or are at risk of developing, dementia

This research aimed to identify current national provision by health services in Scotland in relation to proactive screening and reactive assessment for people with an intellectual disability in Scotland who have, or are at risk of developing, dementia. Staff from 12 intellectual disability services, representing the 11 health board areas in Scotland, completed an online questionnaire which asked about proactive screening and reactive assessment for people with intellectual disability who had, or were at risk of developing, dementia as well as suggested areas for improvement. All of the areas provided services for people with intellectual disability who have, or are at risk of developing, dementia, but differed as to whether this was reactive, proactive or both. Nine services offered intervention following diagnosis. The most common elements used across both proactive screening and reactive assessment were conducting a health check, using a general dementia questionnaire designed for people with an intellectual disability and direct assessment with the person. Clinical psychology and community learning disability nurses were the professions most likely to be involved routinely in both proactive screening and reactive assessments. The psychometric properties of the most commonly used assessments of cognitive and behavioural functioning were mixed. The areas of improvement suggested by practitioners mainly related to ways of improving existing pathways. This research represents the first step in providing an overview of service provision in Scotland. There was some inconsistency in relation to the general and specific components which were involved in proactive screening and reactive assessment. Implications for service provision are discussed.