Glynis H. Murphy

Capacity of adults with intellectual disabilities to consent to sexual relationships

BACKGROUND For people with intellectual disabilities there is a difficult balance to be struck between empowering people to claim their sexual rights and protecting them from abuse. Hypothetically, services should be guided by whether a particular person with intellectual disabilities has the capacity to consent to sexual relationships. However, there has been little agreement on how to define such capacity. This study examines the issue of capacity to consent to sexual relationships using a functional approach. METHOD Adults with intellectual disabilities (n = 60) and young people presumed in law able to consent (n = 60) were assessed for their sexual knowledge and vulnerability to abuse. RESULTS Adults with intellectual disabilities were significantly less knowledgeable about almost all aspects of sex and appeared significantly more vulnerable to abuse, having difficulty at times distinguishing abusive from consenting relationships. Nevertheless, some adults with intellectual disabilities scored highly on all measures, especially if they had relatively high IQs and had had sex education. CONCLUSIONS The reasons for the poorer knowledge and increased vulnerability of people with intellectual disabilities are discussed and it is recommended that they should have on-going access to sex education. Implications of the findings for definitions of capacity to consent to sexual relationships are considered.

Early Development of Self-Injurious Behavior: An Empirical Study

The early development of SIB in young children with developmental disabilities was examined by tracking over an 18-month period 16 school-age children who had recently started to show early SIB. Naturalistic observations were conducted in each childs classroom every 3 months, and the association between early SIB and environmental events was examined. Results showed that for the 4 children whose early SIB had escalated over this period, there was a significant association between early SIB and low levels of social contact across observation points, supporting models of the development of SIB. This association might be considered as a risk marker for the exacerbation of SIB. Implications of this finding for targeting early interventions for SIB are discussed.

The Specificity of TIMP-2 for Matrix Metalloproteinases Can Be Modified by Single Amino Acid Mutations

Residues 1–127 of human TIMP-2 (N-TIMP-2), comprising three of the disulfide-bonded loops of the TIMP-2 molecule, is a discrete protein domain that folds independently of the C-terminal domain. This domain has been shown to be necessary and sufficient for metalloproteinase inhibition and contains the major sites of interaction with the catalytic N-terminal domain of active matrix metalloproteinases (MMPs). Residues identified as being involved in the interaction with MMPs by NMR chemical shift perturbation studies and TIMP/MMP crystal structures have been altered by site-directed mutagenesis. We show, by measurement of association rates and apparent inhibition constants, that the specificity of these N-TIMP-2 mutants for a range of MMPs can be altered by single site mutations in either the TIMP “ridge” (Cys1–Cys3 and Ser68–Cys72) or the flexible AB loop (Ser31–Ile41). This work demonstrates that it is possible to engineer TIMPs with altered specificity and suggests that this form of protein engineering may be useful in the treatment of diseases such as arthritis and cancer where the selective inhibition of key MMPs is desirable.

A systematic review of people with autism spectrum disorder and the Criminal Justice System

This paper provides a systemic review of the available literature on people with autism spectrum disorder (ASD) in the criminal justice system (CJS). The review considers two main types of study: those that examined the prevalence of people with ASD in the CJS and those that examined the prevalence of offending in populations with ASD. In addition, types of offences in people with ASD, co-morbid psychiatric diagnoses, and characteristics of people with ASD who commit offences (including predisposing factors) are considered. A combination of search terms was used in a variety of databases in order to find all of the available literature on this topic, and research studies were included based on specified inclusion and exclusion criteria. It was found that whilst there is an emerging literature base on this topic, there are a wide variety of methodologies used, making direct comparison difficult. Nevertheless it can be concluded so far that people with ASD do not seem to be disproportionately over-represented in the CJS, though they commit a range of crimes and seem to have a number of predisposing features. There is poor evidence of the presence of comorbid psychiatric diagnoses (except in mental health settings) amongst offenders with ASD, and little evidence of the oft-asserted over-representation of certain kinds of crimes. It is recommended that further research of good quality is required in this area, rather than studies that examine populations that are not representative of all those with ASD.

Self-Injurious Behavior in Rett Syndrome: Interactions between Features of Rett Syndrome and Operant Conditioning.

Operant and biological theories of the cause of self-injurious behavior (SIB) in people with a mental handicap are often viewed as mutually exclusive. In this single case study, interactions between features of Rett syndrome and operant conditioning as determinants of SIB are examined. Functional analysis by analog methodology indicated different functions for two forms of SIB shown by the subject: automatic reinforcement by sensory stimulation and escape from social interactions. It is suggested that features of Rett syndrome established conditions under which operant conditioning of self-injurious responding was maximized. The implications of this interaction between features of syndromes and operant conditioning for the conceptualization of the cause of SIB are discussed and it is proposed that the notion of a unitary cause of SIB is inappropriate. It is more productive to consider operant conditioning as the process that maintains responding against a background of predisposing and mediating factors which may be biologically determined.

Measurement error in direct observations: a comparison of common recording methods☆

Abstract Videotapes of three brief duration, three medium duration and three long duration types of stereotyped behaviour (of eight severely retarded children) were analysed to provide a criterion record of the true percentage duration of the behaviour. The criterion record was compared with the records produced by four time-sampling methods: a whole-interval method, two partial-interval methods and a momentary time-sampling method. As predicted, the whole-interval method grossly underestimated and the partial-interval methods grossly overestimated the true percentage duration of the behaviour, except when the duration of individual responses was much longer than the observation interval. Momentary time-sampling was not an errorless method but was consistently superior to the other methods. The implications of these findings for the detection of treatment effects by direct observations are discussed.

Changes in Social Impairment for People with Intellectual Disabilities: A Follow-up of the Camberwell Cohort.

The skills and social impairments of a total population of children with severe intellectual disabilities and/or autism from Camberwell, South London (Wing and Gould, 1978 and 1979), were assessed using the Handicaps, Behaviours and Skills schedule, and they were reassessed when they were adolescents and young adults (Shah, 1986). Changes in social impairment over time are presented here. As Shah (1986) had found with a smaller sample, social impairment remained relatively stable over time: on a simple “socially impaired” versus “sociable” dichotomous grouping, 93% did not change social group. Within the socially impaired group, there was a significant increase in impairment over time (i.e., people who were passive at Time 1, were aloof at Time 2). Implications of these results and predictions for a further follow-up study are discussed.

Analysis of motivation in people with mild learning disabilities (mental handicap) who set fires

Abstract Ten people with mild learning disabilities (mild mental handicap) who had all set rues and had been admitted to a hospital facility for people with challenging behaviours were interviewed about their perceptions of events, feelings and cognitions prior to and after setting fins. They were also asked to rate their excitement/upset in a series of fire-related situations. Results showed that people could identify reliably the events, feelings and cognitions prior to fire-setting but were less reliable at identifying consequences. Most commonly, people had felt angry prior to setting fires but it was also common to feel not listened to, sad or depressed. Multiple factors were relevant for most people. Some people identified the excitement of the rue as relevant and these people gave the highest ratings on the fire-related situations schedule and scored higher than controls on this schedule. Implications for treatment are discussed.

Self‐injurious behaviour in young children with Lesch‐Nyhan syndrome

The early development of self‐injurious behaviour in three young boys (aged 17,25, and 30 months at start of study) with Lesch‐Nyhan syndrome was examined by means of parental interviews and by direct observations completed at 3 to 4 monthly intervals over an 18‐month period. Results suggest that the self‐injury began in a different way from that of other young children with autism and/or developmental disabilities in that, from the start, self‐injurious responses were sudden and violent, rather than emerging gradually over time. Drastic measures, such as removal of the teeth or provision of tooth guards, were often taken to prevent further tissue damage. Direct observations showed that the boys’self‐injury occurred at lower rates, but their carers were highly concerned about the behaviour. Sequential analysis of the observational data indicated that on some occasions the children were more likely to self‐injure during periods of low social interaction, suggesting that their self‐injury may have been influenced by environmental factors. The theoretical and practical implications of these findings are discussed.

Psychological characteristics of children with Shwachman syndrome.

Twelve children and young adults with Shwachman syndrome were compared with their unaffected siblings and with controls suffering from cystic fibrosis in terms of intellectual ability, motor skills, and behaviour. There were highly significant differences in intelligence quotient between those with Shwachman syndrome and the other two groups. Four of the index subjects but none of the control subjects were below the normal range. The differences between groups on other tests of cognitive and motor skills were not significant, though those with Shwachman syndrome tended to have the lowest scores. There was no evidence that those with Shwachman syndrome had more behavioural difficulties than the control subjects. We suggest that the intellectual difficulties of patients with Shwachman syndrome may be of neurological rather than social origin and that they may originate before birth.