Helena Lindstedt

Construct and discriminant validity and dimensionality of the Interview Schedule for Social Interaction (ISSI) in three psychiatric samples.

This study was aimed at investigating the psychometric properties of the Interview Schedule for Social Interaction (ISSI), in terms of construct and discriminant validity and unidimensionality, in three psychiatric samples with varying prerequisites for social interaction: 1) an outpatient sample of working age with mixed diagnoses, 2) an outpatient sample with schizophrenia, and 3) an inpatient sample composed of mentally ill, male offenders. The target constructs were psychosocial functioning and satisfaction in different life domains. It was hypothesized that the ISSI would mainly be related to psychosocial functioning and life domains characterized by social interaction, such as friends and family. A second hypothesis was that the ISSI ratings would discriminate between the three samples. The first hypothesis was confirmed, but the pattern of relationships was somewhat different between the groups. Whereas family contacts were of great importance for social integration in Samples 1 and 2, friends seemed more important for the mentally ill offenders. The second hypothesis was partly confirmed: three ISSI sub-scales out of four discriminated between the samples. Moreover, the ISSI proved to be a unidimensional construct. The support for the four proposed sub-scales was not unanimous, however, and the sub-scales targeting attachment constituted less stable factors. This study demonstrated the construct and discriminant validity of the ISSI when applied to samples with various mental disorders. The fact that similar results were obtained in all three samples, despite varying prerequisites for social interaction, strongly supports the validity of the ISSI. Providing the sub-scales are used with caution, the ISSI seems to be a reliable tool for use with patients with severe mental disorders.

Cognitive assistive technology and professional support in everyday life for adults with ADHD

Abstract Purpose: An evaluation of a model of intervention in everyday settings, consisting of cognitive assistive technology (CAT) and support provided by occupational therapists to adults with attention deficit hyperactivity disorder (ADHD). The purpose was to study how professional support and CAT facilitate everyday life and promote community participation of adults with ADHD. Method: The intervention was implemented in five steps and evaluated in a 15-month study (March 2006 = T1 to June 2007 = T2). One questionnaire and one protocol describe the CATs and provided support. Two questionnaires were employed at T1 and T2 for evaluation of the intervention in everyday settings. Results: The participants tried 74 CATs, with weekly schedules, watches and weighted blankets being most highly valued. Carrying out a daily routine was the most frequent support. More participants were working at T2 than at T1. Frequency of performing and satisfaction with daily occupations as well as life satisfaction were stable over the one-year period. Conclusions: The results indicate a higher frequency of participating in work but only a tendency of increased subjectively experienced life satisfaction. However, to be of optimal usability, CAT requires individually tailored, systematic and structured support by specially trained professionals. Implications for Rehabilitation Adults with ADHD report an overall satisfaction with the cognitive assistive technology, particularly with low-technological products such as weekly schedules and weighted blankets. Using cognitive assistive technology in everyday settings indicate a higher frequency of participating in work, but only a tendency of increased subjectively experienced life satisfaction for adults with ADHD. Prescription of cognitive assistive technology to adults with ADHD in everyday settings requires individually tailored, systematic and structured support by specially trained professionals.

Mentally Disordered Offenders’ Abilities in Occupational Performance and Social Participation

The major aim was to describe occupational performance (OP) and social participation (SP) of mentally disordered offenders (MDO), and to compare professionals’ and MDOs’ appraisals of these abilities. Also, diagnostic groups and groups with/without substance related disorders were compared with regard to OP and SP. Self-report instruments (Capability to Perform Daily Occupations, Self-Efficacy Scale, Importance scale, Interview Schedule for Social Interaction), observations (Allen Cognitive Level Screen), and register data (Psychosocial and Environment Problems—Axis IV; Global Assessment of Functioning Scale—Axis V; Assessment Concerning Support and Service for Persons with Certain Functional Impairments) were utilized. Demographic and register data were collected from the Swedish National Board of Forensic Medicine. Seventy-four out of 161 incarcerated subjects (46%), selected consecutively after informed consent during a period of 16 months, were interviewed on their hospital wards. The MDOs reported some disability in performing occupations and participating in community life. However, they were satisfied with their performance and participation, implying limited awareness of their disabilities. The professionals judged the MDOs as having problems with social participation, and major, longstanding disablements in several areas. Subjects with schizophrenia scored lower in some OP and SP variables than did subjects with personality disorders and other mental disorders. The results suggest that a large proportion of MDOs need support to enable their community living.

Personality traits as predictors of occupational performance and life satisfaction among mentally disordered offenders

The study investigated to what extent personality traits, e.g. socialization, proneness for anxiety, aggression and hostility were associated with and predictive of self-reported and observed occupational performance and perceived life satisfaction among male mentally disordered offenders (MDOs). Also, subjects with psychopathic-related personality traits were compared with subjects without such traits regarding demographic data and dependent variables. The MDOs were included from the Swedish National Board of Forensic Medicine. A total of 55 subjects were visited at their hospital ward for data collection with the Karolinska Scales of Personality (KSP), Capability to Perform Daily Occupation (CPDO), Allen Cognitive Level Screen (ACLS) and the Manchester Quality of Life Scale (MANSA). Seven KSP scales and two KSP factors correlated significantly with the dependent variables. Regression analyses revealed that the KSP Socialization scale, the KSP Anxiety-proneness and Psychopathy factors were the most important predictors. Subjects with psychopathy differed from remaining groups by having more conduct disorders before 15 years, being more often brought up in outcasted families and less subjected to measures of pupil welfare activities. The life history was concluded to be important influencing occupational performance and life satisfaction. Subjects with high anxiety proneness should be given attention in treatment planning.

Daily time management and influence of environmental factors on use of electronic planning devices in adults with mental disability

Abstract Purpose: To describe daily time management in adults with and without mental disability and to examine differences in the level of their daily time management; to describe the possessions and use of electronic planning devices (EPDs) in activities and how environmental factors influence the use of EPDs in adults with mental disability. Methods: In a descriptive and cross-sectional design, 32 participants using EPDs and a matched comparison group of 32 healthy adults was recruited. Time-Self rating scale measuring daily time management was adapted for adults. A study specific questionnaire was applied to collect data on five ICF environmental factors. Rasch modelling, descriptive and non-parametric statistics were applied. Results: Time-S has acceptable psychometric properties for use on adults with mental disability. People with mental disability and low level of daily time management who use advanced EPDs are more influenced by environmental factors. The study group perceived that encouragement and support from professionals as well as services influence their use of EPDs. Conclusions: Time-S can safely be used for people with mental disability. EPDs do not fully compensate the needs of the target-group. Prescribers need to give considerations to this and therefore they should be provided with more knowledge about this matter. Implications for Rehabilitation The Time-S can be applied for measuring daily time management in adults. Adults with mental disability provided with EPDs are not fully compensated in daily time management. Professional support and encouragement as well as backing from the services are important factors for the use of EPDs. Because the smart phones are not prescribed as assistive technology, the need for help from professionals to facilitate daily life is stressed. Therefore, the professionals should be provided with more knowledge about the use of EPDs.

Mentally disordered offenders' daily occupations after one year of forensic care

Abstract Persons detained as mentally disordered offenders need support for transition from care to community life. Few systematic studies have been completed on the outcomes of standard forensic care. The aim was to investigate the target groups life conditions and daily occupations one year after care. In a follow-up design occupational performance (OP) and social participation (SP) were investigated at two time points. After informed consent 36 consecutively recruited participants reported OP using the Capability to Perform Daily Occupations, Self-Efficacy Scale, Importance scale, and Allen Cognitive Level Screen. SP was measured with the Manchester Short Assessment of Quality of Life, and Interview Schedule for Social Interaction. After one year 24 participants were still incarcerated, 11 were conditionally released, and one participant was discharged. The group were generally more satisfied and engaged in daily occupations than at admission. The studys attrition rate, 51%, is discussed. The conclusion and the clinical implications indicate that the target group need early, goal directed interventions in OP and SP for alterations in daily occupations. Furthermore, to increase the knowledge base concerning mentally disordered offenders, studies with research designs that have the potential to uncover changes in daily occupation and other measures for this target group are necessary.

The prerequisites for QoL of people with intellectual disabilities

Quality of life (QoL) is seldom described in terms of the essence of what it is. Also, an essential task for the research community is to create space for the voices of people with intellectual disabilities. The aim of the present study was to understand the lived meaning and the essence of QoL in adults with this disability. Using a phenomenological approach, 21 informants living in a Swedish county were interviewed. The interviews were audio taped and analyzed with the empirical phenomenological psychological method. The results indicate that the general essence of QoL consists of well-being and five themes: social adult status, control of life, personal safety, social belonging and self-chosen solitude. The results challenge the stereotype of the informants as passive receivers of support from others. The interrelatedness between the five themes of QoL should be further studied.

Perception of the influence of environmental factors in the use of electronic planning devices in adults with cognitive disabilities

Abstract Background: Adults with cognitive disabilities often have difficulties in dealing with the complexity of everyday life. With cognitive assistive technology (e.g. electronic planning devices [EPDs] and individual support), they can bring order to their often chaotic life. Assumptions are that environmental factors influence with non-use of EPDs. Objective: To explore how adults with cognitive disabilities perceive the influence of environmental factors in the use of EPDs. Methods: A reference group with experience of use of EPDs assisted the researchers. Twelve adults with cognitive disabilities and experience of using EPDs participated. An interview guide was implemented covering environmental factors according to the International Classification of Functioning, Disability and Health. Qualitative content analysis was applied in the analyses. Results: Five categories and two themes emerged, which were integrated into a model of facilitating factors influencing the use of EPDs. Measures to prevent or eliminate negative influences of the device use are important to be taken. Conclusions: Professionals need more knowledge about EPDs, while users need individual adaption of the EPDs. EPDs need to be user-friendly, manageable and work in any seasons. Implications for Rehabilitation The users should have access to specially trained prescribers. There is a need for development of user-friendly and manageable products to function in any climate. Knowledge is lacking on how to implement the users in all stages of the prescribing process. Prescribers should increase knowledge in the use of EPDs to influence the attitudes of the social environment.