Penny J. Standen

Levels of anxiety and sources of stress in adults with autism.

Clinical reports suggest that anxiety is a pertinent issue for adults with autism. We compared 34 adults with autism with 20 adults with intellectual disabilities, utilizing informant-based measures of anxiety and stress. Groups were matched by age, gender and intellectual ability. Adults with autism were almost three times more anxious than the comparison group and gained significantly higher scores on the anxiety subscales of panic and agoraphobia, separation anxiety, obsessive-compulsive disorder and generalized anxiety disorder. In terms of sources of stress, significant differences between the two groups were also found, and stress was found to correlate with high anxiety levels for the autism group, particularly the ability to cope with change, anticipation, sensory stimuli and unpleasant events. That is, the more anxious the individual with autism, the less likely they were able to cope with these demands. This has important implications for clinicians in terms of both assessment and treatment.

Virtual Reality in the Rehabilitation of People with Intellectual Disabilities: Review

Virtual reality (VR) possesses many qualities that give it rehabilitative potential for people with intellectual disabilities, both as an intervention and an assessment. It can provide a safe setting in which to practice skills that might carry too many risks in the real world. Unlike human tutors, computers are infinitely patient and consistent. Virtual worlds can be manipulated in ways the real world cannot be and can convey concepts without the use of language or other symbol systems. Published applications for this client group have all been as rehabilitative interventions. These are described in three groups: promoting skills for independent living, enhancing cognitive performance, and improving social skills. Five groups of studies are reviewed that utilize virtual technology to promote skills for independent living: grocery shopping, preparing food, orientation, road safety, and manufacturing skills. Fears that skills or habits learnt in a virtual setting would not transfer to the real world setting have not been supported by the available evidence, apart from those studies with people with autistic spectrum disorders. Future directions are in the development of more applications for independent living skills, exploring interventions for promoting motor and cognitive skills, and the developments of ecologically valid forms of assessment.

The attitudes of 'tomorrow's doctors' towards mental illness and psychiatry : changes during the final undergraduate year

To compare the efficacy of two teaching styles, didactic teaching and problem based learning, in producing enduring change in final‐year medical students’ attitudes towards psychiatry and mental illness.

The Effective Use of Virtual Environments in the Education and Rehabilitation of Students with Intellectual Disabilities.

Computer based learning has enjoyed an increasing role in mainstream education with the development of more powerful personal computers available at a lower price. This article reviews work on a specific form of computer software, virtual environments. It aims to illustrate the potential of this computer application in the education and rehabilitation of people with intellectual disabilities. Virtual environments appear to be a fruitful method of teaching skills for independent living to people with intellectual disabilities. Initial studies demonstrate that learning in this way transfers to the real life situation in which the skills are required. However, to effectively exploit their educational potential, interaction with virtual environments needs to be guided. This can be done using a human tutor and a software tutor and preliminary findings from current research suggest guidelines for the effective employment of both. Future directions involve ensuring the availability of the software, making the technology accessible to a wider range of users and researching staff support to ensure that use is facilitated and that this technology is appropriately exploited.

Designing location-based learning experiences for people with intellectual disabilities and additional sensory impairments

The research reported here is part of a larger project which seeks to combine serious games (or games-based learning) with location-based services to help people with intellectual disabilities and additional sensory impairments to develop work based skills. Specifically this paper reports on where these approaches are combined to scaffold the learning of new routes and ultimately independent travel to new work and educational opportunities. A phased development methodology is applied in a user sensitive manner, to ensure that user feedback drives the ongoing development process. Methods to structure this include group feedback on conceptual storyboards, expert review of prototypes using usability heuristics relating to the main system goals, and finally co-discovery methods with student pairs exploring all three modes of the system in real world contexts. Aspects of developmental and cognitive psychological theories are also reviewed and it is suggested that combining games-based learning approaches with location-based services is an appropriate combination of technologies for an application specifically designed to scaffold route learning for this target audience.

Virtual reality and its role in removing the barriers that turn cognitive impairments into intellectual disability

Early expectations of the contribution that virtual reality (VR) could make to education far exceeded actual applications. This was largely due to the initial immaturity of the technology and a lack of evidence base on which to base design and utilisation. While the early developments in computer based learning largely concentrated on mainstream education, leaving those with special needs behind, the potential of VR as an educational tool was exploited for those with intellectual disabilities right from the start. This paper describes the empirical evidence that has contributed to the development of educational virtual reality for those with intellectual disabilities: studies on transfer of learning from the virtual to the real world; how teachers might support those using VR; the design of virtual environments and what input/control devices best facilitate use of desktop VR. Future developments and ethical issues are also considered.

The internet: a comfortable communication medium for people with Asperger syndrome (AS) and high functioning autism (HFA)?

This study builds on previous survey research by the investigators (Benford, 2008), as well as anecdotal reports, which imply that, despite having social interaction and communication difficulties, internet communication (via email, chat rooms, newsgroups and bulletin boards) is welcomed by some people with high functioning autism (HFA) or Asperger syndrome (AS). Qualitative data about individual experiences, perceptions, and motivations regarding internet‐based communication was obtained from 23 adults with HFA or AS, mainly via email interviewing, but also by conventional mail. Analysis based on grounded theory revealed how the sample were able to use the internet to lessen the emotional, social and time pressures experienced in offline situations. Aspects that contributed to the perception of the internet as a potentially more comfortable communication medium included visual anonymity, a different and more flexible pace of communication, and the permanence of text. Overall, the complexity of communication was lessened, and a greater sense of control could be achieved.

Patients' Use of a Home-Based Virtual Reality System to Provide Rehabilitation of the Upper Limb Following Stroke

Background A low-cost virtual reality system that translates movements of the hand, fingers, and thumb into game play was designed to provide a flexible and motivating approach to increasing adherence to home-based rehabilitation. Objective Effectiveness depends on adherence, so did patients use the intervention to the recommended level? If not, what reasons did they give? The purpose of this study was to investigate these and related questions. Design A prospective cohort study, plus qualitative analysis of interviews, was conducted. Methods Seventeen patients recovering from stroke recruited to the intervention arm of a feasibility trial had the equipment left in their homes for 8 weeks and were advised to use it 3 times a day for periods of no more than 20 minutes. Frequency and duration of use were automatically recorded. At the end of the intervention, participants were interviewed to determine barriers to using it in the recommended way. Results Duration of use and how many days they used the equipment are presented for the 13 participants who successfully started the intervention. These figures were highly variable and could fall far short of our recommendations. There was a weak positive correlation between duration and baseline reported activities of daily living. Participants reported lack of familiarity with technology and competing commitments as barriers to use, although they appreciated the flexibility of the intervention and found it motivating. Limitations The small sample size limits the conclusions that can be drawn. Conclusions Level of use is variable and can fall far short of recommendations. Competing commitments were a barrier to use of the equipment, but participants reported that the intervention was flexible and motivating. It will not suit everyone, but some participants recorded high levels of use. Implications for practice are discussed.

How tutors assist adults with learning disabilities to use virtual environments

Purpose : To describe strategies used by tutors teaching adults with learning disabilities to use desktop virtual environments and to investigate their effectiveness by examining changes over time in tutor and learner behaviour. Method : Twenty adults with learning disabilities spent 12 sessions with one of four non-disabled tutors learning to use desktop virtual environments designed to teach independent living skills. Sessions were recorded on videotape, categories of behaviour were described and tapes analysed for frequency of tutor behaviours and goals achieved by learners. Results : Tutor strategies were described in terms of whether they aimed to help the learner master the interaction devices or to navigate and achieve goals in the virtual environments and how directive they were. There were some differences between tutors but this did not relate to whether tutors were experienced users themselves of the environments or were initially unfamiliar with them. Goal achievement was maintained at a constant level while help with the interaction devices and specific information about the environment decreased over repeated sessions. Rates of non-specific information did not change. Conclusions : Pretraining with the interaction devices would free both tutor and learner to concentrate on achieving goals in the environments. Much of the specific help given by the tutor could be incorporated into the software.

Effect of playing computer games on decision making in people with intellectual disabilities

People with intellectual disabilities have difficulty making decisions and this may hinder their independence and inclusion in society. Interactive computer software may give them the opportunity to practice the underlying components of this skill. This study analysed whether repeated sessions playing a computer game involving aspects of decision making, such as collecting relevant information and controlling impulsivity, would improve performance in two non‐computer based tests of decision making. Twelve adults with intellectual disabilities were randomly assigned to either an intervention group or control group. They were all exposed to 10 twice‐weekly sessions, playing either the intervention game or the control game, which involved simple reaction time only. After repeated sessions, the intervention group showed a significant improvement in game score, with researcher assistance significantly decreasing. At follow up, the intervention group showed a significant decrease from baseline in the number of guesses made before guessing correctly on both of the decision‐making tests. The decrease observed in the control group failed to reach significance.