Peter E. Langdon

Psychological therapies for people with intellectual disabilities: A systematic review and meta-analysis

The aim of this study was to evaluate the efficacy of psychological therapies for people with intellectual disabilities (IDs) through a systematic review and meta-analysis of the current literature. A comprehensive literature search identified 143 intervention studies. Twenty-two trials were eligible for review, and 14 of these were subsequently included in the meta-analysis. Many studies did not include adequate information about their participants, especially the nature of their IDs; information about masked assessment, and therapy fidelity was also lacking. The meta-analysis yielded an overall moderate between-group effect size, g=.682, while group-based interventions had a moderate but smaller treatment effect than individual-based interventions. Cognitive-behaviour therapy (CBT) was efficacious for both anger and depression, while interventions aimed at improving interpersonal functioning were not effectual. When CBT was excluded, there was insufficient evidence regarding the efficacy of other psychological therapies, or psychological therapies intended to treat mental health problems in children and young people with IDs. Adults with IDs and concurrent mental health problems appear to benefit from psychological therapies. However, clinical trials need to make use of improved reporting standards and larger samples.

The Attitudes of Medium-Secure Unit Staff Toward the Sexuality of Adults with Learning Disabilities

The attitudes of staff toward the sexuality of adults with learning disabilities within a medium-secure hospital within the United Kingdom were examined using qualitative research methods. Four interviews were conducted with staff members of both sexes from differing occupations. Interviews were transcribed and analyzed using a method adapted from Worthen and McNeill (1996). The analysis revealed that staff members generally held liberal attitudes with respect to the sexuality and masturbation. However, with respect to sexual intercourse, homosexual relationships, and the involvement of adults with learning disabilities in decisions regarding their own sexuality, less liberal attitudes were detected. Concern was also noted with respect to the attitudes of female staff members towards the sexuality of adults with learning disabilities who have committed sexual offences. Training issues were also identified and implications for the service were discussed.

An exploratory evaluation of the Ward and Hudson Offending Pathways model with sex offenders who have intellectual disability

Abstract Background It was predicted that offenders with intellectual disability (ID) categorised according to Ward & Hudsons (1998b) self‐regulation theory as having an Approach goal would have higher levels of distorted cognitions, less victim empathy, and a history of more prolific offending compared to those with an Avoidant goal. Offenders categorised as having a Passive strategy were hypothesised to have lower levels of general intellectual functioning, and more known offences and convictions compared to those with an Active strategy. Method Using a cross‐sectional independent groups design, the offence pathways of 34 men with ID who were taking part in group cognitive behavioural therapy were rated by therapists. Participants assigned to each pathway were then compared using measures of sexual knowledge, distorted cognitions, and victim empathy. Cronbachs alpha for the measures was found to be acceptable. Results Offenders with an Approach goal were found to have higher levels of distorted cognitions and more denial about the negative impact of their offending upon their victims on one measure of distorted cognitions, while on another measure of distorted cognitions there were no differences. There were no differences between Approach and Avoidant offenders in terms of victim empathy, socio‐sexual knowledge, severity of offending, and victim type. Offenders with a Passive strategy were found to have lower levels of general intellectual functioning than offenders with an Active strategy, but did not have more known offences and convictions. Conclusions The findings provide partial support for the usefulness of the Offending Pathways model in understanding the sexual offence processes of men with ID. The difficulties with this study are further discussed, together with the theoretical implications.

Locus of Control and Sex Offenders With an Intellectual Disability

Locus of control has been implicated as an important construct that is related to treatment outcome for several groups of offenders, including sexual offenders. However, little attention has been paid to how this construct is related to sexual offending by people with intellectual disabilities. Given this, 41 participants with intellectual disabilities were recruited into three groups: sex offenders who had undergone psychological treatment, sex offenders who had no history of treatment, and nonoffenders. All participants completed measures of locus of control and distorted cognitions. There was a significant difference between those who had and had not completed treatment in terms of cognitive distortions relating to sexual offending. There was no significant difference between the three groups on the measure of locus of control, with all three groups endorsing an external locus of control. Three possible explanations for how locus of control relates to sexual offending by people with intellectual disabilities is explored and discussed.

Effectiveness of cognitive behavioural therapy with people who have autistic spectrum disorders: A systematic review and meta-analysis.

The aims of this study were to undertake a meta-analytic and systematic appraisal of the literature investigating the effectiveness of cognitive behavioural therapy (CBT) when used with individuals who have autistic spectrum disorders (ASDs) for either a) affective disorders, or b) the symptoms of ASDs. Following a systematic search, 48 studies were included. CBT, used for affective disorders, was associated with a non-significant small to medium effect size, g=0.24, for self-report measures, a significant medium effect size, g=0.66, for informant-report measures, and a significant medium effect size, g=0.73, for clinician-report measures. CBT, used as a treatment for symptoms of ASDs, was associated with a small to medium non-significant effect size, g=0.25, for self-report measures, a significant small to medium effect size, g=0.48, for informant-report measures, a significant medium effect size, g=0.65, for clinician-report measures, and a significant small to medium effect size, g=0.35, for task-based measures. Sensitivity analyses reduced effect size magnitude, with the exception of that based on informant-report measures for the symptoms of ASDs, which increased, g=0.52. Definitive trials are needed to demonstrate that CBT is an empirically validated treatment for use with people who have ASDs.

Moral reasoning theory and illegal behaviour by adults with intellectual disabilities

Abstract Many studies conclude there is a strong relationship between moral reasoning and illegal behaviour amongst young offenders. However, there has been no research examining this relationship amongst people with intellectual disabilities. There is some empirical evidence to suggest that the relationship between moral reasoning and illegal behaviour may be curvilinear, such that lower moral reasoning and higher moral reasoning relates to lower rates of illegal behaviour and inappropriate conduct. Given this, and evidence that people with intellectual disabilities are reasoning at a lower moral stage than their same-age peers, it is proposed that some people with intellectual disabilities may actually be less likely to engage in illegal behaviour because they are reasoning at an earlier moral stage, while those with ‘borderline’ intelligence would be more likely to engage in illegal behaviour. This suggests that the relationship between moral reasoning and illegal behaviour is moderated by intelligence, and this has implications for the design of intervention programmes for people with intellectual disabilities, but further research is needed.

Randomized controlled trial of parent-enhanced CBT compared with individual CBT for obsessive-compulsive disorder in young people.

OBJECTIVE Obsessive-compulsive disorder (OCD) in young people can be effectively treated with Cognitive Behavior Therapy (CBT). Practice guidelines in the United Kingdom recommend that CBT be delivered with parental or family involvement; however, there is no evidence from randomized trials that this enhances effectiveness. The aim of this trial was to assess if CBT with high parental involvement was more effective than CBT with low parental involvement (individual CBT) in reducing symptoms of OCD. METHOD Fifty young people ages 12-17 years with OCD were randomly allocated to individual CBT or parent-enhanced CBT. In parent-enhanced CBT parents attended all treatment sessions; in individual CBT, parents attended only Sessions 1, 7, and the final session. Participants received up to 14 sessions of CBT. Data were analyzed using intent-to-treat and per-protocol methods. The primary outcome measure was the Childrens Yale-Brown Obsessive Compulsion Scale (Scahill et al., 1997). RESULTS Both forms of CBT significantly reduced symptoms of OCD and anxiety. Change in OCD symptoms was maintained at 6 months. Per-protocol analysis suggested that parent-enhanced CBT may be associated with significantly larger reductions in anxiety symptoms. CONCLUSIONS High and low parental involvement in CBT for OCD in young people were both effective, and there was no evidence that 1 method of delivery was superior on the primary outcome measure. However, this study was small. Future trials should be adequately powered and examine interactions with the age of the young person and comorbid anxiety disorders.

An Evaluation of the EQUIP Treatment Programme with Men who have Intellectual or Other Developmental Disabilities

BACKGROUND The Equipping Youth to Help One Another Programme (EQUIP) was designed for young offenders to address a developmental delay in moral reasoning, distorted cognitions and social skills. METHODS The present authors undertook a single case series study and piloted an adapted version of the EQUIP programme with three men with intellectual disabilities and four men with a diagnosis of Asperger Syndrome, all of whom were detained in a medium-secure forensic unit for people with intellectual disabilities. Treatment was delivered over a 12-week period, and participants took part in four-one-hour sessions per week. RESULTS The results suggested that treatment was successful at increasing moral reasoning ability, reducing distorted cognitions and improving ability to choose effective solutions to problems. However, treatment did not have a significant effect upon anger. CONCLUSIONS The EQUIP programme is a promising treatment, but further research is needed to investigate its effectiveness with men with intellectual or other developmental disabilities.

Care staff attributions toward self-injurious behaviour exhibited by adults with intellectual disabilities

Challenging behaviours may elicit negative emotional reactions and increase stress within care staff. The Leeds Attributional Coding System (LACS) was used to elicit spontaneous causal attributions of staff toward hypothetical clients with challenging behaviours. It was hypothesized that there would be relationships (1) between staff exposure to challenging behaviours and burnout, and (2) between staff cognitions and burnout. Using a cross-sectional correlational design, 41 care staff took part in a 10 minute interview about two vignettes depicting self-injurious behaviour. Staff also completed measures of demographic information and burnout. Participants made attributions toward self-injurious behaviour that were typically internal to the client, uncontrollable, unstable and specific.There was a significant association between number of clients cared for and emotional exhaustion and personal accomplishment. Staff who made fewer stable attributions had higher levels of burnout. There were no other relationships found between staff cognition and burnout. The LACS can be successfully employed in this context, and may have some benefits over other methods. Future research is required to explore the relationship between cognition and burnout.

Relationships Among Moral Reasoning, Empathy, and Distorted Cognitions in Men With Intellectual Disabilities and a History of Criminal Offending

Eighty men, spread equally across 4 groups, were recruited, including men with and without intellectual disabilities. The men were either criminal offenders or nonoffenders. Participants completed measures of moral reasoning, empathy, and distorted cognitions. The results indicated that the moral reasoning abilities of offenders with intellectual disabilities were developmentally delayed but were still more mature than those of nonoffenders with intellectual disabilities. Offenders without intellectual disabilities had less mature moral reasoning abilities than nonoffenders without intellectual disabilities. The differences may be partially accounted for by intellectual ability. The results also indicated that the relationship between empathy and distorted cognitions was mediated by moral reasoning. The findings have implications for the use of psychological interventions with offenders with intellectual disabilities.