William R. Lindsay

A controlled comparative investigation of psychological treatments for chronic sleep-onset insomnia.

A sample of physician-referred chronic insomniacs was randomly allocated to either progressive relaxation, stimulus control, paradoxical intention, placebo or no treatment conditions. Treatment process and outcome were investigated in terms of mean and standard deviation (night to night variability) measures of sleep pattern and sleep quality. Only active treatments were associated with significant improvement, but the nature of treatment gains varied. In particular, stimulus control improved sleep pattern, whereas relaxation affected perception of sleep quality. All improvements were maintained at 17 month follow-up. Results are discussed with reference to previous research and guidelines are given for clinical practice.

An evaluation of tailored psychological treatment of insomnia

It seems sensible to tailor treatments of insomnia in relation to the presenting characteristics of the sleeper and of the complaint. This report describes the first study formally to examine the comparative effectiveness of tailored and untailored (randomly allocated) treatments. We developed a questionnaire to facilitate the designing of individualized programmes. Results indicated that statistical analysis may underestimate the benefits of tailoring. Measures of clinically significant change, however, suggested that tailored treatment though it may be highly effective, is no more so than stimulus control therapy.

Risk Assessment in Offenders With Intellectual Disability: A Comparison Across Three Levels of Security

In mainstream offender samples, several risk assessments have been evaluated for predictive validity. This study extends this work to male offenders with intellectual disabilities. Participants from high-, medium-, and low-security settings, as well as community settings, were compared on a range of risk assessments. The Violence Risk Appraisal Guide, HCR-20—Historical Scale, the Risk Matrix 2000-C (combined risk), and the Emotional Problems Scales—Internalising discriminated between groups, with participants from high security having higher scores than those in medium security, who had higher scores than those in the community. The Violence Risk Appraisal Guide, all HCR-20 scales, the Short Dynamic Risk Scale, and the Emotional Problems Scales (Internalising and Externalising) showed significant areas under the curve for the prediction of violence. The Static-99 showed a significant area under the curve for the prediction of sexual incidents. The discussion reviews the value of these various scales to intellectual disability services.

CBT for people with intellectual disabilities : emerging evidence, cognitive ability and IQ effects

Historically people with intellectual disabilities have not been offered or received cognitive behavioural interventions that have been shown to be effective for mental health and emotional problems experienced by those without such disabilities. This is despite many people with intellectual disabilities having life experiences that potentially result in them having an increased risk to such problems. This paper discusses whether such therapeutic disdain is justified based on the evidence that is available and emerging concerning the application of cognitive behavioural interventions for this population. Issues concerning access to services, the ability of people with intellectual disabilities to engage in and benefit from the cognitive components of CBT, and the effect of cognitive abilities and IQ level on treatment effectiveness are explored in relation to this question.

A community forensic intellectual disability service: Twelve year follow up of referrals, analysis of referral patterns and assessment of harm reduction

Background. Previous reports on the outcome of services for offenders with developmental disabilities have found recidivism rates of between 40% and 70% with an elevated prevalence of sex offending, fire-raising, and aggression. Studies have also reported that female offending rates in the intellectual disability population are broadly similar to those found in mainstream populations. All reports have been conducted on in-patient or prison samples. The present report is of a community forensic intellectual disability service.Method. Two male cohorts of sex offenders (N = 121) and other types of offenders (N = 105) and female offenders (N = 21) are studied and compared. Data is reported on characteristics of the cohort, problems identified at referral, criminal justice disposal trends, index offences at time of referral, reoffending rates of up to 12 years after index offence, patterns of referral in the first 6 and second 6 years of the study period and the extent of harm reduction.Results. There were no differences between the groups on IQ and the sex offender cohort tended to be older. Female offenders had higher rates of mental illness although rates for the male cohorts were generally high at around 32%. The sex offending cohort had fewer problems with anger and aggression and alcohol abuse but a higher level of daily living problems and relationship problems. Female offenders had high rates of all problems studied except daily living problems. Unlike certain previous studies, sex offences predominated in the sex offender cohort while other types of offences predominated in the other two cohorts. Average age was lower for more recent referrals. Among recidivists only, a considerable amount of harm reduction was recorded.Conclusions. Fire raising and offences against children are not overly represented when compared with mainstream offenders. When compared with previous studies, it appears that a community forensic intellectual disability service may have an impact in reducing the number of offences committed over a 12 year follow up period. Language: en

The treatment of men with a learning disability convicted of exhibitionism

This paper reviews work on the treatment of men convicted of exhibitionism or indecent exposure. Recidivism is extremely high after treatments, with true figures on recidivism unavailable until 4 years after conviction. It is extremely difficult to control for treatment effects because of the ethical issues surrounding withholding of treatment, but cognitive techniques provide a promising treatment approach. The present study attempted to address all these issues for men with a learning disability. A cognitive treatment is presented and data are available for at least 5 years after conviction. An AB design was used and treatment effects were monitored carefully. Treatment dealt with the issues of accepting that the offense took place, taking responsibility for the offense, accepting the intention of the offending behavior, victim awareness, and behavior consistent with offending for four offenders. All the men responded to treatment, although one offender with only 1 year of probation responded less convincingly than others. Beliefs relating to indecent exposure being fun or not causing harm to women seemed most open to alteration. The beliefs in which the perpetrator thought that the victim shared responsibility for the offense and that women may take a long while to recover from such an incident, seemed the most difficult to alter. Individual characteristics of the case examples are discussed in terms of these general trends.

Treatment of adolescent sex offenders with intellectual disabilities.

The problems of male adolescent sex offenders with intellectual disabilities were described and issues for treatment reviewed. A group treatment based on cognitive therapy was offered. Treatment methods and assessment of attitudes related to commission of sexual offenses were described. Four case studies of teenage male adolescent sex offenders with intellectual disabilities were presented. All subjects responded to treatment. Their individual differences related to their responses were discussed in the context of the type of denial exhibited by each subject. At the time of this study, 3 years had elapsed for 2 subjects and 4 years for the other 2 without a recurrence of an offense.

Snoezelen: Its Effects on Concentration and Responsiveness in People with Profound Multiple Handicaps

This article is an initial investigation into the effects of Snoezelen on concentration and responsiveness in people who have profound and multiple handicaps. Eight subjects with profound learning disabilities took part. Ratings of concentration were recorded at each session using a simple task. The subjects were also assessed at every fifth session for responsiveness to the Snoezelen environment. The results suggest that all the subjects except one, who failed to score, responded In some way with improvements in scores. The improvements in concentration were significant for two subjects, moderate for four and minimal for one. The changes in concentration were not always related to the responsiveness/enjoyment in the Snoezelen environment. However, the two subjects who, in general, showed significant improvements in concentration were also rated as being the most responsive to the Snoezelen environment.

Two studies on the prevalence and validity of personality disorder in three forensic intellectual disability samples

Abstract There is an extensive research literature on the association between personality disorder, antisocial personality disorder, and risk of future violent and sexual offences. Several studies have found an elevated prevalence of personality disorder diagnoses amongst those individuals with severe mental illness and criminal populations. While there has been some work on the prevalence of personality disorder among intellectual disability populations, it has been criticised as being unreliable and inconsistent. The present authors have taken account of these criticisms and recommendations in this comparison of 164 offenders with intellectual disability across three settings – community, medium/low secure, and high secure. In Study 1, DSM-IV diagnoses were made on the basis of four information sources: file review, interview with clinician, observations by care staff, and the Structured Assessment of Personality Interview. Across the samples, total prevalence of PD was 39.3%. The most common diagnosis was antisocial personality disorder. There was a higher rate of diagnosis in the high security setting, with no significant differences between the other two settings. There was no diagnosis of dependent PD, indicating that assessors were not overly influenced by the developmental disability itself. In Study 2 it was found that increase in severity of PD (as indicated by PCL-R scores and/or the number of PD diagnoses) showed a strong lawful relationship with instruments predicting future violence (VRAG, RM 2000/V) and a weaker relationship with instruments predicting future sexual offences (Static-99, RM 2000/S). The results indicate the utility of PD classification in this client group and that a number of individuals with PD classification are being managed successfully in community settings. These findings have considerable implications for staffing, both in terms of which individuals can be treated by these services and staff training.

Predictive validity of the PCL-R for offenders with intellectual disability in a high security hospital: treatment progress

Abstract Background Among mainstream offenders, the severe personality disorder of psychopathy has considerable importance as a construct. The disorder has long been associated with failure to make treatment progress. Previous work has identified that psychopathy as a disorder occurs in samples of offenders with intellectual disability (ID), and suggests that the Psychopathy Checklist – Revised (PCL‐R: Hare, 1991, 2003) as a measure of the disorder has adequate reliability and validity (Morrissey et al., 2005). The present study aimed to compare the predictive power of the PCL‐R in relation to treatment progress with a more general assessment of violence risk, the HCR‐20 (Webster, Douglas, Eaves, & Hart, 1997). Method A sample of 73 residents in a high security intellectual disability service, who had previously been assessed using the PCL‐R and the HCR‐20, were followed up at 2 years post‐assessment, and their outcome determined in terms of two distinct dichotomous variables reflecting definite positive treatment progress and definite negative treatment progress respectively. Results In line with predictions, the PCL‐R Total score and Factor 1 score (Interpersonal and Affective aspects of psychopathy) and the HCR‐20 Total score were significantly inversely associated with a positive move from high to medium security hospital conditions within 2 years of assessment. However against prediction, the PCL‐R Total score had incremental validity over the HCR‐20. The PCL‐R Total and Factor 1, but not the HCR‐20 Total score, were also significantly associated with negative treatment progress in terms of a move to more restricted treatment conditions. Conclusion Psychopathy, and in particular its interpersonal and affective manifestations, is a construct which appears to be associated with indirect measures of treatment progress in this high security ID group. However, caution should be applied in the use of a construct with potentially negative connotations in an already devalued population.