A case series evaluation of the Fearless Me! © program for children with intellectual disabilities and anxiety.

OBJECTIVES: Children and adolescents with intellectual disabilities (ID) have high rates of mental health disorders, particularly anxiety disorders. Cognitive behavior therapy (CBT) has largely remained unexamined as a treatment option for this population. Fearless Me! © is an adapted CBT treatment program specifically designed for children and adolescents with ID. METHOD: Eleven children, aged between eight and 17, completed 10 therapy sessions. Measures of anxiety were completed pre and posttreatment and at 3 and 12-month follow-ups by both the children and parents. RESULTS: Six children reported significant reductions in anxiety, with all showing significant reductions in parent-reported child anxiety at either posttreatment assessment, 3-month follow-up, or 12-month follow-up. Results varied across the six children as all parents reported heightened anxiety, but not all children reported high levels of anxiety for themselves. CONCLUSION: Overall, this evaluation provides a sound basis for continued investigation and research into the use of the Fearless Me! © modified CBT program to treat children with ID and anxiety.

The impact of personality disorders and personality traits on psychotherapy treatment outcome of eating disorders: A systematic review.

A significant proportion of those with eating disorders (EDs) do not respond to first-line treatments. This systematic review was conducted to identify whether personality disorders (PDs)/traits predict or moderate ED treatment outcomes and whether these outcomes were differentially influenced by ED or PD diagnostic subtypes, or treatment approach. A comprehensive systematic literature search was conducted using the PRISMA guidelines. A total of seven randomised controlled trials (RCTs) plus four follow-up studies were reviewed investigating the impact of PD and PD traits on treatment outcomes for EDs. The majority indicated that PD had some impact on treatment outcomes. Outcome measures and time-point measurements varied across studies. Included studies suggested that bulimia nervosa treatment outcomes were not hindered by co-morbidity of borderline PD; however, psychiatric impairment remained high at post-treatment and follow-up. Cluster C PDs were found to negatively impact treatment outcomes for binge ED and attrition rates for anorexia nervosa. Included studies suggested that interventions that addressed aspects of personality pathology showed greater main effects for ED treatment outcomes. There is an urgent need for future RCTs on ED treatments to include routine measures of core personality features to allow their impacts to be more thoroughly examined and for psychotherapies to be tailored accordingly.

Fearless Me!© : A feasibility case series of cognitive behavioral therapy for adolescents with intellectual disability.

OBJECTIVE: This study evaluated the feasibility of the Fearless Me! program, an online cognitive behavioral therapy (CBT) program for children with intellectual disability (ID) and anxiety. METHOD: Twenty-one adolescents with mild to moderate ID participated in ten sessions of the therapist-assisted Fearless Me! program, combining face-to-face group sessions and an online component. A case series design was adopted to assess anxiety symptoms at baseline, throughout intervention, and postintervention. Feasibility of the measures, intervention, and trial design were considered. RESULTS: The measures were appropriate and sensitive to changes in anxiety, whereas the need for attention to factors influencing parent's completion of them was identified. Reliable Change Index and visual analyses of results indicated reductions in anxiety, particularly for older adolescents with heightened levels of anxiety at baseline. CONCLUSIONS: This is one of the first CBT programs for adolescents with ID, and provides preliminary evidence of adapted CBT as a feasible treatment.

Assessing the Confidence of Australian Mental Health Practitioners in Delivering Therapy to People With Intellectual Disability.

Research supports the use of psychological therapies among people with mild to moderate intellectual disability (ID). One barrier to people with ID accessing psychological treatments is the confidence of mental health practitioners. This article explores the confidence of Australian clinicians in providing therapy to people with ID. One hundred and fifty-two psychologists and counselors in Australia completed a survey exploring self-reported confidence when working with clients who have ID and mental health difficulties. Clinicians were most confident with generic counseling skills, but less confident with elements of assessments and interventions. The use of treatment protocols was endorsed as helpful particularly among those with low confidence. This highlights the need for dissemination of treatment guides and training to help increase clinician confidence.

A review of cognitive impairments in children with intellectual disabilities: Implications for cognitive behaviour therapy.

OBJECTIVE: Nearly half of children with intellectual disability (ID) have comorbid affective disorders. These problems are chronic if left untreated and can significantly impact upon future vocational, educational, and social opportunities. Despite this, there is a paucity of research into effective treatments for this population. Notably, one of the most supported of psychological therapies, cognitive behaviour therapy (CBT), remains largely uninvestigated in children with ID. The current review considers the neuropsychological profile of children and adolescents with mild to moderate ID, with a view to informing how CBT might best be adapted for children and adolescents with ID. METHOD: Narrative review of literature considering the neuropsychological profiles of children and adolescents with ID, with specific focus upon attention, memory, learning, executive functioning, and communication. Studies were identified through SCOPUS, PsycINFO, and PubMed databases, using combinations of the key words 'intellectual disability', 'learning disability', 'neuropsychology', 'attention', 'learning', 'memory', 'executive function', 'language', and 'reading'. RESULTS: Children with ID have significant deficits in attention, learning, memory, executive functions, and language. These deficits are likely to have a negative impact upon engagement in CBT. Suggestions for adapting therapy to accommodate these wide ranging deficits are proposed. CONCLUSIONS: There are multiple cognitive factors which need to be considered when modifying CBT for children who have ID. Furthermore, research is required to test whether CBT so modified is effective in this population. PRACTITIONER POINTS: Clinical implications Effective ways of providing cognitive behavioural therapy (CBT) to children with intellectual disability (ID) is unclear. This study provides a framework of potential adaptations for clinical practice As rates of mental illness for children with intellectual disability are high, and rates of treatment provision low, it is hoped that the recommendations provided in this study will encourage more mental health practitioners to provide CBT to children with ID. Limitations These recommendations are based only upon neuropsychological literature. Trialling the effectiveness of an adapted form of CBT for children and adolescents with ID is required. There are varying causes of intellectual disability, with differences in cognitive profiles. The utility of the recommendations made here may vary according to specific aetiologies.