Hey Google! Intelligent personal assistants and well-being in the context of disability during COVID-19.

BACKGROUND: Amidst the greatest technological advancement that societies have seen, the (health)care and quality of life of all, and especially of vulnerable individuals, see unprecedented improvements. Intelligent personal assistants (IPAs), such as Google Home (GH), can easily be implemented in their daily lives to facilitate routines. Technology can offer significant benefits for individuals with impairments and/or limitations in achieving greater autonomy and well-being. However, this opportunity still needs to be fully exploited, especially in long-term care facilities. Furthermore, such potential may be particularly needed during social isolation due to health concerns, such as the COVID-19 lockdowns and restrictions. We investigated the validity of implementing GH in residential care for individuals with visual impairments (VIs) and intellectual disabilities (IDs) and assessed the effects of a 10-week intervention on self-reported well-being. METHODS: We used a mixed-methods multiple case studies approach (N = 7) and performed intensive assessments (20 weeks), including self-report well-being questionnaires and observations focusing on well-being, autonomy, social participation and GH experiences. Nonoverlap of all pairs analyses were performed for quantitative data indexing performance differences between intervention phases. Thematic analysis was performed for the qualitative data. RESULTS: We found meaningful improvements in well-being in five clients, while all rated the experience of using GH positively. CONCLUSIONS: Our findings from the quantitative and qualitative analyses document that individuals with VI and/or ID benefit from IPAs in fostering better autonomy by facilitating access to information and entertainment. Further implications and possible barriers to large-scale implementation of IPAs in residential care are discussed.

Scale of Emotional Development - Short: reliability and validity in adults with intellectual disability.

BACKGROUND: Intellectual disability (ID) is often associated with delays in emotional development (ED). The Scale of Emotional Development - Short (SED-S) was developed to assess the level of ED and to adapt treatment and care accordingly. METHODS: In a sample of 724 adults from five study sites in three countries, a confirmatory factor analysis with a one-factor model was conducted on the entire dataset as well as in different subgroups. Furthermore, internal consistency was investigated using Cronbach's alpha. RESULTS: The confirmatory factor analysis indicated that a single-factor model fits the SED-S data well. The subgroup analyses revealed good model fit, regardless of the severity of ID and irrespective of sex or the presence of autism spectrum disorder or psychiatric disorders. Internal consistency was excellent for the entire sample (Cronbach's alpha = 0.93) and various subgroups (0.869-0.938). CONCLUSION: The results of this study suggest that the SED-S is psychometrically sound and can be used to assess the level of ED in adults with ID.

The LEDs move pilot study: the Light Curtain and physical activity and well-being among people with visual and intellectual disabilities.

BACKGROUND: Moving around and being physically active can often be challenging for people with a visual impairment. The combination of a visual and intellectual disability can make being physically active even more difficult. The aim of the current study was to examine whether a technological device for physical activity promotion would be associated with more movement and whether using it would be experienced as enjoyable for people with visual and intellectual disabilities. METHODS: A randomised multiple baseline design was used for this study. The participants were nine adults with a visual impairment and an IQ between 20 and 50. As participants interacted with the Light Curtain, movement was measured with triaxial accelerometers embedded in the Empatica E4 wristband. Independent observers scored activity, alertness and well-being from video-recordings using the following observation lists: the Happiness Feature Score (HFS) and the Arousal and Valence Scale (AVS). RESULTS: Physical activity measured with the accelerometer and positive excitement measured with the AVS significantly increased among participants when they were engaged with the Light Curtain compared with care-as-usual activities. Well-being measured with the HFS did not show a significant difference between the baseline and intervention phases. CONCLUSIONS: Engagement with the Light Curtain increased physical activity and positive excitement in persons with visual and intellectual disabilities, but more research is necessary to understand how the Light Curtain might affect happiness and well-being.

Effect of the use of an iPad on the attention span of a child with Smith Magenis Syndrome: A single case study.

AIMS: To assess the effectiveness of iPad use on the attention span of a child with Smith Magenis Syndrome (n = 1), compared to attention span while working on the same tasks manually. METHODS: An AB design with a baseline and an intervention phase was used. Three manual tasks were chosen for the baseline, which matched the participant's intellectual age by the Early Intervention Method: a jigsaw puzzle (six pieces), a shape sorter, and matching pictures. These same tasks were performed on an iPad during the intervention phase. Six baseline and nine intervention phase films were included in the analysis. The 15 films were independently scored twice by two observers: once to observe the types of distractions that occurred (such as standing up from the chair, calling the teacher, or turning around on the chair), and a second time to measure the effective working time. RESULTS: iPad use led to a 45% decrease in the number of total distractions. The effective working time improved by 8% and showed a more consistent range compared to working on tasksbmanually. While task enjoyment was not directly measured, the observers and teachers agreed that working on the iPad appeared to be more enjoyable. CONCLUSIONS: In this single case study the participant showed that in his case iPad use can be effective in decreasing his distractions and therefore can improve his attention span. Enjoyment was higher while working with the iPad than performing tasks manually. This technology could therefore create more learning engagement for the participant, which could positively impact his behavior. Further research into iPad implementation for children with intellectual disabilities, poor fine motor skills, and/or attention deficits is needed.

[Effect of psychotherapy for persons with an intellectual disability, and required adjustments]. / Effect van psychotherapie bij mensen met een verstandelijke beperking, en benodigde aanpassingen.

BACKGROUND: The prevalence of psychological problems in people with (visual and) intellectual disabilities is high and therefore there is a substantial need for adequate psychological treatment.
AIM: To examine the effectiveness of psychotherapy in people with a (visual and) intellectual disability and to study which adjustments are needed in treatment protocols.
METHOD: A random selection of client files (n = 50) was studied, therapists completed questionnaires (n = 5) and videos of mentalisation based therapy sessions (n = 12) were analysed.
RESULTS: A qualitative assessment of therapy effect showed that for 88% of clients therapy was effective, half or all treatment goals were achieved. The psychotherapeutic methodologies corresponded, as recommended in the literature, to methodologies used for persons without a disability, although practical and specific adjustments were needed.
CONCLUSION: A large number of psychotherapeutic methods, with the necessary adjustments, can be used in the treatment of persons with (visual and intellectual) disabilities with psychological problems.

Self-concept in institutionalized children with disturbed attachment: The mediating role of exploratory behaviours.

BACKGROUND: Self-concept is seen as both an outcome of sociocognitive and emotional development, and a factor in social and mental health outcomes. Although the contribution of attachment experiences to self-concept has been limited to quality of primary attachment relationships, little is known of the effects of disturbed attachment on self-concept in institutionalized children. Thus, the current study examined associations between disturbed attachment behaviours in institutionalized children and self-concept, testing limited exploration as an explanatory factor. METHODS: Thirty-three institutionalized children, aged 4-12, participated in a multimethod and multi-informant assessment of disturbed attachment behaviours (i.e., Disturbances of Attachment Interview and Behavioral Signs of Disturbed Attachment in Young Children), self-concept (i.e., Pictorial Scale of Perceived Competence and Social Acceptance for Young Children), and exploratory behaviours (i.e., Student Exploratory Behaviours Observation Scale). Analyses were conducted using bootstrapping techniques. RESULTS: Global self-concept converged with teacher-rated children's self-concept, except for physical competence domain. Disturbed attachment behaviours were identified in 62.5% of the children, and this was associated with lower levels of exploration and lower scores on self-concept, compared with children without disturbed attachment behaviours. Furthermore, exploratory behaviours mediated the effects of disturbed attachment behaviours on self-concept. CONCLUSIONS: Institution-reared children with disturbed attachment behaviours were likely to have a negative perception of self and one's own competences. Limited exploratory behaviours explained this linkage. Targeting disordered attachment in children reared in institutions and their caregivers should become a high priority as a means for preventing socioemotional development issues.

Screening for ASD in adults with ID-moving toward a standard using the DiBAS-R and the ACL.

BACKGROUND: Identification of Autism Spectrum Disorder (ASD) in persons with intellectual disability (ID) is challenging but essential to allow adequate treatment to be given. This study examines whether the combination of two ASD screening instruments specifically developed for persons with ID, namely, the Diagnostic Behavioral Assessment for ASD-Revised (DiBAS-R) and the Autism Checklist (ACL), improves diagnostic accuracy when used in combination compared to the application of the single instrument. METHOD: A clinical sample of adults with ID who are suspected of having ASD (N =148) was assessed using two ID specific screening scales (DiBAS-R and ACL). The diagnostic validity of the single instruments and of their combination was assessed. RESULTS: While both instruments showed acceptable diagnostic validity when applied alone (DiBAS-R/ACL: sensitivity: 75%/91%; specificity: 75%/75%; overall agreement: 75%/83%), specificity increased when two positive screening results were used (88%), and sensitivity increased (95%) when at least one positive screening result was used. CONCLUSIONS: Different combinations of the ASD screening instruments DiBAS-R and ACL lead to improvements in sensitivity and specificity. The complementary use of the ACL in addition to the sole use of the DiBAS-R improves overall accuracy.

Attachment relationships of preschool-aged children of mothers with HIV and HIV-related psychosis.

Children from mothers with HIV-related psychosis are frequently raised in challenging contexts, yet the extent to which these children grow up in insecure or disordered attachment relationships is unknown. Using the Strange Situation Procedure the distribution of attachment relationships of children from mothers with HIV and psychosis (n = 45) was compared with children from mothers with HIV without psychosis (n = 41). No significant differences in the distributions were found between the two groups and attachment was not associated with specific psychotic symptomatology. Security of attachment was associated with more people providing the mother with emotional support, but only in the psychosis group. Disordered attachment (24%) was more often found in the total sample than in studies with other normal and high risk populations. Recommendations were made for future research about factors facilitating resilience in the children and on interventions increasing emotional support for affected mothers.

Psychiatric diagnostic screening of social maladaptive behaviour in children with mild intellectual disability: differentiating disordered attachment and pervasive developmental disorder behaviour.

BACKGROUND: Children with intellectual disability (ID) are at risk for maladaptive development of social relatedness. Controversy exists whether Pervasive Developmental Disorder (PDD) takes precedence over disordered attachment for describing maladaptive social behaviour. The aim of this study was to assess the prevalence of disordered attachment symptoms in children with ID referred for mental health diagnosis, and to study the potential diagnostic overlap between symptoms of disordered attachment and PDD symptoms. METHOD: Children (n = 102) in the age of 5-11 with IDs (borderline or mild; IQ 50-85) referred for psychiatric consultation were recruited. Parents were administered a screening interview for disturbances of attachment and teachers were administered a screening questionnaire for PDD. RESULTS: Behavioural symptoms of disordered attachment were reported for 42%* of the children, with 16%* showing symptoms of inhibited and 37%* showing symptoms of disinhibited attachment disorder. In 11% both types of symptoms were noted. Attachment disorder symptoms were not significantly associated with gender, ethnic background or age. Positive screening for PDD occurred for 27%. Positive screening for PDD was not significantly associated with symptoms of attachment disorder. CONCLUSIONS: Among children with ID referred for psychiatric consultation, Reactive Attachment Disorder (RAD) and PDD symptoms were both highly prevalent. RAD and PDD symptoms appear as distinct, but sometimes comorbid, forms of aberrant social relatedness.

The effectiveness of the use of a technology toolkit on activities and mother-child interactions: children with complex care needs.

PURPOSE: Meaningful interactions with significant others are crucial for children's well-being, including those with severe to profound intellectual and multiple disabilities. This study aimed to gain more insight into the potential of an ICT-Toolkit in enhancing or contributing to the interaction between parents and their children with complex care needs. METHODS: A multiple case study with an AB experimental design was conducted. Four mother-child dyads were observed during eight two-and-a-half-hour home visits. Children between 6 and 16 years with severe to profound intellectual and multiple disabilities were included. A participatory research observation approach was used. RESULTS: Using the ICT-Toolkit compared to the baseline phase stimulated a decrease in the repetitive activities of two of the four dyads. Overall, the activity repertoire of the children and the length of time being engaged in individual activities increased, and the activities together increased in three of the dyads. There were more turn-taking interactions; the children took more initiative to engage their mother in their activity, and the children exhibited more affection when engaging with the ICT-Toolkit items. Three mothers followed their children more in their play, and all mothers were more verbally and physically active in instructing and/or motivating their children. DISCUSSION: All mothers noticed their child's "new" behaviour when interacting with an ICT-Toolkit item. The mothers followed the child's lead when engaged with the ICT-Toolkit. The ICT-Toolkit's added effect may be due to the predictability, uncomplicated and highly perceivable stimuli it provides with minimal effort and maximum effect.

A technology toolkit contributes to activities and mother-child interactions for children with intensive care needs.The ICT-Toolkit contributes to more turn-taking interactions and more initiative taking by the children to engage their mother in their activity.Children exhibited more affection towards their mothers when engaging with the ICT-Toolkit items.The participation in this study led mothers of children with intensive care needs to mentalise about the needs of their child and how their behaviour may influence the behaviour of their child.The ICT-Toolkit's added effect may be due to the predictability, uncomplicated and highly perceivable stimuli it provides with minimal effort and maximum effect.

Designing pain visualisation for caregivers of people with special needs: A co-creation approach.

Recognizing pain in people with communicative disabilities is challenging. A support system detecting pain signals provides caregivers with information to intervene adequately. This study aims to develop a design for a user interface visualizing pain experiences for a signalling system intended for caregivers. Caregivers receive alerts, indicating the presence or absence of pain experienced by a disabled individual. The design process included the use of value proposition, a brainstorm, a mood board with basic design elements, and multiple questionnaires and focus groups. During the multi-disciplinary design process end-users were extensively involved. The final design was deemed intuitive, clear and recognizable, and useable in daily caregiving. This article describes the creation process for a non-hedonistic visualization for this niche end-user group.

Scale of emotional development-short: Reliability and validity in two samples of children with an intellectual disability.

BACKGROUND: Intellectual disability (ID) is often accompanied by more significant delays in emotional development than in cognitive development. Diagnostic assessment can provide insight into emotional functioning. However, few standardized assessment instruments are available. AIMS: Examine the reliability and validity of the Scale of Emotional Development-Short (SED-S) in children with ID. METHODS AND PROCEDURES: This methodological instrument validation study was conducted in the Netherlands and Switzerland with children (N = 118) older than 3 and younger than 18 years with ID ranging from profound to mild. Measures included: demographic and medical data, SED-S, and the Vineland. Coherence and reliability of the SED-S were determined using Cronbach's alpha, and validity was examined using Goodman and Kruskal's γ, Kruskal-Wallis H, and Mann-Whitney U tests. OUTCOMES AND RESULTS: The reliability of the SED-S was high, the convergent validity was good, and divergent validity was indicated in relation to autism spectrum disorder (ASD), visual and/or auditory impairment, and adaptive functioning. FURTHER RESEARCH: Research is needed to better understand the implications of ASD and visual and/or auditory impairment on emotional development and their association with (normal) intelligence. Children with ID may also benefit from (more) detailed guidelines for imbalanced profiles on the SED-S.

Physiological Measures of Acute and Chronic Pain within Different Subject Groups: A Systematic Review.

Results: The methods' heart rate variability and electroencephalogram show clear and consistent results as acute pain assessment. Magnetic resonance imaging can measure chronic pain. Ordered by invasiveness and vulnerability, a trend shows that the invasive methods are used more with less vulnerable subjects. Only instruments used for skin conductance and automatic facial recognition have a lower-than-average technological maturity. Conclusions: Some pain assessment methods show good and consistent results and have high technological maturity; however, using them as pain assessment for persons with ID is uncommon. Since this addition can ameliorate caregiving, more research of assessment methods should occur.

The effect of technology assisted therapy for intellectually and visually impaired adults suffering from separation anxiety: Conquering the fear.

Persons with an intellectual disability (ID) are at risk of developing separation anxiety (SA) and, if left untreated, this can be a risk factor for the development of psychopathology. The effects of an intervention, namely technology assisted therapy for SA (TTSA), were examined on the SA, challenging behavior, psychosocial functioning, and quality of life (QOL) experienced by moderate to mild intellectually and visually disabled adults. This study aimed to determine whether TTSA reduces SA and challenging behavior in persons with ID and visual impairment, and if this results in increased psychosocial functioning and QOL. A pre-experimental within-group design with randomized multiple baselines and staggered intervention start-points was used (n = 6). The variables were monitored with standardized instruments. The frequencies of each participant's use of the technology and the frequency and intensity of their behavior were recorded over time. Results indicate that the SA and challenging behavior experienced by the participants decreased significantly and their psychosocial functioning and QOL increased significantly. The conclusions are that TTSA has the potential to be a valid intervention to address SA in adults with visual and moderate to mild IDs.

"Stop bullying now!" Investigating the effectiveness of a serious game for teachers in promoting autonomy-supporting strategies for disabled adults: A randomized controlled trial.

BACKGROUND: Individuals with disabilities are at heightened risk for bullying and can lack the ability to cope in bullying situations. Teachers and caregivers have an important responsibility to promote optimal strategies for individuals with disabilities to cope with bullying. Three types of strategies have been identified: autonomy-supporting, autonomy-neutral, and autonomy-undermining strategies. OBJECTIVES: The current study investigates the effectiveness of a serious game, "Stop bullying now!", for teachers to use in working with individuals with disabilities to enhance autonomy-promoting strategies and increase generalized self-efficacy. METHODS: In this superiority parallel randomized controlled trial, we tested 150 participants in three conditions: the experimental group (n = 62) played the serious game for 20 min, the active control group (n = 41) read a digital information package about bullying, and the passive control group (n = 47) read a digital information package that was not bullying related. Outcomes were measured before and after the interventions and at 4-6 weeks of follow-up. RESULTS: The serious game significantly improved autonomy-supporting strategies post-intervention, and marginally significant effects were identified at follow-up. The experimental group did not significantly differ from the active control group, and the experimental group and the active control group showed significant improvements compared to the passive control group. CONCLUSIONS: Findings suggest that playing the serious game yields positive effects in promoting autonomy-supporting strategies compared to not receiving an intervention. The effects are comparable to reading the information based on which the game was developed.

Developing a therapeutic relationship with a blind client with a severe intellectual disability and persistent challenging behaviour.

PURPOSE: A blind, severely intellectually impaired boy aged 17 with Down syndrome and persistent serious challenging behavior received attachment-based behavior modification treatment. The aim was to study the effect of the treatment and the development of the therapeutic attachment relationship. METHOD: In a single-case study, attachment therapy sessions alternated with control sessions. Treatment started with attachment therapy (phase 1), followed by behavior modification (phase 2). The instruments used were: Residential observation lists for challenging behavior, video analyses of attachment behavior in therapy sessions and physiological indicators of affect regulation measuring the pre-ejection period (PEP) and respiratory sinus arrhythmia (RSA) as indices of cardiac sympatho-vagal activity. RESULTS: The client exhibited less frequent and less intensely challenging behavior. The data indicated more appropriate replacement behavior and less PEP arousal during the behavior modification treatment given by the attachment therapist compared to the control therapist who used the same protocol. The client showed more active and longer-lasting attachment behavior, especially proximity seeking, towards the attachment therapist than towards the control therapist. CONCLUSIONS: Attachment-based psychotherapy proved successful in eliciting attachment behavior in a severely intellectually disabled, socially deprived, behaviorally and affectively dysregulated adolescent. The resulting relationship proved to be a therapeutic platform conducive to behavior change.

The effectiveness of a serious game to enhance empathy for care workers for people with disabilities: A parallel randomized controlled trial.

BACKGROUND: Empathic care is fundamental in healthcare settings and is associated to several positive outcomes for care workers (i.e. burnout, compassion satisfaction) and patients (i.e. therapeutic alliance, trust, wellbeing). Yet, studies showed a decrease in empathy in care workers, which is argued to be a product of personal distress. Thus, interventions should aim at enhancing empathy in care workers working for vulnerable populations to ensure optimal client-carer relationships. OBJECTIVES: The current study investigates the effectiveness of the serious game "The world of EMPA" in enhancing empathy in care workers for people with disabilities, and tests the effect of personal distress on empathy change post intervention. METHODS: We conducted a superiority parallel randomized controlled trial (RCT) and tested 224 participants in two conditions: the experimental group (n = 111) played a serious game and the control group (n = 113) read a digital information package about disabilities. Participants were assessed on empathy and personal distress prior to and after the intervention. RESULTS: Main results showed that the serious game did not significantly enhance empathy in care workers, whereas reading a digital information package yield a significant decrease in empathy. Exploratory analysis showed that the serious game decreased significantly personal distress in care-workers. CONCLUSIONS: This study showed that while the serious game "The world of EMPA" did not enhance empathy, it resulted in a decrease in personal distress in care workers for people with disabilities. Further evidence should corroborate these findings to unveil the mechanisms of this intervention and the long-term effects on personal distress.

Caregiver-mediated therapy for an adult with visual and intellectual impairment suffering from separation anxiety.

BACKGROUND: Separation anxiety among intellectually disabled (ID) persons with comorbid visual impairment could be rooted in a weak sense of person permanence. Technology-assisted Therapy for Separation Anxiety (TTSA) was used to address this problem. AIMS: The primary aim was to determine whether technology alone or including caregivers was the best option, and whether TTSA decreased separation anxiety and challenging behaviour. Also, how the caregivers and the client experienced TTSA. METHODS AND PROCEDURES: A pre-experimental, quantitative approach (AB1C1B2C2D) was used for this single-subject study. The frequency of the client's text messages was recorded daily. The variables were monitored with standardised instruments and caregivers rated the intensity and frequency of the client's anxious and challenging behaviour. The social validity was evaluated by means of questionnaires. OUTCOMES AND RESULTS: There was a significant decrease in the anxious and angry messages sent, and in anxious and challenging behaviour, in the phase in which the caregivers were included, compared with the phase in which technology alone was used. The client and the caregivers were positive about TTSA. CONCLUSION AND IMPLICATION: Technology and the caregivers reactions reduces the anxiety and challenging behaviour. It might also aid the acquisition of the concept of person permanence.

Self-controlled technologies to support skill attainment in persons with an autism spectrum disorder and/or an intellectual disability: a systematic literature review.

Persons with an autism spectrum disorder and/or intellectual disability have difficulties in processing information, which impedes the learning of daily living skills and cognitive concepts. Technological aids support learning, and if used temporarily and in a self-controlled manner, they may contribute to independent societal participation. This systematic review examines the studies that applied self-controlled technologies. The 28 relevant studies showed that skills and concepts are learned through prompting, interaction with devices, and practicing in (realistic) virtual environments. For attaining cognitive concepts, advanced technologies such as virtual reality are effective. Five studies focussed on cognitive concepts and two on emotion concepts. More research is necessary to examine the generalization of results and effect of using technology for learning cognitive and emotional concepts. Implications for Rehabilitation Persons with a moderate to mild intellectual disability and/or with autism can use self-controlled technology to learn new activities of daily living and cognitive concepts (e.g. time perception and imagination). Specific kinds of technologies can be used to learn specific kinds of skills (e.g. videos on computers or handheld devices for daily living skills; Virtual Reality for time perception and emotions of others). For learning new cognitive concepts it is advisable to use more advanced technologies as they have the potential to offer more features to support learning.

Supporting affect regulation in children with multiple disabilities during psychotherapy: a multiple case design study of therapeutic attachment.

In a controlled multiple case design study, the development of a therapeutic relationship and its role in affect regulation were studied in 6 children with visual disabilities, severe intellectual disabilities, severe challenging behavior, and prolonged social deprivation. In the 1st phase, children had sessions with an experimental therapist stimulating therapeutic attachment, alternating with a control therapist providing positive personal attention only. In the 2nd phase, both therapists applied behavior therapy. Clients sought more proximity to the experimental therapist compared with the control therapist. Psychophysiological arousal (respiratory sinus arrhythmia and pre-ejection period) was lower when the experimental therapist applied behavior modification than when the control therapist did. Despite prolonged social deprivation, the attachment behavioral system appeared responsive to stimulation. The effects on affect regulation may explain the synergy between psychotherapy based on interpersonal and behavior modification approaches.