An initial assessment of the psychometric properties of the Complicated Grief Questionnaire for People with Intellectual Disabilities (CGQ-ID).

Given the research evidence that people with intellectual disability (ID) do grieve following bereavement, the present study aimed to describe and gather preliminary psychometric data for a version of the Inventory of Complicated Grief [Prigerson, H. G., Maciejewski, P. K., Reynolds, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., et al. (1995). Inventory of Complicated Grief: A scale to measure maladaptive symptoms of loss. Psychiatry Research, 59, 65-79] adapted for use with this population. Carers completed the Complicated Grief Questionnaire for People with ID (CGQ-ID) for 76 individuals with ID, half of whom had experienced a parental bereavement within the last 2 years. The final scale and subscales (Separation Distress and Traumatic Grief) showed very good internal and inter-rater reliability and distinguished between the two groups. While the findings suggest that the CGQ-ID is suitable for identifying complicated grief-type symptoms among adults with ID, further research must be conducted to ascertain whether the findings can be replicated.

The psychometric properties of the Attention-Distraction, Inhibition-Excitation Classroom Assessment Scale (ADIECAS) in a sample of children with moderate and severe intellectual disabilities.

The Attention-Distraction, Inhibition-Excitation Classroom Assessment Scale (ADIECAS) [Evans, P. L. C. (1975). Inhibition and stimulus generalization in the discrimination learning of ESN(S) and ESN(M) children. Unpublished Ph.D. thesis. Manchester, UK: University of Manchester] assesses attention-related difficulties in children with intellectual disabilities (ID). The present study explored the psychometric properties of the ADIECAS with a sample of 84 children with moderate and severe ID whose teachers completed the ADIECAS and the Conners' Teachers Rating Scale [Goyette, C. H, Conners, C. K., & Ulrich, R. F. (1978). Normative data on revised Conners' parent and teachers rating scales. Journal of Abnormal Child Psychology, 6, 221-236]. Following factor analysis the Evans and Hogg [Evans, P. L. C., & Hogg, J. (1984). A classroom rating scale for use with mentally retarded children. British Journal of Clinical Psychology, 23, 187-194] structure was the most appropriate for use with this sample. Moderate to strong positive relationships were found between the ADIECAS and the Conners', and the ADIECAS factors were significant predictors of the Conners' subscales. This study provides further support for the ADIECAS as a reliable and valid measure of ADHD-related symptoms among children with moderate and severe ID.

The challenge of applying mental health law reform to the intellectual disability sector in Ireland.

The full implementation of the Irish Mental Health Act 2001 brings about the introduction of an altered legal definition of mental disorder, mandatory review of involuntary detention within a 21-day period and new statutory rules regarding the use of seclusion and mechanical means of bodily restraint. This legislation came into full effect on November 1, 2006. The implications of this for the intellectual disability psychiatry sector are profound and the full ramifications of these changes will only become fully apparent over time. This also occurs at a time when we are facing unprecedented developments in government mental health policy, major changes to postgraduate training in psychiatry, difficulty recruiting appropriately skilled staff and increasing legal requirements on employers to ensure staff safety. Several of these drivers for change may appear at face value to be in conflict and a complex balance will be required if these changes are to be blended to ultimately improve the care provided to clients of our services.

Recognising, assessing and managing offending behaviour in persons with intellectual disability.

The association between intellectual disability and offending is complex. Recent evidence would suggest that the received wisdom of intellectually disabled persons being more prone to offending is either incorrect or only tells part of the story. Those within the 'borderline' intellectual disability range may be more prone to committing sexual and criminal damage offences but those with an IQ less than 50 rarely offend. The offender with intellectual disability shares characteristics with his counterpart from the general population. As with the general population as a whole, offending in this group is often unreported and its recognition is complicated by issues of competence. The lack of validated forensic assessment schedules for this population poses a further challenge. Some general approaches to assessment in this population are discussed. This case report illustrates the difficulties of assessing and managing offending behaviour in an individual with moderate intellectual disability. The challenge of treating offenders with an intellectual disability is immense and requires specialist expertise. Managing such cases in a generic setting is inappropriate and the need for a forensic learning disability service in Ireland is highlighted.

Combining psychiatric and psychological approaches in the inpatient assessment of aggression in a client with moderate intellectual disability.

The literature on challenging behaviour is large, with heavy emphasis on behavioural approaches. In recent years more attention has been given to the effect of psychiatric illness on the behaviour of people with intellectual disability. However, theoretical differences between disciplines can lead to one or other approach dominating the assessment process. Increasingly, functional assessment is receiving attention as an assessment approach by both psychiatrists and psychologists. When used properly it can give a holistic overview of the individual and their behaviour, allowing a team approach to assessment and treatment that ensures the consideration of all possible psychiatric/medical/behavioural/environmental possibilities (a bio-behavioural model) in the aetiology and maintenance of challenging behaviour. This case study illustrates the effectiveness of teamwork in this area using functional assessment as a tool. The case also illustrates the possible futility of such comprehensive assessments of challenging behaviour in the absence of appropriate resources to implement the recommendations of such an assessment.

Dysmorphic features and learning disability in an adult male with pure partial trisomy 17q24-q25 due to a terminal duplication.

We describe an adult male with severe learning disability, epilepsy, and dysmorphic features. Cytogenetic studies demonstrated a terminal duplication of the long arm of chromosome 17, resulting in partial trisomy 17q24-q25. Our patient shows some of the characteristic features of the distal 17q phenotype, but in addition has more unusual features such as epilepsy, sensorineural hearing loss, and long fingers and overlapping toes. We suggest that these features occur with terminal duplications of 17q.