The experiences of therapists providing psychological treatment for adults with depression and intellectual disabilities as part of a randomised controlled trial.

BACKGROUND: Health professionals were trained to deliver adapted psychological interventions for depression to people with learning disabilities and depression alongside a supporter. Exploring the delivery of psychological interventions can help increase access to therapy. METHOD: Twenty-seven participants took part in six focus groups, and the data were subject to a Framework Analysis. RESULTS: The structure and focus of the manualised therapies, and the use of specific techniques were perceived as key to service-user engagement. Supporters' involvement was valued by therapists if they had a good relationship and regular contact with the individual they supported. Regular clinical supervision was regarded as vital in understanding their role, assessing progress and delivering the interventions. CONCLUSIONS: The findings highlight that health professionals can embrace a focussed therapeutic role and increase access to psychological therapies for people with intellectual disabilities.

The benefits of errorless learning for people with amnestic mild cognitive impairment.

The aim of this study was to explore whether errorless learning leads to better outcomes than errorful learning in people with amnestic mild cognitive impairment (MCI), and to examine whether accuracy in error recognition relates to any observed benefit of errorless over errorful learning. Nineteen participants with a clinical diagnosis of amnestic MCI were recruited. A word-list learning task was used and learning was assessed by free recall, cued recall and recognition tasks. Errorless learning was significantly superior to errorful learning for both free recall and cued recall. The benefits of errorless learning were less marked in participants with better error recognition ability. Errorless learning methods are likely to prove more effective than errorful methods for those people with MCI whose ability to monitor and detect their own errors is impaired.

The role of shame in the development and maintenance of psychological distress in adults with intellectual disabilities: A narrative review and synthesis.

BACKGROUND: The role of shame in the development and maintenance of psychological distress in adults with mild-to-moderate intellectual disabilities has been relatively under-researched. This study provides a review of diverse current research that has implicitly or explicitly investigated shame processes in this population in some form. METHODS: A narrative review of the literature was undertaken. An electronic search of four databases identified 17 studies that met the eligibility criteria. RESULTS: Findings indicate that individuals with mild-to-moderate intellectual disabilities may experience difficulties with both external and internal shame, which appear to be related to increased psychological distress. Experiences of being shamed may significantly negatively impact on self-to-self and other self-relating, processes of social comparison, subsequent self-worth and emotional well-being. CONCLUSION: Shame may be a contributory factor in the development and maintenance of psychological distress and subsequent mental health issues in some adults with mild-to-moderate intellectual disabilities.

"We are all there silently coping." The hidden experiences of parents of adults with Asperger syndrome.

BACKGROUND: The experiences of older parents of adults with Asperger syndrome have not been explored in the research literature. METHOD: Four families who had middle-aged offspring with Asperger syndrome were interviewed (3 mothers and 1 couple), and the interviews were analysed using interpretative phenomenological analysis (IPA). RESULTS: Six themes emerged from the analysis: (a) providers of "hidden" support, (b) role of advocate, (c) social isolation, (d) intrafamilial relationships, (e) support for parents, and (f) future concerns. CONCLUSIONS: The findings of this study offer insight into the experience of parents of adult sons with Asperger syndrome. Implications for future support interventions and research are suggested.

Behavior-Analytic Approaches to Working with People with Intellectual and Developmental Disabilities who Develop Dementia: a Review of the Literature.

Behavior analysis has made contributions in the development of evidence-based interventions for people with intellectual and developmental disabilities (IDD), and there is a growing evidence base for behavior-analytic interventions for older adults with dementia. As there is an increased number of adults with IDD living to old age, and an increased prevalence of comorbid dementia in people with IDD, a review of the behavior-analytic contributions with this population is warranted. We searched Web of Science and PsycInfo and manually reviewed the last 20 years of five behavioral journals. Six behavior-analytic studies with people with IDD and dementia were identified, and all but one were published outside of core behavior-analytic journals. These articles were analyzed in terms of Baer, Wolf, and Risley's (Journal of Applied Behavior Analysis, 1, 91-97, 1968) seven dimensions of applied behavior analysis (ABA). The possible explanations and implications of these findings are discussed with consideration of the unique features of a comorbid diagnosis of IDD and dementia that may make it appropriate for increased focus in behavior-analytic research and practice.

Diagnosis, disclosure, and having autism: an interpretative phenomenological analysis of the perceptions of young people with autism.

BACKGROUND: Although there is extensive research examining parental experiences of assessment and diagnosis of autism, there is a paucity of research from the perspective of individuals with autism. METHOD: Semi-structured interviews were conducted with nine young people with high functioning autism who were capable of providing a verbal account of their perceptions of autism and diagnosis experiences. Data were analysed using interpretative phenomenological analysis. RESULTS: Diagnosis, and the disclosure of the diagnosis of autism, were embedded in respondents' perceptions of "having" autism. This superordinate theme included five themes: (i) disclosure delay, (ii) providing explanations, (iii) potential effects of labelling, (iv) disruptions and opportunities, and (v) acceptance and avoidance. CONCLUSION: In relation to the existing literature, it is suggested that the effects of diagnosis, or disclosure of diagnosis, from the perspective of the person with autism be given greater consideration.

Care staff attributions about challenging behaviors in adults with intellectual disabilities.

A number of researchers have explored the attributions that care staff make about challenging behavior. The expectation, based on behavioral and cognitive models, is that these attributions may help predict why staff inadvertently reinforce challenging behavior. Two studies of staff attributions about challenging behavior are reported. In the first, a high level of consistency in attributions across staff was found. In a second quasi-experimental study, staff made attributions about two known clients' behavior. Analysis of these data showed that attributions varied in a manner broadly consistent with the hypothesized functions of the behaviors. The weight of the evidence suggests that staff may be sensitive to the causes of challenging behavior. The practical implications of these data are discussed.

'I'm really glad this is developmental': autism and social comparisons - an interpretative phenomenological analysis.

The present qualitative study comprised interviews with nine young people with autism (aged 16-21 years) about their perceptions of autism. Using interpretative phenomenological analysis, three underlying themes were illuminated, and all these formed the superordinate theme Making Comparisons: (a) Changes over time: 'I'm really glad this is developmental'; (b) Degrees of autism: 'They've got it really bad'; and (c) Degrees of ability: 'I'm not really disabled-disabled'. Such comparisons were not explicitly sought at the outset of the study, and instead emerged from their conceptualisations of the autism concept. When comparing how they perceived themselves now, and how they perceived themselves in the past, the young people viewed themselves more positively in the present. In addition, when making comparisons with other people with autism, they tended to locate themselves as being in a better position than others were. The perspective of being in a more fortunate position because of heightened abilities also emerged from the comparisons made with people who did not have autism. Furthermore, similar comparisons were made when autism was compared to disability, with autism being evaluated as being more favourable than what was termed 'proper' disability. The results of this study are discussed in relation to the existent social comparison literature.

BEAT-IT: Comparing a behavioural activation treatment for depression in adults with intellectual disabilities with an attention control: study protocol for a randomised controlled trial.

BACKGROUND: Depression appears to be more enduring amongst people with intellectual disabilities, suggesting that it is a more chronic problem or more poorly managed in this population. This is not helped by a lack of evidence about the effectiveness of psychological therapies for people who have intellectual disabilities and depression. Behavioural activation, which aims to counteract depression by increasing individuals' level of meaningful activity and their exposure to positive reinforcers, has proven to be as effective as cognitive behavioural therapy in the general population. Given that this therapy makes fewer communicative demands and focuses on activity, it was thought that behavioural activation would be both accessible and apt for people with intellectual disabilities, who are often socially marginalised. METHODS/DESIGN: This study is a multi-centre single-blind randomised controlled trial of behavioural activation versus a self-help attention control intervention for depression in adults with mild/moderate intellectual disabilities. The study has an internal pilot in one centre, to establish that recruitment can be built up and sustained at the required level, before being rolled out across the other sites. One hundred sixty-six participants will be randomly assigned to the behavioural activation or self-help interventions, which will be delivered to individuals with mild to moderate intellectual disabilities, accompanied by someone who provides them with regular support. Both interventions are manualised and will be delivered over a period of approximately 4 months. The primary outcome measure will be the Glasgow Depression Scale, a self-report measure which is completed at baseline and 4 and 12 months post-randomisation. Secondary outcomes include measures of participants' activity levels, proxy reports of depressive symptoms, and cost-effectiveness. DISCUSSION: The study will provide evidence about the effectiveness of behavioural activation for depression, adapted for people who have mild/moderate intellectual disabilities, and will inform the delivery of psychological therapies to people with intellectual disabilities in practice. TRIAL REGISTRATION: Date trial registered: Nov. 13, 2012; trial registration number: ISRCTN 09753005.

Mental retardation and memory for spatial locations.

Although memory for spatial location has been frequently investigated with mentally retarded populations, it is not clear that these individuals possess the same spatial memory skills as do their peers without mental retardation. We compared 30 persons with and 30 persons without mental retardation. Following either intentional or incidental learning, participants recalled and then relocated 16 objects on a matrix. The control group recalled more intentionally learned than incidentally learned material. The experimental group performed both tasks better after incidental learning than after intentional learning and scored as highly as the controls on incidental spatial memory. Results suggest that memory for spatial location is an automatic process and, to some extent at least, is not directly affected by the individual's level of intelligence.

Outcomes of anti-bullying intervention for adults with intellectual disabilities.

Although existing research is scarce, evidence suggests that children and adults with intellectual disabilities may be at increased risk of being bullied (as they are for maltreatment generally) and possibly more likely than those without disabilities to also engage in bullying behavior. Despite significant clinical interest in bullying, we could find no published research on the outcomes of bullying intervention for individuals with intellectual disabilities. Adults with intellectual disabilities in three work center settings participated in one of two interventions for perpetrators and/or victims of bullying: (a) psychoeducational intervention with a cognitive behavioral orientation (n=20), or (b) the same intervention but with additional involvement of community stakeholders such as parents, the police, and local schools (n=22). A third work center (n=18) acted as a waiting list control comparison. Pre-intervention, 43% of participants reported that they had been bullied within the preceding three months and 28% identified themselves as having bullied others. Reports of being bullied decreased significantly within the two intervention groups over time but not in the control group. There were no differences between the two intervention groups, and no statistically significant reduction in self-reported bullying behavior. Initial data on this intervention suggest that its effects might be clinically meaningful with an associated Numbers Needed to Treat for reduction in exposure to bullying of 5.55.

Errorless learning in the rehabilitation of memory impairment: a critical review.

This review considers the origins of the errorless learning (EL) concept, its application in memory rehabilitation, the evidence for its effectiveness, and the theoretical basis for the observed findings. The evidence suggests that EL offers valuable benefits for at least some people with memory impairments when teaching certain types of tasks. However, the benefits are not evident for all groups, some findings are equivocal, and there are some limitations associated with this approach. We discuss methodological issues impacting on these mixed findings, consider which theoretical explanations might account for the findings regarding benefits and limitations of EL, and comment on the implications for rehabilitation practitioners of the current state of evidence in this area.

Practitioner consensus in the use of cognitive behaviour therapy for individuals with a learning disability.

Cognitive behaviour therapy (CBT) has been acknowledged as one of the most successful treatments for mental health problems. However, only a small number of practitioners engage in CBT with people with learning disabilities. A group of eight clinical psychologists who currently use CBT with this population gave details about their work in an attempt to gain a consensus on how to adapt CBT. The collective experiences of a wider group of experts produced a wealth of knowledge and suggestions to promote the use of CBT with this client group. Results suggested that although CBT needs to be creatively delivered, it does not necessarily need extensive adaptation.

Spatial negative priming in early Alzheimer's disease: evidence for reduced cognitive inhibition.

Some studies of negative priming and other tasks assumed to reflect inhibitory functions suggest a decline in inhibitory processes in Alzheimer's disease. However, none of the measures used in previous studies can be interpreted as an unambiguous reflection of distractor inhibition. The present study investigates whether reductions in negative priming associated with Alzheimer's disease reflect reduced distractor inhibition, rather than perceptual review processes. Individuals with early Alzheimer's disease were predicted to show reduced negative priming on a spatial localization task designed to provide an unambiguous measure of distractor inhibition. Sixteen clinical participants showed significantly less negative priming than old and young healthy control groups, which is interpreted as evidence for reduced distractor inhibition in early dementia. A second analysis indicated that, within the clinical sample only, negative priming effect size was significantly correlated with prime trial response speed. Clinical participants showing the least negative priming were slower to respond to an initial stimulus. The results may mean that people with early Alzheimer's disease have a reduced capacity to use excitatory as well as inhibitory processes in selection.