Welcome to the latest evidence bulletin
This new Evidence Bulletin is formatted differently from previous issues as it combines the Monthly Bulletin and Quarterly Update. It includes extended summaries of three articles and links to newly published articles by topic.
The Bulletin also continues to be available in PDF format, as many people have told us that they like this facility.
We have created extended summaries of three recent papers for this month’s bulletin, looking at:
- What differences exist between patients in the same facility, with or without forensic involvement
- Risk factors for tardive dyskinesia, and
- Personal goal setting as a way of helping people achieve their outcomes
back to top Mental health
Are there differences in the profiles of patients in the same specialist service, with and without forensic involvement?
This retrospective chart review of 78 individuals (39 forensic and 39 non-forensic) supported in an intellectual disability service in Canada between 2006 and 2008, looked at potential similarities and differences between two matched groups. The study found that the forensic sample was more likely to have a diagnosis of borderline to mild ID and that psychotic disorder was more common in this group. Forensic patients were also found to have had issues with the abuse of drugs and alcohol in their past, suggesting a need for more interventions to be developed for this group.
Forensic inpatients had significantly longer lengths of stay than those in the non-forensic group and were also more likely to change residence from admission to discharge. Global Assessment of Functioning (GAF) scores did not differ between the two groups at admission or discharge however.
Although only 39% of the forensic group and 14% of the non-forensic group were given a psychotic disorder diagnosis, 75% (n = 27) and 77% (n = 27) were prescribed at least one antipsychotic medication respectively. Anxiolytics and anti-depressants were also prescribed.
Higher rates of personality disorders were not found amongst the forensic group and an equal gender distribution was found amongst the forensic clients.
The authors found an even gender distribution, despite findings elsewhere suggesting there would be a greater proportion of men in the forensic group. One possible explanation put forward by the authors suggests that an increasing number of women with ID and mental health problems are being legally charged for behaviours due to unrecognized mental health concerns, particularly when symptoms are internalizing in nature.
Finally, the authors raise a concern that 18% (n = 7) of the forensic clients were given a diagnosis in the moderate–severe level of intellectual disability, and they suggest that it may be inappropriate to legally charge such individuals.
A comparison study of adults with intellectual disability and psychiatric disorder with and without forensic involvement, Raina P & Lunsky Y, in Research in Developmental Disabilities 31, 1, 218-223
Link to LDSC Extended summary
We also found five further single studies.
the first, using PAS-ADD found mental health problems in 24% of a sample of 92 adults with Williams syndrome. The most common problem was anxiety (16.5%). Mental Health Problems in Adults With Williams Syndrome, Stinton C et al., in American Journal on Intellectual and Developmental Disabilities, 115, 1, 3–18
Link to article: http://tinyurl.com/mhN0201
See other mental health single studies on the website
back to top Challenging Behaviour
Are there identifiable predispoing factors for tardive dyskinesia?
Side effects of psychotropic medications, commonly used in treatment in large-scale facilities for adults with learning disabilities have been long recorded. This study looked at Tardive dyskinesia (TD), involuntary, repetitive movements caused by a history of neuroleptic medication use. This is a serious disorder which can severely impact on quality of life. The study looked at the possibility of identifying predisposing factors for TD in a population of adults with learning disabilities.
Participants in the study were 264 in-patients (male 130, female 134) with intellectual disabilities from one of two developmental centres in the US who were participating in a broader study of side effects from long term psychotropic use in adults with ID. Data were collected during quarterly psychiatric evaluations as part of treatment planning. Each participant was also individually observed within the centre to rate presence of extra-pyramidal motoric movements. Two primary outcome groups (no presence of tardive dyskinesia [non-TD] and tardive dyskinesia [TD]) established following administrations of the MEDS protocol. 145 individuals were classified as belonging to the Non-TD group. 119 (45.1%) individuals were classified as belonging to the TD group.
In the TD group, 99% had been on their medications for over a year. 79%had been on psychotropic medications for longer than 10 years.
The study found that that age, gender, age x gender, Axis I diagnosis, level of learning disability, recent medication use, lifetime medication use, antipsychotic use, SSRI use, and total psychotropic dose when considered together significantly predicted whether or not an individual met criteria for TD.
The authors suggest the data reinforce previous research showing cognitive impairment and age to be significant risk factors for TD. They suggest the more severe the intellectual disability the greater the risk of TD becomes. The authors conclude that given the mounting evidence on the untoward effects of psychotropic drugs, they should be used carefully and sparingly. In addition they suggest that increasing evidence on the effectiveness of operant methods for challenging behaviours for example merits a reassessment of current practices.
Risk factors for tardive dyskinesia in adults with intellectual disability, comorbid psychopathology, and long-term psychotropic use, Matson J et al. in Research in Developmental Disabilities, 31, 1, 108-116
Link to LDSC Extended summary
In addition we found five single studies,
The first looked at the experiences of parents’ use of restraint, where the authors recommend that professionals work in partnership with parents and provide training and advice about restraint. 'A Very Fine Line': Parents' Experiences of Using Restraint with Their Adult Son/Daughter with Intellectual Disabilities, Elford H et al, in Journal of Applied Research in Intellectual Disabilities 23, 1, 75 – 84
Link to article: http://tinyurl.com/cbN0202
See other challenging behaviour single studies on the website
back to top Supporting Family Carers
We found five single studies this month, one of which, using data from the UK's Millennium Cohort Study, suggests that children with early cognitive delay (ECD) were significantly less likely than others to be living in households with both biological parents or in households where the mother was married and that families with a child with ECD were more likely than others to experience changes in family composition and marital status over the first 5 years of the child's life. Changes in Family Composition and Marital Status in Families with a Young Child with Cognitive Delay, Hatton C et al., in
Journal of Applied Research in Intellectual Disabilities 23, 1, 14-26
Link to article: http://tinyurl.com/sfcN0202
See other supporting family carers single studies on the website
back to top Health
We found three single studies this month. One found a prevalence rate for anaemia of 11.6% in children and adolescents with ID. Prevalence and associated risk factors of anemia in children and adolescents with intellectual disabilities, Jin-Ding Lin et al., in Research in Developmental Disabilities, 31, 1, 25-32
Link to article: http://tinyurl.com/hlthN0202
See other health single studies on the website
back to top Person Centred Services
Can Goal setting help people get the lives they want?
This study set out to examine the usage and outcomes of a goal setting approach with individuals living in different types of supported accommodation over an 18-month period and to identify the variables that helped or hindered individuals in achieving their stated goals they set.
130 participants were recruited (average age 45 years; 81 (62.3%) female. All were white Irish/British. People lived in one of four forms of supported accommodation including registered care homes with 24 support staff; shared homes where people had a tenancy agreement and individual funding packages to cover support staffing; supported living and clustered and dispersed housing schemes. A Person-centred plan was in place for nearly all participants in shared housing and clustered supported living,
Researchers carried out individual structured interviews at three time points, 9 months apart where participants were invited to think about three things ('goals') they would like to try in following 6–9 months and keep a record of goals chosen; goals achieved and not achieved, and issues relating to achievement and non achievement.
The most commonly chosen goals involved social activities with other people. Over half the participants reported attaining at least one of their goals within 9 months, particularly those in supported living arrangements with more hours of staff support.
Interestingly, as time went on, fewer people chose goals, although the same proportion as before were successful. Information provided support given by staff was the main factor associated with goal attainment.
The authors conclude that gains can be achieved from using goal setting to enable tenants in various accommodation options to participate in more social activities, although the crucial role of support staff in goal attainment was clearly highlighted in the findings.
Using personal goal setting to promote the social inclusion of people with intellectual disability living in supported accommodation, McConkey R & Collins S, in Journal of Intellectual Disability Research, 54 2 135-143
Link to LDSC Extended Summary
back to top Autism
We found one single study this month, a randomised clinical trial which found that that a self-directed learning program produced positive results, with parents reporting high ratings of satisfaction. The Use of a Self-Directed Learning Program to Provide Introductory Training in Pivotal Response Treatment to Parents of Children with Autism, Nefdt N et al., in Journal of Positive Behavior Interventions, 12, 1, 23-32
Link to article: http://tinyurl.com/autN0201
back to top Profound and Multiple Disabilities
We found one single study which suggested Snoezelen intervention decreased disruptive behaviours in individuals with autism and Stimulus Preference increased pro-social behaviours in participants with profound learning disabilities with co-occurring poor motor and linguistic abilities. Multi-sensory rooms: Comparing effects of the Snoezelen and the Stimulus Preference environment on the behavior of adults with profound mental retardation, Fava, L & Strauss K in Research in Developmental Disabilities, 31, 1, 160-171
Link to article: http://tinyurl.com/pmldN0201
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