The Impact of Training and Staff Attributions on Staff Practice in Learning Disability Services: A Pilot Study

The present study examines the impact of a training course which has previously been found to significantly increase the knowledge of staff working in learning disability services on staff attributions and practice. No significant changes were found in staff (n = 39) attributional dimensions following training. However, a decrease in the use of the attributional category ‘communication deficit’ was found 8 weeks after training. Staff rated their knowledge levels as higher both immediately following training and 8 weeks later. The subgroup (n = 14) of staff who were examined in relation to staff practice were found to change their practice significantly from baseline to follow-ups 4 and 5 months later. Methodological limitations and implications of the study are discussed

Implementation of an evidence-based seizure algorithm in intellectual disability nursing: A pilot study

Based on the results of the Surrogate Decision-Making Self Efficacy Scale (Lopez, 2009), this study sought to determine if nurses working in the field of intellectual disability experience increased confidence when they implemented the “American Association of Neuroscience Nurses Seizure Algorithm” during telephone triage. The results of the study indicated using the AANN Seizure Algorithm increased self-confidence for many of the nurses in guiding care decisions during telephone triage. The treatment effect was statistically significant -3.169, p, .01 for a small sample of study participants. This increase in confidence is clinically essential for two reasons. Many individuals with intellectual disability and epilepsy reside within community based settings. Intellectual disability nurses provide seizure guidance to this population living in community based settings via telephone triage. Nurses improved confidence is clinically essential and has implications for practice. Evidenced-based training tools provide a valuable mechanism by guiding nurses via best practices. Nurses may need to be formally trained for seizure management due to high epilepsy rates in this population

Reading and arithmetic in adolescents with autism spectrum disorders: Peaks and dips in attainment

In describing academic attainment in autism spectrum disorders (ASD), results are typically reported at the group mean level. This may mask subgroups of individuals for whom academic achievement is incommensurate with intellectual ability. The authors tested the IQ, literacy, and mathematical abilities of a large group (N = 100) of adolescents (14–16 years old) with ASD. Seventy-three percent of the sample had at least one area of literacy or mathematical achievement that was highly discrepant (approximately 14 standard score points) from full-scale IQ (FSIQ). The authors focused on four subgroups with either word reading (“Reading Peak” and “Reading Dip”) or arithmetic (“Arithmetic Peak” and “Arithmetic Dip”) higher or lower than FSIQ. These subgroups were largely mutually exclusive and were characterized by distinct intellectual profiles. The largest was the “Arithmetic Peak” subgroup of participants, who presented with average intellectual ability alongside superior arithmetic skills and who were predominantly in a mainstream educational setting. Overall, the most pervasive profile was discrepantly poor reading comprehension, which associated with severity of social and communication difficulties. The high rate of uneven academic attainment in ASD has implications for educational practice

Profiling executive dysfunction in adults with autism and comorbid learning disability

Executive dysfunction is thought to be primary to autism. We examined differences in executive function between 20 adults with autism and learning disability and 23 individuals with learning disabilities outside the autistic spectrum. All participants were matched for chronological age and full-scale IQ, and were given a battery of tasks assessing fluency, planning, set-shifting, inhibition and working memory. Analyses of the individual tasks revealed very few significant differences between the two groups. However, analyses of composite scores derived for each executive domain revealed that the group with autism showed impaired performance on the working memory and planning tests. Together, these two measures were sufficient to classify participants into their diagnostic groups significantly better than would be expected by chance (75% of the autism group; 65% of the control group). Executive impairments were neither universal nor exclusive to the autism group, and we suggest that an alternative cognitive theory may better explain the cognitive profile we found

Weight management interventions in adults with intellectual disabilities and obesity: a systematic review of the evidence

o evaluate the clinical effectiveness of weight management interventions in adults with intellectual disabilities (ID) and obesity using recommendations from current clinical guidelines for the first line management of obesity in adults. Full papers on lifestyle modification interventions published between 1982 to 2011 were sought by searching the Medline, Embase, PsycINFO and CINAHL databases. Studies were evaluated based on 1) intervention components, 2) methodology, 3) attrition rate 4) reported weight loss and 5) duration of follow up. Twenty two studies met the inclusion criteria. The interventions were classified according to inclusion of the following components: behaviour change alone, behaviour change plus physical activity, dietary advice or physical activity alone, dietary plus physical activity advice and multi-component (all three components). The majority of the studies had the same methodological limitations: no sample size justification, small heterogeneous samples, no information on randomisation methodologies. Eight studies were classified as multi-component interventions, of which one study used a 600 kilocalorie (2510 kilojoule) daily energy deficit diet. Study durations were mostly below the duration recommended in clinical guidelines and varied widely. No study included an exercise program promoting 225–300 minutes or more of moderate intensity physical activity per week but the majority of the studies used the same behaviour change techniques. Three studies reported clinically significant weight loss (≥ 5%) at six months post intervention. Current data indicate weight management interventions in those with ID differ from recommended practice and further studies to examine the effectiveness of multi-component weight management interventions for adults with ID and obesity are justified

Training verbal working memory in children with mild intellectual disabilities: effects on problem-solving

This multiple case study explores the effects of a cognitive training program in children with mild to borderline intellectual disability. Experimental training effects were evaluated comparing pre-post-test changes after (a) a baseline phase versus a training phase in the same participant, (b) an experimental training versus either a no intervention phase or a control training in two pairs of children matched for cognitive profile. Key elements of the training program included (1) exercises and card games targeting inhibition, switching, and verbal working memory, (2) guided practice emphasizing concrete strategies to engage in exercises, and (3) a variable amount of adult support. The results show that both verbal working memory analyzed with the listening span test and problem-solving tested with the Raven’s matrices were significantly enhanced after the experimental trainin

Psychological impacts of challenging behaviour and motivational orientation in staff supporting individuals with autistic spectrum conditions

Despite increased risk of experiencing challenging behaviour, psychological impacts on community and residential staff supporting adults with autistic spectrum conditions are under-explored. Studies examining related roles indicate protective psychological factors may help maintain staff well-being. This study investigated relationships between motivational orientation (eudaimonic or hedonic), challenging behaviour frequency and type (physical, verbal or self-injurious), and psychological impacts (anxiety, depression and life satisfaction). Participants (N=99) were recruited from six organisations providing autism-specific adult services within Scotland. A series of binary logistic regressions demonstrated weekly challenging behaviour exposure (compared to monthly or daily) significantly increased the likelihood of anxiety caseness. Increased eudaimonic motivation significantly reduced the likelihood of anxiety caseness while also predicting higher life satisfaction. Further, having high levels of eudaimonic motivation appeared to moderate the impact of weekly challenging behaviour exposure on anxiety. No motivational orientation or challenging behaviour factor significantly predicted depression. This sample also demonstrated higher anxiety, lower depression, and equivalent life satisfaction levels compared to general population norms. The results highlight the need for considering staff’s motivational orientations, their frequency of exposure to challenging behaviour, and both positive and negative psychological outcomes, if seeking to accurately quantify or improve well-being in this staff population

Stroke treatment academic industry roundtable recommendations for individual data pooling analyses in stroke

Pooled analysis of individual patient data from stroke trials can deliver more precise estimates of treatment effect, enhance power to examine prespecified subgroups, and facilitate exploration of treatment-modifying influences. Analysis plans should be declared, and preferably published, before trial results are known. For pooling trials that used diverse analytic approaches, an ordinal analysis is favored, with justification for considering deaths and severe disability jointly. Because trial pooling is an incremental process, analyses should follow a sequential approach, with statistical adjustment for iterations. Updated analyses should be published when revised conclusions have a clinical implication. However, caution is recommended in declaring pooled findings that may prejudice ongoing trials, unless clinical implications are compelling. All contributing trial teams should contribute to leadership, data verification, and authorship of pooled analyses. Development work is needed to enable reliable inferences to be drawn about individual drug or device effects that contribute to a pooled analysis, versus a class effect, if the treatment strategy combines ≥2 such drugs or devices. Despite the practical challenges, pooled analyses are powerful and essential tools in interpreting clinical trial findings and advancing clinical care

HREC members\u27 personal values influence decision making in contentious cases

This article identifies 14 contentious issues faced by Human Research Ethics Committees (HRECs). The authors argue that HREC members will respond variably to these issues based on their own fundamental values and worldview. In particular, we propose that personal interpretations of current ethics regulations and HREC members’ attitudes to consequentialism, Kantianism, and utilitarianism in some cases affect their responses to contentious research issues. We seek to promote understanding of how personal and professional back­grounds of HREC reviewers influence their approaches to value-laden issues embedded in ethics applications. Taking the form of a literature review, our con­tribution highlights the need for further exploration of how HREC members make decisions, and what factors influence the outcomes of ethics applications

Parental perspectives of students' strengths in transition planning

The most recent revision of the Individuals with Disabilities in Education Act (IDEA) mandates that students’ strengths be considered in the transition planning process for students with disabilities; however, there is evidence that individuals’ strengths are not being utilized to support their transition to adulthood (Shogren & Plotner, 2012; Landmark & Zhang, 2012). Strengths refer to all of an individual’s assets, both personal and contextual, that improve that individual’s ability to function (Davis et al., 2007; McCammon, 2012). Parents have unique perspectives of their sons’ and daughters’ strengths (Carter, Brock, & Trainor, 2014) and have the potential to influence the transition planning process in a positive way. This study used qualitative methods to understand how parents describe their son or daughter’s strengths, both personal and contextual, in relation to transition planning. Findings indicated that parents identify equal amounts of personal and contextual strengths for their children. However, strengths were described as being context dependent; the trait or resource described as an asset in one aspect of transitioning to adult life was also described as a barrier to another aspect. These findings highlighted the value of including parents in the transition planning process and that students have many strengths available for consideration as they enter adult life