Disability and disability services

This chapter provides a profile of people who are at various points on this disability continuum, but with an emphasis on those facing more severe limitations. Information is presented on both mainstream and sector-specific service use, and the outcomes associated with the use of these services. The focus in this chapter is on people aged under 65 years.<br /

Anxiety sensitivity as a predictor of outcome in the treatment of obsessive-compulsive disorder

BACKGROUND AND OBJECTIVES: To address the fact that not all individuals who receive cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) exhibit complete symptom reduction, research has examined factors that predict outcome; however, no studies have examined anxiety sensitivity (AS) as a predictor of outcome of CBT for OCD. AS refers to the fear of anxious arousal that results from mistaken beliefs about the dangerousness of anxiety-related body sensations. It is important to understand whether AS influences OCD treatment outcome, considering that (a) some obsessions directly relate to AS, and (b) OCD patients with high AS may be reluctant to engage in anxiety-provoking components of CBT for OCD. METHODS: Patients (N = 187) with a primary diagnosis of OCD who received residential CBT for OCD participated in this study, which involved completing a self-report battery at pre- and post-treatment. RESULTS: Results supported study hypotheses, in that (a) baseline AS positively correlated with baseline OCD severity, and (b) greater baseline AS prospectively predicted higher posttreatment OCD symptom severity even after controlling for pretreatment OCD and depression severity. LIMITATIONS: The study was limited by its use of an older measure of AS, reliance on self-report measures, and nonstandardized treatment across participants. CONCLUSIONS: Findings highlight the importance of AS in the nature and treatment of OCD. Clinical implications and future directions are discussed

Limited refugia and high velocity range-shifts predicted for bat communities in drought-risk areas of the Northern Hemisphere

Abstract Species occupying semi-arid and dry regions around the globe face an uncertain future due to increases in the frequency and severity of droughts. In this study we modelled the potential effect of climate change on bat communities within two high-drought risk regions of the world and assessed the magnitude and direction of the predicted shifts in climatic suitability, locating climate change refugia and identifying species at greatest risk of population declines. To do this, we compared climate suitability models for 43 species using three global climate models and three emissions scenarios for current (1950–2000) and future (2061–2080) climates within two regions where droughts are predicted to increase, the Western Palaearctic and Western North America. Our models predicted an overall reduction in bat richness with future climates. Areas projected to support high species richness in the current climate coincided with greatest predicted species loss and greatest future drought risk. For species with the potential to extend their range, high velocity range shifts would be required to keep pace with these changes, particularly in the Western Palaearctic, where additional barriers to movement include seas and areas of high human population density. Predicted refugial zones were limited and occurred in similar areas across continents (montane and high latitude with some coastal areas). The area of climate suitability was predicted to contract for around half of study species, with nine identified as species of conservation concern due to low overlap between current and future modelled ranges. The best-case scenario for bat diversity in semi-arid and dry regions in the future is likely to be reduced species richness, with many species facing rapid range expansion over challenging landscapes to access climatically suitable areas. Conservation of bats in high drought risk regions will likely depend on protection of identified refugia and networks of water sources, as well as global measures to protect biodiversity and human wellbeing, such as reduction in global carbon emissions

Assessment of age-at-onset criterion for adult attention-deficit hyperactivity disorder

To investigate the accuracy of the age-at-onset criterion in those who meet other DSM-5 ADHD criteria (N=138), using a prospective population cohort, we compared four different approaches to asking those at age 25 years when their symptoms started. Receiver Operating Characteristic curves showed variation between the approaches (χ((3)))=8.99, p=0.03); all four showed low discrimination against symptoms that had been assessed when they were children (area under the curve 0.57-0.68). Asking adults to recall specific symptoms may be preferable to recalling at what age symptoms started. However limitations to retrospective recall add to debate on the validity of ADHD age-at-onset assessment

A roadmap for pyrodiversity science

Abstract: Background: Contemporary and projected shifts in global fire regimes highlight the importance of understanding how fire affects ecosystem function and biodiversity across taxa and geographies. Pyrodiversity, or heterogeneity in fire history, is often an important driver of biodiversity, though it has been largely overlooked until relatively recently. In this paper, we synthesise previous research to develop a theoretical framework on pyrodiversity–biodiversity relationships and propose future research and conservation management directions. Theoretical Framework: Pyrodiversity may affect biodiversity by diversifying available ecological niches, stabilising community networks and/or supporting diverse species pools available for post‐fire colonisation. Further, pyrodiversity's effects on biodiversity vary across different spatial, temporal and organismal scales depending on the mobility and other life history traits of the organisms in question and may be mediated by regional eco‐evolutionary factors such as historical fire regimes. Developing a generalisable understanding of pyrodiversity effects on biodiversity has been challenging, in part because pyrodiversity can be quantified in various ways. Applying the Pyrodiversity Concept: Exclusion of Indigenous fire stewardship, fire suppression, increased unplanned ignitions and climate change have led to dramatic shifts in fire regimes globally. Such shifts include departures from historic levels of pyrodiversity and add to existing challenges to biodiversity conservation in fire‐prone landscapes. Managers navigating these challenges can be aided by targeted research into observed contemporary pyrodiversity–biodiversity relationships as well as knowledge of historical reference conditions informed by both Indigenous and local ecological knowledge and western science. Future Research Directions: Several promising avenues exist for the advancement of pyrodiversity science to further both theoretical and practical goals. These lines of investigation include but are not limited to (1) testing the increasing variety of pyrodiversity metrics and analytical approaches; (2) assessing the spatial and temporal scale‐dependence of pyrodiversity's influence; (3) reconstructing historical pyrodiversity patterns and developing methods for predicting and/or promoting future pyrodiversity; and (4) expanding the focus of pyrodiversity science beyond biodiversity to better understand its influence on ecosystem function and processes more broadly

Co-development of attention deficit hyperactivity disorder and autistic trait trajectories from childhood to early adulthood

Background: Attention deficit hyperactivity disorder (ADHD) and autism, defined as traits or disorders, commonly co-occur. Developmental trajectories of ADHD and autistic traits both show heterogeneity in onset and course, but little is known about how symptom trajectories co-develop into adulthood. Methods: Using data from a population cohort, the Avon Longitudinal Study of Parents and Children, we examined correlations between ADHD and autistic traits across development, using the Social Communication Disorders Checklist and ADHD subscale of the Strengths and Difficulties Questionnaire. We modelled joint developmental trajectories of parent-reported ADHD and autistic traits between 4 and 25 years, then characterised trajectory classes based on sociodemographic, perinatal, psychopathology, cognition and social functioning variables and tested for associations with neurodevelopmental/ psychiatric polygenic scores (PGS). Results: Three classes of trajectories were identified; a typically developing majority with low-stable ADHD-autistic traits (87%), a male-predominant subgroup with child/adolescent-declining traits (6%) and a subgroup with late-emerging traits (6%). ADHD-autistic trait correlations were greatest in young adulthood for the two nontypically developing classes. There were higher rates of emotional and conduct problems, low IQ, childhood seizures and poor social functioning in the declining and late-emerging classes compared to the low-stable class. Emotional, conduct and peer problems were more prevalent during childhood in the childhood/ adolescent-declining class compared to other classes, but were more prevalent in young adulthood in the late�emerging class. Neurodevelopmental/psychiatric PGS also differed: both nontypically developing classes showed elevated ADHD PGS compared to the low-stable group, and the late-emerging group additionally showed elevated schizophrenia PGS and decreased executive function PGS, whereas the declining group showed elevated broad depression PGS. Conclusions: Distinct patterns of ADHD-autism co-development are present across development in the general population, each with different characterising factors and genetic signatures as indexed by PG

Investigating young-adult social outcomes of attention deficit hyperactivity disorder

Objective: Attention-deficit/hyperactivity disorder (ADHD) is associated with a range of adverse outcomes in adult life. However, it is unclear whether the risk pathways to adverse adult outcomes are established during childhood or whether associations are driven by concurrent ADHD symptoms that have persisted to adulthood. Methods: We examined associations between broadly defined child-limited (remitted) and persistent ADHD (assessed using the ADHD subscale of the Strengths and Difficulties Questionnaire) with negative social outcomes (low emotional and instrumental support, antisocial behavior, employment, receipt of state benefits as an indicator of socio-economic disadvantage, homelessness) at age 25 years in a UK longitudinal population sample, the Avon Longitudinal Study of Parents and Children (age 25 data collected between years 2017 and 2018; total N = 6,439). Results: Up to 20% of young people with less favorable social outcomes at age 25 had persistent ADHD. Persistent ADHD was associated with an increased likelihood of being not in education, employment, or training (NEET) (OR = 3.71, 95% CI = 2.06 to 6.67, P = 1 í 10−05) and receiving state benefits (OR = 2.72, 95% CI = 1.62 to 4.57, P = 2 × 10−04) at age 25 years compared to those without ADHD. We did not find strong evidence of associations between child-limited ADHD and social outcomes (NEET OR = 1.20, 95% CI = 0.54 to 2.69, P = .65; state benefits OR = 1.38, 95% CI = 0.76 to 2.51, P = .29). Persistent ADHD associations with negative social outcomes were observed across family-of-origin income groups and sex and were not explained by comorbidity. Conclusions: Our findings highlight the importance of continued monitoring and management of ADHD symptoms and related social as well as clinical outcomes across development into adulthood. Future research is needed to identify what factors promote positive social outcomes, including effective treatment of adult ADHD symptoms

Mental Distress among Young People in Inner-Cities:the Resilience, Ethnicity and AdolesCent Mental Health (REACH) study

BACKGROUND: Recent estimates suggest around 14% of 11–16 years in England have a mental health problem. However, we know very little about the extent and nature of mental health problems among diverse groups in densely populated inner cities, where contexts and experiences may differ from the national average. AIMS: To estimate the extent and nature of mental health problems in inner city London, overall and by social group, using data from our school-based accelerated cohort study of adolescent mental health, Resilience, Ethnicity and AdolesCent Mental Health. METHODS: Self-report data on mental health (general mental health, depression, anxiety, self-harm) were analysed (n, 4353; 11–14 years, 85% minority ethnic groups). Mixed models were used to estimate weighted prevalences and adjusted risks of each type of problem, overall and by gender, cohort, ethnic group and free school meals (FSM) status. RESULTS: The weighted prevalence of mental health problems was 18.6% (95% CI 16.4% to 20.8%). Each type of mental health problem was more common among girls compared with boys (adjusted risk ratios: mental health problems, 1.33, 95% CI 1.18 to 1.48; depression, 1.52, 1.30 to 1.73; anxiety, 2.09, 1.58 to 2.59, self-harm, 1.40, 1.06 to 1.75). Gender differences were more pronounced in older cohorts compared with the youngest. Mental health problems (1.28, 1.05 to 1.51) and self-harm (1.29, 1.02 to 1.56)—but not depression or anxiety—were more common among those receiving (vs not receiving) FSM. There were many similarities, with some variations, by ethnic group. CONCLUSIONS: Adolescent mental health problems and self-harm are common in inner city London. Gender differences in mental health problems may emerge during early adolescence