The face validity of an initial sub-typology of people with autism spectrum disorders detained in psychiatric hospitals

Autistic adults who have a history of committing crimes present a major problem for providers of services in terms of legal disposal options and possible interventions, and greater understanding of this group and their associated needs is required. For this reason, we aimed to investigate the face validity of a proposed sub-typology of autistic adults detained in secure psychiatric hospitals in the United Kingdom. Initially, a focus group was completed with psychiatrists, clinical psychologists, healthcare workers, family members, and autistic adults who had been detained in hospital, leading to revisions of the sub-typology. Following this, a consensus rating exercise of ten clinical vignettes based upon this subtypology with three rounds was completed with fifteen psychiatrists and clinical psychologists; revisions to the vignettes to improve clarity were made following each round. The findings indicated these subtypes possess face validity and raters were able to classify all ten clinical case vignettes into the sub-typology and percentage of agreement ranged from 96% to 100% for overall subtype classification. This study suggests that the further validity of the sub-typology should be investigated within a larger study, as these sub-types have the potential to directly inform the hospital care-pathway such that length of stay can be minimised

Management of epilepsy in adults with intellectual disability

This long-awaited report offers an important step towards clarifying the role of the psychiatrist in ID in the management of epilepsy. The proposed tiered system of professional competency gives psychiatrists the option to identify their role in care provision and ensures a framework for training. It provides a structure from which a competency evaluation can be developed. The vision should be for all psychiatrists working with people with ID to have training and certification to one of the three levels of competency (Bronze, Silver and Gold). An Appendix is provided as a separate document, which includes a list and samples of currently used good practice tools relevant to people with ID and epilepsy, as well as a ‘frequently asked questions’ section on Epilepsy that would be of particular use to patients, families and carers

Restrictive Interventions in Inpatient Intellectual Disability Services: How to Record, Monitor and Regulate

This report is concerned with the standards of recording, monitoring, and regulation of restrictive interventions involving people with intellectual disabilities with mental health and/or behaviour that challenges within inpatient services. Restrictive interventions, a central concern for all stakeholders of intellectual disability services, has come under increased scrutiny following the abuse scandal at Winterbourne View. Current efforts to monitor them rely almost exclusively on the numbers of such incidents. This approach is fundamentally flawed because numbers alone do not assess the quality of a services’ overall restrictive interventions practice and cannot be used to infer good or poor standards of practice and abuse. Further, there are problems with the variable use of definitions, the failure to distinguish between various degrees of physical restraint, the impact of outliers, the failure to capture individual patient progress and the absence of meaningful benchmarking. Service providers and regulators must therefore rely on other methods to evaluate the use of restrictive interventions and move from basing their conclusions on just the total number of restrictive interventions to one of examining a wider range of quality parameters. With representative examples, this document makes recommendations on how restrictive interventions should be recorded, monitored, regulated and published

Prescribing anti-epileptic drugs for people with epilepsy and intellectual disability

This report addresses the extremely important area of epilepsy in the field of intellectual disability (ID), also known as learning disability. Epilepsy and ID are two conditions that carry stigma and can lead to social isolation. An individual who experiences both these problems faces huge challenges. This report aims to provide epileptologists, psychiatrists, doctors and clinicians working with people with ID and epilepsy an overview of good practice prescribing. Its focus is on using current evidence and applying it to support practical prescribing for people with ID. The document is not a substitute for recognised prescribing guides such as the British National Formulary (BNF). It is not a complete or comprehensive overview of epilepsy management or of epilepsy service provision. The contents of this report need to be considered as guidance, especially where most practitioners struggle when the evidence does not inform the complex clinical challenges. The report is a consensus statement on the application of current evidence used in the general population to people with ID and should be used for the purpose of guiding holistic decision-making in prescribing AEDs. It is important that clinicians keep themselves up to date using the latest information on the subject as part of their continuing professional development, as the subject area covered by this report changes rapidly

Epilepsy, anti-seizure medication, intellectual disability and challenging behaviour – Everyone’s business, no one’s priority

Purpose People with Intellectual Disability (ID) and epilepsy are more likely to experience psychiatric conditions, challenging behaviour (CB), treatment resistance and adverse effects of anti-seizure medications (ASM) than those without. This population receives care from various professionals, depending on local care pathways. This study evaluates the training status, confidence, reported assessment and management practices of different professional groups involved in caring for people with ID, epilepsy and CB. Methods A cross sectional survey using a questionnaire developed by expert consensus which measured self-reported training status, confidence, and approaches to assessment and management of CB in people with ID and epilepsy was distributed to practitioners involved in epilepsy and/or ID. Results Of the 83 respondents, the majority had either a psychiatry/ID (n = 39), or Neurology/epileptology background (n = 31). Psychiatry/ID and Neurology/epileptology had similar confidence in assessing CB in ID-epilepsy cases, but Psychiatry/ID exhibited higher self-rated confidence in the management of these cases. While assessing and managing CB, Psychiatry/ID appeared more likely to consider mental health aspects, while Neurology/epileptology typically focused on ASM. Conclusion Psychiatry/ID and Neurology/epileptology professionals had varying training levels in epilepsy, ID and CB, had differing confidence levels in managing this patient population, and considered different factors when approaching assessment and management. As such, training opportunities in ID should be offered to neurology professionals, and vice versa. Based on the findings, a best practice checklist is presented, which aims to provide clinicians with a structured framework to consider causal explanations for CB in this population

Sexuality and relationships education for people with ASD – pilot programme implementation

No abstract available

A systematic review and synthesis of outcome domains for use within forensic services for people with intellectual disabilities

Aims. In response to the large number of people with intellectual disabilities (IDs) and offending behaviour being treated in psychiatric hospitals, this study identified and developed the domains that should be used to measure treatment outcomes for this population using both a systematic review and consultation exercises. Methods. A systematic search of relevant databases, and sixty studies met the eligibility criteria, and findings were synthesised using content analysis. The findings were refined within a consultation and consensus exercises with carers, service users, and experts. Results. The final framework encompassed three a priori superordinate domains (a) effectiveness, (b) patient safety, and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviours, reactive and restrictive interventions, quality of life and patient satisfaction. Conclusions. To index recovery, services need to measure outcome using this framework