How service‐users with intellectual disabilities understand challenging behaviour and approaches to managing it

Background This study explored understandings that service‐users with intellectual disabilities and challenging behaviour held around their behaviour, what shaped these understandings, and the relationship between how behaviours are managed and well‐being. Methods Eight participants (three female, five male) partook in individual semi‐structured qualitative interviews. Interviews were transcribed and analysed using interpretative phenomenological analysis. Results Three master themes emerged from this analysis: (a) challenging behaviour can be explained via an internal or external frame of reference, with each framework having different implications for how participants attempted to manage behaviour. (b) Positive relationships provide a long‐term buffer to challenging behaviour, with positive relationships with family, staff and peers operating through different mechanisms to achieve this. (c) A greater ability to exert power and control in day‐to‐day life was perceived to reduce challenging behaviour in the long term. Conclusions Implications for practice are discussed

Psychometric properties of the Clinical Outcome Routine Evaluation‐Learning Disabilities 30‐Item (CORE‐LD30)

Background There is paucity in availability of valid and reliable measures of psychopathology that can be routinely applied with an ID population in clinical practice. The psychometric properties of the Clinical Outcome Routine Evaluation-Learning Disabilities 30-Item version (CORE-LD30) are examined. Method The CORE-LD30 was administered to 271 sequential referrals to three NHS ID services providing psychological support. A Principal Components Analysis with oblique rotation was conducted with examination of convergent validity for extracted domains. Results Three rotated factors were extracted with good levels of internal consistency reported for the overall measure (α=.92) and each of the domains, conceptually labelled Problems/Symptoms (PS; α=.90), Risk to Self (RS; α=.76) and Risk to Others (RO; α=.71). Convergent validity is reported for two domains (PS with the GDS-LD, and RO with the HoNOS-LD), and support for the CORE-LD30 as a ‘core’ measure indicated. Conclusion The CORE-LD30 is recommended as a useful broad ranging measure of psychopathology for use with an ID population. Domains may prove to be useful for research and clinical purposes. Further research is recommended to examine the ability to monitor clinical change associated with specific levels of presentation and different clinical presentations/cohorts

Cognitive Behavior Therapy for Anxious Adolescents: Developmental Influences on Treatment Design and Delivery

Anxiety disorders in adolescence are common and disruptive, pointing to a need for effective treatments for this age group. Cognitive behavior therapy (CBT) is one of the most popular interventions for adolescent anxiety, and there is empirical support for its application. However, a significant proportion of adolescent clients continue to report anxiety symptoms post-treatment. This paper underscores the need to attend to the unique developmental characteristics of the adolescent period when designing and delivering treatment, in an effort to enhance treatment effectiveness. Informed by the literature from developmental psychology, developmental psychopathology, and clinical child and adolescent psychology, we review the ‘why’ and the ‘how’ of developmentally appropriate CBT for anxious adolescents. ‘Why’ it is important to consider developmental factors in designing and delivering CBT for anxious adolescents is addressed by examining the age-related findings of treatment outcome studies and exploring the influence of developmental factors, including cognitive capacities, on engagement in CBT. ‘How’ clinicians can developmentally tailor CBT for anxious adolescents in six key domains of treatment design and delivery is illustrated with suggestions drawn from both clinically and research-oriented literature. Finally, recommendations are made for research into developmentally appropriate CBT for anxious adolescents

Psychological Therapy for At Risk Mental State for Psychosis in a Prison Setting:A Case Study

There is a very high prevalence of psychosis in U.K. prisons; moreover, a significant number of prisoners meet risk criteria for psychosis. We provide a report of psychological therapy with a client who met risk criteria for psychosis that took place in a prison setting. We applied a self-reflectivity framework when formulating the case, which we believe allowed the flexibility required by the presenting problem and, crucially, the demands of the setting. This approach had two key advantages. First, it enabled the therapist to tailor the work according to the level of self-reflectivity demonstrated by the client. We believe this approach ensured that the client understood the therapist's interventions. Second, it helped prepare, and choose a appropriate point, for a move to more traditional interventions for managing the client's main presenting problem. We believe this work represents progress in working with clients in this complex and demanding setting

Do video reviews of therapy sessions help people with mild intellectual disabilities describe their perceptions of cognitive behaviour therapy?

<b>Background</b> This study examined the potential of a retrospective video reviewing process [Burford Reviewing Process (BRP)] for enabling people with intellectual disabilities to describe their experiences of cognitive behaviour therapy (CBT). It is the first time that the BRP, described in this paper, has been used with people with intellectual disabilities and the aim was to assess the feasibility of the procedure and gain a picture of the information it might yield.<p></p> <b>Methods</b> Using the BRP, 12 clients reviewed tapes of their fourth and ninth CBT sessions and six reviewed the fourth session only. All reviews were audio recorded for later verbatim transcriptions of clients' comments. Reviews and transcriptions were conducted by non-clinical researchers. Thematic analysis was applied to the transcripts by a researcher who was not CBT-trained.<p></p> <b>Results</b> All clients were able to follow the instructions for the BRP. Three broadly based themes encapsulated their responses – how they felt about themselves, how they felt the therapist was helping and how CBT was helping. A fourth theme referred to comments on issues that were currently troubling clients, which were prompted by watching the video but did not refer to actual events on screen.<p></p> <b>Conclusions</b> The BRP seems a feasible approach with this client group and gave insights into their feelings and opinions on CBT. Clinical implications of the results and the potential for further developments are discussed