Children with disrupted attachment histories: Interventions and psychophysiological indices of effects

Diagnosis and treatment of children affected by disruptions of attachment (out of home placement, multiple changes of primary caregiver) is an area of considerable controversy. The possible contribution of psychobiological theories is discussed in three parts. The first part relates the attachment theoretical perspective to major psychobiological theories on the developmental associations of parent-child relationships and emotional response. The second part reviews studies of autonomic reactivity and HPA-axis activity with foster children, showing that foster children show more reactivity within physiological systems facilitating fight or flight behaviours rather than social engagement, especially foster children with atypical attachment behaviour. The third part is focused on treatment of children suffering from the consequences of disrupted attachment, based on a psychotherapy study with psychophysiological outcome measures. Implications are discussed for theory, diagnosis, and intervention

Self-concept and facial appearance of individuals with an intellectual disability:A scoping review

This paper looks at how self-concept is related to facial appearance. Very little information can be found on how persons with intellectual disabilities think and feel about their own facial appearance. In this review 19 articles on subject of self-concept in people with intellectual disabilities were included. Results show that self-concept of individuals with intellectual disabilities is affected by the relationships they have (positively and negatively). The perceptions of caregivers, peers and their awareness of stigma effects self-concept. How facial appearance affects the self-concept of persons with intellectual disabilities remains unclear and should be a focus of research in future. Abstract: Background The mental health and well-being of individuals can be positively affected by improving facial appearance through orthodontic treatment. However, research is limited on the relationship between facial appearance and self-concept of individuals with intellectual disabilities. Materials and methods This scoping review includes 19 articles and is aimed to examine the self-concept of individuals with intellectual disabilities and determine how the self-concept might be impacted by facial appearance. Furthermore, this review is exploratory in the way that an attempt was made to extract constructs that contribute to the self-concept of persons with intellectual disabilities. Results Unfortunately, no articles were found on how individuals with intellectual disabilities think about their own facial appearance. However, the articles on self-concept in persons with intellectual disabilities do mention some interesting facts: social comparisons lead to social stigma that can contribute negatively to the self-concept of individuals with intellectual disabilities. Also, the ability to communicate and express oneself can contribute to one's self-esteem. Furthermore, parents/caregivers often influence the concept of oneself. Moreover, an individual's relationship with their social environment defines their self-concept. Conclusion It is currently unknown how individuals with intellectual disabilities view their own facial appearance and whether their self-concept is influenced by their appearance. Questionnaires which address attitudes on facial appearance could provide a deeper understanding of the self-concept of individuals with intellectual disabilities and possibly make way for orthodontic treatment. However, caution is needed concerning changing the physical appearance of persons with intellectual disabilities. One should also battle stigma by encouraging the social inclusion of persons with intellectual disability

Exploration of the effects of an innovative mentalization-based training on patient-centered communication skills of pharmacy staff:A video-observation study

OBJECTIVE: To explore whether a mentalization-based communication training for pharmacy staff impacts their ability to elicit and recognize patients' implicit and explicit medication related needs and concerns.METHODS: A single-arm intervention pilot study was conducted, in which pre-post video-recordings of pharmacy counter-conversations on dispensed-medication (N = 50 and N = 34, respectively; pharmacy staff: N = 22) were coded. Outcome measures included: detecting needs and concerns, and implicitly and explicitly eliciting and recognizing them. Descriptive statistics and a multi-level logistic regression were conducted. Excerpts of videos with needs or concerns were analyzed thematically on mentalizing attitude aspects.RESULTS: Indications show that patients more often express their concerns in an explicit way post-measurement, just as pharmacy staffs' explicit recognition and elicitation of needs and concerns. This was not seen for patients' needs. No statistically significant differences were found for determinants for detecting needs or concerns (i.e., measurement-, professional-type, or interaction). Differences in mentalizing attitude were observed between pre-post-measurements, e.g., more attention for patients.CONCLUSION: This mentalizing training shows the potential of mentalizing to improve pharmacy staff members' explicit elicitation and recognition of patients' medication-related needs and concerns.PRACTICE IMPLICATIONS: The training seems promising for improving patient-oriented communication skills in pharmacy staff. Future studies should confirm this result.</p

People with intellectual disabilities living in care facilities engaging in virtual social contact: A systematic review of the feasibility and effects on well-being.

Funder: Project Digitaal op bezoek bij mensen met beperkingenFunder: Academische Werkplaats Leven met een verstandelijke beperking, Tranzo, Tilburg UniversityFunder: Academische Werkplaats EMB, Rijksuniversiteit GroningenFunder: Academische Werkplaats's Heeren Loo ‐ VUFunder: Academische Werkplaats Sociale relaties en gehechtheid, Bartiméus ‐ VUBACKGROUND: During the initial phase of the COVID-19 pandemic, many people with disabilities living in home care facilities could not receive visitors. The use of virtual social contact has been recommended by health authorities. This systematic review examined the scientific evidence of the use and feasibility of information and communication technology (ICT) for social contact by people with intellectual disabilities living in care facilities, and potential effects on well-being. METHODS: Five databases were searched using traditional systematic screening and machine-learning supported screening. Findings are presented in a narrative synthesis using thematic analysis. RESULTS: Nine studies were included. We described three themes: means of ICT used for social contact; effects on well-being; and benefits, barriers, and preconditions. CONCLUSIONS: Engaging in virtual social contact may be feasible for people with severe to mild intellectual disabilities, but there is little concrete evidence that this can be used as an alternative for in-person contact

For happy children with a visual or visual-and-intellectual disability: Efficacy research to promote sensitive caregiving with the Barti-mat

Cycles of miscommunication often occur within the caregiver–child dyad when a child has a visual or visual-and-intellectual disability, influencing sensitive and responsive caregiver behaviour and child happiness. This study aims to examine the efficacy of using interactive technology, the Barti-mat, to promote sensitive and responsive caregiver behaviour, specifically mirroring behaviour, and increase the happiness of children with a visual or visual-and-intellectual disability. The secondary aim is to examine the social validity of the Barti-mat. A mixed-method approach was used, combining quantitative data from a multiple within-series single-case design and qualitative data comparing play-as-usual with play on the Barti-mat. Eleven caregiver–child dyads participated in a home-based study. No significant effects were found for Attunement nor for Valence. Significant improvements were found for Total Mirroring, Happiness, and Arousal. Overall, the caregivers enjoyed using the Bart-mat and were enthusiastic about the development of specialized play material for children with visual impairments. Results of the current study suggest that the Barti-mat can act as catalyst for caregiver mirroring behaviour and improve the happiness of a child with a visual or visual-and-intellectual disability. Caregivers were generally motivated to use and recommend the Barti-mat again. Minor product improvement recommendations were made. The Barti-mat is appropriate for a diverse group of caregivers and children with a visual or visual-and-intellectual disability and would be a good adjunct to preventive attachment-based interventions

Improving adaptive and cognitive skills of children with an intellectual disability and/or autism spectrum disorder: Meta-analysis of randomised controlled trials on the effects of serious games

The aim of this meta-analysis is to investigate the effectiveness of serious games on social and cognitive skills of children with an intellectual disability (ID) and/or autism spectrum disorder (ASD). Randomised controlled trials of the effectiveness of serious games were identified through a systematic search of PubMed, Web of Science, PsycINFO, and Embase, using keywords related to serious games and the target groups. Eleven studies with a total of 654 participants (mean age 4–11 years) were included. The methodological quality of the studies was assessed using the Cochrane risk of bias assessment tool V2. Serious games were associated with improved adaptive and cognitive skills of children with ID or ASD compared with controls, with a small effect size (g = 0.420, 95% confidence interval 0.130–0.710; p = .009; number needed to treat = 4.28), with moderate to high heterogeneity. Multiple influence analyses showed that zero heterogeneity could be achieved with exclusion of three studies, one by one, while retaining a significant effect size. Moderation analyses showed no significant differences between the skills examined, the type of controls, involvement of another person, duration of the intervention, or age of the children. These findings indicate that serious games are linked to improvements in adaptive and cognitive functioning of children with ID or ASD, but the association is not necessarily straightforward. Although more study is needed into the effective elements of these games, these results represent an important first step in implementing serious games proven to strengthen daily functioning and social participation of children with ID or ASD

Improving empathy and self-efficacy in caregivers of persons with intellectual disabilities, using m-learning (HiSense APP-ID): study protocol for a randomized controlled trial

Abstract Background A secure attachment with one or more caregivers is one of the most important predictors of cognitive development and emotional wellbeing. Persons with intellectual disabilities (ID) have extra need for secure relationships with primary caregivers but can find making connections difficult. This study aims to explore the effect of a non-invasive m-learning intervention on the empathy and self-efficacy of caregivers, in view of improving attachment relationships with persons with ID. Methods A randomized controlled trial (RCT) will be conducted to assess the efficacy of the HiSense APP-ID. The study will include 100 parents/relatives and 100 professional caregivers of adults with mild or moderate ID (18 years and older). Of both groups of participants, half will complete the m-learning intervention. Data will be collected before the intervention starts, immediately after completion of the m-learning, and 1 month after the intervention. Participants will complete questionnaires concerning knowledge about attachment theory, empathy and self-efficacy (primary outcome measures) and social validity (secondary measures). Discussion The intervention aims to increase caregiver understanding of attachment theory and to improve empathy and self-efficacy, which may lead to better care and less stress in social interactions. The HiSense APP-ID is an m-learning intervention that can be done independently on any digital device. The course is therefore easily accessible for caregivers of persons with ID. The current study will provide insight into the effectiveness of the intervention for parents/family members and professional caregivers of persons with mild or moderate ID. Trial registration Nederlands Trial Register, NTR 6944. Registered on 16 December 2017

COVID-19 Vaccination Intentions amongst Healthcare Workers: A Scoping Review

A worldwide vaccination programme is the chosen strategy against the COVID-19 pandemic. Vaccine hesitancy, however, forms a threat to achieving a high degree of vaccination. Healthcare workers (HCWs) are exposed to greater risks, in addition to HCWs who care for people with intellectual disabilities (ID). However, little is still known about these groups’ vaccine hesitancy. This review aims to provide insight into the intentions and attitudes of HCWs on COVID-19 vaccination, including those who care for people with ID. The search included both types and was conducted in nine databases. A total of 26 papers were identified concerning the vaccine intentions of 43,199 HCWs worldwide. The data were gathered both quantitively and qualitatively. The papers were analysed for all of the themes regarding vaccine intentions, which were: (1) percentages of vaccine willingness; (2) predictors of willingness; (3) attitudes of willingness and hesitancy; (4) sources of vaccination information; (5) contextual factors and changes in COVID-19 vaccine acceptance over time; and (6) future strategies for interventions. Concerns about vaccine safety, efficacy and short- and long-term side effects were the most prominent in HCWs and, therefore, should be addressed in future intervention strategies. Furthermore, interactive interventions are recommended to facilitate exchange, and accurate information should be accessible to target groups on social media platforms