Restraint of adults with intellectual disabilities: A critical review of the prevalence and characteristics associated with its use

2018 ◽  
Vol 24 (2) ◽  
pp. 268-283 ◽  
Author(s):  
Lucy Fitton ◽  
Dominic Ryan Jones
Keyword(s):  
Intellectual Disabilities ◽  
External Factors ◽  
Future Research ◽  
Challenging Behaviour ◽  
Prevalence Rates ◽  
Multiple Forms ◽  
Cross Sectional ◽  
Restraint Use ◽  
People With Intellectual Disabilities ◽  
Adults With Intellectual Disabilities

Background: As part of their care, adults with intellectual disabilities are often subject to restrictive interventions including restraint. Method: A review examining the prevalence of restraint use with people with intellectual disabilities and the characteristics associated with its use. Results: The seven papers identified used quantitative methodologies and had cross-sectional designs. Prevalence rates of restraint ranged from 11% to 78%, multiple forms of restraint were common. Most studies focused on characteristics within the person with an intellectual disability, three considered external factors. Challenging behaviour was the most consistent characteristic associated with the use of restraint, but how this was defined varied. Conclusions: The review highlights a need for more consistent means of defining and measuring restraint and its associated characteristics. Future research into this area may also want to focus on the context of restraint such as whether it is the least restrictive option used.

scholarly journals Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036862
Author(s):  
Angela Henderson ◽  
Paula Mcskimming ◽  
Deborah Kinnear ◽  
Colin McCowan ◽  
Alasdair McIntosh ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Cohort Study ◽  
Intellectual Disabilities ◽  
Cross Sectional ◽  
Problem Behaviours ◽  
Medication Reviews ◽  
People With Intellectual Disabilities ◽  
Antipsychotic Prescribing ◽  
Adults With Intellectual Disabilities ◽  
General Community

ObjectivesTo investigate psychotropic prescribing in the intellectual disabilities population over 10 years, and associated mental ill health diagnoses.DesignComparison of cross-sectional data in 2002–2004 (T1) and 2014 (T2). Longitudinal cohort study with detailed health assessments at T1 and record linkage to T2 prescribing data.SettingGeneral community.Participants1190 adults with intellectual disabilities in T1 compared with 3906 adults with intellectual disabilities in T2. 545/1190 adults with intellectual disabilities in T1 were alive and their records linked to T2 prescribing data.Main outcome measuresEncashed regular and as-required psychotropic prescriptions.Results50.7% (603/1190) of adults in T1 and 48.2% (1881/3906) in T2 were prescribed at least one psychotropic; antipsychotics: 24.5% (292/1190) in T1 and 16.7% (653/3906) in T2; antidepressants: 11.2% (133/1190) in T1 and 19.1% (746/3906) in T2. 21.2% (62/292) prescribed antipsychotics in T1 had psychosis or bipolar disorder, 33.2% (97/292) had no mental ill health or problem behaviours, 20.6% (60/292) had problem behaviours but no psychosis or bipolar disorder. Psychotropics increased from 47.0% (256/545) in T1 to 57.8% (315/545) in T2 (p<0.001): antipsychotics did not change (OR 1.18; 95% CI 0.87 to 1.60; p=0.280), there was an increase for antidepressants (OR 2.80; 95% CI 1.96 to 4.00; p<0.001), hypnotics/anxiolytics (OR 2.19; 95% CI 1.34 to 3.61; p=0.002), and antiepileptics (OR 1.40; 95% CI 1.06 to 1.84; p=0.017). Antipsychotic prescribing increased for people with problem behaviours in T1 (OR 6.45; 95% CI 4.41 to 9.45; p<0.001), more so than for people with other mental ill health in T1 (OR 4.11; 95% CI 2.76 to 6.11; p<0.001).ConclusionsDespite concerns about antipsychotic prescribing and guidelines recommending their withdrawal, it appears that while fewer antipsychotic prescriptions were initiated by T2 than in T1, people were not withdrawn from them once commenced. People with problem behaviours had increased prescribing. There was also a striking increase in antidepressant prescriptions. Adults with intellectual disabilities need frequent and careful medication reviews.

scholarly journals Clinical and cost evaluation of intensive support team (IST) models for adults with intellectual disabilities who display challenging behaviour: a comparative cohort study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e043358
Author(s):  
Angela Hassiotis ◽  
Athanasia Kouroupa ◽  
Rebecca Jones ◽  
Nicola Morant ◽  
Ken Courtenay ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Intellectual Disabilities ◽  
Online Survey ◽  
Service Use ◽  
Cost Evaluation ◽  
Challenging Behaviour ◽  
Health And Social Care ◽  
Adults With Intellectual Disabilities

IntroductionApproximately 17% of adults with intellectual disabilities (ID) living in the community display behaviours that challenge. Intensive support teams (ISTs) have been recommended to provide high-quality responsive care aimed at avoiding unnecessary admissions and reducing lengthy inpatient stays in England. We have identified two models of ISTs (model 1: enhanced provision and model 2: independent provision). This study aims to investigate the clinical and cost-effectiveness of the two models of ISTs.Methods and analysisA cohort of 226 adults with ID displaying behaviour that challenges who receive support from ISTs from each model will be recruited and assessed at baseline and 9 months later to compare the clinical and cost-effectiveness between models. The primary outcome is reduction in challenging behaviour measured by the Aberrant Behaviour Checklist-Community (ABC-C). The mean difference in change in ABC score between the two IST models will be estimated from a multilevel linear regression model. Secondary outcomes include mental health status, clinical risk, quality of life, health-related quality of life, level of functioning and service use. We will undertake a cost-effectiveness analysis taking both a health and social care and wider societal perspective. Semistructured interviews will be conducted with multiple stakeholders (ie, service users, paid/family carers, IST managers/staff) to investigate the experience of IST care as well as an online survey of referrers to capture their contact with the teams.Ethics and disseminationThe study was approved by the London–Bromley Research Ethics Committee (REC reference: 18/LO/0890). Informed consent will be obtained from the person with ID, or a family/nominated consultee for those lacking capacity and from his/her caregivers. The findings of the study will be disseminated to academic audiences, professionals, experts by experience and arm’s-length bodies and policymakers via publications, seminars and digital platforms.Trial registration numberClinicalTrials.gov Registry (NCT03586375).

A practical example of an open disclosure process for people with intellectual disabilities in the Republic of Ireland

2021 ◽  
pp. 174462952110189
Author(s):  
Feabhra Mullally ◽  
Deirdre Corby
Keyword(s):  
Intellectual Disabilities ◽  
Service Providers ◽  
Republic Of Ireland ◽  
Open Disclosure ◽  
The Usa ◽  
People With Intellectual Disabilities ◽  
Adults With Intellectual Disabilities ◽  
The Republic ◽  
Communication Needs ◽  
The Uk

Literature pertaining to open disclosure predominantly refers to acute care settings; this is the case in, for example, the UK, Republic of Ireland, Australia, Korea and the USA. There is, however, a dearth of literature regarding open disclosure related to people with intellectual disabilities. A practice example of open disclosure is presented here, following a serious adverse event in an organisation supporting adults with intellectual disabilities. The aim of the process was to openly disclose in a meaningful way to adults with significant intellectual disabilities and communication difficulties. An apology pathway was developed by a multidisciplinary team based on individual communication needs. A suite of resources was developed including easy read-picture agendas and sign language to support increased understanding of the apology. Service users received the apology first, followed by meetings with their families. This practice example has positive implications for service providers for people with intellectual disabilities.

Commentary on “A family’s battle to understand ‘challenging behaviour’”

2017 ◽  
Vol 22 (2) ◽  
pp. 105-108
Author(s):  
Joann Kiernan
Keyword(s):  
Intellectual Disabilities ◽  
Design Methodology ◽  
Local Communities ◽  
Challenging Behaviour ◽  
Content Type ◽  
People With Intellectual Disabilities ◽  
Individuals With Intellectual Disabilities

Purpose The purpose of this paper is to provide a commentary on issues raised in the paper “A family’s battle to understand ‘challenging behaviour’”. Design/methodology/approach Drawing on literature associated with issues identified in the paper this commentary will reflect on the evidence associated with providing specialist support to people with intellectual disabilities and challenging behaviour. Findings Families, individuals and services are unable to access timely and appropriate specialist support for individuals with intellectual disabilities and challenging behaviour. As individuals go on to develop behaviours associated with a lack of intervention their levels of vulnerability increase due to their exclusion from services and their local communities. Originality/value The commentary provides a discussion on the issues faced by individuals and their families in relation to intellectual disabilities and challenging behaviour.

Pregabalin use in adults with intellectual disabilities

2017 ◽  
Vol 41 (S1) ◽  
pp. S597-S597 ◽  
Author(s):  
K. Courtenay ◽  
S. Jaydeokar ◽  
B. Perera
Keyword(s):  
Anxiety Disorder ◽  
Intellectual Disabilities ◽  
Dose Range ◽  
Case Series ◽  
Generalised Anxiety Disorder ◽  
Anti Epileptic Drug ◽  
Mental Health Difficulties ◽  
People With Intellectual Disabilities ◽  
Adults With Intellectual Disabilities ◽  
Competing Interest

IntroductionPregabalin is a well-established anti-epileptic drug in the treatment of epilepsy. It is also indicated for the treatment of generalised anxiety disorder and neuropathic pain. In addition, it has mood modulating properties. In people with intellectual disabilities it is used to treat epilepsy. There is little evidence of the use of pregabalin in managing mental health difficulties in people with intellectual disabilities.ObjectivesTo describe the use of pregabalin in adults with intellectual disabilities.MethodA descriptive case series of adults with intellectual disabilities living in the community, under the care of a community psychiatrist, who are prescribed Pregabalin. Outcomes of treatment were measured using the health of the nation outcome scale for people with intellectual disabilities (HoNOS-LD).ResultsFourteen cases were identified in the community service of adults with Intellectual Disabilities. Twelve were men and two were women. The average age of the sample was 29 years. The range in duration of using pregabalin was from 3 to 72 months. Thirteen adults had a diagnosis of Autism of which three also had ADHD. The indications for using pregabalin and numbers were : anxiety (12); liability of mood (2); generalised anxiety disorder (1); epilepsy (1). The daily dose range was from 150 mg to 300 mg The mean change in HoNOS-LD scores was 32%.ConclusionsPregabalin is a useful treatment in people with intellectual disabilities who experience anxiety. It is especially effective among adults with ID and autism to modulate mood and anxiety symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Underdiagnosis of psychiatric disorders in people with intellectual disabilities: Differences between psychiatric disorders and challenging behaviour

2018 ◽  
Vol 24 (3) ◽  
pp. 326-338 ◽  
Author(s):  
Carlos Peña-Salazar ◽  
Francesc Arrufat ◽  
Josep Manel Santos ◽  
Abel Fontanet ◽  
Gretel González-Castro ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Psychiatric Disorders ◽  
Psychiatric Diagnosis ◽  
Cross Sectional Study ◽  
Assessment Tools ◽  
Challenging Behaviour ◽  
Cross Sectional ◽  
Intelligence Scale ◽  
Severely Handicapped ◽  
People With Intellectual Disabilities

Background and purpose: The purpose of this study was to assess the level of mental disorders and challenging behaviour in individuals with intellectual disability (ID) supported by specialized services, but without a prior psychiatric diagnosis, and to compare the levels of different disorders depending on the severity of ID. Methods: This is a cross-sectional study ( N = 142) of population with ID. Inclusion criteria were the following: adult patients with ID and with no previous psychiatric diagnosis prior to this survey. The Wechsler Adults Intelligence Scale-II, the Psychiatric Assessment Schedule for Adults with Developmental Disability checklist and clinical interview, the Diagnostic Assessment for the Severely Handicapped scale and the Inventory for Client and Agency Planning were the assessment tools. Results: A previously undiagnosed mental disorder was found in 29.6% of the sample. The most prevalent mental disorders were major depressive and anxiety disorders. An association between psychiatric comorbidity and challenging behaviour was found only for mild/moderate ID, especially for affective disorders. Conclusions: The presence of a psychiatric as well as a medical comorbidity is associated with severe ID, unlike challenging behaviour. Clinical limitations of the study have been discussed.

scholarly journals Screening of Cognitive Changes in Adults with Intellectual Disabilities: A Systematic Review

2020 ◽  
Author(s):  
Andreia F. Paiva ◽  
Adam Nolan ◽  
Charlotte Thumser ◽  
Flavia H. Santos
Keyword(s):  
Systematic Review ◽  
Intellectual Disabilities ◽  
Best Practice ◽  
Web Of Science ◽  
Total Sample ◽  
Cognitive Changes ◽  
Cross Sectional ◽  
Age Related ◽  
Adults With Intellectual Disabilities ◽  
Practice Methods

Abstract: Background and Aims: Screening and assessment of cognitive changes in adults with Intellectual Disabilities, mainly Down Syndrome (DS), is crucial to offer appropriate services to their needs. We present a systematic review of the existing instruments assessing dementia, aiming to support researchers and clinicians’ best practice. Methods: Searches were carried out in the databases Web of Science; PubMed; PsycINFO in March 2019 and updated in May 2020. Studies were selected and examined if they: (1) focused on assessing age-related cognitive changes in person with ID; (2) included adults and/or older adults; (3) included scales and batteries for cognitive assessment. Results: Forty-eight cross-sectional studies and twenty-six longitudinal studies were selected representing a total sample of 5,851 participants (4,089 DS and 1,801 with other ID). In those studies, we found 38 scales, questionnaires, and inventories, and 13 batteries for assessing cognitive and behavioural changes in adults with DS and other ID. Conclusion: The most used instrument completed by an informant or carer was the Dementia Questionnaire for Learning Disabilities (DLD), and its previous versions. We discuss the strengths and limitations of the instruments and outline recommendations for future use.

Prevalence of pain in institutionalized adults with intellectual disabilities: A cross-sectional approach

2013 ◽  
Vol 34 (8) ◽  
pp. 2399-2406 ◽  
Author(s):  
Anneke A. Boerlage ◽  
Abraham J. Valkenburg ◽  
Erik J.A. Scherder ◽  
Gertrud Steenhof ◽  
Peter Effing ◽  
...  
Keyword(s):  
Intellectual Disabilities ◽  
Cross Sectional ◽  
Prevalence Of Pain ◽  
Adults With Intellectual Disabilities

scholarly journals People with intellectual disabilities, relationship and sex education programmes: A systematic review

2019 ◽  
Vol 78 (8) ◽  
pp. 885-900 ◽  
Author(s):  
Edward McCann ◽  
Lynne Marsh ◽  
Michael Brown
Keyword(s):  
Systematic Review ◽  
Intellectual Disabilities ◽  
Sex Education ◽  
Education Programme ◽  
Unintended Consequences ◽  
Future Research ◽  
Policy Practice ◽  
Sexual Activities ◽  
People With Intellectual Disabilities

Objective: The aim of this systematic review was to examine the research evidence concerning the views and experiences of people with intellectual disabilities regarding their participation in and the effectiveness of relationship and sex education programmes. Methods: A systematic search of relevant electronic databases was conducted using defined inclusion criteria. All papers reviewed were from October 1998 to October 2018. PRISMA guidelines were followed in the design and reporting of the systematic review. Results: A total of eight studies published in English were included in the review. Data were analysed and the key themes identified were (1) designing and developing relationship and sex education programmes, (2) participating in relationship and sex education programmes and (3) perceived benefits of relationship and sex education programme participation. Conclusion: This review identified that people with intellectual disabilities are accessing relationship and sex education programmes and appear to find them helpful. Further research is required to investigate the extent to which programmes impact on long-term behaviours that enable the development of sustainable relationships and reduce the unintended consequences of sexual activities. Implications for policy, practice and future research developments are discussed.

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