Tizard Learning Disability Review

O'Farrell, Kevin; Garner, Nick; Symes, Matt

2024 Tizard Learning Disability Review

doi: 10.1108/tldr-10-2023-0026

This paper aims to explore using the children’s accelerated trauma technique (CATT) in an adult intellectual disability population, with the aim of reducing symptoms of post-traumatic stress disorder (PTSD).Design/methodology/approachA service evaluation was completed to investigate differences between pre- and post-CATT trauma scores.FindingsScores on a measure of PTSD decreased significantly following CATT.Practical implicationsThe findings support continued use of CATT in adults with intellectual disabilities, and they highlight the need to evaluate effectiveness in a larger sample.Originality/valueThis paper evaluates the novel application of a trauma treatment – developed for use with children – in an adult intellectual disability population and adds to the existing evidence base.

Rickard, Georgina; Deveau, Roy

2024 Tizard Learning Disability Review

doi: 10.1108/tldr-01-2024-0001

This study aims to investigate the experiences of frontline managers supervising and developing staff to support autistic adults living in two types of residential housing in the community.Design/methodology/approachA qualitative approach used semi-structured interviews with 14 frontline managers. Audio-taped material was transcribed and analysed using thematic analysis.FindingsTwo main themes emerged. Theme 1 “autism in practice” illustrates commonalities observed to affect autistic adults with learning disabilities receiving staff support; whilst one sub-theme illustrated the diversity in how these commonalities may be experienced and expressed, another focused on participants’ experiences of staff concerns regarding behaviours described as challenging. Theme two, “what’s important in autism-informed support” reflected participants’ perceptions of the features of successful person-centred staff support for autistic service users.Research limitations/implicationsThe “rich” experiences of these managers may not be readily generalised.Practical implicationsFeatures of good staff support for autistic adults who may show behaviours of concern included attending to individuals’ specific communication and sensory needs and for predictability within their environments. Developing staff skills and confidence to implement skilled approaches in the context of often high risk behaviour of concern took time and frontline managers “on site” to observe, coach, mentor and demonstrate good practice. More intellectually (verbally) able service-users were perceived as more “difficult” to support.Social implicationsStaff supporting autistic adults in ordinary housing need frontline managers to act as practice leaders rather than administrators.Originality/valueThis study is the first to report, to the best of the authors’ knowledge, on management for staff supporting autistic adults living in community housing.

Locke, Hayley; Fennell, Brian

2024 Tizard Learning Disability Review

doi: 10.1108/tldr-12-2022-0030

Autistic children, particularly those with an intellectual disability, often face difficulties with early verbal development and social interaction. The science of behaviour analysis has developed procedures shown through research to help support and teach these skills. Interventions focusing solely on manipulating the antecedent stimuli in the environment are presented less frequently in the literature than those concerned with response consequences. This study aims to evaluate if changes to the classroom environment would evoke prosocial behaviours during play sessions.Design/methodology/approachA multiple treatment reversal design was used to compare the presence of anthropomorphic toys, pet animals and toys themed upon preferred interests, introduced on a central table within the existing play area. Data were collected on the social behaviour of peers in two primary classrooms.FindingsFor five of the six participants, all three conditions resulted in increased social behaviour compared to baseline conditions.Originality/valueAt the time of the study, social interaction opportunities were limited due to the COVID-19 pandemic restrictions, placing greater emphasis on safely encouraging opportunities within the classroom to ensure skill maintenance. Due to the reported outcomes, educators, particularly in specialised settings, should focus on evaluating their classroom environment to ensure the contents and layout support children in maintaining and generalising their social skills. Further research on the benefits of class pets is also encouraged.

Phillips, Jisan

2024 Tizard Learning Disability Review

doi: 10.1108/tldr-06-2024-0025

This paper aims to explore the challenges and themes discussed in the associated article “The Effects of Changing the Classroom Play Environment on the Peer Interactions of Autistic Children with an Intellectual Disability.” It expands on the research's context, foundation and potential impact, critically analysing the evidence on this topic.Design/methodology/approachThis commentary evaluates the perceptions and effectiveness of different classroom play environments for autistic children with intellectual disabilities, using a multiple treatment reversal design (ABACADA) to investigate how various play conditions impact prosocial behaviours.FindingsThe inclusion of toys related to preferred interests, such as anthropomorphic toys and small animals, promotes engagement and social interactions. The commentary highlights common barriers, but the study’s results are encouraging. Further investigation could benefit clinicians and educators in optimising classroom setups for applied practice. Potential solutions to barriers are considered.Originality/valueThe value and design of classroom play environments for autistic children with intellectual disabilities remain debated. This commentary provides a balanced, evidence-based perspective on how specific stimuli can enhance prosocial behaviours, contributing to ongoing discussions on inclusive and supportive educational practices.

Arnold, Rosalyn Marie; Acton, Danny; Jaydeokar, Sujeet

2024 Tizard Learning Disability Review

doi: 10.1108/tldr-10-2023-0027

This study aims to investigate the demographic and clinical characteristics associated with different risk stratification levels on the Decision Support Tool for Physical Health (DST-PH). The DST-PH was designed to stratify risk of avoidable mortality in adults with intellectual disabilities.Design/methodology/approachA prospective cohort study design was used. Data, including age, gender, ethnicity and completed DST-PH assessments, was collected from adults with intellectual disabilities within an NHS trust in the North-West of England. Descriptive statistics and a risk factor analysis were used to investigate differences between those rating Red, Amber and Green on the DST-PH.FindingsRisk factor analysis revealed key clinical indicators linked to avoidable mortality. Notably, those experiencing posture or mobility difficulties, transitions in care, an untreated or unstable mental health condition or significant behavioural problems were identified to be at significantly heightened risk of avoidable death. These findings emphasise the importance of proactively recognising and addressing these experiences, particularly posture- and mobility-related challenges, in individuals with intellectual disabilities. It is important to note this study’s findings are based on a small sample size. Therefore, further research with a larger and more diverse population is recommended to validate and expand upon these results.Originality/valueTo the authors’ knowledge, this is the first study which has used a risk stratification tool to investigate the clinical and demographic characteristics of individuals with intellectual disability at higher risk of avoidable mortality.

McMahon, Martin; Doyle, Carmel; Burke, Éilish; Fleming, Sandra; Cleary, Michelle; Byrne, Kathleen; McGlinchey, Eimear; Keenan, Paul; McCarron, Mary; Horan, Paul; Sheerin, Fintan

2024 Tizard Learning Disability Review

doi: 10.1108/tldr-06-2024-0026

People with intellectual disabilities are high users of acute hospital care. Given their varied and often complex health-care needs, they often experience health inequalities and inequities, contributing to poorer health outcomes. As nurses are the largest health-care workforce with a patient-facing role, they have an important responsibility in meeting this populations health needs. The purpose of this paper is to explore key issues relating to the role nurses play in providing equitable health care for people with intellectual disabilities.Design/methodology/approachThis service feature draws upon relevant literature to examine key contextual issues highlighting the importance of nurses in providing equitable health care for people with intellectual disabilities.FindingsThe findings from this service feature highlight the importance of nurses taking a leadership role in advocating for, and actively supporting the health needs of people with intellectual disabilities. Nurses’ leadership role, along with implementing reasonable adjustments, should be underpinned by education and training relating to the bespoke health needs of people with intellectual disabilities. This should help nurses promote the health and well-being of this population.Originality/valueAddressing this populations health needs is a collective responsibility of all nurses. There are many examples of how nurses can be supported through policy, education, training and advocacy and this needs to be considered by key stakeholders and addressed as a matter of priority.