Adapting suicide safety plans for youth with intellectual and developmental disabilities

INTRODUCTION

Although risk for suicide appears elevated in individuals with intellectual and developmental disorders (I/DD), few interventions or tools addressing suicide prevention have been adapted for this population. Among evidence-based interventions for preventing suicide, safety planning interventions are an effective and commonly employed intervention for reducing suicide-related risk.

METHODS

By drawing on Special Education praxis for supporting the learning needs of individuals with I/DD, we provide recommendations for adapting suicide safety planning interventions for youth with I/DD.

RESULTS

Specific visual, content, teaching, and communication components of the safety plan intervention can be adapted to better meet the needs of youth with I/DD.

DISCUSSION

Although future research is needed to evaluate these recommendations, these modifications may support clinicians serving youth with I/DD and suicide-related risk.

Differences in Healthcare Utilization in Children with Developmental Disabilities Following Value-Based Care Coordination Policies

GOAL

To address healthcare spending growth, coordinate care, and improve primary care utilization, a majority of states in the United States have adopted value-based care coordination programs. The objective of this study was to identify changes in national healthcare utilization for children with developmental disabilities (DDs), a high-cost and high-need population, following the broad adoption of value-based care coordination policies.

METHODS

This retrospective study included 9,109 children with DDs and used data from 2002-2018 Medical Expenditure Panel Survey. We applied an interrupted time series design approach to compare pre- and post-Affordable Care Act (ACA) care coordination policies concerning healthcare utilization outcomes, including outpatient visits, home provider days, emergency department (ED) visits, inpatient discharge, and inpatient nights of stay.

PRINCIPAL FINDINGS

We found statistically significant increases in low-cost care post-ACA, including outpatient visits (5% higher, p < .001) and home provider days (11% higher, p < .001). The study findings also showed a statistically significant increase in inpatient nights of stay post-ACA (4% higher, p = .001). There were no changes in the number of ED and inpatient visits. Overall, broad implementation of care coordination programs was associated with increased utilization of low-cost care without increases in the number of high-cost ED and inpatient visits for children with DDs. Our study also found changes in population composition among children with DDs post-ACA, including increases in Hispanic (16.9% post-ACA vs. 13.4% pre-ACA, p = .006) and non-Hispanic multiracial children (9.1% post-ACA vs. 5.5% pre-ACA, p = .001), a decrease in non-Hispanic Whites (60.2% post-ACA vs. 68.6% pre-ACA, p = .001), more public-only insurance (44.3% post-ACA vs. 35.7% pre-ACA, p = .001), fewer children with DDs from middle-income families (27.4% post-ACA vs. 32.8% pre-ACA, p < .001), and more children with DDs from poor families (28.2% post-ACA vs. 25.1% pre-ACA, p = .043).

PRACTICAL APPLICATIONS

These findings highlight the importance of continued support for broad care coordination programs for U.S. children with DDs and potentially others with complex chronic conditions. Policymakers and healthcare leaders might consider improving care transitions from inpatient to community or home settings by overcoming barriers such as payment models and the lack of home care nurses who can manage complex chronic conditions. Healthcare leaders also need to understand and consider the changing population composition when implementing care coordination-related policies. This study provides data regarding trends in hospital and home care utilization and evidence of the effectiveness of care coordination policies before the COVID-19 interruption. These findings apply to current healthcare management because COVID-19 has incentivized home care, which may have a strong potential to minimize high-cost care for people with complex chronic conditions. More research is warranted to continue monitoring care coordination changes over a longer period.

Stage IV breast, colorectal, and lung cancer at diagnosis in adults living with intellectual or developmental disabilities: A population-based cross-sectional study

BACKGROUND

Cancer is a leading cause of death among people living with intellectual or developmental disabilities (IDD). Although studies have documented lower cancer screening rates, there is limited epidemiological evidence quantifying potential diagnostic delays. This study explores the risk of metastatic cancer stage for people with IDD compared to those without IDD among breast (female), colorectal, and lung cancer patients in Canada.

METHODS

Separate population-based cross-sectional studies were conducted in Ontario and Manitoba by linking routinely collected data. Breast (female), colorectal, and lung cancer patients were included (Manitoba: 2004-2017; Ontario: 2007-2019). IDD status was identified using established administrative algorithms. Modified Poisson regression with robust error variance models estimated associations between IDD status and the likelihood of being diagnosed with metastatic cancer. Adjusted relative risks were pooled between provinces using random-effects meta-analyses. Potential effect modification was considered.

RESULTS

The final cohorts included 115,456, 89,815, and 101,811 breast (female), colorectal, and lung cancer patients, respectively. Breast (female) and colorectal cancer patients with IDD were 1.60 and 1.44 times more likely to have metastatic cancer (stage IV) at diagnosis compared to those without IDD (relative risk [RR], 1.60; 95% confidence interval [CI], 1.16-2.20; RR, 1.44; 95% CI, 1.24-1.67). This increased risk was not observed in lung cancer. Significant effect modification was not observed.

CONCLUSIONS

People with IDD were more likely to have stage IV breast and colorectal cancer identified at diagnosis compared to those without IDD. Identifying factors and processes contributing to stage disparities such as lower screening rates and developing strategies to address diagnostic delays is critical.

A systematic review of self and observer assessment of pain and related functioning in youth with brain-based developmental disabilities

ABSTRACT

Pain experiences of youth with brain-based developmental disabilities are often overlooked and/or misinterpreted, increasing the risk for poor or inadequate pain assessment and management. Ample measures exist to assess acute and chronic pain, yet their utility and frequency of use in youth with brain-based developmental disabilities is unclear and available measures do not have strong measurement properties for this diverse group. This systematic review identified the scope of self-reported and observer-reported pain assessment in studies of youth (aged 3-24 years) with brain-based developmental disabilities (phase 1) and summarized other measures of pain-related functioning for acute and chronic pain (ie, physical, emotional, social, sleep, and quality of life, within the subset of quantitative studies focused primarily on pain, phase 2). A comprehensive search for English-language studies was conducted in August 2022 in Web of Science, CINAHL, MEDLINE, Cochrane CENTRAL, EMBASE, and APA PsychINFO (PROSPERO registration: CRD42021237444). A total of 17,029 unique records were screened. Of the 707 articles included in phase 1, most assessed chronic pain (n = 314; 62.0%) and primarily used observer-report (n = 155; 31%) over self-report (n = 67; 13%). Of the 137 articles included in phase 2, other outcomes assessed alongside pain intensity included motor ability (16.8%), adaptive functioning (11%), quality of life (8%), pain interference (6.6%), mental health (5.8%), and communication ability (2.9%). Cerebral palsy was the most common population in both phase 1 (n = 343; 48.5%) and phase 2 (n = 83; 59.7%). This review provides a foundational understanding of pain assessment in brain-based developmental disabilities and highlights continued inequities in holistic pain assessment for this population.

Cognitive reserve proxies for individuals with intellectual developmental disability: A scoping review

BACKGROUND

Cognitive reserve (CR) has not been studied in people with Intellectual Developmental Disability, a population with a high incidence of dementia. Commonly adopted CR proxies should be adapted to reflect more specifically the experiences of people with Intellectual Developmental Disability.

METHOD

This scoping review intended to identify CR proxies relevant to people with this condition.

RESULTS

Some of these were the same already detected in a population without intellectual disabilities (education, occupation, physical activity, leisure, community and social activities); others were found to be specifically relevant for this population: type of schooling, parental educational level, environmental stimulation and living place.

CONCLUSIONS

These proxies need to be considered in studies on CR and Intellectual Developmental Disability and in clinical practice. Research on the protective effect of CR aims to encourage policies promoting lifestyle-based educational and preventive interventions and overcome participation barriers for people with Intellectual Developmental Disability.

The Impact of Emergency Pandemic HCBS Funding on the Continuity and Security of People with Intellectual and Developmental Disabilities

This study's aim was to examine the impact of pandemic emergency Home- and Community-Based Services (HCBS) payments on the continuity and security of people with intellectual and developmental disabilities (IDD). Using a multilevel logistic regression, we analyzed secondary Personal Outcome Measures interviews from 738 people with IDD (March 2020 through April 2022), and state pandemic emergency HCBS payment data from 16 states. The odds of people with IDD experiencing continuity and security during the pandemic increased by 3% for every 1% states increased their payment rates, and by 398% when states offered retainer payments. Increased reimbursement rates and retainer payments can help providers maintain operations and promote the continuity and security of people with IDD.

Loss-of-function of kinesin-5 KIF11 causes microcephaly, chorioretinopathy, and developmental disorders through chromosome instability and cell cycle arrest

Kinesin motors play a fundamental role in development by controlling intracellular transport, spindle assembly, and microtubule organization. In humans, patients carrying mutations in KIF11 suffer from an autosomal dominant inheritable disease called microcephaly with or without chorioretinopathy, lymphoedema, or mental retardation (MCLMR). While mitotic functions of KIF11 proteins have been well documented in centrosome separation and spindle assembly, cellular mechanisms underlying KIF11 dysfunction and MCLMR remain unclear. In this study, we generate KIF11-inhibition chick and zebrafish models and find that KIF11 inhibition results in microcephaly, chorioretinopathy, and severe developmental defects in vivo. Notably, loss-of-function of KIF11 causes the formation of monopolar spindle and chromosome misalignment, which finally contribute to cell cycle arrest, chromosome instability, and cell death. Our results demonstrate that KIF11 is crucial for spindle assembly, chromosome alignment, and cell cycle progression of progenitor stem cells, indicating a potential link between polyploidy and MCLMR. Our data have revealed that KIF11 inhibition cause microcephaly, chorioretinopathy, and development disorders through the formation of monopolar spindle, polyploid, and cell cycle arrest.

Alloparental Support and Infant Psychomotor Developmental Delay

Receiving social support from community and extended family has been typical for mothers with infants in human societies past and present. In non-industrialised contexts, infants of mothers with extended family support often have better health and higher survival through the vulnerable infant period, and hence shared infant care has a clear fitness benefit. However, there is scant evidence that these benefits continue in industrialised contexts. Better infant health and development with allocare support would indicate continued evolutionary selection for allocare. The research reported here used multiple logistic regression analysis to test whether a lack of family and other social support for mothers was associated with an increased risk of developmental delay in 9-month-old infants in the UK Millennium Cohort (analysis sample size, 15,696 infants). Extended family-based childcare during work hours and more maternal time spent with friends were the most influential kin and social support variables: infants of mothers with kin-based childcare versus all other childcare arrangements had a lower risk of developmental delay (OR = 0.61, 95% CIs: 0.46-0.82). Infants of mothers who spent no time with friends when compared with those who saw friends every day had double the odds of delay. Greater paternal involvement in infant care was associated with a lower odds of developmental delay. In conclusion, shared care of infants and social support for mothers may influence fitness-related traits in industrialised societies rather than being factors that influenced selection only in the past and in societies which retain close kin networks and a strong local community focus.

Perceived Impact of the COVID-19 Pandemic on Adults with Intellectual and Developmental Disability: A Qualitative Study

The current study examined the impact that the COVID-19 pandemic and resulting restrictions have had on individuals with intellectual and developmental disability. Semi-structured focus groups were conducted to collect data from participants who attended day programming by local community agency. Results indicate that the COVID-19 pandemic and its safety restrictions impacted participants' knowledge of the disease, programming and work, relationships, activities, and emotions in ways that were both similar to and different from other findings in other populations. Implications of these findings for research and practice are discussed.

Postschool Goal Expectations for Youth With Intellectual and Developmental Disabilities

Using National Longitudinal Transition Study 2012 data, this study explored parent and youth expectations in the areas of postsecondary education, employment, independent living, and financial independence. Compared to youth with other disabilities, youth with intellectual and developmental disabilities and their parents had much lower expectations for the four postschool goals, and parent expectations were much lower than youth's own expectations. Also, youth's race, along with their daily living skills and functional abilities, were positively associated with parent and youth expectations in several future goal areas. Our discussion highlights implications for improving the transition experiences of youth with intellectual and developmental disabilities.

Facilitators and impediments in inclusive education for students with intellectual developmental disability: Perceptions of school staff and parents in Israel

Students with intellectual developmental disability (IDD) may have impairments in conceptual, social, and daily life areas that will require support when these students are included in mainstream settings. In order to examine the facilitators and impediments involved in inclusion of students with IDD in regular schools in Israel, we interviewed six parents of students with IDD who were enrolled in inclusive classes, five teachers of inclusive classes, one teaching assistant and two school principals. Analysis of the interview transcripts revealed the perceptions regarding the included students, by their parents and the school staff. The school staff perceived family involvement and the connection between them and the parents as the most important. Parents perceived the possibility of studying in an inclusive class as an opportunity for social integration and scholastic advancement. All the participants indicated the social aspect as crucial to the inclusion of students with IDD.

Vitamin D levels of pregnant immigrant women and developmental disorders of language, learning and coordination in offspring

BACKGROUND

Prenatal vitamin D deficiency is a common health concern among immigrants. No previous studies have examined the associations between prenatal vitamin D levels and developmental disorders of language, scholastic skills, and coordination in an immigrant sample.

METHODS

The sample included 542 immigrant mothers of cases with language, scholastic, coordination or mixed developmental disorders, 443 immigrant mothers of controls without these disorders and 542 Finnish mothers of controls. Maternal vitamin D was measured in serum samples collected during early pregnancy and stored in a national biobank.

RESULTS

The mean vitamin D levels during pregnancy were 25.0 (SD 14.4) nmol/L for immigrant mothers of cases, 25.4 (SD 15.5) for immigrant mothers of controls and 42.3 (SD 19.1) for Finnish mothers of controls. Low maternal vitamin D levels during pregnancy were not associated with the selected developmental disorders in offspring when immigrant mothers of cases were compared to immigrant mothers of controls (adjusted OR for continuous log-transformed vitamin D: 1.01, 95% CI 0.75-1.36, p = 0.96). When immigrant mothers of cases were compared to Finnish mothers of controls, the adjusted OR for continuous vitamin D was 18.94 (95% CI 11.47-31.25), p <0.001). The results were similar when vitamin D was examined as a categorical variable or divided into quintiles.

CONCLUSIONS

Prenatal vitamin D levels were low, and similar, among immigrant mothers of cases with selected developmental disorders and unaffected controls. This indicates that vitamin D unlikely mediates previously observed associations between maternal immigrant status and the selected developmental disorders in offspring. The proportion of immigrant mothers with severe vitamin D deficiency was very high, which underlines the importance of prenatal counselling and overall public health efforts to improve immigrant health.

The Effects of an Inclusive Badminton Program on Static Postural Control for Individuals with Intellectual and Developmental Disabilities

The purpose of the study was to examine static postural control/balance in young adults with intellectual and developmental disabilities (IDD) and typically developing (TD) young adults before, during, and after an inclusive badminton intervention. Eight participants (four IDD-BADM and four TD-BADM) participated in a 12-week inclusive badminton intervention, with the other eight participants as matched controls (four IDD-CONTR and four TD-CONTR) (74.19 kg ± 9.8 kg, 171.96 cm ± 5.4 cm; 21.7 ± 1.8 years of age; nine females and seven males; eight with IDD and eight TD). The study followed a repeated measures design (pre, mid, post) before the intervention, at 6 weeks, and after 12 weeks. Static postural sway conditions included: bilateral stance eyes open (20 s), eyes closed (10 s), foam eyes open (20 s), foam eyes closed (10 s), and unilateral stance eyes open (10 s) and foam eyes open (10 s). Sway measurements included: average anterior/posterior (A/P) displacement (in), average medial/lateral (M/L) displacement (in), average 95% ellipsoid area (in2), and average velocity (ft/s). Significant time × group interactions were reported for average velocity (EO) (p = 0.030), average length (EO) (p = 0.030), 95% ellipsoid area (EO) (p = 0.049), and average A/P displacement (1LEO) (p = 0.036) for IDD-BADM. Significant time main effects were reported for average A/P displacement (FEO) (p = 0.040) for IDD groups. Significant time main effects were reported for average M/L displacement (EO) (p = 0.001), (EC) (p = 0.004), (FEO) (p = 0.005), (FEC) (p = 0.004), and average A/P displacement (EO) (p = 0.006) and (FEO) (p = 0.005) for TD groups. An inclusive badminton program indicated evidence of improved static postural control for those with IDD. However, no significant differences were reported for TD peers.

Investigating inequalities in cancer staging and survival for adults with intellectual or developmental disabilities and cancer: A population-based study in Manitoba, Canada

BACKGROUND

Cancer is a leading cause of death among adults living with intellectual or developmental disabilities (IDD). However, few epidemiological studies exist worldwide quantifying inequalities in cancer stage at diagnosis and survival for people with IDD relative to those without IDD.

METHODS

A population-based, retrospective cohort study was conducted using provincial health and social administrative data in Manitoba, Canada. Adults (≥18 years) with a cancer diagnosis between 2004 and 2017 were included. Lifetime IDD was identified before the cancer diagnosis using an established algorithm. Modified Poisson regression with robust error variance was used to estimate the association between IDD status and metastatic cancer at diagnosis. Multivariable Cox proportional hazards analyses were used to the effect of IDD on overall survival following the cancer diagnosis.

RESULTS

The staging and prognosis cohorts included 62,886 (n = 473 with IDD) and 74,143 (n = 592 with IDD) cancer patients, respectively. People living with IDD were significantly more likely to be diagnosed with metastatic cancer and die following their cancer diagnosis compared to those without IDD (RR=1.20; 95 % CI 1.05-1.38; HR= 1.53; 95 % CI 1.38-1.71). Significant heterogeneity by sex was identified for cancer survival (p = 0.005).

DISCUSSION

People with IDD had more advanced cancer stage at diagnosis and worse survival relative to those without IDD. Identifying and developing strategies to address the factors responsible that contribute to these disparities is required for improving patient-centred cancer care for adults with IDD.

Dyslexia and dyscalculia: which neuropsychological processes distinguish the two developmental disorders?

This study analyses the specific neuropsychological profiles of children with dyslexia and/or dyscalculia, in particular concerning phonological awareness, lexical access, working memory and numerical processing. Four groups were selected, through a screening process that used strict criteria, from 1568 7-10-year-old children: 90 with typical development, 61 with dyslexia, 13 with dyscalculia, and 14 with dyslexia + dyscalculia. Children with dyslexia show a deficit in phonological processing, lexical access, and verbal working memory, especially with alphabetic stimuli. Children with developmental dyscalculia show a deficit of phonological processing, verbal working memory with digits and visual-spatial working memory. They also show an impairment in spatial representation of numbers and in the automatic access to numerical semantics to a greater extent than those with double disturbance. Children with dyslexia + dyscalculia show a profile generally characterized by the summation of the deficits of the two disorders, although they have a lower deficit in access to numerical semantics and mental representation of numbers.

Developing and Evaluating the Fidelity and Understandability of Plain Language Summaries of Position Statements

The American Association on Intellectual and Developmental Disabilities (AAIDD) and The Arc of the United States (The Arc) have a long history of taking jointly held positions on matters of public policy that affect people with intellectual and developmental disabilities (IDD). This article describes the methods used to develop and evaluate the understandability and fidelity of written plain language summaries of the organizations' joint position statements for an audience of people with IDD who read. Implications for adapting source material for nonreading audiences are discussed.

Factors That Influence the Tenure of Direct Support Professionals in New York State Provider Agencies

The New York State Office for People With Developmental Disabilities seeks to better understand the direct support professional (DSP) workforce and offer data-informed strategies for DSP retention. We used the 2018 NCI-IDD Staff Stability Survey (now called State of the Workforce Survey) to investigate agency-level factors influencing DSP tenure. A total 303 provider agencies completed the survey in New York State, representing 72,252 DSPs. Multiple linear regression analysis revealed that selected agency-level variables explained 12.6% of the variance in DSP tenure, R2 = .16, Radj2 = .126, F (11, 260) = 4.54, p < .05. This study yielded strong empirical evidence consistent with existing national reports and research on the role that wages, benefits, and supervisory support play on DSP tenure.

Teaching Earthquake Preparedness Skills to Students With Developmental Disabilities: A Preliminary Evaluation

This study investigated the effects of behavioral skills training (BST) in teaching earthquake preparedness skills to students with developmental disabilities within a small group arrangement. A multiple probe design across behaviors and replicated across participants evaluated the effectiveness of BST when teaching three high school students to prepare an earthquake emergency kit, do drop-cover-hold, and share location through a personal safety app. All students acquired, maintained, and generalized the target behaviors. Participating students and their teachers had positive opinions regarding the target behaviors, procedure, and outcomes. Limitations and implications for future research are discussed.

An evaluation of video-prompting procedures via telehealth to teach first aid skills to children with intellectual and developmental disabilities

Unintentional injuries are one of the leading causes of morbidity and mortality among children with intellectual and developmental disabilities (IDD). First aid training involves teaching critical first aid skills, some of which are designed to treat unintentional injuries. To date, no study has (a) evaluated the effects of a video-prompting procedure to teach first aid skills to children with IDD or (b) attempted to teach these skills to children by using a telehealth delivery format. We used a concurrent multiple-baseline-across-skills design to evaluate the efficacy of a video-prompting procedure via telehealth to teach five children with IDD to perform first aid on themselves for insect stings, minor cuts, and minor burns under simulated conditions. For all participants, our procedure produced large improvements that maintained for a minimum of 4 weeks. Furthermore, the effects of the training generalized to novel confederates for all participants, and these effects maintained for a minimum of 4 weeks.

Distinct Neurodevelopmental Trajectories in Groups of Very Preterm Children Screening Positively for Autism Spectrum Conditions

Very preterm (VPT; < 33 weeks' gestation) toddlers screening positively for autism spectrum conditions (ASC) may display heterogenous neurodevelopmental trajectories. Here we studied neonatal brain volumes and childhood ASC traits evaluated with the Social Responsiveness Scale (SRS-2) in VPT-born toddlers (N = 371; median age 20.17 months) sub-divided into three groups based on their Modified-Checklist for Autism in Toddlers scores. These were: those screening positively failing at least 2 critical items (critical-positive); failing any 3 items, but less than 2 critical items (non-critical-positive); and screening negatively. Critical-positive scorers had smaller neonatal cerebellar volumes compared to non-critical-positive and negative scorers. However, both positive screening groups exhibited higher childhood ASC traits compared to the negative screening group, suggesting distinct aetiological trajectories associated with ASC outcomes.