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Hronis A, Hao J, Roberts R, Roberts L, Shires A, Kneebone I. A case series evaluation of the Fearless Me! © program for children with intellectual disabilities and anxiety. J Clin Psychol 2024. [PMID: 38781683 DOI: 10.1002/jclp.23709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 03/25/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Children and adolescents with intellectual disabilities (ID) have high rates of mental health disorders, particularly anxiety disorders. Cognitive behavior therapy (CBT) has largely remained unexamined as a treatment option for this population. Fearless Me! © is an adapted CBT treatment program specifically designed for children and adolescents with ID. METHOD Eleven children, aged between eight and 17, completed 10 therapy sessions. Measures of anxiety were completed pre and posttreatment and at 3 and 12-month follow-ups by both the children and parents. RESULTS Six children reported significant reductions in anxiety, with all showing significant reductions in parent-reported child anxiety at either posttreatment assessment, 3-month follow-up, or 12-month follow-up. Results varied across the six children as all parents reported heightened anxiety, but not all children reported high levels of anxiety for themselves. CONCLUSION Overall, this evaluation provides a sound basis for continued investigation and research into the use of the Fearless Me! © modified CBT program to treat children with ID and anxiety.
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Affiliation(s)
- Anastasia Hronis
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Jichun Hao
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Rachel Roberts
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Lynette Roberts
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Alice Shires
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Ian Kneebone
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
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Arvidsson P, Janeslätt G, Wennberg B, Lidström-Holmqvist K, Holmefur M, Hayat Roshanay A. Evaluation of the group intervention "Let's Get Organized" for improving time management, organisational, and planning skills in people with mild intellectual disability. Scand J Occup Ther 2023; 30:1257-1266. [PMID: 37278986 DOI: 10.1080/11038128.2023.2217545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 05/19/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Limited time management skills cause problems in daily life for people with mild intellectual disability (ID) and "Let's Get Organized" (LGO) is a promising manual-based occupational therapy group intervention aiming to support management skills. AIMS/OBJECTIVES To evaluate the applicability of the Swedish version of LGO-S by i) exploring enhancements in time management skills, satisfaction with daily occupations, and aspects of executive functioning in people with time-management difficulties and mild ID, and ii) describing clinical experiences of using the LGO-S for people with mild ID. MATERIAL AND METHODS Twenty-one adults with mild ID were included. Data were collected pre-/post-intervention and at 3- and 12-month follow-ups with: Swedish version of Assessment of Time Management Skills (ATMS-S), Satisfaction with Daily Occupation (SDO-13), and Weekly Calendar Planning Activity (WCPA-SE). There were few follow-up participants (n = 6-9). RESULTS Significant change in time management skills that maintained at 12-months follow-ups. Significant increase in regulation of emotions at 12-month follow-up. Results at 12-months follow-up indicated sustainability in outcomes as measured by ATMS-S. A non-significant positive trend was observed in other outcomes between pre- and post-intervention. CONCLUSIONS AND SIGNIFICANCE LGO-S seems applicable for improving skills in time management, organisation and planning also for people with mild ID.
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Affiliation(s)
- Patrik Arvidsson
- Centre for Research & Development, Region Gävleborg, Gävle, Sweden
- School of Health and Welfare, Disability Research, Jönköping University, Jönköping, Sweden
| | - Gunnel Janeslätt
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research in Dalarna, Uppsala University, Sweden
| | - Birgitta Wennberg
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Marie Holmefur
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Panditaratne S, Hronis A, Roberts R, Kneebone I. Participant experiences of Fearless Me! ©: Cognitive behaviour therapy for anxiety in children with intellectual disabilities. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractResearch shows that almost half of children with intellectual disabilities (ID) experience mental ill-health at any given time point. However, traditional cognitive behaviour therapy (CBT) may not be appropriate for children with ID due to the cognitive deficits associated with their diagnosis. The Fearless Me! © CBT program for anxiety is adapted to accommodate the cognitive abilities of children with ID. The aim of the current study was to provide the first qualitative evaluation of the Fearless Me! © program by exploring participant experiences. Eight mother–child dyads were interviewed using a semi-structured protocol. The responses were transcribed and analysed using thematic analysis. Identified codes and themes were cross-checked with an independent researcher and discrepancies were resolved. Parents found the program to be positive and useful for acquiring knowledge. They commented on features of the program, significance of inter- and intra-personal factors and whether the program suited the capability of their child. They also discussed features of treatment outcomes. The qualitative results highlighted that experiences of the program varied. Themes identified included those relating to barriers and facilitators to participation and treatment-related change. The themes provide guidance for program revisions and can inform future delivery of the Fearless Me! © program.
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Oudshoorn CEM, Frielink N, Nijs SLP, Embregts PJCM. Psychological eHealth interventions for people with intellectual disabilities: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:950-972. [PMID: 33704872 PMCID: PMC8359285 DOI: 10.1111/jar.12877] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of eHealth, which has accelerated in the wake of the COVID-19 pandemic, could contribute to the access to tailor-made psychological interventions for people with intellectual disabilities. METHOD A scoping review was conducted on peer-reviewed studies between 1996-2019. RESULTS Thirty-three studies reported on the use of psychological eHealth interventions focused on mental health problems and/or challenging behaviour. The vast majority of these studies reported on interventions that were delivered at the individual level. The context in which these interventions were delivered varied, primarily ranging from the home setting to residential settings, as well as day or activity centres and schools. The studies described various types of interventions: telehealth interventions, computerized cognitive behavioural therapy, and interventions focused on (social) learning principles targeting challenging behaviour. CONCLUSIONS eHealth provides new opportunities for both therapists and lay-therapists to deliver psychological interventions. Future studies should focus on the effectiveness of psychological eHealth interventions.
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Affiliation(s)
- Cathelijn E. M. Oudshoorn
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
- ASVZSliedrechtThe Netherlands
| | - Noud Frielink
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - Sara L. P. Nijs
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - Petri J. C. M. Embregts
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
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Granlund M, Imms C, King G, Andersson AK, Augustine L, Brooks R, Danielsson H, Gothilander J, Ivarsson M, Lundqvist LO, Lygnegård F, Almqvist L. Definitions and Operationalization of Mental Health Problems, Wellbeing and Participation Constructs in Children with NDD: Distinctions and Clarifications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1656. [PMID: 33572339 PMCID: PMC7916140 DOI: 10.3390/ijerph18041656] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 01/02/2023]
Abstract
Children with impairments are known to experience more restricted participation than other children. It also appears that low levels of participation are related to a higher prevalence of mental health problems in children with neurodevelopmental disorders (NDD). The purpose of this conceptual paper is to describe and define the constructs mental health problems, mental health, and participation to ensure that future research investigating participation as a means to mental health in children and adolescents with NDD is founded on conceptual clarity. We first discuss the difference between two aspects of mental health problems, namely mental disorder and mental illness. This discussion serves to highlight three areas of conceptual difficulty and their consequences for understanding the mental health of children with NDD that we then consider in the article: (1) how to define mental health problems, (2) how to define and assess mental health problems and mental health, i.e., wellbeing as separate constructs, and (3) how to describe the relationship between participation and wellbeing. We then discuss the implications of our propositions for measurement and the use of participation interventions as a means to enhance mental health (defined as wellbeing). Conclusions: Mental disorders include both diagnoses related to impairments in the developmental period, i.e., NDD and diagnoses related to mental illness. These two types of mental disorders must be separated. Children with NDD, just like other people, may exhibit aspects of both mental health problems and wellbeing simultaneously. Measures of wellbeing defined as a continuum from flourishing to languishing for children with NDD need to be designed and evaluated. Wellbeing can lead to further participation and act to protect from mental health problems.
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Affiliation(s)
- Mats Granlund
- CHILD, School of Health and Welfare, Jönköping University, 55110 Jönköping, Sweden; (A.K.A.); (F.L.)
- The Swedish Institute for Disability Research, 58183 Linköping, Sweden; (L.A.); (H.D.); (M.I.); (L.-O.L.)
| | - Christine Imms
- Department of Paediatrics, The University of Melbourne, Melbourne 3052, Australia;
| | - Gillian King
- Bloorview Research Institute, Torornto, ON M4G 1R8, Canada;
| | - Anna Karin Andersson
- CHILD, School of Health and Welfare, Jönköping University, 55110 Jönköping, Sweden; (A.K.A.); (F.L.)
- The Swedish Institute for Disability Research, 58183 Linköping, Sweden; (L.A.); (H.D.); (M.I.); (L.-O.L.)
| | - Lilly Augustine
- The Swedish Institute for Disability Research, 58183 Linköping, Sweden; (L.A.); (H.D.); (M.I.); (L.-O.L.)
- CHILD, School of Education and Communication, Jönköping University, 55110 Jönköping, Sweden
| | - Rob Brooks
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds LS1 3HE, UK;
| | - Henrik Danielsson
- The Swedish Institute for Disability Research, 58183 Linköping, Sweden; (L.A.); (H.D.); (M.I.); (L.-O.L.)
- Department of Behavioural Sciences and Learning, Linköping University, 58183 Linköping, Sweden
| | - Jennifer Gothilander
- School of Health, Care and Social Welfare, Mälardalen University, 72123 Vasteras, Sweden; (J.G.); (L.A.)
| | - Magnus Ivarsson
- The Swedish Institute for Disability Research, 58183 Linköping, Sweden; (L.A.); (H.D.); (M.I.); (L.-O.L.)
- Department of Behavioural Sciences and Learning, Linköping University, 58183 Linköping, Sweden
| | - Lars-Olov Lundqvist
- The Swedish Institute for Disability Research, 58183 Linköping, Sweden; (L.A.); (H.D.); (M.I.); (L.-O.L.)
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 70185 Örebro, Sweden
| | - Frida Lygnegård
- CHILD, School of Health and Welfare, Jönköping University, 55110 Jönköping, Sweden; (A.K.A.); (F.L.)
- The Swedish Institute for Disability Research, 58183 Linköping, Sweden; (L.A.); (H.D.); (M.I.); (L.-O.L.)
| | - Lena Almqvist
- School of Health, Care and Social Welfare, Mälardalen University, 72123 Vasteras, Sweden; (J.G.); (L.A.)
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Blakeley-Smith A, Meyer AT, Boles RE, Reaven J. Group Cognitive Behavioural Treatment for Anxiety in Autistic Adolescents with Intellectual Disability: A Pilot and Feasibility Study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:777-788. [PMID: 33410240 DOI: 10.1111/jar.12854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/09/2020] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adolescents with Autism Spectrum Disorder (ASD) and intellectual disability evidence significant anxiety. This study aimed to adapt a group cognitive behaviour therapies (CBT) programme designed for youth with ASD and anxiety to meet the cognitive, communication, and behavioural needs of adolescents with intellectual disability, and assess initial feasibility and efficacy of the intervention. METHODS Structural, content and procedural adaptations were made to a 14-week family-focused CBT intervention. Twenty-three adolescents with ASD, intellectual disability and anxiety were included. Treatment acceptability along with adolescent anxiety symptoms was assessed via parent report measures. RESULTS Of the 23 participants, 19 completed treatment and attended 94% of sessions. Parent acceptability was high. Significant reductions were noted on anxiety symptoms post-intervention. CONCLUSIONS Results indicate that the CBT group was feasible and acceptable. Preliminary outcomes suggest that adolescent anxiety improved, although replication with a larger sample and comparison to a control group is needed.
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Affiliation(s)
- Audrey Blakeley-Smith
- JFK Partners, Psychiatry & Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Allison T Meyer
- JFK Partners, Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard E Boles
- JFK Partners, Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Judy Reaven
- JFK Partners, Psychiatry & Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Badawy SM, Radovic A. Digital Approaches to Remote Pediatric Health Care Delivery During the COVID-19 Pandemic: Existing Evidence and a Call for Further Research. JMIR Pediatr Parent 2020; 3:e20049. [PMID: 32540841 PMCID: PMC7318926 DOI: 10.2196/20049] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 12/15/2022] Open
Abstract
The global spread of the coronavirus disease (COVID-19) outbreak poses a public health threat and has affected people worldwide in various unprecedented ways, both personally and professionally. There is no question that the current global COVID-19 crisis, now more than ever, is underscoring the importance of leveraging digital approaches to optimize pediatric health care delivery in the era of this pandemic. In this perspective piece, we highlight some of the available digital approaches that have been and can continue to be used to streamline remote pediatric patient care in the era of the COVID-19 pandemic, including but not limited to telemedicine. JMIR Pediatrics and Parenting is currently publishing a COVID-19 special theme issue in which investigators can share their interim and final research data related to digital approaches to remote pediatric health care delivery in different settings. The COVID-19 pandemic has rapidly transformed health care systems worldwide, with significant variations and innovations in adaptation. There has been rapid expansion of the leveraging and optimization of digital approaches to health care delivery, particularly integrated telemedicine and virtual health. Digital approaches have played and will play major roles as invaluable and reliable resources to overcome restrictions and challenges imposed during the COVID-19 pandemic and to increase access to effective, accessible, and consumer-friendly care for more patients and families. However, a number of challenges remain to be addressed, and further research is needed. Optimizing digital approaches to health care delivery and integrating them into the public health response will be an ongoing process during the current COVID-19 outbreak and during other possible future pandemics. Regulatory changes are essential to support the safe and wide adoption of these approaches. Involving all relevant stakeholders in addressing current and future challenges as well as logistical, technological, and financial barriers will be key for success. Future studies should consider evaluating the following research areas related to telemedicine and other digital approaches: cost-effectiveness and return on investment; impact on quality of care; balance in use and number of visits needed for the management of both acute illness and chronic health conditions; system readiness for further adoption in other settings, such as inpatient services, subspecialist consultations, and rural areas; ongoing user-centered evaluations, with feedback from patients, families, and health care providers; strategies to optimize health equity and address disparities in access to care related to race and ethnicity, socioeconomic status, immigration status, and rural communities; privacy and security concerns for protected health information with Health Insurance Portability and Accountability Act (HIPAA)-secured programs; confidentiality issues for some specific populations, especially adolescents and those in need of mental health services; early detection of exposure to violence and child neglect; and integration of training into undergraduate and graduate medical education and subspecialty fellowships. Addressing these research areas is essential to understanding the benefits, sustainability, safety, and optimization strategies of telemedicine and other digital approaches as key parts of modern health care delivery. These efforts will inform long-term adoption of these approaches with expanded dissemination and implementation efforts.
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Affiliation(s)
- Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ana Radovic
- Department of Pediatrics, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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