Quality of Life Model Development and Use in the Field of Intellectual Disability

Perspectives of Adults with Intellectual Disabilities on Quality of Life: A Qualitative Study

Experiences of occupational participation of adults with Intellectual Disabilities (IDs) were explored through the lens of the Model of Occupational Justice (MOJ) and Critical Theory in order to shape and develop an occupation-centered model of quality of life (QoL). This qualitative study involved thirteen adults with IDs (N = 13). A semi-structured interview, constructed based on MOJ and Critical Theory principles, was administered to explore perspectives on QoL, as well as injustices regarding occupational participation. The interviews were analyzed using QSR NVivo8 and followed a content analysis methodology. A preliminary model of Occupational Quality of Life (O-QoL), with an everyday occupations core component, has been formed. The model includes three core O-QoL domains: (i) social well-being, (ii) emotional-physical well-being, and (iii) material adequacy. Key indicators of O-QoL were identified as leisure and social activities, while socioenvironmental factors such as occupational deprivation were noted as aggravating. Specific occupations, including leisure activities, physical exercise/sports, art, video games, and vocational training, were found to be beneficial for O-QoL. Moreover, the importance of promoting and supporting the rights of people with IDs for employment, independent living, and sexual expression was highlighted. The model of O-QoL (version 1) could be a valuable alternative conceptual framework of QoL in the field of IDs; however, further research is needed to validate and refine the model.

Measuring quality of life of adults with intellectual disabilities: Psychometric evaluation of the personal outcomes scale in the United Kingdom

BACKGROUND

The Personal Outcomes Scale (POS) is a scale developed to measure quality of life of adults (18+) with intellectual disability. Previous studies have reported good fit for Spanish and Portuguese language versions of POS.

AIMS

This study aimed to evaluate the factor structure of the English language version of POS when used to measure the quality of life of adults (18+) with intellectual disability in the UK.

MATERIALS AND METHODS

Analysis was conducted on POS data from 310 adults with an intellectual disability. First and second order factor models and multi-level models were used to assess fit.

RESULTS

There was poor fit to the data for all tested models. We estimated that 23% of variance in POS scores was accounted for by interviewer cluster.

DISCUSSION

This was the first UK-based evaluation of POS and our data did not confirm the factor structure of the POS measure. The identification of systematic variability within the dataset indicates that inter-rater reliability is a potential limitation of the POS tool.

CONCLUSION

Further research is needed to investigate inter-rater reliability of POS interviewers and to explore factor structure.

Adapting a quality of life scale for children and young people with Down syndrome in Chile

In Chile, there are no validated instruments for the evaluation of quality of life (QoL) of people with Down syndrome (DS). To analyze construct validity and reliability of the KidsLife-Down scale in Chile to measure QoL in people with DS aged from 4 to 21 years. Families of boys, girls, and young people with DS between 4 and 21 years were invited to participate. The scale was answered by relatives or caregivers. To assess the internal consistency, reliability tests were performed using Cronbach's alpha coefficient. A confirmatory factor analysis was performed. The scale was answered by 531 relatives or caregivers. Cronbach's coefficient was greater than 0.7 in all the items. The confirmatory factor analysis of the scale allowed its validation for clinical use in the Chilean population. "Kids Life Down-Chile" scale has adequate psychometric properties to be used in clinical practice and to help us improve QoL with better support strategies.

Photographic visualization of stories: documenting the experiences of people with intellectual disabilities with guided photovoice

People with intellectual disabilities are often excluded from participation in research, whilst research has the potential to enhance positive change in their lives. In the current study, using a guided photovoice procedure, the experiences of people with intellectual disabilities regarding participation in research are evaluated. A total of 14 participants with intellectual disabilities were interviewed using guided photovoice. Through thematical analyses the experiences of people with intellectual disabilities regarding photovoice are discussed. Benefits were taking time, visual cues and the opportunity to speak out. Challenges were abstract concepts and aftercare. Guided photovoice helps to better understand the perspective of people with intellectual disabilities and thus can help to improve their quality of life. People with intellectual disabilities were interested in taking part in the current research project and experienced participating as a positive experience. However careful planning and expertise in communication with people with intellectual disabilities is necessary to include people with intellectual disabilities in research.

Adult Independence Living Measurement Scale: Psychometric validation of a scale to estimate personal skills for independent living in people with intellectual and developmental disabilities

BACKGROUND

The United Nations has declared that people with disabilities should be enabled to live as independently as possible, since independence is correlated with a better quality of life. Consequently, services need to have common and validated measurement tools for the evaluation of the different levels of personal support needs in order to promote independent living skills. We aimed to create and validate the Adult Independence Living Measurement Scale (AILMS) to estimate personal skills considered tantamount for independent living in adult persons with intellectual and developmental disabilities.

METHODS

AILMS is a short informant-rated assessment tool consisting of 19 items (goals) regarding the most important skills related to independent living. AILMS total score is directly proportional to the degree of independence, with scores ranging from 19 to 76. Our validation is a multicentre study attended by 243 subjects, 110 female and 123 males, with a median age of 37 years and with an interquartile range (IQR) of 18 (25th percentile [Q1] 29 years to 75th percentile [Q3] 47 years). All subjects had a diagnosis of intellectual disability associated with various neurodevelopmental disorders or syndromic conditions.

RESULTS

The AILMS shows a wide range of scores with a minimum score of 21 and a maximum of 72. We found no floor or ceiling effects for the total score on the AILMS. Cronbach's α coefficient (= 0.95), based on the 19 AILMS items, indicated high internal consistency. The tool demonstrates a very good agreement even when comparing the results submitted by two different interviewers. It also shows an excellent temporal stability of 1 week, with intraclass correlation coefficients both of 0.97. AILMS total scores do not differ by sex or age, while statistically significant differences are observed between people with different levels of severity of ID. Convergent validity of AILMS was analysed by correlating its total scores with the Italian validated versions of the Support Intensity Scale (SIS-I) and the Alzheimer's Functional Assessment Tool (AFAST-I) scores. Strong inverse Spearman correlations coefficients (r_s ) were found both for the Support Need Index of the SIS-I (r_s  = -0.66; P < 0.001) and AFAST-I (r_s  = -0.73; P < 0.001). Scores of support needs in exceptional health disorders of the SIS-I appear unrelated to AILMS total scores (r_s  = -0.01; P = 0.05), confirming the divergent validity of the new scale. Exploratory factor analysis reveals three underlying factors within the AILMS, with factor 1 explaining 51.2% of the total variance (Cronbach's α = 0.92) composed of predominantly nine advanced daily activities.

CONCLUSIONS

The AILMS has good psychometric properties and user friendliness and may therefore be a valuable addition to the current informant-rated tools for screening and assessment of independent living skills of individuals with intellectual and developmental disabilities.

Association between employment status and quality of life for individuals with intellectual or developmental disability

The current study examined how employment conditions (competitive employment, work center employment, unemployment) are associated with the quality of life (QoL) for individuals with intellectual or developmental disabilities. Using the Comprehensive Quality of Life Scale - Intellectual/Cognitive Disability (5th Edition; ComQoL-I5; Cummins, 1997a) to measure objective QoL factors, and the PWI-ID (Personal Wellbeing Index - Intellectual Disability, 3rd Edition; Cummins & Lau, 2005b) to measure subjective well-being, participants answered self-reporting questions regarding the seven QoL domains. Kruskal-Wallis H for Oneway Analysis of Variance was used to determine statistical significance between comparison work conditions. Results indicate significant findings in the objective QoL domains of Material Well-Being, Productivity, and Safety between the work conditions for individuals with intellectual and developmental disabilities, with participants in the competitive-employment group reporting the highest QoL objective scores in these areas. Implications of these findings for practice and research are discussed.

Support needs of older people with intellectual disabilities: An exploratory study among psychologists in the Netherlands

BACKGROUND

Information regarding the common-daily support needs of older people with intellectual disabilities remains scarce, despite the necessity of such knowledge to the provision of adequate support. This exploratory study aims to identify the most important support needs.

METHOD

A mixed-method design was conducted, in which 11 semi-structured interviews were held with psychologists to gain insight into the support needs of older people with intellectual disabilities.

RESULTS

The data provide an overview of the support needs of older people with intellectual disabilities in all quality-of-life (QoL) domains. Physical well-being, emotional well-being, interpersonal relationships and self-determination were identified as the most important domains for older people with intellectual disabilities.

CONCLUSIONS

The findings of this study may guide the development of a specific training for support staff and constitute a valuable contribution to raising awareness among support staff concerning the broad range of support needs existing among older people with intellectual disabilities.

Ableism, racism, and the quality of life of Black, Indigenous, people of colour with intellectual and developmental disabilities

BACKGROUND

Research indicates Black, Indigenous, people of colour (BIPOC) with intellectual and developmental disabilities face disparities in quality of life outcomes. This study's aim was to examine how ableism and racism impacted the quality of life of BIPOC with intellectual and developmental disabilities.

METHODS

Using a multilevel linear regression, we analysed secondary quality of life outcome data from Personal Outcome Measures® interviews with 1393 BIPOC with intellectual and developmental disabilities and implicit ableism and racism data from the 128 regions of the United States in which they lived (discrimination data came from 7.4 million people).

RESULTS

When BIPOC with intellectual and developmental disabilities lived in regions of the United States which were more ableist and racist, they had a lower quality of life, regardless of their demographics.

CONCLUSION

Ableism and racism are a direct threat to BIPOC with intellectual and developmental disabilities' health, wellbeing, and overall quality of life.

A person-centered approach to home and community-based services outcome measurement

In the United States, over 2.5 million people with disabilities are recipients of supports through the Center for Medicare and Medicaid Services (CMS) Home and Community-Based Services (HCBS) program. Recent decades have seen a growing focus on providing HCBS in a person-centered manner thereby supporting outcomes that are both important for and to the person. HCBS outcome measurement, however, has not kept pace with advancements in person-centered thinking as it relates to providing supports to people with disabilities. The concept of person-centered outcome measurement has been inadequately defined and is frequently misunderstood including by those in the measurement field. The authors first operationally define person-centered measurement and establish its importance within the context of HCBS and the recent CMS's Final Settings Rule. The important role that person-centered measurement has to play in quality improvement efforts in this area is then explored. A discussion is subsequently provided as to the challenges that are faced in person-centered measurement specific to the disability field. In addition to further conceptualizing and defining this form of measurement, recommendations are provided for moving the field forward.

Aligning quality of life and guidelines for off-label psychotropic drugs in adults with intellectual disabilities and challenging behaviour

Introduction

Adults with intellectual disabilities have an increased vulnerability to mental health problems and challenging behaviour. In addition to psychotherapeutic or psychoeducational methods, off-label pharmacotherapy, is a commonly used treatment modality.

Objective

The aim of this study was to establish evidence-based guideline recommendations for the responsible prescription of off-label psychotropic drugs, in relation to Quality of Life (QoL).

Method

A list of guidelines was selected, and principles were established based on international literature, guideline review and expert evaluation. The Delphi method was used to achieve consensus about guideline recommendations among a 58-member international multidisciplinary expert Delphi panel. Thirty-three statements were rated on a 5-point Likert-scale, ranging from totally disagree to totally agree, in consecutive Delphi rounds. When at least 70% of the participants agreed (score equal or higher than 4), a statement was accepted . Statements without a consensus were adjusted between consecutive Delphi rounds based on feedback from the Delphi panel.

Results

Consensus was reached on 4 general:the importance of non-pharmaceutical treatments, comprehensive diagnostics and multidisciplinary treatment. Consensus was reached in 4 rounds on 29 statements. No consensus was reached on 4 statements concerning: freedom-restricting measures, the treatment plan, the evaluation of the treatment plan, and the informed consent.

Conclusion

The study led to recommendations and principles for the responsible prescription - aligned with the QoL perspective - of off-label psychotropic drugs for adults with intellectual disabilities and challenging behaviour. Extensive discussion is needed regarding the issues on which there was no consensus to furthering the ongoing development of this guideline.

A Tool for Assessing the Quality of Life of Adolescents in Youth Care: Psychometric Properties of the QOLYSS

Quality of life (QOL) has gained increased interest as a critical pathway to better understanding the lives and circumstances of children and adolescents in both the general population and among specific populations. Yet, QOL assessment among youngsters in youth care services remains a highly under-researched topic. This study examines the suitability and psychometric properties of a new QOL self-report scale for adolescents between 12 and 18 years old in youth care: the Quality of Life in Youth Services Scale (QOLYSS). The provisional version of the QOLYSS was pre-tested in a sample of 28 adolescents in youth care to examine its applicability and feasibility. Next, a comprehensive evaluation of the psychometric properties of the field-test version was conducted in a sample of 271 adolescents in youth care in Flanders, Belgium (M = 15.43, SD = 1.73). Classical item and factor analyses were carried out per subscale, (test-retest) reliability and item-discriminant validity of the subscales were examined, convergent validity was explored, and confirmatory factor analysis was used to examine the goodness-of-fit of different measurement models. Reliability measures of the scale are satisfactory, results are indicative of convergent validity, and confirmatory factor analysis provides evidence for the eight correlated factors model. Future lines of research concerning the ongoing development and application of the QOLYSS are discussed.

The IDD Paradigm of Shared Citizenship: Its Operationalization, Application, Evaluation, and Shaping for the Future

Changes in the field of intellectual and developmental disabilities (IDD) over the last 5 decades has resulted in the emergence of the shared citizenship paradigm. This paradigm is currently guiding the development of IDD-related policies and practices, and providing a framework for application, research-based inquiry, and evaluation. A shared citizenship paradigm is one that envisions, supports, and requires the engagement and full participation of people with IDD as equal, respected, valued, participatory, and contributing members of every aspect of society. The overall goals of the paradigm are to (a) further advance and focus on people with IDD as active agents in the change process, and (b) improve outcomes for people with IDD, including their access to and opportunity for shared citizenship. This article describes the paradigm's operationalization, application, evaluation, shaping for the future, and specific strategies to overcome implementation challenges.

Implications of COVID-19 Regulations for People With Visual and Intellectual Disabilities: Lessons to Learn From Visiting Restrictions

Background

Due to the COVID-19 pandemic, governments of many countries announced regulations to prevent the virus from spreading. For people with a disability living in a sheltered care facility in the Netherlands, this meant that they were not able to receive any visitors for almost 3 months.

Aim

This study examines how people with an intellectual and visual disability and their families experienced the period in which it was mandated not to have any physical contact. The aim is to examine the experiences of this target group and gain insight in the way measures were taken in order to be able to advise care organizations about adequate care with respect to possible restrictive measures in the future.

Methods

In-depth interviews were conducted with two groups of people: (1) fourteen people with an intellectual and visual disability, living in sheltered care facilities and (2) twelve people being relatives of residents of these same sheltered care facilities. In the interviews, the participants were questioned about their experiences with respect to the adjusted visiting regulations and with respect to the relation with their family during this period. A thematic analysis was performed first separately and then combined.

Results and Discussion

A number of themes resulted from the analysis that were related to (1) the instructed regulations of the sheltered care facilities and the government; (2) the relation with family and friends; and (3) the consequences of COVID-19 and the regulations. Both relatives and residents were understanding of the difficult situation, but also expressed criticism about the chosen regulations, the communication thereof, and the practical implementation. Both groups have experienced the interruption of close contact as emotional and difficult. However, also positive consequences of the restrictions due to COVID-19 were mentioned. The results provide a list of recommendations for sheltered care facilities.

The Impact of Human Service Provider Quality on the Personal Outcomes of People With Intellectual and Developmental Disabilities

Background

Quality of life is multidimensional—influenced by individual, organizational, and environmental factors. As such, when examining personal outcomes, it is also important to consider meso and macro factors that contribute to people with intellectual and developmental disabilities' (IDD's) quality of life. While it is widely acknowledged that organizational factors contribute to people's quality of life, there is less research directly examining how the quality of human service providers contributes to people with IDD's personal outcomes. For these reasons, the aim of this study was to explore the relationship between provider quality and people with IDD's personal quality of life outcomes.

Methods

Using a multilevel linear regression we analyzed secondary Personal Outcome Measures® (personal outcomes) and Basic Assurances® (provider quality) data from 2,900 people with IDD served by 331 human service providers.

Results

People with IDD's personal outcomes, regardless of their support needs or other demographics, were significantly impacted by the quality of the human service providers they received services from—the higher the quality of the provider, the more personal outcomes they had present. In addition, the following demographic covariates were correlated with personal outcomes: gender; race; complex support needs; residence type; and organizations that offered therapy services.

Discussion

While quality improvement initiatives may require a great deal of cost and time commitment from providers, our findings suggest the effort translates to improved personal outcomes among people with IDD. The ultimate goal of service providers should be improvement of quality of life among those they support.

Role of Callous and Unemotional (CU) Traits on the Development of Youth with Behavioral Disorders: A Systematic Review

Numerous studies have shown that youth with behavioral disorders (BD) present an increased risk for developing severe and persistent antisocial behaviors in adulthood. Retrospective research notes that not all children and adolescents follow a negative trajectory and explains this heterogeneity in particular by the severity of CU traits. Our study examines how these traits affect the functioning of children and adolescents with BD. Method: A systematic literature review conducted through various databases and using different keywords made it possible to analyze 52 studies published from 2015 to 2020 that measured the bidirectional effects of CU traits on the functioning of young. Results: Out of the 52 studies, 47 analyzed links between CU traits and neurobiological or mental health, 20 examined family and school contexts, eight focused on social adjustment, 10 on social interactions and 19 measured links with cognitive functioning, especially executive functions. Conclusion: Consistent with previous recommendations in the field, our findings emphasize the importance of assessing the presence of UC traits in early childhood to prevent the emergence of comorbid disorders and to target multimodal (early) interventions to influence the life trajectories of youth with high CU traits.

Evaluating quality of life in families with Williams Syndrome patients

Background

Williams Syndrome is a developmental disorder characterized by a variable intellectual disability. People with Williams Syndrome need the intervention of several clinical and educational specialists throughout their life. However, little is known about the impact produced by this disability in their immediate environment, especially in families. The purpose was to know the level of quality of life described by families with Williams Syndrome.

Methods

The sample was made up of 33 families belong to Spanish Williams Syndrome Association who were evaluated using the Kidslife Scale. Their children and adolescents were between 4 and 20 years old. Eight main quality of life domains were evaluated: emotional well-being, physical well-being, material well-being, personal development, interpersonal relations, social inclusion, self-determination and rights

Results

The obtained data indicated that the degree and presence of intellectual disability did not homogeneously influence people’s quality of life, but many variables could alter their quality of life to a greater or lesser extent. There are no significant differences between quality of life areas but significant differences appeared for level of dependence in the self-determination subarea (p < .05).

Conclusions

These results led us to analyse the social and emotional implications for families and their environment.

Quality of life in individuals with Down syndrome aged 4 to 21 years

BACKGROUND

To date, investigations of quality of life (QoL) in children with Down syndrome (DS) are rather limited. The purpose of this study was twofold: to examine QoL in children with DS and to explore possible differences in the QoL by age and gender.

METHODS

A cross-sectional study of 211 parents of children with DS was conducted using an online survey that included a consent form, a demographic questionnaire and the English version of KidsLife, which is a measure of children's QoL.

RESULTS

Our results demonstrated moderate or favourable levels of QoL except for the emotional well-being domain among children with DS. The children's QoL showed no variance by gender. However, emotional and material well-being, interpersonal relations and social inclusion varied by age.

CONCLUSIONS

The current findings provide important evidence that will help healthcare, educational and social services professionals to understand the multiple aspects of QoL in children with DS and support parents in their efforts to ensure the child's QoL. The results also point to the need to develop interventions aimed at improving QoL in those areas where children with DS are at increased risk for poorer QoL.

An exploration of lifestyle/obesity programmes for adults with intellectual disabilities through a realist lens: Impact of a 'context, mechanism and outcome' evaluation

BACKGROUND

Obesity is higher in people with intellectual disabilities.

AIMS

There are two aims of this explorative paper. Firstly, using a realist lens, to go beyond 'what works' and examine the 'context, mechanisms and outcomes' (CMO) of lifestyle/obesity programmes for this population. Second, using a logic model framework to inform how these programmes could be implemented within practice.

METHOD

We explored six-review papers and the individual lifestyle/obesity programmes that these papers reviewed using the CMO framework.

RESULTS

There were few theoretically underpinned, multi-component programmes that were effective in the short to long-term and many failed to explore the 'context and mechanisms'. We developed a logic model and engaged in two co-production workshops to refine this model.

DISCUSSION

Using a realist approach, programmes need to be underpinned by both individual and systems change theories, be multi-component, have a closer understanding of the interplay of the 'context and mechanisms', and co-designed using a logic model framework.

Identifying gaps in using artificial intelligence to support students with intellectual disabilities from education and health perspectives

Purpose

Students with developmental/intellectual disabilities (ID/DD) often have serious health issues that require additional medical care and supervision. Serious health issues also mean increased absence and additional lags in academic achievement and development of adaptive and social skills. The incorporation of artificial intelligence in the education of a child with ID/DD could ameliorate the educational, adaptive and social skill gaps that occur as a direct result of persistent health problems.

Design/methodology/approach

The literature regarding the use of artificial intelligence in education for students with ID/DD was collected systematically from international online databases based on specific inclusion and exclusion criteria. The collected articles were analyzed deductively, looking for the different gaps in the domain. Based on the literature, an artificial intelligence–based architecture is proposed and sketched.

Findings

The findings show that there are many gaps in supporting students with ID/DD through the utilization of artificial intelligence. Given that the majority of students with ID/DD often have serious and chronic and comorbid health conditions, the potential use of health information in artificial intelligence is even more critical. Therefore, there is a clear need to develop a system that facilitates communication and access to health information for students with ID/DD, one that provides information to caregivers and education providers, limits errors, and, therefore, improves these individuals' education and quality of life.

Practical implications

This review highlights the gap in the current literature regarding using artificial intelligence in supporting the education of students with ID/DD. There is an urgent need for an intelligent system in collaboration with the updated health information to improve the quality of services submitted for people with intellectual disabilities and as a result improving their quality of life.

Originality/value

This study contributes to the literature by highlighting the gaps in incorporating artificial intelligence and its service to individuals with ID/DD. The research additionally proposes a solution based on the confounding variables of students’ health and individual characteristics. This solution will provide an automated information flow as a functional diagnostic and intervention tool for teachers, caregivers and parents. It could potentially improve the educational and practical outcomes for individuals with ID/DD and, ultimately, their quality of life.

Quality of Life Outcome and Support Disparities Among People With More Severe Impairments

People with intellectual and developmental disabilities (IDD) with more severe impairments often face service disparities. The aim of this study was to explore not only disparities in quality of life outcomes for people with IDD with severe impairments, but also disparities in the supports they receive from disability service organizations. Our analysis of Personal Outcome Measures interviews from 1,300 people revealed people with severe impairments experienced quality of life disparities in most domains, attributed to the fact that they also received fewer organizational supports than people with less severe impairments. By paying attention to person-centered outcomes, including these disparities, organizations' roles can shift from just providing services to supporting people to achieve the outcomes that are truly important to them.

Direct Support Professionals and Quality of Life of People With Intellectual and Developmental Disabilities

Direct Support Professionals (DSPs) are the "backbone" of long term services and supports (LTSS) in the United States ( Bogenschutz, Hewitt, Nord, & Hepperlen, 2014 , p. 317). This study examined the relationship between DSPs and people with intellectual and developmental disabilities' (IDD) quality of life. To do so, we utilized Personal Outcome Measures® interviews from over 1,300 people with IDD to examine the impact DSP change has at individual and organizational levels. We found DSP continuity is central to quality of life of people, including human security, community, relationships, choice, and goals. States cannot continue to provide near-poverty level reimbursement rates for DSPs and still ensure quality of life.

A model of well-being for children with neurodevelopmental disorders: Parental perceptions of functioning, services, and support

BACKGROUND

Both child function and supports and services have been found to impact the well-being of parents of children with neurodevelopmental disorders (NDD). The relationship between function and services and the well-being of children with NDD is less well-understood and is important to clarify in order to effect program and service change.

METHODS

The current project assessed whether child function as well as the adequacy of formal supports and services provided to children and their families were predictive of child well-being. Well-being was assessed using a measure of quality of life developed for use with children with NDD. Data from 234 parents were analysed using structural equation modelling.

RESULTS

Each predictor was found to load significantly on the overall outcome variable of well-being. Parent concerns about child function were significantly related to child well-being; parents who reported more concerns about their children's functioning reported lower levels of child well-being. Unmet needs for formal supports and services were also significantly related to child well-being; parents who reported that more of their children's and family's service needs were unmet reported lower child well-being. An indirect relationship was also found between child function and child well-being. When parents reported that their formal support needs were adequately met, their children's functional difficulties had a lower impact on parent perceptions of their children's overall well-being.

CONCLUSIONS

Taken together, the results of the current study enrich our understanding of well-being for children with NDD. Discussion focuses on the service implications for children with NDD and their families.

Quality of life of children and adolescents with visual impairment

The conceptual framework of quality of life (QOL) have received considerable attention within students with visual impairment. The main purpose of this study was to analyse the QOL of children and adolescents with low vision and blindness. Data were collected from 18 children and adolescents, and respective parents ( n = 18). QOL was assessed by the KIDSCREEN 52 questionnaire. Cronbach’s alpha and correlations were calculated to examine the psychometric properties of the scale in the visual impairment field. The scale showed suitable internal consistency and construct validity. The findings highlighted that the mean scores were higher in participants with low vision, in male group, and in children. Furthermore, children and adolescents reported higher scores regarding their QOL than their parents. The results emphasized the importance of collecting information from the person about his or her own life to know the personal outcomes, as well as the perception of their parents.

Dimensionality and internal structure of the Colombian version of the INICO-FEAPS quality of life scale

BACKGROUND AND OBJECTIVE

Measuring quality of life (QoL) in people with intellectual disabilities (IDs) can help organisations and practitioners to implement evidence-based practices and develop person-centred planning and individualised supports. There is no reliable and valid instrument for assessing QoL in people with ID in Colombia. We investigated the internal structure of the Colombian version of the INICO-FEAPS scale and tested whether the scale identified the eight interrelated domains of the QoL conceptual framework originally described by.

METHOD

Data were collected from 602 adults with moderate levels of ID and respective proxies, who completed the self-report and the report by other scales, respectively. Five measurement models were tested through confirmatory factor analysis.

RESULTS

The eight correlated dimension model showed the best fit to the data. Reliability and convergent validity of the indicators were satisfactory in both versions of the scale (self-report and proxy report).

CONCLUSIONS

This study contributes to research on QoL measurement by providing the first empirical evidence regarding the dimensionality, internal structure and psychometric properties of the Colombian version of the INICO-FEAPS scale. Moreover, the study presents the first adaptation of a specific QoL scale for people with ID in Colombia, which may in the future be useful for implementing evidence-based practices and developing person-centred support plans.

Challenging behavior, functioning difficulties, and quality of life of adults with intellectual disabilities

Objective: The current study aimed at examining the correlations between challenging behaviors, difficulties in functioning, and quality of life in institutionalized adults with intellectual disabilities. Methods: A sample of 53 people with intellectual disabilities and challenging behavior who resided in a large institutional care facility was recruited. The research questionnaire included the following instruments: (1) The challenging behavior scale; (2) The World Health Organization Disability Assessment Schedule 2.0; and (3) The Personal Well-Being Index. Results: No significant correlation was found between challenging behavior and quality of life. However, more challenging behavior found to be correlated with greater difficulties in functioning. Furthermore, a weak correlation was found between difficulties in functioning and quality of life. Participants who had greater difficulty functioning tended to exhibit lower levels of quality of life. No significant associations were found between the sample's personal characteristics (gender, age, and the severity of intellectual disability) and challenging behavior, difficulties in functioning, and quality of life. Conclusion: Empowering personal functioning of people with intellectual disabilities is important in planning rehabilitation interventions. Such interventions are likely to promote a higher quality of life. There is the need for future research to further investigate the relationship found in this study.

Comparing the quality of life of adults with and without intellectual disability

BACKGROUND

Quality of life (QOL) is an important issue for all citizens, comprising equity, equality, inclusion and participation of each person in society. The research purposes driving this investigation were (1) to compare QOL among people with and without intellectual disability (ID) and (2) to examine the predictors of QOL in both groups of participants.

METHODS

Data were collected from 1929 adults, including 1264 individuals with an ID and the remainder (n = 665) were participants without a disability. QOL was assessed by the Portuguese version of the Personal Outcomes Scale.

RESULTS

The findings supported significantly higher QOL for adults without ID. Furthermore, QOL is influenced by individual and environmental variables, stressing that the health status was the highest mutual predictor of QOL among those with and without ID.

CONCLUSION

The gaps among both groups of participants should be addressed in service provision and policies. Taking into account the research findings, the personalised supports should enable the full inclusion and participation of adults with ID in community-based settings.

Moving Us Toward a Theory of Individual Quality of Life

This article discusses three steps involved in moving us toward a theory of individual quality of life: developing a conceptual model, integrating theory components, and applying and evaluating the theory. Each of the proposed steps is guided by established standards regarding theory development and use. The article concludes with a discussion of criteria that can be used to evaluate the theory and the contribution that a theory of individual quality of life would make to the field of disability.

Operationalisation of quality of life for adults with severe disabilities

BACKGROUND

The operationalisation of quality of life for people with more severe disabilities has been acknowledged in the published research for more than two decades. This study aims to contribute to our knowledge and understanding of the quality of life of adults with severe disabilities by developing a set of quality of life indicators appropriate to this population using a Delphi method and the eight-domain conceptual model proposed by Schalock & Verdugo (2002).

METHOD

The participating panel in the Delphi method included 12 experts who evaluated each proposed item according to four criteria: suitability, importance, observability and sensitivity. Descriptive analyses were used to select the best items in each of the four rounds of this Delphi study, as well as examining the coefficients of concordance that were calculated for the final pool of items.

RESULTS

The four rounds of the Delphi study resulted in a final pool of 118 items (91 that were considered valid in the first round plus 27 items proposed, reformulated or discussed in the following rounds). Importance and sensitivity were the criteria that received the highest and lowest ratings, respectively, but also the ones that had the highest and lowest mean coefficients of concordance. Experts showed the strongest agreement for items related to material well-being, while the weakest was found for items related to personal development.

CONCLUSIONS

This study further contributes to our understanding of how to operationalise and measure quality of life in adults with severe disabilities. The item pool generated may prove helpful in the development of instruments for the measurement of quality of life-related outcomes in this population.

How organizations can enhance the quality of life of their clients and assess their results: the concept of QOL enhancement

This article presents the framework of a dynamic approach to quality of life (QOL) enhancement based on the conceptualization and measurement of individual-referenced quality of life. Sections of the article summarize the premises of QOL enhancement, provide the rationale for a dynamic approach to QOL enhancement, discuss six components of QOL enhancement, and discuss the parameters of an emerging theory of quality of life and the contributions such a theory would make to service delivery, policy development, and QOL-related research.

The concept of quality of life and its role in enhancing human rights in the field of intellectual disability

BACKGROUND

The changed societal views of persons with disabilities are reflected in the 2006 United Nations Convention on the Rights of Persons with Disabilities. However, what is not specified in the Convention is how to operationalise and measure the Articles composing the Convention, and how to use that information to further enhance the human rights of persons with disabilities.

METHOD

The authors analyse the relationships between eight core quality of life domains and the 34 Articles contained in the Convention.

RESULTS

There is a close relationship between the core quality of life domains and the 34 Articles contained in the Convention. Furthermore, the current status of these Articles can be evaluated through the assessment of indicators associated with the eight core quality of life domains.

CONCLUSIONS

Based on the assessment of these quality of life-related outcomes, three strategies can be used to enhance the human rights of persons with intellectual disability. These three are to employ person-centred planning, publish provider profiles and implement a system of support.

Application of the Rasch rating scale model to the assessment of quality of life of persons with intellectual disability

BACKGROUND

Most instruments that assess quality of life have been validated by means of the classical test theory (CTT). However, CTT limitations have resulted in the development of alternative models, such as the Rasch rating scale model (RSM). The main goal of this paper is testing and improving the psychometric properties of the INTEGRAL Quality of Life Scale (i.e., fit statistics, person and item reliability coefficients) with RSM.

METHOD

The sample comprised 271 Spanish adults with intellectual disability.

RESULTS

The results showed that the data fitted the model, point-biserial correlations were adequate, items showed precision, reliability of items (.98) and persons (.89) were adequate, and the response categories were suitable (thresholds were ordered). However, one item ("I feel excluded from society") did not fit the model and a few items were too easy for participants to achieve.

CONCLUSIONS

Although it seems necessary to include more difficult items and to delete one, the INTEGRAL Scale is a useful instrument with evidence of validity.