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Schipper-Eindhoven SM, de Knegt NC, Mevissen L, van Loon J, de Vries R, Zhuniq M, Bekker MHJ. EMDR treatment for people with intellectual disabilities: a systematic review about difficulties and adaptations. Front Psychiatry 2024; 14:1328310. [PMID: 38274435 PMCID: PMC10808451 DOI: 10.3389/fpsyt.2023.1328310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction People with intellectual disabilities (ID) are at increased risk for developing Post Traumatic Stress Disorder (PTSD). Emerging evidence indicates that Eye Movement Desensitization and Reprocessing (EMDR) therapy is feasible and potentially effective for this group. However, communication, cognition, stress regulation, and attachment difficulties may interfere with the EMDR process. Adaptation of the EMDR protocol seems therefore required for this population. Aim This review aims to systematically identify and categorize the difficulties in applying EMDR to people with ID and the adaptations made by therapists to overcome these challenges. Methods A literature search was performed in May 2023. Article selection was based on inclusion and exclusion criteria and quality appraisal. Results After screening, 13 articles remained for further review. The identified difficulties and adaptations were categorized into the three domains of adaptive functioning (i.e., conceptual, social, and practical functioning). Considerable difficulties in applying the EMDR protocol for this group were reported. The adaptations made by therapists to overcome these difficulties were highly variable. They could be divided into three main categories: adaptions in EMDR delivery (e.g., tuning to the developmental level of the client, simplifying language, decreasing pace), involvement of others (e.g., involving family or support staff during or in between sessions), and the therapeutic relationship (e.g., taking more time, supportive attitude). Discussion The variability of the number of mentioned difficulties and adaptations per study seems to be partly related to the specific EMDR protocol that was used. In particular, when the Shapiro adult protocol was administered, relatively more detailed difficulties and adaptations were described than in publications based on derived existing versions of an EMDR protocol for children and adolescents. A probable explanation is that already embedded modifications in these protocols facilitate the needed attunement to the client's level of functioning. Practical implications The authors of this review suggest that EMDR protocols for children and adolescents could be adapted for people with an intellectual disability. Further research should focus on the involvement of trusted others in EMDR therapy for people with ID and the therapeutic relationship from an attachment and relational-based perspective.
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Affiliation(s)
- Simone M. Schipper-Eindhoven
- Zodiak, Prinsenstichting, Purmerend, Netherlands
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | | | | | - Jos van Loon
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - Ralph de Vries
- Vrije Universiteit, Medical Library, Amsterdam, Netherlands
| | - Majlinda Zhuniq
- Department of Clinical Psychology, Biological Psychology, and Psychotherapy, University of Mannheim, Mannheim, Germany
| | - Marrie H. J. Bekker
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, Netherlands
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Stewart SL, Dave HP, Lapshina N. Family dynamics, trauma, and child-related characteristics: examining factors associated with co-occurring mental health problems in clinically-referred children with and without an intellectual (and developmental) disability. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:701-714. [PMID: 35584277 DOI: 10.1177/17446295221093967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Psychiatric disorders are common in youth with intellectual and developmental disabilities. This is a vulnerable group of children whose behavioural problems often have more complicated care needs than other children, which can place a great deal of stress on their families. However, the association of family mental health issues, level of intellectual ability, and diagnostic co-morbidity in children is relatively under-studied. In the present study, we investigated the relationship among child diagnoses, family mental health problems, risk for self-injury, and disruption in care among children with (N = 517) and without (N = 517) intellectual and developmental disabilities. A negative binomial regression showed that mental health problems in multiple family members, self-injurious behaviour, and self-reported abuse/trauma was related to greater likelihood of provisional diagnoses of co-occurring psychiatric disorders in both a clinically referred sample and a sample with IDD. Implications for care-planning are discussed.
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Affiliation(s)
| | - Hiten P Dave
- Faculty of Education, Western University, London, ON, Canada
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van Balkom ID, Burdeus-Olavarrieta M, Cooke J, de Cuba AG, Turner A. Consensus recommendations on mental health issues in Phelan-McDermid syndrome. Eur J Med Genet 2023; 66:104770. [PMID: 37085014 DOI: 10.1016/j.ejmg.2023.104770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/23/2023]
Abstract
Phelan-McDermid syndrome is a rare genetic condition caused by a deletion encompassing the 22q13.3 region or a pathogenic variant of the gene SHANK3. The clinical presentation is variable, but main characteristics include global developmental delay/intellectual disability (ID), marked speech impairment or delay, along with other features like hypotonia and somatic or psychiatric comorbidities. This publication delineates mental health, developmental and behavioural themes across the lifetime of individuals with PMS as informed by parents/caregivers, experts, and other key professionals involved in PMS care. We put forward several recommendations based on the available literature concerning mental health and behaviour in PMS. Additionally, this article aims to improve our awareness of the importance of considering developmental level of the individual with PMS when assessing mental health and behavioural issues. Understanding how the discrepancy between developmental level and chronological age may impact concerning behaviours offers insight into the meaning of those behaviours and informs care for individuals with PMS, enabling clinicians to address unmet (mental health) care needs and improve quality of life.
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Affiliation(s)
- Ingrid Dc van Balkom
- Jonx, Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, the Netherlands; Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands.
| | - Monica Burdeus-Olavarrieta
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; School of Psychology, Universidad Autónoma, Madrid, Spain
| | - Jennifer Cooke
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom
| | - A Graciela de Cuba
- Jonx, Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, the Netherlands
| | - Alison Turner
- Phelan-McDermid Syndrome Foundation UK, 99 Highgate W Hill, London, N6 6NR, United Kingdom
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4
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Langdon PE, Bisson JI, Rogers G, Swain S, Hiles S, Watkins A, Willner P. Evaluation of an adapted version of the International Trauma Questionnaire for use by people with intellectual disabilities. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:471-482. [PMID: 36932469 DOI: 10.1111/bjc.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/05/2023] [Indexed: 03/19/2023]
Abstract
AIMS The International Trauma Questionnaire (ITQ) is a novel assessment instrument that is aligned to the ICD-11 diagnoses of post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). The purpose of this study was to develop and evaluate an adapted version of the ITQ suitable for use by people with intellectual disabilities. METHODS The ITQ-ID follows the original ITQ, using wording developed in collaboration with a focus group of people with intellectual disabilities The ITQ-ID was administered to 40 people with intellectual disabilities recruited from learning disability forensic and community settings, alongside a Trauma Information Form and the Impact of Event Scale-Intellectual Disabilities (IES-IDs). RESULTS Most participants reported multiple traumatizing events. Around half of the participants met strict criteria for a diagnosis of PTSD, and around three quarters met looser criteria. Depending on definitions, between 66% and 93% of those who met criteria for PTSD also met criteria for a diagnosis of CPTSD. The ITQ-ID showed a single-component structure, with very good-to-excellent internal consistency, excellent test-retest reliability, and evidence of concurrent, discriminant, and content validity. SIGNIFICANCE The results support the potential of the ITQ-ID for assessment of PTSD and CPTSD in people with intellectual disabilities in both clinical and research contexts and highlight the need for further validation work.
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Affiliation(s)
- Peter E Langdon
- Centre for Educational Development, Appraisal and Research and Centre for Mental Health and Wellbeing Research, University of Warwick, Coventry, UK.,Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.,Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Gemma Rogers
- Kent and Medway NHS and Social Care Partnership Trust, Maidstone, UK
| | - Sophie Swain
- Midlands Partnership NHS Foundation Trust, The Redwoods Centre, Shrewsbury, UK
| | - Steve Hiles
- Swansea Trials Unit, Clinical Research Facility, Institute of Life Science, Swansea University, Swansea, UK
| | - Alan Watkins
- Swansea Trials Unit, Clinical Research Facility, Institute of Life Science, Swansea University, Swansea, UK
| | - Paul Willner
- School of Psychology, Swansea University, Swansea, UK
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5
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Olszewski AE, Dervan LA, Smith MB, Asaro LA, Wypij D, Curley MAQ, Watson RS. Risk Factors for Positive Post-Traumatic Stress Disorder Screening and Associated Outcomes in Children Surviving Acute Respiratory Failure: A Secondary Analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure Clinical Trial. Pediatr Crit Care Med 2023; 24:222-232. [PMID: 36728954 PMCID: PMC9992163 DOI: 10.1097/pcc.0000000000003150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To identify risk factors and outcomes associated with a positive post-traumatic stress disorder (PTSD) screen following pediatric acute respiratory failure treated with invasive mechanical ventilation. DESIGN Nonprespecified secondary analysis of a randomized clinical trial. SETTING Thirty-one U.S. PICUs. PATIENTS Children in the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial (NCT00814099, ClinicalTrials.gov ) over 8 years old who completed PTSD screening 6 months after discharge. INTERVENTIONS RESTORE sites were randomized to a targeted, nurse-directed sedation strategy versus usual care. MEASUREMENTS AND MAIN RESULTS PTSD screening was completed by 102 subjects using the Child Post-Traumatic Stress Disorder Symptom Scale; a score of greater than or equal to 11 was considered screening positive for PTSD. Cognitive status was categorized using Pediatric Cerebral Performance Category; health-related quality of life (HRQL) was evaluated using child-reported Pediatric Quality of Life Inventory, Version 4.0. Thirty-one children (30%) screened positive for PTSD. Children with a positive screen endorsed symptoms in all categories: reexperiencing, avoidance, and hyperarousal. Most endorsed that symptoms interfered with schoolwork ( n = 18, 58%) and happiness ( n = 17, 55%). Screening positive was not associated with RESTORE treatment group. In a multivariable logistic model adjusting for age, sex, and treatment group, screening positive was independently associated with lower median income in the family's residential zip code (compared with income ≥ $80,000; income < $40,000 odds ratio [OR], 32.8; 95% CI, 2.3-458.1 and $40,000-$79,999 OR, 15.6; 95% CI, 1.3-182.8), renal dysfunction (OR 5.3, 95% CI 1.7-16.7), and clinically significant pain in the PICU (OR, 8.3; 95% CI, 1.9-35.7). Children with a positive screen experienced decline in cognitive function and impaired HRQL more frequently than children with a negative screen. CONCLUSIONS Screening positive for PTSD is common among children following acute respiratory failure and is associated with lower HRQL and decline in cognitive function. Routine PTSD screening may be warranted to optimize recovery.
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Affiliation(s)
- Aleksandra E Olszewski
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington, Seattle, WA
| | - Leslie A Dervan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, WA
| | - Mallory B Smith
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Lisa A Asaro
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - David Wypij
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington, Seattle, WA
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, WA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, Seattle, WA
| | - Martha A Q Curley
- Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
| | - R Scott Watson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, Seattle, WA
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Houck EJ, Dracobly JD. Trauma-Informed Care for Individuals with Intellectual and Developmental Disabilities: From Disparity to Policies for Effective Action. Perspect Behav Sci 2023; 46:67-87. [PMID: 37006597 PMCID: PMC10050265 DOI: 10.1007/s40614-022-00359-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/25/2022] Open
Abstract
People with intellectual disabilities (ID) are an often overlooked minority population. They experience significant health disparities and a high risk of exposure to traumatic events that can lead to stress-related disorders. Access to effective treatments for stress-related disorders is limited for people with ID due to a lack of appropriate assessments and common communication deficits. We discuss and analyze four factors that have led to these disparities: (1) historical segregation; (2) society's response to identification of trauma in vulnerable populations; (3) lack of accessible assessments and treatments for stress disorders in people with ID; and (4) communication deficits common in people with ID. Based on this analysis, we suggest behavior analysts advocate for policy development that would (1) increase acknowledgement of trauma in people with ID and mandate sharing of information about trauma across providers; (2) require observable and measurable goals be included in the assessment and treatment of trauma-related behavior change; and (3) increase funding for services and research in this area.
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Affiliation(s)
- Elizabeth J. Houck
- University of North Texas, 1155 Union Circle, Box 310919, Denton, TX 76201 USA
| | - Joseph D. Dracobly
- University of North Texas, 1155 Union Circle, Box 310919, Denton, TX 76201 USA
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7
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Unwin G, Stenfert‐Kroese B, Rogers G, Swain S, Hiles S, Clifford C, Farrell D, Willner P. Some observations on remote delivery of eye‐movement desensitisation and reprocessing to people with intellectual disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2023. [DOI: 10.1111/jppi.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Gemma Unwin
- School of Psychology University of Birmingham Birmingham UK
| | | | - Gemma Rogers
- Kent and Medway NHS and Social Care Partnership Trust Kent UK
| | - Sophie Swain
- Midlands Partnership NHS Foundation Trust, The Redwoods Centre Shrewsbury UK
| | - Steve Hiles
- Swansea Trials Unit, Clinical Research Facility Institute of Life Science, Swansea University Swansea UK
| | | | | | - Paul Willner
- Department of Psychology Swansea University Swansea UK
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8
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Codina M, Pereda N. Characteristics and Prevalence of Lifetime Sexual Victimization Among a Sample of Men and Women with Intellectual Disabilities. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP14117-NP14139. [PMID: 33866835 DOI: 10.1177/08862605211006373] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study examines the prevalence and characteristics of sexual victimization experiences suffered by people with intellectual disabilities (ID). The sample consisted of 260 adults with an ID diagnosis (154 men and 106 women), ranging in age from 20 to 71 years (M = 41.69, SD = 12.05). The results showed that 35% of the sample had been sexually victimized at some point in their life. Being a woman, being declared legally incapable, and having comorbid mental health diagnoses were the most relevant characteristics of sexual victims with ID. Fondling was the most reported victimization, and rape showed the greatest gender differences, with a higher risk for women with ID of being raped compared to their male counterparts (odds ratio = 4.28, p < .05). The offender was generally a known male adult, and the percentage of incidents reported to the authorities was very low (7.4%). The psychological consequences of abuse were general distress, anxiety, and depressive symptomatology. Intervention and prevention programs targeting this population, as well as the training of professionals and caregivers, are essential to deal with sexual victimization and to protect and ensure the quality of life of people with ID.
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9
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Boamah DA, Barbee AP. Prevalence of Secondary Traumatic Stress Among Direct Support Professionals in Intellectual and Developmental Disabilities Field. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:273-287. [PMID: 35868303 DOI: 10.1352/1934-9556-60.4.273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 11/10/2021] [Indexed: 06/15/2023]
Abstract
Direct support professionals (DSPs) are deemed by existing literature as vital support to persons with intellectual or developmental disabilities (IDD). They may be exposed to the traumatic experiences of people with IDD with potential psychological implications. Secondary traumatic stress (STS) has been studied among related professionals across human services, but little is known among DSPs. The current study examines the prevalence of STS in a sample of DSPs. The results suggested that DSPs are exposed to traumatic experiences, and exposure to a greater number of traumatized clients is significantly correlated with symptoms of STS. At least 12.4% of DSPs in this sample met the diagnostic criteria for experiencing post-traumatic stress disorder (PTSD) symptoms. Also, results suggest STS differences in DSPs based on demographics.
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10
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von Scheibler ENMM, van Amelsvoort TAMJ, Vingerhoets C, van Eeghen AM, Boot E. Post-traumatic stress in adults with 22q11.2 deletion syndrome. BJPsych Open 2022; 8:e126. [PMID: 35795982 PMCID: PMC9301773 DOI: 10.1192/bjo.2022.525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
22q11.2 deletion syndrome (22q11.2DS) is associated with an elevated genetic risk of several psychiatric disorders. However, the prevalence of post-traumatic stress disorder (PTSD) in individuals with 22q11.2DS has been reported to be only 0.9%; this is lower than that of the general population (3.9%). We explored the occurrence of PTSD and traumatic events in a Dutch cohort of 112 adults with 22q11.2DS, and found PTSD in 8.0%, traumatic events in 20.5% and trauma-focused treatment in 17.9% of patients. Our novel findings suggest that PTSD may be underdiagnosed in individuals with 22q11.2DS. Clinicians and other caregivers should be alert to trauma in this population in order to enable treatment and minimise psychiatric burden.
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Affiliation(s)
- Emma N M M von Scheibler
- Advisium, 's Heeren Loo Zorggroep, Amersfoort; and Department of Psychiatry and Neuropsychology, MHeNs, Maastricht University, The Netherlands
| | | | - Claudia Vingerhoets
- Advisium, 's Heeren Loo Zorggroep, Amersfoort; and Department of Psychiatry and Neuropsychology, MHeNs, Maastricht University, The Netherlands
| | - Agnies M van Eeghen
- Advisium, 's Heeren Loo Zorggroep, Amersfoort; and Emma Children's Hospital, University of Amsterdam, The Netherlands
| | - Erik Boot
- Advisium, 's Heeren Loo Zorggroep, Amersfoort, The Netherlands; Department of Psychiatry and Neuropsychology, MHeNs, Maastricht University, The Netherlands; and The Dalglish Family 22q Clinic, University Health Network, Toronto, Canada
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11
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Totsika V, Liew A, Absoud M, Adnams C, Emerson E. Mental health problems in children with intellectual disability. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:432-444. [PMID: 35421380 DOI: 10.1016/s2352-4642(22)00067-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 12/16/2022]
Abstract
Intellectual disability ranks in the top ten causes of disease burden globally and is the top cause in children younger than 5 years. 2-3% of children have an intellectual disability, and about 15% of children present with differences consistent with an intellectual disability (ie, global developmental delay and borderline intellectual functioning). In this Review, we discuss the prevalence of mental health problems, interventions to address these, and issues of access to treatment and services. Where possible, we take a global perspective, given most children with intellectual disability live in low-income and middle-income countries. Approximately 40% of children with intellectual disability present with a diagnosable mental disorder, a rate that is at least double that in children without intellectual disability. Most risk factors for poor mental health and barriers to accessing support are not unique to people with intellectual disability. With proportionate universalism as the guiding principle for reducing poor mental health at scale, we discuss four directions for addressing the mental health inequity in intellectual disability.
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Affiliation(s)
- Vasiliki Totsika
- Division of Psychiatry, University College London, London, UK; Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, VIC, Australia; Centre for Educational Development Appraisal and Research (CEDAR), University of Warwick, Coventry, UK; Tavistock & Portman NHS Foundation Trust, London, UK.
| | - Ashley Liew
- Centre for Educational Development Appraisal and Research (CEDAR), University of Warwick, Coventry, UK; National & Specialist CAMHS, South London and Maudsley NHS Foundation Trust, London, UK; Department of Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK; Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Michael Absoud
- Department of Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK; Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Colleen Adnams
- Division of Intellectual Disability, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Eric Emerson
- Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK; Centre for Disability Research & Policy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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12
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Byrne G. A Systematic Review of Treatment Interventions for Individuals With Intellectual Disability and Trauma Symptoms: A Review of the Recent Literature. TRAUMA, VIOLENCE & ABUSE 2022; 23:541-554. [PMID: 32969328 DOI: 10.1177/1524838020960219] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Individuals with intellectual disabilities (IDs) are at increased susceptibility to adverse life experiences and trauma sequelae. There is a disparate range of therapeutic interventions for post-traumatic stress disorder (PTSD) and associated symptoms. This systematic review aimed to appraise the effectiveness of both cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) for PTSD and associated symptoms for both adults and children with mild, moderate, or severe intellectual delay. A systematic search, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, of the PsychInfo, PubMed, Cochrane Database of Systematic Reviews, and MEDLINE databases were performed, and all relevant articles published between 2010 and March 2020 were included. A total of 11 articles were included, eight that focused on EMDR and three on CBT. The methodological quality of many of these articles was generally weak. Tentative findings suggest that EMDR and CBT are both acceptable and feasible treatment options among adults and children with varying levels of intellectual delay, but no firm conclusions can be drawn regarding effectiveness due to small sample sizes, lack of standardized assessment, and a paucity of methodological rigorous treatment designs. This review highlights the continued use of therapeutic approaches with clients presenting with IDs and PTSD. It adds to the extant literature by providing an expansive and broad overview of the current effectiveness of both EMDR and CBT. Further high-quality research is needed to provide more conclusive findings regarding treatment effectiveness and modifications to treatment needed with this population.
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Affiliation(s)
- Gary Byrne
- Primary Care Psychology Department, Churchtown, Health Service Executive, Dublin, Ireland
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13
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de Vogel V, Didden R. Victimization history in female forensic psychiatric patients with intellectual disabilities: Results from a Dutch multicenter comparative study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 122:104179. [PMID: 35101719 DOI: 10.1016/j.ridd.2022.104179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/07/2022] [Accepted: 01/22/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Victimization is highly prevalent in individuals with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and is an important risk factor for mental health problems and violent behavior. Not much is known, however, about victimization history in women with MID-BIF admitted to forensic mental health care. AIMS The aim of this multicenter study is to gain insight into victimization histories and mental health problems of female forensic psychiatric patients with MID-BIF. METHODS File data were analyzed of 126 women with MID-BIF who have been admitted to one of five Dutch forensic psychiatric hospitals between 1990 and 2014 and compared to data of 76 female patients with average or above intellectual functioning and to a matched sample of 31 male patients with MID-BIF. RESULTS All forensic patients had high rates of victimization, but women with MID-BIF showed an even higher prevalence of victimization during both childhood and adulthood and more complex psychopathology compared to female patients without MID-BIF. Compared to male forensic patients with MID-BIF, women with MID-BIF were more often victim of sexual abuse during childhood. During adulthood, the victimization rate in these women was more than three times higher than in men. CONCLUSIONS Victimization is a salient factor in female forensic patients with MID-BIF and more gender-responsive trauma-focused treatment is needed.
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Affiliation(s)
- Vivienne de Vogel
- Maastricht University, Maastricht, the Netherlands; De Forensische Zorgspecialisten, Utrecht, the Netherlands; University of Applied Sciences Utrecht, Utrecht, the Netherlands.
| | - Robert Didden
- Radboud University, Nijmegen, the Netherlands; Trajectum, Zwolle, the Netherlands
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14
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Rich AJ, DiGregorio N, Strassle C. Trauma-informed care in the context of intellectual and developmental disability services: Perceptions of service providers. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:603-618. [PMID: 32319343 DOI: 10.1177/1744629520918086] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Traumatic life events have pervasive impacts on health and well-being. A growing body of literature shows that people with intellectual and developmental disabilities are disproportionately impacted by trauma. Trauma-informed care (TIC) is a philosophy of service provision that is committed to preventing traumatization and re-traumatization and promoting healing. This study explores the perceptions of 130 leaders in the field of intellectual and developmental disabilities services on the adoption and practice of TIC through the analysis of quantitative data. Results indicated a disconnect between the level of TIC integration and perceptions detailing how well organizations are currently performing in aspects of TIC. Barriers to TIC included high staff turnover, lack of accessible mental health providers, lack of affordable training, stigma, and restrictive funding structures. Implications and recommendations for service organizations and educators are provided.
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15
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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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16
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Knappe S. “Mutig werden kann ich lernen”: Kognitive Verhaltenstherapie bei ausgeprägter Angstsymptomatik, Entwicklungsstörung und Intelligenzminderung. VERHALTENSTHERAPIE 2021. [DOI: 10.1159/000516539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Die psychotherapeutische Behandlung von Kindern und Jugendlichen mit geistiger Behinderung unterliegt einer Vielzahl von Barrieren. <b><i>Fallbericht:</i></b> Der hier vorgestellte Behandlungsfall illustriert die erfolgreiche Anwendung kognitiver Verhaltenstherapie bei einem 10-jährigen Mädchen bei Entwicklungsstörung und Intelligenzminderung. Nach einer medizinisch notwendigen Untersuchung entstanden ausgeprägte Angstsymptome und Verhaltensprobleme. Infolge einer bekannten Epilepsie war der Einsatz expositionsbasierter Techniken fraglich. Die kognitive Verhaltenstherapie umfasste 64 Behandlungseinheiten. Das Vorgehen zur Selbstbeobachtung, Rationalvermittlung und Angstbewältigung war stark handlungsbezogen und wenig kognitiv orientiert und fand im häuslichen Setting mit Einbezug der Familienmitglieder statt. Nachfolgend wurden – auch aufgrund der zunehmenden Reifung des Kindes – kognitiv anspruchsvollere Techniken eingesetzt. Zur 38. Behandlungseinheit wurden zuvor angstbesetzte Situationen dem Entwicklungsstand angemessen und selbstständig bewältigt. Eine nachfolgende medizinische Untersuchung ähnlich der Auslösesituation wurde therapeutisch vorbereitet und sicher bewältigt. Zu Behandlungsende waren die Alltagskompetenzen maßgeblich erweitert. <b><i>Schlussfolgerungen:</i></b> Entgegen der Vorannahmen bedurfte es nur weniger Anpassungen an das Setting und die Behandlungstechniken im Vergleich zum Vorgehen bei ähnlicher Symptomatik ohne geistige Behinderung. Durch die psychotherapeutische Behandlung konnte kurz- und langfristig eine Manifestation (Eskalation) von weiterem Problemverhalten verhindert werden. Das Erkennen und die Auseinandersetzung mit dem “Anderssein” infolge der geistigen Behinderung und verfügbarer Alltagskompetenzen bergen Entwicklungsrisiken und -chancen, die durch eine psychotherapeutische Begleitung gut bewältigt werden können.
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17
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McNally P, Taggart L, Shevlin M. Trauma experiences of people with an intellectual disability and their implications: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:927-949. [PMID: 33772975 DOI: 10.1111/jar.12872] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/14/2021] [Accepted: 02/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with an intellectual disability are more vulnerable to psychological trauma compared with the general population. The aim of this scoping review was to identify the current status of the literature on trauma that is specific to the experiences of adults with an intellectual disability, living in community settings. METHODS A scoping review was conducted using the Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19) framework. Forty-one international papers were reviewed spanning 2000-2020, and their quality assessed using the MMAT. FINDINGS (1) Aggressive behaviours can be symptoms of trauma, (2) there are appropriate assessment tools for the impact of trauma, (3) evidence-based interventions for trauma may be effective, and (4) factors associated with disability can be experienced as traumatic. CONCLUSION There is a growing body of literature highlighting assessment needs and potential interventions for people with an intellectual disability who have experienced psychological trauma. Further research is needed to develop trauma-informed pathways.
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Affiliation(s)
- Paddy McNally
- Institute of Nursing and Health Science, Ulster University, Newtownabbey, UK
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18
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Rumball F, Brook L, Happé F, Karl A. Heightened risk of posttraumatic stress disorder in adults with autism spectrum disorder: The role of cumulative trauma and memory deficits. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 110:103848. [PMID: 33454451 DOI: 10.1016/j.ridd.2020.103848] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Individuals with Autism Spectrum Disorder (ASD) are known to be at increased risk of exposure to traumas such as maltreatment and abuse, however less is known about possible susceptibility towards the development of Posttraumatic Stress Disorder (PTSD) and associated risk factors. AIMS This study investigated the rates of trauma exposure and PTSD, and the role of cumulative trauma exposure and memory as risk factors for PTSD in adults who self-reported having received an ASD diagnosis, compared to a typically developing (TD) comparison group. METHODS Questionnaires assessing self-reported frequency of trauma exposure (LEC), PTSD symptomology (PCL-S) and memory (EMQ- R and BRIEF-A) were completed online by 38 ASD adults and 44 TD adults. RESULTS Rates of trauma exposure and PTSD symptomatology were significantly higher in the ASD group, compared to the TD group, with deficits in working memory and everyday memory mediating this association. Interestingly, a cumulative effect of trauma exposure on PTSD symptom severity was only found in the ASD group. CONCLUSIONS High rates of trauma and probable PTSD in ASD adults highlight the importance of routine screening. Cumulative trauma exposure and memory deficits may act to increase risk of PTSD in ASD; longitudinal research is called for.
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Affiliation(s)
- Freya Rumball
- University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK; King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience - PO80, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Lucinda Brook
- University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
| | - Francesca Happé
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience - PO80, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Anke Karl
- University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK.
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19
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Dursun OB, Turan B, Gulsen M, Karayagmurlu A, Tugce Mustan A, Kutlu A, Rodopman Arman A, Gokcen C, Dogru H, Esin IS, Kaya I, Coskun M, Soylu N, Erbilgin S, Tanır Y. Caring for the Most Vulnerable: A Model for Managing Maladaptive Behavior in Children with Mental Special Needs During the COVID-19 Pandemic. Telemed J E Health 2020; 27:1068-1073. [PMID: 33232640 DOI: 10.1089/tmj.2020.0380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: This article presents the results of a comprehensive national model developed for managing maladaptive behaviors (MBs) in children with mental special needs (CMSNs) during the coronavirus disease 2019 (COVID-19) pandemic that combines telehealth-based Applied Behavioral Analyses, psychiatric interventions, and support from local psychosocial teams. This study aims to determine the effectiveness of a system that combined telehealth applications with local psychosocial support teams, allowing services from video calls to emergency interventions. Materials and Methods: The system combines the telehealth applications with the services from local psychosocial intervention teams. In addition to system records covering sociodemographic variables and initial complaints, a telephone survey questioning the effectiveness and satisfaction of the system was used as the main outcome. Results: In total, 347 individuals used the system with mothers constituting the majority of applicants (88.7%, n = 332). The overall satisfaction of the system was 8.8/10. In terms of effectiveness, 63.3% (n = 237) of caregivers reported an improvement in the reason of application. Counselors decided on a need for follow-up visits for 36.6% (n = 137) of applications. A referral to a psychiatrist was asked for 40 patients (10.6%). Discussion: To our best knowledge, this is the first study presenting a model for managing MBs of CMSNs during the COVID-19 outbreak. In general, therefore, it seems that there is a need for unique systems to handle behavioral problems of CMSNs. Conclusions: The findings of this study suggest that it is possible to establish an integrative multistep multidisciplinary telehealth-based approach in a short while.
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Affiliation(s)
- Onur Burak Dursun
- Autism, Mental Special Needs and Rare Disease Department in Turkish Ministry of Health, General Directorate of Health Services, Ankara, Turkey
| | - Bahadir Turan
- Autism, Mental Special Needs and Rare Disease Department in Turkish Ministry of Health, General Directorate of Health Services, Ankara, Turkey
| | - Murat Gulsen
- Autism, Mental Special Needs and Rare Disease Department in Turkish Ministry of Health, General Directorate of Health Services, Ankara, Turkey
| | - Ali Karayagmurlu
- Child and Adolescent Psychiatry Department, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Aybuke Tugce Mustan
- Child and Adolescent Psychiatry Unit, Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
| | - Ayse Kutlu
- Child and Adolescent Psychiatry Department, University of Health Science, Dr. Behcet Uz Children's Education and Research Hospital, Izmır, Turkey
| | - Ayse Rodopman Arman
- Child and Adolescent Psychiatry Department, Marmara University, Faculty of Medicine, Istanbul, Turkey
| | - Cem Gokcen
- Child and Adolescent Psychiatry Department, Gaziantep University, Faculty of Medicine, Gaziantep, Turkey
| | - Hicran Dogru
- Child and Adolescent Psychiatry Department, Ataturk University, Faculty of Medicine, Erzurum, Turkey
| | - Ibrahim Selcuk Esin
- Child and Adolescent Psychiatry Department, Ataturk University, Faculty of Medicine, Erzurum, Turkey
| | - Ilyas Kaya
- Child and Adolescent Psychiatry Department, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Murat Coskun
- Child and Adolescent Psychiatry Department, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Nusret Soylu
- Child and Adolescent Psychiatry Department, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Seda Erbilgin
- Child and Adolescent Psychiatry Unit, Prof. Dr. Cemil Tascıoglu State Hospital, Istanbul, Turkey
| | - Yasar Tanır
- Child and Adolescent Psychiatry Department, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
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20
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Rittmannsberger D, Yanagida T, Weber G, Lueger‐Schuster B. The association between challenging behaviour and symptoms of post-traumatic stress disorder in people with intellectual disabilities: a Bayesian mediation analysis approach. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:538-550. [PMID: 32378249 PMCID: PMC7317343 DOI: 10.1111/jir.12733] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/25/2020] [Accepted: 04/09/2020] [Indexed: 05/03/2023]
Abstract
BACKGROUND A preponderance of behavioural symptoms is assumed to be the main difference in the manifestation of symptoms of post-traumatic stress disorder (PTSD) in people with intellectual disability (ID). However, no study so far has assessed the relationship between challenging behaviour (CB) and PTSD. The present study aims to explore this relationship by exploring whether CB is directly related to trauma exposure or whether this relationship is mediated through core symptoms of PTSD. METHODS Trauma exposure and current symptoms of PTSD were assessed in 43 adults with mild to moderate ID. Parallel versions were administered to 43 caregivers, including the Aberrant Behaviour Checklist to measure CB. Bayesian mediation analyses were conducted using self-rated and informant-rated data. RESULTS The self-report data showed no associations of CB with trauma exposure or PTSD symptoms. The association between informant-rated trauma exposure and irritability was mediated by severity and frequency of PTSD symptoms. The associations between informant-reported trauma exposure and the Aberrant Behaviour Checklist subscales hyperactivity and inappropriate speech were mediated by PTSD symptom severity. CONCLUSIONS The relationship between trauma exposure and CB was mediated by PTSD symptoms. PTSD core symptoms should be considered as underlying causes of CB, highlighting the necessity to explore trauma biography and symptoms of PTSD. The improvement of self-report assessment in people with ID is an important task for future studies.
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Affiliation(s)
- D. Rittmannsberger
- Department of Clinical and Health PsychologyFaculty of Psychology, University of ViennaViennaAustria
| | - T. Yanagida
- Department of Developmental and Educational PsychologyFaculty of Psychology, University of ViennaViennaAustria
| | - G. Weber
- Department of Clinical and Health PsychologyFaculty of Psychology, University of ViennaViennaAustria
| | - B. Lueger‐Schuster
- Department of Clinical and Health PsychologyFaculty of Psychology, University of ViennaViennaAustria
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21
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Keesler JM. Trauma‐Specific
Treatment for Individuals With Intellectual and Developmental Disabilities: A Review of the Literature From 2008 to 2018. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2020. [DOI: 10.1111/jppi.12347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- John M. Keesler
- Indiana University Bloomington, School of Social Work Bloomington IN USA
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22
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Cowles M, Randle-Phillips C, Medley A. Compassion-focused therapy for trauma in people with intellectual disabilities: A conceptual review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2020; 24:212-232. [PMID: 29759022 DOI: 10.1177/1744629518773843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Trauma exposure and post-traumatic stress disorder are more prevalent in people with intellectual disabilities (PWID) than in the general population, yet the evidence base for trauma interventions in this population is sparse. Compassion-focused therapy (CFT) may be particularly well-suited to PWID for a number of reasons, including its adaptability to different developmental levels. PWID are more likely to have issues with self-relating (e.g. shame and self-criticism) and attachment than the general population, two issues that are compounded by trauma and which CFT explicitly seeks to address. Furthermore, compassion-focused approaches emphasize cultivating a sense of safeness while empowering people to make behavioural changes; this is particularly pertinent to PWID who have been traumatized and may feel unsafe and disempowered. An overview of CFT and its application to trauma are given, as well as some case studies using CFT with PWID.
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Affiliation(s)
- Megan Cowles
- Avon and Wiltshire Mental Health Partnership NHS Trust, UK
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23
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Rumball F, Happé F, Grey N. Experience of Trauma andPTSDSymptoms in Autistic Adults: Risk ofPTSDDevelopment FollowingDSM‐5 andNon‐DSM‐5 Traumatic Life Events. Autism Res 2020; 13:2122-2132. [DOI: 10.1002/aur.2306] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Freya Rumball
- King's College London London UK
- South London and Maudsley NHS Foundation Trust London UK
| | | | - Nick Grey
- Sussex Partnership NHS Foundation Trust Worthing UK
- University of Sussex Brighton UK
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24
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Rittmannsberger D, Weber G, Lueger-Schuster B. Applicability of the post-traumatic stress disorder gate criterion in people with mild to moderate intellectual disabilities: Do additional adverse events impact current symptoms of Post Traumatic Stress Disorder in people with intellectual disabilities? JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1100-1112. [PMID: 32316075 PMCID: PMC7496863 DOI: 10.1111/jar.12732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 03/08/2020] [Accepted: 03/16/2020] [Indexed: 12/05/2022]
Abstract
Background Diagnostic manuals provide a strict definition of the PTSD gate criterion. Research on the adequacy of this definition in people with intellectual disabilities is lacking. This study aims to test the adequacy of the gate criterion for this population. Method Fourty nine adults with mild to moderate intellectual disabilities and 43 caregivers were questioned. Traumatic events included in the gate criterion definition and adverse events going beyond it were assessed. It was tested whether adverse events affect symptoms of PTSD additionally to traumatic events. Results The current data showed ambiguous findings in self‐ and informant report. Informant data suggested an additional impact of adverse events on PTSD symptoms. Self‐report data suggested the contrary. Conclusion Adverse events seem to have an impact on externalizing behavioural symptoms, such as hyperarousal. Self‐report assessment of more specific, intrapsychic PTSD symptoms, such as intrusions and avoidance, should be addressed in future studies.
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Affiliation(s)
- Doris Rittmannsberger
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Germain Weber
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Brigitte Lueger-Schuster
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Vienna, Austria
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25
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Miodrag N, Richards DA, Fedoroff JP, Watson SL. Sex and genes, part 2: A biopsychosocial approach to assess and treat challenging sexual behavior in persons with intellectual disabilities including fragile X syndrome and 22q11.2 deletion syndrome. BEHAVIORAL SCIENCES & THE LAW 2020; 38:152-172. [PMID: 32017177 DOI: 10.1002/bsl.2447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
Individuals with intellectual disabilities (IDs) - and specifically those with genetic disorders - are more prone to medical and psychological challenges that affect their sexual development, experiences, and fertility. In this review paper we first provide an overview of the biopsychosocial (BPS) model and then explain how the model can guide and improve the assessment and treatment of challenging sexual behaviors by persons with IDs. We discuss two genetic conditions - fragile X syndrome and 22q11.2 deletion syndrome - in case studies, showing how the BPS model can be used to assess and treat the sexual problems of individuals with various types of ID. We conclude with BPS-formulated treatment considerations in three key domains: biomedical treatment (e.g., medication side effects; stopping or changing medications), psychological treatment (e.g., providing psychological therapies), and socio-environmental interventions (e.g., providing socio-sexual education and staff training). Together, these treatment interventions can aid clinicians to prevent and/or treat problematic sexual behaviors of people with IDs.
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Affiliation(s)
- Nancy Miodrag
- Department of Child and Adolescent Development, California State University Northridge, Northridge, CA, U.S.A
| | - Deborah A Richards
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - J Paul Fedoroff
- Division of Forensic Psychiatry, Ottawa University, Ottawa, Ontario, Canada
| | - Shelley L Watson
- Department of Psychology, Laurentian University, Sudbury, Ontario, Canada
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26
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Rittmannsberger D, Weber G, Lueger-Schuster B. Social reactions to disclosure of sexual violence in female adults with mild to moderate intellectual disabilities: a qualitative analysis of four cases. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 68:136-146. [PMID: 35309708 PMCID: PMC8928797 DOI: 10.1080/20473869.2020.1729017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/07/2020] [Accepted: 02/07/2020] [Indexed: 06/12/2023]
Abstract
Socio-interpersonal factors have a strong potential to protect individuals against pathological processing of traumatic events. While perceived social support has emerged as an important protective factor, this effect has not been replicated in people with intellectual disabilities (ID). One reason for this might be that the relevance of socio-interpersonal factors differs in people with ID: Social support may be associated with more stress due to a generally high dependency on sometimes unwanted support. An exploration of the role of posttraumatic, socio-interpersonal factors for people with ID is therefore necessary in order to provide adequate support. The current study aims to explore the subjective perception of social reactions to disclosure of sexual violence in four women with mild to moderate ID. The study was conducted in Austria. The women were interviewed about their perception of received social reactions as benevolent or harmful, their emotional response, and whether they perceived being treated differently due to their ID diagnosis. The interviews were analysed using qualitative content analysis. First, the interviews were coded inductively, and social reactions were then deductively assigned to three categories that were derived from general research: positive reactions, unsupportive acknowledgement, turning against. Findings on the perception of social reactions were in line with findings from the general population. Overall, participants reported that they did not feel that they were treated any differently from persons without disabilities. However, the social reactions they received included unjustified social reactions, such as perpetrators not being held accountable. A possible explanation may be a habituation and internalisation of negative societal attitudes towards women with ID. Empowerment programmes and barrier-free structural support for women with ID following trauma exposure should be improved.
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Affiliation(s)
- Doris Rittmannsberger
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Germain Weber
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Brigitte Lueger-Schuster
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Vienna, Austria
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27
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Non-Behavioral and Non-Medical Psychosocial Interventions in Individuals with Intellectual Disabilities. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2019. [DOI: 10.1007/s40474-019-00184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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28
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Peterson JL, Earl R, Fox EA, Ma R, Haidar G, Pepper M, Berliner L, Wallace A, Bernier R. Trauma and Autism Spectrum Disorder: Review, Proposed Treatment Adaptations and Future Directions. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2019; 12:529-547. [PMID: 31819782 PMCID: PMC6901292 DOI: 10.1007/s40653-019-00253-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Empirical investigations of trauma and post-traumatic stress disorder (PTSD) in individuals with autism spectrum disorder (ASD) are lacking despite indications of increased risk for exposure to potentially traumatic events in this population. Research on the treatment of traumatic stress psychopathology in ASD is even more limited and suggests a critical need for guidance in the area of ASD-specific treatment adaptations. The current paper provides preliminary recommendations for adapting current evidenced-based, trauma-specific interventions, specifically trauma-focused cognitive behavioral therapy (TF-CBT), for individuals with ASD based on well-established and evidence-based practices for working with this population. These adaptations highlight the need to incorporate treatment goals related to ASD core symptoms and associated characteristics during treatment targeting traumatic stress symptoms. Future directions are discussed, including the development of instruments measuring trauma reactions in ASD, empirical investigations of modified trauma interventions for children with ASD to evaluate effectiveness, and collaboration between professionals specializing in ASD and trauma/PTSD to advance research and facilitate effective care for this community.
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Affiliation(s)
- Jessica L Peterson
- Seattle Children's Autism Center, , 4909 25th Ave NE, Seattle, WA 98105, M/S CAC, PO Box 5371, Seattle, WA 98145-5005
| | - Rachel Earl
- University of Washington, Psychiatry and Behavioral Sciences / Seattle Children's Hospital
| | - Emily A Fox
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA / Seattle Children's Hospital, M/S CAC PO Box 5371, 508.851.0996
| | - Ruqian Ma
- University of Washington College of Education and Department of Psychiatry & Behavioral Sciences, CHDD Box 357920, Seattle, WA 98195
| | - Ghina Haidar
- University of Washington College of Education & Department of Psychiatry and Behavioral Sciences, CHDD Box 357920, Seattle, WA 98195
| | - Micah Pepper
- University of Washington Department of Psychiatry and Behavioral Sciences, CHDD Box 357920, Seattle, WA 98195
| | - Lucy Berliner
- University of Washington Medicine, Mailing Address: 325 Ninth Avenue, MS 359947 Seattle, WA 98104, 206 744-1600 (main line)
| | - Arianne Wallace
- University of Washington Department of Psychiatry and Behavioral Sciences, CHDD Box 357920, Seattle, WA 98195
| | - Raphael Bernier
- Department of Psychiatry & Behavioral Sciences, University of Washington, ,
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29
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Smit MJ, Scheffers M, Emck C, van Busschbach JT, Beek PJ. Clinical characteristics of individuals with intellectual disability who have experienced sexual abuse. An overview of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2019; 95:103513. [PMID: 31654947 DOI: 10.1016/j.ridd.2019.103513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/13/2019] [Accepted: 10/04/2019] [Indexed: 05/24/2023]
Abstract
BACKGROUND Sexual abuse in individuals with average IQ or above is associated with a wide range of behavioural, psychological and body-related characteristics. It is unknown whether individuals with intellectual disability (ID) and a history of sexual abuse suffer from similar clinical characteristics. OBJECTIVE The aim of the review is to provide an overview of the literature on the clinical characteristics of individuals with ID who have experienced sexual abuse. METHOD PubMed, Embase, PsycInfo, CINAHL, Cochrane Library and Web of Sciences were searched for relevant publications using terms related to concepts of "intellectual disability" and "sexual abuse". Two independent reviewers screened and selected articles for inclusion in the study, resulting in seven studies. RESULTS The studies mostly reported behavioural and psychological characteristics such as aggression, self-injury, or posttraumatic stress, anxiety or depressive symptoms associated with sexual abuse in individuals with ID. None mentioned body-related characteristics. CONCLUSIONS Similar to individuals with average IQ or above, sexual abuse in individuals with ID is associated with a broad range of behavioural and psychological characteristics. Conduct disorders, self-injury, inappropriate sexualised talk and poor feelings of personal safety seem to be more indicative for the ID population. Anxiety, depression and PTSD are prevalent in individuals with and without ID who both have experienced sexual abuse. Whether individuals with ID experience body-related characteristics is unclear.
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Affiliation(s)
- Manon J Smit
- Windesheim University of Applied Sciences, Campus 2-6, 8017 CA Zwolle, the Netherlands; VU Amsterdam, Faculty of Behavioural and Movement Sciences, Van der Boechorstraat 7, 1081 BT Amsterdam, the Netherlands.
| | - Mia Scheffers
- Windesheim University of Applied Sciences, Campus 2-6, 8017 CA Zwolle, the Netherlands.
| | - Claudia Emck
- VU Amsterdam, Faculty of Behavioural and Movement Sciences, Van der Boechorstraat 7, 1081 BT Amsterdam, the Netherlands.
| | | | - Peter J Beek
- VU Amsterdam, Faculty of Behavioural and Movement Sciences, Van der Boechorstraat 7, 1081 BT Amsterdam, the Netherlands.
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Schepens HR, Van Puyenbroeck J, Maes B. “One does not forget, it all comes back”: elderly people with intellectual disability review adversities and stress-protection in their lives. QUALITY IN AGEING AND OLDER ADULTS 2019. [DOI: 10.1108/qaoa-11-2018-0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
People with intellectual disability are reported to encounter many negative life events during their increasingly long lives. In the absence of protective elements, these may cause toxic stress and trauma. Given the reported negative effects of such adverse events on their quality of life (QoL), the perspective of older people with intellectual disability themselves may be of relevance. The paper aims to discuss these issues.
Design/methodology/approach
The authors questioned nine participants with mild intellectual disability, aged 61–88 years old, in four 90-min focus group sessions and thematically analysed the data.
Findings
Many recent and bygone negative life events still weighed heavily on the participants. Negative interactions, experiences of loss, lack of control and awareness of one’s disability caused stress. Their emotional response contrasted with their contentment, compliance and resilience. Having (had) good relationships, having learnt coping skills, remaining active, talking about past experiences and feeling free of pain, safe, well supported, capable, respected and involved seemed to heighten resilience and protect participants from toxic stress.
Research limitations/implications
Monitoring and preventing adverse (childhood) experiences, supporting active/emotional coping strategies, psychotherapy and life story work may facilitate coping with negative events and enhance QoL of elderly people with intellectual disability.
Originality/value
Elderly people with mild intellectual disability run a higher risk of experiencing (early) adverse events in life. They are very capable of talking about their experiences, QoL, and the support they need. Focus groups were a reliable method to capture their insights.
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Seo JH, Park HS, Park SS, Kim CJ, Kim DH, Kim TW. Physical exercise ameliorates psychiatric disorders and cognitive dysfunctions by hippocampal mitochondrial function and neuroplasticity in post-traumatic stress disorder. Exp Neurol 2019; 322:113043. [PMID: 31446079 DOI: 10.1016/j.expneurol.2019.113043] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 07/24/2019] [Accepted: 08/20/2019] [Indexed: 12/15/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a stress-related condition that can be triggered by witnessing or experiencing a life-threatening event, such as a war, natural disaster, terrorist attack, major accident, or assault. PTSD is caused by dysfunction of the hippocampus and causes problems associated with brain functioning, such as anxiety, depression, and cognitive impairment. Exercise is known to have a positive effect on brain function, especially in the hippocampus. In this study, we investigated the effect of aerobic exercise on mitochondrial function and neuroplasticity in the hippocampus as well as behavioral changes in animal models of PTSD. Exposure to severe stress resulted in mitochondrial dysfunction in the hippocampus, including impaired Ca2+ homeostasis, an increase in reactive oxygen species such as H2O2, a decrease in the O2 respiration rate, and overexpression of membrane permeability transition pore-related proteins, including voltage-dependent anion channel, adenine nucleotide translocase, and cyclophilin-D. Exposure to extreme stress also decreased neuroplasticity by increasing apoptosis and decreasing the brain-derived neurotrophic factor level and neurogenesis, resulting in increased anxiety, depression, and cognitive impairment. The impairments in mitochondrial function and neuroplasticity in the hippocampus, as well as anxiety, depression, and cognitive impairment, were all improved by exercise. Exercise-induced improvement of the brain-derived neurotrophic factor level in particular might alter mitochondrial function, neuroplasticity, and the rate of apoptosis in the hippocampus. Therefore, exercise might be an important non-pharmacological intervention for the prevention and treatment of the pathobiology of PTSD.
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Affiliation(s)
- Jin-Hee Seo
- Department of Adapted physical education, Baekseok University, Cheonan, Republic of Korea
| | - Hye-Sang Park
- Department of Kinesiology, College of public health and Cardiovascular Research Center, Lewis Katz school of Medicine, Temple University, Philadelphia, PA, USA
| | - Sang-Seo Park
- Department of physiology, College of medicine, Kyung Hee University, Seoul, Republic of Korea; Kohwang Medical Research Institute, Kyung Hee University, Seoul, Republic of Korea
| | - Chang-Ju Kim
- Department of physiology, College of medicine, Kyung Hee University, Seoul, Republic of Korea; Kohwang Medical Research Institute, Kyung Hee University, Seoul, Republic of Korea
| | - Dong-Hyun Kim
- College of Sports science, Sungkyunkwan University, Suwon, Republic of Korea
| | - Tae-Woon Kim
- Department of physiology, College of medicine, Kyung Hee University, Seoul, Republic of Korea; Kohwang Medical Research Institute, Kyung Hee University, Seoul, Republic of Korea; Exercise Rehabilitation Research Institute, Department of Exercise & Health Science, Sangmyung University, Seoul, Republic of Korea.
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Truesdale M, Brown M, Taggart L, Bradley A, Paterson D, Sirisena C, Walley R, Karatzias T. Trauma‐informed care: A qualitative study exploring the views and experiences of professionals in specialist health services for adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1437-1445. [DOI: 10.1111/jar.12634] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/17/2019] [Accepted: 05/15/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Maria Truesdale
- School of Health and Social Care Edinburgh Napier University Edinburgh UK
| | - Michael Brown
- School of Nursing & Midwifery Queen's University Belfast Belfast UK
| | | | - Aoife Bradley
- School of Health and Social Care Edinburgh Napier University Edinburgh UK
| | | | | | - Robert Walley
- School of Health and Social Care Edinburgh Napier University Edinburgh UK
| | - Thanos Karatzias
- School of Health and Social Care Edinburgh Napier University Edinburgh UK
- Rivers Centre for Traumatic Stress NHS Lothian Edinburgh UK
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Not recognized enough: The effects and associations of trauma and intellectual disability in severely mentally ill outpatients. Eur Psychiatry 2019; 58:63-69. [DOI: 10.1016/j.eurpsy.2019.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/02/2019] [Accepted: 02/06/2019] [Indexed: 11/19/2022] Open
Abstract
AbstractBackground:Little is known about the association between trauma and intellectual disability in SMI patients.Aim:To establish the prevalence of trauma and its association with intellectual functioning in SMI outpatients.Methods:A cross-sectional study was conducted in two mental health trusts in the Netherlands. We used the Trauma Screening Questionnaire (TSQ) to screen for trauma and PTSD, and the Screener for Intelligence and Learning disabilities (SCIL) for suspected MID/BIF. Chi-square and t-tests were used to test differences in outcome over patient characteristics. Post-hoc analysis was used to investigate gender differences between patients with and without MID/BIF on trauma and sexual trauma.Results:Any trauma was found in 86% of 570 patients and 42% were suspected for PTSD. The SCIL suggested that 40% had Borderline Intellectual Functioning (BIF), half of whom were suspected of having Mild Intellectual Disability (MID). These patients had more traumatic experiences (1.89 in BIF, 1.75 in MID, against 1.41 in SCIL-negative patients). Female MID/BIF patients (61%) had experienced significantly more sexual abuse than male MID/BIF patients (23%).Conclusions:Significantly more SMI outpatients who screened positive for MID/BIF reported having experienced traumatic events than those who screened negative. Rates of all trauma categories were significantly higher in the screen-positive group, who were also more likely to have PTSD. Sexual abuse occurred more in all females but the SCIL positive women are even more often victim. Clinical practice has to pay more attention to all of these issues, especially when they occur together in a single patient.
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Karatzias T, Brown M, Taggart L, Truesdale M, Sirisena C, Walley R, Mason‐Roberts S, Bradley A, Paterson D. A mixed‐methods, randomized controlled feasibility trial of Eye Movement Desensitization and Reprocessing (EMDR) plus Standard Care (SC) versus SC alone for DSM‐5 Posttraumatic Stress Disorder (PTSD) in adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:806-818. [DOI: 10.1111/jar.12570] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 12/06/2018] [Accepted: 01/06/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Thanos Karatzias
- School of Health and Social Care Edinburgh Napier University Edinburgh UK
- Rivers Centre for Traumatic Stress NHS Lothian Edinburgh UK
| | - Michael Brown
- School of Nursing and Midwifery Queens University Belfast Belfast UK
| | - Laurence Taggart
- Institute of Nursing and Health Research University of Ulster Newtownabbey UK
| | - Maria Truesdale
- School of Health and Social Care Edinburgh Napier University Edinburgh UK
| | | | - Robert Walley
- School of Health and Social Care Edinburgh Napier University Edinburgh UK
- Learning Disability Service NHS Lanarkshire Lanarkshire UK
| | | | - Aoife Bradley
- School of Health and Social Care Edinburgh Napier University Edinburgh UK
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Unwin G, Willott S, Hendrickson S, Stenfert Kroese B. Eye movement desensitization and reprocessing for adults with intellectual disabilities: Process issues from an acceptability study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:635-647. [PMID: 30632662 DOI: 10.1111/jar.12557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 10/08/2018] [Accepted: 11/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Eye movement desensitization and reprocessing (EMDR) is recommended for post-traumatic stress disorder and emerging evidence indicates that it is effective for people with intellectual disabilities. However, acceptability from the perspectives of clients with intellectual disabilities, their therapists and other key people has not been formally evaluated. This study investigates process issues in the implementation of EMDR from perspectives of multiple stakeholders. METHOD Semi-structured interviews were conducted with two adults with intellectual disabilities and three clinical psychologists who had participated in EMDR as well as a key supporter (N = 6) to provide information relating to three cases. The interviews were analysed thematically either directly from the audio recording or from transcripts. RESULTS Five themes were identified: EMDR feels very different; EMDR is a technical process; the need to work with the present; talking is important; cautious optimism. CONCLUSIONS Whilst a range of client- and therapist-related factors served as barriers to using EMDR in this small-scale study, such as preferences in working with the present and inexperienced therapists, there was cautious optimism that EMDR may be useful for "the right person at the right time.".
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Affiliation(s)
- Gemma Unwin
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Sara Willott
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
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Rittmannsberger D, Kocman A, Weber G, Lueger‐Schuster B. Trauma exposure and post‐traumatic stress disorder in people with intellectual disabilities: A Delphi expert rating. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:558-567. [DOI: 10.1111/jar.12549] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 10/11/2018] [Accepted: 10/11/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Doris Rittmannsberger
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology University of Vienna Vienna Austria
| | - Andreas Kocman
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology University of Vienna Vienna Austria
| | - Germain Weber
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology University of Vienna Vienna Austria
| | - Brigitte Lueger‐Schuster
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology University of Vienna Vienna Austria
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Dagnan D, Jackson I, Eastlake L. A systematic review of cognitive behavioural therapy for anxiety in adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:974-991. [PMID: 30225989 DOI: 10.1111/jir.12548] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 06/20/2018] [Accepted: 08/23/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND Anxiety disorders have high prevalence in people with intellectual disabilities. In populations without intellectual disabilities, cognitive behavioural therapy is a first line psychological therapy for these presentations. There is no existing review of the range of methods and outcomes from intervention studies in this area. METHOD A systematic review was carried out following guidance in the Cochrane handbook for systematic reviews of interventions. RESULTS Nineteen studies were identified. The majority of reports were descriptive case studies; the most frequently described presentations were non-specific anxiety disorders and post-traumatic stress disorder; the most frequently described cognitive techniques were psycho-education and interventions directly aimed at thoughts and beliefs and most studies reported positive outcomes, although the better controlled studies tended to report less comprehensive impacts. CONCLUSIONS A range of presentations have been described although the area is still at a primarily descriptive stage. We discuss intervention structures and approaches that require further research.
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Affiliation(s)
- D Dagnan
- Community Learning Disabilities Service, Cumbria Partnership NHS Foundation Trust and Lancaster University, UK
| | - I Jackson
- Community Learning Disability Service, Cumbria Partnership NHS Foundation Trust, UK
| | - L Eastlake
- Community Learning Disability Service, Cumbria Partnership NHS Foundation Trust, UK
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Man J, Kangas M, Trollor J, Sweller N. Clinical Practices and Barriers to Best Practice Implementation of Psychologists Working with Adults with Intellectual Disability and Comorbid Mental Ill Health. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2018. [DOI: 10.1111/jppi.12256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joyce Man
- Centre for Emotional Health Macquarie University; Sydney NSW Australia
| | - Maria Kangas
- Centre for Emotional Health Macquarie University; Sydney NSW Australia
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Mason-Roberts S, Bradley A, Karatzias T, Brown M, Paterson D, Walley R, Truesdale M, Taggart L, Sirisena C. Multiple traumatisation and subsequent psychopathology in people with intellectual disabilities and DSM-5 PTSD: a preliminary study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:730-736. [PMID: 29856097 DOI: 10.1111/jir.12505] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 03/18/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Individuals with intellectual disability (ID) are at greater risk of exposure to traumatic life events compared with the non-ID population. Yet no study to date has examined the role of multiple traumatisation and subsequent psychopathology in people with ID. The aim of this study was to explore the association between multiple traumatisation and subsequent mental health. METHODS A preliminary cross-sectional study involving 33 participants with DSM-5 post-traumatic stress disorder completed self-report questionnaires on exposure to traumatic life events and post-traumatic stress disorder symptoms, anxiety, depression and general distress. RESULTS A proportion of 42.4% of the sample reported multiple traumatisation, including exposure to life events in both childhood and adulthood. Those who reported exposure to life events in childhood and adulthood reported significantly higher risk of harm, depression and general psychological distress compared with those who reported exposure to life events only in adulthood. CONCLUSIONS Preliminary results indicate that more severe psychopathology is associated with multiple traumatisation in childhood and adulthood compared with trauma experienced solely in adulthood.
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Affiliation(s)
- S Mason-Roberts
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - A Bradley
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - T Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - M Brown
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - D Paterson
- Learning Disability Service, NHS Ayrshire & Arran, Crosshouse, UK
| | - R Walley
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - M Truesdale
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - L Taggart
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Newtownabbey, UK
| | - C Sirisena
- Learning Disability Service, NHS Borders, Newstead, UK
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Borghus A, Dokkedahl S, Elklit A. Pilot study: undetected post-traumatic stress disorder symptoms among intellectually disabled. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2018; 66:36-45. [PMID: 34141365 PMCID: PMC8115620 DOI: 10.1080/20473869.2018.1475539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background: Individuals with intellectual disability respond differently to traumatic events, compared to the general population, which makes post-traumatic stress disorder (PTSD) symptoms difficult to recognize. The current study aims to examine the presence of undetected PTSD among individuals with intellectual disability and a known history of trauma exposure. Method: Nine individuals, who have not previously been diagnosed with PTSD, were evaluated for PTSD symptoms through case reports, which include descriptions of medical history, symptoms and behavior described in the former diagnostic reports, potential traumatic experiences, current symptoms and behavior in accordance to the Lancaster and North Gate Trauma Scale, and PTSD criteria from DM-ID. Results: Four out of the nine participants met the DM-ID criteria for PTSD. Conclusions: The current findings highlight the importance of including cognitive impairment and developmental level in the screening, referral and treatment process of PTSD.
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Affiliation(s)
- A. Borghus
- Department of Psychology, National Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark
| | - S. Dokkedahl
- Department of Psychology, National Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark
| | - A. Elklit
- Department of Psychology, National Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark
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Levine KA, Proulx J, Schwartz K. Disconnected lives: Women with intellectual disabilities in conflict with the law. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31:249-258. [PMID: 28718998 DOI: 10.1111/jar.12387] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women with intellectual/developmental disabilities in conflict with the law experience childhood trauma, substance abuse and intimate partner violence but continue to have difficulty accessing appropriate therapeutic services, both within correctional settings and upon discharge. The aim of this study is to explore women's service needs and to critically assess whether the available services are meeting their identified needs. METHOD Semi-structured interviews were conducted with 16 women with intellectual/developmental disabilities who were in the Special Needs Unit of a women's correctional centre from December 2014 to March 2015. RESULTS Women with intellectual/developmental disabilities struggle to manage the impact of intergenerational trauma, exacerbated by issues of substance abuse and addiction, poor coping skills and minimal education, all of which impact their sense of well-being. CONCLUSIONS This study highlights the need for increasing trauma treatment for women with intellectual/developmental disabilities, and emphasizes the need for accessible intervention to facilitate coping, trauma processing and community integration.
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Keesler JM, Isham C. Trauma-Informed Day Services: An Initial Conceptualization and Preliminary Assessment. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2017. [DOI: 10.1111/jppi.12206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- John M. Keesler
- Indiana University School of Social Work; Bloomington, Indiana USA
| | - Cory Isham
- MSW, Lion Court; Kings Drive, Prescot UK
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Stough LM, Ducy EM, Kang D. Addressing the Needs of Children With Disabilities Experiencing Disaster or Terrorism. Curr Psychiatry Rep 2017; 19:24. [PMID: 28405894 DOI: 10.1007/s11920-017-0776-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW This paper reviews the empirical literature on psychosocial factors relating to children with disabilities in the context of disaster or terrorism. RECENT FINDINGS Research indicates adults with disabilities experience increased exposure to hazards due to existing social disparities and barriers associated with disability status. However, studies on the psychological effects of disaster/terrorism on children with pre-existing disabilities are exceedingly few and empirical evidence of the effectiveness of trauma-focused therapies for this population is limited. Secondary adversities, including social stigma and health concerns, also compromise the recovery of these children post-disaster/terrorism. Schools and teachers appear to be particularly important in the recovery of children with disabilities from disaster. Disasters, terrorism, and war all contribute to increased incidence of disability, as well as disproportionately affect children with pre-existing disabilities. Disaster preparedness interventions and societal changes are needed to decrease the disproportionate environmental and social vulnerability of children with disabilities to disaster and terrorism.
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Affiliation(s)
- Laura M Stough
- Department of Educational Psychology, Center on Disability and Development, Texas A&M University, Mail Stop 4225, College Station, TX, 77843, USA.
| | - Elizabeth McAdams Ducy
- Department of Educational Leadership and Special Education, School of Education, Sonoma State University, 1801 East Cotati Ave, Rohnert Park, CA, 94928, USA
| | - Donghyun Kang
- Department of Educational Psychology, Center on Disability and Development, Texas A&M University, Mail Stop 4225, College Station, TX, 77843, USA
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Mevissen L, Didden R, Korzilius H, de Jongh A. Eye movement desensitisation and reprocessing therapy for posttraumatic stress disorder in a child and an adolescent with mild to borderline intellectual disability: A multiple baseline across subjects study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 30 Suppl 1:34-41. [DOI: 10.1111/jar.12335] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Liesbeth Mevissen
- Department Kinnik; Mental Health Organisation (MHO) GGZ Friesland; Leeuwarden the Netherlands
| | - Robert Didden
- Behavioural Science Institute; Radboud University; Nijmegen the Netherlands
| | - Hubert Korzilius
- Institute for Management Research; Radboud University; Nijmegen the Netherlands
| | - Ad de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and VU University Amsterdam; Amsterdam the Netherlands
- School of Health Sciences; Salford University; Manchester UK
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Kerns CM, Newschaffer CJ, Berkowitz SJ. Traumatic Childhood Events and Autism Spectrum Disorder. J Autism Dev Disord 2016; 45:3475-86. [PMID: 25711547 DOI: 10.1007/s10803-015-2392-y] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Traumatic childhood events are associated with a wide range of negative physical, psychological and adaptive outcomes over the life course and are one of the few identifiable causes of psychiatric illness. Children with autism spectrum disorder (ASD) may be at increased risk for both encountering traumatic events and developing traumatic sequelae; however, this topic has been understudied. This review considers the rationale for examining traumatic events and related symptomology in individuals with ASD and summarizes the limited research on this topic. A conceptual framework for understanding the interplay of ASD, trauma and traumatic sequelae is proposed and recommendations for future research presented.
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Affiliation(s)
- Connor Morrow Kerns
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA.
| | - Craig J Newschaffer
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Steven J Berkowitz
- Department of Psychiatry, University of Pennsylvania, Pennsylvania, PA, USA
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Bakken TL, Sageng H. Mental Health Nursing of Adults With Intellectual Disabilities and Mental Illness: A Review of Empirical Studies 1994-2013. Arch Psychiatr Nurs 2016; 30:286-91. [PMID: 26992884 DOI: 10.1016/j.apnu.2015.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 07/28/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
Abstract
Mental health nursing for adults with intellectual disabilities and mental illness is underresearched. The aim of this review is to summarize empirical mental health nursing studies including adults with intellectual disabilities and additional mental illness. Out of 137 hits, 16 articles were reviewed in full text. Thirteen of the articles presented modified nursing interventions. Three articles discussed training and education. The main finding is that mental health nursing interventions in patients with intellectual disabilities and additional mental illness are in line with mental health nursing for the general population. There are still not many publications on empirical studies concerning mental health nursing for adults with intellectual disabilities. Clinical implications are primarily related to the need for facilitated nurse-patient communication adjusted to the patients' cognitive levels. Insights drawn from this review illuminate the importance of mental health nursing interventions adjusting to the particular patients' symptoms, instead of targeting behavior change. The findings underpin factors found to have a positive impact on patients with mental illness in the general population as relevant topics for future research.
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Affiliation(s)
| | - Heidi Sageng
- Special need pedagogue, Oslo University Hospital, Norway
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Shpigelman CN, Gelkopf M. The experiences and needs of individuals with disabilities exposed to chronic political violence. Disabil Rehabil 2016; 39:23-35. [DOI: 10.3109/09638288.2016.1138557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Marc Gelkopf
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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Carrigan N, Allez K. Cognitive Behaviour Therapy for Post-Traumatic Stress Disorder in a person with an Autism Spectrum Condition and Intellectual Disability: A Case Study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:326-335. [DOI: 10.1111/jar.12243] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Neil Carrigan
- Swindon Psychological Therapies Service; AWP NHS Trust; Swindon UK
| | - Kate Allez
- Community Learning Disabilities Team (North Locality); 2gether NHS Foundation Trust; Cheltenham UK
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Mevissen L, Didden R, Korzilius H, de Jongh A. Assessing posttraumatic stress disorder in children with mild to borderline intellectual disabilities. Eur J Psychotraumatol 2016; 7:29786. [PMID: 26758506 PMCID: PMC4710805 DOI: 10.3402/ejpt.v7.29786] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Evidence suggests that children with mild to borderline intellectual disabilities (MBID; IQ 50-85) have an elevated risk for both being exposed to potentially traumatic events and developing a posttraumatic stress disorder (PTSD). In this target group, PTSD often remains undiscovered due to a lack of diagnostic instruments. Valid instruments for the assessment of PTSD in children with MBID are therefore needed. OBJECTIVE The aim of the current study was to validate the adapted PTSD section of the Anxiety Disorders Interview Schedule for Children (ADIS-C) for the assessment of PTSD in children with MBID according to DSM-IV-TR and DSM-5 criteria. METHOD Eighty children (aged 6-18 years) with MBID who were referred to an outpatient psychiatric service and their primary caregivers were interviewed using the adapted ADIS-C. RESULTS The adapted ADIS-C PTSD section has excellent interrater reliability and good convergent validity. PTSD symptoms described spontaneously by children with MBID and their caregivers closely matched those included in the DSM-IV-TR and DSM-5. Many of the children who met Criterion A did not meet PTSD symptom criteria. Conversely, children meeting the full PTSD criteria were more likely than other children with MBID to have been exposed to at least one traumatic event meeting Criterion A and to a higher total number of potentially traumatic events. CONCLUSIONS The results support the reliability and validity of the adapted ADIS-C PTSD section for assessing PTSD in children with MBID. The use of this clinical interview helps to improve detection of PTSD and subsequent access to trauma-focused interventions for this at risk target group.
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Affiliation(s)
- Liesbeth Mevissen
- Department De Swaai Youth, Mental Health Organisation (MHO) GGZ Friesland, Drachten, The Netherlands; ;
| | - Robert Didden
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Hubert Korzilius
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - Ad de Jongh
- Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.,School of Health Sciences, Salford University, Manchester, United Kingdom
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Consumer Information and Treatment Resources for Posttraumatic Stress Disorder: Within Reach but Not Grasp. Harv Rev Psychiatry 2015; 23:426-37. [PMID: 26544093 DOI: 10.1097/hrp.0000000000000056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In the context of multiple treatment options for posttraumatic stress disorder (PTSD) and a large, growing need for consumer information regarding accessible and effective treatments, this article identifies and reviews available information and treatment resources. Multiple search strategies identified a suite of information sources, including meta-analyses and systematic reviews of PTSD treatments, the program evaluation and implementation literature, the economics literature, Internet sites, and other resources for veteran and civilian consumers. Resources were evaluated with regard to their target audiences, depth and breadth of treatment options covered, nature of the information provided, and accessibility to consumers. A large body of research covers the various treatments and sets of treatment guidelines for PTSD. Despite the extensive scientific information targeted at providers and researchers, the quality, accessibility, and usability of the published research varies widely. The Veterans Health Administration provides the most extensive information on various treatment options and where to obtain treatment within that system. Publicly available websites provide information on multiple treatment options, but information to help nonveterans navigate treatment choices is limited. Published reports of PTSD program-evaluation and implementation studies are sparse. Information on PTSD treatment options available to consumers can be overwhelming and confusing, which places an unnecessary burden on an already vulnerable group of patients and their families. Exacerbating the situation is the shortage of program-evaluation and implementation research. The dearth of centralized and accessible information related to nonveteran PTSD patient groups needs to be addressed.
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