Expecting change: mindset of staff supporting parents with mild intellectual disabilities

Reproductive health of women with intellectual disability: antenatal care, pregnancies and outcomes in the Dutch population

BACKGROUND

Research in a handful of countries found that women with intellectual disability (ID) faced barriers and risks regarding antenatal care and reproductive health. This study tested disparities between women in the Netherlands with and without ID in antenatal care, pregnancy rates and pregnancy outcomes.

METHODS

Secondary analyses on the large representative panel of primary health patients in the Netherlands by the Netherlands Institute for Health Services Research (NIVEL) compared women in their reproductive age (18-49 years) with (n = 2397) and without (n = 228 608) indicators of ID. Bias due to underreporting and under-identification was reduced by linkage with an index of ID for the total Dutch population from Statistical Netherlands.

RESULTS

Women with ID were more likely to receive contraceptive care [95% confidence interval (CI) for odds ratio (OR) = 1.37-1.61] and became somewhat more often pregnant (95% CI OR = 1.06-2.30) than women from the general population, adjusting for age difference and follow-up time. No statistical differences were found in medical complications during pregnancy, delivery and immediately after birth, but women with indicators of ID had a higher risk of losing their pregnancy, including through induced abortion (95% CI OR = 1.26-1.99).

CONCLUSIONS

Women with ID have specific needs around contraceptive care and risks around their pregnancy that may require more awareness among practitioners and better understanding of the processes of care and decision-making.

The desire for parenthood among individuals with intellectual disabilities : systematic review

Background: This qualitative systematic review provides an overview of existing studies on the desire for parenthood of people with intellectual disabilities. Method: The scientific studies were identified following the Prisma protocol on 18 databases using keywords relating to sexuality and parenting. Results: Sixteen studies have been included and three categories identified: the obstacles and motivations to becoming a parent; parents' decision making during pregnancy; and the social construction of a parental identity. The results from these studies show that people with intellectual disabilities have a genuine desire for children, which is repressed because of an unfavorable social context. Conclusion: Further clinical and participatory research is needed to better understand the singular modes of expression of people's intimate desires and how to better accompany them on this issue.

Health mindsets as a predictor of physical activity and body mass index in American Indian college students

American Indians are at increased risk for cardiovascular disease in adulthood, and levels of physical activity and body mass index associate with cardiovascular disease risk. Recent research indicates that one's mindset may play a role in determining health behaviors and outcomes. In a sample of 105 American Indian college students, greater growth health mindset associated with lower body mass index. Bootstrapping analyses revealed a significant indirect effect of health mindset on body mass index through levels of physical activity. These findings suggest that interventions aiming to promote growth health mindsets may be successful in reducing risk for cardiovascular disease in American Indian college students.

Support needs of parents with intellectual disabilities: Systematic review on the perceptions of parents and professionals

This review aimed to examine the perceptions of parents, professionals and informal network members regarding support needs of parents with intellectual disabilities (ID). In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, five databases were systematically searched and 19 qualitative studies were reviewed using thematic analyses. No data were available on the perceptions of the informal social network. Data on parents and professionals were categorized in four themes (type of support, sources of support, conditions of successful support and characteristics of support members). Data from professionals did not refer to emotional support needs or to the potential support of volunteers, friends and neighbours. Data from parents indicated a preference to be treated as 'full' parents, whereas professionals tended to focus on disabilities of parents. Results and implications contribute to insights into support needs of parents with ID from different perspectives and may help identify new entry points to improve future interventions and working alliances.

Stigma research in the field of intellectual disabilities: a scoping review on the perspective of care providers

Care providers are key agents in the lives of individuals with an intellectual disability (ID). The quality of their support can be affected by manifestations of stigma. This scoping review was conducted to explore studies that provide indications of care providers' stigmatization of people with ID. Methods: A structured search was made in four databases to identify relevant studies in English-language peer-reviewed journals. Records were systematically and independently screened by the researchers. Results: The 40 articles included in this review were mainly conducted in Western countries and used Likert-type self-report measures of explicit attitudes. Stigmatization seemed more distinct concerning people with high support needs. The few studies on public stigma preliminary suggest that staff may also stigmatize people with ID based on other social identities. Regarding the support of structural stigma, staff reported skepticism regarding community inclusion for people with high support needs, and tended to be ambivalent about the protection-or-empowerment balance in the support of people with ID. Possible indications of stigmatization regarding sexuality were found on specific issues, such as self-determination and privacy. Agreement of staff with certain rights did not necessarily lead to staff acting in accordance with such rights. Conclusion: Indications of stigmatization of people with ID by care providers were found. Stigmatizing attitudes might affect the quality of care providers' support. Potential leads for future interventions concern creating awareness, sharing power, addressing diagnostic overshadowing, and providing explicit policy translations. Directions for future research concern strengthening the methodology of studies and enriching the studied topics.

Does having a similar disability matter for match outcomes?: A randomized study of matching mentors and mentees by visual impairment

Mentoring is modestly effective for youth with a chronic illness or physical disability; however, program effectiveness may be enhanced when mentors and mentees are matched on shared interests and experiences. To test this hypothesis, mentees were randomly assigned to having a mentor with or without visual impairment (VI). Results showed that mentors without VI were younger and more likely to work or be educated in a helping profession and less likely to have a fixed mindset and extremely high positive expectations than mentors with VI. The main analyses on match outcomes showed that mentors with VI had significantly fewer and shorter match meetings, had a weaker relationship with their mentees, and were more likely to end their match prematurely. Mentor age, helping profession background, and fixed mindset were confounds in several analyses and reduced the significance of the relationship between VI group and match meeting quantity. The only relationship that remained significant controlling for covariates showed that matches including a mentor with VI were significantly more likely to end in premature closure than matches including a mentor without VI. Implications of the findings for future research and program practices related to matching were discussed.

Effects of video-feedback intervention on harmonious parent-child interaction and sensitive discipline of parents with intellectual disabilities: A randomized controlled trial

BACKGROUND

This study tested whether video-feedback intervention based on attachment and coercion theory increased harmonious parent-child interaction and sensitive discipline of parents with mild intellectual disabilities or borderline intellectual functioning.

METHODS

Observer ratings of video-recorded structured interaction tasks at home formed pretest, post-test, and 3-month follow-up outcome data in a randomized controlled trial with 85 families. Repeated measures analyses of variance and covariance were conducted to test for the intervention effect and possible moderation by IQ and adaptive functioning.

RESULTS

The intervention effect on harmonious parent-child interaction was conditional on parental social adaptive behaviour at pretest, with lower adaptive functioning associated with stronger intervention benefit at post-test and follow-up compared to care as usual. Intervention effects were not conditional on parental IQ. Intervention effects for sensitive discipline were not found.

CONCLUSION

Although the video-feedback intervention did not affect observed parenting for the average parent, it may benefit interaction between children and parents with lower parental adaptive functioning.

Parents with intellectual disability

Questions around parents with intellectual disability have changed according to sociocultural shifts in the position and rights of people with intellectual disability. The early research focus on capacity for parenting has given way to a contextual model of parenting and child outcomes, increasingly tested in population-based samples. Epidemiological research shows that contextual variables such as low income, exposure to violence, and poor mental health partly account for negative outcomes. As theoretical models developed for other at risk populations prove increasingly helpful for understanding the challenges of parenting with intellectual disability, it becomes viable to adapt existing evidence-based parenting interventions and test these for this population. Ultimately, parenting research should become fully inclusive.