Quality of life in adults with an intellectual disability: the Evaluation of Quality of Life Instrument

Exploring the social care-related quality of life outcomes of adults with intellectual disabilities through the use of Talking Mats®

BACKGROUND

Views on social care related quality of life (SCRQol) are typically gathered directly from individuals or from proxy informants. Easy-read options are available, although such methods may not be accessible to those with greater communication challenges.

METHODS

Fifteen people with intellectual disabilities were interviewed about their SCRQoL using Talking Mats® (TM). A descriptive approach was taken to exploring what people had to say.

RESULTS

Participants reported high levels of satisfaction with living conditions and personal care routines. They were mostly satisfied with the level of choice and control they had and with their carers.

CONCLUSIONS

People with intellectual disabilities who have greater communication challenges can make meaningful contributions to the assessment of the care they receive. Talking Mats is one tool which can be used to support people with intellectual disabilities to give their views.

A scoping review of measures examining the environments of persons with neurodevelopmental disorders in a supported housing setting

Introduction: Having a neurodevelopmental disorder (NDD) can impact the abilities of an individual in many areas of life, including the ability to live independently. The environment of an individual impacts their day-to-day life throughout their lifespan. To improve supported housing experiences, it is important to map the evidence, especially relating to quality and satisfaction with the environment (as defined by the International Classification of Functioning, Disability and Health (ICF) framework). This has been exacerbated by COVID-19 pandemic restrictions, therefore more insight is needed in measuring this. Objective and methods: This scoping review searched 5 health and social science databases with the objective to identify and examine the outcome measures that integrate aspects of the environment that examine supported housing in individuals with NDD. Results and discussion: Fifteen studies met the inclusion criteria. We found that most measures targeted the satisfaction of individuals about their environment, with the ICF Support and Relationships factor of the environment assessed most. Measures were most often completed by a proxy through an interview. This work enhances our understanding of aspects of the environments of supported housing that are currently measured, laying an essential base for future research to improve the lives of individuals with NDDs.

Development and sensibility assessment of a health-related quality of life instrument for adults with severe disabilities who are non-ambulatory

BACKGROUND

Insight in health-related quality of life (HRQoL) of adults with severe disabilities who are non-ambulatory is important, but a measure is lacking. The aim was to develop a HRQoL measure for this group.

METHOD

The developmental process consisted of the adaptation process of a proxy HRQoL measure for children with severe disabilities who are non-ambulatory and the assessment of the sensibility of the developed instrument. A three-step process was used: focus groups, e-survey and interviews.

RESULTS

In total, 72% of the items remained unchanged. Three new items and one element to an existing item were added. In ten items, the formulation of the items was adapted to the target group. Concerning the sensibility, respondents suggested minor changes to the instruction and the output scales.

CONCLUSIONS

This study has yielded a proxy HRQoL measure for adults with severe disabilities who are non-ambulatory, the CPADULT, with good sensibility.

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

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

Impact of the intellectual disability severity in the Spanish Personal Outcomes Scale

BACKGROUND

The interest in measuring quality of life (QoL) in persons with intellectual disability (ID) has brought about a number of QoL measurements for this population. These measurements need to address two issues that have contributed to enhancing the current instruments. First, the necessity to develop measures with adequate psychometric properties, which has been discussed in recent studies, and second, the agreement between experts in analysing objective and subjective perspectives, as well as the use of self-report to include the participation of the person with ID. The question that we set out to investigate in this paper is whether the measurements function properly for the person with ID, independent of their level of severity. We used the Spanish version of the Personal Outcomes Scale, as it is a psychometrically sound instrument and includes three sources of information (the person with ID, a professional and a family member).

METHOD

The sample was composed of 529 persons with ID (296 men, representing 55.95% of the total sample, and 233 women, with M_age  = 35.03, SD = 10.82) from several regions of Spain, along with their professional of reference and a family member. The severity variable was estimated for each item based on estimations of differential item functioning.

RESULTS

The results showed that several items were undervalued by the assessments if the severity of the ID was greater. Mainly, this difference was observed in the assessments by professionals and in the dimensions of rights, personal development and self-determination.

CONCLUSIONS

This paper focuses on the uses and interpretations of the results of the QoL measurements in the Personal Outcomes Scale. The results indicate that, in our sample, when people with high levels of ID are assessed, the functioning of some items are affected by the severity of this disability. For correct use, these items must be interpreted on the basis of the results obtained. Additionally, it is necessary to thoroughly review the QoL indicators for persons with severe or profound ID.

The differential effects of Autism and Down's syndrome on sexual behavior

Although sexuality plays a major role in the socialization of people, few studies have examined the sexual behaviors of individuals with developmental disabilities. Because of this, we decided to investigate sexuality in adolescents with autism spectrum disorder (ASD) and Down's syndrome (Ds) and to compare them with typically developing adolescents, by surveying their parents. Specifically, it was hypothesized that young people with ASD would display lower levels over five domains: social behavior, privacy, sex education, sexual behavior, and parental concerns, than peers with Ds and typically developing young people. In addition, we sought to verify developmental trends in five domains with age for each group. Overall, 269 parents participated; 94 parents of typically developing adolescents, 93 parents of adolescents diagnosed with Ds, and 82 parents of adolescents diagnosed with ASD. Participants were surveyed with a Sexual Behavior Scale developed by Stokes and Kaur [] that assesses parents' reports of their child's: social behavior, privacy awareness, sex education, sexual behavior and parental concerns about the child's behaviors. It was found that three groups were significantly different on all five domains, adolescents with ASD reportedly displaying lower levels than other groups. Moreover, there was a significant improvement in knowledge of privacy and parental concerns with age for adolescents with ASD and a decline in sex education for adolescents with Ds. The results obtained emphasize the need to train adolescents with developmental disability, and especially for adolescents with ASD through sex education programs.

Social networks of people with mild intellectual disabilities: characteristics, satisfaction, wishes and quality of life

BACKGROUND

A supportive social network is crucial for facilitating social inclusion, which can, in turn, contribute to the quality of life (QOL) for people with intellectual disabilities (ID). In this study, we investigate how people with mild ID perceive their social networks and which network characteristics relate to satisfaction with the network and perceived QOL.

METHOD

Data were gathered from 33 young adults with a mild to borderline ID using structured questionnaires: the MSNA to map the social network, the IDQOL-16 to assess QOL, and a questionnaire to determine satisfaction and wishes with regard to the social network.

RESULTS

The majority of the participants (73.1%) were satisfied with their social networks. Improvement in the area of strengthening existing ties (e.g. more frequent contact, better contact) was desired as opposed to expansion of the network. Affection--especially towards family and professionals--was most strongly related to perceived QOL. It appears to be essential that relatives live in the same town, can frequently meet up and provide both emotional and practical support.

CONCLUSIONS

The significance of family and the importance of high-quality interpersonal relationships between professional and client in the lives of young adults with ID cannot be overestimated. Although measures of satisfaction and wishes can have limitations, in actual practice it is considered useful to assess the opinions of clients with respect to their social networks. Interventions can then be tailored to the needs and wishes of the persons themselves.

Evaluating quality of life in adults with profound learning difficulties resettled from hospital to supported living in the community

This article describes a longitudinal evaluation of the quality of life of service users with profound learning difficulties who were resettled from hospital accommodation to supported housing in the community. The Trident approach was used for the design of the evaluation with data gathered regarding outcomes, process and stakeholder perspectives. Using a specially designed tool, quality of life was measured in seven domains for 39 service users in the hospital as a base line and at six months, twelve months and eighteen months in supported housing. A statistically significant improvement in quality of life overall and in each of the seven domains was found. Questionnaire surveys of parents/next of kin and support staff confirmed these findings as did a number of qualitative case studies.

Self-reported health of people with intellectual disability

Self-reported health is an important outcome in the evaluation of health care but is largely ignored in favor of proxy-based reporting for people with an intellectual disability. This study briefly reviews the role of self-report in health assessment of people with intellectual disability and the challenges and recommendations that have emerged from the considerable body of research on interviewing and self-report. Limitations in current recommendations are addressed from the perspective of the cognition of self-report. The review describes conceptual directions for the reconciliation of the two contradictory themes in the treatment of self-report: the centrality given to personal perceptions and choices and the methodological concerns over the meaningfulness and validity of the self-reporting process.

Review: a systematic review of quality of life measures for people with intellectual disabilities and challenging behaviours

BACKGROUND

The quality of life (QOL) construct is proposed as a method to assess service outcomes for people utilising disability services. With this in mind, the aim of this study was to conduct a systematic review of available QOL measures for people with intellectual disability (ID) to pinpoint psychometrically sound measures that can be routinely used for service evaluation.

METHOD

A systematic search of the disability literature published between 1980 and 2008 was conducted in order to identify appropriate QOL tools for use within an Australian context. Twenty-four QOL instruments were identified and each instrument was then evaluated against a set of psychometric and measurement criteria.

RESULTS

Six of the instruments examined were deemed to be psychometrically sound on the available information. No instruments were found that specifically assess QOL for people with ID who exhibit challenging behaviour. Most of the instruments assess QOL from a subjective perspective, use a questionnaire format and measure only some (not all) of the eight theoretically accepted domains of QOL.

CONCLUSIONS

More instruments that measure QOL need to be developed and rigorously validated. This is especially the case for high-needs disability populations like those individuals that exhibit challenging behaviour or have severe to profound ID, as it is questionable whether existing measures can be used with these populations.

Comparing residential programmes for adults with autism spectrum disorders and intellectual disability: outcomes of challenging behaviour and quality of life

BACKGROUND

Owing to methodological issues, little research has been conducted to examine quality of life (QoL) as a treatment outcome in autism spectrum disorders (ASD) and intellectual disabilities (ID). This study was conducted to combine QoL measures and objective observations of challenging behaviours (CB) in order to evaluate changes over time in adults with ASD and ID who were treated in two different residential programmes; we hypothesised that a decrease in CB would be related to an improved QoL.

METHOD

In a longitudinal study (45 months), we followed 31 adults with ASD and ID who had been integrated into two residential programmes [Autism Programme with a Structured Method (PAMS) vs. traditional programme for ID (No-PAMS)] for 2-19 years. QoL [Quality of Life Inventory in a Residential Environment (IQVMR)] and severity of autistic features (Childhood Autism Rating Scales) were evaluated annually. CB, as measured by the Aberrant Behaviour Checklist (ABC), including stereotypic behaviour and inappropriate speech, were repeatedly assessed every 3 months.

RESULTS

Observed separately, the groups' results were different. In the PAMS programme, stereotypic behaviour and inappropriate speech (ABC scores) significantly decreased, and the IQVMR total score increased; in contrast, in the comparison group, ABC scores did not change and the IQVMR total score decreased. In all, three mixed-effect ANCOVAs partially confirmed that the PAMS programme had an effect on CB and that QoL improvement did not directly depend on the type of programme but on reducing CB as measured by the ABC.

CONCLUSION

The PAMS programme has a positive and indirect influence on QoL by reducing CB.

[Psychotherapy in intellectual disability. Theoretical background and implementation]

BACKGROUND

Every third person with intellectual disability suffers from additional mental health problems, among others phobic disorders. Yet we do not know whether psychotherapeutic methods that are effective in the normal population are applicable to people with intellectual disabilities.

PATIENTS AND METHODS

We give a survey of the development and the present state of the art of psychotherapy, particularly with regard to phobic disorders in intellectual disability. Therapeutic recommendations described in the literature will be evaluated in a case study of one patient.

RESULTS

The confrontation with the phobic stimulus is the basis of behavior therapy for people with intellectual disability as well. However, with respect to the special needs of these people, some modifications need to be considered in the treatment strategy. In addition to some general rules like simple language or the use of visual materials, some techniques of intervention turned out to be particularly effective, e.g., graduated in vivo exposure, involving significant others, contingency management, and coping strategies.

CONCLUSION

Specific phobias in intellectual disability can be treated with behavior therapy as well. However, the special needs of these people need to be considered.

Ideas and thoughts of Italian teachers on the professional future of persons with disability

BACKGROUND

The literature places special focus on the quality of life (QoL) of individuals with disability and on their self-determination and social and work participation. The field of vocational guidance also considers the satisfaction these individuals experience concerning their future crucial to their QoL. At the same time, however, persons with disability are at great risk of not making highly advantageous choices for their future. Hence, teachers and career counsellors can play an important role in vocational guidance for persons with disability.

METHODS

The present study was aimed at investigating the ideas of a group of teachers asked to describe in writing the future of hypothetical students with disability. Their descriptions were first analysed to verify whether any reference was made to the construct of QoL and whether a significant role was attributed to aspects of work inclusion and work satisfaction. Response category differences were then compared for curricular teachers vs. specialised teachers, elementary school teachers vs. middle school teachers, and low self-efficacy vs. high self-efficacy teachers.

RESULTS

Teachers describing the future of a hypothetical student with Down's syndrome mentioned some aspects of QoL and emphasised certain features over others. Several category type differences teachers emerged, although not always in line with expectations.

CONCLUSIONS

Teachers' ideas on the future of individuals with intellectual disability are characterised by a certain bias towards the restrictions that impairment can imply. In consideration of our findings, the need for training actions is highlighted.

Conceptions of Work in Italian Adults With Intellectual Disability

People's ideas about work can greatly affect the ways in which they characterize their own work experience and their lives. The first aim of the present study was to analyze the concept of work in individuals with mild or moderate intellectual disability working in competitive or sheltered work settings and, second, to compare the notions of work of individuals with mental retardation with nondisabled adults and young adolescents. The study therefore examined 48 participants with mental retardation, 48 nondisabled adults of the same chronological age, and 48 nondisabled adolescents of the same mental age as the participants with mental retardation. A semistructured interview assessing participants' concepts about work was administered. Qualitative and quantitative analysis results are discussed. No differences emerged for individuals with MR working in competitive or sheltered work contexts, but were conversely observed among participants with mental retardation, same chronological age adults, and same mental age young adolescents.

Self-determination, social abilities and the quality of life of people with intellectual disability

BACKGROUND

The international literature has documented that self-determination is impacted by environmental factors, including living or work settings; and by intraindividual factors, including intelligence level, age, gender, social skills and adaptive behaviour. In addition, self-determination has been correlated with improved quality of life (QoL). This study sought to contribute to the growing literature base in this area by examining the relationship among and between personal characteristics, self-determination, social abilities and the environmental living situations of people with intellectual disabilities (ID).

METHODS

The study involved 141 people with ID residing in Italy. Healthcare professionals and social workers who had known participants for at least 1 year completed measures of self-determination, QoL and social skills. Analysis of variance was conducted to verify whether different levels of intellectual impairment were associated with different degrees of the dependent variables. The Pearson product-moment correlation was used to examine any relationships among dependent variables and IQ scores. Finally, discriminant function analysis was used to examine the degree to which IQ score, age, self-determination and social abilities predicted membership in groups that were formed based on living arrangement, and on QoL status (high vs. low).

RESULTS

The anova determined, as expected, that participants with more severe ID showed the lowest levels of self-determination, QoL and social abilities. Discriminant function analysis showed that (a) individuals attending day centres were distinguished from those living in institutions in that they were younger and showed greater autonomy of choice and self-determination in their daily activities; (b) basic social skills and IQ score predicted membership in the high or low QoL groups; and (c) the IQ score predicted membership in the high or low self-determination groups. A manova conducted to examine gender- and age-level differences on self-determination found gender differences; women had higher self-determination scores than men.

CONCLUSIONS

These findings contribute to an emerging knowledge base pertaining to the role of intraindividual and environmental factors in self-determination and QoL. In general, the study replicated findings pertaining to the relative contribution of intelligence to self-determination and QoL, added information about the potential contribution of social abilities, and pointed to the potentially important role of opportunities to make choices as a particularly important aspect of becoming more self-determined, at least in the context of residential settings.