Young people with intellectual disabilities attending mainstream and segregated schooling: perceived stigma, social comparison and future aspirations

Using a life course health development framework to combat stigma-related health disparities for individuals with intellectual and/or developmental disability (I/DD)

In the U.S., 1 in 6 children has an intellectual and/or developmental disability (I/DD). This population experiences a multitude of negative health outcomes across the life course, relative to the general population. Stigma-the social devaluation of individuals with certain characteristics, identities, or statuses within interpersonal, educational, healthcare, and policy contexts-is a potentially preventable contributor to health disparities. To date, existing approaches for addressing and preventing stigma are limited to discrete and siloed interventions that often fail to address the lifelong, cumulative impacts of the specific types of stigma experienced by the I/DD population. In the current paper, we describe three elements of Life Course Health Development (LCHD)-a novel translational framework that draws on evidence from biology, sociology, epidemiology, and psychology-that healthcare providers can use to prevent stigma-related health disparities and improve outcomes for individuals with I//DDs. We discuss the utility of targeting prevention to sensitive periods; prioritizing interventions for the most damaging types of stigmas; and leveraging supports from multiple service systems and sectors. By incorporating evidence from life course science into efforts to address stigma-related health disparities, providers can more effectively and strategically prevent and combat stigma-related health disparities for the I/DD population in childhood and across the life course.

Ableism among children and youth with acquired brain injury and their caregivers: a systematic review

PURPOSE

Children and youth with acquired brain injury (ABI) experience persistent discrimination and ableism. The purpose of this systematic review was to understand the experiences and impact of ableism among children and youth with ABI.

METHOD

Six international databases were systematically searched for articles from 2002-2022. Studies were screened independently by four researchers who performed the data extraction. Study quality was appraised using the Standard quality assessment criteria for evaluating primary research.

RESULTS

Of the 2085 studies identified in the search, 15 met the inclusion criteria, which involved 1442 children and youth with brain injuries or caregivers representing them. Studies in the review showed the following key trends: (1) incidence of ableism among children and youth with ABI; (2) experiences of ableism at the individual and institutional levels, (3) impact of ableism (i.e., mental health, social relationships, quality of life) and (4) coping strategies (i.e., resources, supports).

CONCLUSIONS

Our findings reveal the alarming incidence of ableism among youth with ABI. Therefore, there is a critical need for more research to explore youth's lived experiences of ableism, especially from their perspectives along with the co-development of solutions to help enhance their social inclusion and well-being.

The Role of Cognition and Social Factors in Competition: How Do People with Intellectual Disabilities Respond to Opponents?

Exploring pacing behaviour in people with intellectual disabilities (ID) in competition will help to better understand the impact of cognition and social environment in sports, providing support for the shaping of proper inclusive sports environments. The present experimental study aimed to (1) compare the pacing behaviour and performance between people with and without ID who are inexperienced in cycling and (2) investigate how these are influenced by an opponent. Participants with (n = 8) and without ID (n = 10) performed two randomised 4-km maximal cycling trials, alone and against an opponent. Non-parametric tests for repeated measures data (p ≤ 0.05) revealed that people with ID cycled slower, but with higher inter-individual variation (both conditions) and paced themselves differently compared to people without ID when competing against an opponent. In contrast to the previous literature in athletes without ID, the presence of a faster opponent resulted in a decrease in the performance in the participants with ID. The negative influence of the opponent highlights the potential difficulties people with ID experience to adequately use their opponents to enhance their self-regulatory processes and optimize their pacing and performance in maximal exercise trials. Coaches who want to offer inclusive sports environments for people with ID could take these findings into consideration.

Applying the mixed-blessings model and labeling theory to stigma in inclusive education: An experimental study of student and trainee teachers’ perceptions of pupils with ADHD, DLD, and intellectual disability

Institutional and individual stigmatization represent major barriers that prevent children with disabilities from accessing education. It can be presumed that children with disabilities are labeled as such even in inclusive educational settings and that teachers’ attitudes toward inclusive education and children with disabilities play a crucial role in this context. Against this background, the present study aims to (a) apply and conceptualize the mixed-blessings model in the context of stigma-related reactions to children’s disability labels in inclusive education and (b) shed light on the causal attributions of teachers that underlie stigma-related attitudes toward children with various disabilities. A 3 × 2 × 2 × 2 × 2 online experiment examined the ways in which disability-specific causes and symptoms, the type of disability in question, the children’s sex, and efficacy cues regarding educational efforts affect future teachers’ attitudes toward and expectations of inclusive education as well as their social distance toward children with disabilities. The participants in this experiment were N = 605 German student and trainee teachers representing different types of teaching professions. A multivariate analysis of variance (MANOVA) revealed that, in particular, the cause attributed to the disability, the depicted type of disability and the probability of learning success led to changes in attitudes. Respondents’ teaching self-efficacy and their status as students or trainees emerged as moderators of the effect of pupils’ type of disability. As a result, teacher education and training as well as communication regarding pupils with disabilities require a high degree of sensitivity to disability-specific and efficacy-related cues to prevent (accidental) professional or institutional stigmatization.

Cognitive factors and educational placement affecting mathematical attainment in middle school students with mild intellectual disability

The study investigated the relationship between mathematics achievement, cognitive and motor skills, and general intellectual ability among seventy 10-12 years old students with mild intellectual disability (MID) attending regular school (n = 30) and special school (n = 40). The purpose of the study was to identify the critical deficits teachers need to consider when teaching mathematics at the secondary school level. The students attending regular schools had significantly higher fluid intelligence scores (p = 0.036), but we found no difference in the total score of the math achievement test. Special school students were more eager to use assistance and aids when solving math problems (p = 0.040). The study indicated significant associations between basic mathematical skills, verbal and visuospatial processing, and motor skills. Thus, it is essential to compensate for the delay of students' cognitive development to improve their basic mathematical skills and, in general, mathematical performance. The educational placement affects the willingness or ability to seek academic help when solving mathematical problems.

Access to Services from Persons with Disabilities in Afghanistan: Is Community Based Rehabilitation Making a Difference?

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), ratified in 2006, states that the achievement of equal rights, empowerment, and social inclusion of people with disabilities requires comprehensive rehabilitation services involving educational, social, economic, and medical interventions, all dimensions of the World Health Organization Community based rehabilitation (CBR) matrix. CBR programs aim at achieving those goals. In the present study, we investigated whether a large scale CBR program is improving access to multiple services (namely physical therapy, assistive technology, education, employment, advocacy, and community awareness) and providing satisfactions (by measuring the reduction in unmet needs) of Afghans with disabilities. We enrolled in the study 1861 newly recruited CBR participants with disabilities from 169 villages between July 2012 and December 2013, and 1132 controls screened with disabilities randomly selected with a two-stage process within 6000 households from 100 villages in the same provinces as the CBR but outside its catchment area. Using propensity score matching (PSM) and difference in difference analysis, we estimated the differences in accessing services. There were statistically significant differences between participants and controls on the access of available services between the baseline and endline. Using PSM we also found that needs were more often met among CBR participants compared to the controls. Our study indicates that a CBR program may be an effective way to provide services for persons with disabilities even in a conflict context such as Afghanistan. It contributes to addressing the longstanding question whether CBR can actually improve the rehabilitation of persons with disabilities.

A qualitative exploration of stigma experience and inclusion among adults with mild to moderate intellectual disability in an Indonesian context

BACKGROUND

People with intellectual disability are among the most stigmatised groups in society. There is a paucity of studies reporting on how stigma is experienced in low- and middle-income countries. This study aims to explore the experience of stigma among adults with mild/moderate intellectual disability and the extent of their inclusion in Indonesian society.

METHOD

Fifteen adults with mild/moderate intellectual disability were purposively recruited from three service providers and were interviewed using a semi-structured interview schedule. The data were analysed using thematic analysis.

RESULTS

The findings suggest that adults with intellectual disability experience stigma in multiple settings (family, school, community), have limited access to social activities, and internalised the experienced stigma.

CONCLUSION

This study adds to the international understanding of stigma experienced by adults with mild/moderate intellectual disability in daily life and their inclusion in society in a middle-income country.

Parent-Reported Contribution of Family Variables to the Quality of Life in Children with Down Syndrome: Report from an International Study

PURPOSE

The intent of this study was to determine parents' views of the contribution of family variables to the quality of life (QoL) of children with Down Syndrome (DS). Based on prior research, we hypothesized that parents would report that family variables reflecting positive aspects of family functioning contributed to better QoL; and family variables reflecting the negative aspects of family functioning contributed to poorer QoL.

DESIGN AND METHODS

A cross-sectional study was carried out. Invitation letters were sent to DS support groups. Upon agreement, the parents of the children were sent a link to an online survey that included a consent form, demographic questionnaire, and child and family measures.

RESULTS

Results demonstrated the contribution of family demands to children's interpersonal relations. Family appraisals concerning the child and the family's ability predicted the children's physical and material well-being, personal development, self-determination, social inclusion, interpersonal relations, and rights. Family problem-solving served as a prominent predictor for children's physical and emotional well-being, personal development, interpersonal relations, and rights. Also, family resources predicted various aspects of children's QoL including physical, emotional, and material well-being, self-determination, social inclusion, interpersonal relations, and rights.

CONCLUSION

Results confirmed the significant relationship between family and children's QoL variables. Family appraisal and family problem-solving were especially identified as significant predictors of children's QoL that can be targeted for family interventions, since the family variables are modifiable aspects of family life.

PRACTICE IMPLICATIONS

Nurses can use current findings to develop interventions to enhance QoL of children with DS and families.

Stigma of persons with disabilities in South Africa: Uncovering pathways from discrimination to depression and low self-esteem

Despite the fact that universal inclusion is a basic principle of the Sustainable Development Goals, the inclusion of persons with disabilities in humanitarian interventions and development policies remains elusive. Persons with disabilities face high risks of poverty, poor nutrition, limited inclusion in labor markets and poor mental health as a result. Stigma is likely to play a negative role in this regard and yet, no study has investigated the impact of stigma on depression and self-esteem of persons with disabilities. To address this gap in the literature, we conducted in June 2017 a random sample disability case control household study in Soweto, a township in Johannesburg, South Africa. Using propensity score analysis and structural equation modeling, we investigated the relationship between disability, stigma, depression and self-esteem controlling for socioeconomic covariates. Our main empirical results showed that stigma significantly mediates the association between disability and higher depression on the one hand and between disability and lower self-esteem on the other. This mediating effect exists even after controlling for age, gender, marital status, education, employment and wealth. We also found strong direct associations between disability and depressive mood, somatic indicators and negative feelings such as unhappiness and low self-esteem. Unemployment aggravates depression and low self-esteem while low education worsens self-esteem only. In addition, depression exacerbates low self-esteem. Both unemployment and low education are more common among persons with disabilities aggravating the disability, depression, poor self-esteem nexus. Similarly, persons with disabilities who are more likely to be depressed are also at higher risk of low self-esteem. These results point to a vicious reinforcing circle of exclusion from society, despair and self-deprecation, which could prove difficult to break. Substantial psycho-social support and anti-stigma policies anchored in local cultural values, engaging persons with disabilities and their communities, are required to break this vicious circle.

Exploring the ability of individuals with an intellectual disability to generate and use a compassionate image

BACKGROUND

There is a growing interest in adapting third-wave therapies such as mindfulness for people who have intellectual disabilities. This study explored their ability to generate and use a compassionate image.

METHOD

Nineteen people with an intellectual disability and twenty people without were recruited from further education colleges. A compassion-focused therapy technique was adapted to help participants generate their own compassionate image, and examine whether they could use their images in potentially distressing situations.

RESULTS

With appropriate support, participants with intellectual disabilities were just as able as those without disabilities to generate their own compassionate image. They were also able to generate self-soothing statements.

CONCLUSIONS

The participants' success in generating compassionate images suggests this approach may have clinical utility with people who have intellectual disabilities. The next question is whether this client group can use this technique to deal with personally salient stressors.

Impact of an Inclusive Postsecondary Education Program on Implicit and Explicit Attitudes Toward Intellectual Disability

People with intellectual disability (ID) experience negative consequences as a result of stigmas held by the public. Students with ID involved in inclusive postsecondary education (IPSE) programs demonstrate positive outcomes. This study examines the impact of an IPSE program on typically matriculating student attitudes toward ID. Explicit and implicit attitudes were measured at the start and end of a semester among IPSE volunteer peer mentors (n = 17) and an uninvolved student group (n = 14). Findings indicate that volunteers demonstrated lower discomfort after their volunteer experience, as measured by the Attitudes Toward Intellectual Disability Questionnaire (ATTID). Volunteers also demonstrated higher knowledge of causes and preference for interaction with people with ID than nonvolunteers. This demonstrates that volunteer involvement in IPSE positively impacts attitudes toward people with ID among typically matriculating college students.

How do people with intellectual disabilities construct their social identity? A review

BACKGROUND

A 2005 review by Beart, Hardy and Buchan, asking how people with intellectual disabilities view their social identities, has been widely cited, indicating this important topic needs an updated review. This review covers research on how people with intellectual disabilities view their ascribed label; to what extent they ascribe it to themselves; and whether they recognize it as devalued in society.

METHOD

Rapid review methodology using PsycINFO, citation- and hand-searching identified relevant studies.

RESULTS

The 16 studies identified indicate that the majority are aware of their ascribed label, or acknowledge they are "different". Others reject it, focusing on alternative attributes or roles. Most recognize others view the label negatively and express feelings of shame, anger and powerlessness.

CONCLUSIONS

The review advances our understanding of social identity formation in people with intellectual disabilities, with implications for future research and practice to support construction of positive social identities and stigma resistance.

Associating disabilities, school environments, and child victimization

Inclusive education has become one of the key policy objectives for the education for children with disabilities in recent decades. However, its effectiveness in promoting happy school life among those children has been questioned. In this study, we aimed to provide a detailed profile of the associations between disabilities and child victimization, and to examine the effects of school environments on those associations. We conducted a cross-sectional survey with a sample of 4114 school-aged children (6-18 years), who were receiving primary or secondary education in Hong Kong in 2016-2017. Children's experiences of 7 types of victimization in the past year, status of disabilities, type of school attending, and other demographic factors were captured with questionnaire completed by the children or their parents. Apart from descriptive statistics, we conducted logistic regression analyses to examine the associations between disabilities, types of school, and child victimization. Children with ADHD, internalizing disorder, autistic spectrum disorder, and restrictions in body movement were at higher risks of victimization while other types of disabilities were not. Children attending special schools were at lower risks of victimization, while children with disabilities who had been placed in ordinary schools for inclusive education were at higher risks of most types of victimization when compared to children without disabilities. Our findings suggested an important role of the school environments on the associations between disabilities and victimization. When placed in a protective environment, children with disabilities could even be less vulnerable to victimization than those without disabilities.

The social complexities of disability: Discrimination, belonging and life satisfaction among Canadian youth

Although disability has been on the psychological agenda for some time, there is limited empirical evidence on the life satisfaction of youth with a disability, especially the effect of discrimination and factors that might mitigate it. We address this critical gap by examining the complex social experiences of youth with a disability and the culminating effect on life satisfaction. We ask three questions: (1) Is having a disability associated with lower life satisfaction? (2) Do youth with a disability experience discrimination and, if so, how does this affect life satisfaction? (3) Can a sense of belonging mitigate the negative effect of discrimination? We address these questions using microdata from the Canadian Community Health Survey, which is nationally representative. Our sample consists of 11,997 adolescents, of whom 2193 have a disability. We find that life satisfaction is lower among youth with a disability. Moreover, many experience disability-related discrimination, which has a negative effect on life satisfaction. However, this is mitigated by a sense of belonging to the community. Specifically, youth with a disability do not report lower life satisfaction when high belonging is present, even if they experience discrimination. This is true for boys and girls. We conclude that belonging, even if it is not disability-related, is protective of well-being. This has important implications for policy whereby organizations that cultivate a sense of belonging may alleviate the harm sustained by youth who experience discrimination as a result of their disability.

Self-reported stigma and its association with socio-demographic factors and physical disability in people with intellectual disabilities: results from a cross-sectional study in England

PURPOSE

The aim of this study was to investigate whether socio-demographic variables and physical disability (e.g. sensory impairment and mobility problems) were associated with self-reported stigma in people with intellectual disabilities (ID), and to examine whether age, sex and ethnicity modified the relationship between severity of intellectual disability and self-reported stigma.

METHODS

229 participants with mild or moderate intellectual disabilities were recruited from 12 centres/sites in England from community intellectual disability services, day centres, supported housing schemes, voluntary organisations and invitation letters. Information on physical disability and socio-demographic variables were obtained using a structured data collection form. Self-reported stigma was measured using a validated questionnaire.

RESULTS

Age was associated with self-reported stigma, with older adults reporting more stigmatising experiences. Participants with moderate intellectual disabilities were more likely to report being treated differently such as being made fun of and being treated like children. Physical disability such as sensory, mobility and speech problems were not associated with self-reported stigma. Gender modified the relationship between severity of ID and self-reported stigma as participants who were male and had moderate ID were more likely to report stigma compared to females with moderate ID. Categorical age also modified the relationship between severity of ID and self-reported stigma as older participants who had moderate ID were more likely to report stigma compared to younger people with moderate ID.

CONCLUSIONS

Older adults and those with moderate ID are potentially at higher risk of being targets of public stigma or are more likely to report stigma. Interventions to help individuals cope with stigma could be targeted to this group.

Leaving school: a comparison of the worries held by adolescents with and without intellectual disabilities

BACKGROUND

Leaving school is an important time for adolescents, with increasing autonomy and developing adult identities. The present study sought to shed light on the content and emotional impact of worries amongst adolescents with and without intellectual disabilities (IDs) at this time of change.

METHODS

Twenty-five adolescents with mild to moderate IDs and 27 adolescents without IDs, aged 15 to 18 years, took part in the study. Participants' worries were elicited using a structured interview. The levels of rumination and distress related to their most salient worries were also examined, along with their self-reported levels of anxiety.

RESULTS

Content analysis of the interviews identified differences between the worries of the two groups of participants, with the adolescents with IDs expressing more general worries about failure and personal threat. Level of distress about worries was positively correlated with anxiety in both groups. The adolescents with IDs were significantly more anxious than their non-disabled peers.

CONCLUSIONS

The differences between the groups' worries may be linked to differences in life experience and expectations. Consideration should be given to the specific worries of adolescents at the stage of leaving school. Doing so may allow solutions for their concerns to be identified, thus easing distress and leading to a less stressful transition.

Public stigma in intellectual disability: do direct versus indirect questions make a difference?

BACKGROUND

Stigma may negatively impact individuals with intellectual disabilities (ID). However, most studies in the field have been based on the use of direct measurement methods for assessing stigma. This study examined public stigma towards individuals with ID within a representative sample of the Israeli public by comparing direct versus indirect questioning.

METHODS

Vignette methodology was utilised with two questionnaire versions. In the direct questionnaire (n = 306), the participants were asked how they would think, feel and behave if a man with ID asked them a question in a public place. In the indirect questionnaire (n = 301), the participants were asked to report how a hypothetical 'other man' would think, feel and behave in the same situation.

RESULTS

Higher levels of stigma were reported among participants that answered the indirect questionnaire version. Furthermore, among those participants that answered the indirect questionnaire version, subjective knowledge of ID was a less important correlate of stigma than for those participants that answered the direct questionnaire.

CONCLUSION

Several explanations are suggested for the finding that indirect questioning elicits more negative stigmatic attitudes. Among others, indirect questioning may be a more appropriate methodology for eliciting immediate beliefs. Furthermore, the results call for implementing a comprehensive, multi-level programme to change stigma.

Stigma in the Area of Intellectual Disabilities: Examining a Conceptual Model of Public Stigma

Studies in the area of intellectual disability (ID) stigma are few and atheoretical. This study examined the adequacy of the conceptual framework of stigma from the mental illness field regarding ID. Telephone interviews were conducted with a nationally representative sample of 304 adults in Israel. Participants were read a vignette describing a man with ID and answered items related to cognitive, emotional, and behavioral reactions. Behavioral dimensions included: Withdrawal, Social distance, and Helping behaviors. The stigma process leading to Withdrawal was drawn through Negative affect, whereas the process to Social distance was drawn through Calm affect. One unique aspect of the stigma process in ID is the importance of Calm affect, which helped reduce Social distance.

Ethnicity and self-reported experiences of stigma in adults with intellectual disability in Cape Town, South Africa

BACKGROUND

Studies have shown that individuals with intellectual disability (ID) are aware of stigma and are able to describe experiences of being treated negatively. However, there have been no cross-cultural studies examining whether self-reported experiences of stigma vary between ethnic groups.

METHOD

Participants with mild and moderate ID were recruited from a number of different settings in Cape Town, South Africa. Self-reported experiences of stigma in three ethnic groups were measured using the South African version of the Perceived Stigma of Intellectual Disability tool, developed by the authors. One-way anova was used to test whether there were differences in the total stigma score between the ethnic groups. Regression analysis was performed to identify factors associated with stigma.

RESULTS

A total of 191 participants agreed to take part; 53 were Black, 70 were of mixed ethnicity and 68 were Caucasian. There were no differences in the levels of stigma reported by the three groups but the Black African ethnic group were more likely to report being physically attacked and being stared at, but were also more likely to report that they thought they were 'the same as other people'. There was an interaction effect between ethnicity and level of ID, with participants with mild ID from the Black African group reporting higher levels of stigma compared with those with moderate ID. Younger age was the only factor that was associated with stigma but there was a trend towards ethnicity, additional disability and socio-economic status being related to stigma.

CONCLUSION

Interventions should target the Black African community in South Africa and should include the reduction of both public stigma and self-reported stigma.

Psychosocial experiences of chronic illness in individuals with an intellectual disability: A systematic review of the literature

BACKGROUND

Increased life expectancy has led to an increase in diagnoses of chronic illness in people with an intellectual disability; despite this increase, research about the psychological impact is rare. This review explored the psychosocial experiences of chronic illness in adults with an intellectual disability, revealing potential predictors and moderators of these experiences.

METHODS

Online databases were systematically searched to identify relevant literature, using predefined inclusion criteria. Of the 25,058 titles initially identified, 4 were included, that is, those collecting data on people with an intellectual disability and diagnosed with cancer (n = 2), chronic pain (n = 1) and diabetes (n = 1).

RESULTS

Narrative synthesis of the data identified six themes, namely, (1) delayed diagnosis, (2) information, communication and understanding, (3) negative psychological consequences, (4) negative physical consequences, (5) social perception and (6) social support.

CONCLUSIONS

There are unmet needs within this population, including a lack of assistance in understanding their illness. A substantial gap in the literature should be addressed through further empirical work.

They stole her teeth! An exploration of adults with developmental disability experiences with dental care

PURPOSE

The aim of this paper was to explore the experiences of adults with developmental disabilities (AWDD) in accessing and utilizing dental services in Vancouver, BC.

METHODS

Participants were either self-advocates or parents/caregivers who discussed their experiences in five focus group discussions with 20 participants in total (age range 17-60 years, 2 males). Each focus group lasted on average 40 minutes. Transcripts were coded for thematic analysis; the codes were organized into themes and finally into domains.

RESULTS

Seven domains relating to the participants' experiences with dental care were identified, and included communication, trust, and respect as provided-based domains to the quality of the dental experience for AWDD and their parents, while financial issues, transitional services, and waiting times were system-based barriers to access to dental care for theses AWDD. Finally, what makes for a positive dental experience was shared in terms of acknowledging parent's role as advocates and making simple accommodations to see AWDD by the dental office.

CONCLUSIONS

Access to a care provider did not necessarily equate to satisfaction with quality of experience. Efforts have to focus on establishing communication and trust with AWDD patients as key to a positive dental experience. We encourage a global discussion on the need to better incorporate dental care for special needs individuals within dental school curricula.

Public stigma and the perception of rights: differences between intellectual and physical disabilities

Stigma may have detrimental effects on the rights of individuals with disabilities. This study examined the association between stigma and the perception of rights of people with intellectual disabilities and people with physical disabilities. Telephone interviews using vignette methodology were conducted with a nationally representative sample of 605 adults. Items included stereotypes, prejudice, behavioral reactions and the perception of rights of these individuals. More negative stereotypes, greater social distance and greater withdrawal behaviors were found toward people with intellectual disabilities as compared to people with physical disabilities. Lower support of rights was found toward people with intellectual disabilities as compared to people with physical disabilities. Lower degree of acceptance and higher perception of dangerousness were associated with greater social distance, which was related to lower perception of rights. Programs should aim at decreasing social distance to improve support to exercise rights, especially among people with intellectual disabilities.

Baseline evaluation in youth ice hockey players: comparing methods for documenting prior concussions and attention or learning disorders

STUDY DESIGN

Cross-sectional.

OBJECTIVE

To examine differences in concussion history and attention or learning disorders reported by elite youth ice hockey players, using a questionnaire that allows parental input compared to a clinic-based test battery that does not.

BACKGROUND

A history of previous concussion and the presence of attention or learning disorders can affect concussion-management decisions; however, youth athletes may not accurately report their medical history because they may not know or recall important details.

METHODS

The sample included 714 Bantam (ages 12-14 years) and Midget (ages 15-17 years) ice hockey players (601 male, 113 female) from the most elite divisions of play (AA and AAA). Players completed a take-home preseason questionnaire (PSQ) with the input of a parent/guardian, and also independently completed the baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) at the beginning of the 2011-2012 hockey season.

RESULTS

In 21.1% (95% confidence interval: 18.1%, 24.1%) of cases, there was disagreement between the PSQ and ImPACT in the number of previous concussions reported. Among those who reported an attention disorder on the PSQ, 85.7% also reported an attention disorder on the ImPACT. Only 9.5% of those who reported a learning disorder on the PSQ also reported a learning disorder on the ImPACT.

CONCLUSION

In 1 of 5 players, reported concussion history differed between the PSQ and ImPACT, and there was substantial disagreement between instruments for those reporting learning disorders. The method of obtaining medical history may, therefore, affect baseline and postconcussion evaluations.

'We just stick together': how disabled teens negotiate stigma to create lasting friendship

BACKGROUND

Friendship is a crucial relationship offering practical support, enjoyment and improved health. When disability is added into the mix, the permutations of friendship shift. Despite the presence of inclusive social policies many disabled teens continue to experience stigma and social isolation, yet some teens are able to establish long-term friendships.

METHODS

A nuanced understanding about how disabled teens navigate stigma to create lasting friendships was constructed through this qualitative study. Seven boys and seven girls between the ages 15 to 20 years who experienced disability engaged in research interviews and participant observation sessions. Nine adults were also interviewed. A critical approach to data analysis was complimented by coding in Atlas.ti.

RESULTS

This article describes the strategies used by these disabled teens to make and keep friends: disrupting norms about friendship, coming out as disabled, connecting through stigma and choosing self-exclusion.

CONCLUSION

Disabled teens in this study felt a greater sense of belonging when with peers who shared the disability experience, thus self-exclusion was a viable strategy for creating sustainable friendships in the context of oppression. Social policy informed by the experiences of disabled youth in the current study will more effectively promote social inclusion by first acknowledging and then disrupting ableism.

Public perceptions of intellectual disability in a shantytown community in Lima, Peru

Disability is the result of interactions between biological and environmental factors including the physical, economic, and social barriers imposed on an individual by society. In low and middle-income countries, limited attention has been given to the situation of individuals with intellectual disabilities, who remain seriously neglected. Given the lack of resources available to address mental disorders, it is essential to examine the role of socioeconomic and socio-cultural factors in the lives of these individuals. We conducted interviews of key informants and community members in a shantytown community in Lima, Peru, to explore public knowledge, perceptions, and attitudes regarding intellectual disability. Findings indicated that the most important concern for community members was the longstanding issues associated with poverty. There was a profound lack of awareness of intellectual disability among the general population and an absence of social integration for these individuals. However, interviewees also recognized the productive potential of persons with intellectual disabilities provided they received currently inaccessible support services. The results suggest that educational efforts and intervention strategies must be mindful of the challenges of chronic poverty in order to successfully facilitate the social integration of individuals with intellectual disabilities into the community.

Self stigma in people with intellectual disabilities and courtesy stigma in family carers: a systematic review

People with intellectual disability are one of the most stigmatised groups in society. Despite this, research in this area has been limited. This paper provides a review of studies examining self stigma in people with intellectual disability, and courtesy and affiliate stigma in family carers. An electronic search of studies published between 1990 and February 2012, using four databases and hand searching of journals was conducted. Thirty-seven papers were included in the review: 17 studies examined self stigma and 20 studies examined courtesy or affiliate stigma. The findings indicate that both individuals and family carers experience stigma and that it may have a negative impact on psychological wellbeing. Awareness of stigma in people with intellectual disability appears to be related to the extent to which individuals accept and internalise the label of intellectual disability. Most of the studies were qualitative studies or small descriptive studies. There is a lack of large prevalence studies and longitudinal studies examining the impact of stigma, in both individuals with intellectual disability and their carers.

Stigma and intellectual disability: a review of related measures and future directions

The theoretical construct of stigma has received much attention in psychiatric disability research, leading to the development of widely used measures. Such measures have had real world impact in that they allow for the assessment of stigma change efforts. The study of stigma has not received the same level of attention for persons with intellectual disabilities. In this manuscript we evaluate existing measures of intellectual disability stigma through a systematic review of the literature. Twenty-four scales were reviewed and evaluated. Findings indicate a paucity of stigma measures based on theoretical conceptualizations pointing to a need for further development of measures to pursue the study of public, self, and family stigma as related to intellectual disability.

The image of people with intellectual disability in Taiwan newspapers

BACKGROUND

There is limited research on the development of newspaper analysis about the images of people with ID in Chinese newspapers. The purpose of this study was: (a) to understand the general image of persons with ID presented in printed newspapers in Taiwan, and (b) to classify the various images of persons with ID and to measure the relative proportions among these classifications.

METHOD

Articles from 2008 from the media databank UDNDATA were analysed by content analysis.

RESULTS

Three main images were portrayed. The greatest number of articles revolved around the "dispirited" image (44.5%), followed by "needy" (32.7%), and "affirmative" (22.8%). Articles focused on families with a member with ID made up 20.8% of the total articles, and 81% of these stories had a negative theme.

CONCLUSION

The pessimistic portrayal of people with ID is popular and newspapers may create stigma for people with ID in Taiwan.

The process of perceiving stigmatization: perspectives from Taiwanese young people with intellectual disability

BACKGROUND

There is a dearth of studies about the causes of stigmatization in people with intellectual disability. This study is aimed at gaining an understanding of how feelings of stigmatization are formed and perceived among young people with intellectual disability in Taiwanese cultural and social contexts.

MATERIALS AND METHODS

Fourteen young people with intellectual disability, ranging in age from 17 to 22 years, participated in this study. Data were collected and analysed using grounded theory.

RESULTS

Three persistent themes were noted in regard to the formation of feelings of stigmatization among these young people with intellectual disability. (i) Being labelled: the sources of their stigma often resulted from the educational and social welfare systems. (ii) Perceiving oneself: they viewed themselves as 'not good' students, as troublemakers, as sick people and as odd people. (iii) Living with the labelling: they attempted to manage the impression that their intellectual disability had on others by using avoidance, isolation and self-promotion.

CONCLUSIONS

Stigmatization among this intellectual disability group is invisibly formed while attending school and receiving social services. The value of the intellectual performance is not yet waived for young people with intellectual disability in Taiwan. Changing the social opinions of intellectual disability can help to avoid stigmatizing these people with intellectual disability.

Understanding attitudes toward people with Down syndrome

Understanding attitudes of the public toward people with Down syndrome is important because negative attitudes might create barriers to social integration, which can affect their success and quality of life. We used data from two 2008 U.S. surveys (HealthStyles(c) survey of adults 18 years or older and YouthStyles(c) survey of youth ages 9-18) that asked about attitudes toward people with Down syndrome, including attitudes toward educational and occupational inclusion and toward willingness to interact with people with Down syndrome. Results showed that many adults continue to hold negative attitudes toward people with Down syndrome: A quarter of respondents agreed that students with Down syndrome should go to special schools, nearly 30% agreed that including students with Down syndrome in typical educational settings is distracting, and 18% agreed that persons with Down syndrome in the workplace increase the chance for accidents. Negative attitudes were also held by many youth: 30% agreed that students with Down syndrome should go to separate schools, 27% were not willing to work with a student with Down syndrome on a class project, and nearly 40% indicated they would not be willing to spend time with a student with Down syndrome outside of school. Among both adult and youth, female sex and respondents with previous relationships with people with Down syndrome were consistently associated with more positive attitudes. These results may be helpful in the development of educational materials about Down syndrome and in guiding policies on educational and occupational inclusion.

Technology and Communications Coursework: Facilitating the Progression of Students with Learning Disabilities through High School Science and Math Coursework

Students identified with learning disabilities experience markedly lower levels of science and mathematics achievement than students who are not identified with a learning disability. Seemingly compounding their disadvantage, students with learning disabilities also complete more credits in non-core coursework-traditionally considered non-academic coursework-than students who are not identified with a learning disability. The Education Longitudinal Study of 2002, a large national dataset with both regular and special education high school students, is utilized to determine whether credit accumulation in certain types of non-core coursework, such as Technology and Communications courses, is associated with improved science and math course-taking outcomes for students with learning disabilities. Results show that credit accumulation in Technology and Communications coursework uniquely benefits the science course-taking, and comparably benefits the math course-taking, of students identified with learning disabilities in contrast to students who are not identified with a learning disability.

A measure of perceived stigma in people with intellectual disability

BACKGROUND

There is a lack of validated instruments measuring perceived stigma in people with intellectual disability.

AIMS

To develop a valid and reliable self-rated instrument to measure perceived stigma that can be completed by people with mild to moderate intellectual disability.

METHOD

A literature search was used to generate a list of statements. Professionals, individuals with intellectual disability and carers were consulted about the suitability of statements. An instrument was developed containing statements about stigma with accompanying photographs. Test-retest reliability, internal consistency and the factor structure of the instrument were evaluated.

RESULTS

The instrument was completed by 109 people once and 88 people twice. Items with limited variability in responses and kappa coefficients lower than 0.4 were dropped. Exploratory factor analysis revealed two factors: ;perceived discrimination' (seven items) and ;reaction to discrimination' (four items). One item loaded onto both factors. Cronbach's alpha for the ten-item instrument was 0.84.

CONCLUSIONS

This instrument will further our understanding of the impact of stigma in people with intellectual disability in clinical and research settings.