Psychological therapies for people with intellectual disabilities: comments on a matrix of evidence for interventions in challenging behaviour

Mental Health Concerns in Individuals With Developmental Disabilities: Improving Mental Health Literacy Trainings for Caregivers

Although approximately a third of individuals with intellectual and developmental disabilities (IDD) also experience a mental health concern, caregivers often miss early identification of these issues. In this perspective piece, we present an outline for a mental health literacy program that can enhance existing training approaches for caregivers of individuals with IDD. We describe three processes of the Mental Health Awareness and Advocacy (MHAA) curriculum and detail how it provides a strong preventative model to train caregivers to increase their mental health literacy. In describing these processes, we provide illustrative examples and conclude by providing a brief vignette that highlights how this process could be used by caregivers to help reduce mental health concerns in individuals with IDD.

The online mindset intervention 'The Growth Factory' for adolescents with intellectual disabilities: moderators and mediators

BACKGROUND

The online mindset intervention The Growth Factory (TGF) has shown promising effects-increasing growth mindsets and perseverance and decreasing mental health problems among youth with intellectual disabilities (ID). Studying moderators and mediators of intervention effects is essential to elucidate for whom and why TGF works. Using a randomised controlled trial design, we examined youth's baseline mindset, gender, age, level of ID and intervention satisfaction as moderators of TGF effects and examined whether the intervention effects of TGF on improvements in mental health were mediated by perseverance.

METHODS

The sample consisted of 119 participants with mild to borderline ID (M_age  = 15.83; SD = 2.23), randomly assigned to the intervention (n = 60) or passive control group (n = 59). Participants reported mindsets, perseverance, internalising, externalising, attention and total mental health problems at pre-test, at post-test and at 3-month follow-up. Additionally, youth in the intervention group graded their satisfaction with a score at the end of each session.

RESULTS

Findings indicated that the effectiveness of TGF was not affected by participants' baseline mindsets, age and ID level. TGF was more effective in reducing internalising problems in girls and increasing perseverance in boys. In addition, in the intervention group TGF was more effective in improving internalising, externalising and total mental health problems for youth who reported higher levels of intervention satisfaction at post-test. Finally, TGF indirectly decreased internalising and externalising problems at follow-up through improvements in perseverance reported at post-test.

CONCLUSIONS

TGF offers a universal, 'add-on' mindset intervention complementing usual care programmes. It improves mindsets, perseverance and mental health in youth with ID. Both practical and theoretical implications are discussed.

Empirically supported psychological treatments: The challenges of comorbid psychiatric and behavioral disorders in people with intellectual disability

This paper reviews the current state of knowledge on psychological interventions with empirical evidence of efficacy in treating common psychiatric and behavioral disorders in people with intellectual disability (ID) at all stages of their life. We begin with a brief presentation of what is meant by psychiatric and behavioral disorders in this population, along with an explanation of some of the factors that contribute to the increased psychosocial vulnerability of this group to present with these problems. We then conduct a review of empirically supported psychological therapies used to treat psychiatric and behavioral disorders in people with ID. The review is structured around the three generations of therapies: Applied behavior analysis (e.g., positive behavior support), cognitive behavioral therapies (e.g., mindfulness-based cognitive therapy), and contextual therapies (e.g., dialectical behavior therapy). We conclude with some recommendations for professional practice in the fields of ID and psychiatry.

Effectiveness of the online mindset intervention 'The Growth Factory' for adolescents with intellectual disabilities

BACKGROUND

This study examines participant satisfaction and effectiveness of the online mindset intervention 'The Growth Factory' (TGF) for youth with intellectual disabilities using a randomised controlled trial design.

METHOD

Youth with mild to borderline intellectual disabilities (N = 119; 12-23 years) were randomly assigned to TGF (n = 60) or control group (n = 59). Primary outcome measures were mindsets and perseverance. Secondary outcomes were empowerment, mental health problems, self-esteem, treatment motivation, therapeutic alliance and challenge seeking. Measurements were conducted at pre-test, post-test and at 3 and 6 months follow-up.

RESULTS

TGF had positive effects on perseverance, mental health problems, self-esteem and therapeutic alliance at post-test. TGF had follow-up effects on mental health problems (3 months), mindset of intelligence (3 and 6 months) and mindset of emotion and behaviour (6 months).

CONCLUSIONS

TGF offers a promising add-on intervention complementing usual care programmes accelerating improvements in mindsets and mental health in youth with intellectual disabilities.

A systematic review of community psychosocial group interventions for adults with intellectual disabilities and mental health conditions

BACKGROUND

People with intellectual disabilities have a high risk of developing mental ill-health. Treatment is often neglected and diagnosis is misattributed to a person's disability. Standard psychosocial interventions can improve a person's well-being. This review aimed to understand what interventions are being delivered, any benefits, and future recommendations.

METHODS

Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed, and the review registered with PROSPERO-CRD42020160254. Databases searched included: MEDLINE, Embase, and PsycINFO. A framework synthesis approach was used to present the findings.

RESULTS

There are limited psychosocial interventions offered for this population. When groups are delivered having a creative element, multiple activities over a short period of time, with breaks and group rules outcomes can be improved.

CONCLUSIONS

Adaptations and reasonable adjustments should be used specifically to a person's ability. A mixed-method design allows people to share their experiences alongside quantitative data that provides clinical information.

Psychological eHealth interventions for people with intellectual disabilities: A scoping review

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.

A Systematic Review of the Effectiveness of Intergenerational Programs

Purpose of the study: The objective of the present review study is to identify the determinant elements of the effectiveness of empirically based interventions (EBI) in the field of intergenerational work, contrasting face-to-face and combined (face-to-face and virtual) intervention modalities against variables relating to this field according to EBI indicators. Design and Methods: An extensive literature search returned a total of 553 studies. Of these, just 50 studies met the inclusion criteria of being an empirical investigation of the effectiveness of intergenerational programs that contain appropriate elaboration on theoretical constructs and methods. Results: The descriptive and multivariate analysis conducted demonstrates that programs with a greater number of EBI controls have the greatest effectiveness, regardless of the intervention mode employed, and that this effectiveness is also modulated by other variables such as the participants' disabilities, their literacy level, or their membership of an organization. Conclusions: We examined the implications of these findings, noting the need to increase the number of virtual interventions that could improve the efficiency of the activities undertaken, and at the same time ensuring that EBI indicators are also fulfilled.

Identification and Analysis of Factors Contributing to the Reduction in Seclusion and Restraint for a Population with Intellectual Disability

BACKGROUND

A cohort of 11 patients with an intellectual disability and a psychiatric diagnosis present severe behavioural disorders in psychiatric hospital of Quebec in 2009. Control-measure use for this clientele has now been reduced. How do management personnel, families and care teams explain the changes? What clinical interventions did management and care providers implement that contributed to the reduction?

METHOD

A retrospective case study was conducted. Five focus groups were held with people involved in their care, and the patient files were examined.

RESULTS

The factors contributing to this change were the cohesion of the care providers, the involvement of the families and the efforts to determine the function of the behaviour.

IMPLICATIONS

This study may inspire other care teams to try new approaches in dealing with patients with severe behavioural disorders. Also, the model of factors and interventions supporting a reduction in seclusion and restraint measures may inspire future studies.

Problem behaviours and symptom dimensions of psychiatric disorders in adults with intellectual disabilities: An exploratory and confirmatory factor analysis

BACKGROUND

The limited evidence on the relationship between problem behaviours and symptoms of psychiatric disorders experienced by adults with intellectual disabilities leads to conflict about diagnostic criteria and confused treatment. This study examined the relationship between problem behaviours and other psychopathology, and compared the predictive validity of dimensional and categorical models experienced by adults with intellectual disabilities.

METHODS

Exploratory and confirmatory factor analyses appropriate for non-continuous data were used to derive, and validate, symptom dimensions using two clinical datasets (n=457; n=274). Categorical diagnoses were derived using DC-LD. Severity and 5-year longitudinal outcome was measured using a battery of instruments.

RESULTS

Five factors/dimensions were identified and confirmed. Problem behaviours were included in an emotion dysregulation-problem behaviour dimension that was distinct from the depressive, anxiety, organic and psychosis dimensions. The dimensional model had better predictive validity than categorical diagnosis.

CONCLUSIONS

International classification systems should not include problem behaviours as behavioural equivalents in diagnostic criteria for depression or other psychiatric disorders. Investigating the relevance of emotional regulation to psychopathology may provide an important pathway for development of improved interventions.

WHAT THIS PAPER ADDS

There is uncertainty whether new onset problem behaviours or a change in longstanding problem behaviours should be considered as symptoms of depression or other types of psychiatric disorders in adults with intellectual disabilities. The validity of previous studies was limited by the use of pre-defined, categorical diagnoses or unreliable statistical methods. This study used robust statistical modelling to examine problem behaviours within a dimensional model of symptoms. We found that problem behaviours were included in an emotional dysregulation dimension and not in the dimension that included symptoms that are typical of depression. The dimensional model of symptoms had greater predictive validity than categorical diagnoses of psychiatric disorders. Our findings suggest that problem behaviours are a final common pathway for emotional distress in adults with intellectual disabilities so clinicians should not use a change in problem behaviours as a diagnostic criterion for depression, or other psychiatric disorders.

Interventions for adults with mild intellectual disabilities and mental ill-health: a systematic review

BACKGROUND

People with intellectual disabilities have very high rates of mental ill health. Standard psychosocial interventions designed for the general population may not be accessible for people with mild intellectual disabilities, and drug usage tends to be modified - 'start low and go slow'. This systematic review aims to synthesise the evidence on psychological, pharmacological and electroconvulsive therapy (ECT) interventions for adults with mild intellectual disabilities and mental ill health.

METHOD

PRISMA guidelines were followed. Medline, Embase, PsycINFO and CINAHL were searched, as was grey literature and reference lists of selected papers. Papers were selected based on pre-defined inclusion and exclusion criteria. A proportion of papers were double reviewed. Data was extracted using a structured table.

STUDY REGISTRATION

PROSPERO 2015:CRD42015015218.

RESULTS

Initially, 18 949 records were identified. Sixteen studies were finally selected for inclusion; seven on psychological therapies, two on group exercise, five on antipsychotics and two on antidepressants. They do not provide definitive evidence for effectiveness of psychosocial interventions, nor address whether starting low and going slow is wise, or causes sub-optimum therapy.

CONCLUSIONS

There are few evidence-based interventions for people with mild intellectual disabilities and mental ill-health; existing literature is limited in quantity and quality. Group cognitive-behavioural therapies have some supporting evidence - however, further randomised control trials are required, with longer-term follow-up, and larger sample sizes.