An anxious time? Exploring the nature of worries experienced by young people with a mild to moderate intellectual disability as they make the transition to adulthood

Family Caregiver Adaptation during the Transition to Adulthood of Individuals with Intellectual Disabilities: A Scoping Review

During the transition to adulthood, individuals diagnosed with intellectual disability (ID) and their family caregivers have unique experiences. This scoping review studies the sources of the family caregiver's objective burden, support, coping mechanisms, positive caregiving, and quality of life to understand the caregiver's adaptation process when the individual with ID transits to adulthood, according to Joanna Briggs Institute (JBI) Scoping Review methodology guidelines. The inclusion criteria included studies of family caregivers of any age who provide unpaid care and live with individuals diagnosed with ID who are transitioning to adulthood. Of 2875 articles identified, 12 published studies were included. The main themes included caregivers reporting dissatisfaction with the available adult services and exhaustion from being a caregiver. Overall, a vicious cycle of likely increased demands during the transition, with caregivers not being prepared to cope with these demands while concurrently being dissatisfied with the adult services system, leads the caregivers to develop a pervasive sense of helplessness. Future studies would benefit from recruiting caregivers from sources other than adult-only service centres and using qualitative (to identify the broad aspects of the key factors) and quantitative (to identify the significant differences between the key factors) methodologies.

School Experiences and Anxiety Trajectories Among Youth with Intellectual Disabilities

This study investigated how the school experiences and personal characteristics of youth with Intellectual Disabilities (ID) contribute to their longitudinal trajectories of anxiety. To this end, we relied on a sample of 390 youth with mild (48.2%) to moderate (51.8%) levels of ID, aged from 11 to 22 (M = 15.70), and recruited in Canada (n = 140) and Australia (n = 250). Across three yearly time points, all participants completed self-report measures of anxiety, school climate, and victimization. Our results revealed a slight normative decrease in anxiety over time and showed that experiences of school victimization were associated with higher levels of anxiety (initially and momentarily) and increases in victimization were accompanied by increases in anxiety over time. Perceptions of attending a school that fosters security and promotes learning also tended to be accompanied by lower levels of anxiety (initially and momentarily). Momentary increases in perceptions of attending a school that fosters positive peer interactions were associated with momentary decreases in anxiety, whereas momentary increases in perceptions of attending a school characterized by positive teacher-student relationships and an equitable treatment of all students both led to small momentary increases in anxiety once all other components of student school experiences were considered. The theoretical and practical implications of these results are discussed.

The perspective of emerging adults with Down syndrome - On quality of life and well-being

This study explored the thoughts of emerging adults with Down syndrome on quality of life and subjective well-being. Eight 22-year-olds participated in interviews. Data was analysed with content analysis. Four themes were revealed: Work based on interest and capability, having an active and social leisure life, a safe place to live and the use of information and communication technology. Two context related patterns were identified showing that quality of life and subjective well-being were related to individualised support to enhance independency in work, social leisure and place of living. Knowledge of their perception of independency and their awareness of needing customised help and support is valuable. This study supports the proposed emerging Quality of Life Supports Paradigm in the field of intellectual disabilities, which integrates key concepts of quality of life and supports.

A comparison of the content and nature of worries of autistic and neurotypical young people as they transition from school

LAY ABSTRACT

Autistic young people experience higher levels of anxiety than neurotypical young people. Having worries is part of feeling anxious. This makes it surprising that very little research has looked at the kind of worries autistic young people have. Leaving school, in particular, can be a worrying time for young people. Twenty-two autistic young people and 22 neurotypical young people who were at mainstream secondary schools agreed to take part in the study. They were between 16 and 18 years of age. They were asked to sort through a series of pictures, showing the different types of worries that young people might experience. They were then asked to pick out their four main worries and say how much they thought about each worry and how upset the worry made them. They also completed a questionnaire about their level of anxiety. There were similarities and differences between the autistic and neurotypical young people's worries. Both groups worried about failing and how they might get on in further education. The autistic young people were more worried about change and friendships. Work and money were particular concerns for the neurotypical young people. The autistic young people said that they found their worries more upsetting than the neurotypical young people. Having a better understanding of autistic young people's worries at important points in their lives might mean that more timely help and support can be given to them. Simply knowing what to ask young autistic school leavers about may help them to express unspoken concerns.

Impact of Equine-Assisted Interventions on Heart Rate Variability in Two Participants with 22q11.2 Deletion Syndrome: A Pilot Study

People with disabilities due to genetic origin often present high levels of stress: non-pharmacological interventions such as Equine-Assisted Interventions (EAI) may be a useful strategy. The objective of this pilot study was to evaluate stress levels in two participants with 22q11.2 deletion syndrome diagnosis, immediately after carrying out the EAI. A single case experimental design methodology was chosen due to the small sample size. Two participants with 22q11.2 Deletion Syndrome, a rare disease, with different comorbidities were included. The present study considered the EAI as the independent variable while the Heart Rate Variability (HRV) represented the dependent one, as HRV is considered an indicator of stress level. Measurements were performed before and after carrying out the interventions. The results showed an HRV increase in one of the participants and an increase in the arousal level evidenced by a decrease in his HRV. After having carried out the program, EAI seems to cause an impact on the activation level of the participants depending on the typology and nature of the intervention. However, these results should be treated with caution due to the small sample size. This study is a pilot to test the feasibility of the proposed interventions on the variable under study.

The Effects of Integrated Step Training into the Physical Education Curriculum of Children with Intellectual Disabilities

(1) Background: This study investigated the changes in step frequency, walking ability, and standing posture of students with intellectual disabilities by integrating step training into the students' physical education curriculum; (2) Methods: The centroid formula was used to estimate the geometric center of the students' bodies in video footage of each participant. Each participant's stepping frequency per minute was recorded. After training, the teachers involved were interviewed regarding the participants' everyday activities in school. Each step training session was recorded by two video cameras. Each step training session was observed and photographed by a senior physical education teacher with special education qualifications; (3) Results: The step training increased the stability of the participants' body axes. The participants' average steps per minute of the participants significantly improved from 24.200 ± 7.554 to 28.700 ± 8.629. Additionally, despite the students exhibiting anxious behavior (e.g., squeezing their hands and grasping at their clothes) at baseline, the frequency of these behaviors decreased significantly from week 4. Overall, the students' daily activities, motivation, interpersonal interaction, self-confidence, and anxiety behaviors improved; (4) Conclusions: After the 8-week step program, the participants with intellectual disabilities improved their step frequency, movement stability, ability to perform daily activities, walking speed, motivation, interpersonal interaction, and self-confidence, and they exhibited a lower level of anxiety-related behaviors.

Development of the Perth Adolescent Worry Scale (PAWS)

Tools to assess worry among adolescents exist but do not capture the content of worries. This study reports on the development of a brief, psychometrically sound measure of worry for use with adolescents. Phase 1 involved identification of 27 potential items from existing instruments as well as item generation identified in interviews with students, teachers, school psychologists, and parents. In Phase 2, the candidate items were completed by 835 Australian adolescents (317 males, 508 females, 10 unspecified; Mean age = 13.55, SD = 1.31) from Grades 5 to 10. These data were randomly split in half, and an exploratory factor analysis on the first half identified a two-factor solution with 12 items: Peer Relationships (6 items) and Academic Success and the Future (6 items). On the second half of the data, confirmatory factor analyses supported the factor structure and supported strong invariance across age, socioeconomic status, and presence/absence of a diagnosed neurodevelopmental disorder. Weak invariance was evident across sex. Differences across groups are reported as are correlations with indicators of psychological wellbeing. In conclusion, the Perth Adolescent Worry Scale provides both applied professionals and researchers with a short, easy-to-administer, and psychometrically strong instrument to evaluate adolescents’ everyday worries.

IDTWO: A Protocol for a Randomised Controlled Trial of a Web-Based Mental Health Intervention for Australians with Intellectual Disability

People with intellectual disability (ID) experience higher rates of mental illness and reduced access to appropriate care and treatment. Tailored electronic mental health (eMH) programs offer opportunities to address these disparities. The aim of this study is to examine whether a fully automated and self-guided eMH program tailored to the needs of people with ID can reduce symptoms of anxiety and depression and improve daily functioning in people with borderline-to-mild ID. Australians with borderline-to-mild ID, aged 16 years and older with mild-to-moderate depression and/or anxiety symptoms will be eligible to participate with the help of a nominated carer, if necessary. A randomised controlled trial with a sample size of 150 participants divided into treatment and waitlist control arms will be conducted. Participants randomised to the intervention group will have full access to the Healthy Mind program for eight weeks. The waitlist control group will gain full access to the program following the eight-week treatment period. Efficacy will be assessed on the Anxiety, Depression, and Mood Scale; Kessler-10; and the World Health Organisation Disability Assessment Schedule 2.0 across three time-points (baseline, eight weeks, and three months). We expect that people who use the intervention will report reduced depression and anxiety, relative to the control group. To our knowledge, this is the first study to examine the effectiveness of a fully automated eMH program for improving mental health in people with ID. We expect our study to render new knowledge on the delivery and effects of internet-based cognitive behaviour therapy (CBT) tools for people with ID.

Group Cognitive Behavioural Treatment for Anxiety in Autistic Adolescents with Intellectual Disability: A Pilot and Feasibility Study

BACKGROUND

Adolescents with Autism Spectrum Disorder (ASD) and intellectual disability evidence significant anxiety. This study aimed to adapt a group cognitive behaviour therapies (CBT) programme designed for youth with ASD and anxiety to meet the cognitive, communication, and behavioural needs of adolescents with intellectual disability, and assess initial feasibility and efficacy of the intervention.

METHODS

Structural, content and procedural adaptations were made to a 14-week family-focused CBT intervention. Twenty-three adolescents with ASD, intellectual disability and anxiety were included. Treatment acceptability along with adolescent anxiety symptoms was assessed via parent report measures.

RESULTS

Of the 23 participants, 19 completed treatment and attended 94% of sessions. Parent acceptability was high. Significant reductions were noted on anxiety symptoms post-intervention.

CONCLUSIONS

Results indicate that the CBT group was feasible and acceptable. Preliminary outcomes suggest that adolescent anxiety improved, although replication with a larger sample and comparison to a control group is needed.

Transition to adulthood: prospective content in joint parent-youth conversations for young people with intellectual or developmental disabilities (IDD)

PROBLEM AND OBJECTIVE

Transition to adulthood for young people with (IDD) is challenging for both youth and parents. Prospection, an important human adaptive tool and critical for independent living, involves constructing, encoding, and remembering the future. It may be jointly enacted between parents and young people as they discuss the future. This study identified and described evidence of prospective content in parent-youth conversations about the transition to adulthood.

METHOD

This study involved the content analysis is of eight parent-youth conversations about this transition. Two mother-daughter, three father-daughter, and three mother-son dyads, representing a range of IDD diagnoses, provided 790 min of joint conversations and reflection on them. These conversations were examined for the following characteristics of prospection: simulation, reasoning about counterfactuals, constructing multiple possible futures, and episodic memory of the past.

FINDINGS

Among the four characteristics, simulation and episodic memory of the past were used most frequently and reasoning about counterfactuals the least. Giving advice and scaffolding were additional strategies that emerged from the data.

CONCLUSION

Identifying how prospection may be fostered in joint parent-youth conversations provides a step toward future research.

Health disparities and health promotion needs of college students with intellectual and/or developmental disabilities: A systematic literature review

Objective: A new population of college students is emerging on campuses across the United States: students with intellectual and/or developmental disabilities (IDD). With this new and growing population of college students, an important question persists: are their health and wellness needs being identified and met?Participants/Methods: ProQuest Central, WorldCat, General OneFile, and ArticleFirst were searched in June 2017 using the following criteria: health of college students with IDD, health of adults with IDD, health of adolescents with IDD, and peer-reviewed. Twenty-four articles were selected for final review.Results: Specific health and wellness topics were revealed: transition experiences and worries; college experiences, coping strategies, and support needs; sexuality, dating, and romantic relationships; mental health; and drugs and alcohol.Conclusions: Research on this unique population should continue, and the etiology of health and wellness issues of college students with IDD should be established to develop and implement evidence-based programing.

Parents' psychological, social and financial outcomes as related to the transition of their offspring with ID from adolescence to adulthood

BACKGROUND

In general, there is extensive research on parents of young children with ID, particularly studies on stress and coping, social support as associated with quality of life. Unfortunately, there is scarce evidence -based knowledge on parental coping resources and well-being during the transition of their offspring from childhood to adulthood and thereafter.

AIMS

This research responds to the scarce knowledge on the effect of the transition of children with ID into adulthood and particularly within adulthood on families. It examined the social, psychological, and financial differences among caregivers of offspring with ID in three age groups: (1) under the age of 21; (2) 21-30; (3) 31 and above.

METHODS AND PROCEDURES

Three hundred and one caregivers completed an income and expenditure survey, including out-of-pocket expenditures, assets and liabilities index, services use survey, financial and other types of assistance from friends and family, a questionnaire regarding resources and stress levels, a social participation scale, and personal wellbeing index.

RESULTS

A statistically significant differences have been detected in the three caregivers' groups regarding the number of hours spent outside the house, social support, negative feelings such as frustration, sadness, and concern, life satisfaction and well-being. No significant differences have been identified in financial outcomes among caregivers' groups.

CONCLUSIONS AND IMPLICATIONS

Findings are discussed in respect to research and practice and highlight caregivers' concerns regarding the transition of their offspring from adolescence to adulthood and afterward and in parallel to their own aging process.

Resilience in the face of adversity in adults with an intellectual disability: A literature review

Background

Persons with an intellectual disability are at a higher risk of experiencing adversities. The concept of resilience offers promising insights into facilitating personal growth after adversity. The current study aims at providing an overview of the current research on resilience and the way this can contribute to quality of life in people with intellectual disability.

Method

A literature review was conducted in the databases PsycINFO and Web of Science. To evaluate the quality of the studies, the Mixed Method Appraisal Tool (MMAT) was used.

Results

The themes, autonomy, self‐acceptance and physical health, were identified as internal sources of resilience. External sources of resilience can be found within the social network and daily activities.

Conclusion

The current overview shows promising results to address resilience in adults with intellectual disability. More research is needed to identify the full range of resiliency factors.

A family systems perspective on supporting self-determination in young adults with intellectual and developmental disabilities

BACKGROUND

This study explored the way families support self-determination in young adults with intellectual and developmental disabilities (IDD) during life transitions.

METHOD

Qualitative case studies were conducted with two Canadian families who participated in semi-structured interviews and ethnographic observations every quarter for one year. Analyses were informed by family systems theory and self-determination theory.

FINDINGS

Families considered the needs and preferences of the young adults with IDD, suggesting individualized approaches for balancing independence and protection. Families set short-term and long-term goals for increased independence, scaffolded the learning of new skills and collaborated on important choices. Collaboration occurred to the extent that all family members perceived agency in planning and implementing transitions.

CONCLUSIONS

Families supported the young adults with IDD in their psychological needs for competence, relatedness and autonomy, which allowed them to experience self-determination. Findings have implications for supporting self-determination and transition planning in the family system.

Transitioning to adulthood with a mild intellectual disability-Young people's experiences, expectations and aspirations

AIM

Very little attention has been paid to the views and experiences of young people with mild intellectual disabilities on the broad topics of adulthood and adult identity. The following study was undertaken to explore how young adults with mild intellectual disabilities conceptualize, relate to, and experience the process of transition.

METHOD

Eight young adults with mild to borderline intellectual disabilities participated in semi-structured interviews. Results were analysed using interpretive thematic analysis.

RESULTS

Two umbrella themes were identified: "On a developmental pathway" and "Negotiations in the environment".

CONCLUSIONS

The participants concerns were surprisingly similar to those commonly expressed by young adults without disabilities. Self-perceived adult identity appeared to be affected by the participants' personal definitions of adulthood, as well as by social comparisons with both peers and adults. Finally, while concerns were expressed about their capacity to cope with responsibility, most felt optimistic about adopting full adult status in the future.

Employability of Disabled Graduates: Resources for a Sustainable Employment

In the frame of the psychology of sustainability, this research aims at exploring how the related concepts of risk factors, protective factors, and resilience might inform our understanding of the postgraduate outcomes of disabled youth. The number of disabled students is growing steadily, nevertheless, relatively little is known about the employment experiences and skill development of disabled youth. Following the positive primary preventive approach, this explorative research investigates the role of resilience and employability resources both in preventing perceived negative impact of disability on the employment opportunities and promoting the perception of employability. Fifty disabled students responded to an online questionnaire and their responses were compared to those of a nondisabled sample (N = 190). Motivations and meanings associated with entry into the workplace are equivalent in the two groups, but perceived impact of disability is a risk factor that hinders perceived employability. Resilience resources and soft skills show their effectiveness in reducing perceived disability impact and improving perceived employability, but between group comparison shows differences in the set of available resources. Overall, results provide insights for implementing actions to promote sustainable employment in order to foster a positive, sustainable organizational development.

Psychometric Properties of the Basic Psychological Need Satisfaction and Frustration Scale – Intellectual Disability (BPNSFS-ID)

Abstract. The Basic Psychological Need Satisfaction and Frustration Scale – Intellectual Disability (BPNSFS-ID), an adapted version of the original BPNSFS ( Chen, Vansteenkiste, et al., 2015 ), operationalizes satisfaction and frustration with the three basic psychological needs according to self-determination theory (SDT): autonomy, relatedness, and competence. The current study examined the psychometric properties of the BPNSFS-ID in a group of 186 adults with mild to borderline intellectual disability (MBID). The results indicated an adequate factorial structure of the BPNSFS-ID, comprising the satisfaction and frustration of each of the three needs. The associations between BPNSFS-ID subscales autonomy, relatedness, and competence and the self-determination subscale of the Personal Outcome Scale (POS), the De Jong Gierveld Loneliness Scale, and the General Self-Efficacy Scale – 12 (GSES-12), supported the construct validity. In addition, the BPNSFS-ID demonstrated high internal consistency (α = .92) and 2-week test-retest reliability ( r = .81 for the composite subscale autonomy, r = .69 for the composite subscale relatedness, and r = .85 for the composite subscale competence). Overall, the BPNSFS-ID proved to be a valid and reliable measure of basic psychological need satisfaction and need frustration among people with MBID.

A systematic review of cognitive behavioural therapy for anxiety in adults with intellectual disabilities

BACKGROUND

Anxiety disorders have high prevalence in people with intellectual disabilities. In populations without intellectual disabilities, cognitive behavioural therapy is a first line psychological therapy for these presentations. There is no existing review of the range of methods and outcomes from intervention studies in this area.

METHOD

A systematic review was carried out following guidance in the Cochrane handbook for systematic reviews of interventions.

RESULTS

Nineteen studies were identified. The majority of reports were descriptive case studies; the most frequently described presentations were non-specific anxiety disorders and post-traumatic stress disorder; the most frequently described cognitive techniques were psycho-education and interventions directly aimed at thoughts and beliefs and most studies reported positive outcomes, although the better controlled studies tended to report less comprehensive impacts.

CONCLUSIONS

A range of presentations have been described although the area is still at a primarily descriptive stage. We discuss intervention structures and approaches that require further research.

Measuring emotional support in family networks: Adapting the Family Network Method for individuals with a mild intellectual disability

Background

Informal supportive networks of individuals with intellectual disability have become increasingly important. The aim of this paper is to describe how the Family Network Method – Intellectual Disability (FNM‐ID) offers a way to gather the perspective of people with mild intellectual disability on their family support.

Method

The FNM is designed to explore how individuals define their family contexts, and more specifically how they perceive existing supportive relationships in these contexts.

Results

By carefully piloting ways of questioning people with mild intellectual disability, systematic adaptations were made to the original FNM. Data obtained by the FNM‐ID can be analysed using social network analysis. Thereby, the FNM‐ID provides rich, theoretically significant information on emotional support in the family networks of individuals with mild intellectual disability.

Conclusions

The FNM‐ID is a useful and successfully adapted tool for other researchers and professionals to systematically explore the family support experiences of individuals with mild intellectual disability.

"Having friends is like having marshmallows": Perspectives of transition-aged youths with intellectual and developmental disabilities on friendship

BACKGROUND

The literature emphasizes that friendships are essential to youths' successful transition to and adjustment in adulthood. Few studies have explored the friendships of transition-aged youths with intellectual and developmental disabilities (IDD), and even fewer include youths' own perspectives. This qualitative study explored the perspectives of transition-aged youths with IDD regarding their own experiences of friendship.

METHOD

A subset of video-recorded data of 21 interviews with seven participants (20-24 years) was extracted from a larger study for secondary analysis. Data were analysed using thematic analysis, informed by constructivist grounded theory methods.

RESULTS

Three themes were revealed: meanings of friends and friendship, deepening self-knowledge and negotiating in(ter)dependence.

CONCLUSIONS

The findings expand existing knowledge about friendships of transition-aged youths with IDD. Findings can potentially inform development of new services or enhancement of existing services aimed at facilitating transition to adulthood for youths with IDD and point to key areas for future research.

"I like talking to people on the computer": Outcomes of a home-based intervention to develop social media skills in youth with disabilities living in rural communities

PURPOSE

To investigate the effectiveness of a home-based social media use intervention to enhance the social networks of rural youth with disabilities.

METHOD

Participants were nine youth (mean age = 17.0 years) with disabilities from two rural Australian communities. The intervention consisted of providing appropriate assistive technology and social media training on individualised goals. Using mixed methods, quantitative (a single group pre-post) and qualitative (interviews with participants and their carers) measures were used to examine outcomes of training, individual experiences of the intervention, and changes to online social networks.

RESULTS

Participants increased their performance and satisfaction with performance on social media problem areas post-intervention; paired t-tests showed statistical significance at p < .001. There was also a significant increase in the number of online communication partners; Wilcoxon Signed Ranks showed statistical significance at p < .05. The interviews highlighted increased social participation, independence and improvements to literacy. Ongoing parental concerns regarding cyber safety and inappropriate online content were noted.

CONCLUSIONS

The findings suggest that social media training is a feasible method for increasing social networks among rural-based youth with disabilities. To sustain ongoing benefits, parents need knowledge and training in integrating assistive technology and social media.

Depression and anxiety symptoms during the transition to early adulthood for people with intellectual disabilities

BACKGROUND

The transition to adulthood is a major developmental milestone; a time of self-discovery and increased independence. For young adults (YA) with intellectual disabilities (ID), however, this period is especially challenging. The increased incidence of mental health disorders in this population, such as depression and anxiety, make this transition even more difficult, increasing caregiver burden at a time when the young adult would traditionally be gaining independence. It is not clear, however, why YA with ID are more susceptible and what factors may predict mental health symptoms.

METHOD

Potential risk and protective factors (demographic variables, coping styles, sense of hopelessness, unmet achievement of adulthood milestones, self-reflection and insight) of anxiety and depression symptoms were assessed in 55 YA with ID and a sample of age-matched controls.

RESULTS

Insight was the strongest predictor of anxiety (with gender in the controls) for YA with and without ID, with increased insight predicting fewer anxiety symptoms. However, YA with ID had significantly less insight than their aged-matched counterparts and significantly higher levels of anxiety. They were also less likely to have achieved traditional adulthood milestones. Maladaptive coping was the strongest predictor of depression for YA with ID. In comparison, both maladaptive coping and insight predicted depression in controls. More maladaptive coping predicted increased depressive symptoms in both populations, whilst increased insight predicted fewer depressive symptoms in controls.

CONCLUSIONS

Insight and maladaptive coping are potential targets in the treatment of anxiety and depression among YA with ID. Longitudinal intervention studies exploring the efficacy of such targeted programmes in reducing mental health symptoms and improving the transition to adulthood for these young people are recommended.

Identity constructions and transition to adulthood for young people with mild intellectual disabilities

This article explores the self-constructions of young adults with mild intellectual disabilities in talk about their everyday living and how parents and professionals construct young adults with disabilities in talk about their involvement in transition processes. The analysis is related to an interpretive tradition and conducted based on individual interviews with four young adults with mild intellectual disability, five parents of young adults with mild intellectual disabilities and five professionals in the adult service system. The findings show that the young adults define themselves as actors in their own lives, while the parents recognize young adults with mild intellectual disabilities as both actors with resources and actors in need of assistance. Professionals in the adult service system, however, appear to rely on an identity perspective that might hamper young adults' agency positioning and opportunities to define themselves and influence their future lives.

Social anxiety and parental overprotection in young adults with and without intellectual disabilities

OBJECTIVES

Developmental literature highlights peer relationships and parental overprotection as factors implicated in the development of social anxiety. These factors are highly prevalent in the lives of people with intellectual disabilities; however research has not examined whether these factors are associated with social anxiety for this population.

METHODS

Twenty-one individuals without intellectual disabilities and 21 individuals with intellectual disabilities (aged 16-24 years) completed the Social Anxiety Scale for Adolescents with follow-up questions, the Glasgow Anxiety Scale-Intellectual disabilities and the parental overprotection subscale of the Parental Bonding Instrument with follow-up questions.

RESULTS

Aspects of general and social anxiety were significantly greater in the intellectual disabilities group. There were no significant differences in parental overprotection between groups, however, qualitative analyses revealed differences in experiences of social anxiety and parental overprotection.

CONCLUSIONS

Further research into factors associated with social anxiety in people with intellectual disabilities may inform adaptations to therapies and early intervention.

The effect of slow-paced breathing on stress management in adolescents with intellectual disability

BACKGROUND

Intellectual disabilities often create a state of chronic stress for both the person concerned and their significant others (family, caregivers). The development of stress management methods is therefore important for the reduction of stress in persons with intellectual disability. The aim of this experiment was to investigate the effect of slow-paced breathing on stress symptoms experienced by adolescents with intellectual disabilities during a cognitive task under time pressure.

METHOD

Fourteen adolescents with intellectual disabilities (M_age  = 17.39 years, range 15-19 years) took part in two laboratory sessions - a slow-paced breathing session (experimental condition) and an audiobook session (control condition) - the order of which was counterbalanced across participants. Vagal tone was measured through heart rate variability to index stress management.

RESULTS

No difference in vagal tone was observed at baseline between experimental and control conditions. Compared with the control condition, vagal tone was significantly higher during the experimental condition.

CONCLUSIONS

The slow-paced breathing task enhanced stress management to a greater extent than did listening to an audiobook. Slow-paced breathing seems to be an easy to learn stress management technique that appears as an effective auxiliary method of lowering stress in adolescents with intellectual disabilities.

A multimodal day treatment program for multi-problem young adults: study protocol for a randomized controlled trial

BACKGROUND

Effective interventions for young adults with severe, multiple problems - such as psychosocial and psychiatric problems, delinquency, unemployment and substance use - are scarce but urgently needed in order to support an adequate transition to adulthood. A multimodal day treatment program called "New Opportunities" (in Dutch: "De Nieuwe Kans"; DNK) was specifically developed to target multi-problem young adults in The Netherlands. The aim of this study protocol is to describe the design of a randomized controlled trial (RCT) in clinical practice to examine the effectiveness of DNK in comparison with care as usual (CAU).

METHODS/DESIGN

Multi-problem young adults in Rotterdam, The Netherlands, will be assigned randomly to DNK (expected N = 150) and CAU (expected N = 150). Primary outcome measures are recidivism and self-sufficiency. Secondary outcome measures include quality of life, attending school/work, psychological functioning, cognitive distortions and substance use. Participant and program characteristics will be examined as potential moderators of effectiveness. Additionally, cost-effectiveness will be measured. During 14 months, data from multiple resources will be collected at four time points.

DISCUSSION

This study is one of the first RCTs on the effectiveness of interventions developed for multi-problem young adults. The results will contribute to the currently scant knowledge about what works for various multi-problem young adults in their transition to adulthood. In addition, the study protocol will provide insight into implementing an RCT in a dynamic setting of clinical practice.

TRIAL REGISTRATION

Dutch Trial Register, identifier: NTR5163 . Registered on 17 April 2015; retrospectively registered during the recruitment phase.

Transition to adulthood for young people with intellectual disability: the experiences of their families

Whilst the transition from school to adult roles can be challenging for any adolescent, for those with an intellectual disability it can present as a particularly difficult time both for the individual and their family. The process may involve coordinated planning, collaboration and decision-making among school staff, families and community agencies. This mixed-methods study utilised information from two cohorts: young people with Down syndrome in Western Australia (n = 190) and young people with intellectual disability (of any cause) in Queensland, Australia (n = 150). The parent-report questionnaires administered in both states comprised two parts: part 1 collected information about the individual with intellectual disability including information on health, functioning and service needs, and about specific transition related issues; and part 2 collected information about the health and well-being of their family. The majority (87 %) of parents said that they were involved in decision-making about transition planning but less than two-thirds (59.5 %) of young people were involved in this process. The three most helpful strategies indicated by parents that assisted with transition planning related to the provision of more information about financial assistance, the school transition program and the building of informal community-based supports. A number of themes emerged from the qualitative data which included parents' views and concerns about the capacity of their young adult to adapt and change to life in adulthood, their difficulty navigating services and programs, issues and challenges around their young person building connectedness, strain on family wellbeing and finances and worry about the longer term future.

What Effect Does Transition Have on Health and Well-Being in Young People with Intellectual Disabilities? A Systematic Review

BACKGROUND

Transition to adulthood might be a risk period for poor health in people with intellectual disabilities. However, the present authors could find no synthesis of evidence on health and well-being outcomes during transition in this population. This review aimed to answer this question.

METHOD

PRISMA/MOOSE guidelines were followed. Search terms were defined, electronic searches of six databases were conducted, reference lists and key journals were reviewed, and grey literature was searched. Papers were selected based on clear inclusion criteria. Data were extracted from the selected papers, and their quality was systematically reviewed. The review was prospectively registered on PROSPERO: CRD42015016905.

RESULTS

A total of 15 985 articles were extracted; of these, 17 met the inclusion criteria. The results of these articles were mixed but suggested the presence of some health and well-being issues in this population during transition to adulthood, including obesity and sexual health issues.

CONCLUSION

This review reveals a gap in the literature on transition and health and points to the need for future work in this area.

Quality of Life for Transition-Age Youth with Autism or Intellectual Disability

We examined the subjective health and well-being of 389 transition-age youth with autism or intellectual disability using the parent proxy version of the KIDSCREEN-27. Parents reported well-being of youth with autism and youth with intellectual disability lower than a normative sample in the domains of Physical Well-being, Psychological Well-being, and Social Support and Peers. For both groups of young people, the lowest ratings were reported in Social Support and Peers. Higher ratings of well-being in one or more domains were predicted by minority status, youth character strengths, involvement in community activities, and religious faith. Challenging behaviors, autism, age, and speech as the primary mode of communication were predictive of lower ratings of well-being. We discuss implications for special educators and service providers and offer directions for future research.

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.

Functioning and post-school transition outcomes for young people with Down syndrome

AIM

To investigate the relationship between functioning and post-school day occupation for young adults with Down syndrome.

METHODS

Families of young people with Down syndrome (n = 269) aged 15-30 years in 2009 were recruited from the population-based Down syndrome 'Needs Opinion Wishes' database in Western Australia. Questionnaires were mailed to participating families and involved two parts, young person characteristics and family functioning; 203 were returned (75%). Of those families who returned questionnaires, 164 (80.8%) of their young adults had left school. Participation in post-school day occupations was the main outcome and included; open employment, training, sheltered employment or alternatives to employment (ATE).

RESULTS

Young adults were reported as participating in open employment (n = 42), training (n = 17), sheltered employment (n = 64) or ATE (n = 41) post-school. Those who reported better functioning in self-care, community and communication skills were more likely to be in open employment and/or attending Technical and Further Education compared with those attending sheltered employment and/or ATE after adjusting for age, gender and rural/metropolitan regions. Current health as measured by visits to a general practitioner (GP) and hospitalizations revealed a weak relationship with post-school day occupations, with increasing likelihood of participating in open employment or training with increasing hospitalizations and GP visits.

CONCLUSIONS

Our analysis shows that functioning in activities of daily living was related to post-school day occupation. Current health status and behaviour were found to have a weak relationship with post-school day occupation adjusting for functioning in the final model.