Why do some people with intellectual disability engage in offending behaviour and what can we do about it? Editorial

The relationship between cognitive variables and offending behaviour in adults with intellectual disabilities: A systematic review

BACKGROUND

Interventions for offenders with intellectual disabilities (ID) have used cognitive variables as measures of treatment outcome. However, the relevance of cognitive variables to offending in people with intellectual disabilities is unclear. This review aimed to evaluate the evidence for a relationship between cognitive variables and offending in people with intellectual disabilities.

METHOD

A systematic search identified studies comparing offenders and non-offenders with intellectual disabilities on an aspect of cognition. Seven cognitive variables were found and compared across 15 studies. These were appraised for their quality using an adapted quality appraisal checklist. The reliability and validity of cognitive measures were also considered.

RESULTS AND CONCLUSIONS

Other than for cognitive distortions, the evidence for a relationship between cognitive variables and offending in people with intellectual disabilities is currently limited due to methodological weaknesses and the small number of studies assessing each variable. Clinicians are advised to focus on cognitive distortions until better evidence is available.

Adapting dialectical behaviour therapy in forensic learning disability services: A grounded theory informed study of "what works"

BACKGROUND

Emerging evidence indicates effectiveness of dialectical behaviour therapy (DBT) for people with intellectual disabilities (PWID) in forensic settings; however, little is known about "what works" facilitating engagement and change.

METHODS

Eleven interviews were conducted with nine service users across two secure inpatient services. Grounded theory was used to develop a model of perceived engagement and change.

RESULTS

The model provides insights into how change occurs during DBT delivered in forensic settings. DBT constitutes a challenging journey, yet provides the motivation and means to address individual's intra-/interpersonal aggression and progress towards release. Participants experienced engaging with DBT as difficult and coercive, moving from compliance and avoidance to acceptance and change. Key factors included participants' motivation, beliefs about safety and ability to change, and interactions with staff.

CONCLUSION

Recommendations are made for increasing intrinsic motivation, reducing perceived coercion and distress, and for future research to address potential aversive elements and enhance effectiveness.

Clinical, Demographic, and Criminal Behavior Characteristics of Patients With Intellectual Disabilities in a Canadian Forensic Program

Background: People with intellectual disability (ID) and forensic issues constitute a challenging clinical group that has been understudied in forensic settings. Methods: We assessed the characteristics of patients with ID under the authority of the Ontario Review Board (ORB) in a large forensic program of a tertiary psychiatric hospital (excluding those with a cognitive disorder) and compared their characteristics with those of a non-ID control group. Results: Among 510 adult ORB patients, 47 had an ID diagnosis. ID patients were of younger age at index offense, with a lower level of education, and were less likely to have been married or employed, more likely to have committed a sexual offense, more likely to have a diagnosis of paraphilia, less likely to be "not criminally responsible," and more likely to be "unfit to stand trial." They were also more likely to have committed their index offenses against care professionals and be treated in a secure unit. Conclusion: Our findings have major implications for clinicians, clinical leaders, and policymakers about the specific needs of patients with ID presenting with forensic issues and differing needs in terms of treatment and risk management.