Informal Social Networks of People with Profound Intellectual and Multiple Disabilities: Relationship with Age, Communicative Abilities and Current Living Arrangements

From assistive to inclusive? A systematic review of the uses and effects of technology to support people with pervasive support needs

BACKGROUND

Although particular technologies can enhance the quality of life (QoL) of people with profound intellectual and multiple disabilities (we use the term pervasive support needs), their objectives and outcomes are understudied. A systematic literature review was therefore conducted to explore this topic.

METHOD

A search of four databases yielded 64 studies. Data were extracted on their general characteristics, methods and sample characteristics as well as the technology types, QoL domains and application within ecological systems. A narrative synthesis was subsequently developed.

RESULTS

Most of the studies applied assistive technology (AT) and focused on personal development and self-determination on an individual level.

CONCLUSIONS

Technology can enhance the QoL of people with pervasive support needs. There are indications that although MT and UD-based technology are used in practice, few studies have examined these technologies. Therefore, there is a knowledge gap regarding the kinds of technology that are used in practice.

Transition to adulthood of adolescents with profound intellectual and multiple disabilities: Content validation of the SGU-PIMD to support families

BACKGROUND

For families with adolescent children, the transition to adulthood is usually challenging. This period may be extra demanding for families with a child with profound intellectual and multiple disabilities due to the child's strong and persistent support needs. To support these families during this phase and to facilitate the transition process of these adolescents, we adapted the Canadian skills for growing up (SGU) into the skills for growing up-profound intellectual and multiple disabilities (SGU-PIMD). The aim of this study is to determine its content validity.

METHOD

A Delphi study with family members and healthcare professionals was conducted.

RESULTS

Results showed good content validity. However, the Delphi panel suggested minor adjustments to improve relevance, comprehensibility and comprehensiveness.

CONCLUSIONS

The current SGU-PIMD can be used in practice for supporting adolescents with profound intellectual and multiple disabilities. However, there are also recommendations for research into the feasibility and acceptability of the instrument.

'It's a 24/7 Deal': Parents of adults with intellectual and developmental disabilities discuss natural supports

BACKGROUND

Natural supports are widely used by adults with intellectual and developmental disabilities. However, little research has been conducted on this topic. This study adds to the literature by examining the role of parents as natural supporters, other members of the natural support network, challenges families face as they secure natural supports, and advice parents have for other families.

METHOD

Twenty-three parents of adults with intellectual and developmental disabilities were interviewed. Data was analyzed using a constant comparative approach.

RESULTS

Family members and friends were key natural supporters. However, parents provided the bulk of support. A hesitation with asking others for support was a common barrier to building natural support networks. Parents encouraged others to connect with families with similar circumstances.

CONCLUSIONS

To ensure proper care for adults with intellectual and developmental disabilities, we must develop supports that meet family members' needs and identify ways to strengthen natural support networks.

A microswitch-aided program to enable people with extensive multiple disabilities to control environmental stimulation through different responses

Objectives

This study assessed whether a simple technology-aided program (i.e., a program involving the use of microswitches linked to a smartphone) could be set up to enable people with motor, sensory and intellectual disabilities to control preferred environmental stimulation through two different response movements.

Methods

Ten participants were involved in the study. Each of them was exposed to an ABAB design, in which A represented baseline phases without the program and B intervention phases with the use of the program. The study assessed whether the participants (a) had significant increases of each of the two response movements available and/or showed response variability across sessions and over time and (b) had signs of satisfaction/happiness during the study sessions, in connection with their stimulation access and control.

Results

The program was effective in increasing the participants' responding and consequently their self-regulated stimulation input. Half of the participants showed a significant increase of both responses available from the first intervention phase. Other participants seemed to focus more on one of the two responses. Even so, they tended to have occasionally high performance frequencies also with regard to their non-dominant (not significantly increased) response. Finally, all participants showed clear signs of satisfaction/happiness during the intervention sessions.

Conclusions

The program represents a potentially useful approach for enabling people with extensive multiple disabilities to self-regulate their access to preferred environmental stimulation and improve their mood.

Variables related to the quality of life of families that have a child with severe to profound intellectual disabilities: A systematic review

Background

Family quality of life (FQoL) of families that have a child with severe to profound intellectual disabilities (SPID) is an important and emerging concept, however, related variables are inconclusive.

Aim

To gain a better understanding of variables related to the FQoL of families that have a child with SPID, variables related to the FQoL of families that have a child with intellectual disabilities (ID) were systematically reviewed.

Methods and procedures

A search strategy was performed in five databases. Critical appraisal tools were employed to evaluate the quality of both quantitative and qualitative studies. Data extraction and synthesis occurred to establish general study characteristics, variables, and theoretical concepts. Variables were categorised into four key concepts of the FQoL: systemic concepts, performance concepts, family-unit concepts and individual-member concepts.

Outcomes and results

A total of 40 studies were retrieved with 98 variables. Quality scores ranged from 7 to 13 (quantitative) and 5 to 13 (qualitative) out of 13 and 14 points, respectively. Five out of the 40 studies (13%) focused on individuals with SPID. Variables related positively or negatively to the FQoL, and were categorised within systemic concepts (n = 3); performance concepts (n = 11); family-unit concepts (n = 26); and individual-member concepts (n = 58).

Conclusions and implications

Several variables were found to be (inter)related to the FQoL of families that have a child with ID. A contrasting picture emerged regarding the impact of a disability in relation to transitional phases. However, studies which include families of children with SPID were minimal, therefore, it remained ambiguous to what extent the identified variables apply to these families.

Persons with intellectual and multiple disabilities activate via non-verbal responses a smartphone's Google Assistant to access preferred stimulation

OBJECTIVES

The present study evaluated a new smartphone-based program to help 12 participants with intellectual disability plus visual and motor impairments to self-regulate their stimulation input (thus avoiding their dependence on staff) through simple non-verbal responses.

METHOD

Nonconcurrent multiple baseline designs across participants were used to assess the effects of the program. The technology used for the program involved a Samsung J4 Plus smartphone with Android 9.0 operating system, two voice recording devices, smart-plugs, and a mini speaker. The smartphone was provided with a Google account and Internet connection, which allowed the participants to access Google Assistant and Google Play Music. The participants could make requests for two different types of stimulation (e.g. songs and familiar voices or noises) by activating via hand pressure the two voice recording devices. The verbal request messages emitted by the devices were recognized by the Google Assistant, which led the smartphone to deliver the related stimulation.

RESULTS

During the baseline sessions (without the support of the voice recording devices), the participants failed to access any stimulation. During the intervention and post-intervention phases (with the support of the voice recording devices), all participants managed to access the types of stimulation available independently. The mean frequency of responses (i.e. activations of both voice recording devices) per session ranged between about 8 and 14.

CONCLUSION

The new smartphone-based program can be viewed as a useful resource to enable individuals like the participants of this study to access preferred stimulation independently.

One social network, two perspectives: Social networks of people with Down syndrome based on self-reports and proxy reports

BACKGROUND

For people with intellectual disabilities (ID), social networks play a key role in facilitating social inclusion, health, and quality of life. This study shows that a multi-informant approach to collecting social network data improves our understanding of the social worlds of people with Down Syndrome (DS).

METHOD

A mixed methods egocentric network approach was employed to investigate 27 dyads comprised of people with DS and their family members as proxy reporters to examine variability in network characteristics across self- and proxy reports.

RESULTS

The self-reported total network size of people with DS was significantly smaller than the network size based on proxy reports. Significant differences were found between self- and proxy-reported networks with respect to most relationship groups. Proxy informants reported more "paid staff".

CONCLUSION

Our study showed that multiple perspectives on the social networks of people with DS are advantageous for researchers, policy makers, and practitioners.

Personal relationships during end-of-life care: Support staff views of issues for individuals with intellectual disability

BACKGROUND

Life expectancy for persons with intellectual disability has increased dramatically over the past decade, which has seen an associated rise in the need for end-of-life care. However, little is known regarding how end-of-life affects the individual's personal relationships with family, friends and staff.

METHODS

Focus group interviews were undertaken with 35 disability support workers from four rural and two metropolitan locations in NSW and Queensland, Australia. A semi-structured interview guide was used, with a focus on the gaining an understanding of the impact that end-of-life has on personal relationships for persons with intellectual disability.

RESULTS

The thematic analysis identified three key thematic areas: Relationships with Family, Relationships with Friends and Staff Roles. Relationships with Family had three sub-themes of 'Active and Ongoing', 'Active but Limited' and 'After Death'. Relationships with Friends had two sub-themes of 'Positive Experiences' and 'Negative Experiences', and Staff Roles had two sub-themes of 'Loss of Contact' and 'Default Decision Making'.

DISCUSSION

The frequency of family contact was not reported as increasing or decreasing following the diagnosis of a life-ending illness and during an individual's end-of-life. A lack of counselling support was noted as potentially impairing the individual's friends' ability to cope with death. Staff also reported a number of concerns regarding how their relationships with the individual changed, particularly when end-of-life entailed potential movement of the individual with intellectual disability to a new residential setting.

Transition from school to adult services for young people with severe or profound intellectual disability: A systematic review utilizing framework synthesis

BACKGROUND

The transition to adulthood has been described as a difficult time in the lives of young people with intellectual disability. There has been little emphasis on young people with severe or profound intellectual disability specifically, even though their pathways may differ, due to greater support needs across the life course.

METHODS

A systematic review was conducted utilising Bronfenbrenner's ecological model to inform framework analysis to synthesise qualitative findings.

RESULTS

Taking an ecological perspective proved valuable. The transition process was described as stressful and barriers were identified across the ecological levels. Parents accounted for the majority of participants in studies, and the needs of young people and their parents emerged as highly interdependent.

CONCLUSION

Themes reflect the complex nature of the question what adulthood should look like for individuals with severe or profound intellectual disability. There is a lack of involvement of multiple stakeholders and young people themselves within studies.

Efforts to increase social contact in persons with profound intellectual and multiple disabilities: Analysing individual support plans in the Netherlands

Most people with profound intellectual and multiple disabilities (PIMD) have limited social contact and it is unclear what is done to maintain or increase these contacts. Individual support planning (ISP) can be used in the systematic enhancement of social contacts. This study analyses the content of ISPs with respect to the social contacts of people with PIMD. ISPs for 60 persons with PIMD in the Netherlands were inductively coded and illustrated with quotations. It turned out that every ISP contained information about social contacts. Of all the quotations extracted, 71.2% were about current conditions, 6.2% were about the future and less than 1% concerned actual goals. The social contacts of people with PIMD are mentioned in their ISPs, but this is rarely translated into goals. The results of the current study suggest that attention should be paid to ensuring that professionals understand the importance of social contacts and their application in practice.

Vocational Rehabilitation Service Patterns: An Application of Social Network Analysis to Examine Employment Outcomes of Transition-Age Individuals With Autism

Young adults with autism spectrum disorder (ASD) face poor employment outcomes following transition from school to adult life. Social network analysis is a useful approach for examining service patterns associated with employment success for this population. An advantage of this approach is its focus on the interdependence of variables rather than individual predictors. This study applies network methodology to examine the relations between vocational rehabilitation services and young adults with ASD to predict employment status. Using the Rehabilitation Services Administration (RSA-911) data set, participants included 2,219 individuals with ASD between the ages of 16 and 24 served by the public vocational rehabilitation system and closed as either competitively employed or not employed. A two-mode network was constructed such that a relation was defined for each service an individual received. Results from a core-periphery analysis indicated that of the 22 services available, core services included assessment, counseling/guidance, job placement, on-the-job support, job search support, and transportation services. Follow-up analyses suggested that the greater number of these six core services an individual received, the better the employment outcome. Findings highlight that these services should be viewed as interconnected and suggest a set of six core services that may be particularly beneficial for this population.