Subjective and objective quality of life assessment: responsiveness, response bias, and resident:proxy concordance

Exploring the Psychosocial Experiences of Individuals with Developmental Language Disorder During Childhood: A Qualitative Investigation

Children with Developmental Language Disorder (DLD) often experience co-occurring psychosocial difficulties, the developmental trajectories of which are still not fully understood. This study sought to explore the manifestation of such difficulties during childhood, through first-hand accounts of those with DLD and their close relatives. Individual semi-structured interviews were conducted with 11 mothers of children with DLD (aged 6-12 years old) and were analysed alongside the secondary data from interviews of five adults with DLD. Interviews were conducted online; all participants resided in Europe and were fluent in spoken and written English. A process of interpretive phenomenological analysis resulted in the development of five overall themes: experiencing anxiety, social frustrations, maintaining factors, childhood strengths and the parenting experience. Cognitive appraisals appeared particularly important during childhood in both escalating and maintaining anxiety, low self-esteem, emotion dysregulation and social frustrations. High levels of isolation and stress were experienced by all mothers. The findings suggest parents in the United Kingdom and Ireland require more support and guidance at the point of diagnosis than is currently provided. Emphasis was given to the link between children's experience of anxiety and social behaviours, such as withdrawal, as well as their intolerance of uncertainty. Internalising symptoms were a prioritisation for intervention during childhood by both parents and adults with DLD.

Measuring quality of life of adults with intellectual disabilities: Psychometric evaluation of the personal outcomes scale in the United Kingdom

BACKGROUND

The Personal Outcomes Scale (POS) is a scale developed to measure quality of life of adults (18+) with intellectual disability. Previous studies have reported good fit for Spanish and Portuguese language versions of POS.

AIMS

This study aimed to evaluate the factor structure of the English language version of POS when used to measure the quality of life of adults (18+) with intellectual disability in the UK.

MATERIALS AND METHODS

Analysis was conducted on POS data from 310 adults with an intellectual disability. First and second order factor models and multi-level models were used to assess fit.

RESULTS

There was poor fit to the data for all tested models. We estimated that 23% of variance in POS scores was accounted for by interviewer cluster.

DISCUSSION

This was the first UK-based evaluation of POS and our data did not confirm the factor structure of the POS measure. The identification of systematic variability within the dataset indicates that inter-rater reliability is a potential limitation of the POS tool.

CONCLUSION

Further research is needed to investigate inter-rater reliability of POS interviewers and to explore factor structure.

Content validity of the instrument 'Picture My Participation' for measuring participation of children with and without autism spectrum disorder in mainland China

BACKGROUND

Picture My Participation (PMP) is a valid instrument for measuring participation of children with disabilities, but it has not yet been evaluated for its content validity for children with autism spectrum disorders (ASD) in mainland China.

AIM

To explore the content validity of the simplified Chinese version of PMP (PMP-C; Simplified) for children with ASD and typically developing (TD) children in mainland China.

METHODS

A sample of children with ASD (n = 63) and TD children (n = 63) recruited through purposive sampling were interviewed using the PMP-C (Simplified), which contains 20 items of everyday activities. Children rated attendance and involvement on all activities and selected three most important activities.

RESULTS

Children with ASD selected 19 of 20 activities as the most important activity while TD children selected 17 activities. Children with ASD used all scale points for rating attendance and involvement on all activities. TD children used all scale points for rating attendance and involvement in 10 and 12 of 20 activities, respectively.

CONCLUSION

The contents of 20 activities of PMP-C (Simplified) were relevant for all children and especially for children with ASD for assessing participation in community, school and home activities.

Developing the Diagnostic Interview for Adolescents and Adults with Mild/Moderate Intellectual Disabilities: An interview schedule of mental disorders (DIAAID)

Introduction

Young people with intellectual disabilities (ID) are at an increased risk for experiencing mental health issues compared to their peers without disabilities. Further, there are limited resources available to help accurately assess mental health disorders and that are accessible for adolescents with ID.

Method

This paper describes the iterative development and pilot testing of the Diagnostic Interview for Adolescents and Adults with Intellectual Disabilities (DIAAID). The authors utilized Evidence Center Design and Universal Design principals to develop the DIAAID; a multi-informant diagnostic interview.

Results

The DIAAID development resulted in the creation of 15 adolescents disorder interviews and 24 caregiver disorder interviews. Preliminary results suggest that the DIAAID is a feasible and accessible diagnostic interview for adolescents with ID and their caregivers.

Discussion

Lessons learned from DIAAID implementation and future areas research are discussed.

Exploring the social care-related quality of life outcomes of adults with intellectual disabilities through the use of Talking Mats®

BACKGROUND

Views on social care related quality of life (SCRQol) are typically gathered directly from individuals or from proxy informants. Easy-read options are available, although such methods may not be accessible to those with greater communication challenges.

METHODS

Fifteen people with intellectual disabilities were interviewed about their SCRQoL using Talking Mats® (TM). A descriptive approach was taken to exploring what people had to say.

RESULTS

Participants reported high levels of satisfaction with living conditions and personal care routines. They were mostly satisfied with the level of choice and control they had and with their carers.

CONCLUSIONS

People with intellectual disabilities who have greater communication challenges can make meaningful contributions to the assessment of the care they receive. Talking Mats is one tool which can be used to support people with intellectual disabilities to give their views.

Proxy-report in individuals with intellectual disability: A scoping review

BACKGROUND

Views can be collected from individuals (self-report) or others on their behalf (proxy-report).

OBJECTIVE

We aimed to review the literature on methods and statistical approaches used to evaluate observer versus self-report responses from individuals with intellectual disability or Down syndrome.

METHODS

A series of key questions related to statistical approaches and data collection methods were formulated a priori to inform the search strategy and review process. These addressed the topics of self-report in individuals with intellectual disability, including Down syndrome. Using the National Library of Medicine database, PubMed, detailed literature searches were performed. The quality of available evidence was then evaluated, the existing literature was summarised, and knowledge gaps and research needs were identified.

RESULTS

Fifty relevant original articles were identified which addressed at least one key question. Study details, including: research design, internal validity, external validity, and relevant results are presented. Review of studies of individuals with intellectual disability which used a variety of statistical approaches showed mixed agreement between self-report and proxy-report.

CONCLUSION

Few studies identified to-date have used self-report from individuals with Down syndrome, but lessons from the existing intellectual disability literature can guide researchers to incorporate self-report from individuals with Down syndrome in the future.

Straight from the horse's mouth: Increasing self-report in mental health assessment in individuals with intellectual disability

BACKGROUND

Mental health conditions are common among individuals with intellectual disability. Under recognition of mental health disorders leading to unmet treatment needs is common in this population. This article addresses one major contributing factor, the lack of cognitively accessible self-report measures for individuals with intellectual disability.

METHOD

In this literature-informed overview of the state of the field, we discuss the need for, and complexities of, including individuals with intellectual disability in mental health assessments.

RESULTS

With appropriate supports, many individuals with intellectual disability can respond to mental health questions. We discuss evidence-based strategies to make mental health assessments more accessible.

CONCLUSION

We highlight the need to engage individuals with intellectual disability to provide first-hand information about their health and well-being. New instruments and research procedures should be developed in partnership with individuals with intellectual disability. Self-report may be essential to advancing the science of mental health research.

"I sit all of the time": Health-related time-use among adults with intellectual disabilities

BACKGROUND

Adults diagnosed with intellectual disabilities (ID) are more likely to have cardiometabolic risk factors, including low physical activity (PA), high sedentary behavior (SB), and poor sleep. While these behaviors have typically been studied in isolation, emerging frameworks propose a more integrated approach to the study of these behaviors, asserting that the relative proportion of time spent in each of the health-related time-use behaviors (i.e. PA, SB and sleep) across the 24 -h period is a more powerful determinant of the incidence and progression of disease. This approach has yet to be considered for adults with ID. The purpose of this study was to explore how adults with ID and their formal caregivers (i.e. employed caregivers) perceived their health-related time-use, including the factors that influence their time-use.

METHOD

Five focus groups were conducted with twelve adults with ID and ten formal-caregivers. Consistent with an interpretive paradigm, this study employed an interpretative phenomenological analysis (IPA) methodology.

RESULTS

Three interrelated themes were identified: (1) Caregivers as gatekeepers to healthy time-use; (2) Places to move; and (3) Daily movement. The themes captured the participants' perspectives of interpersonal and environmental factors that influence health-related time-use, and how these factors were common to engagement in at least on health-related time-use behavior.

CONCLUSIONS

Interpersonal factors, including caregivers support and modeling-behaviors, and community factors, in the form of local, accessible, affordable spaces to be active, were identified as the most pertinent factors in determining PA, SB and sleep behaviors. Moreover, adults with ID and caregivers perceived health-related time-use behaviors to be interrelated. Further investigation in this area will ultimately inform the development of pilot interventions that support caregivers as gatekeepers and provide access to health-promoting environments to engage adults with ID in healthy levels of PA, SB, and sleep.

Test-retest reliability of Picture My Participation in children with intellectual disability in South Africa

BACKGROUND

Picture My Participation (PmP) is a promising instrument for measuring the participation in everyday situations of children with intellectual disability (ID), particularly in low- and middle-income countries.

AIM

To explore test-retest reliability of PmP by comparing two repeated measurements of children with ID in an urban context in South Africa.

METHODS

A picture-supported interview with 31 children with ID, aged 7-17 years, was conducted twice, two weeks apart. The children rated their participation, operationalised as attendance and involvement, in 20 everyday activities. Analyses were completed for total scores, for the four subcomponents and at item level.

RESULTS

Test-retest agreement at an item level for both attendance and involvement showed slight/fair agreement for most activities (Kappa = 0.01-0.40), and moderate agreement for some activities (Kappa = 0.41-0.60). Moderate agreement was shown for the total scale and at component level (ICC = 0.5-0.75), except for (firstly) attendance of and involvement in 'Family Activities' (ICC = 0.26 for attendance, 0.33 for involvement), and (secondly) involvement in 'Personal Activities' (ICC = 0.33).

CONCLUSION

The result indicates that PmP can reliably be used at component level and as a screening tool for intervention planning to identify participation and participation restrictions in children with ID.

In pursuit of meaningful occupation: Employment and occupational outcomes for older Irish adults with an intellectual disability

BACKGROUND

Adults with an intellectual disability (ID) have much lower rates of employment than their counterparts without intellectual disability, which increases their risk of poverty and social exclusion. Differential treatment of people with intellectual disability in welfare and training policies suggests an expectation they will be passive welfare recipients rather than productive employees.

METHODS

This paper aims to examine occupational activities by older people with intellectual disability in Ireland, exploring factors influencing outcomes using data from the IDS-TILDA study (n = 708).

RESULTS

Most people were unemployed but engaged in regular occupational activity. Occupational activity was associated with better emotional/mental health. Activities of Daily Living (ADL) functioning was associated with an active occupational status, while social supports most strongly predicted high occupational engagement across a range of activities.

CONCLUSIONS

A focus on the individual meaning derived from a broad range of engagement may better support people with intellectual disabilities to benefit from regular occupational activity.

Impact of the intellectual disability severity in the Spanish Personal Outcomes Scale

BACKGROUND

The interest in measuring quality of life (QoL) in persons with intellectual disability (ID) has brought about a number of QoL measurements for this population. These measurements need to address two issues that have contributed to enhancing the current instruments. First, the necessity to develop measures with adequate psychometric properties, which has been discussed in recent studies, and second, the agreement between experts in analysing objective and subjective perspectives, as well as the use of self-report to include the participation of the person with ID. The question that we set out to investigate in this paper is whether the measurements function properly for the person with ID, independent of their level of severity. We used the Spanish version of the Personal Outcomes Scale, as it is a psychometrically sound instrument and includes three sources of information (the person with ID, a professional and a family member).

METHOD

The sample was composed of 529 persons with ID (296 men, representing 55.95% of the total sample, and 233 women, with M_age  = 35.03, SD = 10.82) from several regions of Spain, along with their professional of reference and a family member. The severity variable was estimated for each item based on estimations of differential item functioning.

RESULTS

The results showed that several items were undervalued by the assessments if the severity of the ID was greater. Mainly, this difference was observed in the assessments by professionals and in the dimensions of rights, personal development and self-determination.

CONCLUSIONS

This paper focuses on the uses and interpretations of the results of the QoL measurements in the Personal Outcomes Scale. The results indicate that, in our sample, when people with high levels of ID are assessed, the functioning of some items are affected by the severity of this disability. For correct use, these items must be interpreted on the basis of the results obtained. Additionally, it is necessary to thoroughly review the QoL indicators for persons with severe or profound ID.

Living with family: perceptions of health and subjective well-being of adults with an intellectual disability

BACKGROUND

Little is known about the role of living circumstances to the perception of subjective well-being (SWB) and health of adults with intellectual disability (ID). The aim of the present study was to examine whether living circumstances impact differently on the perception of health and SWB and whether potential differences persist after accounting for other variables (e.g. level of support needs and reporting method).

METHODS

Secondary data analysis was undertaken of a large national survey of adults with an ID in England, aged 16 years and over. Participants were identified as living with family (N = 1528) or living out of home (N = 874).

RESULTS

The results of t-test and chi-square revealed that levels of health and SWB were perceived as being higher for people living with family than those living in out-of-home settings. Multiple linear regression analyses fitted to explore factors associated with these reported differences revealed that, when controlling for other variables, living with family was highly associated with reports of better SWB. Multiple logistic regression revealed that whilst the health status of people living with families were perceived as better, this was only true when their support needs were low. Poorest health outcomes were found for people with highest support needs who lived with family.

CONCLUSIONS

On the whole, the health and well-being of adults living with family were perceived more positively than those living out of home. However, potential health disparities exist for those with high support needs who live with family. Further longitudinal research is needed to explore causes and potential solution to these inequalities.

Item response theory analysis applied to the Spanish version of the Personal Outcomes Scale

BACKGROUND

The study of measurements of quality of life (QoL) is one of the great challenges of modern psychology and psychometric approaches. This issue has greater importance when examining QoL in populations that were historically treated on the basis of their deficiency, and recently, the focus has shifted to what each person values and desires in their life, as in cases of people with intellectual disability (ID). Many studies of QoL scales applied in this area have attempted to improve the validity and reliability of their components by incorporating various sources of information to achieve consistency in the data obtained. The adaptation of the Personal Outcomes Scale (POS) in Spanish has shown excellent psychometric attributes, and its administration has three sources of information: self-assessment, practitioner and family. The study of possible congruence or incongruence of observed distributions of each item between sources is therefore essential to ensure a correct interpretation of the measure. The aim of this paper was to analyse the observed distribution of items and dimensions from the three Spanish POS information sources cited earlier, using the item response theory.

METHOD

We studied a sample of 529 people with ID and their respective practitioners and family member, and in each case, we analysed items and factors using Samejima's model of polytomic ordinal scales.

RESULTS

The results indicated an important number of items with differential effects regarding sources, and in some cases, they indicated significant differences in the distribution of items, factors and sources of information.

CONCLUSIONS

As a result of this analysis, we must affirm that the administration of the POS, considering three sources of information, was adequate overall, but a correct interpretation of the results requires that it obtain much more information to consider, as well as some specific items in specific dimensions. The overall ratings, if these comments are considered, could result in bias.

The factors associated with care-related quality of life of adults with intellectual disabilities in England: implications for policy and practice

Over the last three decades, quality of life (QoL) has been advocated as an indicator of social care outcomes for adults with intellectual disabilities. In England, the Adult Social Care Survey (ASCS) is conducted annually by local authorities to contribute to the evidence base of the care-related QoL of people receiving publicly funded adult social care. This study explores relationships between QoL and non-care-related factors to identify relationships that could inform social care policy and practice. Cross-sectional data collected from 13,642 adults who participated in the 2011 and 2012 ASCS were analysed using regression to explore the factors associated with QoL measured using the Adult Social Care Outcomes Toolkit (ASCOT). Self-rated health, rating of the suitability of home design and anxiety/depression were all found to be significantly associated with ASCOT. Other individual and survey completion factors were also found to have weak significant relationships with ASCOT. The models also indicate that there was an increase in overall ASCOT-QoL and in five of the eight ASCOT domains (Personal comfort and cleanliness, Safety, Social participation, Occupation and Dignity) between 2011 and 2012. These findings demonstrate the potential value of QoL data for informing policy for people with intellectual disabilities by identifying key factors associated with QoL, the characteristics of those at risk of lower QoL, and QoL domains that could be targeted for improvement over time. Future research should establish causal relationships and explore the risk adjustment of scores to account for variation outside of the control of social care support.

Measuring choice for adults with an intellectual disability - a factor analysis of the adapted daily choice inventory scale

BACKGROUND

For most people, choice making is an everyday occurrence, but for adults with an intellectual disability (ID), such opportunities are often limited, if not, absent. Defining choice, and related opportunity capacity and supports continue to feature prominently in academic, practice and policy discourse within the field of ID as reflected in the range of measures available. This paper examines the factor analytic properties of an adapted 14-item choice inventory scale.

METHOD

Presence and type of choice were recorded in wave 1 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing using a choice inventory scale adapted for the Irish context for 753 participants with ID over age 40 years. Analysis included both an exploratory and confirmatory factor analysis. Descriptive statistics on choice by type of living arrangement, type of interview (proxy, self or supported) and level of ID are presented.

RESULTS

Exploratory factor analysis indicates good model fit when using both a 3-item and 4-item response with the 4-item version suggesting a two-factor model. Further exploration of this two-factor model through confirmatory factor analysis highlighted an improved fit for the 4-item model. Further improvement in model fit is found when four item pairs are co-varied within the model.

CONCLUSION

Two broad types of choice were found to exist for adults with ID - everyday decisions and key life decisions. In addition, the factor analysis support for the inclusion of a 'no choice' response may help reduce the potential for missing data.

The Relationship Between Intelligence Quotient and Aspects of Everyday Functioning and Participation for People Who Have Mild and Borderline Intellectual Disabilities

BACKGROUND

This study explored the relationship between intelligence quotient (IQ) and aspects of everyday functioning/participation in individuals (age 16-40) who have a mild/borderline intellectual disability (IQ 55-85).

METHOD

Correlations were examined between IQ and (i) self-rated (n = 72) ability, participation as performance (how often an activity is performed), important participation restriction (not/seldom performing an activity perceived as important) and general well-being and (ii) proxy-rated (n = 41) ability and participation as performance.

RESULTS

No significant correlations between IQ and any of the explored measures were found. However, the effect sizes of the correlations between IQ and ability were considered as small but not negligible.

CONCLUSIONS

The results support the notion that IQ is a poor predictor of general aspects of everyday functioning in persons with mild/borderline intellectual disability. The result indicates that self-ratings partly generate other information than proxy ratings which may be important for assessments of supportive requirements and diagnosis.

Family Members' Perceptions of the Quality of Long-Term Care

The aim of the study is to assess family members' perceptions of the quality of nursing care of older people and its relationships between demographic factors and family involvement. Data were gathered from family members of four residential homes ( N= 474) using structured questionnaires. Data were analyzed using descriptive statistics, correlation, and predictive analyses. The results imply that family members' perceptions of quality were fairly positive. Age, educational background, and the frequency of visits on the ward were related with the quality perception. The association between quality perceptions and family involvement in care proved to be strong. The information and support from the staff and possibilities to participate in decision making were associated with high-quality ratings. The results demonstrate the need for formulating ward policies and training the nursing staff to allow increased family involvement and to support it in an appropriate way.

Linking user and staff perspectives in the evaluation of innovative transition projects for youth with disabilities

A key challenge in formative evaluation is to gather appropriate evidence to inform the continuous improvement of initiatives. In the absence of outcome data, the programme evaluator often must rely on the perceptions of beneficiaries and staff in generating insight into what is making a difference. The article describes the approach adopted in an evaluation of 15 innovative projects supporting school-leavers with disabilities in making the transition to education, work and life in community settings. Two complementary processes provided an insight into what project staff and leadership viewed as the key project activities and features that facilitated successful transition as well as the areas of quality of life (QOL) that participants perceived as having been impacted positively by the projects. A comparison was made between participants' perceptions of QOL impact with the views of participants in services normally offered by the wider system. This revealed that project participants were significantly more positive in their views than participants in traditional services. In addition, the processes and activities of the more highly rated projects were benchmarked against less highly rated projects and also with usually available services. Even in the context of a range of intervening variables such as level and complexity of participant needs and variations in the stage of development of individual projects, the benchmarking process indicated a number of project characteristics that were highly valued by participants.

Validation of the Portuguese version of the Personal Outcomes Scale

BACKGROUND/OBJECTIVE

Quality of life (QOL) is actually helpful to organizations for guiding personalized support plans and enhance personal outcomes. However, there is a lack of consensus about the QOL construct in the field of intellectual disability (ID). This study aims (a) to analyze the first-order factor structure (i.e., eight domains) of the Portuguese version of the Personal Outcomes Scale (POS), and (b) to compare two alternative models of the higher factor structure of the QOL construct (i.e., Salamanca and Schalock).

METHOD

Both aims were investigated by examining self-report and report-of-others measures. Data were collected from 1,264 adults with mild or moderate levels of ID and respective proxies.

RESULTS

Results from confirmatory factor analysis (CFA) showed evidence of suitable psychometric properties of the QOL dimensions. Findings also highlighted that the first-order model was more robust than either of the two second-order models. Nevertheless, the Schalock structure was stronger than the Salamanca structure.

CONCLUSIONS

Although further research is needed, the results reveal that the Portuguese POS may be a valid and reliable instrument to measure QOL of adults with ID. The implication of these results are discussed highlighting the scale as a useful tool to serve as the basis for planning and evaluating personalized supports.

Comparing the quality of life of adults with and without intellectual disability

BACKGROUND

Quality of life (QOL) is an important issue for all citizens, comprising equity, equality, inclusion and participation of each person in society. The research purposes driving this investigation were (1) to compare QOL among people with and without intellectual disability (ID) and (2) to examine the predictors of QOL in both groups of participants.

METHODS

Data were collected from 1929 adults, including 1264 individuals with an ID and the remainder (n = 665) were participants without a disability. QOL was assessed by the Portuguese version of the Personal Outcomes Scale.

RESULTS

The findings supported significantly higher QOL for adults without ID. Furthermore, QOL is influenced by individual and environmental variables, stressing that the health status was the highest mutual predictor of QOL among those with and without ID.

CONCLUSION

The gaps among both groups of participants should be addressed in service provision and policies. Taking into account the research findings, the personalised supports should enable the full inclusion and participation of adults with ID in community-based settings.

Human rights of children with intellectual disabilities: comparing self-ratings and proxy ratings

BACKGROUND

A child rights-based approach to research articulates well with Article 12 of the United Nations Convention on the Rights of the Child (CRC) and highlights the importance and value of including children's own views about aspects that concern them. The aim of this study is to compare children with intellectual disability's own ratings (as self-raters) to those of their primary caregivers (as proxy raters) regarding human rights of children. The study also aims to establish whether there is an inter-rater agreement between the self-raters and proxy raters concerning Maslow's hierarchy of needs.

METHOD

This study is nested in a larger study examining the human rights of children with intellectual disability in South Africa. In total, 162 children with intellectual disability from 11 schools across three provinces and their primary caregivers participated by answering parts of a Children's Rights Questionnaire (CRQ) developed by the researchers based on the United Nation's CRC. We compared the answers for six questions in the questionnaire that were addressed to self-raters (children) and proxy raters (primary caregivers) in the same way.

RESULTS

Questions regarding basic needs, such as access to clean water or whether the child had food to eat at home, were answered similarly by self-raters and proxy raters. Larger differences were found when self-raters and proxy raters were asked about whether the child had things or friends to play with at home. Socio-economic variables seemed to affect whether self-raters and proxy raters answered similarly.

CONCLUSION

The results underscore the importance of promoting children's rights to express themselves by considering the opinions of both the children as self-raters and their primary caregivers as proxy raters - not only the latter. The results indicate that it is especially important to include children's own voices when more complex needs are surveyed. Agreement between self- and proxy ratings could be affected by socio-economic circumstances.

Including Youth with Intellectual Disabilities in Health Promotion Research: Development and Reliability of a Structured Interview to Assess the Correlates of Physical Activity among Youth

BACKGROUND

The input of youth with intellectual disabilities in health promotion and health disparities research is essential for understanding their needs and preferences. Regular physical activity (PA) is vital for health and well-being, but levels are low in youth generally, including those with intellectual disabilities. Understanding the perceptions of and barriers to PA as reported by youth with intellectual disabilities themselves is important for designing effective interventions.

MATERIALS AND METHODS

We developed a structured interview that queried youth with intellectual disabilities and typically developing youth (ages 13-21 years) about their enjoyment, preferences and perceived barriers to PA. We describe the development of this interview and present its test-retest reliability on 15 youth with intellectual disabilities and 20 typically developing youth.

RESULTS

Twenty-three of 33 questions were reliable in both groups. The results suggest that youth with intellectual disabilities can reliably report activities that they do or do not enjoy, as well as their beliefs and perceived benefits of PA.

CONCLUSIONS

Self-reported information on the experiences, preferences, beliefs and perceptions about among youth with intellectual disabilities is key for research efforts in health promotion and health disparities.

Subjective quality of life of those 65 years and older experiencing dementia

BACKGROUND/OBJECTIVES

To describe how people experiencing dementia define quality of life and how this may be supported.

DESIGN

Qualitative descriptive component of mixed methods cross-sectional study.

SETTING

Western Canadian community (4-h weekly care minimum), supportive housing (24-h support/supervision), personal care homes (24-h nursing).

PARTICIPANTS

One hundred and thirty-six persons aged 65+ experiencing dementia.

MEASUREMENTS

Semi-structured interview questions. Rating of meeting life's goals.

RESULTS

Participants characterised quality of life as: freedom, independence, having basic needs met, physical health, engagement in meaningful activities and tranquility. A need for self-determination/choice was evidenced across all domains. Increased access to skilled nursing care, support for meaningful engagement with family and meeting life's goals were endorsed as adding most to quality of life; 43% reported meeting all life's major goals.

CONCLUSION

People experiencing dementia may have better quality of life when choice/self-determination is supported. Enhancements in care environment, independence, engagement and meeting of life's goals merit urgent attention.

Characterizing associations and dissociations between anxiety, social, and cognitive phenotypes of Williams syndrome

Williams syndrome (WS) is a neurogenetic disorder known for its "hypersocial" phenotype and a complex profile of anxieties. The anxieties are poorly understood specifically in relation to the social-emotional and cognitive profiles. To address this gap, we employed a Wechsler intelligence test, the Brief Symptom Inventory, Beck Anxiety Inventory, and Salk Institute Sociability Questionnaire, to (1) examine how anxiety symptoms distinguish individuals with WS from typically developing (TD) individuals; and (2) assess the associations between three key phenotypic features of WS: intellectual impairment, social-emotional functioning, and anxiety. The results highlighted intensified neurophysiological symptoms and subjective experiences of anxiety in WS. Moreover, whereas higher cognitive ability was positively associated with anxiety in WS, the opposite pattern characterized the TD individuals. This study provides novel insight into how the three core phenotypic features associate/dissociate in WS, specifically in terms of the contribution of cognitive and emotional functioning to anxiety symptoms.

Facilitators and barriers to physical activity as perceived by older adults with intellectual disability

Older people with intellectual disability (ID) are characterized by low physical activity (PA) levels. PA is important for reducing health risks and maintaining adequate fitness levels for performing activities of daily living. The aim of this study was to explore preferences of older adults with ID for specific physical activities, and to gain insight into facilitators and barriers to engaging into PA. Fourteen in-depth interviews and four focus groups were undertaken, with a total of 40 older adults with mild and moderate ID included in the analysis. NVivo software was used for analysing the transcribed verbatim interviews. In total, 30 codes for facilitators and barriers were identified. Themes concerning facilitators to PA were enjoyment, support from others, social contact and friendship, reward, familiarity, and routine of activities. Themes concerning barriers to PA were health and physiological factors, lack of self-confidence, lack of skills, lack of support, transportation problems, costs, and lack of appropriate PA options and materials. The results of the present study suggest that older adults with ID may benefit from specific PA programs, adapted to their individual needs and limitations. Results can be used for developing feasible health promotion programs for older adults with ID.

Responsiveness to self-report questions about loneliness: a comparison of mainstream and intellectual disability-specific instruments

BACKGROUND

We compared responsiveness to two self-report assessments of loneliness: the UCLA Loneliness Scale (UCLALS) designed for the general community, and the Modified Worker Loneliness Questionnaire (MWLQ) designed for people with intellectual disability (ID).

METHODS

Participants were 56 older adults with disability - 40 individuals with ID and 16 without ID. They were individually assessed on the MWLQ and the UCLALS. The difficulty of the items in both scales was evaluated in relation to readability, features of question wording, question length and response format.

RESULTS

The UCLALS was more difficult than the MWLQ on each of the difficulty dimensions assessed. There was significantly greater responsiveness to the MWLQ than the UCLALS, especially among people with ID.

CONCLUSIONS

To enable as many people with ID as possible express their views on loneliness, the ID-specific MWLQ is a much better choice. However, this choice comes at the cost of ready comparison to loneliness data for the general community, which is available for widely used assessments such as the UCLALS.

Measuring quality of life in people with intellectual and multiple disabilities: validation of the San Martín scale

Although there are numerous quality of life instruments in the, field of intellectual disability, most of them are addressed to those, people with the highest levels of functioning, while only a few are, suitable for people with the lowest levels (i.e., people with profound, and severe intellectual disabilities, or people with intellectual and, developmental disabilities and other significant medical conditions or, disabilities). This study provides reliability and validity evidence of, the San Martín Scale, a 95-item Likert scale questionnaire that is, completed by a third-party respondent. The validation sample was composed, of 1770 people from Spain with intellectual and developmental, disabilities that showed extensive or pervasive support needs (8.7% had, mild intellectual disability, 28.25% moderate, 41.6% severe, and 21.4%, profound). The age of the participants ranged between 16 and 77 years old, (M=7.78; SD=12.32). The results suggested that the eight quality of, life domains assessed on the scale are reliable (Cronbach's alpha ranging, from .821 to .933). Confirmatory Factor Analyses provided construct, validity evidences related to the internal structure of the San Martín, Scale, and indicated that the eight first-order factor solution provided, the best fit to the data over unidimensional and hierarchical solutions. Implications of these findings and guidelines for further research are, discussed.

Issues concerning self-report data and population-based data sets involving people with intellectual disabilities

This article examines two methodological issues regarding ways of obtaining and analyzing outcome data for people with intellectual disabilities: (a) self-report and proxy-report data and (b) analysis of population-based data sets. Some people with intellectual disabilities have difficulties with self-reporting due to problems of understanding and communication. However, there are serious doubts about the validity of proxy data for subjective issues. One important challenge with secondary analysis of population-based data sets is the difficulty of accurately identifying survey participants with intellectual disabilities. In both areas examined, it is important to recognize these constraints when interpreting research based on such data.

Walk Well: a randomised controlled trial of a walking intervention for adults with intellectual disabilities: study protocol

BACKGROUND

Walking interventions have been shown to have a positive impact on physical activity (PA) levels, health and wellbeing for adult and older adult populations. There has been very little work carried out to explore the effectiveness of walking interventions for adults with intellectual disabilities. This paper will provide details of the Walk Well intervention, designed for adults with intellectual disabilities, and a randomised controlled trial (RCT) to test its effectiveness.

METHODS/DESIGN

This study will adopt a RCT design, with participants allocated to the walking intervention group or a waiting list control group. The intervention consists of three PA consultations (baseline, six weeks and 12 weeks) and an individualised 12 week walking programme.A range of measures will be completed by participants at baseline, post intervention (three months from baseline) and at follow up (three months post intervention and six months from baseline). All outcome measures will be collected by a researcher who will be blinded to the study groups. The primary outcome will be steps walked per day, measured using accelerometers. Secondary outcome measures will include time spent in PA per day (across various intensity levels), time spent in sedentary behaviour per day, quality of life, self-efficacy and anthropometric measures to monitor weight change.

DISCUSSION

Since there are currently no published RCTs of walking interventions for adults with intellectual disabilities, this RCT will examine if a walking intervention can successfully increase PA, health and wellbeing of adults with intellectual disabilities.

TRIAL REGISTRATION ISRCTN

ISRCTN50494254.

Spanish family quality of life scales: under and over 18 years old

BACKGROUND

Researchers, professionals, and families have shown increasing concern with the family quality of life (FQoL) of people with intellectual disability (ID) and their families. The goals of this research were (a) to explore how Spanish families understand FQoL by developing 2 different measurement tools for families with a member with ID under and over 18 years old, and (b) to provide 2 diagnostic instruments that will be useful for designing action plans.

METHOD

The study comprised 4 stages: (a) focus groups, (b) expert assessment, (c) pilot study, and (d) normalisation and standardisation. The data were collected in 5 regions in Spain, and 1,205 families with a member with ID took part in the normalisation and standardisation of the scales.

RESULTS

Both FQoL scales were consistent and have valid psychometric characteristics.

CONCLUSIONS

The scales have a diagnostic purpose for use in designing action plans aimed at producing significant changes in families' lives.

Expanding Assessment of Fear of Falling among Older Adults with an Intellectual Disability: A Pilot Study to Assess the Value of Proxy Responses

Introduction. Fear of falling (FOF) has emerged as an important health concern in older adults, yet it has rarely been investigated in people with intellectual disabilities (ID). Valid and reliable measurement approaches are a particular challenge. Scales that have been developed to measure FOF have not been validated for use with older people with ID and are not routinely used with proxy respondents. Method. 63 people comprised purposeful samples of 3 groups, people with ID , their nominated key workers , and additional support workers . Test-retest reliability and interrater reliability were assessed for using a dichotomous, single-item FOF screening measure. The degree of FOF and activity restriction due to FOF were also investigated. Results. Inter-rater reliability was found to be moderate to excellent with Kappa = 0.77 on ratings of the FOF item. Test-retest reliability for each group of reviewers for the FOF item were also found to be excellent (0.95). Conclusion. The global item is a suitable screening measure for FOF in older adults with ID and can assist in identification of individuals requiring further assessment. Proxies, if carefully selected, can provide consistent and reliable reports of the presence of FOF in people with ID.

Tools for surveying and improving the quality of life: people with special needs in focus

PURPOSE

This article seeks to describe online tools for surveying and improving quality of life for people with disabilities living in assisted living centers and special education service organizations.

DESIGN/METHODOLOGY/APPROACH

Ensuring a decent quality of life for disabled people is an important welfare state goal. Using well-accepted quality of life conceptions, online diagnostic and planning tools were developed during an Institute for Education, University of Zurich, research project.

FINDINGS

The diagnostic tools measure, evaluate and analyze disabled people's quality of life. The planning tools identify factors that can affect their quality of life and suggest improvements.

RESEARCH LIMITATIONS/IMPLICATIONS

Instrument validity and reliability are not tested according to the standard statistical procedures. This will be done at a more advanced stage of the project. Instead, the tool is developed, refined and adjusted in cooperation with practitioners who are constantly judging it according to best practice standards.

PRACTICAL IMPLICATIONS

The tools support staff in assisted living centers and special education service organizations.

ORIGINALITY/VALUE

These tools offer comprehensive resources for surveying, quantifying, evaluating, describing and simulating quality of life elements.

Self-reported health of people with intellectual disability

Self-reported health is an important outcome in the evaluation of health care but is largely ignored in favor of proxy-based reporting for people with an intellectual disability. This study briefly reviews the role of self-report in health assessment of people with intellectual disability and the challenges and recommendations that have emerged from the considerable body of research on interviewing and self-report. Limitations in current recommendations are addressed from the perspective of the cognition of self-report. The review describes conceptual directions for the reconciliation of the two contradictory themes in the treatment of self-report: the centrality given to personal perceptions and choices and the methodological concerns over the meaningfulness and validity of the self-reporting process.

Identifying factors associated with self-rated health according to age at onset of disability

PURPOSE

Although later-onset disability has been associated with poor self-rated health (SRH), factors mediating differences in SRH related to age at onset of disability remain unclear. The present study was designed to identify the variables explaining poor SRH in later-onset disability. We examined chronic disease and functional status as alternatives to psychosocial adaptation as explanatory variables.

METHOD

Our data were taken from the seventh National Survey for People with Disabilities among Korean individuals ≥18 years of age (n =5311).

RESULTS

Those with later-onset disability (onset ages 20-40, 41-64 and ≥65 years) showed higher age-adjusted odds ratios (ORs) for poor SRH compared with those with earlier-onset disability (onset ages 0-19 years). The ORs for poor SRH in individuals with later-onset disability were not substantially changed after adjusting for confounding variables including alternatives to psychosocial adaptation (chronic diseases and functional status) as explanatory variables.

CONCLUSIONS

Failure to explain poor SRH in later-onset disability with explanatory variables other than psychosocial adaptation indirectly supports the role of psychosocial adaptation in differences in SRH related to age at onset. Because we could not include appropriate measures of psychosocial adaptation, the use of additional instruments should be considered in future studies.

Parent and athlete perceptions of special olympics participation: utility and danger of proxy responding

Abstract Participation in athletics has benefits for persons with intellectual disabilities and their parents. Our purposes here were to confirm these benefits and to determine whether reports from athletes and parents were comparable (i.e., to test the validity of proxy responding). We conducted interviews with 34 Special Olympics sailing/kayaking athletes and their parents. Interviews took place at a regional Special Olympics competition and 12 months later by telephone. Findings suggest that Special Olympics participation has a positive impact on parents and athletes. However, relative to athletes, parents overstated the benefit, indicating that parental proxy responding should not be routinely used.

Behavior problems, psychiatric symptoms, and quality of life for older adults with intellectual disability with and without autism

The evidence base on outcomes associated with autism in older adulthood is limited. The expected increase in the prevalence of older adults with autism highlights the need to describe their profiles and service needs. Adults 50 years or older with an intellectual disability (ID) and the triad of impairments characteristic of autism spectrum disorders (ASD) were compared to peers with ID only, and younger adults with ASD and ID. After accounting for ability differences, older adults with ASD did not differ from those with ID in terms of behavior problems, psychiatric disorder, and quality of life. Any differences in the skills of adults with ASD were associated with decreased adaptive skills, and not the presence of ASD per se.

What makes them feel like they do? Investigating the subjective well-being in people with severe and profound disabilities

BACKGROUND

Because of the problems measuring subjective well-being in people with severe and profound intellectual disabilities, there are no studies to date which explore the factors contributing to the subjective well-being in these groups. We wanted to explore the client and service characteristics contributing to the subjective well-being of persons with severe and profound intellectual disabilities, as measured by the MIPQ (Ross & Oliver, 2003).

MATERIALS AND METHODS

The MIPQ was completed for 360 persons with severe or profound intellectual disabilities by a member of the direct support staff. They also provided us with information on client, service and informant characteristics.

RESULTS

We found that the subjective well-being of persons with profound intellectual disabilities was lower than the subjective well-being of people with mild, moderate or severe intellectual disabilities or people without disabilities. Client and informant characteristics but no service characteristics were found to have an influence on the subjective well-being of people with severe and profound intellectual disabilities.

CONCLUSION

As it is important for policy making to identify residence service and staff factors related to subjective well-being of persons with severe and profound intellectual disabilities, further research should try to identify these factors, taking in account the client characteristics that are found to be related to subjective well-being in this study.

Predictors of life satisfaction in individuals with intellectual disabilities

BACKGROUND

The purpose of this study was to examine factors that predict life satisfaction in individuals with intellectual disabilities (ID). Two groups of variables were studied: life skills (interpersonal, instrumental and leisure) and higher-order predictors (social support, self-determination and productivity).

METHOD

Fifty-six participants with ID were recruited from two community agencies in Wisconsin. Data were collected using both a self-report inventory, which was administered to each individual in an interview format, and a behaviour rating scale, which was completed by a knowledgeable staff member. Hierarchical regression was used to analyse the data.

RESULTS

Both sets of variables were found to explain a significant amount of the variance in life satisfaction. Within the sets, social support and interpersonal skills were individually significantly associated with life satisfaction.

CONCLUSION

It is hoped that the results of this study will help support providers organise services in such a way that maximises the life satisfaction of the consumers that they serve.