Residential transitions among adults with intellectual disability across 20 years

The meaning of adulthood for emerging adults with Down syndrome: Parent perspectives on relevant skills

BACKGROUND

Parents' conceptualizations of adulthood for their emerging adults with Down syndrome have the potential to impact the transition planning process as families prepare for life after graduation.

AIMS

This study aimed to explore parent perceptions of the meaning of adulthood for their emerging adults with Down syndrome.

METHODS

In this qualitative study, we interviewed 11 parents of emerging adults with Down syndrome using phenomenological methodology and analysed these data using thematic analysis.

RESULTS

Three topics emerged: (1) Parents' constructions of the meaning of adulthood; (2) Parents' perceptions about the transition to adulthood; and (3) Parents' perceptions of current adult life skills. Ten themes arose out of these topics.

CONCLUSIONS

Parents expressed ambivalence about the meaning of adulthood for their emerging adults with Down syndrome, sharing that in some ways they were adults and in others they were not. The meaning of adulthood was closely tied to obtained skills, particularly those related to personal safety.

Factors Related to Physical Activity in Adults With Intellectual Disabilities in Group Home Settings: A Systematic Literature Review

This systematic review of literature aimed to synthesize the multilevel factors related to physical activity (PA) among adults (age 18-65) with intellectual disability living in group homes. Keyword searches were used to identify articles from electronic databases, resulting in the inclusion of 10 articles for full-text review. Data were extracted relating to study and sample characteristics and study findings. Methodological quality of the studies was also evaluated. Factors related to PA in group homes were identified at all levels of the social-ecological model. Intrapersonal factors (e.g., health and functional status, attitude to PA), interpersonal factors (e.g., staff attitude, encouragement for PA, and coparticipation in PA), and organizational factors (e.g., program offerings, staff education, and staff-client ratios) were prominent findings in the reviewed studies. The findings support a social-ecological approach for PA promotion in group homes that target intrapersonal, interpersonal, and organizational factors.

The delivery of healthy lifestyle interventions for people with disability living in supported accommodation: a scoping review of intervention efficacy and consumer involvement

BACKGROUND

People with disability living in supported accommodation experience health disparities that may be partly attributed to sedentary lifestyle behaviors and poor dietary quality. Healthy lifestyle interventions have been suggested as a method of health promotion for this population; however, a synthesis of their efficacy has not yet been conducted.

OBJECTIVE

The primary aims were to (1) identify healthy lifestyle interventions delivered to people with disability living in supported accommodation and (2) examine their efficacy in supporting health and well-being. A secondary aim was to explore whether people with disability have been involved in the codesign of these interventions.

METHODS

A scoping review was conducted following the Joanna Briggs Institute's guidance for conducting scoping reviews, and six databases were searched from January 2011 to November 2021.

RESULTS

Thirty-two studies were included. Identified intervention types included training and education, exercise programs, and multicomponent interventions. A broad range of outcomes were examined; however, findings regarding efficacy were overall mixed and limited due to significant heterogeneity and the underreporting of consistently measured outcomes. The codesign of interventions in consultation with people with disability was underexplored.

CONCLUSIONS

Health promotion training for staff and tailored education for people with disability hold promise in creating a care environment that supports a healthy lifestyle. The paucity of interventions developed in consultation with people with disability is concerning and highlights the importance of meaningful co-design. The development of a theoretically informed intervention that is codesigned and addresses the broader social determinants that influence health behavior is recommended.

Assessing Alignment Between Intellectual and Developmental Disability Service Providers and Trauma-Informed Care: An Exploratory Study

People with intellectual and developmental disabilities (IDD) are disproportionately impacted by potentially traumatic experiences; however, organizations serving this population have lagged in their integration of trauma-informed care (TIC). Trauma-informed care is a systemwide response to the pervasiveness of trauma that frequently requires an organizational shift rooted in staff training. Using an online statewide survey, the present study examined beliefs and training among IDD service providers. Responses from 288 service providers suggested some alignment among beliefs and staff training content with TIC principles. Although the findings indicate a foundation for TIC, intentional efforts are needed for IDD agencies to fully embrace TIC.

A model proposal development study for adults with intellectual disabilities in Turkey compared to USA

Intellectual disability (ID) persists from birth through adulthood and aging. Thus, the support provided to individuals with intellectual disabilities (IwID) in adulthood is essential to increase their self-determination and quality of life. This research aimed to determine how IwID may receive support for education, working life, accommodation, and leisure in adulthood in the Turkish context by increasing their and their families' quality of life without socially discriminating against them. Qualitative data were collected in two stages, combining semi-structured interviews and the Delphi study technique. Results prompted the recommendation that a legal basis for transition-to-adulthood planning be established in Turkey for a functional adult service model. Next, a model with specific standards by which multidisciplinary experts analyse education, work, leisure, and housing alternatives for preadulthood and adulthood should be developed and coordinated by the Turkish Ministry of National Education and the Ministry of Family. Implications for the future are further discussed.

Post-High School Transition Outcomes for Young Adults With Down Syndrome

There is limited available research on the post-high school outcomes of young adults with Down syndrome (DS). The purpose of this study, therefore, was to characterize employment, community-based living, and community engagement outcomes and their correlates among young adults with DS who recently transitioned out of high school. Caregivers (n = 100) of young adults with DS who exited high school within the past 5 years completed an online survey. Approximately half of the individuals with DS were working in some capacity; almost all were living with caregivers. Individuals with DS were engaging in a variety of community activities each week. Adaptive functioning was related to both employment and community engagement. Parent involvement in transition planning was also related to community engagement.

Negative Events Related to School Functioning and Their Relationship with the Risk of Depression in Adolescents

Negative experiences experienced by adolescents can cause the risk of developing mental health disorders, social maladaptation and academic problems. The aim of the study is to identify the risk of depression in adolescents in connection with experienced negative life events. The study involved 507 students of urban and rural secondary schools aged 12–17 years (median, quartiles 14 [14; 15]), 47.5% boys, 52.5% girls. The M. Kovacs Depression Scale (Children's Depression Inventory, CDI) and the Adolescent Mental Life Events Scale (ASLEC) were used. With adolescents who showed a high level of risk of depression on the CDI scale, an additional clinical interview was conducted. It is shown that adolescents perceive most of the negative events they have experienced as significant. A significant proportion of them account for life events related to school functioning, while no significant differences were found in the groups of boys and girls. It is suggested that the events experienced by students related to school functioning, in the absence of a statistically significant relationship with the risk of depression, may still increase the risk of depression in the presence of events in the life of adolescents related to family functioning (family conflicts, physical punishment in the family) and psychological factors (criticism or punishment). The data obtained concerning the frequency of experiencing negative life events related to the school sphere and noted by respondents as significant, make it necessary to work with teachers in the context of health-preserving psychological and pedagogical support.

Trauma-informed care in the context of intellectual and developmental disability services: Perceptions of service providers

Traumatic life events have pervasive impacts on health and well-being. A growing body of literature shows that people with intellectual and developmental disabilities are disproportionately impacted by trauma. Trauma-informed care (TIC) is a philosophy of service provision that is committed to preventing traumatization and re-traumatization and promoting healing. This study explores the perceptions of 130 leaders in the field of intellectual and developmental disabilities services on the adoption and practice of TIC through the analysis of quantitative data. Results indicated a disconnect between the level of TIC integration and perceptions detailing how well organizations are currently performing in aspects of TIC. Barriers to TIC included high staff turnover, lack of accessible mental health providers, lack of affordable training, stigma, and restrictive funding structures. Implications and recommendations for service organizations and educators are provided.

The Sibling-in-Law: Understanding an Unknown Member of the Disability Community

Little attention has focused on siblings-in-law, the spouses of siblings of people with disabilities. Using an online survey, 102 siblings-in-law provided information concerning themselves, their spouses, in-law family, and experiences. Overall experiences were rated as positive (51.0%), mixed (34.3%), or negative (14.7%). Compared to respondents with negative outcomes, respondents with positive and mixed outcomes felt being a sibling-in-law more positively impacted their marriage, relationship with in-laws, parenting, desire to advocate, and career. Before marriage, these two groups better understood sibling-in-law responsibilities and reported less worry about marrying into a family with a member with disabilities or having children with disabilities. In open-ended reflections, 1/3 of respondents discussed family dynamics; improving disability knowledge; future planning; and marriage considerations. Practice and research implications are discussed.

Development and Psychometric Properties of the Detection of Sexual Abuse Risk Screening Scale (DSARss)

People with intellectual disability (ID) are more vulnerable to being victims of sexual abuse (SA) because, in most cases, they are not able to detect the warning signs that abuse could occur. However, there is a lack of appropriate assessment tools to determine their vulnerability. To address this limitation, the current study tests the psychometric properties of the Detection of Sexual Abuse Risk Screening Scale (DSARss), a new scale developed to assess the ability of individuals with mild or moderate ID to detect the risk of SA. In all, 246 individuals with mild or moderate ID (55.3% males) completed the DSARss, along with other scales assessing related dimensions (e.g., psychopathological symptoms, quality of live). Exploratory factor analysis (EFA) yielded a four-factor structure explaining 65.34% of the total variance in the DSARss. Two independent EFAs in males and females were also performed to confirm the suitability of this four-factor structure according to gender. The reliability of the total score and subscales ranged between .70 and .93. Likewise, correlations with other related scales were positive and significant. Temporal stability 6 months after the first application was .47. Finally, we explored the criterion-related validity of the DSARss across different SA indicators. These results, along with the absence of sound questionnaires to assess the risk of SA in people with ID, justify the use of the DSARss to assess this construct in both men and women.

Homelessness and people with intellectual disabilities: A systematic review of the international research evidence

BACKGROUND

People with intellectual disabilities can experience homelessness, and some of the reasons differ from the general homeless population. Specific policy and practice responses are required.

METHOD

A systematic review of studies examining homelessness among people with intellectual disabilities utilizing CINAHL, MEDLINE, PsycINFO and Sociological Abstracts databases from inception to November 2019.

RESULTS

The search produced 259 papers, and following screening, a total of 13 papers were included in the review. The themes identified were (i) pathways into homelessness, (ii) experiencing homelessness and (iii) routes out of homelessness.

CONCLUSIONS

People with ID become homeless due to multifactorial issues. The identification of people within homeless services and their care and support concerns remains challenging, impacting upon the provision of assessments, interventions, care and supports. Psychosocial assessments, interventions and supports are necessary to assist people with ID to leave homelessness.

Diabetes in adults with intellectual disability: prevalence and associated demographic, lifestyle, independence and health factors

BACKGROUND

As people with intellectual disabilities (ID) are now living longer, they are more at risk of developing non-communicable diseases, including type 2 diabetes mellitus. However, understanding of factors associated with diabetes for targeted management and prevention strategies is limited. This study aimed to investigate prevalence of diabetes in adults (aged ≥18 years) with ID and its relationship with demographic, lifestyle, independence and health factors.

METHOD

This was a cross-sectional analysis of interview data from 1091 adults with ID from the Leicestershire Learning Disability Register from 1 January 2010 to 31 December 2016. Logistic regression models were used to identify factors associated with diabetes in the study population.

RESULTS

The study population did not have healthy lifestyles: just under half reported having lower physical activity levels than people without ID of a similar age; one-quarter consumed fizzy drinks daily; and 20% consumed five or more fruit and/or vegetables per day. Prevalence of carer/self-reported diabetes was 7.3% (95% confidence interval 5.9-9.0). After adjustment, diabetes was positively associated with South Asian ethnicity (P = 0.03) and older age groups (P < 0.001). Diabetes was less common in people living with family members (P = 0.02). We did not find a relationship between any of the lifestyle, independence and health factors investigated.

CONCLUSIONS

A significant proportion of people with ID are living with diabetes. Diabetes management and prevention strategies should be tailored to individuals' complex needs and include consideration of lifestyle choices. Such strategies may want to focus on adults of South Asian ethnicity and people living in residential homes where prevalence appears to be higher.

Intellectual disability and dementia: perspectives on environmental influences

Purpose

The purpose of this paper is to improve understandings of environmental influences on participation in routine and familiar activities for people with intellectual disabilities and dementia from first-person and caregiver perspectives.

Design/methodology/approach

Four adults with intellectual disabilities and dementia participated in 2 nominal group technique sessions and 12 family and staff caregivers participated in 5 standard focus groups. Transcripts were analyzed utilizing thematic analysis centering the findings from nominal group technique sessions and an ecological systems lens.

Findings

Participants with intellectual disabilities and dementia identified six important themes: activity access, caregiver assistance, social interactions, responsibilities, privacy, and health and wellness. Their perspectives focused primarily at an immediate environment level, while caregiver input added additional understandings from broader ecological systems levels.

Originality/value

This study provides a beginning point to establishing a framework for creating supports and addressing barriers to participation for adults with intellectual disability and dementia based on direct input from potential service consumers and their caregivers. People with intellectual disabilities and dementia provide valuable insights into their experiences through engagement in accessible research.

Perceptions de pères vivant avec un fils ou une fille adulte ayant une déficience intellectuelle sur la transition de l'après-parents

With the increase in life expectancy, many people with intellectual disabilities (ID) are living in the family home with their parents. This research focuses on the experience of 17 fathers of adults with ID. These fathers answered a questionnaire including open and closed questions. During the individual interview, fathers described their motivations to cohabit with their son or daughter, cohabitation benefits and constraints, housing options considered and planning for the future. Results indicate that fathers chose this cohabitation. However, they experience anxiety because they do not know who will support the adult with ID when they can no longer do so. Postparental planning considerations include legal concerns and informal discussions with siblings or the extended family. These results describe a complex parental situation in which there is interaction between their emotions, their attachment to the adult with ID and their previous experiences with residential, social or rehabilitation services.

Mortality in individuals with autism spectrum disorder: Predictors over a 20-year period

Research has shown that individuals with autism spectrum disorder have higher rates of health problems throughout childhood, adolescence, and adulthood, and that this may result in elevated risk of early mortality. This study reported the rate, timing, and causes of death in a large community-based cohort of adolescents and adults with autism spectrum disorder (n = 406) over a 20-year period (1998-2018) and identified predictors of mortality. Over this period, 6.4% of individuals died at an average age of 39 years. Causes of death included chronic conditions (such as cancer and heart disease), accidents (such as choking on food and accidental poisoning), and health complications due to medication side effects. Even after controlling for age and health status, significant predictors of mortality were early childhood levels of impairments in social reciprocity and high levels of functional impairments at the start of the study period. The results suggest the importance of social engagement and functional self-sufficiency across the life course, as well as adequate access to health care for individuals with autism spectrum disorder.

Intellectual and developmental disabilities research centers: Fifty years of scientific accomplishments

Progress in addressing the origins of intellectual and developmental disabilities accelerated with the establishment 50 years ago of the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health and associated Intellectual and Developmental Disabilities Research Centers. Investigators at these Centers have made seminal contributions to understanding human brain and behavioral development and defining mechanisms and treatments of disorders of the developing brain. ANN NEUROL 2019;86:332-343.

Adverse Childhood Experiences in Children with Intellectual Disabilities: An Exploratory Case-File Study in Dutch Residential Care

Adverse Childhood Experiences (ACEs) are negative childhood events occurring in a child’s family or social environment, that may cause harm or distress. Children with intellectual disabilities (ID) and their families are underrepresented in international ACEs research, while current insights can also contribute to the improvement of their health and well-being. Deficiencies in intellectual and adaptive functioning and living circumstances can increase their vulnerability to adversities. In the present exploratory study 69 case-files of children referred to a Dutch national center for residential youth care for children with ID were analyzed to assess the prevalence and associations of ACEs. It was found that almost half (49.3%) of the children experienced 2 ACEs from the original ACEs framework or more (M (mean) = 2.1; SD (standard deviation) = 1.8) and that the number of ACEs in children was related to the presence of ACEs in parents. Both child and parental ACEs were also related to attachment- and trauma- and stressor-related disorders. Finally, living circumstances and multiple ACEs from the expanded ACEs framework, especially related to parental characteristics, were found to be related to ACEs in children with ID. This implicates the importance of a transgenerational approach when further investigating the impact of ACEs on mental and physical health in children with ID (intellectual disabilities).

Irish persons with intellectual disability moving from family care to residential accommodation in a period of austerity

BACKGROUND

Ireland has a growing population of adult persons living with family carers, thereby increasing the demand for residential places. Simultaneously, government policy aimed to reprovision residents living in congregated settings but at a time when funding was curtailed due to the economic crisis. This study examines the movements of people into and among three types of residential options between 2009 and 2014.

METHOD

A cohort of 20,163 persons recorded on the National Intellectual Disability Database in 2009 was identified and tracked to the 2014 database.

RESULTS

An estimated 200 persons per annum (@1.6% of those living with families) moved from family care although the number of places available nationally fell by 9%. Moreover, transfers of existing residents into vacated places tended to exceed those from families.

CONCLUSIONS

More people will have to continue living with their families and for longer if funding for new places remains curtailed.

Who Helps? Characteristics and Correlates of Informal Supporters to Adults With Disabilities

This study examined who provides informal (or unpaid) supports to people with intellectual and developmental disabilities (IDD). Participants included 657 adult siblings of people with disabilities who responded to a national survey about informal supports in the areas of recreation, employment, and housing. Results indicated that most people with IDD received informal supports, with parents and sibling respondents most often providing those supports. Support was most commonly received in recreation, as opposed to housing or employment. Asked to list nonfamily informal supporters, respondents often mentioned paid staff and disability organizations. Correlates of total numbers of informal supporters included the individual with disability's functioning level and parents' ability to care for their offspring with disabilities.

The Association between Education and Mortality for Adults with Intellectual Disability

Although the relationship between education and mortality is well documented in the general population, it has not been examined for adults with intellectual disability. Informed by fundamental cause theory, I explore the association between education and mortality in a sample of 4,241 adults with intellectual disability from the 1986-2009 National Health Interview Survey with Linked Mortality Files through 2011. Cox regression models were utilized to analyze the predictive effect of education on mortality risk while taking into account birth cohort differences. Increased education was associated with lower mortality risk for adults with intellectual disability, and this relationship strengthened in later birth cohorts who had greater access to the public education system. Comparison with a sample of 21,205 adults without intellectual disability demonstrates that the association between education and mortality risk was not as robust for adults with intellectual disability and highlights the ongoing socioeconomic challenges faced by this population.

Quality of chest compressions by Down syndrome people: a pilot trial

INTRODUCTION

Immediate bystander cardiopulmonary resuscitation (CPR) is essential for survival after out-of-hospital cardiac arrest. Down syndrome (DS) citizens have improved their active engagement in society. The objective of this pilot trial was to investigate if they are able to perform quality chest compression-only CPR after a brief training.

METHODS

Nineteen DS young people (15-30 year old) and 20 University level subjects (18-29 year old) were trained by means of a short video and a brief hands-on session on manikins, to perform chest compression-only CPR. All participants were naïve in CPR. Chest compression (CC) quality (percentage of correct CC, CC rate and depth and chest complete release) was measured during a 2min test. CPR quality goal was according to 2010 European Resuscitation Council guidelines.

RESULTS

DS people had similar weight, lower height and a higher BMI than controls. They were able to deliver chest compression-only CPR but with higher mean CC rate (140±30 vs 123±12CC/min, p=0.03), less mean CC depth (35.4±10.3 vs 47.2±9.6mm, p=0.03) and lower % of full correct CC (13±18 vs 39±37, p=0.02) than controls. Differences were maintained when first and second minute of test were compared.

CONCLUSIONS

After a short instruction based on a brief video and hands-on session DS people were able to deliver CC but with poor quality.

Change in autism symptoms and maladaptive behaviors in adolescence and adulthood: the role of positive family processes

Little is known about outcomes for individuals with autism spectrum disorders (ASD) into adulthood. Several characteristics of individuals with ASD predict long-term outcomes, and the family environment may also play a role. The present study uses a prospective, longitudinal design to describe and predict trajectories of autism symptoms and maladaptive behaviors over 8.5 years in a large, community-based sample of adolescents and adults with ASD. Overall, autism symptoms and maladaptive behaviors were observed to improve over the study period. Above and beyond the adult's gender, age, and level of intellectual disability, greater improvements were associated with higher levels of maternal praise (based on maternal speech samples) and higher quality mother-child relationships. Implications for future research and intervention are discussed.