Psychodynamic Therapy and Intellectual Disabilities: Dealing with challenging behaviour

One of the most serious problems facing families and care staff concerns the treatment of extremely behaviourally disturbed individuals with an intellectual disability. Frequently these people are termed "dual-diagnosed" or with "challenging behaviour." The kinds of behaviour which present in this group can be broadly described as extremely aggressive either in their environment, to others (parents, staff, and other residents), to themselves (self-injurious behaviour which in its extreme forms are life threatening), or who are so withdrawn that living with others is unbearable. Treatment is often only possible in closed facilities and with special medication, as the prognosis for community living and social acceptance is extremely poor. In this article some theoretical material on a psychodynamic orientation concerning the diagnosis and treatment of mental illness in this group is presented. Four cases concerning long term treatment are then described--an extremely aggressive young man with a mild intellectual disability, a young man with multiple disabilities whose behaviour is destructive, a very withdrawn young woman with life threatening self-destructive behaviour, and a young autistic man with a broad spectrum of extremely uncontrollable behaviour. Finally, the success and limitations of the approach are discussed.     

Evaluating Circle Time as a support to social skills development – reflections on a journey in school-based research

The authors of this article argue that deficit in socially skilled behaviour is often one of the distinguishing characteristics that sets people with intellectual disability apart from their non-disabled peers. The need for social skills training to take place within the context of real life daily situations has been emphasised in more recent literature as essential in enabling people with an intellectual disability to generalise new skills. The researchers involved in this study, Catherine Canney, a senior educational psychologist, and Alison Byrne, a senior speech and language therapist, both work in a school for children with mild intellectual disability in Ireland as part of a multidisciplinary team. Analysis of teachers' referrals to the team indicated a significant and ongoing need for supporting social skills development among the students.
The purpose of this study was to investigate the merits of Circle Time as a classroom intervention aimed at improving the social skills of students with a mild intellectual disability. The research is presented here as an evaluative case study reflecting this experience. Organisational and interactional issues arising are presented and discussed with the intention of supporting those involved in facilitating Circle Time with children who have special educational needs. The authors also identify avenues for future research.     

Reduce,manage or cope: a review of strategies for training school staff to address challenging behaviours displayed by students with intellectual/developmental disabilities

Members of a knowledge translation and exchange (KTE) research team assessed the training needs of the teaching staff at a school for individuals with intellectual/developmental disabilities (IDD). In response to this need, KTE researchers retrieved peer‐reviewed articles for training staff working with individuals with IDD who exhibit challenging behaviours. These articles were categorised according to the following training content: (1) interventions designed to reduce the frequency of challenging behaviours; (2) appropriate ways to manage challenging behaviours in the moment to promote safety for all parties and/or to terminate the ongoing behaviour; and/or (3) procedures or perspectives relevant to coping with or ameliorating the negative impacts of challenging behaviours on staff. We then examined the training methods (teaching strategies, training duration) involved in teaching the content and assessed the effectiveness of these programmes. Overall, we found that effective training programmes consisted of workshops, practica and feedback on specific skill performance. Some forms of brief training were effective for increasing staffs' knowledge/skills and reducing the frequency of challenging behaviour.     

Evaluation of Self by Young People with Down Syndrome

There have been relatively few studies of self-esteem with young people with moderate and severe intellectual disability. One reason for this is likely to be measurement difficulties. The purpose of the present study was to assess the usefulness of three measures of self-esteem in 72 young people with Down syndrome aged from 17 to 24 years. Forty-five young people, mean VMA 5 years 10 months, were assessed on the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children and the Joseph PreSchool and Primary Self-Concept Screening Test. Nineteen young people, mean VMA 8 years 9 months, completed the Self-Perception Profile for Learning Disabled Students. Validity was assessed by reading scores and by interviews with the young people and their parents. Eight young people with the most severe intellectual disability could not do any test; the remainder were able to respond to the format of the appropriate tests. On all measures they rated themselves positively. Internal consistency estimates were high, but validity was only demonstrated for the Self-Perception Profile for Learning Disabled Students, supporting its use with the young people who had VMAs of around 7 years. Evaluation of self also showed a standard developmental trend.     

Parents with Intellectual Disability Learning to Parent: the role of experience and informal learning

Parenthood for people with intellectual disability remains controversial. This is so despite current concern about the participation of people with intellectual disability in socially valued roles. Formal parent training is frequently presumed necessary to teach competent parenting. Effective programs require specific skill assessment followed by performance‐based training. Training needs to include modelling, practice, and feedback and to occur in situations where the skill is needed. The role of the informal and naturally occurring context of parenting‐‐the context of everyday family life‐‐has been overlooked. Drawing on an ethnographic study of family life with six parent couples, two central themes on the role of informal learning and experience in parenting are reported. Several ways in which service providers can take account of the experiential nature of learning about parenting are proposed.     

Inclusion: identifying potential stressors for regular class teachers

This research investigates the potential stressors for teachers during inclusion. The study reports findings from 571 Queensland primary school teachers who were involved with including a child with a moderate or severe intellectual disability in their regular classrooms. Teachers who responded to the Teacher Stress and Coping Questionnaire (TSC) did not appear to be overly stressed by inclusion. Issues that related to a teacher's professional competence and the behaviour of the child with the intellectual disability were the most stressful for teachers. Female teachers reported greater stress than their male counterparts when coping with classroom issues. An increase in number of years involved with inclusion and participation in formal training were associated with a reduction in stress. Discussion focuses on the need to identify potential stressors during inclusion to enable more appropriate preservice and inservice training and support to be provided.     

Conditions of Employment of Residential Direct-Care Staff in The Netherlands as Related to Their Distribution of Activities

This study investigated the relationship between conditions of employment of direct-care staff in The Netherlands and the distribution of their activities in residential facilities for people with intellectual disability. Three hundred and eighty-eight direct-care staff working at 39 living groups in 10 residential facilities participated. Data were obtained by natural observations. The results suggest that (a) leaders of living groups are clearly different from other direct-care staff in terms of their distribution of activities, (b) educational and training level of staff did not differentially affect resident-oriented care, and (c) extent of contract does affect time staff spend on organisation and housekeeping. Generally, employee characteristics tended to affect nonresident-oriented activities of direct-care staff (i.e., organisation, housekeeping, and off-task) rather than resident-oriented activities, such as stimulative custodial care, recreation, and training.     

An exploratory study investigating the viability of a communication and feedback intervention for school children at risk of exclusion: analysis of staff perspectives

Every day nearly 900 children will be excluded from UK schools for disruptive behaviour and almost one-third of this population has a diagnosed mental health disorder. Exclusion from school is the endpoint of most schools’ sanction-based behaviour management policies. This exploratory study investigated staff opinions for using a communication and feedback intervention for children at risk of exclusion from school. Workshops to demonstrate the model were facilitated for staff participants followed by group interviews. The interview data were analysed using Template Analysis. Staff considered the intervention as viable both for themselves and for children at risk of exclusion. The analysis highlighted two broad categories: Communication Skills Training; weighing the potential, and Adapting to the Population. Sub-categories encompassed a range of factors related to the viability of the model and potential outcomes for both staff groups and young people. Due to ethical considerations, children were not recruited at this exploratory stage, but further investigation is warranted with child participants to ascertain their views. Psychologists working within schools are in a good position to utilise the model for both staff training and interventions.     

Assessing the Occurrence of Learning in Children with Profound Intellectual Disability: A Conditioning Approach

Although children with the most profound forms of intellectual disability are clearly capable of learning, they are frequently unable to acquire skills and knowledge through the familiar social learning processes of modelling and verbal instruction. Instead, they rely on more basic learning processes, such as habituation, classical conditioning, and operant conditioning. This paper defines these basic processes and indicates their importance in allowing behaviour to adapt flexibly to changing environmental circumstances. Research on basic learning processes in which children and young adults with profound intellectual disability have acted as participants is then evaluated. The literature indicates that work of this kind is of clear relevance to those involved in facilitating the development and education of children with intellectual disability. This is because research and theory in the area of learning suggests effective ways of assessing non‐verbal children's cognitive capabilities and preferences and indicates ways of changing behaviour to produce educational outcomes and remediation of problem behaviours. Work of this kind thus provides the basis for intervention programs that can enhance the quality of life for this most disadvantaged group of children.     

‘They’re a lot cleverer than I thought’: challenging perceptions of disability support staff as they tutor in an adult literacy program

Being literate empowers individuals to be effective consumers, to be informed about lifestyle options, to read aesthetically for relaxation and enjoyment and to further their knowledge of people and places that can enable them to participate more fully in communities. However, there are limited literacy opportunities and programs specifically designed to meet the needs of individuals with intellectual disabilities across their lifespan. The aim of this Australian National Training Authority funded project was to develop and implement a training, teaching and resource package for the development of literacy for adults with intellectual disabilities. The aim of this project was to assess, develop, train and assist support staff in two community‐based services for clients with intellectual disabilities to act as literacy tutors for their clients. The project was undertaken within two disability‐service programs using an applied action research approach. The results indicated that the tutors learnt much about tutoring and about the literacy abilities of their clients. There was some initial resistance from the tutors about the value of literacy learning for their clients. However, resistance decreased as tutors developed confidence, and clients demonstrated interest, engagement and skills in the activities. Implications for the effectiveness of such programs lie in the needs to tailor any training specifically to the needs of the support staff; and to provide time for implementation, on‐going support and access to appropriate resources.     

Special Education Policy for Learners with Mild Intellectual Disability in New Zealand: Problems and Issues

Current policy developments are intended to broaden the group of children receiving special education provisions traditionally reserved for those with mild intellectual disability. A definite policy has been formulated to close special classes and the use of individualized intelligence testing has been largely discontinued as a basis for establishing special educational need‐‐thus ostensibly providing greater flexibility for service allocation. The term “backward” (the traditional term for mild intellectual disability in New Zealand) has been rejected, and children with mild intellectual disability are now included in a new category “children with educational and social difficulties"‐‐a category which also includes children with specific learning difficulties, those with mild sensory disabilities, and those with mild emotional/behavioural difficulties. It is argued that available resources are grossly insufficient to provide high quality special educational services for all “children with educational and social difficulties,” that the decision to close special classes represents a premature and unsound reduction in the range of options available to children with mild intellectual disability, and that research into the effects of current policies on the lives of learners with mild intellectual disability and their families is urgently required but will now be very difficult to undertake.     

Effects of Social Skills Training for Students with an Intellectual Disability

This study examined the effects of a computer‐assisted social skills intervention on the social competence of 73 students with a mild intellectual disability (age range: 11.0 to 15.0) within an experimental and control group design. The experimental group (N= 38) was trained with the I Found a Solution computer‐supported package while the control group (N= 35) worked on computer‐related keyboard and writing skills. The intervention consisted of the computer‐supported program and teacher‐guided work, small‐group discussions and transfer to actual real‐life conflicts. Each student was assessed before and after the training on: teacher‐rated social skills and disruptive behaviour, peer‐rated social acceptance, and self‐rated loneliness. A 2‐way MANOVA with repeated measures (grouping by gender, with pre/post training scores as the repeated measures) revealed that the experimental group increased their different measures of social competence, and the differences between them and the control group were significant following the intervention. However, no significant differences between the experimental and control groups were found in their loneliness experience. Implications for intervention and additional research are discussed.     

Competence is in the Eye of the Beholder: Perceptions of intellectually disabled child witnesses

This study examines mock jurors’ perceptions of a young witness according to whether or not he was described as having an intellectual disability. Our study examined perceptions of a child witness younger (five or seven years) than previously studied. Mock jurors (n = 71) viewed a short video excerpt of a boy recalling a personally experienced event, and then rated him across nine domains of eyewitness ability. The boy was described as either having an intellectual disability or typically developing. Participants rated the child more negatively on dimensions relating to cognitive competence, but not trustworthiness, when he was presented as having an intellectual disability. Participants also watched the child answer a series of suggestive questions; when described as having an intellectual disability he was rated as less accurate in responding to these. The findings have implications for the involvement of children with intellectual disabilities within the legal system.     

Changes in domain specific self-perception amongst young people with intellectual disability: a longitudinal study

This study examines the changes that occur in multidimensional self-concept of adolescents with a diagnosis of intellectual disabilities, across gender and category of intellectual disability (borderline, mild, moderate) groups. A sample of 54 young people completed the Harter Self-Perception Profile. Using a three-wave longitudinal study conducted during their first year in a segregated special second-level school, stability and change in multiple domains of self-perception were examined. Findings indicate that gender and level of cognitive function are important variables in changes in self-perception across time, highlighting the heterogeneous nature of the special school population.     

A Comparison of Self-Observation,Self-Modeling,and Practice Without Video Feedback for Improving Counselor Interviewing Behaviors

This study evaluated the effects of three different feedback procedures on counselor trainees' interviewing behaviors that were judged by their supervisors as being inappropriate in a counseling session. In addition to informing each trainee in writing of the specific target behavior(s) he or she was to attempt to improve, the feedback conditions consisted of either (a) self-observation of edited videotapes of appropriate-only behavior (entitled self-as-a-model), (b) self-observation of unedited videotapes of appropriate and inappropriate behaviors, or (c) practice without video feedback. The results indicate that all three feedback strategies promoted the reduction of inappropriate interviewing behaviors. Only the self-as-a-model technique (self-observation of appropriate-only responses), however, completely extinguished the occurrence of inappropriate interviewing behaviors. Of the seven inappropriate behaviors monitored for the group using self-as-a-model, five were completely extinguished after only three practice sessions.     

RESEARCH SECTION: Provision in further education colleges for 14‐ to 16‐year‐olds with social,emotional and behavioural difficulties

Previous research set out to identify and examine practice and provision for young people exhibiting behaviour problems who may have been placed in colleges of further education for a variety of reasons. In this paper, Natasha Macnab, John Visser and Harry Daniels explore some of the implications faced by college staff and examine some of the key themes that emerged from this previous study. The first of these themes concerns ‘college culture’, which is seen as being ‘adult orientated’ and therefore more likely to appeal to young people who are tired of school. Indeed, college staff suspect at times that schools are using the transition to college as an alternative to exclusion for some young people. This form of ‘managed transfer’ raises real issues in colleges, especially when some members of college staff do not yet appreciate the ‘appeal of teaching young people with social, emotional and behavioural difficulties (SEBD)’, regarding them as ‘disaffected’ and ‘switched off’ from education. The authors of this article note the need for ‘skilled and committed adults’ to build relationships with these young people in order to promote their social inclusion. They argue that this work will require professional development for staff but will have real benefits for the young people concerned.     

Physical education and sport and special needs in Germany

Abstract

Historically, in Germany individuals with special needs have been offered participation in physical education (PE) both in segregated and increasingly in integrated settings. Specific curricula for children with disabilities (physical disabilities, hearing, and visual impairments, speech and behaviour disorders as well as intellectual disabilities) were developed in the 1960s and 1970s. They all emphasized the specific importance of physical activities for people with a disability focusing not only on motor competencies but also on the psychological and social benefits of physical education. During the 1970s so‐called model schools started to include children with disabilities in mainstream schools. Unlike developments in the United States, for example, where integrated or mainstream schooling was based on legal requirements, in Germany improved integration or inclusion was not based on federal law, but on parents’ or teachers’ initiatives in different Bundesländer (states of Germany). Parallel to these developments, new approaches to PE have accentuated a positive orientation towards ‘ability’ rather than ‘disability’. Professionals in PE in universities and in schools have been challenged to develop better diagnostic skills and more individualized programmes. On the initiative of nine European universities, a European Master's degree of Adapted Physical Activity has been developed to offer advanced training on a European scale. However, despite these positive and innovative developments serious concerns remain concerning the situation of children with disabilities in the school system. This article argues that there is still a significant lack of specially trained professionals and support staff and that the ongoing process of reducing the amount of PE in schools for all children, including those with a disability, does not contribute to improved physical and social skills or increased participation in recreational and sport activities outside schools.     

‘THOMAS’ Training: An early years intervention for children with an autistic spectrum disorder (ASD)

The ‘THOMAS’ course (The Hampshire Outline for Meeting the needs of under fives on the Autistic Spectrum) is a four‐day training programme to enhance the learning of young children with impairments in social understanding, communication and play by increasing the use of appropriate interventions. It has been supporting families and professionals in the early years settings for over five years and feedback has been exceptionally positive. This article reviews the extent to which training skills have been embedded in the long‐term. Results indicate that the training is still as effective a year on, with many techniques, including visual structure and behaviour management, seen as highly effective interventions. Furthermore, there is an indication that course participants may experience an increase in confidence that enables them to become more independent and generate their own solutions as skills and knowledge become embedded over time.     

Post-secondary education for young people with intellectual disabilities: A systematic review of stakeholders’ experiences

Post-secondary education (PSE) is an important option in the educational and employment paths of students with intellectual disabilities (ID). However, PSE for young adults with ID is not in wide use across the world. Different issues might affect the geographical spread of PSE programmes. Some of these are related to the attitudes, expectations and/or funding for those programmes. In this systematic review, the PSE experiences of different stakeholder groups (young adults with ID, their parents, PSE staff and students without a disability) were examined by reviewing findings across 22 studies that investigated PSE for students with ID. This examination encompassed attitudes and motivation to engage with PSE, as well as stakeholders’ perceived barriers and facilitators in accessing and remaining in the three PSE models (separate, inclusive and mixed). Students with ID and their parents were the stakeholder groups least represented in the available evidence. Findings suggested that most stakeholder groups reported positive experiences of PSE derived mostly from gains in social skills and independence. Several barriers to accessing PSE were reported by each group, namely physical and academic barriers by students with ID, an understanding of the PSE system by their parents, and the lack of training by PSE staff. Evidence from the present review seems to indicate that inclusive PSE models were associated with a more positive experience across stakeholder groups.     

Family Contribution to the Vocational Lives of Vocationally Competent Young Adults with Intellectual Disabilities

This paper reports the results of a qualitative research study of vocationally competent young adults with mild intellectual disabilities. The purpose of the study was to examine the contributions which families made to the success of these young adults in competitive employment. The participants were clients of a competitive employment and training program who were purposively sampled using the criterion of having maintained competitive employment for 6 months and ranged in age from 19 to 30 years. The data were collected through semi-structured interviews with the participants and some of their family members. Content analysis was used to generate categories and themes. The significant finding was how families contribute to the individuals' efforts to maintain competitive employment. Analysis of the themes indicated that certain family characteristics led to more successful employment outcomes. These characteristics were moral support, practical assistance, role models of appropriate work ethic, protection from difficulties and exploitation, and family cohesion. An interesting finding was that the families responded to these young people as if they were in an earlier developmental stage except in the area of employment. Implications for families and vocational education practitioners are suggested.