Search

This study aimed to compare cognitive and memory abilities between older adults with and without autism over the age of 50. Twenty-eight individuals with autism and 29 typically developing (TD) older adults took part in the current study. Participants' cognitive and memory abilities were assessed by WAIS-IV and WMS-IV. Older autistic adults were found to have poorer performance in processing speed and visual working memory, but they performed at a similar level as TD controls in all other domains. Poorer processing speed and visual working memory are also often found to be associated with age-related decline in neurotypical adults. Longitudinal studies are warranted to explore how the combination of ageing and autism affects cognitive functioning in older adults. [ABSTRACT FROM AUTHOR]

Research on the experience of growing older with autism is very limited. In this study, 13 people with autism aged over 50 years participated in semi-structured interviews about their experiences of diagnosis, social support and getting older. Interviews were analysed using thematic analysis. Three overarching themes were generated: difference, life review and longing for connection. Prior to diagnosis, individuals had awareness of their difficulties, attributed these to intrinsic difference and engaged in a deliberate process of reducing the visibility of this difference. Diagnosis prompted a process of life review and externalisation, whereby past negative experiences were reattributed to autism as opposed to the self. Loneliness, isolation and yearning for interpersonal connection were ubiquitous and longstanding. Autism support and social groups were highly valued, offering opportunities for belonging, acceptance and social comparison. Results highlight the similarity to younger age groups in terms of lived experience and need for greater support, particularly with respect to reducing isolation and improving access to diagnosis. [ABSTRACT FROM AUTHOR]

Purpose – Whilst there is a growing evidence base for the use of cognitive behavioural therapies (CBT) for people with intellectual disabilities, there may be challenges to using an approach that locates problems within people rather than as being generated and maintained through social relations and social discourses. The purpose of this paper is to present a cautionary case that demonstrates some of the potential dilemmas and challenges that can be experienced in therapy when applying this way of working to a client with intellectual disabilities. Design/methodology/approach – The authors present a case example of work with Mark, a young man with intellectual disabilities who accessed services for support with his low mood and outline the challenges faced when using CBT in understanding his presenting problem. Findings – There is evidence from the case example that there is the potential for therapeutic techniques used in CBT to promote questions that invite, generate and reinforce feelings of incompetence and inability in people with intellectual disabilities. Originality/value – The use of narrative techniques is discussed as a means of avoiding locating the problem as being within clients with intellectual disabilities; the implications that this has for the use of CBT with this client group are considered. [ABSTRACT FROM AUTHOR]

Research into the relationship between stigmatization and well-being suggests that identification with a stigmatized group can buffer individuals from the adverse effects of stigma. In part, this is because social identification is hypothesized to provide a basis for social support which increases resistance to stigma and rejection of negative in-group stereotypes. The present research tests this model among individuals with mental health problems. As hypothesized, group identification predicted increased social support, stereotype rejection, and stigma resistance. These self-protective mechanisms were in turn found to predict higher levels of self-esteem. However, the general effect of these associations was to suppress a negative relationship between social identification and self-esteem. This confirms that the positive impact of identification lies in its capacity to provide access to stress-buffering mechanisms but also indicates that the impact of identification with a severely stigmatized group is not necessarily positive. Implications for theory and practice are discussed. [ABSTRACT FROM AUTHOR]

Two studies are presented which examine self-evaluation in adolescents with learning difficulties and how these adolescents strategically protect their self-concept through the use of social comparison. Study one involved 145 adolescents with learning difficulties and the same number of non-disabled adolescents aged between 11 to 16 years. All adolescents completed Harter's ‘Self Perception Profile for Children’ (SPPC). No significant overall differences were found between the self-evaluations of the adolescents with learning difficulties and non-disabled adolescents. In addition, adolescents with learning difficulties strategically devalued less favourable comparison dimensions and valued more positive comparison attributes. Study two utilized a four condition between-groups design with a sample of 68 adolescents with learning difficulties. All participants completed the SPPC, but the availability of a social comparison group was systematically varied between conditions. The self-evaluations made by adolescents changed significantly when the social comparison group made available was altered. The findings are discussed with regard to their theoretical implications and in terms of inclusion policies for adolescents with learning difficulties. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper considers current workforce issues facing psychological professionals working in NHS services, examining the challenges, and identifying opportunities to better meet the needs of autistic people and people with an intellectual disability (PwID) across the lifespan. The aim of this paper is to identify and publicly articulate the need for a coherent approach to guide the practice of psychological professionals when helping autistic people and/or PwID. It should be noted that the scope of the paper is limited to autism and intellectual disability. In addressing these broad groups and their co-occurring conditions and needs, we anticipate that many principles could be applied to other neurodevelopmental conditions. We also note the significant potential challenges in linking intellectual disability and autistic populations, hence have attempted – in drawing together a working group to write this paper – to ensure representation from a range of psychological professionals including those in policy, leadership, and training roles, those working in specialist or generic mental health services and undertaking clinical research across the lifespan. Objectives: ■ To help define and support clear action so that all sectors welcome and adequately support people with neurodevelopmental differences, including autistic people and/or PwID. ■ To play a role in the development, planning and evaluation of new psychological professions roles such as the Clinical Associates in Psychology (CAPS) and Education Mental Health Practitioners (EMHPs). ■ To reflect on the obstacles to recruiting to autism and learning disability services and to propose approaches to developing a sustainable psychological workforce in these areas. ■ To recognise where good examples of education and training programmes exist to address training, confidence and competence for all psychological professionals working with those who may be autistic and/or have an ID, and consider how to establish a more consistent approach to education, training and CPD across the workforce. ■ To engage in policy discussions around the current gaps, such as the demand for diagnostic assessments and support which significantly outstrips capacity, whilst highlighting unrealised opportunities, through for example, a systematic approach to training. ■ To advocate for the need for the voice of autistic people and PwID and their families/carers which is often absent from the design and offer of help. [ABSTRACT FROM AUTHOR]

Introduction: The Resident Choice Assessment Scale (RCAS) is used to assess choice availability for adults with intellectual disabilities (ID). The aim of the study was to explore the factor structure, construct validity, and internal consistency of the measure in community settings to further validate this tool. Method: 108 paid carers of adults with ID living in supported accommodation and residential care facilities in urban, rural, and semirural areas in England completed the RCAS. Exploratory factor analyses were performed and the construct validity and internal consistency of the emerging factors were assessed. Results: Principal axis factoring with oblique rotations suggested a scale with two factors (Everyday Choices and Participation in Household Activities) which explained 45% of the variance; the factors showed favorable construct validity as they identified significant differences between those living in residential care homes compared with supported living; the factors also differentiated between people with different levels of intellectual impairment with less choice and participation in domestic activities for those with more severe ID compared to their counterparts with moderate and mild impairment. Five items did not load onto any factor, suggesting that these could be dropped from the scale when administered in community settings, thus resulting in an 18-item measure (RCAS-18). Conclusion: The RCAS-18 may provide a useful measure to assess choice availability for people with ID supported by paid carers in the community. The revised measure may be more suitable in capturing choice than the original version for use in community samples. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disabilities are at risk of experiencing stigma and require the skills and confidence to deal with stigma in their daily lives. Method: Development and piloting of a 5‐session manualised psychosocial group intervention designed to increase the capacity of people with intellectual disabilities aged 16+ to manage and resist stigma. Ten pre‐existing groups (N = 67) in third sector and education settings participated. Interviews with participants (n = 26), facilitators (n = 9) and significant others (n = 7) 2–4 months after the intervention assessed perceived impact. Results: Perceived benefits of the intervention for participants included increased understanding, improved connections with others, drive for advocacy, increased activity and self‐efficacy, and opportunity to process difficult events and emotions. Differential impact depending on individuals' pre‐existing self‐advocacy skills was noted. Conclusions: This early‐stage study indicates that further evaluation is merited to examine feasibility and outcomes of the STORM intervention. [ABSTRACT FROM AUTHOR]

The increasing complexity and uncertainty of the future may stimulate demand for more monitoring emerging issues. Futurists have long advocated for monitoring the future on an ongoing basis or for tracking the findings of project work in practice. However, clients have historically been reluctant to invest time and money in monitoring, and little practical guidance is available on how to set up a monitoring. This article describes a pilot monitoring capability that is simple and practical to implement. It was developed as a "plug-in" to supplement an ongoing horizon scanning system. The monitoring system tracks the movement of emerging issues that were identified by horizon scanning. It provides a means to keep policy-makers informed about the progress of emerging issues and provides advance warning to develop an appropriate strategic response. [ABSTRACT FROM AUTHOR]

Background: Although Positive Behaviour Support (PBS) is a widely used intervention for ameliorating challenging behaviour (CB), evidence for its use in adults with intellectual disability (ID) and comorbid autism (ASD) is lacking. We report a planned subsidiary analysis of adults with both ASD and ID who participated in a randomised trial of PBS delivered by health professionals. Methods: The study was a multicentre, cluster randomised trial conducted in 23 community ID services in England, participants were randomly allocated to either the delivery of PBS (n = 11 clusters) or to treatment as usual (TAU; n = 12). One-hundred and thirteen participants (46% of all participants in the trial) had a diagnosis of ID, autism spectrum disorder and CB (ASD+); (47 allocated to the intervention arm, and 66 to the control). CB (primary outcome) was measured with the Aberrant Behaviour Checklist total score (ABC-CT). Secondary outcomes included mental health status, psychotropic medication use, health and social care costs and quality adjusted life years (QALYs) over 12 months. Results: There were no statistically significant differences in ABC-CT between ASD+ groups randomised to the two arms over 12 months (adjusted mean difference = − 2.10, 95% CI: − 11.3 7.13, p = 0.655) or other measures. The mean incremental cost of the intervention per participant was £628 (95% CI -£1004 to £2013). There was a difference of 0.039 (95% CI − 0.028 to 0.103) for QALYs and a cost per QALY gained of £16,080. Conclusions: Results suggest lack of clinical effectiveness for PBS delivered by specialist ID clinical teams. Further evidence is needed from larger trials, and development of improved interventions. Trial registration: ClinicalTrials.gov: NCT01680276. [ABSTRACT FROM AUTHOR]

Background: Positive Behaviour Support (PBS) for challenging behaviour is a complex intervention. Process evaluation is pivotal in fully understanding the mechanisms and contextual factors that impact on participant outcomes. Aims: To conduct a process evaluation of a national clinical trial investigating the impact of PBS-based staff training on the level of challenging behaviour in adults with intellectual disability. Method: The Medical Research Council guidance for process evaluation of complex interventions was followed. Semi-structured interviews with 62 stakeholders from the intervention arm (service users, family and paid carers, service managers, staff who delivered the intervention and PBS trainers), quantitative data from the study database and an external evaluation of the quality of the PBS plans were used. Results: Twenty-one health staff volunteered to be trained in delivering PBS. Available log data from 17 therapists revealed that they worked with 63 participants a median of 11.50 hours (IQR 8–32). Only 33 out of 108 reports had included all elements of the intervention. Another 47 reports had some elements of the intervention. All PBS plans were rated weak, indicating insufficient quality to impact challenging behaviour. Stakeholders reported an appreciation of PBS and its potential to impact quality of care and engagement with the participant. However, they also identified important challenges including managing PBS-related caseloads, paid carer turnover and service commitment to the delivery of PBS. Conclusions: PBS-based staff training was well received, but therapists found it difficult to undertake all the elements of the intervention in routine care. Implementing a workforce training strategy is important to better define the active components of PBS, and resource implications if the intervention is no better than usual care. [ABSTRACT FROM AUTHOR]

We developed a brief, informant-report interview for assessing autism spectrum conditions (ASC) in adults, called the Developmental, Dimensional and Diagnostic Interview-Adult Version (3Di-Adult); and completed a preliminary evaluation. Informant reports were collected for participants with ASC (n = 39), a non-clinical comparison group (n = 29) and a clinical comparison group (n = 20) who had non-autistic mental health conditions. Mean administration time was 38 min (50 min for ASC). Internal consistency (αs ≥ 0.93) and inter-rater agreement (ICCs ≥ 0.99) were high. When discriminating ASC from non-ASC, the 3Di-Adult showed excellent sensitivity (95%) and specificity (92%). The 3Di-Adult shows promise as a psychometrically sound and time-efficient interview for collecting standardised informant reports for DSM-5 assessments of ASC in adults, in research and clinical practice. [ABSTRACT FROM AUTHOR]

Our STORM intervention was developed for people (16 +) with intellectual disabilities to enhance their capacity to manage and resist stigma. The current study describes the adaptation of STORM for (synchronous) on-line delivery in the context of the Covid-19 pandemic. To adapt the manualised face-to-face STORM group intervention for delivery via web-based meeting platforms and to conduct an initial pilot study to consider its acceptability and feasibility. The 5-session STORM intervention was carefully adapted for online delivery. In a pilot study with four community groups (N = 22), outcome, health economics and attendance data were collected, and fidelity of delivery assessed. Focus groups with participants, and interviews with facilitators provided data on acceptability and feasibility. The intervention was adapted with minimal changes to the content required. In the pilot study, 95% of participants were retained at follow-up, 91% attended at least three of the five sessions. Outcome measure completion and fidelity were excellent, and facilitators reported implementation to be feasible. The intervention was reported to be acceptable by participants. When provided with the necessary resources and support, people with intellectual disabilities participate actively in web-delivered group interventions. [ABSTRACT FROM AUTHOR]

Background: Many people with intellectual disability present with challenging behaviour which often has serious consequences such as the prescription of long term medication, in-patient admissions and disruption of normal daily activities. Small scale studies of Positive Behaviour Support (PBS) delivered by paid carers suggest that it reduces challenging behaviour and costs of care and improves quality of life. This study aims to investigate whether professionals training in the delivery of PBS as part of routine practice is clinically and cost effective compared to treatment as usual in community intellectual disability services. Method: The study is a multi-centre cluster randomised controlled trial involving community intellectual disability services in England and service users with mild to severe intellectual disability and challenging behaviour. The teams will be randomly allocated into one of two conditions, either training and support to deliver PBS or treatment as usual. We will carry out assessments of challenging behaviour, use of services, quality of life, mental health, and family and paid carer burden at six and 12 months. We will monitor treatment fidelity and we will interview a sample of paid and family carers, service users, staff and managers about what they think of the treatment and how best we can deliver it in routine care. The main outcome is reduction in challenging behaviour at one year after randomisation. We will also carry out a health economic evaluation to examine the costs and consequences of staff training in PBS. Discussion: The study findings will have significant implications for the delivery of PBS in community based services with the potential for reducing inpatient admissions and out-of-area placements for adults with intellectual disability and challenging behaviour. [ABSTRACT FROM AUTHOR]

In this paper, we focus on fluid–structure interaction (FSI) modeling of ringsail parachutes, where the geometric complexity created by the “rings” and “sails” used in the construction of the parachute canopy poses a significant computational challenge. It is expected that NASA will be using a cluster of three ringsail parachutes, referred to as the “mains”, during the terminal descent of the Orion space vehicle. Our FSI modeling of ringsail parachutes is based on the stabilized space–time FSI (SSTFSI) technique and the interface projection techniques that address the computational challenges posed by the geometric complexities of the fluid–structure interface. Two of these interface projection techniques are the FSI Geometric Smoothing Technique and the Homogenized Modeling of Geometric Porosity. We describe the details of how we use these two supplementary techniques in FSI modeling of ringsail parachutes. In the simulations we report here, we consider a single main parachute, carrying one third of the total weight of the space vehicle. We present results from FSI modeling of offloading, which includes as a special case dropping the heat shield, and drifting under the influence of side winds. [ABSTRACT FROM AUTHOR]

The stabilized space–time fluid–structure interaction (SSTFSI) technique developed by the Team for Advanced Flow Simulation and Modeling (T★AFSM) was applied to a number of 3D examples, including arterial fluid mechanics and parachute aerodynamics. Here we focus on the interface projection techniques that were developed as supplementary methods targeting the computational challenges associated with the geometric complexities of the fluid–structure interface. Although these supplementary techniques were developed in conjunction with the SSTFSI method and in the context of air–fabric interactions, they can also be used in conjunction with other moving-mesh methods, such as the Arbitrary Lagrangian–Eulerian (ALE) method, and in the context of other classes of FSI applications. The supplementary techniques currently consist of using split nodal values for pressure at the edges of the fabric and incompatible meshes at the air–fabric interfaces, the FSI Geometric Smoothing Technique (FSI-GST), and the Homogenized Modeling of Geometric Porosity (HMGP). Using split nodal values for pressure at the edges and incompatible meshes at the interfaces stabilizes the structural response at the edges of the membrane used in modeling the fabric. With the FSI-GST, the fluid mechanics mesh is sheltered from the consequences of the geometric complexity of the structure. With the HMGP, we bypass the intractable complexities of the geometric porosity by approximating it with an “equivalent”, locally-varying fabric porosity. As test cases demonstrating how the interface projection techniques work, we compute the air–fabric interactions of windsocks, sails and ringsail parachutes. [ABSTRACT FROM AUTHOR]