Search

This study aims to develop a valid and reliable assessment tool for the assessment of safety skills of individuals with intellectual disabilities, examine the effectiveness of the Safety Skills Instruction Program (SSIP) in teaching safety skills to these individuals, determine the preservation of skills after instruction by observation, and determine the views of parents and students respecting the teaching of safety skills. This research is designed in an explanatory sequential design, which is one of the mixed research methods. The examination of the construct validity process has indicated that the Safety Skills Test (SST) has a structure of four factors. 540 individuals with intellectual disabilities participated in the development of the measurement tool, and 32 individuals with intellectual disabilities participated in the implementation of the curriculum. It is determined that the level of safety skills of the students with mild intellectual disabilities who have attended the instruction is higher than the ones who have not attended, according to the mean ranks. It is found that the safety skills of students are preserved at a rate of 85-85%, according to the observation data gathered one week later. According to the result of the interview data, students and parents feel pleased about the instruction and think that the skills have been learned to a large extent.

This study aims to describe the use of technology in learning for students with special needs during the transition period after the COVID-19 pandemic to the new normal. This study is descriptive research with a survey method. The survey was conducted with 41 special education teachers with variety of special needs students. Data is collected using Google Form questionnaires. Data analysis is carried out by calculating the frequency and is presented as percentages. Participants in this study were chosen randomly for data variation. The presentation of data is carried out qualitatively based on the respondents' answers to the questions asked. The study participants argued that hybrid learning was feasible, even though it was recognized as encountering obstacles. Based on the results of a survey conducted by special education teachers at special education school (SLB), for hybrid learning, digital platforms are used to support online learning. The platforms used are WhatsApp and video conferencing, such as Google Meet. Integrating technology is considered important for teachers to support the learning process. Conscious and planned efforts and teacher motivation are critical to increasing their experience and skills in utilizing technology in learning.

This paper addresses the question of why young Australians with intellectual disability (ID) remain underrepresented in open employment despite significant investment by various stakeholders. It uses the analogy of Whack-a-Mole (an arcade game) to draw attention to the complexity young people face during transition, and to illustrate how addressing one barrier in isolation is unlikely to result in successful transitions. In response to repeated calls for more holistic understandings of the transition process for young adults with ID, the paper draws upon the work of Urie Bronfenbrenner to present an adaptation of his model to map the ecologies of young people with ID's as they seek to transition from school to open employment. The model illustrates the complexity of transition, a proliferation of stakeholders, and traces how transition is contingent on much more than young adults with ID's capabilities. It invites further consideration of, and utility for, an ecological model as a basis for imagining possibilities to increase the number of people with ID in open employment and concludes by raising some questions that stakeholders might ask.

The field of special education for people with mental disabilities is a discipline that is constantly evolving and changing as well as being inclusive. Teachers working in this field are guiding the way as long as they improve their professional qualifications. Even if special education processes are under state guarantee, it is always a lifelong process that brings a financial obligation for families. Therefore, the field teachers should be a complementary element for the student in many areas such as development, change, education and rehabilitation. Music elements also find a prominent place among these complementary elements. However, the field teacher can only support this process on the basis of music to the extent that he/she realizes his/her own music-based competence professionally. In this direction, it was aimed to determine the music-based competencies of field teachers and their utilization of music elements in their lessons and the data were collected for this purpose. Because music is present in all areas of special education. However, it is not possible to employ a music professional for every special education institution. Therefore, the field teacher is expected to handle the process within the framework of inclusiveness. Within the framework of this idea, the study was conducted with 10 volunteer teachers who were reached during the 2021-2022 academic year. In order to obtain the data, 26 three-point Likert-type instructions were prepared and online interviews were conducted with each participant teacher. This study is a case study. The data were described on the axis of interpretive paradigm and categorized in the findings section. The validity and reliability of the instructions were ensured in line with the opinions of special education experts. As a result, it was found that the field teachers who participated in the study have music-based competence and consciously utilize music elements in their lessons. However, it was also seen that field teachers need music-based professional development. Therefore, it is an evident that they need professional development trainings on how to use music elements more effectively for non-musical purposes. It is essential to conduct this study with a group of more participants. Nevertheless, it is believed that the findings obtained have a quality that will pave the way for new researchers.

Despite the importance of reading comprehension, many secondary students with Intellectual Disabilities (ID) struggle with this skill. Students with ID also experience greater challenges in foundational literacy skills (i.e., skills related to phonological awareness) and the cognitive skills temporal processing and nonverbal reasoning (Van Wingerden et al., 2017, 2018). Limitations in these areas may make it difficult for students with ID to synthesize information (either when reading or listening to text) to be able to identify main ideas and summarize text -- essential reading comprehension skills. The inability to identify main ideas in text has important implications for middle school students with ID. Although several methods can be used to identify main ideas, Get the Gist (Klingner et al., 1998) is one of the most well-known strategies for main idea identification and has evidence of effectiveness supporting its use. The current article explains how teachers can provide middle school students with ID explicit instruction on how to use Get the Gist while also promoting students' background and vocabulary knowledge to support their reading comprehension needs.

This study aimed to describe the behavioral profile of individuals with SYNGAP1-ID. Parents/carers of 30 individuals aged 3-18 years old with a diagnosis of SYNGAP1-ID and 21 typically developing individuals completed the Vineland-3 Adaptive Behavior Scale and the Child Behavior Checklist. We found that those with SYNGAP1-ID showed fewer adaptive behaviors and higher levels of internalizing and externalizing behaviors across almost all domains compared to typically developing controls. There was some evidence that these differences were greatest in older children, and more apparent in those with co-occurring epilepsy. This characterization of the phenotype of SYNGAP1-ID significantly aids our understanding of the behavioral profile of this population and is a step towards the development of tailored interventions.

Individuals with intellectual and developmental disabilities (IDD) continue to experience disparities in health and well-being despite improved provisions of person-centered care. Patient-centered outcomes research (PCOR) translates evidence into practice for meaningful outcomes. This piece describes findings from an environmental scan and stakeholder outreach to identify and prioritize opportunities to enhance IDD PCOR data infrastructure. These opportunities include developing a standardized research definition; advancing data standards for service systems; improving capture of IDD at point of care; developing standardized outcome measures; and encouraging Medicaid data use for IDD research. Within this piece, we discuss the implications of addressing data gaps for enhanced research. While the identified activities provide a path towards advancing IDD PCOR data infrastructure, collaborative efforts between government, researchers, and others are paramount.

Measurement invariance (MI) is a psychometric property of an instrument indicating the degree to which scores from an instrument are comparable across groups. In recent years, there has been a marked uptick in publications using MI in intellectual and developmental disability (IDD) samples. Our goal here is to provide an overview of why MI is important to IDD researchers and to describe some challenges to evaluating it, with an eye towards nudging our subfield into a more thoughtful and measured interpretation of studies using MI.

This article comprehensively reviews motor impairments in children with autism spectrum disorder (ASD) to: (1) determine the prevalence of motor problems in children with ASD; (2) understand the nature of motor difficulties in ASD and whether they are consistent with developmental coordination disorder (DCD); and (3) determine if the term DCD was used as a co-occurring diagnosis in children with ASD after publication of the DSM-5 in 2013. The following databases were systematically searched: MEDLINE, EMBASE, CINAHL, and PsycINFO from 2010 to December 2021. Articles were included if they: (1) were peer-reviewed and published in a scientific journal; (2) included children with ASD who were between 5 and 12 years; (3) used motor or function measures to assess motor abilities in children with ASD. Studies that included children with intellectual disabilities were excluded. Two independent reviewers reviewed titles, abstracts, and full-text articles for inclusion. Twenty-seven studies met the inclusion criteria and were assessed for quality by two independent reviewers using the Appraisal tool for Cross-Sectional Studies. The majority of articles (92.5%) indicated that 50-88% of children with ASD had significant motor impairments on standardized motor assessments and/or functional questionnaires. The nature of motor and function problems in ASD were consistent with DCD; however, only three out of 20 papers (15%) that were published from 2014 described the motor problems as DCD. One study reported that 15.1% of children with ASD with motor impairments had a co-occurring diagnosis of DCD, suggesting that DCD is under-recognized in this clinical population.

Autistic individuals with intellectual disability are at greater risk of experiencing anxiety than their non-autistic peers without intellectual disability. Anxiety in this group may present as behaviour that challenges, often leading families to reach out to healthcare or support services. However, many families experience difficulties accessing services and, due to the lack of research into evidence-based anxiety interventions for people with intellectual disability, may not receive individualised support once in a service. This study explored caregivers' experiences of accessing services for autistic individuals with intellectual disability, and their considerations when developing new interventions for this population. Interviews and focus groups were completed with 16 caregivers of autistic people with intellectual disability. Reflexive thematic analysis was used to develop five themes about service access experiences, and three themes about caregiver considerations for anxiety interventions. Caregivers reported that their experiences of accessing services did not meet their expectations, and considerations for future anxiety interventions were often reflective of this. Interventions being flexible to family circumstances to aid accessibility, the embedding of peer support in services, and skills that can be generalised across the lifespan could be applied when aiming to improve outcomes and develop interventions for this under-served population.

Autistic people appear to be at increased risk of post-traumatic stress disorder, and experiences involving violence or sexual abuse appear to be common in this population. However, knowledge concerning trauma in autistic people with co-occurring intellectual disabilities is limited. In this cross-sectional study, we explored the prevalence of post-traumatic stress disorder, as well as the prevalence and clinical correlates of reported experiences of violence and sexual abuse, in a clinical sample of 88 autistic adults with intellectual disabilities referred for mental health assessment. Only three participants (3.4%) were diagnosed with post-traumatic stress disorder, even if experiences involving violence (34.1%) or sexual abuse (17.0%) were common. Anxiety and affective disorders were common diagnoses among participants with these experiences. Controlling for autism characteristics, level of intellectual disability and communication skills, experiences of violence/sexual abuse were found to be associated with a measure of 'challenging' behaviours (Aberrant Behaviour Checklist). These results indicate that potentially traumatic experiences are common in autistic adults with intellectual disabilities referred for mental health assessment and that post-traumatic stress disorder may be under-recognised. The findings highlight the importance of trauma screening and post-traumatic stress disorder assessment, as well as the importance of trauma-informed care, in this population.

Background: The Reducing Disability in Alzheimer's Disease in Kansas City (RDAD-KC) intervention has been shown to improve the health of individuals with dementia and caregiver dyads. This manuscript reports the results of implementing the RDAD among individuals with intellectual disabilities and caregiver dyads. Methods: Nine community agencies deployed the 12-week intervention. We assessed changes in individuals with intellectual disabilities' behavioural symptom related severity and physical activity, and caregivers' behavioural symptom-related distress, unmet needs, and caregiver strain. Results: Forty-four dyads enrolled, and 23 (~60 years, 48% female) completed [greater than or equal to] 75% of the intervention. We observed decreases in behavioural symptom related severity (p = 0.07) and increases in physical activity (p = 0.20) among individuals with intellectual disabilities. We also observed decreases in behavioural symptom related distress (p = 0.14), unmet needs (p = 0.50), and caregiver strain (p = 0.50) among caregivers. Conclusions: The RDAD-KC intervention showed promising, although statistically non-significant, benefits among individuals with intellectual disabilities and their caregivers.

Background: While barriers to participation in physical activity are well documented, there is no consolidated evidence on strategies promoting participation of people with intellectual disability in physical activities. Methods: We conducted a scoping review to examine initiatives used to facilitate the inclusion of people with intellectual disability in community-based sporting and recreation activities. We searched Medline, Embase, CINAHL+ and PsycINFO for articles published in English between 2000 and 2022. Results: Eight articles were included. Initiatives included: (1) building knowledge, awareness and attitudinal change (2) organisational alliances/partnerships (3) relationship-building (4) modifications/adaptions to activities/environment (5) organisational policy (6) engagement with people with disability. Initiatives were implemented through international collaborations, in local fitness/recreational facilities and public spaces, and targeted athletes, coaches, volunteers and organisational leaders. Conclusion: While some increase in awareness and inclusion of people with intellectual disability was reported, no longitudinal data reported on the impact of initiatives on sustained social inclusion for people with intellectual disability.

Background: Research into befriending for people with intellectual disabilities is limited. This study aimed to explore the impact, mechanisms of change, and limitations of a befriending scheme for adults with intellectual disabilities and/or autism. Methods: Participants were recruited using convenience sampling. Thirteen individuals with intellectual disabilities and/or autism were interviewed and data thematically analysed. Results: Four themes were generated: 'Something fun for me'; 'A good connection'; 'Increasing independence'; and 'A life less quiet'. Befriending had direct benefits through the activities undertaken and the befriending relationships themselves being fun and reducing isolation. Befriending facilitated belonging, improved access to mainstream activities, and fostered independence by providing safety and support. The importance of shared interests and external support for the relationship was highlighted. Conclusions: Positive outcomes of befriending were found, supporting existing literature and revealing new information from the voices of participants with intellectual disabilities themselves.

Background: Static and dynamic balance skills can be related to the activities of daily living (ADL) in children with non-syndromic intellectual disabilities, and the type of balance skills affecting ADL can differ depending on the domain of ADL (self-care, mobility, and social function). Methods: The ADL capabilities of 66 children with intellectual disabilities were assessed using the Pediatric Evaluation of Disability Inventory (PEDI) and were examined in relation to static and dynamic balance skills. Results: Significant positive correlations were found between the one-leg standing and PEDI (r = 0.841 for self-care, r = 0.700 for mobility, and r = 0.760 for social function). Our analysis showed that static balance skills affected self-care, dynamic balance skills affected mobility, and intelligence quotient affected social function. Conclusions: Improving balance skills is important for enhancing ADL capabilities, and the type of balance skills that need enhancement vary based on the domain of ADL.

Background: The Fragile X community has expressed a desire for centralised, national guidelines in the form of integrated guidance for Fragile X Syndrome (FXS). Methods: This article draws on existing literature reviews, primary research and clinical trials on FXS, a Fragile X Society conference workshop and first-hand experience of clinicians who have worked with those living with FXS over many years. Results: The article scopes proposed integrated guidance over the life course, including appendices of symptoms, comorbidities and referral options for FXS and Fragile X Premutation Associated Conditions. Conclusion: Integrated guidance would provide an authoritative source for doctors, health professionals, therapists, care workers, social workers, educators, employers, families and those living with FXS, so that a holistic, person-centred approach can be taken across the United Kingdom to garner the best outcomes for those with FXS.

Background: Only about 9% of individuals with intellectual disabilities reach the government's physical activity (PA) recommendations. Combining gamification and technology seems particularly promising in overcoming personal and environmental barriers to PA participation. Method: Eighteen adults with varying levels of intellectual disabilities completed a pilot study to assess the initial effects of a cycling gamification intervention on levels of PA, fitness, psychosocial outcomes, and challenging behaviours. The study comprised three designs: pre-post single group, AB single-case, and qualitative. Social validity, implementation barriers and facilitators were also explored. Results: Nearly all 18 participants cycled daily. Time and distance cycled daily increase during the intervention while a decrease in stereotyped behaviours was observed. Participants and staff found the intervention enjoyable and socially valid. Conclusions: Results of the multiple-design study suggest that gamification interventions may be a suitable, enjoyable, and promising way to contribute to PA participation of adults with intellectual disabilities.

Background: Knowledge about how disability professionals understand ableism may provide insight into the production of inequalities. The aim of this study was to examine how disability professionals understand ableism. Methods: We asked 347 disability professionals, all of whom worked with people with intellectual and developmental disabilities, among other populations, to define ableism and then analysed those definitions using content analysis. Results: The themes about how participants understood ableism were--discrimination; differential treatment; individualization; norms and othering; ableist language; microaggressions; and systems and environments. It was also not uncommon for participants to say ableist things, and express misconceptions in their definitions. This included these themes: avoiding disability; using ableist language; framing disability as in/ability; centring people without disabilities; ignoring invisible disabilities; believing only people without disabilities have bias; and believing ableism does not exist. Conclusions: Knowing disability professionals' understandings of ableism is necessary to intervene biased attitudes and reduce ableism.

Background: The benefits of friendships among peers with and without intellectual and developmental disabilities are well supported by research. However, little is known about the nature of these inclusive friendships in inclusive college courses. Method: We explored the perspectives of peers on the development of authentic friendships among peers with and without intellectual and developmental disabilities in inclusive college courses in the United States. We used a sequential, explanatory, transformative mixed methods-grounded theory research design. We integrated quantitative (N = 44) and qualitative (N = 8) findings using blended analysis to inform a preliminary grounded theory of inclusive and reciprocal friendships. Results: Quantitative findings suggest two relationships and one predictor of peers' perceived social engagement. Qualitative findings resulted in five themes that promote friendships. Conclusions: We propose that the context for developing inclusive friendships could be fostered using the preparation and actions stages of the grounded theory model.

Background: Individuals with severe motor and intellectual disabilities have become an aging population, and high cancer morbidity and mortality are critical issues affecting their survival. Cancer screening is a crucial method of resolving this issue; however, a suitable screening method for them has not been established. Methods: We used ultrasonography alone and performed breast cancer screening for women over 30 years old in our facility from 2016 to 2023. We observed the outcomes and calculated the recall/detection rate in this screening. Results: Three cases among 379 tested positive in this screening, all of which underwent radical surgery. They are alive and well without relapse present. We detected these breast cancer cases with a low recall rate. Conclusion: We were able to successfully detect breast cancer cases using ultrasonography alone. Ultrasonography is an effective and feasible tool for breast cancer screening in individuals with severe motor and intellectual disabilities.

Background: We investigated the prevalence of swallowing difficulties and associated factors in people with intellectual disability. Methods: We included people aged 50+ receiving care for people with intellectual disabilities. The Dysphagia Disorder Survey (DDS) was used to assess swallowing difficulties. We determined the agreement between the DDS and swallowing difficulties in medical records. We used logistic regression analyses to explore associated factors. Results: One thousand and fifty people were included. The prevalence of swallowing difficulties was 43.8%. Swallowing difficulties were not reported in the medical records of 83.3% of these cases. Frailty (odds ratio (OR) = 4.22, 95% CI = 2.05-8.71), mobility impairment (OR = 2.50, 95% CI = 1.01-6.19), and mealtime dependency (OR = 3.05, 95% CI = 1.10-8.47) were independently associated with swallowing difficulties. Conclusion: Swallowing difficulties are prevalent in older people with intellectual disability but may be under-recognised. Frailty may be a good indicator for population-based screening for swallowing difficulties.

Background: Non-communicable diseases (NCDs), also known as chronic diseases, now constitute a major proportion of ill-health across most adult and older populations including in people with intellectual disability. The current paper is a comparative analysis of prevalence of NCDs across mid-aged and older-aged people with mild intellectual disability. Method: Comparative data comes from two cross-sectional surveys using similar methodology and timeframes. The analysis sample comprises mid-aged group (30-50 years, N = 291) and older-aged group (=60 years, N = 391). Results: People with mild intellectual disability start developing NCDs in early to mid-adulthood and increases with age. The mean number of NCDs in mid-aged group was 0.86 (SD, 0.84) compared to 3.82 in older group (SD, 2.67). Conclusion: There needs to be early identification and management of NCDs using relevant health promotion and preventative measures at optimal intervention points. The training of healthcare professionals needs improvement.

Background: Virtual mindfulness may be helpful for individuals with intellectual disabilities in the context of COVID-related disruptions of in-person programming, such as Special Olympics (SO). This study examined the feasibility of a virtual mindfulness intervention for SO athletes and their caregivers. Method: SO athletes (n = 44) and their caregivers (n = 29) participated in a 6-week adapted virtual mindfulness intervention. Athletes completed mindfulness and well-being questionnaires prior to, immediately following, and 3-months post-intervention. Caregivers completed questionnaires assessing their own stress, mindfulness, and well-being, as well as athlete mental health. Exit interviews were conducted immediately following the intervention. Results: The intervention was feasible in terms of demand, implementation, acceptability, and limited testing efficacy. There were significant improvements in athlete well-being and mental health, and caregiver stress and mindfulness post-intervention. Conclusions: Adapted virtual mindfulness groups may be an effective intervention in improving the well-being of adults with intellectual disabilities and their caregivers.

Introduction: This study investigated the reliability and validity of the dynamic risk outcome scales--short version (DROS-SV). This instrument is developed to monitor treatment progress using dynamic risk factors in clients with mild intellectual disabilities or borderline intellectual functioning and behavioural and/or mental health problems. Method: Data were collected from 264 clients who received Flexible Assertive Community Treatment (FACT), a form of intensive outpatient treatment. Results: A principal component analysis showed that there were six components explaining 73.9% of the variance. Furthermore, the DROS-SV showed good internal consistency of its subscales and total score ([alpha] > 0.78). Correlating the DROS-SV with the Historical and Clinical subscales of the Historical, Clinical and Future--30 indicated convergent and divergent validity. Discussion: The DROS-SV has good psychometric properties for measuring dynamic risk factors in clients with mild intellectual disabilities or borderline intellectual functioning in FACT teams.

Background: To build capacity among people with intellectual and developmental disabilities to become co-researchers they need the opportunity to learn about research. Method: An inclusive research team developed an online training to support people with intellectual and developmental disabilities to serve as co-researchers. Seven participants were recruited as pilot trainees. The co-researcher training consisted of two 1-h training sessions. Pre- and post-surveys and a focus group were conducted to examine participant experiences with the co-researcher training. Results: The participants were actively engaged during the co-researcher training sessions and shared they had a positive experience with it. They expressed that people with intellectual and developmental disabilities add value to the research team because of their lived experiences. Conclusion: The co-researcher training can instill a baseline level of knowledge about research in people with intellectual and developmental disabilities, and can be adjusted for different types of research in different settings and organisations.

Background: People with intellectual and developmental disabilities are among the most underserved in an inequitable healthcare system. Methods: Using Arksey and O'Malley's methodology and a social determinants of health framework, we conducted a scoping review of literature on the state of practice in education of healthcare professionals in the health and healthcare needs of this population. Results: Searches found 4948 articles, with 182 included in the final review. Themes identified included gaps of not being informed by workforce needs, continued use of the medical model of care, not addressing intersectionality with racial/ethnic and other discriminations, and lack of involvement of the population in developing/evaluating programs and promising trends of development of competency-based interprofessional programs with experiential learning. Conclusion: We provide recommendations for best practices in a concerted effort to educate a healthcare workforce equipped with the knowledge and skills to address the health needs of this population.

Background: A multi-phase Canadian study was conducted as part of a large-scale community and academic research partnership focused on understanding and improving the employment experiences of people with intellectual disabilities. Method: This multi-method study utilized a sequential approach, using findings from qualitative interviews (n = 28) to inform an online survey (n = 149). Participants were invited to share their experiences with paid employment or with persons with intellectual disabilities. Results: Thematic analysis of data across interview and survey findings resulted in six themes: (1) assumptions and attitudes, (2) knowledge and awareness, (3) accessibility of processes, (4) use of accommodations, (5) workplace relationships, and (6) supports and resources. Conclusions: A holistic and systemic approach has the potential to improve inclusive employment experiences of people with intellectual disabilities. Action is needed mainly at the policy and employer level to reduce barriers and improve on facilitating measures reinforced by the themes shared in this study.

Background: Studies have found that presence of challenging behaviours and mental health problems limits employment for people with intellectual disabilities. This study investigates the associations between age, gender, living condition, level of intellectual disability, diagnoses, behaviour, mental health, and employment in adults with intellectual disabilities in Norway. Method: A cross-sectional community-based survey including 214 adult participants (56% men) with intellectual disabilities. Results: In our sample, 25% had no organised day activity, 27% attended non-work day care, 19% attended sheltered employment, or day care with production, without pay and 29% worked in paid sheltered employment. One participant attended mainstream employment. Moderate and severe/profound level of intellectual disability, possible organic condition and irritability significantly reduced the odds of employment (paid and unpaid). Conclusion: Findings suggest unequal access to the sheltered employment that was meant to be inclusive. More individualised evaluation of prerequisites is suggested to further facilitate employment for this group.

Background: To improve the quality of palliative care, six evidence-based tools were implemented in 10 care services specialised in care for people with intellectual disabilities. Contextual differences were taken into account by using a participatory action research approach. Method: The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) structured the evaluation. Data sources were online questionnaires completed by 299 professionals at baseline (response 45.2%) and 250 professionals after 2.5 years (35.1%), 11 semi-structured group interviews with 43 professionals, field notes and implementation plans. Results: A total of 767 professionals and 43 teams were reached. The effectiveness of the intervention was demonstrated in an improved knowledge of palliative care policy and increased competences among professionals. 79% of the professionals adopted tools in the toolbox. The participatory action research method was perceived as valuable in driving change. Conclusions: Improving palliative care needs a context-specific, flexible approach, with involvement of all stakeholders.

Background: People with intellectual disabilities may experience frailty earlier than the general population. This scoping review aimed to investigate how frailty is defined, assessed, and managed in adults with an intellectual disability; factors associated with frailty; and the potential impact of COVID-19 on frailty identification and management. Method: Databases were searched from January 2016 to July 2023 for studies that investigated frailty in individuals with intellectual disabilities. Results: Twenty studies met the inclusion criteria. Frailty prevalence varied between 9% and 84%. Greater severity of intellectual disability, presence of Down syndrome, older age, polypharmacy, and group home living were associated with frailty. Multiagency working, trusted relationships and provision of evidence-based information may all be beneficial in frailty management. Conclusion: Frailty is common for people with intellectual disabilities and is best identified with measures specifically designed for this population. Future research should evaluate interventions to manage frailty and improve lives.

Background: NHS England's "Transforming Care" agenda aims to reduce the number of adults with intellectual disabilities and autistic adults in mental health hospitals. The aim was to understand the demographic and clinical characteristics of those most at risk of admission. Method: A cohort, retrospective study of adults using community intellectual disability services in the North West of England from 2018 to 2022 was undertaken. Results: We compared 211 adults at imminent risk of admission to a mental health hospital and 249 at significant (but not imminent) risk on a validated risk stratification tool. Individuals at significant risk were more likely to have moderate intellectual disability. Individuals at imminent risk were more likely to have diagnoses of mild intellectual disability, autism, personality disorder, or psychosis. Conclusion: By furthering our understanding of the clinical characteristics of those most at risk of admission, the findings inform more appropriate targeting of resources.

Background: Little is known about how health issues identified at the annual health check (AHC) are followed up and addressed, how participants self-manage their health in between AHCs, and what support they receive. This research aimed to explore this. Methods: People with intellectual disabilities (n = 12), and/or their supporters residing in Wales, were interviewed following their AHC and again at 6 and 11 months. A recurrent cross-sectional thematic analysis was undertaken. Results: Five main themes emerged from interview one: going for a health check, issues identified, and actions taken, supporting the self-management of health, the personal context, and addressing health inequities. Four main themes emerged from follow-up interviews: follow-up, supporting the self-management of health, the need for reasonably adjusted health services, and going for another health check. Conclusion: A broader system of support around the AHC is required if people are to achieve or maintain the best possible health.

Background: Newborns of parents with intellectual disabilities face higher risks in their environment for child unsafety, despite parents' good intentions. To help parents prevent unsafe circumstances, a good understanding of the risk factors faced by these parents is needed. Methods: This casefile study examined (1) which risk factors were present for expectant parents with intellectual disabilities in child protection, (2) which domains of risk factors, and (3) whether a cumulation of risk factors was related to child safety. Results: Expectant parents with intellectual disabilities in child protection before the child was born often experienced a cumulation of risk factors. Child, family, and care factors best predicted child safety. A cumulation of risk factors over multiple life domains increased the risks for child unsafety. Conclusions: To reduce the risks of unsafe parenting conditions for newborns, preventive interventions for expectant parents with intellectual disabilities should address their needs from an ecological perspective.

Background: Paid employment represents a challenge for people with an intellectual disability and/or autism. This paper analyses the quality of jobs offered by the Engage to Change project and their relationship to the 'typicalness' of the employment offered. Method: Data on the quality of 384 paid jobs were collected, including hours worked and wages earned, and reported social integration at work. The typicalness of the employment experience was assessed for 141 young people, using the Index of Typicalness of Placement Questionnaire. Results: The Engage to Change project offered a wide range of jobs. There is no difference in the typicalness of the employment experience in relation to the interactions in the workplace, but there are some differences in the recruitment process for men and women. Conclusion: Job coaches should make sure that, despite the procedures being 'atypical' for the workplace, the outcome is 'a typical employment experience' for each employee.

Background: Chewing difficulty, poor oral health, inadequate and imbalanced nutrition are serious health problems in individuals with intellectual disabilities. The participants' chewing abilities, oral health and nutritional status were analysed in this study. Methods: Forty-five adult participants with intellectual disabilities were included. Anthropometric measurements, oral health assessments, chewing ability evaluations and dietary intake analyses were conducted. Results: A 56.8% of the participants were classified as overweight or obese. Teeth grinding was reported in 33.3% of the participants, while 40.0% experienced drooling. All participants with Down syndrome and 58.6% of the participants with developmental delay had chewing difficulties. Inadequate nutrient intake was observed and the fibre, vitamins B1, B3, B9, sodium, phosphorus and iron intakes were significantly lower than reference values in those with chewing difficulty (p < 0.05). Conclusions: Chewing difficulties were associated with lower intake of certain nutrients, highlighting the importance of addressing oral health and dietary counselling in this population.

Background: Despite the enactment of disability laws/policies in India, research shows that caregivers of adults with intellectual and/or developmental disabilities experience inadequate formal supports/services due to dissemination barriers and lack of awareness about them. To address discrepancy between caregivers' support needs and the professionals' understanding of their needs, the study proposed to conduct a caregiver needs assessment so that culturally-tailored programs are developed. Method: A strengths-based mixed methods needs assessment was conducted with a convenience sample of 100 caregivers in Hyderabad, India. One hundred caregivers completed the survey and 15 caregivers participated in semi-structured interviews. Results: Caregivers needed more and improved formal supports/services, particularly from the government. Caregivers faced systemic and attitudinal barriers, and personal impediments to accessing them. Needs differed by care recipients' intellectual disability level, gender, and intellectual disability related conditions. Conclusions: Researchers, service providers and policymakers need to adopt innovative strategies to improve formal supports/services access.

Background: During the COVID-19 pandemic, the United States' Centers for Disease Control and Prevention (CDC) created guidance documents that were too complex to be read and understood by the majority of adults with intellectual and developmental disabilities who often read at or below a third-grade reading level. This study explored the extent to which these adults could read and understand CDC documents simplified using Minimised Text Complexity Guidelines. Method: This study involved 20 participants, 18-48 years of age. Participants read texts and responded to multiple-choice items and open-ended questions to gather information about how they interacted with and understood the texts. Results: The results provide initial evidence that the Minimised Text Complexity Guidelines resulted in texts that participants could read and understand. Conclusion: Implications for increasing the accessibility of public health information so that it can be read and understood by adults with extremely low literacy skills are discussed.

Early childhood home visiting programs are well positioned to improve equity and reduce health disparities for families headed by caregivers with intellectual disabilities and other learning differences. Early identification of learning differences through screening may help home visiting staff tailor services and thus improve family engagement and outcomes. Using a mixed methods design, this study assessed potential determinants and outcomes related to implementation of a screening tool for learning differences adapted for the home visiting context. Participants were six home visiting staff and nine caregivers from multiple home visiting programs in one state. Staff completed surveys at enrollment and each time they conducted a screen with a caregiver. Staff also completed semi-structured interviews after conducting screens with at least two caregivers. Caregivers completed semi-structured interviews after taking part in a screen. At study enrollment, staff felt it was important to know if caregivers had learning differences, yet some believed caregivers would not like being asked about them. Survey and interview data aligned with theoretical determinants of implementation success, including staff competencies related to screening (e.g., knowledge, skills), perceived fit of screening with staff role and organizational context, and beliefs that the screening would improve engagement of caregivers and service delivery. Staff perceived the tool to be acceptable, feasible, and useful, although some acknowledged that caregivers might feel uncomfortable if the tool was not used carefully. Overall, caregivers found the tool to be acceptable and most believed it was helpful for the home visitor to have information about their learning experiences and needs. Findings lend initial support for the use of an adapted screening tool to identify potential learning differences.

Serious game-based learning is a high-fashioned topic in educational technology which helps children learn and train their skills. Most existing literature focuses on the improvement of children's specific abilities or skills, such as reading comprehension, attention, memory, etc. However, for cognitively impaired children, it is necessary to train their comprehensive cognitive ability. In this paper, serious game-based learning is defined as the integration of cognitive theory, instructional content and gaming elements to create educational games that leverage the motivational and immersive nature of gaming to enhance learning outcomes. We classify the gamification elements involved in cognitive training and then combine them with Piaget's theory of cognitive development in order to develop a cognitive training framework consists of four sessions which is expected to enhance the cognitive function of children with cognitive deficits. In total 50 cognitively impaired children are recruited to participate in the test. Evaluation results reveal that our cognitive training framework is helpful in improving the cognitive ability of children with cognitive deficits. However, the issue of how long this cognitive improvement will last still remains to be explored in future research.

This study evaluated the efficacy of an 8-week (two sessions/week; 60 min/session) adapted soccer intervention on skill performance and retention in 30 adults (18 men and 12 women) ages 17-40 years with autism spectrum disorder, Down syndrome, and intellectual disability. Of these 30 participants, 18 completed a 1-month retention test. The program included behavior supports and adaptations for participants with varying levels of behavioral needs. Dribbling, kicking a moving ball, kicking a stationary ball, throw-ins, trapping, and a composite skill score were examined. Linear mixed-effect regression revealed a significant time main effect with improvements from pretest to posttest and pretest to retention for all skills. In addition, modest offline gains (i.e., posttest < retention) were observed for throw-ins, kicking a moving ball, and the composite skill score. A significant main effect of diagnosis was observed such that participants with autism spectrum disorder had better performance on kicking a moving ball than those with Down syndrome and intellectual disability. Finally, a significant main effect of level of function was observed. This program enabled adults with various disabilities to acquire fundamental soccer skills that may lead to meaningful participation in community soccer programs.

A growing number of adults with intellectual and developmental disabilities (IDD) attend day programming. These programs are designed to give consumers the opportunity to explore the community, socialize with community members, and to engage in community activities. Unfortunately, activities offered may be selected by program staff without much input from the day program participants. Researchers examined the use of video-based paired stimulus preference assessments (VPA) to identify potentially preferred activities for three adults with IDD in a day program setting. Participant engagement levels during identified preferred activities were compared with staff-selected activities. Consistent with previous research, researchers were able to identify a hierarchy of preferred activities using the VPA. Researchers found preferred activities identified by the VPA maintained more engagement than staff-selected activities for all three participants. Our findings suggest VPA may be beneficial to incorporate into daily activity planning for adults with IDD in day programs.

Individualizing instruction is a time-consuming aspect of classroom practice. Testing multiple interventions, and monitoring each to see which is most effective for a student can be prohibitively time consuming. However, Brief Experimental Analysis (BEA) is an assessment procedure that can be used to quickly identify an intervention that is likely to be successful with an individual student. BEA provides teachers with a method to efficiently collect data and predict which intervention is most likely to be successful before a significant amount of time and resources are invested. The BEA process can be used with students at a variety of grade levels for the purpose of academic and behavior intervention. This paper describes how to implement BEA in reading with students with intellectual disabilities in order to prepare them for opportunities in postsecondary education. We will also discuss how to overcome hurdles that practitioners may experience implementing the process.

Check-in/check-out (CICO) is a widely used strategy for students with and without disabilities that is used in schools, sometimes as a tiered strategy within a multi-tiered system of support. Several adaptations to CICO have emerged across applications including extension to other educational settings (e.g., residential treatment facilities) and applied settings outside of school. We provide an overview of CICO, the adaptations made to date, and offer an example of how to integrate CICO into vocational training settings for students with intellectual disabilities to assist with establishing natural, on-the-job supports between a student and a supervisor while improving job skills.

This integrative review explores the barriers to and facilitators of healthcare access in adults with intellectual and developmental disorders (IDD) and communication difficulties (CD) using Levesque et al.'s conceptual framework of access to health. IDDs are a group of disorders that occur early in childhood and often involve language dysfunction. CDs are prevalent in adults with IDD. Several themes emerged as barriers to access for adults with IDDs and CDs including health literacy, understanding health information, and screening; fear and negative patient expectations; impaired autonomy; time; accommodation needs; insurance coverage and financial hardship; communication; coordination and continuity of care; and supporter presence and inclusion. Communication between providers, patients, and supporters is a significant barrier for adults with IDD and CD.

This meta-analysis reviews the literature on communication modes, communicative functions, and AAC type examined during interventions with school-age participants with ASD and/or ID who experience CCN. Considering potential differences related to outcomes taught could help identify the most effective means of individualizing AAC interventions. We performed a comprehensive literature search. A multi-level meta-analysis was implemented across 114 included studies with 330 participants and 767 effect size using two case-level effect size metrics, Tau and log response ratio. There were few statistically significant differences found between moderator categories (e.g., communication mode, communicative function, and AAC type implemented). This is likely due, in part, to the participant heterogeneity and an under-reporting of implementation factors.

Researchers have implemented inclusive research for over 30 years. This article describes how two research projects collaborated with researchers with disabilities and aligns the description with four attributes of inclusive research developed by a consensus of international experts with and without disabilities. The first project, the Person Experiences Interview Survey (PEIS) Workgroup, reviewed and revised items for a self-report survey of mental health service experiences. The second project describes the peer-led implementation of the Self-Determined Career Design Model (SDCDM) intervention. Four factors facilitated or were barriers to the projects' alignment with inclusive research attributes. First, relationships enhanced capacity to engage in meaningful ways. Second, balance between consistency and adaptability promoted engagement. Third, long-term capacity was enabled by ongoing engagement and peer mentorship. Fourth, time and funds impacted inclusive implementation. Engaging researchers with disabilities meaningfully enhanced the research process and products.

The current study was carried out to examine the effectiveness of the use of direct instruction together with the digital dialogue cards in teaching English introductory phrases and mutual dialogue to students with intellectual disabilities was studied. The study started with four students with mild intellectual disability, however, one student dropped out due to absenteeism and the study was concluded with three students. Multiple probe model with probe phase of the single-subject research model was used in teaching English introductory phrases and the ability to establish mutual dialogue. The research findings showed that the use of the direct instruction method together with the digital dialogue cards was effective in teaching the target behaviours to the three participants. It is also seen that after the end of the instruction the participants provide generalization between people, environments and tools regarding the target behaviours and they maintain the target behaviours at a high rate after 2, 4 and 6 weeks intervals. The social validity findings of the study show that the parents of the participants were satisfied with the study and expressed positive opinions about the research. At the end of the research, suggestions were made for the future.

Students' discussions of their experiences in postsecondary programs for undergraduates with intellectual disability is a largely untapped yet fundamental resource in the examination of inclusive university programs. Through phenomenological interviews of undergraduates enrolled in a program for students with intellectual disability, we explored student descriptions of their experiences in their first semester living on a college campus. Additionally, we assessed the perceptions of others involved in the program, including students' peer mentors, their parents, and their faculty. Students' experiences mirrored those of many college students throughout their first semester, yet there were successes and challenges specific to these students with respect to relationships, belonging, sense of self, and understanding others. Parents reported gains in students' sense of self, confidence, and interpersonal skills, but reported that students may need more focus on developing career-related skills. Peer-mentors and faculty noted both positive effects of the program on the students as well as on themselves. We offer recommendations for research and practice focused on creating truly inclusive environments for undergraduate students with intellectual disability.

Inclusive Postsecondary Education (IPSE) programs offer students with intellectual disabilities (ID) the opportunity to enhance academic, career, and independent living skills, with the ultimate goal of preparing them for meaningful employment. Given the significance of such programs and their rapid growth across the country and in Florida, an ongoing examination of the progress, challenges, and support needs of IPSE programs is crucial. To extend current research efforts at the state level, two focus groups (n = 12) were conducted representing 11 of Florida's IPSE programs and one state agency to explore the experiences of IPSE programs in Florida. Four major themes were generated following thematic analysis of data: the need for preparing students and families for postsecondary education environments, the types of support Florida's IPSE programs have received, the major barriers IPSE programs are currently facing, and finally, what IPSE programs need in the future to continue to support students with ID. Findings from this study offer significant insights into the current status and needs of Florida's IPSE programs and serve to inform the work of disability resource providers, and the creation, expansion, and sustainability of IPSE programs across the state.