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Objectives: To characterise the changes at work experienced by psychologists working with people with intellectual disabilities during the pandemic and whether these changes, stressors and aspects of working life were associated with mental wellbeing and occupational stress. Methods: Ninety-seven psychologists completed an online survey. Free text comments were analysed using thematic analysis and triangulated with our quantitative findings. Results: Occupational stress, learning new roles, demands at home, and changes due to COVID-19 were associated with poorer mental wellbeing, while uncertainty about the role, a shortage of personal protective equipment, and poorer mental wellbeing were associated with occupational stress. Two main themes emerged during the thematic analysis: being human and being an employee, and triangulation revealed agreement. Conclusions: The wellbeing and occupational stress of psychologists working with people with intellectual disabilities have been affected during the pandemic. It is of note that almost a quarter of our sample reported having been redeployed.

Recent COVID-19 lockdown restrictions resulted in reduced access to educational, professional and social support systems for children with intellectual disabilities and their carers. Aim: The aim of this study was to gain insight into the ways mothers of children with intellectual disabilities coped during the first 2020 lockdown period. Methods: Eight mothers of children with intellectual disabilities were interviewed. The recordings of these interviews were subjected to a thematic analysis. Results: Three main themes were identified: carrying the burden; a time of stress; and embracing change and looking to the future. Conclusions: All mothers experienced increased burden and stress. However, some also described some positive impact of lockdown conditions on them as well as on their child's well-being and behaviour. These findings are discussed in the light of the (Journal of Applied Research in Intellectual Disabilities, 33, 2020, 1523) survey results on parental coping and suggestions for future service provision during pandemic conditions are proposed.

It is imperative that we devote resources and research effort to find out what is going on in families where there is a member with Intellectual and Developmental Disabilities (IDD) over the course of the COVID 19 pandemic and how adaptations can be made to provide the most effective help. This article discusses the need for more research to be done in this area. The authors share their current research that they are conducting, and they explain future steps to continue this research.

Introduction: The measures implemented to manage the COVID-19 pandemic have been shown to impair mental health. This problem is likely to be exacerbated for carers. Method: Informal carers (mainly parents) of children and adults with intellectual disabilities, and a comparison group of parents of children without disabilities, completed an online questionnaire. Almost all the data were collected while strict lockdown conditions were in place. Results: Relative to carers of children without intellectual disability, carers of both children and adults with intellectual disability had significantly greater levels of a wish fulfilment coping style, defeat/entrapment, anxiety, and depression. Differences were 2-3 times greater than reported in earlier pre-pandemic studies. Positive correlations were found between objective stress scores and all mental health outcomes. Despite their greater mental health needs, carers of those with intellectual disability received less social support from a variety of sources. Conclusions: The greater mental health needs of carers in the context of lesser social support raises serious concerns. We consider the policy implications of these findings.

Background: Many people with intellectual disabilities display high levels of anger, and cognitive-behavioural anger management interventions are used routinely. However, for these methods to be used optimally, a better understanding is needed of different forms of anger assessment. The aim of this study was to investigate the relationship of a range of measures to self- and carer reports of anger expression, including instruments used to assess mental health and challenging behaviour. Method: Adults with intellectual disabilities, who had been identified as having problems with anger control, their key-workers and home carers all rated the service users' trait anger, using parallel versions of the same instrument (the Provocation Inventory). In addition, service users completed a battery of mental health assessments (the Glasgow Depression Scale, Glasgow Anxiety Scale and Rosenberg Self-Esteem Scale), and both groups of carers completed a battery of challenging behaviour measures (the Hyperactivity and Irritability domains of the Aberrant Behavior Checklist and the Modified Overt Anger Scale). Results: Participants had high levels of mental health problems (depression: 34%; anxiety: 73%) and severe challenging behaviour (26%). Hierarchical linear regression analysis was used to explore the extent to which anger ratings by the three groups of respondents were predicted by demographic factors, mental health measures and challenging behaviour measures. Older service users rated themselves as less angry and were also rated as less angry by home carers, but not by key-workers. More intellectually able service users were rated as more angry by both sets of carers, but not by the service users themselves. Significantly, mental health status (but not challenging behaviour) predicted service users' self-ratings of anger, whereas challenging behaviour (but not mental health status) predicted carers' ratings of service users' anger. Conclusions: Service users and their carers appear to use different information when rating the service users' anger. Service users' self-ratings reflect their internal emotional state and mental health, as reflected by their ratings of anxiety and depression, whereas staff rate service users' anger on the basis of overt behaviours, as measured by challenging behaviour scales.

Introduction: We describe a simple and rapid screening test for basic financial knowledge that is suitable for administration to people with mild intellectual disabilities. Method: The Coins and Costs test asks respondents to name coins, and to estimate prices of objects ranging between 1 British Pound (an ice cream) and 100K British Pounds (a small house). The test was administered, alongside a battery of neuropsychological tests, to 40 people attending day services (mean Full-Scale IQ = 59.1). Results: Total scores were normally distributed, and correlated significantly with receptive language ability and performance on memory tests, but not with IQ or executive functioning. Conclusion: The test provides a rapid (less than 5 min) screening test that has good psychometric properties and appears very suitable for assessing basic financial knowledge of people with mild intellectual disabilities.

Background: The aim of this study was to evaluate the extent to which care managers in learning disability services understand the role of the Independent Mental Capacity Advocate (IMCA) service, and the difference between the newly created statutory IMCA and existing general advocacy (GA) services. Method: There were 22 participants from three community teams within learning disabilities services, all but one of whom had attended training on the Mental Capacity Act (2005). Participants completed a questionnaire based on a set of nine scenarios where they were asked to identify the appropriate professional to contact in relation to the situation described, and to explain what their role would be. Results: Respondents' understanding of these issues was generally poor. There was a substantially less than 50% correct response rate for identification of scenarios that called for an IMCA referral, and respondents' ability to discriminate between the roles of GA and IMCA was limited. Only around half of the respondents correctly identified that the function of advocacy is to represent the client's views, and a significant minority incorrectly attributed decision-making functions to the IMCA. Only a single participant identified the statutory requirement to involve an IMCA in relation to a change of long-term accommodation (where the person lacks capacity and has no other non-professional support), and none of the participants identified this as a statutory requirement in relation to serious medical treatment. Conclusion: A better understanding of the statutory functions of the IMCA service may require a different approach to Mental Capacity Act training.

Background: The aim of this study was to evaluate the state of knowledge of mental capacity issues among health and social services professionals working in community teams supporting people with learning disabilities. Methods A structured interview was constructed around three scenarios, based on actual cases, concerning a financial/legal issue, a health issue and a relationships issue, as well as a set of ten "true/false" statements. The interview aimed to elicit respondents' understanding in relation, primarily, to assessment of capacity and best-interests decision making. Forty interviews were conducted (two social workers and two health professionals from each of ten community teams). Most participants had attended training on the Mental Capacity Act (2005). Results: Performance of social services and health staff was similar throughout. Fourteen areas of concern were identified where there appeared to be significant gaps in knowledge. Conclusions: Participants, particularly those who had experience of dealing with mental capacity issues, had good insight into the extent of their knowledge, and most participants said that the interview had made them aware of further training needs.

Previous studies have shown that people with mild intellectual disabilities have difficulty in "weighing-up" information, defined as integrating information from two different sources for the purpose of reaching a decision. This was demonstrated in two very different procedures, temporal discounting and a scenario-based financial decision-making task. In the present study, both tasks were presented to 24 participants who attended day services for people with learning disabilities (mean Full-Scale IQ = 59.8), half of whom were trained to use a visual aid to support decision-making. Performance of control participants did not change over repeated testing, but use of the visual aid substantially improved the quality of decision-making on both tasks: temporal discounting performance became more orderly, and participants were able to provide more information to justify their decisions in the financial decision-making task. The visual aid also substantially improved participants' ability to justify decisions they made about their own lives. We suggest that, while the visual aid was designed and evaluated as a means of increasing the quality of reasoning that supports a decision, it may also have potential as an aid to therapeutic interventions aimed at encouraging wiser decision-making. (Contains 1 table and 4 figures.)

The subjective value of rewards declines as a function of the delay to receive them (temporal discounting). Three temporal discounting tasks that assessed preferences between small amounts of money (10 pence) over short delays (60 s), moderate amounts of money (10 British Pounds) over moderate delays (2 weeks), and large amounts of money (1000 British Pounds) over long delays (12 months) were presented to people with intellectual disabilities (Full-Scale IQ less than 70) and to a comparison group (ns = 20 for each group). Measures of IQ, financial knowledge, memory, and executive functioning were also obtained. Only a third of the service users were able to perform the temporal discounting tasks consistently, and they tended to respond impulsively. The proportion of participants responding consistently increased following training. Both the initial performance and the effect of training were related to executive functioning but not IQ.

Individuals with intellectual and developmental disabilities often have difficulties foregoing short-term loss for long-term gain. The Iowa Gambling Task (IGT) has been extensively adopted as a laboratory measure of this ability. In the present study, we undertook the first investigation with people with intellectual disabilities using a two-choice child version of the IGT, with measures of intellectual and executive functioning. Compared to a group of matched controls, people with intellectual disabilities performed advantageously and showed high levels of subjective awareness about the relative goodness and badness of the decks. A symbol labelling intervention, in which participants were taught to label the good and bad decks at regular intervals significantly improved advantageous decision-making to levels approximating that of controls. Factor analysis of executive functioning scores identified working memory and mental flexibility (response initiation and set shifting), with a near-significant inverse correlation between the extent to which the intervention was required and mental flexibility. These findings show, for the first time, that people with intellectual disabilities are capable of performing advantageously on the IGT and add to the growing clinical literature on decision-making. (Contains 4 figures.)

Objective: To evaluate the extent to which anger management training provided within a learning disabilities day service generalizes to residential settings. Method: Eleven day-service users participated in one of two anger management groups. Treatment was delivered by day-service staff and an assistant psychologist, using a standard cognitive-behavioural therapy (CBT) package shown to be effective in earlier studies. Evaluation was by the Provocation Index and the Profile of Anger-Coping Skills, which measure, respectively, the potential to react in an angry manner, and the utilization of eight different anger-coping skills. Results: Participants showed a decrease in anger and an increase in anger-coping skills, which was maintained at 6-month follow-up. Similar changes were reported by day-service key-workers and by residential carers (and by the participants themselves). At the level of the group, key-workers and home carers did not differ significantly, at any time, in their ratings of anger, aggregate coping skills or individual coping skills. Within each setting, profiles of coping skills differed between individuals but were relatively stable across the 6-month follow-up period. However, there was no significant correlation between the profiles of coping skills reported for individual service users in the two settings. Conclusions: The results confirm that group-based CBT is an effective treatment for people with learning disabilities and anger management problems. Therapeutic gains are maintained for at least 6 months and generalize across settings. Different anger-coping skills may be used by different people, or by the same person in different environments.

Aims: This case study describes the formulation and cognitive-behavioural treatment (CBT) of obsessive-compulsive thoughts and behaviours in a woman with an intellectual disability. The report aimed to distinguish the cognitive deficits that reflect her disability from the cognitive distortions integral to her obsessive-compulsive disorder. Case study: Hence, we present one account of the cognitive-behavioural interventions aimed at correcting the cognitive distortions, and a separate account of the modifications necessary to compensate for specific cognitive deficits, which include impairments not only of "cognitive therapy skills", but also of aspects of memory and executive functioning skills. Discussion: We suggest that this analysis may provide a rational approach to the problem of simplifying CBT to meet the needs of people with intellectually disabilities, by identifying more clearly the specific adaptations that are needed by a particular individual. We also discuss the assessment of cognitive deficits that might impact on CBT, and some implications of this approach for research and training.

Aims: Cognitive therapies are increasingly being offered by clinical psychologists to people with intellectual disabilities. This paper reviews some of the factors that influence people's readiness to engage in cognitive therapy. Literature review: Limited verbal ability, psychological-mindedness (particularly in relation to the understanding of emotions and the mediating role of cognitions), and self-efficacy, are all likely to present significant barriers. There may also be motivational barriers to treatment, including the functionality of some psychological presentations, maladaptive beliefs promoting resistance to change, the intellectually challenging nature of cognitive therapy, and external factors such as inappropriate settings. Engagement with therapy can be promoted by involving carers to support the therapy, but carers may themselves display a range of limitations of ability and motivation similar to those displayed by clients, which need to be recognized, and where possible addressed, in order for their involvement to be effective. Recommendations: If barriers to treatment are recognized, significant steps can be taken to increase accessibility. In addition to simplifying the delivery of therapy, there is also scope to simplify the model; this point is illustrated by case examples, and some principles for formalizing modifications to standard procedures are suggested. As barriers to treatment can often be surmounted, a decision whether or not to offer cognitive therapy should be derived from a comprehensive formulation, and should never be based solely on a client's performance on tests of cognitive ability.

Aim: This study examined the responses of care managers and direct care staff to vignettes of inappropriate sexual behaviour (ISB) by a man with an intellectual disability. The aim was to identify psychological factors that influenced their assessment of risk and the perceived need for risk management strategies. Method: The vignettes varied in response topography and the age of the victim. Regression analysis was used to examine the effect of three sets of psychological factors (causal explanations, causal attributions and emotional responses) on perceptions of risk, seriousness and appropriate service level responses to the ISB, and the inter-relationships between these outcome variables. Results: Behaviours involving intimate sexual contact or a child victim were rated as more serious, and more in need of supervision and management, than vignettes describing non-contact behaviours or in which the victim was another adult with an intellectual disability. Levels of concern were generally lower for care managers than for direct care staff. The study cast little light on how care staff make decisions concerning the risk of recurrence of ISB. For care managers, high levels of concern were associated with the perception that the ISB was sexually motivated or was triggered by a negative emotional state, and with high levels of anger. Care managers appeared to make decisions about the appropriate intensity of service response based on an evaluation of the seriousness of the ISB, which was informed by the topography of the ISB and the identity of the victim. For direct care staff, high levels of concern were associated primarily with the perception that the cause of the behaviour was poor management; other factors associated with high levels of concern were the perception that the ISB was sexually motivated, and attributions that the ISB was controllable and stable. The central constructs in the decision making of direct care staff appeared to be the perceptions that, for it to have occurred, the behaviour must have been badly managed, and that offences against children require a response. Implications: These differing approaches to decision making by care managers and care staff may lead to conflict in the implementation of care plans for men with intellectual disabilities who display ISB.