Using the cognitive interview with adults with mild learning disabilities

Abstract

Forty-seven adults with mild learning disabilities (mild intellectual disabilities) attending day-centres and thirty-eight adults from the general population viewed a videorecording of an accident. A day later the participants were interviewed using either a cognitive interview (CI) or a structured interview (SI, a control interview). Compared with their counterparts with learning disabilities, adults from the general population recalled more correct information and made fewer confabulations about persons and objects. Nevertheless, the type of interview had an impact. For both groups, the CI was more effective than the SI in enhancing recall although, for the ‘learning disabilities’ group, the CI also produced a disproportionate increase in the reporting of person confabulations. All the same, the accuracy ratios were similar across interview types (80% for the CI and 82% for the SI). It is suggested that the CI could be helpful in assisting people with learning disabilities to provide information about events they have seen.     

Prediction of institutional aggression among personality disordered forensic patients using actuarial and structured clinical risk assessment tools: prospective evaluation of the HCR-20, VRS,Static-99, and Risk Matrix 2000

A minority of men and women with intellectual disabilities at times engage in, and are suspected, or convicted, of illegal activity. Recent policy developments in England and Wales emphasise the need to respond appropriately to putative offending risk through the provision of safe and effective community management, treatment, and support services. In line with these concerns, research has focused increasingly on testing the utility of an evolving variety of risk assessment procedures. Here, the authors set out to challenge the repertoire of a number of prominent and/or recently developed risk assessment procedures and the scope of an associated research literature, on the basis that contextual risk factors are receiving insufficient attention in relation to offending among people with intellectual disabilities. Drawing on the wider criminological literature, a novel study is reported that compares key contemporary proximal social and environmental circumstances in the lives of offenders and non-offenders with intellectual disabilities. A contextual risk score is derived, providing statistical support for increased consideration of the impact of relevant social and environmental circumstances. Increased emphasis on key contextual risk factors is recommended to strengthen community service responses to offenders with intellectual disabilities.     

Clinical assessment of adult sexual offenders with learning disabilities

Abstract

Assessment and treatment of adults with learning disabilities who commit sexual offences presents a number of challenges. Much of the professional forensic and psychiatric literature on work with this group concentrates on the development of interventions based on theoretical models of sexual offending originating from the mainstream criminal justice system and have often been adapted and applied to people with learning disabilities. Currently, there is very little evidence to demonstrate the effectiveness or validity of the adaptation and application of mainstream models to this population. The efficacy of such adapted models used to describe sexual offending in people with learning disabilities clearly has an impact of any intervention informed by them. In particular, some researchers suggest that key factors such as cognitive distortions are evident in sexual offenders with learning disabilities; there is, however, no research relating to the prevalence of these or other key factors within the general population of people with learning disabilities. The present literature review highlights some of the clinical issues with a particular focus on the assessment of deviant sexual interest. Specifically, the literature is confused with inconsistencies relating to the definition of the group, the extent and nature of offending and a lack of standardized methodology for assessment and comparison. Consideration is given to the particular needs of this group and the implications for research and treatment.     

A theoretical model of multiple stigma: ostracized for being an inmate with intellectual disabilities

Even though some people are associated with a single stigmatized group, others are associated with several. In order to shed light on such multiple stigma processes, we propose a theoretical model of ‘multiple stigma’ by describing how two stigma-related categories (having intellectual disabilities and being an inmate) merge into a third stigmatized category (being an inmate with intellectual disabilities) that makes it possible to be ostracized for each of these three. We describe how this extensive ostracism is associated with negative psychological problems and antisocial responses. Consequently, we discuss some possible implications for the criminal justice system and future research.     

Prevalence of mental disorders and deliberate self-harm in Greek male prisoners

The aim of this survey was to determine the prevalence of current and lifetime mental disorder and deliberate self-harm among male prisoners in Greece. The subjects were 80 randomly selected remanded and sentenced prisoners in a Greek prison. They were assessed for mental disorder including suicidality and substance misuse using the Mini International Neuropsychiatric Interview (MINI). We also collected information regarding contact with psychiatric services, previous deliberate self-harm as well as physical health and conducted a brief assessment of their intellectual functioning. Mental disorder was diagnosed in 63 (78.7%) prisoners. The main diagnoses were: anxiety disorder, 30 (37.5%); major depression, 22 (27.5%); antisocial personality disorder, 30 (37.5%); alcohol dependence, 21 (26.3%) and opiate dependence 22 (27.5%) and schizophrenic or bipolar disorder 9 (11.2%). Deliberate self-harm prior to and during imprisonment was reported by 15% and 2.5% of prisoners, respectively, and 12 prisoners (15%) had IQ below 75. This survey identified a significant level of need for specialist mental health services in prison. Further studies are required to assess the specific needs of those patients who are too unwell to remain in prison, the need for specific treatments for substance misuse and improved assessment/treatment of common psychiatric disorders.     

THE WAY WALKED WITH CHILDREN: MEDICAL TREATMENT AND REHABILITATION

Due to obstacles in expression and communication, as well as a societal lack of humanitarian spirit and deficiencies in system design, children with intellectual disabilities are confronted with various problems when seeking medical treatment. The dilemma of medical treatment seriously restricts the survival and development of disabled groups. By reviewing the way in which a mother accompanied her disabled child for 28 years together, this article analyzed the reasons for the dilemmas of medical treatment, and appealed to improve the living conditions of persons with intellectual disabilities to guarantee their rights for rehabilitation. In addition, by introducing the recreational and sports activities that parents’ spontaneous organization created for children with intellectual disabilities, it put forward the proposal to prevent in advance the possible deterioration of conditions caused by social isolation, which is definitely a preferable remedy for persons with disabilities.     

The weight of history: child protection and parenting with a disability in 20th Century Iceland

ABSTRACT

This contribution focuses on four periods in Iceland, from the early twentieth century until the time of writing, in order to document and analyse the struggles of people with intellectual disabilities to marry, have a family and maintain custody of their children. Each period is linked to specific pieces of legislation that governed the bodies and lives of disabled people and reflected larger social norms concerning issues of family life and parenthood. An emphasis is placed upon the perspective of contemporary critical disability studies in analysing the historical development of this struggle, and the voices of those who experienced this struggle first-hand, drawn from a number of research projects conducted in Iceland. Our main contention is that the weight of history still comes to bear upon matters of parenting and family life, even in the most recent shift toward a human rights approach to disability. There remains a strong socio-cultural resistance toward parenting with an intellectual disability, rooted in the ideology of early twentieth-century eugenics. Our goal is to document the development of these phases throughout the twentieth century in Iceland in order to illustrate how older ideas and prejudices still inform contemporary child protection practices concerning parents with disabilities.     

Intellectual and developmental disabilities and Ontario’s forensic inpatient system: a population-based cohort study

Individuals with intellectual and developmental disabilities (IDD) in forensic inpatient beds are both complex and understudied. Previous studies have been limited and largely based on smaller clinical samples. We used data from a population-based cohort of Ontario adults with IDD (H-CARDD cohort, n?=?66,000) to describe their prevalence in forensic inpatient beds during 2005–2015 and compare their demographic and clinical profiles with non-IDD forensic patients. Results show that forensic patients with IDD and without IDD have similar profiles, with the exception that patients with IDD are more likely to have a psychiatric disorder and to be younger, rural, and have high or very high morbidity. Strong support was found for disproportionate admission: individuals with IDD are 12.2% of forensic inpatients but only 0.8% of the general population (d?=?1.57). Support for disproportionate utilization was less dramatic and mixed. Little difference was found in terms of the per cent of longer-stay (treatment) admissions or multiple forensic admissions; however, patients with IDD did have longer number of bed days over 10 years (averaging 220.6 days more, d?=?0.28). A better understanding of the barriers to discharge for individuals with IDD will support implementation of appropriate pathways out of the hospital.     

Head banging as a form of self-harm among inpatients within forensic mental health and intellectual disability services

Introduction: ‘Head banging’ is a common form of self-harm, linked to numerous negative outcomes including significant brain damage. However, little research has investigated head banging behaviour and its correlates in clinical populations. Method: Head banging episodes were identified from the incident records (n = 5417) of two inpatient forensic services (one intellectual disability and one mental health), using relevant search terms. Rates were compared between individual patients, by gender, diagnosis and level of security. Incident accounts were analysed qualitatively using thematic analysis. Results: Head banging incidents occurred approximately every 3 days in each service, with 229 incidents recorded in 1 year. Individual patient rates varied widely, ranging from 1 to 38 incidents within 1 year. Women, and patients in higher levels of therapeutic security, were significantly more likely to engage in head banging. Qualitative incident reports indicated that head banging was associated with mental distress, anger and psychotic experiences. Discussion: Head banging occurs frequently in forensic services, and has documented associations with traumatic brain injury in affected individuals, thus negatively impacting progress through the care pathway and treatment outcomes. Further research should investigate short- and long-term management strategies and treatment approaches, in order to minimise harm.     

Learning disabilities and delinquency: a study of Israeli prison inmates

Research consistently illustrates that several intellectual disabilities--namely, learning disabilities (LD), low intelligence, challenging behavior, and inadequate adaptive behavior, as well as attention deficit hyperactivity disorder (ADHD)--are considered risk factors for antisocial and criminal behavior. Although much attention has been paid to the relationship of LD, ADHD, and criminal behavior, three research topics have been overlooked: the frequency of LD with ADHD among inmates, the relationship between LD and/or ADHD and level of education among prisoners, and the connection between LD and/or ADHD and age of criminal onset. The present study examined the frequency of LD and ADHD in a sample of Israeli-born prisoners, in addition to the frequency of each category by itself, and it investigated the relationship of LD and/or ADHD, school dropout age, and onset of criminal activity.     

A community forensic intellectual disability service: Twelve year follow up of referrals,analysis of referral patterns and assessment of harm reduction

Background. Previous reports on the outcome of services for offenders with developmental disabilities have found recidivism rates of between 40% and 70% with an elevated prevalence of sex offending, fire‐raising, and aggression. Studies have also reported that female offending rates in the intellectual disability population are broadly similar to those found in mainstream populations. All reports have been conducted on in‐patient or prison samples. The present report is of a community forensic intellectual disability service. Method. Two male cohorts of sex offenders (N = 121) and other types of offenders (N = 105) and female offenders (N = 21) are studied and compared. Data is reported on characteristics of the cohort, problems identified at referral, criminal justice disposal trends, index offences at time of referral, reoffending rates of up to 12 years after index offence, patterns of referral in the first 6 and second 6 years of the study period and the extent of harm reduction. Results. There were no differences between the groups on IQ and the sex offender cohort tended to be older. Female offenders had higher rates of mental illness although rates for the male cohorts were generally high at around 32%. The sex offending cohort had fewer problems with anger and aggression and alcohol abuse but a higher level of daily living problems and relationship problems. Female offenders had high rates of all problems studied except daily living problems. Unlike certain previous studies, sex offences predominated in the sex offender cohort while other types of offences predominated in the other two cohorts. Average age was lower for more recent referrals. Among recidivists only, a considerable amount of harm reduction was recorded. Conclusions. Fire raising and offences against children are not overly represented when compared with mainstream offenders. When compared with previous studies, it appears that a community forensic intellectual disability service may have an impact in reducing the number of offences committed over a 12 year follow up period.     

The role of intelligence on performance on the Inventory of Legal Knowledge (ILK)

Previous research has shown that individuals with intellectual disabilities perform in the feigning range on malingering measures even when other data suggest that they are performing optimally. However, few studies to date have gone beyond intellectual disabilities and studied the full range of intelligence. Additionally, there are no data available examining the relationship between intelligence and performance on the Inventory of Legal Knowledge (ILK). The relationship between intelligence and performance on malingering tests is important because individuals with intellectual deficits may be incorrectly identified as malingering on these tests. The current study used a sample of state psychiatric hospital residents, adjudicated incompetent to proceed, and a sample of undergraduate university students to examine the relationship between intelligence and performance on the ILK. Results indicated three items on the ILK are correlated with intelligence and total scores were moderately correlated. Participants were further broken into groups using categorical ranges of Intelligence Quotient (IQ). Results were mixed regarding the relationship between ranges of IQ and performance on the ILK. Future directions and implications of this study are discussed.     

The perceived employability of ex-prisoners and offenders

A large-scale study was conducted to examine the perceived employability of ex-prisoners and offenders. Four participant groups comprising 596 (50.4%) employers, 234 (19.8%) employment service workers, 176 (14.9%) corrections workers, and 175 (14.8%) prisoners and offenders completed a questionnaire assessing the likelihood of a hypothetical job seeker's both obtaining and maintaining employment; the importance of specific skills and characteristics to employability; and the likelihood that ex-prisoners, offenders, and the general workforce exhibit these skills and characteristics. Apart from people with an intellectual or psychiatric disability, those with a criminal background were rated as being less likely than other disadvantaged groups to obtain and maintain employment. In addition, ex-prisoners were rated as being less likely than offenders and the general workforce to exhibit the skills and characteristics relevant to employability. Implications for the preparation and support of ex-prisoners and offenders into employment are discussed, together with broader community-wide initiatives to promote reintegration.     

Symptoms of trauma, perceptions of discrimination, and anger: a comparison between Australian indigenous and nonindigenous prisoners

Although the need for the development and provision of culturally appropriate rehabilitation programs for offenders is widely acknowledged, there is a lack of empirical data that can be used as a basis for the development of new programs. This article reports the findings of a comparison of indigenous and nonindigenous male prisoners on a range of measures relevant to the experience of anger by indigenous prisoners in Australia. The results suggest that indigenous participants are more likely to experience symptoms of early trauma, have greater difficulties identifying and describing feelings, and perceive higher levels of discrimination than nonindigenous prisoners. The implications of this work for the development of culturally appropriate and effective anger management programs for indigenous male prisoners are discussed.     

Female prisoners' understanding of ‘bullying’ and their methods of coping: a multinational perspective

Abstract

Whilst prison bullying is a well-researched form of aggressive behaviour, recent studies have suggested that there may be discrepancy between how prisoners and researchers understand the term ‘bullying’. Interviews with 26 female prisoners were subject to constant comparison framework analysis. More than 150 themes were identified. These suggested that whilst there is overall agreement between prisoners and researchers as to what behaviours constitute bullying, a consensus does not exist within the prisoner population. Behaviours identified as bullying behaviours by prisoners are also reported as methods of coping. Cultural differences in behaviour and how these relate to perceptions of aggression were identified by the women prisoners. The findings of this study have implications for researching bullying in institutions such as prisons, and for managing and intervening with bullies in prisons.     

CURRENT TRENDS IN THE DEVELOPMENT OF THE CHINESE SOCIAL SECURITY SYSTEM FOR PEOPLE WITH DISABILITIES

The Law on the Protection of Disabled Persons is the first social security legislation in China, with more than 50 laws directly related to the legal protection of the rights of persons with disabilities and career development for people with disabilities. In terms of employment protections for people with disabilities, it is important to focus on effective legal implementation, utilizing legal rulings to limit employment discrimination against people with disabilities. Educational protections are an important precondition for enabling people with disabilities to live with dignity; it should be guaranteed that people with disabilities are provided “reasonable accommodation” in educational conditions. A barrier-free environment is a necessary condition for social integration of people with disabilities. At the same time, it also benefits other members of the society such as the elderly. Through rehabilitation and exercise, most people with disabilities can return to the society to a significant degree. China should gradually expand the legislative scope of rehabilitation service fee reductions and legal categories of auxiliary appliances, issuing guiding documents that provide specifications for the relevant “dormant” legal provisions.     

Sexual offenders with learning disabilities: risk,recidivism and treatment

Abstract

While the literature on the assessment, treatment and management of non-learning disabled sexual offenders is well established, it is only in recent years that researchers and clinicians have focused on sexual offenders with learning disabilities. In contrast to mainstream sex offender treatment programmes, there are few evaluated community-based treatment programmes for sexual offenders with learning disabilities, and of the small number of published studies that describe treatment programmes, most are based on small samples and few have been validated empirically. Sexual offenders with learning disabilities differ from their non-disabled counterparts in several important ways, having implications for management and treatment. Due to methodological differences between studies, the prevalence of sexual offending by men with learning disabilities is not clear. However, in some studies, the sexual recidivism rate of offenders with learning disabilities is 6.8 times and 3.5 times that of non-disabled sexual offenders at 2- and 4-years’ follow-up, respectively. Sexual offenders with learning disabilities are also at greater risk of re-offending in a shorter time period. There remains an urgent need for further research into the assessment of risk and whether components from mainstream treatment programmes can be adapted to meet the needs of learning disabled sexual offenders. Approaches to working with sexual offenders with learning disabilities and programme development are discussed.     

Disability,right to culture and copyright: which regulatory option?

Access to knowledge and participation in cultural life for persons with disabilities has always constituted a tough challenge. Recent studies show that only 5% of published works are available in accessible format, and the number plummets to 1% in developing countries. Coupled with the high costs of production and distribution, and the full reliance on public funds and intervention of public or non-profit organizations, copyright has traditionally represented an additional obstacle on the path for a broader availability of accessible works. Recently, the situation has worsened with the tilting in the balance between rights and exceptions caused by the legislative response to digital threats, when the unprecedented opportunities offered by new technologies to foster accessibility have been largely trumped by copyright law. Still, the last decades have witnessed the beginning of a paradigm shift, originating from the human rights arena, and moving towards a new definition of the interplay between authors’ rights and the right to take part in cultural life, both at a general level and with particular regards to persons with disabilities. This article offers a diachronic overview of the path that, from the rediscovery of Article 15 of the International Covenant on Economic, Social and Cultural Rights through its General Comments to Article 30 of the United Nations Convention on the Rights of Persons with Disabilities, has led to the adoption of the Marrakesh Treaty. It then analyses, with a focus on the European Union and its Member States, the national and regional responses to the new human rights obligations, looking at the relations between legislative exceptions and model or collective license agreements. The assessment of the strengths and weaknesses of the two main regulatory options lays the groundwork for proposals of further areas of intervention, necessary to fully comply with the international human rights obligations and to achieve the fullest access to and participation in culture possible for persons with disabilities, by using the tools offered by international and national copyright law.     

The reliabilty and validity of a revised version of the How I Think Questionnaire for men who have intellectual disabilities

The aim of this study was to revise an existing measure of distorted cognitions, creating the How I Think Questionnaire – Intellectual Disabilities (HIT-IDs), and to investigate the reliability and validity of the revised questionnaire. To achieve our aims, we recruited 97 men with intellectual disabilities (IDs), with or without a history of engaging in criminal behaviour, and interviewed them on two occasions, inviting them to complete the HIT-IDs, along with measures of moral development and empathy. The results indicated that the internal consistency of the HIT-IDs was acceptable, and the test–retest reliability was good. The HIT-IDs discriminated well between offenders and non-offenders, and as expected, correlated positively with a measure of moral development and negatively with a measure of empathy. The HIT-IDs is a reliable and valid measure for use with men who have IDs.