The rights of people with an intellectual disability in The Netherlands: from restriction to development

The purpose of this article is to discuss whether the right to self-determination is the only and the best principle in health law for care providers to support their clients with an intellectual disability, or whether other principles such as the right to development, the right to good care and the right to protection might lead to a better protection of the rights of clients in this field of care. The right to self-determination is the central principle in the Dutch Psychiatric Hospitals (Compulsory Admissions) Act, which at times seems less than beneficial to the legal position of persons with an intellectual disability. The question is whether a new (alternative) legal framework, in which the focus shifts to the right to good care and the right to development, might improve the legal position of people with an intellectual disability.     

Locus of control and sex offenders with an intellectual disability

Locus of control has been implicated as an important construct that is related to treatment outcome for several groups of offenders, including sexual offenders. However, little attention has been paid to how this construct is related to sexual offending by people with intellectual disabilities. Given this, 41 participants with intellectual disabilities were recruited into three groups: sex offenders who had undergone psychological treatment, sex offenders who had no history of treatment, and nonoffenders. All participants completed measures of locus of control and distorted cognitions. There was a significant difference between those who had and had not completed treatment in terms of cognitive distortions relating to sexual offending. There was no significant difference between the three groups on the measure of locus of control, with all three groups endorsing an external locus of control. Three possible explanations for how locus of control relates to sexual offending by people with intellectual disabilities is explored and discussed.     

Child and adult witnesses with intellectual disability: The importance of suggestibility

Purpose. The main aim of the study was to examine the relationship between learning (intellectual) disability and interrogative suggestibility among children (11‐12 years old) and adults. Method. The Gudjonsson Suggestibility Scale (GSS 2) was administered to 110 children and 221 adults who were categorized into three groups according to fullscale IQ scores: (1) normal IQ (>75); (2) mild impairment (IQ score 55‐75); and (3) moderate impairment (IQ score <55). Results. Highly significant differences in memory and suggestibility emerged in both the child and adult samples across groups. Using memory as a covariate in the analysis eliminated the significant group differences for ‘yield 1’ among the children, but not for adults. There was no significant influence of memory on ‘shift’ in either group. Whereas ‘shift’ was significantly influenced by intellectual disability in children, no significant difference emerged across groups among adults. Conclusions. Children and adults with learning disability have much poorer memory and higher suggestibility scores than their contemporariesof normal intelligence. Differences in suggestibility are only partly explained by poorer memory scores. The findings reveal important differences between children and adults with intellectual disabilities. Children with learning disabilities are more susceptible to altering their answers under pressure than are adults with learning disabilities.     

Dynamic risk and violence in individuals with an intellectual disability: tool development and initial validation

Without a violence risk assessment designed for people with an intellectual disability (ID), assessors are reliant upon tools developed for mainstream offenders or develop their own tools. This study describes the early stages of development of the Current Risk of Violence (CuRV), an informant-reported measure of dynamic risk for aggression in adults with an ID. The pool of items was generated from a multitude of sources. Predictive accuracy for aggression was tested prospectively among 64 adults with an ID and history of aggression. The 34-item CuRV was found to be a brief, uncomplicated risk assessment. Initial findings revealed good predictive validity over a five-month period: area under the curve (AUC) range from .72, 95% CI [.59, .85] to .77, 95% CI [.66, .89]. These preliminary findings suggest that the CuRV may assist staff to perform assessments of risk in busy clinical settings. Future research effort is needed to fully explore the psychometric properties of the CuRV.     

Risk assessment in offenders with intellectual disability: a comparison across three levels of security

In mainstream offender samples, several risk assessments have been evaluated for predictive validity. This study extends this work to male offenders with intellectual disabilities. Participants from high-, medium-, and low-security settings, as well as community settings, were compared on a range of risk assessments. The Violence Risk Appraisal Guide, HCR-20-Historical Scale, the Risk Matrix 2000-C (combined risk), and the Emotional Problems Scales-Internalising discriminated between groups, with participants from high security having higher scores than those in medium security, who had higher scores than those in the community. The Violence Risk Appraisal Guide, all HCR-20 scales, the Short Dynamic Risk Scale, and the Emotional Problems Scales (Internalising and Externalising) showed significant areas under the curve for the prediction of violence. The Static-99 showed a significant area under the curve for the prediction of sexual incidents. The discussion reviews the value of these various scales to intellectual disability services.     

The practical labor lawyer: an employers' guide to strike contingency planning

An employer's capacity successfully to survive a strike will depend largely on the extent to which it has anticipated the strike and taken the steps necessary to defend against it. It is the purpose of this article to catalog the factors employers should consider in approaching an imminent strike and devising contingency plans. It attempts to focus on the types of problems, legal and practical, that frequently arise in strike situations, and suggests certain measures that employers may adopt in preparing for, and defending against, the economic impact of a strike.     

A comparison of seclusion rates between intellectual disability and non-intellectual disability services: the effect of gender and diagnosis

Introduction: The use of seclusion as a means of managing the extreme behaviours forensic patients in secure settings is a controversial yet often common practice, despite there being little evidence that seclusion as a practice has any significant therapeutic value for the patient. The aim of this study was to explore the use of seclusion and whether this differs as a function of gender and diagnosis across secure services. Method: This study collated data from 11 medium and low secure hospitals that admit male and female patients, with some services providing services for patients with intellectual disability (with or without co-morbid disorders), and others for patients with mental illness and/or personality disorder only. Results: Both gender and diagnosis were associated with differential seclusion rates. Seclusions were three times longer for patients in the non-ID compared to the ID service. Male seclusions (for any diagnosis) were around twice as long as those in female services. Female ID patients spent significantly less time in seclusion compared to other groups. Female ID was associated with two to three times the number of seclusion events per patient compared to other groups. No statistically significant association between the type of service and the reason for a patient being secluded. Conclusions: A range of organisational factors that determine the use and duration of seclusion are cited and merit further exploration. High rates of psychiatric co-morbidity and the complexity of patients admitted to services may also mediate risk and use of seclusion. The study supports the use of early intervention techniques and the adoption of positive behaviour support.     

Ireland and medical research with minors: some medico-legal aspects

The practice of medical research with minors in Ireland consist of practices pertaining to therapeutic and non-therapeutic medical research. Clinical trials (a category of therapeutic research), is governed by legislation. However, any other therapeutic research (non-clinical trials research) and non-therapeutic research, e.g. observational medical research such as a longitudinal study of children or non-therapeutic research such as blood sample collection for analysis of cause of disease, are unregulated by legislation. This, article will outline and describe some of the medico-legal issues involved in both types of research and will comment on matters such as what national law exists, how the directive on good clinical practice has been implemented, what guidelines, if any, exist.     

The forensic medical aspects of the toxicokinetics of organophosphate insecticides

The article deals with analysis of toxicokinetics of organophosphorous compounds (malathion and trichlorfon) in blood and of its changes in critical situations (shock, coma). In these forms of viability disturbances provided for mass-transfer and accumulation of poisonous substances in gastrointestinal tract their kinetics was shown to decelerate substantially. Active detoxification therapy improves markedly the parameters of organophosphorous insecticide kinetics. The parameters of toxicokinetics were recommended for use as objective criteria in estimation of intoxication gravity and therapy efficacy.     

The time limit on copyright: an unlikely tragedy of the intellectual commons

With their “tragedy of the commons” paradigm for intellectual property, Landes and Posner argue that the most important benefit of intellectual property rights is not that they generate incentives to create new works, but that they ensure the efficient exploitation of existing intellectual works. This alternative economic case for IP notably relies on the argument that allowing the copyright on certain massively popular works to expire could lead to their overexploitation, generating negative externalities similar to congestion externalities. This article will assess in detail the plausibility of this effect, by reviewing its most plausible interpretations: a boredom effect, a “blurring” or “tarnishment” effect, a snob effect, or a decrease in product diversity. I will argue that while Landes and Posner’s argument is ultimately inconclusive and unverified by the current state of empirical research, it also raises greater challenges than has usually been thought. Moreover, taking their argument seriously can also contribute to a better understanding of the purposes and limits of an intellectual property regime.     

Adapting measures of social climate for use with individuals with intellectual developmental disability in forensic settings

The social climate of forensic settings is thought to impact on a number of important clinical and organisational outcomes and is, therefore, an important construct in relation to the successful functioning of forensic units. A variety of self-report questionnaires have been developed to objectively measure the social climate of forensic settings (e.g. the Correctional Institutions Environment Scale and the Essen Climate Evaluation Schema), however these questionnaires have not been validated for individuals with intellectual developmental disabilities (IDD). Given the prevalence of IDD in prison and forensic psychiatric settings and the potential impact of such cognitive deficits on the ability to complete a range of self-report questionnaires, it is important to consider the potential reliability and validity of existing social climate measures in IDD populations. This article will, therefore: (1) examine the cognitive, linguistic and response format difficulties that may arise when administering self-report measures of social climate in IDD populations; (2) consider potential adaptations to existing measures of social climate that might make them more suitable for use with IDD populations; and (3) identify important directions for future research in the area.