The protective scale of the Armidilo-S: The importance of forensic and clinical outcomes.

BACKGROUND: The Armidilo has two scales-the risk scale and the protective scale. Research has been confined to the risk scale which appears to predict future incidents with medium to large effect sizes. There have been no publications on the use of the protective scale. METHODS: The Armidilo was completed on four individuals with IDD who were either moving on from their placement or whose placement was in jeopardy because of new information or altered policies in the organization. The Armidilo was completed in the usual fashion. RESULTS: Risk and protective results show that for each individual, recommendations could be made that ensured the best outcome. For two participants, restrictive placements were avoided because of the data on protective factors. CONCLSIONS: The protective scale can be a powerful support for the clinician's case in offenders with IDD. The protective scale should be completed routinely for clinical evaluation.

An evaluation and 20-year follow-up of a community forensic intellectual disability service.

BACKGROUND: Since the middle of the 20th century, there have been several heterogeneous studies of recidivism by offenders with intellectual disabilities (ID) who have been in specialist mental health services after an index offence. Although some were long term, as befits a chronically needy group, laws and services have changed in that time. It may no longer be appropriate to rely on findings from the 1960s and 1970s. AIMS: To compare mental health presentations and recidivism between male sex offenders, men convicted of other offences and female offenders from a 1986-2008 cohort of offenders referred to specialist forensic ID services in Scotland. METHOD: A 20-year follow-up of an assessment and treatment service for 309 offenders with ID (156 sex offenders, 126 non sexual male offenders and 27 women) was conducted. RESULTS: Sex offenders were more likely to be referred from the courts and had lower anger levels. Women were more likely to be diagnosed with mental illness. There was a split between groups with sex offenders committing few nonsexual offences and the other groups showing few sexual offences. During the study period, 16% of sexual offenders, 43% of male nonsexual offenders and 23% of women committed at least one further offence. Following assessment and treatment there was a 90-95% reduction in offending incidents. CONCLUSIONS: Although recidivism rates are disappointing, harm reduction data suggests that assessment and treatment for offenders with ID can be highly successful in terms of public safety.

Internal consistency and factor structure of personality disorders in a forensic intellectual disability sample.

BACKGROUND: The publication of the DSM-III (American Psychiatric Association (APA), 1980) prompted a significant increase in interest and research on personality disorder (PD), and the concept has subsequently been incorporated into mental health legislation in the developed world. Despite this, such research on people with intellectual disability (ID) has been sporadic, with widely varying results. The present study addresses a number of criticisms directed at previous research. METHOD: DSM-IV (APA, 2000) diagnoses of PD were made on 164 participants with ID on the basis of four independent sources of classification. RESULTS: Reliability data for each PD was acceptable and alpha was .74 or above, with the exception of schizotypal PD (.63). Exploratory and confirmatory factor analyses were conducted, with the former revealing a 4-factor solution accounting for 58.9% of the variance, and a 2-factor solution accounting for 37.2% of the variance emerging for the latter. The factors were orthogonal, and we called the first factor "avoidant/rumination/inhibited" and the second factor "acting out". DISCUSSION: We review these findings in relation to previous research on PD and alternative frameworks for the understanding of personality. We hypothesise consistencies between these findings and previous work on personality and ID. A number of drawbacks to the research are discussed, including a caution on the pejorative nature of a diagnosis of PD in an already devalued population.