Offenders with intellectual disabilities in prison: what happens when they leave?

BACKGROUND: People with intellectual disabilities, if convicted of offences, may be sentenced to prison, but little is known about their life when they are released. METHOD: This study followed up men with intellectual disabilities who were leaving prisons in England. RESULTS: The men were hard to contact, but 38 men were interviewed, on average 10 weeks after leaving prison. The men were living in a variety of situations and often were very under-occupied, with limited social networks. A total of 70% were above the clinical cut-off for anxiety, and 59.5% were above the clinical cut-off for depression. The men were receiving little support in the community, and many had been reinterviewed by police. CONCLUSIONS: Community teams need to provide better support to this very vulnerable group.

The effects of training on the ability of adults with an intellectual disability to give informed consent to medication.

BACKGROUND: This study had two aims: to investigate the capacity of individuals with intellectual disabilities (ID) to make decisions about their medications, and to evaluate whether the provision of training (information) sessions on medications would increase their capacity. METHOD: Twenty-eight adults (18 male and 10 female), with a mild to moderate ID were included in this study and they were taking either Epilim, Metformin or Haloperidol medications. The participants were split into groups that comprised of participants taking the same medications. Each of the groups received three training sessions on their own medications. Capacity to consent was measured by the Adapted - Assessment of Capacity Questionnaire (A-ACQ), which was specially adapted for each medication type from the original measure (ACQ). Receptive language ability was measured by the British Picture Vocabulary Scale-II (BPVS-II). RESULTS: A two-factor mixed anova analysis indicated that the provision of training had improved the capacity of the participants to give informed consent to taking their medications. Analysis using Pearson's correlations indicated that increased levels of receptive language ability correlated with greater ability to give informed consent to taking medication. CONCLUSIONS: The provision of information that is formatted in a way that individuals with ID can understand may be a useful way to increase knowledge on medications. Further research that investigates the provision of information with larger samples is warranted.

The psychological impact of abuse on men and women with severe intellectual disabilities.

BACKGROUND: In other populations, the psychological impact of abuse has been conceptualized as Post Traumatic Stress Disorder (PTSD, DSM-IV, American Psychiatric Association (APA), 1994), but little is known about whether this is appropriate for adults with severe intellectual disabilities and very limited communication skills. METHODS: An informant interview, based on the framework provided by PTSD, but supplemented with additional questions, was developed and was used to elicit the emotional, behavioural and physiological symptoms of alleged abuse in 18 people with intellectual disabilities at three time points: in the 3 months immediately prior to the alleged abuse (Time 1), in the 3 months immediately after the abuse (Time 2) and in the last 3 months prior to interview (Time 3). RESULTS: The reports of the family and carer informants indicated that, following their alleged abuse, the victims experienced marked increases in the frequency and severity of emotional, physiological and behavioural symptoms of psychological distress. Over time, there was some alleviation of these difficulties, but psychological functioning remained severely compromised. CONCLUSIONS: While the established PTSD framework is appropriate for examining the psychological impact of abuse, some amendments are required to enable clinicians to examine fully the distress of alleged victims with severe intellectual disabilities.

The impact of alleged abuse on behaviour in adults with severe intellectual disabilities.

BACKGROUND: People with intellectual disabilities (ID) are particularly vulnerable to abuse, and most incidents come to light through victim disclosure. Those people with severe or profound ID are not able to describe what has happened to them. This project aimed to describe the consequences of abuse and changes in behaviour following alleged abuse in 18 adults with severe ID. METHOD: Family members or other carers were interviewed to collect information about the alleged abuse. They were also asked about the person's adaptive and challenging behaviours at three time points: in the 3 months immediately prior to the abuse (time 1), in the 3 months immediately after the abuse (time 2) and in the 3 months prior to interview (time 3). RESULTS: A typical pattern emerged for both adaptive and challenging behaviours: there were few problems or difficulties at time 1, major difficulties at time 2 and some recovery by time 3. CONCLUSIONS: Evidence is mounting that clinicians considering the sequelae of abuse for people with severe or profound ID need to consider changes in adaptive and challenging behaviours, as well as the typical symptoms of post-traumatic stress disorder.

Sexual relationships in adults with intellectual disabilities: understanding the law.

INTRODUCTION: Adults with intellectual disabilities (IDs) are known to be very vulnerable to sexual abuse. This may result partly from their lack of sexual knowledge and their powerless position in society. It could also be exacerbated by an ignorance of the law. This study investigates their understanding of the law relating to sexuality. METHOD: Understanding of the law regarding sexual relationships, consent and abuse was assessed in 60 adults with IDs (mean age 37.6 years) and 60 young people aged 16-18 years (deemed in law capable of consenting to a sexual relationship). Questions were wide ranging, including general laws around sexuality and abuse, as well as the law relating to sexual relationships and ID. RESULTS: There were significant differences between the two groups: adults with IDs had a very limited understanding of the general laws relating to sexuality (e.g. age of consent, incest, abuse), as well as the law relating to sexuality and IDs (e.g. whether they could have sexual relationships, whether they were allowed to marry, what protection they should expect from the law). Young people without disabilities showed a better understanding, both for general laws and for those relating specifically to adults with IDs. CONCLUSIONS: These findings show that there is a need to educate people with IDs about the laws relating to sexuality. It is important for people to understand the law and, given the high rates of sexual abuse perpetrated against people with ID, it is essential for them to benefit from the protection the law affords. The new law in England (Sexual Offences Act 2003) post-dated this study. It will be interesting to see whether the new legislation is easier for people with and without disabilities to understand.

Assessing the capacity of people with intellectual disabilities to be witnesses in court.

BACKGROUND: People with intellectual disabilities who have been victims or other witnesses of crime have had limited access to the criminal justice system, often on the basis of assumptions about their incapacity to be interviewed by the police and to give evidence in court. The aim of this study was to assess their capacity to be witnesses in court. METHODS: Forty-nine men and women with intellectual disabilities, all of whom were potential witnesses of ill-treatment, were assessed in order to provide advice, initially to the police, about their capacity to be interviewed for judicial purposes. The assessments included evaluations of each person's intellectual ability, memory, acquiescence, suggestibility, and their ability to explain concepts relating to the oath. RESULTS: Only 37 (76%) were able to complete the assessments. Most of those with a Full Scale IQ score of > or = 60 had a basic understanding of the oath, compared with only a third of those with IQ scores between 50 and 59, and none of those with IQ scores < 50. Nevertheless, some of the people who were unable to demonstrate an understanding of the oath did understand the words 'truth' and 'lie', especially when asked about these concepts in relation to concrete examples. CONCLUSIONS: While intellectual ability appears to be the best overall predictor of the capacity of people with intellectual disabilities to act as witnesses, confining witnesses to those who could explain the meaning of the oath would mean that a number of persons who might be interviewed by the police and subsequently appear in court could be excluded from the judicial process.

Psychological characteristics of children with Shwachman syndrome.

Twelve children and young adults with Shwachman syndrome were compared with their unaffected siblings and with controls suffering from cystic fibrosis in terms of intellectual ability, motor skills, and behaviour. There were highly significant differences in intelligence quotient between those with Shwachman syndrome and the other two groups. Four of the index subjects but none of the control subjects were below the normal range. The differences between groups on other tests of cognitive and motor skills were not significant, though those with Shwachman syndrome tended to have the lowest scores. There was no evidence that those with Shwachman syndrome had more behavioural difficulties than the control subjects. We suggest that the intellectual difficulties of patients with Shwachman syndrome may be of neurological rather than social origin and that they may originate before birth.

Congenital hypothyroidism: physiological and psychological factors in early development.

Children diagnosed as congenitally hypothyroid and treated from a very early age were followed up at 1 and 3 years. At 1 year they seemed to be developing normally, unless they were undertreated or had an additional disorder. There were no significant correlations between biochemical or social factors and psychological outcome at 1 year. At 3 years, however, those children whose T4 and/or T3 had been very low initially had significantly lower IQ scores than both other hypothyroid children and matched controls. Children with only moderately low initial T4 and/or T3, however, were doing just as well as their matched controls. Initial levels of TSH, the number of symptoms at first clinical interview and the age at the start of treatment were not good indicators of ability at 3 years. Undertreatment was rare but did appear to affect ability. Psychological outcome at 3 years was also correlated with social class (for both cases and controls). Multiple regression analyses indicated that both low initial T4 (less than 20 nmol/l) and social class contributed significantly to outcome.

Self-injurious behaviour in people with mental handicap: a total population study.

A survey of self-injurious behaviour in people receiving services for mental handicap was carried out in one health region. Six hundred and sixteen adults and children were found to have engaged in self-injurious behaviour sufficient to have caused tissue damage in the previous 4 months and 596 of these were screened. Half were resident in hospital while 28% were in non-hospital residential care and the remainder (21%) were living at home. Nearly one-fifth (19%) showed self-injurious behaviour, of one or more types, at a rate of at least once per hour and a further 13% wore protective or restraining devices for all or part of the day or night. Only 2% were enrolled on formal psychological treatment programmes but nearly half were receiving psychotropic drugs (excluding anticonvulsants).