Structure and Organization of Sport for People With Intellectual Disabilities Across Europe.

Opportunities to participate and compete in sports for athletes with intellectual disability (ID) have increased; however, this group still encounters limitations in accessing a comprehensive range of sports. This study addressed the current knowledge on how sport for people with ID is organized and the relationships between the major sport organizations for people with ID across 10 European countries. The participants were 29 national sport organizations for people with ID. Data were collected using semistructured interviews with representatives from the key organizations and analyzed thematically. From the results, two major themes emerged: (a) connection and networking between sport organizations and (b) organizational landscape of each nation (i.e., ID, multidisability, or mainstream). The results of this study contribute to understanding how sport for people with ID is organized across the participating nations, demonstrating different models of development and examples of good practice.

Sports Classification and Athletes With Intellectual Disabilities: Measuring Health Status Using a Questionnaire Based on the International Classification of Functioning, Disability and Health.

Most people with intellectual disabilities have comorbid health conditions, which will impact optimization of sporting performance. Classification is used in Paralympic events to ensure that those with similar levels of functional ability compete fairly against each other. An evidence-based approach needs to be developed for athletes with intellectual disabilities to be classified in relation to their overall functional capacity into competition groups of similar ability. This research builds on previous work using the taxonomy of The International Classification of Functioning, Disability and Health (ICF) to group athletes with intellectual disabilities into comparable competition groups as an approach to Paralympic classification. Three groups of athletes-Virtus, Special Olympics, and Down syndrome-are compared using the ICF questionnaire indicating functional health status in relation to sporting performance. The questionnaire was found to discriminate between athletes with Down syndrome and other athletes, and an approach to using a cutoff score to develop competition classes is explored.

Developing additional competition classes for athletes with intellectual impairments: Conceptual approach and efficacy of an ICF derived measure.

The purpose of para sport classification systems is to minimize the impact of impairment on competition outcome. Currently, athletes with intellectual impairment (II) compete in one class, regardless of the extent of activity limitation resulting from their impairment. Consequently, athletes with II that cause relatively minor difficulty in sport have a competitive advantage over athletes who have intellectual impairments that cause more significant advantage. This research investigated the efficacy of a measure of health-related functional impairment, derived from the World Health Organization International Classification of Functioning, Disability, and Health (ICF), as a tool to classify athletes with intellectual impairments (II) into groups with impairments that cause similar activity limitation. The first study used a Delphi technique to identify the most relevant codes within the ICF from which a measure of impairment presence and severity was derived. The second study investigated whether the measure could discriminate between groups of II athletes organized into three competition groups, and whether these groups could be predicted by ICF score. The ICF-based questionnaire shows promise as a conceptual approach and as a tool in this context, but this is a preliminary step before establishing a sport-specific approach to classification.

Conceptual model of sport-specific classification for para-athletes with intellectual impairment.

The present paper describes the conceptual basis of evidence-based classification of para-athletes with intellectual impairment (II). An extensive description of the theoretical and conceptual foundation of the system as currently conceived is provided, as are examples of its applications in the three sports included in the Paralympic programme for II-athletes in 2020 (i.e., athletics, swimming and table tennis). Evidence-based classification for II-athletes is driven by two central questions: i. How can intellectual impairment be substantiated in a valid and reliable way, and ii. Does intellectual impairment limit optimal sport proficiency? Evolution of the system and current best practice for addressing these questions are described, and suggestions for future research and development are provided. Challenges of understanding and assessing a complex (multifaceted and intersectional) impairment in the context of sport also are considered.

Using personal construct methodology to explore relationships with adolescents with Autism Spectrum Disorder.

BACKGROUND: Research shows that adolescents with Autism Spectrum Disorder (ASD) experience difficulties developing friendships, and that loneliness is a significant factor contributing to higher incidence of anxiety and depression within this population. AIMS: This study aimed to provide an in-depth analysis of relationships as described by adolescents with ASD, and, from these descriptions, to explore what can be inferred about the development of successful interpersonal relationships for these individuals. METHODS AND PROCEDURE: Eight adolescents with ASD participated in semi-structured interviews using established personal construct theory (PCT) techniques. OUTCOMES AND RESULTS: PCT was found to be a helpful approach to elicit rich, qualitative data. A thematic analysis identified four themes: relationships as a source of support, perceptions of similarity and difference, valued qualities in self and others, and the development and maintenance of relationships. CONCLUSIONS AND IMPLICATIONS: Whilst this exploratory study highlighted some commonality in terms of perceptions of family support and friendships as protective and desirable, participants differed in their ability to establish and maintain peer relationships. Participants valued personal qualities such as intelligence, humour and trust within relationships, and recognised the important role of peers and siblings in the development of social skills, a finding which has implications for the delivery of social skills training and other interventions. The study provides empirical support for the application of personal construct methodologies in ASD research and offers a potentially useful approach to therapeutic intervention.

Disorders of sex development: Mothers' experiences of support.

BACKGROUND: An increasing body of research has sought to determine the impact of Disorders of Sex Development (DSD) on the family of the affected child. Little is currently understood about the support needs of the family and how well these needs are met. METHODS: Interpretive Phenomenological Analysis was used to analyse semi-structured interviews with eight mothers of children with DSD about their experiences of support. RESULTS: Four master themes emerged which encapsulated (a) the stages in their child's development when mothers most needed support, (b) the importance of developing an understanding of the child's condition, (c) the lack of acknowledgement of the emotional needs of the parent and (d) the importance of having close and trusted networks for support. Continuity and availability of support were considered important and while all participants prioritised maintaining privacy about the condition, a minority felt that this impacted the level of support they received. CONCLUSIONS: Key time points for support were identified and while some felt that they were well supported others felt that the support available did not meet their emotional needs. Clinical implications and directions for future research were considered.

Psychosocial impact of involvement in the Special Olympics.

Existing evidence suggests that people with intellectual disabilities are vulnerable to low self-esteem leading to additional psychosocial issues such as social exclusion and stress. Previous research into the involvement of Special Olympics (SO) of people with intellectual disabilities has indicted positive psychosocial outcomes. Involvement in sport is known generally to have psychological and social benefits. This study aimed to compare the psychosocial impact of involvement in sport through the SO to no or limited sports involvement, for a sample of people with intellectual disabilities. A cross sectional design was employed comparing three groups, SO, Mencap Sports, and Mencap No Sports on the variables: Self-esteem, quality of life, stress levels and social networks. One hundred and one participants were recruited either through the SO or Mencap. Data were collected through the completion of validated questionnaires by one to one interviews with the participants. Analysis revealed that self-esteem, quality of life, and stress were all significantly associated with SO involvement. Logistic regression analysis was used to explore whether scores on these variables were able to predict group membership. Self-esteem was found to be a significant predictor of group membership, those in the SO having the highest self-esteem. The findings provide further evidence of a positive association between sport involvement and increased psychological wellbeing, especially for those involved in the SO. The implications of these findings for practice and future research into the relationship between sport and psychological wellbeing within the learning disabled population are considered.

Public attitudes toward people with intellectual disabilities after viewing Olympic or Paralympic performance.

Despite some changes to the way that people with intellectual disabilities (ID) are viewed in society, negative attitudes prevail. One of the aspirations of the 2012 Paralympic games was to influence the public's attitudes toward people with disabilities. The aim of this study was to investigate whether stimuli depicting people with ID performing at Paralympic level of competition change attitudes toward ID. A mixed randomized comparison design was employed comparing 2 groups: those who viewed Paralympic-level ID sport footage and information and those who viewed Olympic footage and information. One hundred fourteen students, mean age 25 yr, were administered measures of implicit (subconscious) attitudes toward disability and explicit (belief-based) attitudes toward ID. Implicit attitudes significantly changed in a positive direction for both groups. The findings provide evidence that both Paralympic (ID) and Olympic media coverage may have at least a short-term effect on attitudes toward people with disabilities.

Lesbian co-mothers' experiences of maternity healthcare services.

AIM: This article is a report of a study of lesbian co-mothers' experiences of UK maternity healthcare services. BACKGROUND: With the increase in fertility provision to lesbian couples, maternity healthcare services are increasingly coming into contact with lesbian co-mothers. Literature highlights the need to investigate donor-conceived lesbian families and an absence of research focusing on the unique experiences of co-mothers in the maternity process. DESIGN: The study followed a qualitative design and interpretative phenomenological analysis methodology. METHODS: A qualitative study was carried out involving ten lesbian co-mothers, whose children were conceived via anonymous donor insemination to their partners. Data collection took place between May-September 2009. FINDINGS: Interpretative phenomenological analysis revealed two main types of co-mothers' experiences, those connected with maternity service structures and interpersonal experiences with maternity care staff. Co-mothers felt excluded by heterocentric organizational service structures. However, the co-mothers' overwhelming experiences with staff were positive and inclusive. Despite this, co-mothers reported that any ambiguous or non-inclusive experiences with professionals left them questioning whether these experiences were due to homophobic attitudes or professional incompetence. CONCLUSION: The results indicate that these lesbian co-mothers felt predominantly included and accepted by maternity services. Ambiguous interpersonal experiences, however, evoked doubts in this regard. In addition, organizational heterocentric structural barriers remain. Structural service delivery changes could facilitate co-mothers' feelings of inclusion and highlight the important role practitioners have in contributing to co-mothers' experiences.

The evacuation of cairns hospitals due to severe tropical cyclone Yasi.

On February 2, 2011, Tropical Cyclone Yasi, the largest cyclone to cross the Australian coast and a system the size of Hurricane Katrina, threatened the city of Cairns. As a result, the Cairns Base Hospital (CBH) and Cairns Private Hospital (CPH) were both evacuated, the hospitals were closed, and an alternate emergency medical center was established in a sports stadium 15 km from the Cairns central business district. This article describes the events around the evacuation of 356 patients, staff, and relatives to Brisbane (approximately 1,700 km away by road), closure of the hospitals, and the provision of a temporary emergency medical center for 28 hours during the height of the cyclone. Our experience highlights the need for adequate and exercised hospital evacuation plans; the need for clear command and control with identified decision-makers; early decision-making on when to evacuate; having good communication systems with redundancy; ensuring that patients are adequately identified and tracked and have their medications and notes; ensuring adequate staff, medications, and oxygen for holding patients; and planning in detail the alternate medical facility safety and its role, function, and equipment.

What is narrative therapy and what is it not?: the usefulness of Q methodology to explore accounts of White and Epston's (1990) approach to narrative therapy.

OBJECTIVE. 'What is narrative therapy and how do you do it?' is a question that is repeatedly asked of narrative therapy, with little consistent response. This study aimed to explore and distil out the 'common themes' of practitioner definitions of White and Epston's approach to narrative therapy. DESIGN. This was an Internet-based study involving current UK practitioners of this type of narrative therapy using a unique combination of a Delphi Panel and Q methodology. METHOD. A group of experienced practitioners were recruited into the Delphi Poll and were asked two questions about what narrative therapy is and is not, and what techniques are and are not employed. These data combined with other information formed the statements of a Q-sort that was then administered to a wider range of narrative practitioners. FINDINGS. The Delphi Panel agreed on a number of key points relating to the theory, politics and practice of narrative therapy. The Q-sort produced eight distinct accounts of narrative therapy and a number of dimensions along which these different positions could be distinguished. These included narrative therapy as a political stance and integration with other approaches. CONCLUSIONS. For any therapeutic model to demonstrate its efficacy and attract proponents, an accepted definition of its components and practice should preferably be established. This study has provided some data for the UK application of White and Epston's narrative therapy, which may then assist in forming a firmer base for further research and practice.

The dilemmas of residential care staff working with the challenging behaviour of people with learning disabilities.

OBJECTIVES: To investigate residential care staff beliefs and feelings about the challenging behaviour of adults with learning disabilities in their care, and how they perceive these beliefs and feelings to have developed over time. DESIGN: A qualitative study using thematic analysis. METHODS: A group of 18 staff from 10 different residential services participated in indepth semi-structured interviews. Transcripts were analysed according to thematic analysis techniques drawn from interpretative phenomenological analysis (IPA) and grounded theory. The analysis was then subjected to scrutiny by participants using a respondent validation survey. RESULTS: Staff talked of dilemmas about whether challenging behaviour should be seen as a 'communication' of need or as a 'behaviour problem', how to balance a 'firm' response with 'kindness', and how to deal with unpleasant feelings evoked by the work, especially fear and frustration. Over time, staff reported overcoming initial fears of the client by 'getting to know them', or alternatively, avoiding the client, 'cutting off' emotionally, or protecting themselves with safety procedures. CONCLUSIONS: The analysis suggests that staffs are troubled by the limitations of a narrow behavioural discourse. Staff development and training based on richer approaches that integrate behavioural ideas with a value-based philosophy, might allow staff to respond to needs expressed by behaviour without fear of reinforcing it. Services should attend to staff emotional reactions to their work, to help them maintain nonavoidant coping strategies.