Randomized Control Trial of the 3Rs Health Knowledge Training Program for Persons with Intellectual Disabilities.

BACKGROUND: Persons with intellectual disabilities (ID) experience a wide range of health problems. Research is needed on teaching persons with intellectual disabilities about their health to promote self-advocacy. This study used a RCT to evaluate a health knowledge training program for adults with intellectual disabilities and verbal skills. METHODS: Participants were randomly assigned to training (n = 12) or no training control (n = 10) groups. Topics included key body organs, systems, functions, health maintenance and illnesses. Participants played a game answering questions (e.g. 'What does the heart do?'). Instruction involved visuals (e.g., PowerPoint slides), cueing, modelling and feedback. The control group received pre-, post- and follow-up tests as the training group. RESULTS: The training group had significantly higher overall post-test and follow-up health knowledge test scores than the control group. CONCLUSIONS: Health knowledge training is one step in promoting health self-advocacy and better health in persons with intellectual disabilities.

Persons with intellectual disabilities and problematic sexual behaviors.

Persons with intellectual disabilities who have been identified because they committed a sexual offense may have done so because of a sexual paraphilia. However, special consideration in assessment is required to determine whether the offense is caused by a paraphilia alone or whether other factors relating to the individual's intellectual disabilities may be especially significant. This article reviews some factors that have been identified as significant and provides an overview of treatment approaches from multiple perspectives.

'Counterfeit deviance' revisited.

BACKGROUND: The field has seen a renewed interest in exploring the theory of 'counterfeit deviance' for persons with intellectual disability who sexually offend. The term was first presented in 1991 by Hingsburger, Griffiths and Quinsey as a means to differentiate in clinical assessment a subgroup of persons with intellectual disability whose behaviours appeared like paraphilia but served a function that was not related to paraphilia sexual urges or fantasies. Case observations were put forward to provide differential diagnosis of paraphilia in persons with intellectual disabilities compared to those with counterfeit deviance. The brief paper was published in a journal that is no longer available and as such much of what is currently written on the topic is based on secondary sources. METHOD: The current paper presents a theoretical piece to revisit the original counterfeit deviance theory to clarify the myths and misconceptions that have arisen and evaluate the theory based on additional research and clinical findings. The authors also propose areas where there may be a basis for expansion of the theory. RESULTS: The theory of counterfeit deviance still has relevance as a consideration for clinicians when assessing the nature of a sexual offence committed by a person with an intellectual disability. Clinical differentiation of paraphilia from counterfeit deviance provides a foundation for intervention that is designed to specifically treat the underlying factors that contributed to the offence for a given individual. DISCUSSION: Counterfeit deviance is a concept that continues to provide areas for consideration for clinicians regarding the assessment and treatment of an individual with an intellectual disability who has sexually offended. It is not and never was an explanation for all sexually offending behavior among persons with intellectual disabilities.

Meta-analysis of deinstitutionalization adaptive behaviour outcomes: research and clinical implications.

BACKGROUND: A meta-analysis examined the effects of deinstitutionalisation on adaptive behaviour outcomes in persons with intellectual disability. The need for an updated review in this area is reflected by recent policy shifts in community care practices and the international status of deinstitutionalisation efforts. METHOD: Twenty-three studies were compared using standardised mean effect sizes across 5 demographic, 4 methodological, and 1 outcome variable. RESULTS: Moderate habilitative gains were found in 75% of adaptive behaviour domains. A weighted linear multiple regression revealed that larger effect sizes were significantly predicted by sample size and research design. Disability level also moderated the extent to which sample size affected the magnitude of effect sizes. CONCLUSIONS: These results are discussed in relation to the implications they have for community services for persons with intellectual disability. The difficulties in accurately comparing studies with dissimilar procedures and contexts are also outlined.

Meta-analysis of deinstitutionalisation adaptive behaviour outcomes: Research and clinical implications.

Background A meta-analysis examined the effects of deinstitutionalisation on adaptive behaviour outcomes in persons with intellectual disability. The need for an updated review in this area is reflected by recent policy shifts in community care practices and the international status of deinstitutionalisation efforts. Method Twenty-three studies were compared using standardised mean effect sizes across 5 demographic, 4 methodological, and 1 outcome variable. Results Moderate habilitative gains were found in 75% of adaptive behaviour domains. A weighted linear multiple regression revealed that larger effect sizes were significantly predicted by sample size and research design. Disability level also moderated the extent to which sample size affected the magnitude of effect sizes. Conclusions These results are discussed in relation to the implications they have for community services for persons with intellectual disability. The difficulties in accurately comparing studies with dissimilar procedures and contexts are also outlined.

Trends and challenges in forensic research on offenders with intellectual disability.

BACKGROUND: The Journal of Intellectual & Developmental Disability has a well-respected history of establishing the parameters and contributing to developments in the field of offenders with intellectual disability (ID). METHOD: The field has seen a number of developments over the past 15 years, and this paper identifies several trends that have emerged in the research during this period, including work on prevalence of ID in prison populations, development of risk assessment, consideration of staff issues, developing the psychometrics of offence-specific assessments, evaluating treatment methods, and testing the underlying theoretical frameworks which attempt to account for offending. RESULTS AND CONCLUSIONS: We refer to a number of studies which have advanced these developments in the field and draw the reader's attention to the way in which papers in this special issue contribute to and further develop each of these research trends.

Sexual knowledge and attitudes of men with intellectual disability who sexually offend.

BACKGROUND: Various explanations of sexual offending in men with intellectual disability (ID) have stressed sexual deviance and a lack of developmental socio-sexual knowledge. METHOD: Using the normative dataset of people with ID from the development of the Socio-Sexual Knowledge and Attitudes Assessment Tool - Revised (SSKAAT-R: Griffiths & Lunsky, 2003), two samples of individuals with ID and a history of sexual offence were compared on sexual knowledge to matched samples of individuals with ID and no known sexual offences. RESULTS: Offenders with ID who were identified as having engaged in sexually inappropriate behaviour, such as public masturbation or touching someone inappropriately, did not differ in terms of sexual knowledge from their matched sample of individuals with ID with no sexual offence history, whereas offenders who had committed more serious offences demonstrated greater sexual knowledge than matched non-offenders. When only those individuals who had received prior sex education were compared in terms of sexual knowledge, there were no differences between groups. However, sex offenders (serious offences) expressed more liberal attitudes than sex offenders (inappropriate behaviour) and non-offenders towards same-sex activities. CONCLUSIONS: The study points to the dynamic effect of socio-sexual education on offenders' knowledge and attitudes, and highlights potential differences in the knowledge and attitudes of different subtypes of offenders.