The Tizard Centre

 

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Professor Glynis Murphy

Co-Director and Professor of Clinical Psychology & Disability

Tizard

Glynis Murphy studied PPP at Oxford University, where she obtained a first, and she then undertook her clinical psychology training at Birmingham University, where she was awarded the Crothalls prize. Following this, she was employed as a clinical psychologist in Hilda Lewis House at the Bethlem Royal Hospital and completed her PhD at the Institute of Psychiatry, London. Since that time, she has worked at the Institute of Child Health and Great Ormond Street Hospital, London; the Tizard Centre, University of Kent; and she was academic director on the DClinPsy course in Lancaster University.

Prof Murphy has now returned to the Tizard Centre and currently holds a joint Chair of Clinical Psychology and Disability at the Tizard Centre, University of Kent. She is co-editor of the Journal of Applied Research in Intellectual Disability, a fellow of the British Psychological Society, and was President of the International Association for the Scientific Study of Intellectual Disability between 2008 and 2012. www.iassid.org She is also one of the Associate Directors for the School of Social Care Research.

All Glynis Murphy’s posts have involved teaching. She has taught undergraduate students on mainstream Psychology degrees, and on the Tizard Certificate and Diploma courses. She has taught postgraduate students on clinical psychology courses at the Institute of Psychiatry, Salamons, UEA and Lancaster University. She developed and convened the Tizard MSc in Analysis and Intervention in Learning Disabilities, which is now the Postgraduate course in Intellectual and Developmental Disabilities.  Her teaching is generally very highly rated – averaging around 4.9 on student feedback (on a 1 to 5 scale) in 2011/2012. She has supervised dissertations for numerous MSc students, clinical psychology doctorate students, and 15 PhD students . She has acted as external examiner for a number of programmes and examined PhD theses and Clinical Psychology doctorates at the Universities of Manchester, Birmingham, Cardiff, London, Cambridge, Nottingham, Lancaster and East Anglia.

 

 

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Books

    Emerson, E. and Hatton, C. and Felce, D et al. (2001) Learning Disabilities: the fundamental facts. Foundation for People with Learning Disabilities, London ISBN 9780901944986.

    Watters, C. and Murphy, G.H. (1996) The background and context. BILD, Kidderminster, 64 pp. ISBN 978-1873791134.

    Hollins, S. and Murphy, G.H. and Clare, I.C.H. (1996) You're on Trial. Books Beyond Words S.. Gaskell, 47 pp. ISBN 9781901242003.

    Hollins, S. and Clare, I.C.H. and Murphy, G.H. (1996) You're under arrest. Books Beyond Words S.. Gaskell Press, London, 40 pp. ISBN 9781901242010.

    Murphy, G.H. and Wilson, B. (1984) Self Injurious Behaviour. BIMH Publications, Kidderminster ISBN 9780906054499.

Articles

    Langdon, P. and Murphy, G.H. and Clare, I.C.H. et al. (2011) Relationships among moral reasoning, empathy and distorted cognitions in men with ID and a history of criminal offending. American Journal on Intellectual and Developmental Disabilities, 116 (6). pp. 438-456. ISSN 1944-7558.

    Abstract

    Eighty men, spread equally across 4 groups, were recruited, including men with and without intellectual disabilities. The men were either criminal offenders or nonoffenders. Participants completed measures of moral reasoning, empathy, and distorted cognitions. The results indicated that the moral reasoning abilities of offenders with intellectual disabilities were developmentally delayed but were still more mature than those of nonoffenders with intellectual disabilities. Offenders without intellectual disabilities had less mature moral reasoning abilities than nonoffenders without intellectual disabilities. The differences may be partially accounted for by intellectual ability. The results also indicated that the relationship between empathy and distorted cognitions was mediated by moral reasoning. The findings have implications for the use of psychological interventions with offenders with intellectual disabilities.

    Taylor, L. and Oliver, C. and Murphy, G.H. (2011) The chronicity of self-injurious behaviour: a long-term follow up of a total population study. Journal of Applied Research in Intellectual Disabilities, 24 (2). pp. 105-117. ISSN 1360-2322.

    Abstract

    Background Self-injurious behaviour (SIB) is a relatively common problem for people with intellectual disabilities and it is known to be associated with various risk markers, such as degree of disability, sensory impairments, and autism (McClintock et al. 2003). Less is known about its long-term course however. Method The present study was conducted to examine the quality of life and changes in behaviour for a cohort of 49 people with intellectual disabilities and SIB who were all part of a previous total population study conducted in the south of England by Oliver, Murphy and Corbett (1987). Assessment tools used in the original study, and an additional quality of life measure, the Life Experience Checklist (Ager, 1990), were carried out with informants in the participant's homes or places of day activity. Results The results show that 84% of the sample continued to self-injure nearly 20 years on, with no significant mean changes in number of topographies or severity of SIB across the group. No one was living in hospital in this study (cf. many individuals in the first survey) but for those who had moved out of hospital, their SIB had not reduced. More people were receiving psychological treatment; more were also receiving anti-convulsant and anti-psychotic medications, though polypharmacy had reduced somewhat. The number of people accessing full-time day activities had decreased substantially, with 44% of people only accessing structured daily activities for 21/2 days per week or less. Conclusions The results of the study add to the growing evidence of extreme chronicity for SIB and the relative lack of impact of treatment for people in whom self-injury has become well-established. They imply that early intervention is essential if such behaviour is to be eliminated long term.

    Bhwardwaj, A. and Forrester-Jones, R. and Murphy, G.H. (2010) Social inclusion of people with ID from different cultural backgrounds. Journal of Applied Research in Intellectual Disabilities, 23 (5). pp. 508-508. ISSN 1360-2322.

    Abstract

    Aim: To examine social inclusion among adults with ID and to determine the extent to which it differed depending on the de?nition and measurements used. Method: Social inclusion was measured using the following items in the interRAI ID instrument: (a) social relationships (presence of a con?dant, recent contact with family/friends), (b) participation in social activities of interest, and (c) involvement in structured activities (work, volunteer services, day programmes). Population-level data in Ontario’s institutions (1014 people assessed in 2005) and a sample of 327 community-dwelling adults (collected between 2005 and 2007) were used. Results: Social inclusion differed between persons living in institutional and community settings and within each group based on the conceptualization used. Further, there was great variability within and between groups based on the speci?c measures used within each conceptualization. For example, the rates differed greatly for the three measures of social relationships and the three measures of involvement in structured activities. Conclusion: The ?ndings replicated those of other studies showing greater social inclusion among persons with ID living in community settings. The results also showed that social inclusion differed based on how the concept was de?ned, and what measurements were used to operationalize that de?nition. Findings highlight the need for a common framework for understanding and measuring social inclusion

    Gore, N.J. and Barnes-Holmes, Y. and Murphy, G.H. (2010) The relationship between intellectual functioning and relational perspective-taking. International Journal of Psychology and Psychological Therapy, 10 (1). pp. 1-17. ISSN 1577-7057.

    Abstract

    Several studies have employed an RFT-based test protocol as an assessment of perspective-taking with both typical and atypical samples of adults and children. In addition, other RFT protocols have found significant correlations between competencies on specific relations and outcomes on standardised IQ measures. However, there is no research to date that has examined correlations between relational perspective-taking and IQ. In the current study, 24 adults with varying levels of intellectual disability were exposed to standard measures of language ability and IQ, as well as an RFT-based test protocol for perspective-taking. In line with previous evidence, the results indicated significant differences across performances on different aspects of the perspective-taking protocol. Furthermore, the data indicated that perspective-taking correlated with verbal ability, full-scale IQ and performance IQ. These findings provide further evidence of the utility of the RFT-based protocol of deictic frames and highlight the role of intellectual functioning in perspective-taking.

    Langdon, P. and Clare, I.C.H. and Murphy, G.H. (2010) Developing an understanding of the literature relating to the moral development of people with intellectual disabilities. Developmental Review, 30 (3). pp. 273-293. ISSN 0273-2297.

    Abstract

    Recent reviews of moral development theory (Gibbs, Basinger, Grime, & Snarey, 2007) demonstrate that revisionist theoretical perspectives have cross cultural validity, but moral development in relation to people with intellectual disabilities (IDs) has not been considered within this literature. A structured review of the published literature relating to children, adolescents and adults with IDs, and moral development was carried out. Twenty studies meeting the inclusion criteria were found. The review indicated that people with IDs may not progress through the developmental stages of moral reasoning as quickly as typically developing peers, or reach the more advanced stages. This difference from non-disabled peers tends to disappear if groups are matched on some measure of cognitive ability. However, the studies are fraught with methodological problems and there is a need for further research, given the theoretical developments within the area of moral development, including the evidence of a relationship between moral development and anti-social behaviour amongst typically developing children and adolescents.

    Murphy, G.H. and Sinclair, N. and Hays, S.J. et al. (2010) Effectiveness of group cognitive behavioural treatment for men with intellectual disabilities at risk of sexual offending. Journal of Applied Research in Intellectual Disabilities, 23 (6). pp. 537-551. ISSN 1360-2322.

    Abstract

    Background For non-disabled men, group cognitive-behaviour therapy is a successful form of treatment when men have committed sexual offences. However, men with intellectual disabilities and sexually abusive behaviour are rarely offered treatment for their sexual behaviour and little research data on the effectiveness of such treatment has been collected. Method Nine collaborating sites ran 13, 1-year long cognitive-behavioural treatment groups for men with intellectual disabilities and sexually abusive behaviour. The men came from both community and secure provision and were assessed for sexual knowledge, victim empathy and cognitive distortions before and after the group treatment. Treatment was guided by a common treatment manual. Results Forty-six men consented to take part in the research. Most men (83%) had engaged in more than one incident of sexually abusive behaviour but only 57% of the men who came for treatment were required by law to attend. Almost all the men (92%) who began treatment (and consented to take part in the research) completed treatment 1 year later, indicating considerable motivation amongst the men to get treatment for their difficulties. Over the period of treatment, the men showed statistically significant increases in sexual knowledge and victim empathy, as well as reductions in cognitive distortions. These changes were still significant at 6-month follow-up for sexual knowledge and cognitive distortions. Few men showed further sexually abusive behaviour during the 1-year period when they were attending treatment (three men) or during the 6-month follow-up period (four men). Only the presence of autistic spectrum disorders appeared to be related to re-offending (though this result should be treated with caution, given the small numbers who re-offended). Conclusions This large treatment trial provides some evidence of the effectiveness of such treatment for men with intellectual disabilities but there remains a need for a longer follow-up period and a randomized controlled trial

    Langdon, P. and Murphy, G.H. and Clare, I.C.H. et al. (2010) The psychometric properties of the Socio-Moral Reflection Measure - Short Form and the Moral Theme Inventory for men with and without intellectual disabilities. Research in Developmental Disabilities, 32 (3). pp. 1204-1215. ISSN 0891-4222.

    Abstract

    Drawing conclusions from the literature regarding the moral development of people with intellectual disabilities (IDs) is difficult because of the use of unstandardised and idiosyncratic measures. In order to address this short-coming, a moral reasoning production measure (the Socio-Moral Reflection Measure – Short Form; SRM-SF) and a recognition measure (the Moral Theme Inventory; MTI) were presented to men with and without IDs who had no known history of engaging in illegal behaviour. The instruments were completed on two occasions, separated by a two-week interval, in order to investigate their basic psychometric properties. The results indicated that there was a strong relationship between the MTI and the SRM-SF, suggesting that the MTI has convergent validity. The internal consistency of the MTI and the SRM-SF ranged from moderate to substantial for both men with and without IDs. However, the test–retest reliability of the MTI was poor formen with IDs, while it was good formen without IDs. The test–retest reliability of the SRM-SF was good for both men with and without IDs. Comparison of the moral reasoning abilities of men with and without IDs suggested that many of the differences between the two groups could be accounted for by general intellectual functioning. The exception was overall score on the SRM-SF and moral reasoning in relation to the law, where men with IDs scored at stage 2(1), when intelligence was controlled. The results were interpreted by suggesting that the relationship between moral reasoning and illegal behaviour may take an inverted U curve shape, moderated by intelligence.

    Langdon, P. and Clare, I.C.H. and Murphy, G.H. (2010) Measuring social desirability amongst men with intellectual disabilities: the psychometric properties of the self and other deception questionnaire - Intellectual disabilities. Research in Developmental Disabilites, 31 (6). pp. 1601-1608.

    Abstract

    Background Social desirability has been construed as either inaccurately attributing positive characteristics to oneself (self-deception), or inaccurately denying that one possesses undesirable characteristics to others (other-deception or impression management). These conceptualisations of social desirability have not been considered in relation to people with intellectual disabilities (IDs), but they are important constructs to consider when undertaking a psychological assessment of an individual, especially within forensic contexts. Therefore, we revised two existing measures of self- and other-deception and considered their psychometric properties. Methods Thirty-two men with mild IDs and 28 men without IDs completed the Self- and Other-Deception Questionnaires—Intellectual Disabilities (SDQ-ID and ODQ-ID) on two occasions, two weeks apart. Results Men with IDs scored significantly higher on the SDQ-ID and the ODQ-ID than men without IDs. However, these differences disappeared when Full Scale IQ, Verbal IQ and Performance IQ were controlled in relation to the SDQ-ID, and partially disappeared in relation to the ODQ-ID. The SDQ-ID and the ODQ-ID had substantial internal consistency in relation to men with IDs (k = 0.82 and 0.84 respectively). The test-retest reliability of the SDQ-ID was good (ri = 0.68), while the test-retest reliability of the ODQ-ID was moderate (ri = 0.56), for men with IDs. The SDQ-ID had moderate (k = 0.60) and the ODQ-ID had substantial (k = 0.70) internal consistency in relation to men without IDs, while the test-retest reliability of the SDQ-ID was excellent (ri = 0.87) as was the case for the ODQ-ID (ri = 0.85). Conclusions The SDQ-ID and the ODQ-ID have satisfactory psychometric properties in relation to men with and without IDs. Future research using these instruments is proposed

    McGill, P. and Murphy, G. and Kelly-Pike, A. (2009) Frequency of use and characteristics of people with intellectual disabilities subject to physical interventions. Journal of Applied Research in Intellectual Disabilities, 22 (2). pp. 152-158. ISSN 1360-2322.

    Abstract

    Background The use of physical intervention (PI) with people with intellectual disabilities continues to cause concern. This study sought to clarify the frequency and circumstances of PI use and gather data on the characteristics of individuals subject to PI. Method Data on individuals subject to PI were gathered by postal questionnaire completed by service providers from three samples: people who (a) had attended a PI conference and/or purchased a PI policy document; (b) operated in a specific geographical area of England and (c) operated specialist assessment and treatment settings for children/adults with intellectual disabilities throughout the UK. Results Frequent PI use was reported. Restraint was most commonly reported - monthly or more frequently with most individuals. Overall, those receiving PI were more likely to be young, male, not legally restricted and identified as having an autistic spectrum disorder than those who did not receive PI. Conclusions The relatively frequent use of PI is consistent with routine rather than last resort use. Such use carries risk of physical and psychological damage. Service providers should systematically reduce the frequency of use of PI.

    Punshon, C and Skirrow, P and Murphy, G.H. (2009) The 'not guilty verdict': psychological reactions to a diagnosis of Asperger Syndrome in adulthood. Autism, 13 (3). pp. 265-283.

    Abstract

    Asperger syndrome is a relatively new diagnostic classification. A number of factors make receiving a diagnosis of Asperger syndrome in adulthood a unique experience. This study used a phenomenological approach to examine the experiences of 10 adults receiving such a diagnosis. Results suggested that six major themes were associated with receiving a diagnosis of Asperger syndrome. Individuals discussed their negative life experiences and their experience of services prior to diagnosis, which led to individuals holding certain beliefs about the symptoms of Asperger syndrome. These beliefs had an effect on the formation of each individual's perceived self-identity. Participants made links between how they felt when they received the diagnosis and their current beliefs about both their 'symptoms' and themselves. Finally, participants highlighted the importance of the societal view of Asperger syndrome. The implications of these findings are reappraised in the context of previous research and the wider literature on identity formation.

    Beadle-Brown, J. and Murphy, G.H. and DiTerlizzi, M. (2009) Quality of life for the Camberwell Cohort: a brief report. Journal of Applied Research in Intellectual Disabilities, 22 (4). pp. 380-390. ISSN 1360-2322.

    Abstract

    Background Despite the acknowledged difficulties of measuring satisfaction for people with intellectual disabilities, the current study examined the quality of life (QoL) of the Camberwell Cohort, a total population sample of people with severe intellectual disability and/or autism [ Wing & Gould, Epidemiology and Classification, 9, 1979, 11 ]. Methods The Lifestyle Satisfaction Scale (LSS) [ Harner & Heal, Research in Developmental Disabilities, 14, 1993a, 221 ] was combined with selected questions from the Quality of Life Questionnaire Schalock & Keith 1993, Quality of Life Questionnaire, IDS Publishing Corporation, Worthington and conducted with 12 people with intellectual disabilities and 72 proxy respondents. Results Inter-rater reliability on overall score was available for 10 participants and was acceptable with a Spearman’s Rank order correlation co-efficient over 0.8. There were no significant differences between the scores of proxies and service users on the domains of the LSS. The sample of service users who completed the interviews was too small to allow further detailed analysis of their responses. However, responses from the proxy interviews indicated that there were no differences in life satisfaction between those socially impaired and socially able. However those with autism were reported to be less satisfied on Community Satisfaction while those with challenging behaviour had lower scores overall and specifically on Community Satisfaction. Those with an IQ below 50 had lower scores overall, than those with an IQ above 50 and specifically on Recreation Satisfaction. Linear regression analysis on total QoL score indicated that only three variables seemed to be important in predicting proxy QoL scores: challenging behaviour at Time 3, IQ at Time 3 and independent living skills at Time 1. Conclusions Despite the difficulties encountered, this study provided some support for the widely help belief that QoL is lower for those with intellectual disability and for those with challenging behaviour.

    Lee, P. and Amos, A. and Robertson, L. et al. (2009) Adults with late diagnosed PKU and severe challenging behaviour: a randomised placebo-controlled trial of phenylolanine-restricted diet. Journal of Neurology, Neurosurgery and Psychiatry, 80 (6). pp. 631-635. ISSN 0022-3050.

    Abstract

    BACKGROUND: Although early diagnosis and treatment in phenylketonuria (PKU) leads to excellent outcomes, a population of adults born before the introduction of newborn screening exists. They can have severe intellectual disabilities and behavioural problems, and are often dependent on full-time carers. Anecdotal evidence suggests that a diet that lowers blood phenylalanine concentration can have significant benefits upon behaviour. METHODS: A prospective double-blind randomised placebo-controlled crossover trial of phenylalanine-restricted diet was performed in a group of 34 adults (aged 21-61 years, median 49) with late diagnosed PKU with severe challenging behaviour. RESULTS: Only 17 completed the 60 week study: seven withdrew before the end of the baseline period; five withdrew during the first diet period; five withdrew during the second diet period (after moving into placebo phase). The mean (SD) blood phenylalanine was 1570 (222) micromol/l during baseline, 553(158) mumol/l during the active phase and 1444 (255) micromol/l during the placebo phase. In the 22 participants exposed to both active and placebo phases, no differences were demonstrated in behaviour assessed by the Aberrant Behavior Checklist and Vineland Adaptive Behavior Scales, behaviour diaries or on video analysis of direct observations. However, 76% of carers' comments were scored as positive during the active phase, compared with 54% during the placebo phase (chi(2) = 38.06, p<0.001). CONCLUSIONS: There are significant challenges in studying people with intellectual disabilities and considerable difficulties in instituting phenylalanine-restricted diet in this population. However, if attempted, there are potential benefits to quality of life for the individuals with PKU and their carers.

    Clarkson, R. and Murphy, G.H. and Coldwell, J.B. et al. (2009) 'Not just like a friend to me': What characteristics do service users with ID value in direct support staff within residential forensic services? Journal of Intellectual & Developmental Disabilities, 34. pp. 283-289.

    Amos, A. and Murphy, G.H. (2008) RCT trial of diet treatment for adults with untreated PKU. Journal of Intellectual Disability Research, 52 (8-9). pp. 665-665. ISSN 0964-2633.

    Murphy, G.H. and Johnson, S.M. and Amos, A. et al. (2008) Adults with untreated Phenylketonuria: out of sight, out of mind? British Journal of Psychiatry, 193 (6). pp. 501-502. ISSN 0007-1250(Print)1472-1465(Online).

    Abstract

    Some people with phenylketonuria who were born before screening began were never treated and are still alive. Here we report that far fewer people with untreated phenylketonuria were detected than are thought to exist (about 2000). The majority of those traced had high support needs, challenging behaviour and other symptoms of phenylketonuria. No significant differences were found between those who had or had not tried the phenylalanine-restricted diet. A randomised controlled trial is required to examine the effect of trying the low-phenylalanine diet for people with untreated phenylketonuria.

    Langdon, P.E. and Maxted, H. and Murphy, G.H. (2007) An exploratory evaluation of the Ward and Hudson Offending Pathways model with sex offenders who have intellectual disability. Journal of Intellectual & Developmental Disability, 32 (2). pp. 94-105. ISSN 1366-8250.

    Abstract

    Background It was predicted that offenders with intellectual disability ( ID) categorised according to Ward & Hudson's ( 1998b) self- regulation theory as having an Approach goal would have higher levels of distorted cognitions, less victim empathy, and a history of more prolific offending compared to those with an Avoidant goal. Offenders categorised as having a Passive strategy were hypothesised to have lower levels of general intellectual functioning, and more known offences and convictions compared to those with an Active strategy. Method Using a cross- sectional independent groups design, the offence pathways of 34 men with ID who were taking part in group cognitive behavioural therapy were rated by therapists. Participants assigned to each pathway were then compared using measures of sexual knowledge, distorted cognitions, and victim empathy. Cronbach's alpha for the measures was found to be acceptable. Results Offenders with an Approach goal were found to have higher levels of distorted cognitions and more denial about the negative impact of their offending upon their victims on one measure of distorted cognitions, while on another measure of distorted cognitions there were no differences. There were no differences between Approach and Avoidant offenders in terms of victim empathy, socio- sexual knowledge, severity of offending, and victim type. Offenders with a Passive strategy were found to have lower levels of general intellectual functioning than offenders with an Active strategy, but did not have more known offences and convictions. Conclusions The findings provide partial support for the usefulness of the Offending Pathways model in understanding the sexual offence processes of men with ID. The difficulties with this study are further discussed, together with the theoretical implications

    Hays, S.J. and Murphy, G.H. and Langdon, P.E. et al. (2007) Group treatment for men with intellectual disability and sexually abusive behaviour: Service user views. Journal of Intellectual & Developmental Disability, 32 (2). pp. 106-116. ISSN 1366-8250.

    Abstract

    Background Men with intellectual disability ( ID) and sexually abusive behaviour are a disempowered and marginalised group. Nevertheless, as service users, they can be consulted and involved in a variety of different ways, including ascertaining their views of the services they receive. Method A group of 16 men with ID and sexually abusive behaviour were interviewed to ascertain their views approximately 2 months after completing a 1- year group cognitive behavioural treatment ( CBT) for sexual offending. Two raters independently reviewed interview transcripts and participant responses were summarised. Results The most salient components of treatment recalled by participants were: sex education; legal and illegal behaviours and their consequences; and discussions about specific sexual assaults. Only 3 of the 16 participants stated that they had problems with sexual offending, and only 1 identified that he had learnt about victim empathy, although this is an important component of treatment. Having support, the knowledge that they had the same problems as other group members, and talking through problems, were appreciated as some of the `` best things'' about the group, while the `` worst things'' were generally person- specific. Participants had mixed views on talking about their own offences during group sessions and, overall, viewed the experience as difficult but helpful. Conclusions Valuable insights into the aspects of treatment that group members found useful were explored. Such insights are often not captured by studies that assess the efficacy of treatment models using treatment- specific measures only, and these are important in defining the quality of services provided.

    Murphy, G.H. and Powell, S. and Guzman, A.M. et al. (2007) Cognitive-behavioural treatment for men with intellectual disabilities and sexually abusive behaviour: a pilot study. Journal of Intellectual Disability Research, 51 (11). pp. 902-912. ISSN 0964-2633.

    Abstract

    Background Cognitive-behaviour therapy (CBT) seems to be becoming the treatment of choice for non-disabled sex offenders. Nevertheless, there have been relatively few evaluations of such treatment for men with intellectual disabilities (ID) and sexually abusive behaviour. Method A pilot study providing CBT for two groups of men with ID is described. Measures of change in sexual knowledge, victim empathy and cognitive distortions were collected, together with a log of further sexually abusive behaviour. Results Fifteen men were offered treatment but some dropped out and some declined to take part in the research. The results for the eight men who consented to the research and completed treatment showed significant positive changes in sexual knowledge and victim empathy (two men completed both groups, making 10 sets of data in all). Cognitive distortions showed significant change on only one of the two measures. Some men showed further sexually abusive behaviour either during or after the treatment group (all had been previously diagnosed as on the autistic spectrum). Conclusion There is a need for a larger multi-site trial of treatment with a broad set of measures and the ability to analyse who benefits from such treatments and who does not.

    Murphy, G.H. and O'Callaghan, A.C. and Clare, I.C.H. (2007) The impact of alleged abuse on behaviour in adults with severe intellectual disabilities. Journal of Intellectual Disability Research, 51 (10). pp. 741-749. ISSN 0964-2633.

    Abstract

    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.

    O'Callaghan, A.C. and Murphy, G.H. (2007) Sexual relationships in adults with intellectual disabilities: understanding the law. Journal of Intellectual Disability Research, 51 (3). pp. 197-206. ISSN 0964-2633.

    Abstract

    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.

    Poncelas, A. and Murphy, G.H. (2007) Accessible Information for People with Intellectual Disabilities: Do Symbols Really Help? Journal of Applied Research in Intellectual Disabilities, 20 (5). pp. 466-474. ISSN 1360-2322.

    Abstract

    Background? Recently, symbols have been used to increase understanding of written information for people with intellectual disabilities, yet the effectiveness of this remains largely untested. This study was undertaken around the time of an election and it aimed to test whether a symbol-based manifesto increased the understanding of this material for people with intellectual disabilities. Method? Two versions of a simplified manifesto were produced: one text-based and the other symbol-based (with text). Participants were randomly assigned to two groups: one received the text-based information, and the other the symbol-based information (with text). Participants were asked a series of questions about the material, both immediately (time 1) and a short time afterwards (time 2), to assess understanding (the material was in front of them throughout). Results? Both versions produced relatively low levels of understanding. The group with symbols (and text) showed no better understanding than the group with text only. However, those with better language comprehension scores and those with better reading skills tended to show a higher understanding of the manifesto, in both groups. In the symbols group, those who said they had seen symbols before also showed significantly better understanding of the material at time 2. Conclusions? This study suggests that the addition of symbols to simple texts does not necessarily improve people's understanding of it. It is proposed that a closer examination of people's understanding of symbols should be made and ways of improving this understanding investigated.

    McBrien, J. and Murphy, G.H. (2006) Police and carers' views on reporting alleged offences by people with intellectual disabilities. Psychology, Crime & Law, 12 (2). pp. 127-144.

    Abstract

    Evidence suggests that care staff have difficulty recognizing offending behaviour in adults with intellectual disabilities (ID) and that they are reluctant to report such behaviour to the police. Whilst there has been speculation as to why there may be such reluctance, there are no empirical studies. In this study, questionnaires using vignettes of fictitious crimes were completed by 80 care staff in residential homes and 65 police officers. The fictitious perpetrators in the vignettes were described either as non-disabled or as having ID. Care staff and police ratings of causal attributions and affect were compared, and the effect of perpetrator status (with or without ID) was also examined. The findings confirmed that care staff are still reluctant to report incidents by people with ID to the police. Carer and police views were generally in accord concerning perpetrators without ID but there were significant differences between groups rating perpetrators with ID

    Beadle-Brown, J. and Murphy, G.H. and Wing, L. (2005) Long-Term Outcome for People with Severe Intellectual Disabilities: Impact of Social Impairment. American Journal on Mental Retardation, 110 (1). pp. 1-12. ISSN 0895-8017.

    Abstract

    Results from a 25-year follow-up study of the Camberwell Cohort (L. Wing & Gould, 1978, 1979) were presented. Ninety-one people, ranging in age from 27 to 41 years, were traced, and an outcome measure was developed incorporating independent functioning, residential placement, employment, and quality of life. Outcome was rated as either poor (53%) or fair (43%), with only 3% having a good outcome. Using logistic regression methods, we found that the best predictor of outcome was social impairment, with those who were socially impaired, particularly those in the aloof category, having a poorer outcome. Higher IQ at Time 1 and lower challenging behavior were also predictive of better outcome. An in-depth look at social impairment revealed that social impairment remained stable over time.

    Murphy, G.H. and Beadle-Brown, J. and Wing, L. et al. (2005) Chronicity of challenging behaviours in people with severe intellectual disabilities and/or autism: a total population sample. Journal of Autism and Developmental Disorders, 35 (4). pp. 405-418. ISSN 0162-3257.

    Abstract

    The skills, social impairments and challenging behaviours of a total population of 166 children, with severe intellectual disabilities and/or autism, were assessed through interview with the main carers, when the children were under 15 years old (time 1). Twelve years later, 141 of these individuals were re-assessed, using the same measures (time 2). “Abnormal” behaviours tended to reduce with age and were associated with poorer language skills and poorer quality of social interaction. Individuals with most abnormal behaviours at time 1, tended to have most at time 2. Abnormal behaviour at time 2 was predicted by the presence of abnormal behaviour at time 1, poor expressive language at time 1, poor quality of social interaction at time 1 and a diagnosis of autism/autistic continuum at time 1.

    Oliver, C. and Hall, S. and Murphy, G.H. (2005) The early development of self-injurious behaviour: evaluating the role of social reinforcement. Journal of Intellectual Disability Research, 49 (8). pp. 591-599. ISSN 0964-2633.

    Abstract

    The potential role of social reinforcement in the development of self-injury has not yet been subjected to empirical analysis. In this 2-year prospective study, the pattern of social interactions related to the early presentation of self-injury were examined to identify a potential association with an increase in self-injury. The self-injurious behaviour and social contact with adults of 16 children with intellectual disability (ID) with self-injury of recent onset were observed at 3-month intervals over 2 years. Increase in self-injury over a 2-year period was positively correlated with a distribution of social contact relative to episodes of self-injury that is consistent with a mutual social reinforcement paradigm. When this paradigm was operative, self-injury was evoked under stable antecedent conditions over time but tended to evoke increasing levels of social interaction. These results support the hypothesis that increases in the frequency of early self-injury in children with ID may be determined by social reinforcement with implications for early intervention and proactive identification of children at risk for increases in self-injury

    Murphy, G.H. and O'Callaghan, A.C. (2004) Capacity of adults with intellectual disabilities to consent to sexual relationships. Psychological Medicine, 34 (7). pp. 1347-1357. ISSN 0033-2917.

    Abstract

    For people with intellectual disabilities there is a difficult balance to be struck between empowering people to claim their sexual rights and protecting them from abuse. Hypothetically, services should be guided by whether a particular person with intellectual disabilities has the capacity to consent to sexual relationships. However, there has been little agreement on how to define such capacity. This study examines the issue of capacity to consent to sexual relationships using a functional approach. Method. Adults with intellectual disabilities (n = 60) and young people presumed in law able to consent (n = 60) were assessed for their sexual knowledge and vulnerability to abuse. Results. Adults with intellectual disabilities were significantly less knowledgeable about almost all aspects of sex and appeared significantly more vulnerable to abuse, having difficulty at times distinguishing abusive from consenting relationships. Nevertheless, some adults with intellectual disabilities scored highly on all measures, especially if they had relatively high IQs and had had sex education. Conclusions. The reasons for the poorer knowledge and increased vulnerability of people with intellectual disabilities are discussed and it is recommended that they should have on-going access to sex education. Implications of the findings for definitions of capacity to consent to sexual relationships are considered.

    Murphy, G.H. and Kelly-Pike, A. and McGill, P. et al. (2003) Physical interventions for people with intellectual disabilities: staff training and policy frameworks. Journal of Applied Research in Intellectual Disabilities, 16 (2). pp. 115-125. ISSN 1360-2322.

    Abstract

    Background Physical intervention or restraint with people who have intellectual disabilities is sometimes necessary, even though it is known to present dangers to both staff and service users (some service users have died as a result of restraint). Aims This study aims to investigate the extent to which staff in intellectual disability services were trained in the use of physical interventions or restraint. Their views of a recent policy framework on physical interventions were also sought. Methods There were three groups of participants: (i) group 1 included staff who had attended conferences on the Policy Framework (the conference sample); (ii) group 2 included staff from two geographical areas (the geographical sample); (iii) group 3 included staff in specialist assessment and treatment services (the SpAT sample). All participants were sent a questionnaire asking them about their training in (and use of) physical intervention methods and their opinions on the policy document. Results There were at least 12 different types of training recorded, including a number of varieties of Control and Restraint (C&R). By no means did all the senior staff did have training in physical intervention methods. The degree of training varied with the sample and the type of training varied with the employing organization. Most participants in group 1 were very positive about the BILD & NAS Policy Framework but few staff in groups 2 and 3 had read the document. About two-thirds of the participants said their services had (or were developing) a written policy on physical interventions. Conclusions There remained a clear need for further training in physical interventions and evidence on which the effectiveness of different methods of physical interventions could be judged.

    O'Callaghan, A.C. and Murphy, G.H. and Clare, I.C.H. (2003) The impact of abuse on men and women with severe learning disabilities and their families. British Journal of Learning Disabilities, 31 (4). pp. 175-180. ISSN 1354-4187.

    Abstract

    So far, little systematic attention has been paid to the impact of abuse on men and women with severe learning disabilities. Using the criteria for post-traumatic stress disorder (American Psychiatric Association 1994) and questions about changes in skills and ‘challenging behaviours’, we interviewed parents to collect information about the effects of the abuse experienced by 18 people with severe learning disabilities. The consequences for the survivors were profound and long-lasting, and it was found that their parents and siblings were also deeply affected. Very limited formal support was offered to the men and women who had been abused, or to their families. The implications for assessments of the impact of abuse on people with severe learning disabilities and for service provision are highlighted.

    Hays, S.J. and Murphy, G.H. and Sinclair, N. (2003) Gaining ethical approval for research into sensitive topics: 'Two strikes and you're out?'. British Journal of Learning Disabilities, 31 (4). pp. 181-189. ISSN 1354-4187.

    Abstract

    Researching sensitive topics, such as the treatment of men with intellectual disabilities and sexually abusive behaviour, present a number of ethical issues for researchers. This paper describes our experiences in working with Multi-Centre Research Ethics Committees on a research proposal designed to assess the efficacy of cognitive behaviour therapy for men with intellectual disabilities who are at risk of sexual offending. After submitting to three Multi-Centre Research Ethics Committees and spending a year trying to get ethical approval, we questioned whether: • ? the issue of study design should be part of the Multi-Centre Research Ethics Committees remit; • ? Multi-Centre Research Ethics Committees were sufficiently responsive to concerns raised by researchers; • ? Multi-Centre Research Ethics Committees always understood the research; and • ? the Central Office for Research Ethics Committees should disallow re-submission after rejection by two Multi-Centre Research Ethics Committees (‘two strikes and you’re out').

    Murphy, G.H. (2003) Overview: Capacity to consent to sexual relationships in adults with learning disabilities. Journal of Family Planning & Reproductive Healthcare, 29 (3). pp. 148-149. ISSN 1471-1893.

    Abstract

    People with learning disabilities used to be seen as asexual or promiscuous and were discouraged from expressing their sexuality. However, with the growth of the rights movement, attention has turned to the dilemma of how to both empower and protect people with learning disabilities in relation to their sexuality. A recent research project showed that, on average, adults with learning disabilities knew much less about sex and understood much less about sexual abuse than non-disabled young people aged 16 years. Sex education made a significant difference to their knowledge and understanding however. The implications of the study for services for people with learning disabilities and for definitions of capacity to consent to sexual relationships are discussed.

    Mason, J and Murphy, G.H. (2002) Intellectual disability amongst people on probation: prevalence and outcome. Journal of Intellectual Disability Research, 46 (3). pp. 230-238. ISSN 0964-2633.

    Abstract

    Background Previous research has suggested that people with intellectual disability (ID) can be found in the criminal justice system. However, little is currently known about those supervised in the community on probation orders. Methods Ninety people on probation in south-east England were screened using the Learning Disabilities in the Probation Service (LIPS) screening tool, which was designed to be used by probation officers to identify those with possible ID. The LIPS incorporates two measures of cognitive functioning: (1) the Quick Test (QT); and (2) the Clock Drawing Test (CDT). Results Seven per cent of participants were found to have QT IQs and CDT scores 1.6 SD below the mean. When compared to those who appeared to be functioning within the normal range, those with possible ID were found to be significantly younger. However, no differences were found between the two groups in terms of the final outcome of the probation order. Conclusions It seems likely that the probation service contains a significant minority of people with ID. Despite the fact that no difference was found to exist in terms of outcome, people with ID or borderline ID are likely to have a number of support needs which could affect the success of their time on probation.

    Murphy, G.H. and Feldman, M. (2002) Parents with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 15 (4). pp. 281-284. ISSN 1360-2322.

    Mason, J. and Murphy, G.H. (2002) People with intellectual disabilities on probation: an initial study. Journal of Community and Applied Social Psychology, 12 (1). pp. 44-55. ISSN 1052-9284.

    Abstract

    The two studies in this paper aim to investigate the prevalence and characteristics of people with intellectual disabilities in the probation service in England, Study one screened the abilities of a sample of 70 probationers in one single probation service. Study two compares a sub-set of these to an equal number of control participants in order to further investigate the characteristics of those with intellectual disability on probation. Nearly 6% of service users appeared to have an intellectual disability, and 11% fell into the bottom 5% of the general Population in terms of their intellectual and social functioning. We conclude that a significant minority of those in the probation service have an intellectual disability or similar needs.

    Mason, J. and Murphy, G.H. (2002) People with intellectual disabilities in the Criminal Justice System: developing an assessment tool for measuring prevalence. British Journal of Clinical Psychology, 41 (3). pp. 315-320. ISSN 0144-6657.

    Abstract

    Objectives. To develop a screening tool to detect those who may have intellectual disabilities or borderline intellectual disabilities in the criminal justice system (CJS). Design. The items for the assessment tool were based on data from an earlier study. The assessment tool was piloted on 80 participants, who also completed a short form of the WAIS-R. Method. Items for the screening tool were derived using a discriminant analysis procedure with data from a previous study (measuring IQ and other factors in people on probation). A sample of 40 participants with an intellectual disability and 40 with an IQ in the normal range then completed the screening measure and the WAIS-R. Results. The screening measure showed good concurrent validity, and correctly classified 87% of participants. Conclusions. The screening measure is a useful tool for people working in the CJS to use in the identification of those who may be in need of further support owing to an intellectual disability or borderline intellectual disability.

    Clare, I.C.H. and Murphy, G.H. (2001) Witnesses with learning disabilities. British Journal of Learning Disabilities, 29 (3). pp. 0-0. ISSN 1354-4187.

    Hall, S. and Oliver, C. and Murphy, G.H. (2001) Early development of self-injurious behavior: An empirical study. American Journal on Mental Retardation, 106 (2). pp. 189-199. ISSN 0895-8017.

    Abstract

    The early development of SIE in young children with developmental disabilities was examined by tracking over an 18-month period 16 school-age children who had recently started to show early SIE. Naturalistic observations were conducted in each child's classroom every 3 months, and the association between early SIE and environmental events was examined. Results showed that for the 4 children whose early SIE had escalated over this period, there was a significant association between early SIE and low levels of social contact across observation points, supporting: models of the development of SIE. This association might be considered as a risk marker for the exacerbation of SIE. Implications of this finding for targeting early interventions for SIE are discussed.

    Hall, S. and Oliver, C. and Murphy, G.H. (2001) Self injurious behaviour in young children with Lesch-Nyhan syndrome. Developmental Medicine adn Child Neurology, 43 (11). pp. 745-749. ISSN 0012-1622.

    Abstract

    The early development of self-injurious behaviour in three young boys (aged 17,25, and 30 months at start of study) with Lesch-Nyhan syndrome was examined by means of parental interviews and by direct observations completed at 3 to 4 monthly intervals over an 18-month period. Results suggest that the self-injury began in a different way from that of other young children with autism and/or developmental disabilities in that, from the start, self-injurious responses were sudden and violent, rather than emerging gradually over time. Drastic measures, such as removal of the teeth or provision of tooth guards, were often taken to prevent further tissue damage. Direct observations showed that the boys’self-injury occurred at lower rates, but their carers were highly concerned about the behaviour. Sequential analysis of the observational data indicated that on some occasions the children were more likely to self-injure during periods of low social interaction, suggesting that their self-injury may have been influenced by environmental factors. The theoretical and practical implications of these findings are discussed.

    Murphy, G.H. and Kelly-Pike, A. and McGill, P. (2001) Physical interventions for people with intellectual disabilities: initial survey of training and evaluation of a policy framework. Journal of Applied Research in Intellectual Disabilities, 14 (4). pp. 401-411. ISSN 1360-2322.

    Abstract

    Background. Physical interventions for people who have intellectual disabilities are sometimes necessary, even though they are known to present dangers to both service users and staff. The present report concerns an initial study of training in physical interventions amongst a group of senior staff and their views on a recent policy framework on physical interventions developed by the British Institute of Learning Disabilities (BILD) and National Autistic Society (NAS). Method. The participants in this initial study included those who had attended conferences on the policy and those who had purchased the policy document. All participants were sent a questionnaire asking them about their training in, and use of, physical intervention methods, and their opinions on the policy document. Results. The participants came from a variety of services and were relatively well qualified and senior because of the way the sample was derived. They mostly had some training in physical intervention methods, although the type of training varied somewhat with their employing organization. Most participants were very positive about the BILD and NAS policy framework, and about two-thirds of the participants said that their services had, or were developing, a written policy on physical interventions. Conclusions. This group of staff, many of whom were trained in physical interventions, rated the BILD and NAS policy framework as very helpful. There remained a clear need for guidance with respect to the advantages and disadvantages of the many available methods, and an evidence base on which to judge the effectiveness of different methods of physical interventions

    Beadle-Brown, J. and Murphy, G.H. (2000) Long-term outcome in people with severe intellectual disabilities and/or autism. Journal of Intellectual Disability Research, 44. pp. 057. ISSN 0964-2633.

    Beadle-Brown, J. and Murphy, G.H. (2000) Chronicity of social impairment. Journal of Intellectual Disability Research, 44. pp. 203 -203. ISSN 0964-2633.

    Beadle-Brown, J. and Murphy, G.H. and Wing, L. et al. (2000) Changes in skills for people with intellectual disability: a follow-up of the Camberwell Cohort. Journal of Intellectual Disability Research, 44. pp. 12-24. ISSN 0964-2633.

    Abstract

    The skills of a total population of children with severe intellectual disability and/or autism from Camberwell, South London, UK, and the initial follow-up data. taken when the subjects were adolescents and young adults (Shah 1986), are described in the present study. Changes in skills over time are presented within the categories of communication, self-care, and educational and cognitive skills, as assessed by the Handicaps, Behaviours and Skills schedule. The results indicated that skills had improved in many areas between times 1 and 2, but that this improvement was more noticeable for the children who had been youngest at time 1. The implications of these results and predictions for a further follow-up study are discussed.

    Gudjonsson, G.H. and Murphy, G.H. and Clare, I.C.H. (2000) Assessing the capacity of people with intellectual disabilities to be witnesses in court. Psychological Medicine, 30 (2). pp. 307-314. ISSN 0033-2917.

    Abstract

    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 ii-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 greater than or equal to 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.

    McCarthy, M. and Murphy, G.H (2000) Parents with intellectual disabilities: The experience of being sent to a family centre for assessment. Journal of Intellectual Disability Research, 44. pp. 385-385. ISSN 0964-2633.

    Murphy, G. (2000) Group treatment for men at risk of sex offences. Journal of Intellectual Disability Research, 44. pp. 835. ISSN 0964-2633.

    Murphy, G. and Berkson, G. (2000) Early development of self-injurious behaviour in young children with intellectual disabilities. Journal of Intellectual Disability Research, 44. pp. 836. ISSN 0964-2633.

    Murphy, G. and Macdonald, S. and Hall, S. et al. (2000) Aggression and the termination of "rituals": a new variant of the escape function for challenging behavior? Research in Developmental Disabilities, 21 (1). pp. 43-59. ISSN 0891-4222.

    Abstract

    Aggression and stereotyped behaviors are not uncommon among people with intellectual disabilities and they are often treated separately as operant behaviors. In this single case study, it is argued that the function of a young woman's aggressive behavior appeared to be that of avoiding or escaping the termination of a chain of complex stereotyped behavior (or "ritual"). She became aggressive only when this chain of stereotyped behavior was terminated and the aggression appeared to extinguish when it no longer led to escape from the termination of the "ritual". It is suggested that this is an example of a complex interaction between two behaviors and that it illustrates the need for very careful analysis of the functions of challenging behavior. Furthermore, it is proposed that the lengthening list of variables already documented as determinants of challenging behavior (provision of attention (verbal and physical), mechanical restraint, sensory or tangible events, escape from demands or from social attention, denials, escape from intrusive medical procedures, escape from task difficulty) be lengthened to include the possibility of escape from (or avoidance of) the interruption of a chain of complex stereotyped behavior or "ritual". (C) 2000 Elsevier Science Ltd. All rights reserved.

    Murphy, G.H. (2000) Justice Denied. Mental Health and Learning Disabilities Care, 3. pp. 256-257.

    McGill, P. and Cambridge, P. and McCarthy, M. et al. (2000) Better lives for people with learning disabilities: an evidence based strategy for change. Tizard Learning Disability Review, 5 (3). pp. 37-44. ISSN 1359-5474.

    Murphy, G.H. and Hall, S. and Oliver, C. et al. (1999) Identification of early self-injurious behaviour in young children with intellectual disability. Journal of Intellectual Disability Research, 43. pp. 149-163. ISSN 0964-2633.

    Abstract

    Very little is known about the early stages of self-injurious behaviour (SIB) in young children with developmental disabilities, even though there has been a great deal of research into the prevalence, assessment and treatment of well-established SIB in older individuals. In the present initial study, teachers in special schools for children under I I years of age with severe intellectual disability and/or autism were asked to identify children who were beginning to show early self-injury (the index group). These children were then matched to classroom controls (of the same ability level and mobility), and teachers were interviewed about the children's behaviours and skills. The index children showed significantly more potential SIB than the control group children, but there was overlap between the groups in terms of percentage duration of potential SIB, suggesting that teachers do not find it easy to identify children with 'early' SIB. The index children's skills and problem behaviours, their sensory impairments and degree of autism did not differ significantly from those of the control group. When all the children showing any potential SIB were pooled together, it transpired that developmental age and degree of mobility were significantly correlated with percentage duration of SIE, suggesting that these characteristics may be important risk markers. The index children were also observed at 3-month intervals at school over the following 18 months and self-injury clearly escalated for some of the index children, while it did not do so for others. Using regression analysis, increases in SIB were shown to be associated only with the degree of concern expressed about the child's behaviour at time I by the teacher, no other variables predicting increases in SIB.

    Butler, G.S. and Hutton, M. and Wattam, B.A. et al. (1999) The specificity of TIMP-2 for matrix metalloproteinases can be modified by single amino acid mutations. Journal of Biological Chemistry, 274 (29). pp. 20391-20396. ISSN 0021-9258.

    Abstract

    Residues 1-127 of human TIMP-8 (N-TIMP-2), comprising three of the disulfide-bonded loops of the TIMP-8 molecule, is a discrete protein domain that folds independently of the C-terminal domain. This domain has been shown to be necessary and sufficient for metalloproteinase inhibition and contains the major sites of interaction with the catalytic N-terminal domain of active matrix metalloproteinases (MMPs), Residues identified as being involved in the interaction with MMPs by NMR chemical shift perturbation studies and TIMP/MMP crystal structures have been altered by site directed mutagenesis. We show, by measurement of association rates and apparent inhibition constants, that the specificity of these N-TIMP-2 mutants for a range of MMPs can be altered by single site mutations in either the TIMP "ridge" (Cys(1)-Cys(3) and Ser(68)-Cys(72)) Or the flexible AB loop (Ser(31)-Ile(41)). This work demonstrates that it is possible to engineer TIMPs with altered specificity and suggests that this form of protein engineering may be useful in the treatment of diseases such as arthritis and cancer where the selective inhibition of key MMPs is desirable.

    Murphy, G.H. (1999) Self-injurious behaviour: what do we know and where are we going? Tizard Learning Disability Review, 4 (1). pp. 5-12. ISSN 1359-5474.

    Abstract

    Self-injurious behaviour can become an intransigent difficulty, reduce people's quality of life and lead to hospital admissions or other restrictive outcomes (such as the wearing of protective devices to prevent serious injury). Over the last 15 years there have been some important developments in the treatment of severe self-injury, but the evidence is that these are making little impact on most people's lives. The reasons why this might be are discussed, and it is proposed that it is time for a radical new approach to interventions for self-injurious behaviour.

    Murphy, G.H. and Fernando, S. (1999) Services for people with challenging behaviour and mental health needs at risk of offending. Tizard Learning Disability Review, 4 (3). pp. 31-39. ISSN 1359-5474.

    Abstract

    The closure of long-stay hospitals and the emphasis on community living have highlighted the challenges services face in meeting the needs of some individuals. Government reports since 1990 on services for people with mental health needs, learning disabilities, challenging behaviour and/or criminal offending have recommended community living whenever possible, outlined the characteristics of good services and made suggestions about how these might be achieved (Department of Health, 1992; Department of Health, 1993; Royal College of Psychiatrists, 1996; NHS Executive, 1998). Nevertheless, most health and social service providers still find it difficult to attain the kinds of service proposed and Bouras (1999) recently concluded that this was partly a result of the separation of services for people with learning disabilities from mainstream mental health services. This paper reports the experience of a local service development intervention designed around the needs of this client group

    Murphy, G.H. (1998) Clinical training bypass. Psychologist, 11 (10). pp. 468-468. ISSN 0952-8229.

    Murphy, G. and Clare, I.C.H. (1998) People with learning disabilities as offenders or alleged offenders in the UK criminal justice system. Journal of the Royal Society of Medicine, 91 (4). pp. 178-182. ISSN 0141-0768.

    Oliver, C. and Hall, S. and Hales, J. et al. (1998) The treatment of severe self-injurious behavior by the systematic fading of restraints: Effects on self-injury, self-restraint, adaptive behavior, and behavioral correlates of affect. Research in Developmental Disabilities, 19 (2). pp. 143-165. ISSN 0891-4222.

    Abstract

    Severe self-injurious behavior (SIB) in people with mental retardation is difficult to treat when dangerously frequent or intense responding rules out functional analysis and interventions that permit free responding. This situation is common when restrictive devices, such as straight arm splints, are used. In this study, the effects of introducing flexion into a straight-arm splint, on SIB, self-restraint, adaptive behavior, and behavioral correlates of affect were examined for three individuals with severe mental retardation. Using single-case design methodology, for two individuals self-injury was reduced to zero, while the overall level of restriction was also significantly reduced. From the observed behavioral correlates of affect, there was no evidence of an increase in negative affect with the introduction of the new splint and the fading procedure, but there was evidence of an increase in positive vocalizations. Engagement in activities and social contact were not affected by the introduction of the new splint. The reasons for a decrease in SIB with a corresponding decrease in restriction in the absence of any manipulation of contingencies for SIB are discussed with particular reference to stimulus control.

    Murphy, G.H. (1998) Biobehavioural Issues in Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities. ISSN 1360-2322.

    Beadle-Brown, J.D. and Murphy, G.H. (1998) Changes in skills over time for people with learning disabilities. Tizard Learning Disability Review, 3 (4). pp. 42-46. ISSN 1359-5474.

    Williamson, R.A. and Natalia, C. and Gee, C.K et al. (1996) Chemically and conformationally authentic active domain of human tissue inhibitor of metalloproteinases-2 refolded from bacterial inclusion bodies. European Journal of Biochemistry, 241 (2). pp. 476-483. ISSN 0014-2956.

    Abstract

    The aggregation of recombinant proteins into inclusion bodies is a major problem for expression in bacterial systems. The inclusion bodies must be solubilized and the denatured protein renatured if an active molecule is to be recovered. We have developed such a procedure for the active N-terminal domain of tissue inhibitor of metalloproteinases-2 [TIMP-2-(1-127)], a small mammalian protein containing three disulfide bonds. Conditions for its renaturation were determined by studying the refolding behaviour of reduced and denatured mammalian-cell-expressed TIMP-(1-127) by intrinsic fluorescence. This strategy allows the development of a refolding protocol before generation of a bacterial expression system, and allows rapid and systematic optimization of each refolding variable by assessing its effect on the rate and extent of the refolding reaction. TIMP-(1-127) was expressed at high levels in Escherichia coli, and refolded from TIMP-2-(1-127) inclusion bodies, by means of the method developed with mammalian-cell-expressed protein, to give a refolding efficiency of 30-40% and a final yield of 11-14 mg purified protein/l culture. The chemical structure and conformation of this material was characterized by electrospray mass spectrometry and two-dimensional H-1-NMR; no significant differences were found between it and the native protein. Mass analysis of uniformly C-13-labeled and N-15-labeled protein was used to help identify a mistranslated TIMP-(1-127) contaminant in the purified refolded sample. This technique provides additional information on the nature of the modification and allows a distinction to be made between those modifications that are cell derived, and those that arise from subsequent handling of the protein.

    Murphy, G.H. and Clare, I.C.H. (1996) Analysis of motivation in people with mild learning disabilities (mental handicap) who set fires. Psychology Crime & Law, 2 (3). pp. 153-164. ISSN 1068-316X.

    Abstract

    Ten people with mild learning disabilities (mild mental handicap) who had all set fires and had been admitted to a hospital facility for people with challenging behaviours were interviewed about their perceptions of events, feelings and cognitions prior to and after setting fires. They were also asked to rate their excitement/upset in a series of fire-related situations. Results showed that people could identify reliably the events, feelings and cognitions prior to fire-setting but were less reliable at identifying consequences. Most commonly, people had felt angry prior to setting fires but it was also common to feel not listened to, sad or depressed. Multiple factors were relevant for most people. Some people identified the excitement of the fire as relevant and these people gave the highest ratings on the fire-related situations schedule and scored higher than controls on this schedule. Implications for treatment are discussed.

    Murphy, G.H. and Estien, D. and Clare, I.C.H. (1996) Services for people with mild intellectual disabilities and challenging behaviour: Service-user views. Journal of Applied Research in Intellectual Disabilities, 9 (3). pp. 256-283. ISSN 1360-2322.

    Abstract

    Twenty-six people with mild intellectual disabilities and challenging behaviour, who had all been service-users at a specialist, hospital-based unit, were interviewed after they had left the service for an average of four and a half years, about their current quality of life and their memories of the service. On the whole, people were still living in the community though many had had a large number of placement moves (and some had returned to hospital or prison). The service-user's overall quality of life in their current placement was as good as that of the general population in the less restrictive environments but fell increasingly short of this standard as the placements became more restrictive. Even in the best placements people's social relationships appeared impaired when compared to the general population. With respect to their memories of the specialist service, it appeared that, despite the time period, service-users had a clear memory of the service, appreciated many aspects of it (such as the help staff provided, the therapy and education), were divided about some aspects (such as having to be in hospital, being detained under the Mental Health Act 1983, taking medication) and had very strongly negative feelings about aspects of the care which directly restricted their liberty (such as the locking of the front door, the use of restraint and seclusion). It is argued that there may be a need to re-think services for service-users with challenging behaviour and mild intellectual disabilities.

    Cottle, M. and Kuipers, L. and Murphy, G.H. et al. (1995) Expressed emotions, attributions and coping in staff who have been victims of violent incidents. Mental Handicap Research, 8 (3). pp. 169-183. ISSN 0952-9608.

    Abstract

    In some occupations, there is an increased risk of becoming a victim of a violent incident. Nursing and care work, in settings for people with learning disabilities and challenging behaviour, or who have mental health needs, are occupations which can involve such a risk. This study examined how staff felt, after a violent incident, towards the perpetrator of the incident (expressed emotion), and the reasons (attributions) that the care staff gave as to their belief about the cause of the incident. Coping was investigated by looking at measures of anxiety. Results indicated that anxiety was often increased a week after the incident but then returned to baseline levels after a month. Expressed emotion was often high after an incident, and remained high a month later. Reasons that staff gave about the cause of the violent incident varied but they seldom blamed themselves for the incident. They tended to make attributions which were internal to the client, external to themselves, personal to the client, uncontrollable by themselves, and neither controllable nor uncontrollable by the client.

    Murphy, G.H. and Harnett, H. and Holland, A.J. (1995) A survey of intellectual disabilities amongst men on remand in prison. Mental Handicap Research, 8 (2). pp. 81-98. ISSN 0952-9608.

    Abstract

    Men detained in a South London prison on remand were screened for intellectual disabilities (mental handicap) over a three-month period. Of 157 men screened, 33 reported having intellectual disabilities. Twenty-one of these completed the General Health Questionnaire (GHQ) and were tested for IQ (on the WAIS-R), for reading and numeracy (on the British Ability Scales). An equal number of men were selected for the control group, on a 'next man in' basis, and they were assessed in an identical way. None of the index men had an IQ in the intellectual disabilities (mental handicap) range but the mean Verbal IQ, mean Full Scale IQ, mean reading age and mean numeracy age were all significantly lower in the index group than in the control group. Moreover, the index group had significantly higher scores on the GHQ and often had a recent history of mental illness or psychiatric hospital admission. It is concluded that men with intellectual disabilities were not over-represented in prison but that there were a number of men close to the disability range who were psychologically very vulnerable.

    Williamson, R.A. and Bartels, H. and Murphy, G.H. et al. (1994) Folding and Stability of the Active N-Terminal Domain of Tissue Inhibitor of Metalloproteinse-1 and Metalloproteinase-1 and Metalloproteinase-2. Protein Engineering, 7 (8). pp. 1035-1040. ISSN 0269-2139.

    Abstract

    The truncated forms of tissue inhibitor of metalloproteinase-l and -2 (Delta TIMP-1 and -2), comprising the N-terminal active domain, are ideal molecules for structural analysis by intrinsic fluorescence as each contains a single conserved tryptophan residue. In this paper we describe studies on their conformational stability, unfolding/refolding kinetics and the environment of the unique tryptophan as judged by its fluorescence properties in the native state and exposure to an external quencher, acrylamide. Two forms of Delta TIMP-2 were studied: Delta TIMP-2 T21 derived from the full-length cDNA clone isolated from a mixed-tumour library, and Delta TIMP-2 A21 containing the highly conserved V(18)IRAK(22) sequence. In all three Delta TIMP proteins the tryptophan environments in the native state appeared to be similar, but substantial differences were seen in their conformational stabilities and refolding kinetics. Delta TIMP-1 was approximately twice as stable as Delta TIMP-2 T21 and 1.4-fold more stable than Delta TIMP-2 A21. This stability difference between Delta TIMP-1 and Delta TIMP-2 was shown to be independent of N-linked glycosylation. Delta TIMP-1 and Delta TIMP-2 A21 both showed simple two-state refolding kinetics, whereas Delta TIMP-2 T21 refolding was more complex and biphasic in character. These differences between Delta TIMP-2 T21 and A21 suggest that residue 21 is a structurally important site in the TIMP protein. Ah three truncated molecules can be considered as stable independent folding domains ideally suited for further structural analysis.

    Williamson, R.A. and Martorell, G. and Carr, M.D. et al. (1994) Solution Strucure of the Active Domain of Tissue Inhitor of Metalloprotrinases.2.A new Member of the OB Fold Protein Family. Biochemistry, 33 (39). pp. 11745-11759. ISSN 0006-2960.

    Abstract

    Homonuclear two-dimensional and three-dimensional H-1 nuclear magnetic resonance spectroscopy has been used to obtain essentially complete sequence-specific assignments for 123 of the 127 amino acid residues present in the truncated form of tissue inhibitor of metalloproteinases-2 (Delta TIMP-2), the active N-terminal domain of the protein. Analysis of the through-space nuclear Overhauser effect data obtained for Delta TIMP-2 allowed determination of both the secondary structure of the domain and also a low-resolution tertiary structure defining the protein backbone topology. The protein contains a five-stranded antiparallel beta-sheet that is rolled over on itself to form a closed beta-barrel, and two short helices which pack close to one another on the same barrel face. A comparison of the Delta TIMP-2 structure with other known protein folds reveals that the beta-barrel topology is homologous to that seen in proteins of the oligosaccharide/oligonucleotide binding (OB) fold family. The common structural features include the number of beta-strands and their arrangement, the beta-barrel shear number, an interstrand hydrogen bond network, the packing of the hydrophobic core, and a conserved beta-bulge. Superpositions of the beta-barrels from Delta TIMP-2 and two previously known members of the OB protein fold family (staphylococcal nuclease and Escherichia coil heat-labile enterotoxin) confirmed the similarity in beta-barrel topology. The three-dimensional structure of Delta TIMP-2 has allowed a more detailed interpretation than was previously possible of the functional significance of available protein sequence and site-directed mutagenesis data for the TIMP family. Furthermore, the structure has revealed conserved surface regions of potential functional importance.

    Williamson, R.A. and Smith, B.J. and Angal, S. et al. (1993) Structural analysis of tissue inhibitor of metalloproteinases-1 (TIMP-1) by tryptic peptide mapping. Biochimica Et Biophysica Acta, 1164 (1). pp. 8-16. ISSN 0006-3002.

    Abstract

    Tryptic digests of recombinant TIMP-1 have been resolved on reverse-phase HPLC and the major peaks identified by N-terminal sequencing. This procedure accounted for the entire molecule, except two short peptides of 2 and 4 amino acids in length. The peptide map was used to (i), characterize an insoluble 'core' peptide seen on digestion of TIMP-1 in non-reducing conditions; (ii). confirm the structure of DELTA127-184TIMP-1, a recently described truncated form of the TIMP-1 molecule; (iii), identify exposed regions of the intact and truncated TIMP-1 molecules by measuring the rate of tryptic peptide release and (iv), locate sites of aberrant proteolysis seen when recombinant human TIMP-1 was purified at large scale.

    Clare, I.C.H. and Murphy, G.H. (1993) MIETS III Follow up of the first six clients to be discharged: diverse measures of the effectiveness of the service. Mental Handicap Research, 6 (1). pp. 70-91. ISSN 0952-9608.

    Abstract

    A follow-up study of the first six clients to leave the Mental Impairment Evaluation and Treatment Service is described. Between entering the service and follow-up (mean: 12 months after leaving), all six had made gains in their levels of skills and social functioning. For five of them, there had also been a reduction in the key challenging behaviours for which referral had been sought. All were living in residential facilities which were both less restrictive than those from which they had entered the service and offered a higher quality of care. The majority liked the placement in which they were living at follow-up as much, or more, than the one from which they had entered the service. Nevertheless, some of the resources which assist the functioning of the service were disliked by the clients because they were perceived as placing limits on their liberty. The implications of these results are discussed, as are methodological issues relating to the study.

    Oliver, C. and Murphy, G.H. and Crayton, L. et al. (1993) Self-injurious behaviour in Rett Syndrome: interactions between features of Rett Syndrome and operant conditioning. Journal of Autism and Developmental Disorders, 23 (1). pp. 91-109. ISSN 0162-3257.

    Abstract

    Operant and biological theories of the cause of self-injurious behavior (SIB) in people with a mental handicap are often viewed as mutually exclusive. In this single case study, interactions between features of Rett syndrome and operant conditioning as determinants of SIB are examined. Functional analysis by analog methodology indicated different functions for two forms of SIB shown by the subject: automatic reinforcement by sensory stimulation and escape from social interactions. It is suggested that features of Rett syndrome established conditions under which operant conditioning of self-injurious responding was maximized. The implications of this interaction between features of syndromes and operant conditioning for the conceptualization of the cause of SIB are discussed and it is proposed that the notion of a unitary cause of SIB is inappropriate. It is more productive to consider operant conditioning as the process that maintains responding against a background of predisposing and mediating factors which may be biologically determined.

    Murphy, G.H. (1993) The use of aversive stimuli in treatment: the issue of consent. Journal of Intellectual Disability Research, 37 (3). pp. 211-219. ISSN 0964-2633.

    Abstract

    It has been argued that, in the consideration of the use of aversive stimuli in treatment, the issues are ideological and philosophical as well as technical. Adopting Homer's (1990) definition of what is meant by 'aversive' in die ideological debate, it is suggested that the crucial issue is the inability of making clients to give their informed consent. It is proposed that proxy consent might be an alternative, but that this would be unacceptable if aversive procedures could be shown to be never in the best interests of the client, or shown to violate clients' rights or to be against the interests of society because of anticipated harm or injustice to others. It is concluded that it is difficult to be certain that it is ever in the best interests of the client for aversive procedures to be employed, that aversive interventions appear not to violate clients' rights necessarily (except possibly the right to dignity and respect while the intervention is operating, and perhaps the right to choice at the beginning of the intervention), but that the inescapable difficulty in the use of aversive interventions is the likelihood that they will be misused with other clients than the ones for whom they may be initially designed.

    Clare, I.C.H. and Murphy, G.H. and Cox, D. et al. (1992) Assessment and treatment of fire-setting: a single-case investigation using a cognitive-behavioural model. Criminal Behaviour and Mental Health, 2 (3). pp. 253-268. ISSN 0957-9664.

    Abstract

    There is a dearth of published studies on the treatment of arson in adults. A cognitive-behavioural model of the fire-setting of a young man with a mild learning disability and facial disfigurement is described. On the basis of the model, a comprehensive package of treatment, including facial surgery, social skills and assertiveness training, alternative coping strategies, and 'assisted' covert sensitisation, was carried out. At follow-up, 48 months after moving to an environment which was not secure, there was no evidence that the man had either set further fires or made hoax calls to the fire brigade.

    Murphy, G.H. (1992) Community adjustment, work, social integration and social competence for people with intellectual disabilities or mental retardation. Current Opinion in Psychiatry, 5 (6). pp. 831-835. ISSN 0951-7367.

    Abstract

    The success of the community integration movement over the last 20 years is considered. Theoretical models of community adjustment are beginning to appear and data from studies of social integration at school, home and work are showing that social competence is likely to be a central issue in the future.

    Murphy, G.H. and Holland, A.J. and Fowler, P. et al. (1991) MIETS: a service option for people with mild mental handicaps and challenging behaviour or psychiatric problems. 1. Philosophy, service, and service users. Mental Handicap Research, 4 (1). pp. 41-66. ISSN 0952-9608.

    Abstract

    This paper, the first of a three-part series, describes the philosophy and establishment of the Mental Impairment Evaluation and Treatment Service. It explains how the service operates, the kinds of people referred to the unit during its first 18 months of operation, and the quality of life it has provided for its service users.

    Murphy, G.H. and Clare, I.C.H. (1991) MIETS: a service option for people with mild mental handicaps and challenging behaviour or psychiatric problems. Mental Handicap Research, 4 (2). pp. 180-206. ISSN 0952-9608.

    Abstract

    This paper, the second in a three-part series, describes the assessment and treatment programmes of two service users to illustrate the MIETS approach, and gives details of the skill profiles which were used to plan their future placements. Data on the behavioural characteristics of MIETS users at pre-admission and discharge are also presented, together with a discussion of the difficulty of using such measures to evaluate service effectiveness.

    Murphy, G.H. (1991) MIETS meets needs. Nursing Times, 87 (36). pp. 47-49. ISSN 0954-7762.

    Holland, A.J. and Murphy, G.H. (1990) Behavioural and psychiatric disorders in adults with mild learning difficulties. International Review of Psychiatry, 2 (1). pp. 117-136. ISSN 0954-0261.

    Abstract

    The study of the relationship between the presence of learning difficulties, with its the numerous possible causes, and the onset of behaviour problems or psychiatric disorder is complicated by confusion over terminology, difficulties in ascertaining population rates for these disorders and different theories and ideologies concerning how such problems should be managed. The complexity of such problems demands the collection of data in each individual case and the proper evaluation of the effect of any intervention, whether it be behavioural, social psychotherapeutic or the use of medication. Such an assessment has as its aim the identification of the biological, psychological and environmental components relevant to understanding why a particular person presents with a problem behaviour, and/or the onset of a particular psychiatric disorder, at this point in time. By identifying the relative importance of these different factors appropriate therapeutic interventions can be tried. People who are identified as having learning difficulties, of whatever degree, have the right to expect that help will be available for them, as the presence of behaviour problems or psychiatric disorder can severely affect their quality of life.

    Murphy, G.H. and Hulse, J.A. and Smith, I. et al. (1990) Congenital hypothyroidism; physiological and psychological factors in early development. Journal of Child Psychology and Psychiatry, 31 (5). pp. 711-725. ISSN 0021-9630.

    Abstract

    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 (< 20 nmol/1) and social class contributed significantly to outcome.

    Kent, A.E. and Murphy, G.H. and Milla, P.J. (1990) Psychological characteristics of children with Shwachman's syndrome. Archives in Disease in Childhood, 65 (12). pp. 1349-1352. ISSN 0003-9888.

    Abstract

    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.

    Holland, A.J. and Murphy, G.H. (1990) Behavioural and psychiatric disorders in adults with mild learning difficulties. International Review of Psychiatry, 2 (1). pp. 117-135. ISSN 0954-0261.

    Abstract

    The study of the relationship between the presence of learning difficulties, with its the numerous possible causes, and the onset of behaviour problems or psychiatric disorder is complicated by confusion over terminology, difficulties in ascertaining population rates for these disorders and different theories and ideologies concerning how such problems should be managed. The complexity of such problems demands the collection of data in each individual case and the proper evaluation of the effect of any intervention, whether it be behavioural, social psychotherapeutic or the use of medication. Such an assessment has as its aim the identification of the biological, psychological and environmental components relevant to understanding why a particular person presents with a problem behaviour, and/or the onset of a particular psychiatric disorder, at this point in time. By identifying the relative importance of these different factors appropriate therapeutic interventions can be tried. People who are identified as having learning difficulties, of whatever degree, have the right to expect that help will be available for them, as the presence of behaviour problems or psychiatric disorder can severely affect their quality of life.

    Oliver, C. and Murphy, G.H. and Corbett, J. (1987) Self-injurious behaviour in people with a mental handicap: a total population survey. Journal of Mental Deficiency Research, 31. pp. 147-162. ISSN 0022-264X.

    Abstract

    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).

    Murphy, G.H. (1987) Are Intelligence tests outmoded? Archives of disease in childhood, 62 (8). pp. 773-775. ISSN 0003-9888.

    Abstract

    Most doctors know little about clinical and educational psychologists' areas of expertise; although most do know that they carry out intelligence tests. Now, just when doctors have accepted the intelligence quotient (10) as a measure of intelligence, psychologists seem reluctant to use the term. Why? Is something wrong with the concept of IQ? Are IQ tests outmoded?

    Murphy, G.H. and Carr, J. and Callias, M. (1986) Increasing simple toy play in profoundly mentally handicapped children. II: Designing special toys. Journal of Autism and Developmental Disorders, 16 (1). pp. 45-58. ISSN 0162-3257.

    Abstract

    The purpose of this study was to increase simple toy play in profoundly mentally handicapped children by presenting them with specially designed toys. Twenty children (mean chronological age 14 years, mean mental age less than 1 year) were observed while playing with the special toys, which emitted stimuli (vibration, light, or sound) when appropriately operated. They were also observed with the toys when the stimuli were unavailable. There were large individual differences, but, in general, children interacted significantly more with the experimental toys than with the control toys and engaged in significantly less stereotyped behavior when the experimental toys were available. The implications for clinical and research work are discussed. This research was supported by the National Society for Autistic Children and the Bethlem Royal Hospital Research Fund. Some of the results were reported at the B.P.S. Annual Conference, York, 1983. We are grateful to the children involved in the study, their parents, and the staff. We are also indebted to Mrs. E. Goodall for HBS schedule data, and to Dr. D. Hands and Mr. A. Smith for the multivariate analysis.

    Murphy, G.H. and Hulse, J.A. and Jackson, D. et al. (1986) Early treated hypothyroidism: development at three years. Archives of Disease in Childhood, 61 (8). pp. 761-765. ISSN 0003-9888.

    Abstract

    Eighty children from the North West and North East Thames Regional Health Authorities who had been identified as having congenital hypothyroidism either by neonatal screening (76 cases) or by clinical symptoms (four) were seen for psychological assessments at 1 (60 cases), 3 (58), and/or 5 (20) years of age. Almost all the children's scores were in the normal range, and comparisons with matched controls suggested that they were doing only slightly less well than normal children in overall development. They were significantly slower, however, on a motor skills task. Moreover, a low initial serum thyroxine and triiodothyronine value, considerable delay in initial bone age, and an absence of thyroid tissue on isotope scan seemed to be associated with a somewhat poorer prognosis.

    Murphy, G.H. and Dunger, D. and Grant, D. (1986) Outcome of screening for congenital hypothyroidism. Lancet, 327 (8490). pp. 1130-1131.

    Murphy, G.H. and Callias, M. and Carr, J. (1985) Increasing simple toy play in profoundly mentally handicapped children. I: training to play. Journal of Autism and Developmental Disorders, 15 (4). pp. 375-388. ISSN 0162-3257.

    Abstract

    Abstract The purpose of this study was to increase simple toy play in profoundly mentally handicapped children. Twenty children (mean chronological age, 14 years; mean mental age, less than 1 year) were trained to play with ordinary toys, half by a behavior modification technique and half by a control procedure. The operant training led to some increases in total toy contact but did not appear to be significantly more effective than the control technique in promoting independent constructive play. The possible reasons for the relative lack of success of the behavioral training are discussed. This research was supported by the National Society for Autistic Children and the Bethlem Royal Hospital Research Fund. Some of the results were reported at the B.P.S. Annual Conference, York, April 1983. We are grateful to the children involved in the study, their parents, and the staff. We are also indebted to Mrs. E. Goodall for the H.B.S. schedule data and to Dr. D. Hands and Mr. A. Smith for the multivariate analyses.

    Murphy, G.H. (1985) Self-injurious behaviour in the mentally handicapped: an update. Newsletter of the Association of Child Psychology and Psychiatry, 7. pp. 2-11.

    Murphy, G.H. (1982) Sensory reinforcement in autistic and mentally handicapped children: a review. Journal of Autism and Developmental Disorders, 12 (3). pp. 265-278. ISSN 0162-3257.

    Abstract

    Abstract Sensory reinforcement was first studied by learning theorists working with animals in the 1950s. Attempts to examine the phenomenon with children followed in the 1960s, and the studies demonstrated that sensory stimuli could act like any other reinforcers with normal young children. Similar work with the autistic and mentally handicapped child arose in relation to both the study of receptor development and more treatment-oriented research. It now seems that even profoundly handicapped children can learn to operate simple levers when reinforced by sensory stimuli, and some handicapped children have learned quite complex skills through sensory reinforcement. There also appears to be a close relationship between stereotyped behavior and sensory reinforcement. The clinical implications of the studies reviewed are discussed. This review was written while the author was supported by a Bethlem Royal Hospital research grant. The author is very grateful to Maria Callias, Dr. Janet Carr, Mrs. E. Goodall, and Dr. J. Corbett for their helpful comments on the paper.

    Goodall,, E. and Corbett, J. and Murphy, G.H. et al. (1982) Sensory reinforcement table: an evaluation. Journal of the British Institute of Mental Handicap, 10 (2). pp. 52-55.

    Abstract

    A table, which provides sensory reinforcement on completion of form board tasks, was evaluated for use in teaching and occupying severely mentally handicapped children. Sensory stimulation was found to be more effective than edibles or social reinforcement in occupying two children working at skills already acquired. The addition of sensory reinforcement to social reinforcement was found to enhance learning new skills in three children. Sensory stimulation was no more effective than conventional reinforcers with five children whose performance at form board tasks was generally very low. It is suggested that the use of such equipment be investigated further with larger numbers of children.

    Goodall, E. and Corbett, J. and Murphy, G.H. et al. (1981) Sensory reinforcement table for severely handicapped children. Journal of the Institute of Mental Subnormality (APEX), 9 (3). pp. 96-97.

    Abstract

    A table which provides light, vibration, or sound stimulation on completion of form board tasks is described. Questions relating to the evaluation of such equipment are discussed.

    Murphy, G.H. and Goodall, E. (1980) Measurement error in direct observations: a comparison of common recording methods. Behaviour Research and Therapy, 18 (2). pp. 147-150. ISSN 0005-7967.

    Abstract

    Abstract Videotapes of three brief duration, three medium duration and three long duration types of stereotyped behaviour (of eight severely retarded children) were analysed to provide a criterion record of the true percentage duration of the behaviour. The criterion record was compared with the records produced by four time-sampling methods: a whole-interval method, two partial-interval methods and a momentary time-sampling method. As predicted, the whole-interval method grossly underestimated and the partial-interval methods grossly overestimated the true percentage duration of the behaviour, except when the duration of individual responses was much longer than the observation interval. Momentary time-sampling was not an errorless method but was consistently superior to the other methods. The implications of these findings for the detection of treatment effects by direct observations are discussed.

    Murphy, G.H. (1978) Overcorrection; a critique. Journal of Mental Deficiency Research, 22 (3). pp. 161-173. ISSN 0022-264X.

    Murphy, G.H. and McArdle, M. (1978) Behaviour modification with the retarded: a six month training course for nurses. Nursing Mirror, 146 (17). pp. 31-34. ISSN 0029-6511.

    Murphy, G.H. (1977) Teaching a picture language to a non-speaking retarded boy. Behaviour Research and Therapy, 15 (2). pp. 198-201. ISSN 0005-7967.

    Abstract

    In recent years numerous operant language training programmes have been designed for teaching both receptive and expressive language to autistic and retarded children (e.g. Bricker and Bricker. 1970a; Bricker and Bricker, 1970b; Lovaas, 1968; Sloane et al, 1968). There have been suggestions that the content of such programmes should be to some extent dictated by the findings of psycholinguists, while the methods be designed along behaviour modification lines (Lynch and Bricker, 1972; Miller and Yoder, 1972). Certainly operant programmes have been shown to produce some improvement of language function in autistic and retarded children (Bricker and Bricker. 1970a; Sloane et al, 1968; Lovaas. 1968; Guesset al, 1968); but the problem of whether all retarded children can be taught some language by these means has not been tackled. Psycholinguists, following Chomsky (Chomsky, 1965) maintain that the development of language in children is dependent on the language acquisition device, or LAD. Unfortunately there are no independent means of determining the presence of LAD in a child, so that relating a child's inability to use language to the absence of LAD becomes a circular argument. It frequently seems to be assumed that, provided no perceptual deficits are present, language acquisition is as difficult in one medium as in another. Individuals who are deaf and retarded have been taught sign language with some success (Berger, 1972; Cornforth et al, 1974), and retarded children who are non-speaking have been taught symbolic languages (Bliss symbols in Vanderheiden et al, 1975; Premack symbols in Hollis and Carrier, 1975, and Hodges, 1976). It is unclear, however, whether those learning symbolic languages, but having no gross physical or perceptual handicap, could have learnt sign language or even spoken language with an equivalent method of training. The present study is a report of a retarded boy with unreliable hearing (which ruled out spoken language), who seemed unable to learn (receptive or expressive) sign language after extensive operant training, but who rapidly acquired a limited symbolic “language” using an identical training method. The symbols used were pictorial representations of the objects (cf. Bliss and Premack symbols).

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Total publications in KAR: 128 [See all in KAR]
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Professor Murphy has conducted numerous research projects over the years (see publications tab) latterly managing large and multi-centre grants. Most of her research has been in the field of challenging behaviour and learning disabilities. She has held over £1million in grant funding from Bethlem Royal Hospital, Department of Health (several), Mental Health Foundation (several), Nuffield Foundation, British Institute of Learning Disabilities, Wellcome, Bailey Thomas Fund, NIHR and SSCR.

Current Projects:

Effectiveness for CBT for people with Asperger syndrome and social anxiety. This is an NIHR funded double blind randomised crossover trial of the effectiveness of cognitive behaviour therapy (CBT) for people with Asperger Syndrome (AS) and high functioning autism, who have problems with anxiety (led by Peter Langdon). Many adults with AS have problems with anxiety but there have been no studies which have tried to find out whether or not CBT can help. We want to find out whether or not psychological treatments for anxiety can be adapted and used to successfully treat the anxiety experienced by adults with AS. All participants will be assessed at baseline (time1). Participants will then be randomly assigned to a treatment group or a waiting list group.Those in the treatment group will receive 24 weeks of CBT at which point all participants will be re-assessed (time2).Those in the waiting group will then receive the 24 weeks of treatment and finally all participants will be reassessed (time 3). Measures of anxiety, general functioning, cost will be taken at the three time points in order to examine whether or not treatment has had any effect. The study will help to determine whether or not CBT will be effective at improving anxiety amongst adults with AS and whether it represents good value for money. It may help us to improve satisfaction with the NHS for people with autistic spectrum disorders who have mental health problems but do not receive treatment.

Effectiveness of social care for ex-offenders with learning disabilities. This new project is funded by the School for Social Care Research. Rachel Forrester-Jones, Nick Gore and Jeni Beecham are co-grant holders. The study will select people screened positive for learning disabilities in prison and follow them up in the Community to assess their progress and to evaluate the effectiveness of social care input.

Effectiveness of cognitive-behavioural treatment for men at risk of sexual offending. This was a three year Department of Health funded project (later granted a one year extension). Neil Sinclair (Clinical Psychologist) was a co-grant holder. The project is evaluating group cognitive behavioural treatment for men with learning disabilities who have sexually abusive behaviour (these men have mostly been excluded from prison and probation treatment groups in the past). The treatment groups are run by clinical psychologists and nurses at a number of sites in England (including Hampshire, Surrey, Kent Yorkshire, Norfolk, the North East and the South West). The data collection and provision of treatment is coordinated by SOTSEC-ID (Sex Offender Treatment Services Collaborative - Intellectual Disabilities). See the SOTSEC web site for further information.

Recently completed projects:

The effectiveness of treatment for people with untreated Phenylketonuria (PKU)This was a four year project funded by Wellcome and SHS. Our collaborative partners were Dr Philip Lee at the National Hospital for Neurology and Neurosurgery in London, Dr Brian Fitzgerald (psychiatrist) and Eleanor Weetch (National Society for PKU).The project involved a randomised crossover trial of low phenylalanine diet for 36 people with untreated PKU and severe learning disabilities, scattered across England. The dietary products were being provided by SHS International. there were two research workers on the project Allayne Amos & Lesley Robertson.

Symptoms of abuse for people with severe learning disabilities. This project was funded by the Department of Health. Dr Isobel Clare in Cambridge University was the co-grant holder and Ali O'Callaghan was the research worker.The project found that people with severe learning disabilities suffered very long term symptoms following abuse (including classical symptoms of PTSD). The effects both on the survivors themselves and their families was often devastating. There was little consistent treatment available for people and their families and services often did not support families at all well when abuse was discovered. A number of recommendations for improvements to services were made. Copies of the final report can be obtained by emailing Glynis Murphy.

Capacity to consent to sexual relationships. This project was funded by the Nuffield Foundation. Ali O'Callaghan was the research worker on the project. The background to the study was that adults with learning disabilities were presumed competent in law to consent to sexual relationships but this was often questioned in court, especially following allegations of abuse. This project examined the social networks, sexual knowledge and understanding of abuse of adults with learning disabilities and compared them to mainstream non-disabled 16 year old students (who had reached the age of consent and were routinely presumed competent). Adults with learning disabilities frequently knew little about sex and most appeared very vulnerable to abuse. Those who had had sex education did much better than those who had not. The implications for defining capacity to consent to sexual relations were considered. Copies of the final report (with the measures used) can be obtained by emailing Glyns Murphy.

Moral development and people with learning disabilities. As a Phd student, Peter Langdon undertook a series of studies on the moral development of people with learning disabilities, alongside Glynis Murphy and Isabel Clare. They showed that people with learning disabilities did lag behind their peers in moral development and there appeared to be a curvilinear relationship with criminal offending, those with the lowest level of moral development not offending. A brief test of an intervention programme suggested it was possible to promote people's moral development by a form of group CBT.

Follow-up of first total population survey of SIB. The first total population survey of SIB in children and adults with learning disability took place in the 1980's (by Glynis Murphy and Chris Oliver). Recently MSc student Lorne Taylor completed a follow-up of the original survey in a sample of three South London boroughs. For reports contact Glynis Murphy.

Effectiveness of early intervention in autism. This pilot project, partly funded by the British Academy, has just been completed with Dr Julie Beadle-Brown and Hannah Dorey, University of Kent. The project aimed to examine the effect of early interventions on the social relationships of children with autism. The outcome for children receiving ABA interventions was compared to that for children receiving Sonrise interventions and that for children whose parents chose no special intervention. It is hoped to extend this project to include larger groups of children in the south east and north west.

 

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All of Glynis Murphy’s posts have involved consultancy or clinical work, as well as teaching and research. Over the years she has provided clinical psychology services to a specialist community-based unit for children with severe learning disabilities and challenging behaviour, a specialist service for children with physical and/or learning disabilities, a semi-secure service for people with mild learning disabilities at risk of offending, several community learning disability teams, and an assessment and treatment unit for adults with learning disabilities. She has also conducted consultancy projects, including both service level planning and individual work. For example, she advised the Fife health and social services departments on the setting up of forensic learning disabilities services; completed assessments for court, mainly assessments of suspects, victims and parents with learning disabilities; provided training for services, including Croydon CLDT; provided 1 day per fortnight consultancy to a specialist intensive support team in Cumbria; led a project for the North West Training and Development Team developing a forensic LD strategy for the NW (Breaking the Cycle - see www.nwtdt.com). Glynis Murphy currently acts as forensic LD lead for the Oxleas NHS Trust (2 days per week).

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Last Updated: 25/02/2013