Portrait of Professor Peter Langdon

Professor Peter Langdon

Professor of Clinical and Forensic Psychology

About

Professor Langdon is a Consultant Clinical and Forensic Psychologist and non-medical approved clinician working within the University and NHS.  

He completed his undergraduate degree at Memorial University of Newfoundland, Canada and went on to complete his Doctorate in Clinical Psychology at the Institute of Psychiatry, King's College, London as a Lord Rothermere Fellow.  

He completed his PhD at the Tizard Centre as an NIHR Research Fellow. 

Research interests

  • psychological factors associated with criminal offending behaviour by people with intellectual and developmental disabilities
  • developing improved psychological assessment tools for people
  • developing and testing a virtual immersion training system for teaching social skills and perspective-taking with offenders with intellectual disabilities
  • clinical trials of psychological therapies for people with IDD who have a history of criminal offending
  • hospital care pathways for people with autistic spectrum conditions (mATCH study)
  • Assent Project The development of an assent-based process for the inclusion of adults with impairments of capacity and/or communication in ethically-sound research

Teaching

Professor Langdon teaches on the Tizard postgraduate programmes including autism and IDD as well as a mental health module.

Supervision

Professor Langdon supervises students researching carrying out research into cognitive behavioural therapy, mental health care including forensic mental health care for people with intellectual and developmental disabilities, care systems, criminal justice systems, moral development, information processing with people who have autistic spectrum disorders, diagnosis of autism with girls and women, behavioural interventions for people with intellectual and other developmental disabilities.

Professional

Editor of the Journal of Applied Research in Intellectual Disabilities 

Publications

Showing 50 of 125 total publications in the Kent Academic Repository. View all publications.

Article

  • Daniel, M., Sadek, S. and Langdon, P. (2018). The reliability and validity of a revised version of the How I Think Questionnaire for men who have intellectual disabilities. Psychology, Crime & Law [Online] 24:379-390. Available at: http://dx.doi.org/10.1080/1068316X.2017.1284217.
    The aim of the current study was to revise an existing measure of distorted cognitions, creating the How I Think Questionnaire – Intellectual Disabilities (HIT-IDs), and to investigate the reliability and validity of the revised questionnaire. To achieve our aims, we recruited 97 men with intellectual disabilities (IDs), with or without a history of engaging in criminal behaviour, and interviewed them on two occasions, inviting them to complete the HIT-IDs, along with measures of moral development and empathy. The results indicated that the internal consistency of the HIT-IDs was acceptable, and the test-retest reliability was good. The HIT-IDs discriminated well between offenders and non-offenders, and as expected, correlated positively with a measure of moral development and negatively with a measure of empathy. The HIT-IDs is a reliable and valid measure for use with men who have IDs.
  • Vereenooghe, L. et al. (2018). Interventions for mental health problems in children and adults with severe intellectual disabilities: A systematic review. BMJ Open [Online] 8:1-12. Available at: http://dx.doi.org/10.1136/bmjopen-2018-021911.
    Objective: Mental health problems are more prevalent in people with than without intellectual disabilities, yet treatments options have received little attention. The aim of this study was to identify and evaluate the effectiveness of pharmacological and psychological interventions in the treatment of mental health problems in children and adults with severe and profound intellectual disabilities, given their difficulties in accessing standard mental health interventions, particularly talking-therapies, and difficulties reporting drug side-effects.
    Design: A systematic review using electronic searches of PsycINFO, PsycTESTS, EMBASE, MEDLINE, CINAHL, ERIC, ASSIA, Science Citation Index, Social Science Citation Index, and CENTRAL was conducted to identify eligible intervention studies. Study selection, data extraction and quality appraisal were performed by two independent reviewers.
    Participants: Study samples included at least 70 % children and/or adults with severe or profound intellectual disabilities or reported the outcomes of this subpopulation separate from participants with other levels of intellectual disabilities.
    Interventions: Eligible intervention studies evaluated a psychological or pharmacological intervention using a control condition.
    Outcomes: Symptom severity, frequency or other quantitative dimension (e.g., impact), as assessed with standardised measures of mental health problems.
    Results: We retrieved 41,232 records, reviewed 573 full-text articles and identified 5 studies eligible for inclusion: 3 studies evaluating pharmacological interventions, and 2 studies evaluating psychological interventions. Study designs ranged from double-blind placebo-controlled crossover trials to single-case experimental reversal designs. Quality appraisals of this very limited literature base revealed good experimental control, poor reporting standards, and a lack of follow-up data.
    Conclusions: Mental ill-health requires vigorous treatment, yet the current evidence base is too limited to identify with precision effective treatments specifically for children or adults with severe and profound intellectual disabilities. Clinicians therefore must work on the basis of general population evidence, whilst researchers
  • Rai, R. et al. (2018). A Phenomenological Approach to Diagnosing Psychosis in Autism Spectrum Disorder and Intellectual Disability: A Case Series. Advances in Autism [Online] 4:39-48. Available at: https://doi.org/10.1108/AIA-01-2018-0004.
    Purpose: The diagnosis of psychosis in individuals with autism spectrum disorder poses a
    unique clinical challenge. The presence of intellectual disability further complicates the
    diagnostic picture. Reliable and timely diagnosis of psychosis in such individuals minimizes
    the duration of untreated psychotic symptoms and the subsequent impact on the quality of life
    of the patients concerned.

    Design/methodology/approach: The authors present four patients with psychosis, autism
    spectrum disorder and intellectual disability, who have received care within forensic mental
    health and intellectual disability settings. These examples demonstrate the interaction
    between these conditions, as well as issues pertaining to diagnosis and management.

    Findings: In all four patients, sustained use of antipsychotic medication was objectively
    associated with an improvement in psychotic symptoms and quality of life. In instances
    where autistic phenomena were accentuated upon development of psychosis, such features
    returned to the baseline levels evident prior to the onset of psychosis.

    Practical implications: The discussion and related case examples could improve
    understanding of the possibility of psychosis in individuals with autism spectrum disorder
    and intellectual disability, and increase awareness of this diagnostic possibility among
    healthcare professionals.

    Originality/value: This is the first published case series illustrating the challenges of
    diagnosing psychosis in individuals with autism spectrum disorder and intellectual disability.
  • Garrigan, B., Adlam, A. and Langdon, P. (2018). Moral decision-making and moral development: Toward an integrative framework. Developmental Review [Online]. Available at: https://doi.org/10.1016/j.dr.2018.06.001.
    How moral decision-making occurs, matures over time and relates to behaviour is complex. To develop a full picture of moral decision-making, moral development and moral behaviour it is necessary to understand: (a) how real-time moral decisions are made (including relevant social and contextual factors), (b) what processes are required to develop to enable mature moral decisions, (c) how these processes develop over time, and (d) how moral decisions relate to behaviour. In this paper, psychological and social neuroscience theories of moral decision-making and development are briefly reviewed, as is the development of relevant component processes. Various component processes and factors are seen as required for moral decision-making and development, yet there is no comprehensive framework incorporating these components into one explanation of how real-time moral decisions are made and mature. In this paper, we integrated these components into a new framework based on social information processing (SIP) theory. Situational factors, and how both cognitive and affective process guide moral decisions was incorporated into the Social Information Processing-Moral Decision-Making (SIP-MDM) framework, drawing upon theories and findings from developmental psychology and social neuroscience. How this framework goes beyond previous SIP models was outlined, followed by a discussion of how it can explain
  • Alexander, R., Chester, V. and Langdon, P. (2017). A systematic review and synthesis of outcome domains for use within forensic services for people with intellectual disabilities. European Psychiatry [Online] 41:S152. Available at: http://dx.doi.org/10.1016/j.eurpsy.2017.01.2008.
    Aims
    In response to the Winterbourne scandal, and the large number of people with intellectual disabilities (IDs) and offending behavior being treated in psychiatric hospitals, this study identified the domains that should be used to measure treatment outcomes of this group.
    Methods
    A systematic search of relevant databases was undertaken to identify domains. Sixty studies met the eligibility criteria, and findings were synthesized using content analysis. The findings were refined within a consultation and consensus exercises with carers, service users, and experts.
    Results
    The final framework encompassed three a priori super-ordinate domains (a) effectiveness, (b) patient safety, and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviors, reactive and restrictive interventions, quality of life and patient satisfaction.
    Conclusions
    To index recovery, services need to measure outcome using this framework.
  • Morrissey, C. et al. (2017). Researching outcomes from forensic services for people with intellectual or developmental disabilities: a systematic review, evidence synthesis and expert and patient/carer consultation. Health Services and Delivery Research [Online] 5. Available at: http://dx.doi.org/10.3310/hsdr05030.
    Background: Inpatient services for people with intellectual and other types of developmental disabilities
    (IDD) who also have forensic or risk issues are largely provided in secure hospitals. Although this is a
    health service sector with high levels of expenditure, there is limited empirical information on patient
    outcomes from such services. In order for a future substantive longitudinal outcomes study in forensic IDD services to be informed and feasible, more needs to be understood about the outcome domains that are of relevance and importance and how they should be measured. A preliminary series of studies were undertaken.
    Objectives: To synthesise evidence in relation to the outcome domains that have been researched in the existing literature from hospital and community forensic services for people with IDD, within the broad domains of service effectiveness, patient safety and patient experience. To identify a definitive framework of outcome domains (and associated measures and indicators) based both on this research evidence and on the views of patients, carers and clinicians. To synthesise the information gathered in order to
    inform design of future multisite longitudinal research in the sector.
    Design: Three linked studies were conducted. Stage 1 was a systematic review and evidence synthesis of outcome domains and measures as found within the forensic IDD literature. Stage 2 was a consultation exercise with 15 patients with IDD and six carers. Stage 3 was a modified Delphi consensus exercise with 15 clinicians and experts using the information gathered at stages 1 and 2.
    Results: At stage 1, 60 studies that researched a range of outcomes in forensic IDD services were identified from the literature. This resulted in the construction of an initial framework of outcome domains. The consultation with patients and carers at stage 2 added to these framework domains that related particularly to carer experience and the level of support post discharge in the community. The Delphi process at stage 3 confirmed the validity of the resulting framework for clinician. This survey also identified
    the outcome measures preferred by clinicians and those that are currently utilised in services. Thus, indicators of appropriate measures in some important domains were identified, although there was a paucity of measures in other domains.
    Conclusions: Together, these three linked studies led to the development of an evidence-based framework of key outcome domains and subdomains. A provisional list of associated measures and indicators was developed, although with the paucity of measures in some domains development of specific indicators may be required. With further refinement this could eventually be utilised by services and
    commissioners for comparative purposes, and in future empirical research on outcomes in forensic IDD services. An outline research proposal closely linked to recent policy initiatives was proposed. Limitations of the study include the relatively small number of carers and patients and range of experts consulted. Future work: This would comprise a national longitudinal study tracking IDD in patients through hospitalisation and discharge.

    Study registration: This study is registered as PROSPERO CRD42015016941.

    Funding: The National Institute for Health Research Health Services and Delivery Research programme.
  • Morrissey, C. et al. (2017). A systematic review and synthesis of outcome domains for use within forensic services for people with intellectual disabilities. British Journal of Psychiatry Open [Online] 3:41-56. Available at: http://dx.doi.org/10.1192/bjpo.bp.116.003616.
    Aims. In response to the large number of people with intellectual disabilities (IDs) and offending behaviour being treated in psychiatric hospitals, this study identified and developed the domains that should be used to measure treatment outcomes for this population using both a systematic review and consultation exercises.
    Methods. A systematic search of relevant databases, and sixty studies met the eligibility criteria, and findings were synthesised using content analysis. The findings were refined within a consultation and consensus exercises with carers, service users, and experts.
    Results. The final framework encompassed three a priori superordinate domains (a) effectiveness, (b) patient safety, and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviours, reactive and restrictive interventions, quality of life and patient satisfaction.
    Conclusions. To index recovery, services need to measure outcome using this framework.
  • Melvin, C., Langdon, P. and Murphy, G. (2017). Treatment Effectiveness for Offenders with Autism Spectrum Conditions: A Systematic Review. Psychology, Crime & Law [Online] 23:748-776. Available at: http://dx.doi.org/10.1080/1068316X.2017.1324027.
    Theoretical suppositions suggest a potential vulnerability in some individuals with autism spectrum conditions (ASCs) to displaying offending behaviours. Additionally, it is recognised that the features of ASCs may result in possible barriers to treatment. A systematic review was undertaken to
    identify empirical evidence examining the effectiveness of treatment programmes for offenders with ASCs and to explore the potential impact of ASC symptoms on treatment outcomes. The studies identified consisted of a small number of case series and a collection of case reports with little or no direct comparisons to offenders without ASCs. A synthesis of the findings highlighted variability in treatment approach and impact. Effectiveness was primarily defined by reduction in further offending behaviours and was found to be variable across the data. The potential relationship between the symptoms of ASCs and treatment outcome was explored with all case reports identifying the need for adaptations to treatment programmes, necessitated by the symptoms of ASCs. This systematic review joins an existing body of literature emphasising need for more controlled research into the effectiveness of offending behaviour treatment programmes for individuals with ASCs, and for further investigation into the impact of the clinical features of ASCs on treatment outcomes.
  • Vereenooghe, L., Gega, L. and Langdon, P. (2017). Intellectual disability and computers in therapy: views of service users and clinical psychologists. Cyberpsychology [Online]. Available at: http://dx.doi.org/10.5817/CP2017-1-11.
    Background
    Digital media have increased the accessibility of psychological therapies for the general population, but not for people with intellectual disability (ID), despite their greater mental health needs. This study explores and compares the views of service users and clinicians on how computers can be integrated in psychological therapies for people with ID who are traditionally under-represented in mainstream services.

    Methods
    We conducted in-depth unstructured interviews with three clinicians who had experience of working with people with ID and with three adults with ID who have experienced computerised training in cognitive behaviour therapy skills. The interviews explored the a) potential functions and benefits, b) anticipated challenges and barriers, and c) required design features of computers in therapy for people with ID. We used inductive coding to identify independent themes in the responses of clinicians and service users, and then compared the emerging themes between the two sets of participants to arrive at common themes.

    Results
    Six common themes emerged from service user and clinician responses: confidentiality of personal information and online applications, barriers in the communication with the therapist, value of therapist and personal contact, access to computer technologies, engagement potential of computer programmes and home practice. Three further themes were specific to clinician responses: patient suitability for computerised approaches, clinician distrust of computerised interventions, and involving a third party.

    Conclusion
    Computer technologies open up possibilities for psychological therapy with people with ID by helping them overcome in-session communication difficulties and practise skills at home. On-screen pictures, interactive games, symbols, sign language and touch-screen are key design features to help engagement. The main challenges are clinician-reported difficulties in their own capacity and capability to access and use computers and in fitting computers into their own defined roles.
  • Flynn, S. et al. (2017). Measurement tools for mental health problems and mental well-being in people with severe or profound intellectual disabilities: A systematic review. Clinical Psychology Review [Online] 57:32-44. Available at: https://doi.org/10.1016/j.cpr.2017.08.006.
    Mental health problems affect people with intellectual disabilities (ID) at rates similar to or in excess of the non-ID population. People with severe ID are likely to have persistent mental health problems. In this systematic review (PROSPERO 2015:CRD42015024469), we identify and evaluate the methodological quality of available measures of mental health problems or well-being in individuals with severe or profound ID. Electronic searches of ten databases identified relevant publications. Two reviewers independently reviewed titles and abstracts of retrieved records (n=41,232) and full-text articles (n=573). Data were extracted and the quality of included papers was appraised. Thirty-two papers reporting on 12 measures were included. Nine measures addressed a broad spectrum of mental health problems, and were largely observational. One physiological measure of well-being was included. The Aberrant Behavior Checklist, Diagnostic Assessment for the Severely Handicapped Scale-II and Mood, Interest and Pleasure Questionnaire are reliable measures in this population. However, the psychometric properties of six other measures were only considered within a single study – indicating a lack of research replication. Few mental health measures are available for people with severe or profound ID, particularly lacking are tools measuring well-being. Assessment methods that do not rely on proxy reports should be explored further.
  • Doble, B. et al. (2017). Economic Evaluation alongside a Randomised Controlled Crossover Trial of Modified Group Cognitive Behavioural Therapy for Anxiety Compared to Treatment-as-Usual in Adults with Asperger Syndrome. MDM Policy and Practice 2.
    Background: There is a growing interest in using group cognitive behavioural therapy (CBT) with people who have Asperger Syndrome (AS) and comorbid mental health problems. This study aims to assess the cost-effectiveness of modified group CBT for adults with AS experiencing co-occurring anxiety compared to treatment-as-usual.
    Methods: Economic evaluation alongside a pilot, multi-centre, single-blind, randomised controlled trial. Costs from the UK public sector (National Health Service and Social Services) and societal perspectives, quality-adjusted life-years (QALYs), incremental net (monetary) benefit (INB), expected value of perfect information, expected value of sample information, expected net gain of sampling, and efficient sample size of a future trial are reported.
    Results: Over 48 weeks, from the societal perspective, CBT results in additional costs of £6647, with only a 0.015 gain in QALYs, leading to a negative INB estimate of £6206 and a 23% probability of cost-effectiveness at a threshold of £30,000/QALY. Results from sensitivity analyses support the unlikely cost-effectiveness of CBT, but indicate the potential for cost-effectiveness over longer time horizons. Eliminating decision uncertainty is valued at £277 million and the efficient sample size for a future trial is estimated at 1,200 participants per arm.
    Limitations: Relatively small sample size and prevalence of missing data present challenges to the interpretation of the results.
    Conclusions: Current evidence from this small pilot study suggests that on average, modified group CBT is not cost-effective. However, there is much decision uncertainty so such a conclusion could be wrong. A large, full scale trial to reduce uncertainty would be an efficient investment for the UK health economy.
  • Langdon, P. et al. (2017). Using positive behavioural support as a treatment for trauma symptoms with a man with intellectual disabilities. International Journal of Positive Behavioural Support [Online] 7:31-37. Available at: http://www.ingentaconnect.com/contentone/bild/ijpbs/2017/00000007/00000001/art00005.
    Background. There is robust evidence that psychological therapies are an effective treatment for trauma-related symptoms, including post-traumatic stress disorder. However, there are relatively few studies involving people with intellectual disabilities, and no studies drawing on positive behavioural support as the mechanism for the delivery of treatment.
    Method and materials. This study was a descriptive case report of a young man with intellectual disabilities who had a history of early trauma. His challenging behaviour was associated with demand avoidance. A positive behavioural support plan, incorporating psychological therapies and medication, was developed, implemented and is described.

    Results. Over time, challenging behaviours reduced and were eventually extinguished. This was associated with an increase in engagement in a variety of activities and a reduction in trauma-related symptoms.

    Discussion. Using positive behaviour support plans as the organisational framework for the adaptation and delivery of both psychological therapies and medication for complex cases is advantageous. Excellent team working is necessary to ensure that interventions are successful.
  • Alexander, R. et al. (2016). Heterogeneity within Autism Spectrum Disorder in Forensic Mental Health: The Introduction of Typologies. Advances in Autism [Online] 2:201-209. Available at: http://dx.doi.org/10.1108/AIA-08-2016-0021.
    Purpose: Individuals with diagnoses of Autism Spectrum Disorder (ASD) within criminal
    justice settings are a highly heterogeneous group. Although studies have examined
    differences between those with and without ASD in such settings, there has been no
    examination of differences within the ASD group.
    Design/methodology/approach: Drawing on the findings of a service evaluation project, this
    paper introduces a typology of ASD within forensic mental health and learning disability
    settings.
    Findings: The eight sub-types that are described draw on clinical variables including
    psychopathy, psychosis and intensity/ frequency of problem behaviours that co-occur with
    the ASD. The initial assessment of inter rater reliability on the current version of the typology
    revealed excellent agreement, multirater Kfree = .90.
    Practical implications: The proposed typology could improve understanding of the
    relationship between ASD and forensic risk, identify the most appropriate interventions and
    provide prognostic information about length of stay. Further research to refine and validate
    the typology is ongoing.
    Originality/value: This paper introduces a novel, typology based approach which aims to
    better serve people with ASD within criminal justice settings.
  • Steverson, T., Adlam, A. and Langdon, P. (2016). Development and Validation of a Modified Multiple Errands Test for Adults with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities [Online] 30:255-268. Available at: http://dx.doi.org/10.1111/jar.12236.
    Background: The aims of the current study were to adapt a version of the MET for people with intellectual disabilities (IDs) and assess its ecological and construct validity. Material and Methods: Using a correlational design, 40 participants with IDs were invited to complete a battery of neuropsychological assessments and the modified Multiple Errands Test for Intellectual Disabilities (mMET-IDs). Results: The ability to successfully complete tasks on the mMET-IDs correlated significantly with measures of the Supervisory Attentional System, namely, the Tower of London Test and the Six Parts Test. However, performance on the mMET-IDs and the Six Parts Test could be accounted for by Verbal IQ and receptive vocabulary. The mMET-IDs failed to correlate with the DEX-IR. Conclusions: The mMET-IDs can be successfully used to assess some aspects of the Supervisory Attentional System in people with IDs. Further development is needed, however, to improve the ecological validity of the mMET-IDs.
  • Langdon, P. et al. (2016). The people with Asperger Syndrome and anxiety disorders (PAsSA) Trial: A pilot multi-centre single blind randomised trial of group cognitive behavioural therapy. British Journal of Psychiatry Open [Online] 2:179-186. Available at: http://dx.doi.org/10.1192/bjpo.bp.115.002527.
    Background: There is a growing interest in using cognitive behavioural therapy (CBT) with people who have Asperger Syndrome (AS) and comorbid mental health problems.
    Aims: To examine whether modified group CBT for clinically significant anxiety in an AS population is feasible and likely to be efficacious.
    Method: Using a randomised assessor-blind trial, 52 individuals with AS were randomised into a treatment arm or a waiting-list control arm. After 24 weeks, those in the waiting-list control arm received treatment, while those initially randomised to treatment were followed-up for 24 weeks.
    Results: The conversion rate for this trial was high (1.6:1), while attrition was 13%. After 24 weeks, there was no significant difference between those randomised to the treatment arm compared to those randomised to the waiting-list control arm on the primary outcome measure, the Hamilton Rating Scale for Anxiety.
    Conclusions: Trials of psychological therapies with this population are feasible. Larger definitive trials are now needed.
    Declaration of Interest: None
    Trial Registration: ISRCTN 30265294 (DOI: 10.1186/ISRCTN30265294), UKCRN 8370
  • Weston, L., Hodgekins, J. and Langdon, P. (2016). Effectiveness of cognitive behavioural therapy for people who have autistic spectrum disorders: A systematic review and meta-analysis. Clinical Psychology Review [Online] 49:41-54. Available at: http://dx.doi.org/10.1016/j.cpr.2016.08.001.
    The aims of this study were to undertake a meta-analytic and systematic appraisal of the literature investigating the effectiveness of cognitive behavioural therapy (CBT) when used with individuals who have autistic spectrum disorders (ASDs) for either a) affective disorders, or b) the symptoms of ASDs. Following a systematic search, 48 studies were included. CBT, used for affective disorders, was associated with a non-significant small to medium effect size, g = .24, for self-report measures, a significant medium effect size, g = .66, for informant-report measures, and a significant medium effect size, g = .73, for clinician-report measures. CBT, used as a treatment for symptoms of ASDs, was associated with a small to medium non-significant effect size, g = .25, for self-report measures, a significant small to medium effect size, g = .48, for informant-report measures, a significant medium effect size, g = .65, for clinician-report measures, and a significant small to medium effect size, g = .35, for task-based measures. Sensitivity analyses reduced effect size magnitude, with the exception of that based on informant-report measures for the symptoms of ASDs, which increased, g = .52. Definitive trials are needed to demonstrate that CBT is an empirically validated treatment for use with people who have ASDs.
  • Garrigan, B., Adlam, A. and Langdon, P. (2016). The neural correlates of moral decision-making: A systematic review and meta-analysis of moral evaluations and response decision judgements. Brain and Cognition 108:88-97.
    The aims of this systematic review were to determine: (a) which brain areas are consistently more active when making (i) moral response decisions, defined as choosing a response to a moral dilemma, or deciding whether to accept a proposed solution, or (ii) moral evaluations, defined as judging the appropriateness of another’s actions in a moral dilemma, rating moral statements as right or wrong, or identifying important moral issues; and (b) shared and significantly different activation patterns for these two types of moral judgements. A systematic search of the literature returned 28 experiments. Activation likelihood estimate analysis identified the brain areas commonly more active for moral response decisions and for moral evaluations. Conjunction analysis revealed shared activation for both types of moral judgement in the left middle temporal gyrus, cingulate gyrus, and medial frontal gyrus. Contrast analyses found no significant clusters of increased activation for the moral evaluations-moral response decisions contrast, but found that moral response decisions additionally activated the left and right middle temporal gyrus and the right precuneus. Making one’s own moral decisions involves different brain areas compared to judging the moral actions of others, implying that these judgements may involve different processes.
  • Montgomery, C. et al. (2016). Do adults with high functioning autism or Asperger Syndrome differ in empathy and emotion recognition? Journal of Autism and Developmental Disorders [Online] 46:1931-1940. Available at: http://dx.doi.org/10.1007/s10803-016-2698-4.
    The present study examined whether adults with high functioning autism (HFA) showed greater difficulties in (i) their self-reported ability to empathise with others and/or (ii) their ability to read mental states in others’ eyes than adults with Asperger syndrome (AS). The Empathy Quotient (EQ) and ‘Reading the Mind in the Eyes’ Test (Eyes Test) were compared in 43 adults with AS and 43 adults with HFA. No significant difference was observed on EQ score between groups, while adults with AS performed significantly better on the Eyes Test than those with HFA. This suggests that adults with HFA may need more support, particularly in mentalizing and complex emotion recognition, and raises questions about the existence of subgroups within autism spectrum conditions.
  • Chester, V. and Langdon, P. (2016). The Clinical Utility of Social Information Processing Theory in Assessing and Treating Offenders with Autism Spectrum Disorder. Advances in Autism [Online]. Available at: http://dx.doi.org/10.1108/AIA-07-2016-0019.
    Purpose: Social deficits are central within conceptualisations of autism spectrum disorder
    (ASD), and seperately linked to offending behaviour. Social problem solving interventions
    are often used with offenders, but little research has examined the social information
    processing (SIP) skills of individuals with ASD and a history of criminal offending
    behaviours.
    Design/methodology/approach: This conceptual paper will introduce the SIP model, review
    SIP research as applied to those with ASD and in forensic populations, and further consider
    the relevance to the assessment and treatment of offenders with ASD.
    Findings: Difficulties in all areas of the SIP model are noted in ASD and research suggests
    these difficulties may be directly linked to behaviour.
    Practical implications: It is possible that identifying SIP abilities and deficits could improve
    the effectiveness of rehabilitation programmes for this group.
    Originality/value: This paper reviews the utility of social information models in the
    offending behaviour of people with ASD.
  • Garrigan, B., Adlam, A. and Langdon, P. (2016). Corrigendum to ‘‘The neural correlates of moral decision-making: A systematic review and meta-analysis of moral evaluations and response decision judgements” [Brain Cogn. 108 (2016) 88–97]. Brain and Cognition [Online] 111:104-106. Available at: https://doi.org/10.1016/j.bandc.2016.10.002.
  • McDermott, E. and Langdon, P. (2015). The moral reasoning abilities of men and women with intellectual disabilities who have a history of criminal offending behaviour. Legal and Criminological Psychology [Online] 21:25-40. Available at: http://dx.doi.org/10.1111/lcrp.12051.
    Purpose. The current study had the following two aims (a) to examine the moral reasoning abilities of four groups of people: (i) men and women with IDs who had a documented history of criminal offending, and (ii) men and women with IDs with no known history of criminal offending, and (b) to examine the relationship between emotional and behavioural problems and moral reasoning. It was predicted that (a) there would be no significant difference between the moral reasoning of men and women with IDs, (b) men and women with IDs who are not offenders will have “developmentally immature” moral reasoning in comparison to offenders, and (c) moral reasoning will significantly predict emotional and behavioural problems.
    Methods. Sixty-eight people with IDs were invited to take part in this study and spread across four groups: (a) men with IDs who had committed criminal offences, (b) women with IDs who had committed criminal offences, (c) men with IDs who had no known history of criminal offending, and (d) women with IDs who had no known history of criminal offending. Participants were asked to complete measures of intelligence, moral reasoning, and emotional/behavioural problems.
    Results. As predicted, men and women did not have different moral reasoning, but offenders did have “developmentally more mature” moral reasoning than non-offenders. Women had higher levels of physical and verbal aggression, while offenders, generally, had higher levels of psychopathology. Women with a history of criminal offending had higher levels of sexually inappropriate behaviour compared to men and women in the community. Moral reasoning significantly predicted emotional and behavioural problems.
    Conclusions. Further work in this area is needed, and interventions that aim to address a moral developmental “delay” may be beneficial in reducing recidivism amongst this population.
  • Langdon, P. (2015). Commentary on “The use of cognitive behaviour therapy to treat depression in people with learning disabilities: a systematic review". Tizard Learning Disability Review [Online] 20:65-68. Available at: http://dx.doi.org/10.1108/TLDR-02-2015-0005.
    Purpose
    – The purpose of this paper is to provide a commentary on “The use of cognitive-behaviour therapy to treat depression in people with learning disabilities: a systematic review”.

    Design/methodology/approach
    – Drawing on the literature, as well as both clinical and research experience, some reasons are outlined for the lack of attention given to psychological therapies to treat depression amongst people with intellectual disabilities (IDs).

    Findings
    – More research is needed, but existing evidence is promising regarding the effectiveness of adapted cognitive-behaviour therapy for depression amongst people with IDs.

    Originality/value
    – The commentary draws attention to the scope for developing a range of effective cognitive, behavioural and cognitive-behavioural treatments.
  • Crook, N. et al. (2015). Does the well-being of individuals with Down syndrome and dementia improve when using life story books and rummage boxes? A randomised single case series experiment. Journal of Applied Research in Intellectual Disabilities [Online] 29:1-10. Available at: http://dx.doi.org/10.1111/jar.12151.
    Background: This study investigated whether a personalised life story book and rummage box enhanced well-being and led to changes in behaviour for people with Down syndrome (DS) who have dementia.

    Materials & Methods: A randomised single-case series design was used with five participants who had Down syndrome and a diagnosis of dementia. Participants were invited to take part in three conditions at random a) life story book, b) rummage box and c) no intervention condition.

    Results: The two reminiscence conditions were significantly associated with enhanced well-being as compared to the no-intervention condition. However, for one participant, the life story book was associated with significantly higher well-being, while for another participant, the rummage box was associated with significantly higher well-being, suggesting some participants may prefer one method over another.

    Conclusions: Personalised life story books and rummage boxes are associated with higher levels of well-being for people with DS and dementia.
  • Hockley, O. and Langdon, P. (2015). Men with intellectual disabilities with a history of sexual offending: empathy for victims of sexual and non-sexual crimes. Journal of Intellectual Disability Research [Online] 59:332-341. Available at: http://dx.doi.org/10.1111/jir.12137.
    Background: The objectives were (a) to compare the general empathy abilities of men with intellectual disabilities (IDs) who had a history of sexual offending to men with IDs who had no known history of illegal behaviour, and (b) to determine whether men with IDs who had a history of sexual offending had different levels of specific victim empathy towards their own victim, in comparison to an unknown victim of sexual crime, and a victim of non-sexual crime, and make comparison to non-offenders. Methods: Men with mild IDs (N = 35) were asked to complete a measure of general empathy and a measure of specific victim empathy. All participants completed the victim empathy measure in relation to a hypothetical victim of a sexual offence, and a non-sexual crime, while additionally, men with a history of sexual offending were asked to complete this measure in relation to their own most recent victim. Results: Men with a history of sexual offending had significantly lower general empathy, and specific victim empathy towards an unknown sexual offence victim, than men with no known history of illegal behaviour. Men with a history of sexual offending had significantly lower victim empathy for their own victim than for an unknown sexual offence victim. Victim empathy towards an unknown victim of a non-sexual crime did not differ significantly between the two groups. Conclusions: The findings suggest that it is important include interventions within treatment programmes that attempt to improve empathy and perspective-taking.
  • Vereenooghe, L. et al. (2015). Using computers to teach people with intellectual disabilities to perform some of the tasks used within cognitive behavioural therapy: a randomised experiment. Behaviour Research and Therapy [Online] 76:13-23. Available at: https://doi.org/10.1016/j.brat.2015.11.002.
    Aims: Training has been shown to improve the ability of people with intellectual disabilities (IDs) to
    perform some cognitive behavioural therapy (CBT) tasks. This study used a computerised training
    paradigm with the aim of improving the ability of people with IDs to: a) discriminate between behaviours,
    thoughts and feelings, and b) link situations, thoughts and feelings.
    Methods: Fifty-five people with mild-to-moderate IDs were randomly assigned to a training or attentioncontrol
    condition in a single-blind mixed experimental design. Computerised tasks assessed the participants’
    skills in: (a) discriminating between behaviours, thoughts and feelings (separately and pooled
    together), and (b) cognitive mediation by selecting appropriate emotions as consequences to given
    thoughts, and appropriate thoughts as mediators of given emotions.
    Results: Training significantly improved ability to discriminate between behaviours, thoughts and feelings
    pooled together, compared to the attention-control condition, even when controlling for baseline
    scores and IQ. Large within-group improvements in the ability to identify behaviours and feelings were
    observed for the training condition, but not the attention-control group. There were no significant
    between-group differences in ability to identify thoughts, or on cognitive mediation skills.
    Conclusions: A single session of computerised training can improve the ability of people with IDs to
    understand and practise CBT tasks relating to behaviours and feelings. There is potential for computerised
    training to be used as a “primer” for CBT with people with IDs to improve engagement and
    outcomes, but further development on a specific computerised cognitive mediation task is needed.
  • Rees, J. and Langdon, P. (2015). The Relationship Between Problem-Solving Ability and Self-Harm Amongst People with Mild Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities [Online] 29:387-393. Available at: http://dx.doi.org/10.1111/jar.12187.
    The purpose of this study was to investigate the relationship between depression, hopelessness, problem-solving ability and self-harming behaviours amongst people with mild intellectual disabilities (IDs).
    Methods

    Thirty-six people with mild IDs (77.9% women, Mage = 31.77, SD = 10.73, MIQ = 62.65, SD = 5.74) who had a history of self-harm were recruited. Participants were asked to complete measures of depression, hopelessness and problem-solving ability.
    Results

    Cutting was most frequently observed, and depression was prevalent amongst the sample. There was a significant positive relationship between depression and hopelessness, while there was no significant relationship between self-harm and depression or hopelessness. Problem-solving ability explained 15% of the variance in self-harm scores.
    Conclusions

    Problem-solving ability appears to be associated with self-harming behaviours in people with mild IDs.
  • Vereenooghe, L. et al. (2015). Can a computerised training paradigm assist people with intellectual disabilities to learn cognitive mediation skills? A randomised experiment. Behaviour Research and Therapy 71:10-19.
    Aims: The aim was to examine whether specific skills required for cognitive behavioural
    therapy (CBT) could be taught using a computerised training paradigm with people who have
    intellectual disabilities (IDs). Training aimed to improve: a) ability to link pairs of situations
    and mediating beliefs to emotions, and b) ability to link pairs of situations and emotions to
    mediating beliefs.

    Method: Using a single-blind mixed experimental design, sixty-five participants with IDs
    were randomised to receive either computerised training or an attention-control condition.
    Cognitive mediation skills were assessed before and after training.

    Results: Participants who received training were significantly better at selecting appropriate
    emotions within situation-beliefs pairs, controlling for baseline scores and IQ. Despite
    significant improvements in the ability of those who received training to correctly select
    intermediating beliefs for situation-feelings pairings, no between-group differences were
    observed at post-test.

    Conclusions: The findings indicated that computerised training led to a significant
    improvement in some aspects of cognitive mediation for people with IDs, but whether this
    has a positive effect upon outcome from therapy is yet to be established.
  • Langdon, P. (2015). Commentary on "The use of cognitive behaviour therapy to treat depression in people with learning disabilities: a systematic review". Tizard Learning Disability Review [Online] 20:65-68. Available at: http://dx.doi.org/10.1108/TLDR-02-2015-0005.
    Purpose

    – The purpose of this paper is to provide a commentary on “The use of cognitive-behaviour therapy to treat depression in people with learning disabilities: a systematic review”.

    Design/methodology/approach

    – Drawing on the literature, as well as both clinical and research experience, some reasons are outlined for the lack of attention given to psychological therapies to treat depression amongst people with intellectual disabilities (IDs).

    Findings

    – More research is needed, but existing evidence is promising regarding the effectiveness of adapted cognitive-behaviour therapy for depression amongst people with IDs.

    Originality/value

    – The commentary draws attention to the scope for developing a range of effective cognitive, behavioural and cognitive-behavioural treatments.
  • Mobini, S. et al. (2014). Effects of standard and explicit cognitive bias modification and computer-administered cognitive-behaviour therapy on cognitive biases and social anxiety. Journal of Behavior Therapy and Experimental Psychiatry [Online] 45:272-279. Available at: http://dx.doi.org/10.1016/j.jbtep.2013.12.002.
    Background and objectives
    This study examines the effects of a single session of Cognitive Bias Modification to induce positive Interpretative bias (CBM-I) using standard or explicit instructions and an analogue of computer-administered CBT (c-CBT) program on modifying cognitive biases and social anxiety.

    Methods
    A sample of 76 volunteers with social anxiety attended a research site. At both pre- and post-test, participants completed two computer-administered tests of interpretative and attentional biases and a self-report measure of social anxiety. Participants in the training conditions completed a single session of either standard or explicit CBM-I positive training and a c-CBT program. Participants in the Control (no training) condition completed a CBM-I neutral task matched the active CBM-I intervention in format and duration but did not encourage positive disambiguation of socially ambiguous or threatening scenarios.

    Results
    Participants in both CBM-I programs (either standard or explicit instructions) and the c-CBT condition exhibited more positive interpretations of ambiguous social scenarios at post-test and one-week follow-up as compared to the Control condition. Moreover, the results showed that CBM-I and c-CBT, to some extent, changed negative attention biases in a positive direction. Furthermore, the results showed that both CBM-I training conditions and c-CBT reduced social anxiety symptoms at one-week follow-up.

    Limitations
    This study used a single session of CBM-I training, however multi-sessions intervention might result in more endurable positive CBM-I changes.

    Conclusions
    A computerised single session of CBM-I and an analogue of c-CBT program reduced negative interpretative biases and social anxiety.

Book

  • Potter, G. et al. (2015). A Comprehensive Cognitive Behavioral Program for Offenders: Responsible Adult Culture. [Online]. Springer International Publishing. Available at: http://dx.doi.org/10.1007/978-3-319-17536-2.
    This book presents Responsible Adult Culture (RAC), a truly comprehensive program for helping offenders to think and act responsibly. It provides the tools of the program with great clarity. In addition to exploring the needs of all offenders, the book addresses the special needs of both female and dual-diagnosis offenders. Responsible thinking means habitually seeing others and situations accurately, rather than in self-serving and egocentrically distorted ways. Because self-centered thinking is typically reinforced by negative group norms, RAC starts with the cultivation of a constructive climate (“mutual help” groups) to motivate change. Motivated group members then gain tools for responsible thinking through “equipment” (cognitive behavioral) meetings. These tools pertain to social skills, anger management, and the correction of self-centered thinking through social perspective taking (cognitive restructuring). Beyond documented reductions in distorted thinking and recidivism rates, RAC’s synergy or round-the-clock interpenetration of positive groups and tools promotes a safer and more humane institutional culture.

Book section

  • Langdon, P. and Murphy, G. (2017). Treatment of Violence and Aggression in Offenders with Developmental Disabilities. in: The Wiley Handbook of Violence and Aggression. Wiley-Blackwell. Available at: https://www.wiley.com/en-us/The+Wiley+Handbook+of+Violence+and+Aggression-p-9781119057550.
    Historically, assumptions were made about a relationship between developmental disabilities and criminal offending behaviours. While some people with developmental disabilities, including people with intellectual disabilities, may commit crimes, there is no clear relationship between crime and developmental disabilities. For those that require interventions, there has been a marked increase in the development and use of psychological therapies to treat violence and aggression amongst people with developmental disabilities that would be considered criminal behaviour; the evidence to support the use of many of these interventions remains weak, with the exception of anger management training. Further work is needed to develop robust empirically validated interventions for both violence and aggression amongst people with developmental disabilities.
  • Parkes, G. et al. (2017). Sexual Dysfunction. in: Diagnostic Manual – Intellectual Disability (DM-ID) Version 2. National Association for the Dually Diagnosed (NADD), pp. 493-506. Available at: http://thenadd.org/products/dm-id-2-is-now-available/.
    In this chapter, we consider how diagnostic criteria for sexual dysfunctions can be used with people who have intellectual disabilities (ID), considering that very little is known about the prevalence of sexual dysfunctions amongst this population. The existing literature suggests that a lack of socio-sexual knowledge, poor support systems, mental health problems, and psychotropic medications are likely to be prominent aetiological factors for the development of sexual dysfunction amongst people with ID. However, while people with ID experience atypical development within the cognitive, emotional and social domains, their physical and sexual development is sometimes typical. Clinicians need to be aware of the impact of this dysynchronous development.

    Within this chapter, the relevant biological, genetic, and psycho-social factors, including developmental factors, are reviewed. People with ID may experience extreme negative reactions to normal sexual behaviour which results in concealment and for some, suppression of sexuality, or for others, antisocial behaviours. They are vulnerable to victimisation, including sexual harm, and may conform to the wishes of those around them. Clinicians need to conduct their assessment taking into account cognitive, developmental and psychosocial factors which may impact upon presentation and course, and need to remain involved whilst mainstream services are accessed.

Conference or workshop item

  • Langdon, P. et al. (2018). The Face Validity of an Initial Sub Typology of People with Autism Spectrum Disorders Detained in Hospital (The mATCH Study). in: International Association for the Scientific Study of Intellectual and Developmental Disabilities – 5th Europe Conference. Wiley-Blackwell, pp. 529-568. Available at: https://doi.org/10.1111/jar.12485.
  • Langdon, P. et al. (2017). People with autism detained within hospitals: defining the population, understanding aetiology, and improving care pathways (The mATCH Study). in: Clinical Research Group- Forensic Intellectual and Developmental Disabilities.
  • Langdon, P. and Archibald, S. (2016). Using virtual immersion therapy to teach offenders with intellectual and developmental disabilities social skills: A modelling study. in: International Association for the Scientific Study of Intellectual and Developmental Disabilities World Congress. Wiley-Blackwell, pp. 693-693. Available at: http://dx.doi.org/10.1111/jir.12305.
  • Melvin, C., Murphy, G. and Langdon, P. (2016). Adapted sex offender treatment programmes for men with autism spectrum disorder: Clinician and service user views. in: International Association for the Scientific Study of Intellectual and Developmental Disabilities World Congress. Wiley-Blackwell, pp. 708-708. Available at: http://dx.doi.org/10.1111/jir.12305.
  • Langdon, P., Sadek, S. and Daniel, M. (2016). Attentional bias towards positive and negative images amongst offenders and non-offenders with intellectual disabilities. in: International Association for the Scientific Study of Intellectual and Developmental Disabilities World Congress. Wiley-Blackwell, pp. 794-794. Available at: http://dx.doi.org/10.1111/jir.12306.
    Aims: The aim of the study was to examine attentional bias towards positive and negative images amongst men with intellectual disabilities, some of whom had a history of criminal offending. A secondary aim was to explore the relationship between attentional bias, empathy and distorted cognitions.
    Method: Forty-six men with intellectual disabilities with a history of criminal offending and 51 men with intellectual disabilities without any known history of criminal offending were recruited and invited to complete a dot-probe paradigm using images, as well as measures of distorted cognitions and empathy. Comparisons were made between the two groups.
    Results: Non-offenders had a significant attentional bias away from negative images, while offenders had a small attentional bias towards negative images. There was a significant positive relationship between distorted cognitions and an attentional bias towards negative images. There was a significant negative relationship between empathy and an attentional bias towards negative images.
  • Buell, S. et al. (2016). Easy Read: simplification or reduction? Critical differences in the discourse of UK Department of Health adapted 'easy read' literature for people with intellectual disabilities and their ‘non-easy read’ equivalents. in: International Association for the Scientific Study of Intellectual and Developmental Disabilities World Congress. Wiley-Blackwell, pp. 645-645. Available at: http://dx.doi.org/10.1111/jir.12305.
  • Langdon, P., Daniel, M. and Sadek, S. (2016). The relationship between moral development, distorted cognitions and social problem solving amongst men with intellectual disabilities who have a history of criminal offending. in: International Association for the Scientific Study of Intellectual and Developmental Disabilities World Congress. Wiley-Blackwell, pp. 693-693. Available at: http://dx.doi.org/10.1111/jir.12305.
  • Melvin, C., Murphy, G. and Langdon, P. (2016). Autism and offending: A systematic review of treatment. in: International Association for the Scientific Study of Intellectual and Developmental Disabilities World Congress. Wiley-Blackwell, pp. 708-708. Available at: http://dx.doi.org/10.1111/jir.12305.
  • Buell, S. et al. (2016). The Easy Read Project: How does “easy read” contribute to the construction of meaning? in: International Association for the Scientific Study of Intellectual and Developmental Disabilities World Congress. Wiley-Blackwell, pp. 773-773. Available at: http://dx.doi.org/10.1111/jir.12306.
  • Buell, S. et al. (2016). The effects of linguistic simpli?cation and mediation on the comprehension of adapted (‘easy read’) text by people with intellectual disabilities: A randomised experiment. in: International Association for the Scientific Study of Intellectual and Developmental Disabilities World Congress. Wiley-Blackwell, pp. 644-644. Available at: http://dx.doi.org/10.1111/jir.12305.
  • Lindsay, W. et al. (2016). Assessing cognitive schemas in people with intellectual disabilities. in: International Association for the Scientific Study of Intellectual and Developmental Disabilities World Congress. Wiley-Blackwell, pp. 697-697. Available at: http://dx.doi.org/10.1111/jir.12305.
  • Langdon, P. (2014). Group cognitive behavioural therapy for people with Asperger Syndrome who have problems with anxiety: Participant views. in: British Association for Behavioural and Cognitive Psychotherapy Conference. British Association for Behavioural and Cognitive Psychotherapy.
  • Vereenooghe, L. et al. (2014). Computerised training as a primer for assessing cognitive mediation skills in people with intellectual disabilities. in: Fourth International IASSIDD Europe Regional Congress. Wiley/Blackwell, p. . Available at: http://dx.doi.org/10.1111/jar.12107.
  • Langdon, P. (2014). Psychological therapies within secure services for people with intellectual disabilities. in: Royal College of Psychiatrists Faculty for Intellectual Disabilities and British Psychological Society Faculty for Intellectual Disabilities Joint Conference.

Monograph

  • Chester, V. et al. (2018). Restrictive Interventions in Inpatient Intellectual Disability Services: How to Record, Monitor and Regulate. Royal College of Psychiatrists.
    This report is concerned with the standards of recording, monitoring, and regulation of restrictive interventions involving people with intellectual disabilities with mental health and/or behaviour that challenges within inpatient services. Restrictive interventions, a central concern for all stakeholders of intellectual disability services, has come under increased scrutiny following the abuse scandal at Winterbourne View. Current efforts to monitor them rely almost exclusively on the numbers of such incidents. This approach is fundamentally flawed because numbers alone do not assess the quality of a services’ overall restrictive interventions practice and cannot be used to infer good or poor standards of practice and abuse. Further, there are problems with the variable use of definitions, the failure to distinguish between various degrees of physical restraint, the impact of outliers, the failure to capture individual patient progress and the absence of meaningful benchmarking. Service providers and regulators must therefore rely on other methods to evaluate the use of restrictive interventions and move from basing their conclusions on just the total number of restrictive interventions to one of examining a wider range of quality parameters. With representative examples, this document makes recommendations on how restrictive interventions should be recorded, monitored, regulated and published.

Review

  • Langdon, P. (2019). Cognitive Behaviour Therapy for People with Intellectual Disabilities: Thinking Creatively. Andrew Jahoda, Biza Stenfert-Kroese and Carol Pert. Palgrave Macmillan, London, 2017. ISBN 978‐1‐137‐47853‐5. Journal of Applied Research in Intellectual Disabilities [Online] 32:482-482. Available at: https://doi.org/10.1111/jar.12545.

Forthcoming

  • Langdon, P., Kehinde, T. and Parkes, G. (2017). Psychological therapies with people who have intellectual disabilities. in: Oxford Textbook of the Psychiatry of Learning Disability. Oxford University Press.
    Historically, many people with intellectual disabilities were considered unable to take part in psychological therapies. This view has changed considerably, and there has been an increasing focus on the development of psychological therapies for people with intellectual disabilities, including methods to help improve the accessibility of treatment. Within this chapter, cognitive-behavioural therapy, mindfulness, dialectical behaviour therapy, behavioural therapy, and psychodynamic therapy are reviewed. There is emerging evidence to indicate that a range of psychological therapies are effective with people who have intellectual disabilities, but a lack of large scale and well-designed clinical trials investigating a range of psychological interventions remains problematic.
  • Garrigan, B. and Langdon, P. (2016). Social problem solving and moral development. in: The Wiley Handbook on Offenders with Intellectual and Developmental Disabilities. Wiley-Blackwell.
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