Portrait of Professor Glynis Murphy

Professor Glynis Murphy

Professor of Clinical Psychology and Disability


Professor Murphy studied PPP at Oxford University and then undertook her clinical psychology training at the University of Birmingham, following which she was employed as a Clinical Psychologist at the Institute of Psychiatry, London completing her PhD there.

Since that time, she has worked at the Institute of Child Health and Great Ormond Street Hospital, London and was the academic director of the DClinPsy course at Lancaster University.  She has worked at the Tizard Centre, University of Kent from 1993 - 2004 and 2006 to present, where she was Co-Director from 2012-2016. 

Research interests

  • Effectiveness of CBT for people with Asperger syndrome and social anxiety
  • Effectiveness of social care for ex-offenders with learning disabilities
  • Effectiveness of cognitive-behavioural treatment for men at risk of sexual offending
  • Effectiveness of treatment for people with untreated Phenylketonuria (PKU)
  • Symptoms of abuse for people with severe learning disabilities
  • Capacity to consent to sexual relationships
  • Moral development and people with learning disabilities
  • Early intervention in autism


Professor Murphy has taught on both the undergraduate and postgraduate courses at Tizard.  She developed and convened the MSc in Analysis and Intervention in Learning Disabilities and has been instrumental in developing the MA Postgraduate studies in Intellectual and Developmental Disabilities and Forensic Issues. 


She currently supervises PhD students most of whose research focuses on autism and learning disabilities and the criminal justice system. 


  • Fellow of the British Psychological Society
  • President of IASSIDD 2008-2012
  • Associate Director for the School of Social Care and Research until 2014
  • Fellow of the Academy of Social Sciences
  • Chaired the Guideline Development Group on challenging behaviour and learning disabilities NICE 2013-2015 


Showing 50 of 193 total publications in the Kent Academic Repository. View all publications.


  • Rose, J., Willner, P., Cooper, V., Langdon, P., Murphy, G. and Stenfert Kroese, B. (2020). The effect on and experience of families with a member who has Intellectual and Developmental Disabilities of the COVID-19 pandemic in the UK: developing an investigation. International Journal of Developmental Disabilities [Online]. Available at: https://doi.org/10.1080/20473869.2020.1764257.
  • Melvin, C., Langdon, P. and Murphy, G. (2019). ’I feel that if I didn’t come to it anymore, maybe I would go back to my old ways and I don’t want that to happen’ - Adapted Sex Offender Treatment Programmes: Views of Service Users with Autism Spectrum Disorders. Journal of Applied Research in Intellectual Disabilities [Online]:1-18. Available at: https://doi.org/10.1111/jar.12641.
    Background: The cognitive and behavioural profile associated with autism spectrum disorders (ASD) includes difficulties with social interaction, communication and empathy. Each of these may present barriers to effective participation in sexual offending treatment, leading to poorer outcomes.

    Method: Semi‐structured interviews were conducted with 13 men with autism and an intellectual disability (including the borderline range) who had completed an adapted sex offender treatment programme. Grounded Theory was used to explore the men's experiences of treatment and perceptions of risk.

    Results: The men's perceptions of sexual risk were inextricably linked to constructs of identity and shaped their opinions of treatment effectiveness. Risk of reoffending was conveyed through narratives of changes in self and circumstances and included notions of blame and culpability.

    Conclusions: The findings illustrated some clear benefits for men with ASD associated with attending adapted sex offender treatment programmes, including delivery
    of treatment within groups and opportunities for social development. The study supports the view that difficulties with empathy and cognitive flexibility complicates treatment for sexual offending.
  • Morrison, J., Forrester-Jones, R., Bradshaw, J. and Murphy, G. (2019). Communication and cross-examination in court for children and adults with intellectual disabilities: A systematic review. The International Journal of Evidence & Proof [Online] 23:366-398. Available at: https://doi.org/10.1177/1365712719851134.
    Courts in England, Wales and Northern Ireland have identified children and adults with intellectual disabilities (ID) as vulnerable witnesses. The call from the English Court of Appeal is for advocates to adjust questioning during cross-examination according to individual needs. This review systematically examined previous empirical studies with the aim of delineating the particular communication needs of children and adults with ID during cross-examination. Studies utilising experimental methodology similar to examination/cross-examination processes, or which assessed the communication of actual cross-examinations in court were included. A range of communication challenges were highlighted including: suggestibility to leading questions and negative feedback; acquiescence; accuracy; and understanding of court language. In addition, a number of influencing factors were identified, including: age; IQ level; question styles used; recall memory; and delays. This review highlights the need for further research using cross-examination methodology and live practice, that take into consideration the impact on communication of the unique environment and situation of the cross-examination process.
  • Chiu, P., Triantafyllopoulou, P. and Murphy, G. (2019). Life after release from prison: The experience of ex‐offenders with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities [Online]. Available at: https://doi.org/10.1111/jar.12661.
    Background: In the UK, little is known about the experience of ex‐prisoners with intellectual disabilities. Method: A qualitative study was therefore conducted to investigate what life is like for ten men with intellectual disabilities who left prison at least 9 months previously. Semi‐structured interviews were employed to explore the men's views of post‐prison life, including opportunities/challenges and support received from services. Results: Through interpretative phenomenological analysis, four over‐arching themes were constructed: the nature of support and services, the difficulty of staying out of trouble, the importance of family and the need to act the “tough guy”. The participants reported being extremely under‐supported. They were often hostile about staff who they felt were too focused on their previous crime. Conclusions: In general, men were very under‐supported and the upheavals of post‐prison lives appeared to be “normalized” by them. Better understanding of their lives within their social context would benefit their community re‐entry.
  • Malli, M., Sams, L., Forrester-Jones, R., Murphy, G. and Henwood, M. (2018). Austerity and the lives of people with learning disabilities. A thematic synthesis of current literature. Disability & Society [Online]. Available at: https://doi.org/10.1080/09687599.2018.1497950.
    The Financial Crisis of 2008 resulted in many western economies implementing cuts in health and social care. This systematic review provides a holistic picture of the impact of austerity policy on the lives of people with learning disabilities (LD) and the collateral effects on the people who support them. Our review suggests that in the current climate of economic austerity, available funding to support people with LD is no longer aligned to their care needs. Cuts in disability services have adversely affected the well-being both of people with LD and their informal carers. Individuals with LD have lost social support and are experiencing increased social isolation. Heightened demands on family carers’ time have negatively influenced their wider roles, including parental functioning, and labour market participation. Our review provides the foundations for further discourse and research on the effects of austerity on people with LD and their family carers.
  • MacDonald, A., McGill, P. and Murphy, G. (2018). An evaluation of staff training in positive behavioural support. Journal of Applied Research in Intellectual Disabilities [Online] 31:1046-1061. Available at: https://dx.doi.org/10.1111/jar.12460.
    Background: Positive Behavioural Support (PBS) has been shown to be effective in minimising challenging behaviour, and improving the lives of people with intellectual disabilities. Training in PBS is an important factor in achieving good coverage in the use of PBS. The aim of this study was to evaluate the impact of training managers of social care services in PBS.

    Method: A year-long training programme in PBS was delivered to 50 managers of community-based services for people with challenging behaviour. Data were collected pre and post training, and at 6 month follow-up. A non-randomised control group design was used.

    Results: Data demonstrated significant reduction in challenging behaviour. However, there was no change in quality of life for service users.

    Conclusion: Training in PBS can reduce challenging behaviour in people with intellectual disabilities; demonstrating any impact of PBS training on quality of life remains a challenge.
  • Malovic, A., Rossiter, R. and Murphy, G. (2018). Keep Safe: the development of a manualised group CBT intervention for adolescents with ID who display harmful sexual behaviours. Journal of Intellectual Disabilities and Offending Behaviour [Online] 9:49-58. Available at: https://doi.org/10.1108/JIDOB-10-2017-0023.
    The purpose of this paper is to focus on the development of Keep Safe, a manualised group intervention for adolescents with intellectual disabilities (ID) who display harmful sexual behaviour (HSB) as the initial phase of a feasibility study. National reports have highlighted the need for the development of specialist programmes, as adolescents with ID make up a significant proportion of young people referred to specialist HSB services and there is a lack of evidence or practice-based interventions for them. Aims included taking account of adolescents’ and families’ needs, motivations and practical commitments, integrating best- practice and being accessible and appropriate across different types of services.

    Keep Safe development progressed from the practitioner/researcher collaborative young sex offender treatment services collaborative-ID through a project team, Keep Safe development group, comprising a range of practitioners with a variety of clinical expertise across services and an Advisory Group of people with ID. An expert-consensus methodology based on the Delphi method was used. The iterative process for the manual draws on the slim practice-based evidence from UK, New Zealand, North America and Australia.

    Keep Safe comprises six modules distributed through 36 term-time young people’s sessions, alongside 16 concurrent parental/ carer sessions (some joint). The main focus of Keep Safe is to enhance well-being and reduce harm. Four initial sites volunteered as feasibility leads, and two more were added as recruitment was more difficult than foreseen.

    National reports have highlighted the need for the development of specialist programmes, as adolescents with ID make up a significant proportion of young people referred to specialist HSB services and there is a lack of evidence or practice-based interventions for them. This study is innovative and valuable given the recognition that research and practice is significantly lacking in this area.
  • Doble, B., Langdon, P., Shepstone, L., Murphy, G., Fowler, D., Heavens, D., Russell, A., Mullineaux, L. and Wilson, E. (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.
  • Murphy, G., Chiu, P., Triantafyllopoulou, P., Barnoux, M., Blake, E., Cooke, J., Forrester-Jones, R., Gore, N. and Beecham, J. (2017). Offenders with intellectual disabilities in prison: what happens when they leave?. Journal of Intellectual Disability Research [Online] 61:957-968. Available at: http://dx.doi.org/10.1111/jir.12374.
    People with intellectual disabilities, if convicted of offences, may be sentenced to prison, but little is known about their life when they are released. This study followed up men with ID who were leaving prisons in England. The men were hard to contact, but 38 men were interviewed, on average 10 weeks after leaving prison. The men were living in a variety of situations and often were very under-occupied, with limited social networks. 70% were above the clinical cut-off for anxiety and 59.5% were above the clinical cut-off for depression. The men were receiving little support in the community and many had been re-interviewed by police. Community teams need to provide better support to this very vulnerable group.
  • Bhardwaj, A., Forrester-Jones, R. and Murphy, G. (2017). Social networks of adults with an intellectual disability from south Asian and white communities in the United Kingdom: a comparison. Journal of Applied Research in Intellectual Disabilities [Online]. Available at: http://dx.doi.org/10.1111/jar.12351.
    Background: Little research exists comparing the social networks of people with intellectual disability (ID) from south Asian and white backgrounds. This UK study reports on the barriers that south Asian people with ID face in relation to social inclusion compared to their white counterparts.

    Materials and Methods: A mixed-methods research design was adopted to explore the social lives of 27 men (15 white; 12 South Asian) and 20 women (10 white; 10 South Asian with ID). Descriptive and parametric tests were used to analyse the quantitative data.

    Results: The average network size of the whole group was 32 members. South Asian
    participants had more family members whilst white participants had more service users and staff in their networks; 96% network members from white ID group were also of white background, whilst the south Asian group had mixed ethnic network members.

    Conclusions: Social networks of individuals with ID in this study were found to be larger overall in comparison to previous studies, whilst network structure differed between the white and south Asian population. These differences have implications relating to future service planning and appropriateness of available facilities.
  • Beckene, T., Forrester-Jones, R. and Murphy, G. (2017). Experiences of going to court: witnesses with intellectual disabilities and their carers to speak up. Journal of Applied Research in Intellectual Disabilities [Online]. Available at: http://dx.doi.org/10.1111/jar.12334.
    People with intellectual disabilities are more vulnerable to sexual abuse and are more disadvantaged in the criminal justice system than the general population. However, little is known about the experiences of people with intellectual disabilities who have allegedly been victims of sexual abuse and also been witnesses in court.

    Materials and Methods: This study used semi-structured interviews and a Grounded Theory approach to examine the experiences of four people with intellectual disabilities and four carers/supporters who had all attended trials.

    Results: Findings showed that after the traumatic incident of abuse, a court experience could become a secondary source of trauma. Experience of this trauma was dependent on the quality and quantity of support people received and the understanding of intellectual disabilities amongst the legal participants.

    Conclusion: The findings argue for better training for legal participants who are in contact with vulnerable witnesses and better support structures for alleged victims.
  • 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.
  • Murphy, G. (2017). The NICE guidelines and quality standards on learning disabilities and behaviour that challenges. Tizard Learning Disability Review [Online] 22:71-81. Available at: https://doi.org/10.1108/TLDR-12-2016-0044.
    Purpose: In 2014, National Institute for Health and Care Excellence (NICE) announced it was going to develop its first set of guidelines on learning disabilities. The topic was “behaviour that challenges” and in May 2015 NICE published a full set of guidance (371 pages) covering service user and carer experiences, assessment, risk factors and interventions for behaviour that challenges (NICE, 2015). The linked quality standards were published later in 2015. The paper aims to discuss these issues.

    Design/methodology/approach: This paper explains the process of developing the guidance.

    Findings: The final guidance is described in summary form, together with the quality standards.

    Originality/value: This paper provides a brief summary of the NICE guidelines on people with learning disabilities and behaviour that challenges.
  • Malovic, A., Murphy, G. and Coulton, S. (2016). Finding the Right Assessment Measures for Young People with Intellectual Disabilities Who Display Harmful Sexual Behaviour. Journal of Applied Research in Intellectual Disabilities [Online]. Available at: https://doi.org/10.1111/jar.12299.
    Background: Previous studies and national reports have all noted that a significant proportion of the young people who display harmful sexual behaviours have intellectual disabilities. However, research on the topic has been scarce. This study presents a systematic review of the literature relating to clinical instruments specifically developed or adapted for adolescents with intellectual disabilities who display harmful sexual behaviours.

    Method: An electronic search of databases was completed for published articles in English from the earliest possible date to the end of 2013.

    Results: No published articles met the full search criteria. This confirmed the lack of published clinical measures, apart from two risk assessment instruments.

    Conclusions: Given the lack of measures, it is recommended that the focus of future research needs to be on developing or adapting instruments that will offer researchers’ and clinicians’ empirical as well as clinical data on this all-too-often-overlooked population of vulnerable youth.
  • Blamires, K., Forrester-Jones, R. and Murphy, G. (2016). An investigation into the use of the Deprivation of Liberty Safeguards with people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities [Online]. Available at: http://dx.doi.org/10.1111/jar.12266.

    This small, qualitative study sought to develop a richer understanding of the way in which the deprivation of liberty safeguards (DOLS) were being used for people with intellectual disabilities. It is important to note that this study was completed prior to the changes resulting from the P v Cheshire West and Chester Council judgement.

    Six DOLS cases were identified and two people involved in each case were interviewed (care home managers, key workers, social workers, specialist nurses or psychologists), using semi-structured interviews. The data were analysed using grounded theory techniques.

    The interviewees described DOLS as providing a framework leading to positive outcomes for the people they supported, in some cases avoiding inpatient stays. However, they had a number of concerns including lack of knowledge and training, potential under use of DOLS and disappointment with case law.

    Overall, these findings are encouraging in regard to the specific individuals for whom DOLS applications were made; however, they also highlight the need for a stronger agenda regarding wider dissemination of information, and training about DOLS, as well as some reform.
  • Langdon, P., Murphy, G., Shepstone, L., Wilson, E., Fowler, D., Heavens, D., Russell, A., Rose, A., Malovic, A. and Mullineaux, L. (2016). The people with Asperger Syndrome and anxiety disorders (PAsSA) Trial: A pilot multi-centre single blind randomised trial of group cognitive-behavioural therapy. BJPysch 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
  • Murphy, G., Gardner, J. and Freeman, M. (2015). Screening prisoners for intellectual disabilities in three English prisons. Journal of Applied Research in Intellectual Disabilities [Online] 30:198-204. Available at: http://dx.doi.org/10.1111/jar.12224.

    Prisoners with intellectual disabilities are known to be disadvantaged in prisons and to be more susceptible to bullying, segregation, depression and anxiety than other prisoners.


    In this study, nearly 3000 new prisoners entering three English prisons were offered screening for intellectual disabilities, using the LDSQ.


    On average, 75% of all new prisoners entering prison were offered screening, and only 14% refused screening. Overall, just less than 7% were screened positive on the LDSQ and prisons made some reasonable adjustments as a result.


    It is argued that it is feasible to screen for intellectual disabilities in prisons and, given the inequalities to which prisoners with intellectual disabilities are subject in prison, it is time for such screening to be rolled out to all prisons.
  • Malli, M., Forrester-Jones, R. and Murphy, G. (2015). Stigma in youth with Tourette’s syndrome: a systematic review and synthesis. European Child & Adolescent Psychiatry [Online] 25:127-139. Available at: http://dx.doi.org/10.1007/s00787-015-0761-x.
    Tourette's syndrome (TS) is a childhood onset neurodevelopmental disorder, characterised by tics. To our knowledge, no systematic reviews exist which focus on examining the body of literature on stigma in association with children and adolescents with TS. The aim of the article is to provide a review of the existing research on (1) social stigma in relation to children and adolescents with TS, (2) self-stigma and (3) courtesy stigma in family members of youth with TS. Three electronic databases were searched: PsycINFO, PubMed and Web of Science. Seventeen empirical studies met the inclusion criteria. In relation to social stigma in rating their own beliefs and behavioural intentions, youth who did not have TS showed an unfavourable attitude towards individuals with TS in comparison to typically developing peers. Meanwhile, in their own narratives about their lives, young people with TS themselves described some form of devaluation from others as a response to their disorder. Self-degrading comments were denoted in a number of studies in which the children pointed out stereotypical views that they had adopted about themselves. Finally, as regards courtesy stigma, parents expressed guilt in relation to their children's condition and social alienation as a result of the disorder. Surprisingly, however, there is not one study that focuses primarily on stigma in relation to TS and further studies that examine the subject from the perspective of both the 'stigmatiser' and the recipient of stigma are warranted.
  • Pilling, S., Marcus, E., Whittington, C. and Murphy, G. (2015). Challenging behaviour and learning disabilities: summary of NICE guidance. British Medical Journal [Online]. Available at: http://dx.doi.org/10.1136/bmj.h2652.
  • Dix, L., Fallows, R. and Murphy, G. (2015). Effectiveness of the ADEC as a level 2 screening test for young children with suspected autism spectrum disorders in a clinical setting. Journal of Intellectual and Developmental Disability [Online]. Available at: http://dx.doi.org/10.3109/13668250.2015.1014323.
    Background The Autism Detection in Early Childhood (ADEC) is a clinician-administered, Level 2 screening tool. A retrospective file audit was used to investigate its clinical effectiveness.

    Method Toddlers referred to an Australian child development service between 2008 and 2010 (N?=?53, M age?=?32.2 months) were screened with the ADEC. Their medical records were reviewed in 2013 when their mean age was 74.5 months, and the original ADEC screening results were compared with later diagnostic outcomes.

    Results The ADEC had good sensitivity (87.5%) and moderate specificity (62%). Three behaviours predicted autism spectrum disorders (ASDs): response to name, gaze switching, and gaze monitoring (p???.001).

    Conclusions The ADEC shows promise as a screening tool that can discriminate between young children with ASDs and those who have specific communication disorders or developmental delays that persist into middle childhood but who do not meet the criteria for ASDs.
  • King, C. and Murphy, G. (2014). A systematic review of people with autism spectrum disorder and the Criminal Justice System. Journal of Autism and Developmental Disorders [Online] 44:2717-2733. Available at: https://doi.org/10.1007/s10803-014-2046-5.
    This paper provides a systemic review of the available literature on people with autism spectrum disorder (ASD) in the criminal justice system (CJS). The review considers two main types of study: those that examined the prevalence of people with ASD in the CJS and those that examined the prevalence of offending in populations with ASD. In addition, types of offences in people with ASD, co-morbid psychiatric diagnoses, and characteristics of people with ASD who commit offences (including predisposing factors) are considered. A combination of search terms was used in a variety of databases in order to find all of the available literature on this topic, and research studies were included based on specified inclusion and exclusion criteria. It was found that whilst there is an emerging literature base on this topic, there are a wide variety of methodologies used, making direct comparison difficult. Nevertheless it can be concluded so far that people with ASD do not seem to be disproportionately over-represented in the CJS, though they commit a range of crimes and seem to have a number of predisposing features. There is poor evidence of the presence of comorbid psychiatric diagnoses (except in mental health settings) amongst offenders with ASD, and little evidence of the oft-asserted over-representation of certain kinds of crimes. It is recommended that further research of good quality is required in this area, rather than studies that examine populations that are not representative of all those with ASD.
  • Ferguson, L. and Murphy, G. (2014). The effects of training on the ability of adults with an intellectual disability to give informed consent to medication. Journal of Intellectual Disability Research [Online] 58:864-873. Available at: http://dx.doi.org/10.1111/jir.12101.
    This study had two aims: to investigate the capacity of individuals with intellectual disabilities (ID) to make decisions about their medications, and to evaluate whether the provision of training (information) sessions on medications would increase their capacity.
    Twenty-eight adults (18 male and 10 female), with a mild to moderate ID were included in this study and they were taking either Epilim, Metformin or Haloperidol medications. The participants were split into groups that comprised of participants taking the same medications. Each of the groups received three training sessions on their own medications. Capacity to consent was measured by the Adapted - Assessment of Capacity Questionnaire (A-ACQ), which was specially adapted for each medication type from the original measure (ACQ). Receptive language ability was measured by the British Picture Vocabulary Scale-II (BPVS-II).
    A two-factor mixed anova analysis indicated that the provision of training had improved the capacity of the participants to give informed consent to taking their medications. Analysis using Pearson's correlations indicated that increased levels of receptive language ability correlated with greater ability to give informed consent to taking medication.
    The provision of information that is formatted in a way that individuals with ID can understand may be a useful way to increase knowledge on medications. Further research that investigates the provision of information with larger samples is warranted.
  • Heaton, K. and Murphy, G. (2013). Men with intellectual disabilities who have attended sex offender treatment groups: a follow-up. Journal of Applied Research in Intellectual Disabilities [Online] 26:489-500. Available at: http://dx.doi.org/10.1111/jar.12038.
    There have been a number of studies of treatment for men with intellectual disabilities and sexually abusive behaviour but few follow-up studies. Our aim was to follow up men with intellectual disabilities who had attended group cognitive behavioural treatment (CBT) for sexually abusive behaviour.

    Thirty-four men (from seven treatment sites) were followed up. All had attended SOTSEC-ID groups. The mean length of follow-up, since the end of the treatment group, was 44 months (SD 28.7, range 15–106 months).

    The statistically significant improvements in sexual knowledge, empathy and cognitive distortions that occurred during treatment were maintained at follow-up. In all, 11 of the 34 (32%) men showed further sexually abusive behaviour, but only two of these men received convictions. Analyses of the variables associated with further sexually abusive behaviour indicated that a diagnosis of autism was associated with a higher likelihood of further sexually abusive behaviour.

    This study provides some evidence of the longer-term effectiveness of group CBT for men with intellectual disabilities and sexually abusive behaviour.
  • Langdon, P., Murphy, G., Wilson, E., Shepstone, L., Fowler, D., Heavens, D., Malovic, A. and Russell, A. (2013). Asperger syndrome and anxiety disorders (PAsSA) treatment trial: a study protocol of a pilot, multicentre, single-blind, randomised crossover trial of group cognitive behavioural therapy. BMJ Open [Online] 3. Available at: http://dx.doi.org/10.1136/bmjopen-2013-003449.
    Introduction: A number of studies have established that children, adolescents and adults with Asperger syndrome (AS) and high functioning autism (HFA) have significant problems with anxiety. Cognitive behavioural therapy (CBT) is an effective treatment for anxiety in a variety of clinical populations. There is a growing interest in exploring the effectiveness of CBT for people with AS who have mental health problems, but currently there are no known clinical trials involving adults with AS or HFA. Studies with children who have AS have reported some success. The current study aims to examine whether modified group CBT for clinically significant anxiety in an AS population is likely to be efficacious.

    Methods and analysis: This study is a randomised, single-blind crossover trial. At least 36 individuals will be recruited and randomised into a treatment arm or a waiting-list control arm. During treatment, individuals will receive 3 sessions of individual CBT, followed by 21 sessions of group CBT. Primary outcome measures focus on anxiety. Secondary outcome measures focus on everyday social and psychiatric functioning, additional measures of anxiety and fear, depression, health-related quality of life and treatment cost. Assessments will be administered at pregroup and postgroup and at follow-up by researchers who are blinded to group allocation. The trial aims to find out whether or not psychological treatments for anxiety can be adapted and used to successfully treat the anxiety experienced by people with AS. Furthermore, we aim to determine whether this intervention represents good value for money.

    Ethics and dissemination: The trial received a favourable ethical opinion from a National Health Service (NHS) Research Ethics Committee. All participants provided written informed consent. Findings will be shared with all trial participants, and the general public, as well as the scientific community.
  • Rowsell, A., Clare, I. and Murphy, G. (2013). The psychological impact of abuse on men and women with severe intellectual disabilites. Journal of Applied Research in Intellectual Disabilities [Online] 26:257-270. Available at: http://dx.doi.org/10.1111/jar.12016.
    In other populations, the psychological impact of abuse has been conceptualized as Post Traumatic Stress Disorder (PTSD, DSM‐IV, American Psychiatric Association (APA), 1994), but little is known about whether this is appropriate for adults with severe intellectual disabilities and very limited communication skills.

    An informant interview, based on the framework provided by PTSD, but supplemented with additional questions, was developed and was used to elicit the emotional, behavioural and physiological symptoms of alleged abuse in 18 people with intellectual disabilities at three time points: in the 3 months immediately prior to the alleged abuse (Time 1), in the 3 months immediately after the abuse (Time 2) and in the last 3 months prior to interview (Time 3).

    The reports of the family and carer informants indicated that, following their alleged abuse, the victims experienced marked increases in the frequency and severity of emotional, physiological and behavioural symptoms of psychological distress. Over time, there was some alleviation of these difficulties, but psychological functioning remained severely compromised.

    While the established PTSD framework is appropriate for examining the psychological impact of abuse, some amendments are required to enable clinicians to examine fully the distress of alleged victims with severe intellectual disabilities.
  • Langdon, P., Murphy, G., Clare, I., Palmer, E. and Rees, J. (2013). An evaluation of the EQUIP treatment programme with men who have intellectual and developmental disabilities. Journal of Applied Research in Intellectual Disabilities [Online] 26:167-180. Available at: http://dx.doi.org/10.1111/jar.12004.
    The Equipping Youth to Help One Another Programme (EQUIP) was designed for young offenders to address a developmental delay in moral reasoning, distorted cognitions and social skills.

    The present authors undertook a single case series study and piloted an adapted version of the EQUIP programme with three men with intellectual disabilities and four men with a diagnosis of Asperger Syndrome, all of whom were detained in a medium‐secure forensic unit for people with intellectual disabilities. Treatment was delivered over a 12‐week period, and participants took part in four‐one‐hour sessions per week.

    The results suggested that treatment was successful at increasing moral reasoning ability, reducing distorted cognitions and improving ability to choose effective solutions to problems. However, treatment did not have a significant effect upon anger.

    The EQUIP programme is a promising treatment, but further research is needed to investigate its effectiveness with men with intellectual or other developmental disabilities.

Book section

  • Murphy, G. and McGill, P. (2020). Challenging Behaviours in People with Intellectual Disabilities. In: Bhaumik, S. and Alexander, R. eds. Oxford Textbook of the Psychiatry of Intellectual Disability. Oxford University Press. Available at: https://global.oup.com/academic/product/oxford-textbook-of-the-psychiatry-of-intellectual-disability-9780198794585?cc=gb&lang=en&#.
    This chapter provides definitions of challenging behaviour and reviews the evidence on prevalence and long term risk factors in challenging behaviour. The chapter then considers behavioural assessment and interventions for those with severe and profound disabilities, delineating a practical method for analysing and intervening with referrals.
  • 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.
  • Murphy, G. (2016). Sexual relationships and adults with intellectual disabilities. In: Carr, A., Linehan, C., O’Reilly, G., Noonon Walsh, P. and McEvoy, J. eds. Handbook of Intellectual Disability and Clinical Psychology Practice. London: Routledge, pp. 731-759.

Conference or workshop item

  • 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.
  • 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.
  • Murphy, G. (2016). People with IDD and the criminal justice system. In: 15 World Congress IASSIDD. Wiley, p. 626.
  • Malovic, A., Cygan, L., Richards, S., Murphy, G. and Rossiter, R. (2016). Adolescents with intellectual and developmental disabilities who display harmful sexual behaviours: adaptation of measures. In: 15 World Congress IASSIDD. Wiley, p. 700.
  • Malovic, A., Rossiter, R., Murphy, G., Barry, S. and Marks, E. (2016). Keep Safe: group intervention for young people with intellectual and developmental disabilities and harmful sexual behaviour. In: 15 World Congress IASSIDD. Wiley-Blackwell, p. 797.
  • Triantafyllopoulou, P., Malli, M., Louis, M. and Murphy, G. (2016). Ballet Burst: an intervention study to improve health and fitness in people with intellectual disabilities. In: 15 World Congress IASSIDD. Wiley, p. 815.
  • Chiu, P., Triantafyllopoulou, P. and Murphy, G. (2016). Life after release from prison: the experience of ex-offenders with intellectual disabilities. In: IASSIDD 15th World Congress. Wiley, p. 649. Available at: https://doi.org/10.1111/jir.12305.
    Aim: In the UK, little is known about the experience of exprisoners with intellectual disabilities (ID). This exploratory study investigates what life is like for ex-offenders with ID who have left prison. Method: Individual semi-structured interviews were conducted with 10 men with ID who had left prison at least 9 months before. The interview explored men’s views of post-prison life, including the opportunities, challenges, and the support from professional services. Interviews were subjected to interpretative phenomenological analysis. Results: The upheavals of postprison lives appeared to be ‘normalised’ by the men with ID. Some had to adopt a ‘hard man’ identity to protect themselves from harm. Hostile relationships with staff were
    informed by their experiences of restricted, insufficient, and problem-focussed support, whereas a person-centred support was appreciated. Friends and family played an important role in their lives. Conclusions: More attention is needed to investigate the type of support offered by professional services. It was clear that an individualised approach was the preferable support style. Further understanding of the men’s life within their social context would benefit their community re-entry.
  • Murphy, G., Triantafyllopoulou, P., Chiu, P., Barnoux, M., Blake, E., Cooke, J., Forrester-Jones, R., Gore, N. and Beecham, J. (2016). Life after prison for ex-offenders with intellectual disabilities. In: International Association for the Scientific Study of Intellectual and Developmental Disabilities World Congress. Wiley-Blackwell, p. 712.
  • Langdon, P., Murphy, G., Clare, I. and Palmer, E. (2014). An evaluation of the EQUIP treatment programme with men who have intellectual or other developmental disabilities. In: Fourth International IASSIDD Europe Regional Congress. Wiley/Blackwell, p. 334. Available at: http://dx.doi.org/10.1111/jar.12103.
  • Forrester-Jones, R. and Murphy, G. (2014). The right to a fair trial: is article 6 reality for defendants with ID?. In: 4th International Association of Scientific Study of Intellectual Disabilities Europe Regional Congress. Wiley-Blackwell, pp. 331-331.
  • Langdon, P., Murphy, G., Wilson, E., Shepstone, L., Fowler, D., Heavens, D., Malovic, A., Rose, A. and Mullineaux, L. (2014). Group cognitive behavioural therapy for people with Asperger syndrome who have problems with anxiety: the initial results of the PAsSA pilot treatment trial. In: Fourth International IASSIDD Europe Regional Congress. Wiley/Blackwell, p. 325. Available at: http://dx.doi.org/10.1111/jar.12107.
  • Langdon, P., Murphy, G., Wilson, E., Shepstone, L. and Fowler, D. (2014). Group cognitive behavioural therapy for people with Asperger Syndrome who have problems with anxiety: the initial results of the PAsSA pilot treatment trial. In: Gatlinburg Conference.
  • Triantafyllopoulou, P., Murphy, G. and McGill, P. (2012). Carer’s views of sleep disorders in adults with intellectual disabilities. In: Intellectual Association of the Scientific Study of Intellectual Disabilities World Congress. Wiley, pp. 671-671. Available at: http://dx.doi.org/10.1111/j.1365-2788.2012.01583_3.x.
    Aim: To identify the most common sleep problems carers believe adults with intellectual disabilities (ID) tend to experience; investigate whether the degree of ID affects sleep problems; and, look at whether carers’ views of the individuals’ challenging behaviours correlate with sleep problems.

    Method: The total adult population registered as having ID in a South London NHS Trust and their carers were contacted, out of which 155 participated in the study. Carers completed the Children’s Sleep Habit Questionnaire (adapted for adults), the functional assessments survey (investigating physical and intellectual abilities), and the Short Behaviours That Challenge Checklist.

    Results: Carers reported high prevalence of sleep problems. The most problematic areas were found to be sleep onset delay, sleep duration, night waking and daytime sleepiness followed by parasomnias and sleep disordered breathing.

    Conclusions: Findings confirmed that adults with ID experience sleep problems, with specific sleep problems highlighted within this population. It was also confirmed that adults with severe ID and challenging behaviour experience more sleep problems than adults with higher functioning abilities and no challenging behaviours. Future research should concentrate on specific techniques for treating sleep problems and perhaps investigate in more depth the correlation between severity of ID, challenging behaviour, and sleep.
  • Bhardwaj, A., Forrester-Jones, R. and Murphy, G. (2012). Quality of life of family carers from different cultural backgrounds. In: Intellectual Association of the Scientific Study of Intellectual Disabilities World Congress. Wiley, pp. 804-804. Available at: http://dx.doi.org/10.1111/j.1365-2788.2012.01583_13.x.
    Aim: To identify the quality of life of carers/parents who have children with intellectual disabilities (ID) from south Asian and White communities with a view to understanding differences in service access and family/community support.

    Method: Thirty-eight carers (16 White and 22 Asian) were interviewed using a mixed-methods approach including adaptive behaviour scale, family quality of life measure, semi-structured interviews and participant observation.

    Results: Mothers were the main family carer from both communities. Asian carers reported difficulties around access to services, with too little guidance from an early stage and lack of knowledge of the health system. Generally, services were unsuccessful at trying to match specialists speaking the same language with people with ID and their carers. Carers reported that services were not tailored to specific cultural needs of their children. Both White and Asian carers wanted more support from extended family and from their own community.

    Conclusions: In general both communities of carers were not satisfied with their overall quality of life. Literature highlighting the barriers that carers have accessing services was further highlighted in this study, as well as the many differences faced by both Asian and White families.

Edited book

  • Murphy, G. (2014). People With Intellectual Disabilities and Offending Behaviours. [Online]. Murphy, G. H. and Mason, J. eds. New York: Springer Science. Available at: https://doi.org/10.1007/978-1-4614-8250-5.

Research report (external)

  • Bradshaw, J., Turnpenny, A., Beadle-Brown, J., Milton, D. and Murphy, G. (2020). A Scoping Report on Social Care for Autistic Adults. [Online]. Vol. 23. Available at: https://doi.org/10.21955/amrcopenres.1114922.1.
    The aim of this rapid scoping exercise has been to identify gaps and priorities for adult social care research in autism in order to help Autistica to:

    - Identify key subtopics within adult social care in autism;
    - Understand what we currently know from research on social care in autism;
    - Identify gaps in the literature and the potential impact of these gaps on the outcomes experienced by autistic people;
    - Identify key opportunities for research;
    - Make strategic recommendations for impactful research.

    The review was intended to include people from across the autism spectrum and to take a broad view of social care. The review was to focus specifically on the quantity and quality of the evidence to social care related interventions, assessing a range of outcome measures but with a particular focus on Autistica’s vision of people living ‘long, happy and healthy lives’. Where possible findings related to cost effectiveness were also to be extracted.


  • Melvin, C. (2019). Treatment of Individuals With Autism Spectrum Disorders Who Display Sexual Offending Behaviours.
    Most individuals with autism spectrum disorders (ASD) do not display criminal behaviours, and a penchant for adherence to rules may in fact act as a protective factor against breaking the law in those with ASD . It has however been suggested that the cognitive and behavioural features of ASD such as atypical communication and social interaction styles, difficulties with theory of mind and empathy, inflexibility of thought and repetitive interests, have the potential to leave an individual vulnerable to committing offences, including sexual crimes.

    The Autism Act (2009) and later changes in social policy have led to increased recognition and support for autistic offenders, both in the community and those detained at her Majesty's pleasure or under the Mental Health Act. This includes the need for evidenced-based treatment and as such, research has continued to speculate over the presence of ASD in sexual offenders and any potential impact of the clinical features on positive treatment outcomes. It has thus been suggested that the cognitive and behavioural profile referred to above may result in barriers to treatment, particularly in programmes for sexual offending. Sexual offending treatment is typically delivered in groups and includes therapeutic objectives to increase victim empathy and address cognitive distortions to reduce 'pro-offence thinking styles' and attitudes conducive to offending. While many have supposed the ASD phenotype as challenging within treatment programmes, this has not been subjected to rigorous empirical investigation, with autistic offenders frequently being studied within intellectual disability or neurotypical samples rather than as a distinct population. Three studies have therefore been undertaken to begin to address this gap in the evidence based regarding sexual offending treatment for individuals with ASD.

    It is widely acknowledged that many adult sexual offenders displayed inappropriate or abusive sexual behaviours during childhood and adolescence, with many missed opportunities for intervention. This pattern also appears to be present in adult autistic sexual offenders, therefore an online prevalence survey (Chapter Five) was undertaken to identify children and young people with ASD who display risky sexual behaviours within services across the UK, and explore current assessment and treatment provisions. Response rate to the survey was low however the data attained illustrated inconsistency in practice across services for both assessment and treatment, with little use of tools or measures adapted specifically for intellectual or developmental disability.

    A second study (Chapter Six) provided empirical evidence for sexual offending treatment for individuals with ASD. This was done through interviews with thirteen men with ASD who had completed an adapted sex offender treatment programme and twelve clinicians who facilitated said treatment programmes. The study recorded the collective views and experiences of service users and group facilitators, exploring whether they felt treatment was helpful in reducing risk of re-offending. The findings provided some support for existing propositions regarding the features of ASD and their potential impact on positive treatment outcomes. However, they also illustrated that adapted group sexual offending treatment groups can be beneficial to men with ASD despite potential social or communication difficulties. Challenges remain in shifting cognitive distortions and increasing theory of mind, with changes in affective empathy being a particular caveat in treatment.

    To explore empathy in a non-forensic sample (due to challenges in accessing a youth forensic sample) , a final study piloted an adapted empathy course for adolescents with intellectual and developmental disabilities (Chapter Seven). This study examined empathy amongst autistic adolescents, particularly in relation to those with ASD who display challenging or offending behaviours and those who do not, and to those without ASD. A six-week empathy course was run with sixteen students (mean=17.3yrs; SD=11.42). Measures of empathy were taken at (i) baseline, (ii) following a six-week control period, and (iii) after completion of the empathy course. Whilst the measures did not yield any significant increases in empathy, qualitative data from staff and students highlighted improvements in social skills, including increased understanding and awareness of the thoughts and feelings of others. This study illustrated that a short empathy course can be of benefit to adolescents with and without ASD, however for those with more complex needs further input is required to impact behaviour change.

    These three studies contribute to the developing body of literature on sexual offending treatment for autistic offenders, providing empirical support to some of the existing suggestions in the literature. The findings from the three studies illustrate the need for appropriate and effective treatment for autistic sexual offenders, and that there are benefits to completing an adapted sex offender treatment programme. Many of these benefits are implicit and relate to improvements in identity, self-esteem and quality of life, with reduction of risk stemming from external or indirect treatment outcomes (e.g. development of external management strategies such as staffing levels, or increased monitoring opportunities) rather than internal change (e.g. shift in cognitive distortions or increases in victim empathy). The empathy profile seen in autistic sexual offenders was echoed in a non-forensic sample of autistic adolescents and further investigation is required into the role of empathy in the development pro-social behaviours and risk of sexual offending.
  • Hans, K. (2018). Positive Behaviour Support for Children With Intellectual and Developmental Disabilities in the United Kingdom.
    There is a large body of research indicating that when positive behaviour support is implemented within schools, there are decreases in school discipline referrals and challenging behaviour. There are only two studies that have used schoolwide positive behaviour support in a school where the majority of students have been diagnosed with intellectual disabilities. While these studies have shown the effectiveness of PBS, neither study has used validated measures or direct observations of student behaviour to determine if changes reported by teachers were seen in the students. This study attempted to find out the prevalence of students with intellectual and developmental; disabilities (IDD) and challenging behaviour in the southeast of England. Additionally, positive behaviour support was implemented schoolwide for a special school in England. Validated measures and direct observations were conducted for both school staff and students. Results indicated increases in positive feedback to students were achievable after five hours of training in positive behaviour support. Additionally, student incidents were lower for five of the six students observed in this study. While these changes were measured, due to the number of limitations, no generalizations can be made in regards to the effectiveness of the intervention. The study had a number of challenges however, not least being the drop out of children from the study and the difficulties of obtaining information on standardised questionnaires from parents and teachers.


  • Melvin, C., Langdon, P. and Murphy, G. (2020). ’They’re the hardest group to treat, that changes the least.’ Adapted sex offender treatment programmes for individuals with Autism Spectrum Disorders: Clinician Views and Experiences. Research in Developmental Disabilities.
    Aims: Clinicians working with individuals with autism spectrum disorders (ASD) who display sexual offending behaviours may face challenges during treatment, as a result of the cognitive and behavioural profile associated with ASD. This research explored the views and experiences of those running adapted sex offender treatment groups with men with ASD.
    Method: Semi-structured interviews with group facilitators (n=12) focused on service user engagement and response to the core components of the treatment programme (e.g. increasing victim empathy, addressing cognitive distortions, etc.), and gathered the experiences of those working with men with ASD who display sexual offending behaviours.
    Results: Grounded Theory was used to develop a model conceptualising the potential impact of ASD on treatment outcomes, and this emerged predominantly through clinician’s views of risk of re-offending. Benefits of attending a group included: the presence of other group members, a forum to develop pro-social roles and relationships, and increased opportunity for monitoring. Challenges regarding empathy, specifically emotional empathy, and shifts in cognitive distortions were felt particularly pertinent to those with ASD, as well as questions over internalisation of therapy.
    Conclusion: Despite identification of a number of challenges, adapted sex offender treatment programmes were considered beneficial for men with ASD, especially in light of a dearth of evidenced-based alternatives.
  • Broadhurst, S. (2019). Understanding Resilience in Family Carers.
    Background: Many family carers report suffering high levels of stress as a central part of the caregiver experience. Recently research has begun to examine the role of resilience in enhancing the capacity of individuals to 'bounce back', enabling them to continue to care. Resilience has been defined as 'the process of, capacity for, or outcome of successful adaptation despite challenging or threatening circumstances.'
    This study aimed to understand the nature and complexity of the caring task, identify the emotions and the quality of life outcomes family carers experience, explore their perception of resilience and how it applies to their caregiving roles by developing a carer definition and model of support for enhancing carer resilience. The study then undertook a scoping review to evaluate the effectiveness of two carers' centres to see if there is merit in further evaluative research.

    Methods: A grounded theory study was undertaken, and situational analysis was used to provide a systematic way of interrogating the data and identifying themes. Focus groups were conducted with a range of family carers who were caring for a variety of adults and children with differing needs. The focus groups were recorded, transcribed and then analysed using grounded theory. The software package Nvivo was used to support the analysis. Two carers' centres participated in evaluative research to investigate both the cost and the worth of the services they provided. A logic model was used to create the evaluative research framework, quantitative data was collected using standardised measures and economic costings, qualitative data was collected using observations, surveys and interviews.

    Results: Carers across care groups and across different relationships with the cared for define resilience in the same way. They define carer resilience as the ability to either continue caring or to move on, to continue navigating the changing relationship and to do this by adapting roles and behaviours throughout the carer journey. This includes adapting to the changing relationship with the care recipient; adapting one's identity; adapting one's behaviour to manage the symptoms and behaviour of the care recipient. Carers want commissioned services aimed at building their resilience to focus on supporting the changing relationship between the carer and the cared for and to better support the interplay between carers and the communities they live in.

    Conclusions: Resilience (as defined by carers) would be a useful construct in helping professionals to understand that the key issue is the huge journey of change carers must move through. A common understanding of a social justice model of carer resilience might focus carer strategies on the different types of support carers require at different points in the carer journey to enable them to adapt to these massive changes. Translating policy into practice for carers will require a common understanding of carer resilience, an ability to measure it, a commitment to supporting carers across the carer journey and a more insightful understanding by policy makers of the challenges carers face. There needs to be an increase in studies that involve carers across care groups, across relationships and across the carer journey rather than studying carers in silos. There would be value in future research building on cost-analysis evaluation methods in attempting to gauge both the 'merit' and 'worth' of carer support services.
  • Lindsay, W. and Murphy, G. (2015). The treatment and management of sex offenders. In: Handbook on Offenders With Intellectual and Developmental Disabilities. Chichester: Wiley/Blackwell.
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