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.