A review of cognitive impairments in children with intellectual disabilities: Implications for cognitive behaviour therapy

© 2017 The British Psychological Society Objective: Nearly half of children with intellectual disability (ID) have comorbid affective disorders. These problems are chronic if left untreated and can significantly impact upon future vocational, educational, and social opportunities. Despite this, there is a paucity of research into effective treatments for this population. Notably, one of the most supported of psychological therapies, cognitive behaviour therapy (CBT), remains largely uninvestigated in children with ID. The current review considers the neuropsychological profile of children and adolescents with mild to moderate ID, with a view to informing how CBT might best be adapted for children and adolescents with ID. Method: Narrative review of literature considering the neuropsychological profiles of children and adolescents with ID, with specific focus upon attention, memory, learning, executive functioning, and communication. Studies were identified through SCOPUS, PsycINFO, and PubMed databases, using combinations of the key words ‘intellectual disability’, ‘learning disability’, ‘neuropsychology’, ‘attention’, ‘learning’, ‘memory’, ‘executive function’, ‘language’, and ‘reading’. Results: Children with ID have significant deficits in attention, learning, memory, executive functions, and language. These deficits are likely to have a negative impact upon engagement in CBT. Suggestions for adapting therapy to accommodate these wide ranging deficits are proposed. Conclusions: There are multiple cognitive factors which need to be considered when modifying CBT for children who have ID. Furthermore, research is required to test whether CBT so modified is effective in this population. Practitioner points: Clinical implications. Effective ways of providing cognitive behavioural therapy (CBT) to children with intellectual disability (ID) is unclear. This study provides a framework of potential adaptations for clinical practice As rates of mental illness for children with intellectual disability are high, and rates of treatment provision low, it is hoped that the recommendations provided in this study will encourage more mental health practitioners to provide CBT to children with ID. Limitations. These recommendations are based only upon neuropsychological literature. Trialling the effectiveness of an adapted form of CBT for children and adolescents with ID is required. There are varying causes of intellectual disability, with differences in cognitive profiles. The utility of the recommendations made here may vary according to specific aetiologies

Therapy for Children With Intellectual Disabilities

Anxiety is when people feel worried or nervous, and it is something that many people around the world go through. Some people are more likely to have anxiety than others. Some children are not as good as others at learning and understanding, which is known as an intellectual disability. Children with intellectual disabilities are more likely to experience anxiety—but unfortunately, they often do not get the help they need to feel better. Our research set out to help children with anxiety, especially those with an intellectual disability. We reviewed the research that has already been performed, asked mental health professionals questions, and talked to parents to learn what might work best. Then, we created Fearless Me! Fearless Me! is a program designed especially for children who have difficulties learning and understanding. So far, the Fearless Me! program seems to help reduce anxiety in children with intellectual disabilities.</jats:p

Potential for children with intellectual disability to engage in cognitive behaviour therapy: the parent perspective.

BACKGROUND:This study aimed to obtain the opinions of parents and carers of children with intellectual disability (ID) as to whether cognitive behaviour therapy (CBT) could be useful for their children. METHODS:A mixed qualitative and quantitative method was employed. Twenty-one carers of children aged 10 to 17 having borderline to moderate intellectual functioning responded to an online questionnaire. Participants were provided with information about CBT and asked to respond to open-ended questions. Quantitative data pertained to questions about their child's ability to identify and describe thoughts, feelings and behaviours. Thematic analysis of responses was conducted using an inductive method of identifying themes from the qualitative data collected. RESULTS:Five themes emerged from the qualitative analysis: Emotional Attunement (i.e. parent's understanding and recognition of their child's emotions), Role of the Therapist (i.e. ways therapists could facilitate the intervention), Role of the Parent (i.e. ways parents could engage in the therapy process), Anticipated Obstacles (i.e. what may get in the way of the therapy) and Suggested Adaptations for Therapy (i.e. how CBT can be adapted to suit the needs of children with ID). Seventy-six per cent agreed that their child would be able to engage in CBT with assistance. CONCLUSIONS:The majority of parents believed that CBT is an intervention that children with ID could engage in, provided the therapy is adapted, and the therapist accommodates their needs

The influence of attachment style on interpersonal learning in substance use psychotherapy groups

Substance Use Disorders (SUDs) are prevalent, long-term conditions, commonly treated via group intervention. Additionally, interpersonal learning (IL) is a therapeutic factor unique to group treatment programs, which has been associated with successful group therapy outcomes. While previous research has suggested attachment styles may predict experiences of IL within groups, research in this area is limited. Therefore, this study aims to investigate if attachment style impacts IL, within SUD group treatment programs and specifically, if anxious and avoidant attachment styles influence IL. Participants (N = 38) were recruited voluntarily from an outpatient SUD open group therapy program at a private mental health hospital in Sydney. All participants completed paper-based self-report questionnaires to assess attachment style and IL. Two separate Multiple Linear Regressions (MLRs) revealed anxious attachment was not a significant predictor of IL and avoidant attachment was a significant, negative predictor of IL. Additionally, thematic analysis of qualitative data revealed themes and behaviours which may improve IL. Thus, future directions and implications of the study’s findings indicate the need to conduct additional research into members attachment-based needs to enhance SUD group treatment outcomes

A qualitative evaluation of a video gambling campaign among young Australians

AbstractGambling is an emerging public health issue within Australia, which can lead to various adverse impacts on individuals and society. Online gambling is becoming increasingly popular and is considered a high-risk environment where problem gambling is likely to occur. This rising prevalence emphasises the need for prevention and responsible gambling initiatives in Australia. C’Mon Australia Don’t Let the Game Play Ya! is a recently developed responsible gambling video campaign. The campaign focuses on online gambling and aims to promote responsible gambling messages towards young Australians, a vulnerable population at risk of gambling-related harm. This study qualitatively evaluated the campaign to gather feedback and understand whether the campaign raised awareness of gambling participation and associated risks. The sample (n = 8) was comprised of young adults in Australia, who were aged between 18 and 24 and were not required to be gamblers to participate. Semi-structured focus groups were conducted and responses were analysed using thematic analysis. Results revealed mainly positive feedback, commenting on the design elements, the messaging, and the dissemination of the campaign. The feedback highlighted likeable features of C’Mon Australia Don’t Let the Game play Ya! and provided suggestions for revisions. This study provides valuable insight to inform the development of future responsible gambling campaigns, and future research is recommended to evaluate the campaign across varying contexts, timeframes, and demographics.</jats:p

The influence of members’ attachment style on group cohesion in substance use therapy groups

Group cohesion is an important factor in group therapy as it influences treatment outcomes and group processes. One’s attachment style has been found to impact experiences of group cohesion, however research into this relationship in substance use disorder (SUD) group treatment is lacking. This is of particular concern as insecure attachment presentations are more prevalent in this clinical population and group therapy is often treatment of choice. The current study sought to determine whether attachment style significantly predicted group cohesion. It also provided a qualitative exploration of factors that promote group cohesion in SUD group treatment. Participants (N = 38) attending a SUD therapy program completed self-report measures. Attachment avoidance was a significant negative predictor of positive bonding and positive working, and a significant positive predictor of negative relationships. Attachment anxiety was a significant negative predictor of negative relationships, however, unexpectedly did not significantly predict positive bonding or positive working. The current findings highlight the importance of group therapists tailoring group treatment to meet the attachment needs of individuals to promote a group therapy environment conducive to recovery

A case series evaluation of the Fearless Me! © program for children with intellectual disabilities and anxiety.

OBJECTIVES: Children and adolescents with intellectual disabilities (ID) have high rates of mental health disorders, particularly anxiety disorders. Cognitive behavior therapy (CBT) has largely remained unexamined as a treatment option for this population. Fearless Me! © is an adapted CBT treatment program specifically designed for children and adolescents with ID. METHOD: Eleven children, aged between eight and 17, completed 10 therapy sessions. Measures of anxiety were completed pre and posttreatment and at 3 and 12-month follow-ups by both the children and parents. RESULTS: Six children reported significant reductions in anxiety, with all showing significant reductions in parent-reported child anxiety at either posttreatment assessment, 3-month follow-up, or 12-month follow-up. Results varied across the six children as all parents reported heightened anxiety, but not all children reported high levels of anxiety for themselves. CONCLUSION: Overall, this evaluation provides a sound basis for continued investigation and research into the use of the Fearless Me! © modified CBT program to treat children with ID and anxiety

Participant experiences of Fearless Me! ©: Cognitive behaviour therapy for anxiety in children with intellectual disabilities

Research shows that almost half of children with intellectual disabilities (ID) experience mental ill-health at any given time point. However, traditional cognitive behaviour therapy (CBT) may not be appropriate for children with ID due to the cognitive deficits associated with their diagnosis. The Fearless Me! © CBT program for anxiety is adapted to accommodate the cognitive abilities of children with ID. The aim of the current study was to provide the first qualitative evaluation of the Fearless Me! © program by exploring participant experiences. Eight mother–child dyads were interviewed using a semi-structured protocol. The responses were transcribed and analysed using thematic analysis. Identified codes and themes were cross-checked with an independent researcher and discrepancies were resolved. Parents found the program to be positive and useful for acquiring knowledge. They commented on features of the program, significance of inter- and intra-personal factors and whether the program suited the capability of their child. They also discussed features of treatment outcomes. The qualitative results highlighted that experiences of the program varied. Themes identified included those relating to barriers and facilitators to participation and treatment-related change. The themes provide guidance for program revisions and can inform future delivery of the Fearless Me! © program

Cognitive Behavioural Therapy for children and adolescents with intellectual disability and anxiety: a therapist manual

Up to 50% of children with intellectual disability (ID) have a comorbid mental illness, yet to date, there has been a lack of evidence-based treatments for this population. This paper discusses the development and application of the Fearless Me! © treatment program, a multimodal Cognitive Behavioural Therapy (CBT) intervention for children with mild to moderate ID and anxiety. The program development involved a review of the literature to identify the neuropsychological deficits present for children with ID and suggested ways in which therapy could be adapted for their needs. This was followed by gathering feedback from parents and mental health practitioners. From this, the Fearless Me! © program was developed, involving face-to-face sessions and an online component to support the practice of CBT skills. The program has been trialed among children and adolescents with ID, and shows promise in reducing anxiety in children with mild to moderate ID

Treatment of substance abuse in dual diagnosis

Interventions for substance use–related problems are limited for individuals with intellectual disability (ID). This is problematic, as the lack of interventions can lead to substance use initiation, progression of substance use into substance use disorder, poorer outcomes of treatment, and stigmatization of individuals with dual diagnosis. Additionally, staff who work with individuals with ID and addiction treatment lack resources to effectively help substance use in individuals with ID. Nevertheless, there has been an increase in studies assessing the feasibility and outcomes of interventions for substance use and abuse in individuals with ID. This chapter reviews psychological and pharmacological interventions for individuals with dual diagnosis of substance abuse and ID