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The Use of Mindfulness with People with Intellectual Disabilities: A Systematic Review and Narrative Analysis


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This paper presents a systematic review of the evidence on the effectiveness of mindfulness for people with intellectual disabilities. Primary studies published in the English language between 1980 and 2012 were identified from electronic databases, experts and citation tracking. Eleven relevant studies evaluating mindfulness training and practice were identified: seven studies with people with intellectual disabilities, two studies with staff members or teams and two studies with parents. The studies found improvements in aggression and sexual arousal for people with intellectual disabilities after mindfulness training. Training staff led to benefits for people with intellectual disabilities, decreased use of physical restraint for aggressive behaviour and increased job satisfaction. Training parents led to improved parental satisfaction and well-being and improved parent–child interactions. The reported positive findings suggest that service providers, people with intellectual disabilities and their families may want to consider mindfulness approaches. However, the findings have to be interpreted with caution due to methodological weaknesses identified in the studies. Further high-quality independent research is needed before the reported improvements can be more confidently attributed to mindfulness.
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ISSN 1868-8527
Volume 4
Number 2
Mindfulness (2013) 4:179-189
DOI 10.1007/s12671-013-0197-7
The Use of Mindfulness with People with
Intellectual Disabilities: a Systematic
Review and Narrative Analysis
Melanie J.Chapman, Dougal J.Hare, Sue
Caton, Dene Donalds, Erica McInnis &
Duncan Mitchell
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The Use of Mindfulness with People with Intellectual
Disabilities: a Systematic Review and Narrative Analysis
Melanie J. Chapman &Dougal J. Hare &Sue Caton &
Dene Donalds &Erica McInnis &Duncan Mitchell
Published online: 24 February 2013
#Springer Science+Business Media New York 2013
Abstract This paper presents a systematic review of the evi-
dence on the effectiveness of mindfulness for people with
intellectual disabilities. Primary studies published in the
English languagebetween1980 and 2012 were identified from
electronic databases, experts and citation tracking. Eleven
relevant studies evaluating mindfulness training and practice
were identified: seven studies with people with intellectual
disabilities, two studies with staff members or teams and two
studies with parents. The studies found improvements in ag-
gression and sexual arousal for people with intellectual dis-
abilities after mindfulness training. Training staff led to
benefits for people with intellectual disabilities, decreased use
of physical restraint for aggressive behaviour and increased job
satisfaction. Training parents led to improved parental satisfac-
tion and well-being and improved parentchild interactions.
The reported positive findings suggest that service providers,
people with intellectual disabilities and their families may want
to consider mindfulness approaches. However, the findings
have to be interpreted with caution due to methodological
weaknesses identified in the studies. Further high-quality in-
dependent research is needed before the reported improve-
ments can be more confidently attributed to mindfulness.
Keywords Mindfulness .Systematic review .Intellectual
disabilities .Learning disabilities .Narrative analysis .
Developmental disabilities
Mindfulness involves focussing attention purposefully in a
non-judgmental, non-reactive way on the present moment and
what is happening in an individuals mind, body and the world
around them (Kabat-Zinn 1990). Mindfulness approaches dif-
fer from existing therapy programmes as they aim to help
people to focus on the present moment, to accept difficult to
change symptoms or situations and to enable different ways of
viewing and responding to situations (Fjorback et al. 2011).
There is evidence of the effectiveness of mindfulness for man-
aging various physical and psychological health problems in-
cluding stress, anxiety, depression, pain and disordered eating
(Baer 2003; Chiesa and Serretti 2010;Fjorbacketal.2011).
Mindfulness is a core strategy within treatment packages
such as mindfulness-based stress reduction (Kabat-Zinn
1990) and mindfulness-based cognitive therapy (Segal et
al. 2002). The former is a structured group programme
consisting of eight weekly 22.5-h sessions with daily home
assignments and a day retreat between weeks 6 and 7
(Kabat-Zinn 1990). Mindfulness is cultivated through for-
mal practices such as the body scan, mindful movement and
sitting meditation, which are integrated into everyday life as
a coping resource to improve physical and psychological
well-being (Fjorback et al. 2011). Mindfulness-based cog-
nitive therapy is an adaptation of mindfulness-based stress
reduction which focusses more on thoughts and consists of
M. J. Chapman (*)
Manchester Learning Disability Partnership,
Central Manchester University Hospitals NHS Foundation Trust,
Westwood Street, Moss Side,
Manchester M14 4PH, UK
D. J. Hare
The University of Manchester, Manchester M13 9PL, UK
S. Caton
Manchester Metropolitan University, Manchester M13 0JA, UK
D. Donalds
Pathways Associates Community Interest Company,
Accrington BB5 1NA, UK
E. McInnis
Central Manchester University Hospitals NHS Foundation Trust,
Manchester M16 7AD, UK
D. Mitchell
Manchester Metropolitan University and Manchester Learning
Disability Partnership, Manchester M13 0JA, UK
Mindfulness (2013) 4:179189
DOI 10.1007/s12671-013-0197-7
Author's personal copy
eight weekly 2-h sessions which incorporate elements of
cognitive therapy to facilitate a detached or decentred view
of onesthoughts(Fjorback et al. 2011,p.103).
Mindfulness-based programmes for a range of health
conditions have been provided in the USA since the 1980s
and are increasingly common in the UK. However, mind-
fulness has not been widely used with people with intellec-
tual disabilities, despite the increased prevalence of mental
health problems and vulnerability to chronic health condi-
tions (e.g. epilepsy and diabetes) (Emerson et al. 2011).
People with intellectual disabilities have poor access to
healthcare services (Alborz et al. 2005), including mental
health services, and anecdotal evidence indicates that this is
also true for psychological therapies, including mindfulness.
Systematic and meta-analytic reviews of the use of
mindfulness-based interventions (e.g. Baer 2003;Chiesa
and Serretti 2010; Fjorback et al. 2011) have identified over
60 studies published since 1976 looking at the impact of
mindfulness on physical health conditions such as multiple
sclerosis, cancer, chronic obstructive lung disease, chronic
pain, rheumatoid arthritis, fibromyalgia, psoriasis and HIV,
and mental health problems such as recurrent depression,
anxiety and mood disorders, with some studies also examin-
ing the use of mindfulness with healthy participants. Whilst
there are methodological limitations to many of these studies,
there is some evidence supporting the use of mindfulness-
based interventions to improve psychological functioning and
alleviate various mental health and physical health conditions.
Existing systematic reviews have generally excluded
studies on the use of mindfulness with people with intellec-
tual disabilities. Two recent systematic reviews have exam-
ined the use of mindfulness with people with developmental
and intellectual disabilities (Hwang and Kearney 2013a) and
with caregivers (Hwang and Kearney 2013b). However,
these reviews included people with educational learning
disabilities and autistic spectrum conditions and interventions
which involve additional non-mindfulness components (for
example, lifestyle interventions).
This paper reports on a systematic review conducted to
inform a study evaluating the use of mindfulness sessions
with people with intellectual disabilities (Chapman and
Mitchell 2013). The review objective was to assess the
effectiveness of mindfulness training and practice in relation
to people with intellectual disabilities. The review includes
studies of mindfulness interventions provided to both people
with intellectual disabilities and paid and informal carers.
The systematic review followed the process set out by the
Centre for Reviews and Dissemination (2009). The follow-
ing databases were searched in October 2012: EMBASE,
following search strategy: (learning AND disab*) OR
(mental* AND retard*) OR (intellectual* AND disab*) OR
(developmental* AND disab*) AND mindfulness. A message
was also posted on the Jiscmail list Mindfulness and IDD to
determine whether professionals or academics interested in
the field were aware of additional publications. In addition,
citation tracking and checking of reference lists from journal
articles identified by the search were carried out.
Papers were included if they described a study evaluating
an intervention described as being based on mindfulness
principles with people with intellectual disabilities, their
family members or staff and which were published in an
English language journal from 19805th October 2012.
Papers were excluded if they involved people with autistic
spectrum conditions, attention deficit hyperactivity disorder,
conduct disorder or educational disabilities (e.g. dyslexia)
but not intellectual disabilities, or people who had brain
injuries acquired during adulthood. Studies that described
interventions of which mindfulness formed a component
(e.g. dialectical behaviour therapy, acceptance and commit-
ment therapy) and interventions that included health promo-
tion or behavioural training were also excluded, as it would
not be possible to distinguish whether it was mindfulness or
another aspect of the intervention which was having an
impact. A study examining the impact of mindfulness training
for staff working with people with intellectual disabilities was
excluded as it focussed on the impact on interactions with their
non-disabled children, not their children with intellectual dis-
abilities (Singh et al. 2010). Figure 1gives details of the
selection process.
Quality Assessment, Critical Appraisal and Data Extraction
Each study that met the inclusion criteria was allocated to
two members of the review team for independent quality
assessment and critical appraisal. The Evaluative Method
for Determining Evidence Based Practice (EBP) was used
to assess the quality of the studies (Reichow et al. 2008).
This method provides two rubrics for evaluating research
reports, one for group research and one for single subject
research. Each rubric evaluates primary quality indicators
(e.g. participant characteristics and independent and depen-
dent variables) on a trichotomous ordinal scale (high quality,
acceptable quality and unacceptable quality) and secondary
quality indicators (e.g. inter-observer agreement and social
validity) on a dichotomous scale (evidence or no evidence).
The ratings from the rubrics are combined to provide a
strength of research rating (strong, adequate or weak).
Originally developed for use in autism research, the rubrics
are easily adaptable to research with people with intellectual
disabilities and are recommended as the most rigorous meth-
od for the quality appraisal of single-subject experimental
180 Mindfulness (2013) 4:179189
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designs (Wendt and Miller 2012). An advantage of the method
is that comparable ratings are created for single subject and
group research.
Detailed critical appraisal of the studies was conducted
using tools produced by CASP at the Public Health Resource
Unit (2007). These tools assist reviewers to consider the ap-
propriateness of study design, risk of bias, choice of outcome
measures, recruitment, sample findings, follow-up and gener-
alisability in a structured way. Information was extracted from
the included papers on study aims, design, intervention, sam-
ple, setting, length of follow-up, outcomes and key findings.
As the studies identified were not randomised controlled
trials, a meta-analysis was not possible. Therefore, a narra-
tive analysis was carried out describing and comparing the
main findings from the included studies and discussing their
methodological strengths and weaknesses (Centre for
Reviews and Dissemination 2009).
Review Findings
Eleven relevant studies were identified. Seven studies eval-
uated mindfulness training and practice for people with
intellectual disabilities (Table 1). Two studies evaluated
mindfulness training and practice for staff members or teams
working with people with intellectual disabilities (Table 2).
Two studies evaluated mindfulness training and practice for
parents of people with intellectual disabilities (Table 3).
Mindfulness Training for People with Intellectual
Singh and colleagues carried out six of the seven studies
focussing on the provision of mindfulness training directly
to people with intellectual disabilities (Singh et al. 2003,
2007a,2008b,2011a,c). In these studies, mindfulness pro-
cedures were taught to help people with intellectual disabil-
ities deal with behavioural issues such as anger, aggression
and inappropriate sexual arousal.
Publications identified for review (n=606):
- Database search (n=588)
- Internet searching (n=4)
- Professional networks (n=3)
- Content alerts/WELD Blog and JISCMAIL alerts (n=2)
- Reference tracking (n=9)
Publications retrieved that were potentially
relevant for data extraction (n=57)
Publications excluded after sifting titles
and abstracts (n=549)
Publications included in review (n=11)
Articles excluded after detailed relevance
checks (n=46)
- Not an intervention study (i.e.
discussion piece, book chapter, Editorial,
review, training manual, measure
development) (N=15)
- Intervention incorporates components
other than mindfulness (N=14)
- Not intellectual disabilities (e.g.
dyslexia, ADHD, ADD, high functioning
ASD, chronic health needs, focus on
sibling without ID) (N=10)
- Doctoral dissertation or conference
abstract (N=7)
Fig. 1 Quality of reporting of
meta-analyses (QUORUM)
flow diagram
Mindfulness (2013) 4:179189 181
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Table 1 Studies evaluating mindfulness training and practice for people with intellectual disabilities
Study Aims Study type Rigour Sample Outcomes measured
Singh et al.
To explore the possibility of teaching
a mindfulness-based technique, Soles
of the Feet, to self-regulate aggression
Single subject case study
with an AB design
Weak 27-year-old male with mild intellectual
disabilities who was an inpatient in a
psychiatric hospital
Incidents of physical and verbal
12-month follow-up
Singh et al.
To evaluate the impact of teaching a
mindfulness technique (Soles of the Feet)
to adults with moderate intellectual disabilities
Multiple baseline design
across participants
Weak Three Caucasian adults with moderate
intellectual disabilities at risk of losing
their community placements in group
homes because of aggressive behaviour
Physical aggression
2-year follow-up
Aged 2743. One female, two males
Singh et al.
To evaluate the effectiveness of a
mindfulness-based procedure (Soles
of the Feet) for physical aggression
Multiple baseline design
across participants
Weak 6 male offenders with mild intellectual
disabilities from a forensic mental health
facility for people with intellectual disabilities.
All had a history of physical aggression
against staff
Physical aggression
Aged 2336. 3 Caucasian, 1 African-American,
1 White Hispanic, 1 non-White Hispanic
Physical restraint
Final measure at 27 months
of mindfulness training Staff and peer injuries
Lost days of work
Cost of medical and rehabilitation
due to injury caused by participants
Adkins et al.
To explore the impact of community-
based therapists providing mindfulness
training (Soles of the Feet) to people
with intellectual disabilities
Multiple baseline across
Weak 3 Caucasian people with mild intellectual
disabilities, living in a group home or
with their parents, who were at risk of
losing their job, living placement,
preferred staff or funding
Behaviour (verbal and physical
aggression, disruptive behaviour)
48 weeks follow-up
Aged 2242. 2 male, 1 female
Psychological well-being (stress,
obsessivecompulsive symptoms,
depression, state and trait anxiety)
Chilvers et al.
To investigate impact of mindfulness
group sessions on the aggressive
behaviour of women with intellectual
disabilities in a forensic medium secure
psychiatric unit
Repeated measures design Weak 15 women with mild to moderate intellectual
disabilities in a forensic medium secure
psychiatric unit
Incidents of aggression towards self
and others resulting which resulted
in interventions
No follow-up
Aged 1847
Singh et al.
To evaluate the impact of mindfulness
practice (Soles of the Feet) when taught
by a peer with intellectual disabilities
Multiple baseline design
across participants
Weak 3 adult males with mild intellectual disabilities
who lived in the community in supported
living and had anger and aggression
issues at work. Aged 2632
2-year follow-up
Singh et al.
To examine whether meditation procedures
(Soles of the Feet and mindful observation
of thoughts) could change sexual offenders
inappropriate sexual arousal
Multiple baseline design
across participants
Weak 3 men with mild intellectual disabilities
from a forensic mental health facility
for people with intellectual disabilities
who had been sentenced for aggravated
Sexual assault on a minor or incest
and rape of children
Level of sexual arousal
Aged 2334. 1 African-American,
1 Caucasian, 1 White Hispanic
Final measure at 3540 weeks
mindful observation of
thoughts phase
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Provision of Mindfulness Training The mindfulness training
in the studies incorporated various meditation procedures
provided over different timeframes in both institutional and
community settings by people from a range of backgrounds.
The most commonly taught meditation procedure was Soles
of the Feet (Adkins et al. 2010; Singh et al. 2003,2007a,
2008b,2011b,c). The Soles of the Feet meditation proce-
dure teaches participants to divert their attention from an
emotionally arousing thought, event or situation to an emo-
tionally neutral part of ones body (the soles of the feet).
Once mastered, it becomes automatic to calm the mind by
focussing on the body rather than the thought or situation.
Other mindfulness techniques taught to people with in-
tellectual disabilities included Mindful Observation of
Thoughts which involves a series of mindfulness procedures
(e.g. focussing on the breath, visualising and observing
thoughts as clouds passing through awareness) (Singh et
al. 2011a) and observation of breathing, noises and objects
(Chilvers et al. 2011). Whilst the length and manner of
training in mindfulness techniques varied across studies,
Soles of the Feet training usually involved intensive weekly
or daily sessions of supervised role-play and practice and
home practice assignments (Adkins et al. 2010; Singh et al.
2003,2007a,2008b,2011a,c). Chilvers et al. (2011) held
Table 2 Studies evaluating mindfulness training and practice for staff working with people with intellectual disabilities
Study Aims Study type Rigour Sample Outcomes measured
Singh et al.
To investigate whether
mindfulness training for
paid caregivers would
increase levels of happiness
for adults with profound
multiple disabilities
Alternating treatments
embedded within a
multiple baseline
across subjects design
Weak 6 female African-American
caregivers who worked in
4 group homes. 3 males
with profound intellectual
disabilities and complex
medical and physical
Final measure taken
at end of 16 week
mindfulness practice phase
Singh et al.
To assess how training
staff members in mindfulness
affected their use of
physical restraints
Multiple baseline design
across 2 staff shifts
Weak 23 staff members working
in 4 group homes
for 20 people with
intellectual disabilities
Number of potential and
actual incidents of
physical or verbal
Final measure taken
at end of 22 week
practice phase Physical restraints
Staff verbal redirections
Staff and peer injuries
Table 3 Studies evaluating mindfulness training and practice for parents of people with intellectual disabilities
Study Aims Study type Rigour Sample Outcomes measured
Singh et al.
To assess the effects of
mindfulness training for
parents of children with
intellectual disabilities
on the childrens behaviour
and interactions with
siblings, parental stress
and parental satisfaction
with parenting skills and
interactions with their
Multiple baseline design
across participants
(parentchild dyads)
Weak Four African-American
motherchild dyads. All
children attended a day
centre for children with
intellectual disabilities
Childs aggression towards
mother or siblings
Childs social interactions
with siblings
Interviews with parents
Mothers satisfaction with
their own parenting skills
and their interactions
with their child
Final measures taken
after a 52-week
mindfulness practice stage
Mothers use of mindfulness
in parenting
Parentsexperiences and
perceived outcomes of
Bazzano et al.
To evaluate the feasibility of a
mindfulness-based stress
reduction community-based
program for parents/caregivers
of children with intellectual
Participatory research
using a single group
Weak 37 parents of children with
intellectual disabilities
Psychological well-being
General and parenting stress
Mindfulness (2013) 4:179189 183
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twice weekly 30-min mindfulness sessions over a 6-month
period using observation, description and participation exer-
cises to focus on different mindfulness practices.
A range of people with different levels of mindfulness
skills and experience have provided mindfulness training. In
the majority of studies, mindfulness training was provided
by a single therapist experienced in the practice and teaching
of mindfulness (Singh et al. 2003,2007a,2008b). Training
has also been provided by ward or community-based thera-
pists trained in mindfulness techniques (Adkins et al. 2010;
Chilvers et al. 2011) and by a person with intellectual dis-
abilities trained in the Soles of the Feet technique (Singh et
al. 2011c).
In most studies, mindfulness training was provided to
participants with intellectual disabilities individually, with only
Chilvers et al. (2011) using a group format. Mindfulness
training programmes have been provided in various settings,
including institutional settings such as psychiatric hospitals
and forensic mental health facilities (Chilvers et al. 2011;
Singh et al. 2003,2008b,2011b) and community settings with
people living in group or family homes (Adkins, et al. 2010;
Singh et al. 2007a,2011c).
The Impact of Mindfulness Training All of the studies found
improvements after the mindfulness training and practice.
Singh et al. (2003) found major improvements in behaviour
for the man who was trained in Soles of the Feet with no
aggressive behaviour reported during the 1 year follow-up.
The mean number of incidents of physical aggression re-
duced from 15.4 during baseline to 2.0 during training and 0
during follow-up and those of verbal aggression reduced
from 10.0 at baseline to 2.1 during training and 0 during
follow-up. There were also increases in self-control (from 0
during baseline to 4.5 during follow-up) and reduction and
discontinuation of physical restraints (from 10.4 during
baseline to 0) and medication (from 12.2 during baseline
to 0). Staff injuries reduced from 9.2 during baseline to 0
during follow-up, and resident injuries also reduced to 0
from 8.6 at baseline. The number of activities in which the
participant took part also increased from 3.6 socially inte-
grated activities and 0 physically integrated activities at
baseline to more than 100 of each type of activity at
Singh et al. (2007a) found reductions in aggressive be-
haviour during mindfulness training, with further reductions
during follow-up after 2 years. Michaels mean level of 5.0
aggressive behaviours during baseline reduced to 0.1 at
follow-up, Rosemarys reduced from 3.4 to 0.3 and
Raymonds reduced from 2.8 to 0. All three participants
maintained their community placements.
Singh et al. (2008b) found that physical and verbal ag-
gression decreased substantially. During baseline, the aver-
age number of physically aggressive behaviour made each
month ranged between 1.0 and 2.6. Across the 27 months of
mindfulness training, the number of physically aggressive
behaviours declined to 0, and none of the six participants
made a physically aggressive response for at least 6 months
before training ceased. Mean levels of verbal aggression
reduced, although remaining higher than levels of physical
aggression. The measure of participantsself-reported self-
control increased, and no PRN (as needed) medication or
physical restraint was required. In addition, there was a
reduction in the number of staff days absent and the associ-
ated wage and medical costs.
Adkins et al. (2010) found that target behaviours de-
creased as mindfulness training proceeded and during mind-
fulness practice were maintained at near-zero levels. Low
levels were maintained during follow-up, although with
some variability, and most of the self-reported psychological
well-being scores improved. For example, mean incidents of
Kevins verbal aggression reduced from 4.00 per week
during baseline to 0.35 during mindfulness practice,
Samys disruptive behaviour reduced from 13.50 during
baseline to 5.58 during mindfulness practice, whilst
Monicas verbal aggression reduced from 24.00 to 5.33
and her physical aggression reduced from 12.75 to 1.00.
Chilvers et al. (2011) found a decrease in the number of
incidents of aggression (including self-directed), with a con-
comitant reduction in interventions such as use of the ob-
servation lounge, physical intervention or seclusion. Over a
period of 6 months, the mean number of observations re-
duced from 5.07 to 1.53, mean number of physical inter-
ventions reduced from 3.40 to 1.53 and mean number of
seclusions reduced from 1.20 to 0.53. The changes in obser-
vations and physical interventions were statistically signifi-
cant. There was a relatively sharp reduction when the
sessions were introduced, followed by a more gradual in-
crease and then further reduction.
The three participants who received mindfulness training
from a peer (Singh et al. 2011c) initially had an average of
between 1.00 and 10.63 anger events and between 0.86 and
1.13 aggressive acts per week. After mindfulness training,
the frequency of anger and aggressive events decreased to
zero over the mindfulness practice phase. Whilst the three
participants reported occasional incidents of anger during
the 2-year follow-up, there was no reported aggression.
Singh et al. (2011b) found that mean weekly ratings of
self-reported sexual arousal for the three participants re-
duced from 12 at baseline to 8.75, 10 and 10.75 during the
self-control phase and then to 7.77, 7.38 and 6.92 at the
Soles of the Feet phase. During the mindful observation of
thoughts phase, these ratings reduced further to 2.95, 3.03
and 1.51, respectively.
Feedback from Participants People with intellectual dis-
abilities who have received mindfulness training have
184 Mindfulness (2013) 4:179189
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reported that they valued learning to control their own feel-
ings rather than being told to calm down by others and
found this reinforcing (Singh et al. 2011b). Participants
initially found mindfulness procedures difficult to under-
stand as they could not easily remember and visualise past
events (Singh et al. 2007a) or did not understand instruc-
tions such as observe your thought(Singh et al. 2011b).
Repeated practice, the use of role-plays and discriminative
stimulus being added to the soles of their feet helped to
overcome such difficulties (Singh et al. 2007a,2011b).
Participants varied in their ability to initiate mindfulness
meditation without prompting (Adkins et al. 2010)and
may find it difficult to implement mindfulness procedures
within their lives at first (Singh et al. 2011c). Participants
found it more difficult to use Soles of the Feet for deviant
sexual arousal than for the precursors of aggression due to
their emotional attachment to the strong pleasurable sexual
thoughts (Singh et al. 2011b).
Mindfulness Training for Staff Working with People
with Intellectual Disabilities
Table 2summarises the two studies evaluating the impact of
mindfulness training and practice for people working with
people with intellectual disabilities, both carried out by
Singh and colleagues. The mindfulness training in both
studies covered aspects of mindfulness including meditation
methods, knowing your mind, focussed attention, being in
the present moment, beginners mind, non-judgmental ac-
ceptance, letting go, loving kindness, problem solving and
using mindfulness in daily interactions. The studies looked
at both the impact of mindfulness training on staff in relation
to the interventions and approaches they utilised and work
satisfaction and the impact on people with intellectual
Singh et al. (2004) measured changes in happiness levels
for three adults with profound intellectual disabilities living
in group homes when supported by staff trained in mindful-
ness techniques compared with staff who had received the
same amount of training in behavioural methods training.
Observed happiness increased to a much greater extent
when supported by the staff member trained in mindfulness
(an increase of 146 % when supported by the person trained
in mindfulness compared to 11 % for the untrained caregiver
for the first person, 322 % compared to 1 % for the second
person and 437 % compared to 10 % for the third person).
In another study, Singh and colleagues provided mind-
fulness training to 23 members of staff working in four
group homes for people with mild to profound intellectual
disabilities (Singh et al. 2009). The mean number of inci-
dents reduced from 10.67 during baseline to 6.76 during the
practice phase for the morning shift and from 8.60 to 6.22
for the afternoon shift. The use of physical restraints for
aggressive behaviour decreased to almost none by the end of
the study. Verbal redirections by staff and PRN medication
also reduced and staff and peer injuries were close to zero
levels during the latter stages of mindfulness practice.
Mindfulness Training for Parents of People with Intellectual
Two studies conducted have evaluated the impact of pro-
viding mindfulness training to parents of people with intel-
lectual disabilities (Table 3). These have investigated the
direct impact of mindfulness training and practice on
parentssatisfaction and wellbeing and on parentchild
interactions and the indirect impact on people with intellec-
tual disabilities and other family members.
In the study of Singh et al. (2007b), four mothers of
children with intellectual disabilities received 12 1:1 mind-
fulness sessions following the parent training programme
outlined in Singh et al. (2006a). All four children showed a
decrease in aggressive behaviours during the training stage
with more systematic and substantial reductions during the
mindfulness practice stage. With dyad 1, the childs mean
number of aggressive behaviours per week decreased by
33 % from baseline (14.3) to training (9.6) with an 87 %
decrease from training to practice (1.3). With dyad 2, the
mean number of aggressive behaviours reduced by 26 %
from baseline (8.6) to training (6.3) and 94 % from training
to practice (0.4). With dyad 3, the mean number of aggres-
sive behaviours reduced by 30 % from baseline (13.9) to
training (9.7) and 91 % from training to practice (0.9). With
dyad 4, the mean number of aggressive behaviours reduced
by 36 % from baseline (14.4) to training (9.2) and 88 %
from training to practice (1.1). In addition, there were
improvements in interactions between the child with intel-
lectual disabilities and their siblings, and mothersself-
ratings of parental satisfaction, parental stress and mother
child interaction improved.
Bazzano et al. (2010) provided a community-based
mindfulness-based stress reduction programme for paren-
ts/caregivers of children with intellectual disabilities. The
programme consisted of two concurrent classes twice weekly
in English with Spanish translation over 8 weeks, consisting
of meditation practice, supported discussion of the stressors
parents faced and yoga. Parents also received a 30-min CD for
daily practice. Attendance was good with 78 % attending six
or more classes. Parents reported statistically significant less
stress and statistically significant increases in mindfulness,
self-compassion and well-being after the programme.
Parental feedback suggests that people need to be
disciplined in their meditation practices and exercises in
order to achieve consistent, enduring practice on a daily
basis. Mothers found mindfulness training different to pre-
vious training programmes they had attended, leading to
Mindfulness (2013) 4:179189 185
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transformational change rather than providing them with
specific rules or techniques to use with their child (Singh
et al. 2006a). They felt that the training had enabled them to
take a more holistic view of their child within the context of
family, social and physical environments and to respond to
their child in a calm, positive manner that pre-empted mal-
adaptive behaviour and encouraged positive social behaviour.
Study Quality
All of the studies were rated as weak using the Evaluative
Method for EBP (Reichow et al. 2008). Several serious
methodological weaknesses were identified in all of the
studies under review in areas appertaining to research de-
sign, participants, sample size, treatment fidelity and out-
come measurement. Most studies conducted by Singh and
colleagues used a multiple baseline design, which has several
advantages (e.g. non-withdrawal of a potentially effective
intervention, paralleling clinical practice and ease of conceptu-
alisation and implementation) and can show a causal effect
between an intervention and the outcome, especially at single
case level (Cooper et al. 2007). However, given the small
number of participants, external validity is weak, limiting the
generalisability of the findings (Silver Pacuilla et al. 2011).
A major methodological weakness of all the studies is
that they are uncontrolled with no comparison with other
treatments to determine whether observed improvements are
due to receiving some form of treatment or due to the impact
of the therapist. Moreover, a single therapist provided most
of the mindfulness training, and it is possible that his inter-
personal skills and style led to change rather than mindful-
ness per se. Moreover, Singh and colleagues do not state
which mindfulness approach they are following (mindful-
ness-based stress reduction or mindfulness-based cognitive
therapy) and their training does not follow the typical time-
frames and content of mindfulness-based stress reduction
and mindfulness-based cognitive therapy programmes.
There were no systematic or independent assessments of
the quality of the interventions in the studies (i.e. treatment
compliance) or of how closely interventions conformed to
mindfulness principles (i.e. treatment fidelity).
In addition, the sample sizes within the studies are small
with limited information about sampling criteria used, rais-
ing questions about representativeness. Some people con-
tacted the researchers and may be more motivated to change
than other people. All of the participants in the studies
where mindfulness training was provided directly to people
with intellectual disabilities had mild or moderate intellec-
tual disabilities, and it is difficult to generalise the findings
to people with more severe intellectual disabilities.
In relation to outcome measurement, most of the studies
of Singh et al. utilised more than one observer of the
targeted behaviours to ensure reliability of data and reported
that inter-observer reliability was generally high. However,
reliability and validity data are not reported for many of the
monitoring instruments and scales used in the studies to
determine how appropriate or accurate they are (for example,
Bazzano et al. 2010).
Finally, there is a lack of procedural detail about how the
qualitative data from informal interviews and anecdotal
evidence was gathered, with no information about whether
interview guides were used, whether interviews were
recorded and the method of analysis used. If the mindfulness
trainer carried out interviews about the training, it is possible
that participants would have responded more positively than
if an independent person had conducted the interviews.
Therefore, whilst the majority of published studies suggest
that mindfulness-based training can have a positive impact
on people with intellectual disabilities, their family members
and paid carers, such claims must be treated with extreme
caution due to the serious methodological limitations of all
of the extant studies.
The studies identified by this systematic review indicate that
mindfulness training and practice leads to improvements in
the frequency of problem behaviours and psychological
well-being for people with intellectual disabilities. These
improvements have frequently been maintained over several
years. The studies suggest that whilst benefits can be
achieved by providing mindfulness training and practice
directly to people with mild and moderate intellectual dis-
abilities, people with intellectual disabilities also benefit if
their staff and family receive mindfulness training.
Mindfulness training has been shown to be successfully
provided in a range of community and institutional settings
and by experienced mindfulness practitioners, staff trained
in mindfulness techniques, family members and people with
intellectual disabilities themselves. As the studies have in-
cluded White, African-American and Hispanic populations,
there is some evidence that mindfulness approaches are
acceptable to people from diverse cultural backgrounds. The
feedback from participants with intellectual disabilities dem-
onstrates that mindfulness training must be accessible to them
with clear instructions, regular practice and use of concrete
examples, role play and stimuli to assist people with intellec-
tual disabilities to understand and use mindfulness concepts
and techniques. The feedback from parents indicates that they
too may need support and encouragement to persist with
integrating mindfulness practice within their lives.
The reported positive findings have implications for in-
tellectual disability services considering mindfulness
approaches with their clients and/or staff as an option for
improving the quality of life and well-being of people with
186 Mindfulness (2013) 4:179189
Author's personal copy
intellectual disabilities, particularly if existing approaches
are not effective. People with intellectual disabilities, their
families and organisations may want to consider mindfulness.
Mainstream health services also need to review whether the
mindfulness interventions which they provide are being
accessed by people with intellectual disabilities and, if not,
identify the reasons why and determine what action can be
However, the serious methodological limitations of the
published studies mean that the positive findings should be
treated with caution, and it is debateable whether the evidence
is strong enough to recommend the use of mindfulness. The
Evaluative Method for Evaluating and Determining EBP
provides criteria for determining whether a practice has
enough empirical support to be classified as an established
or promising EBP (Reichow et al. 2008). These criteria look at
the number of strength ratings, how many research teams have
conducted the studies, how many different locations have
conducted studies and the total sample size across studies.
As all of the studies in this review were assessed as being of
weak research report strength, the current evidence cannot yet
be categorised as promising. Similarly, the evidence would be
judged as very low using international criteria for recommend-
ing evidence-based interventions developed by the Grades of
Recommendation, Assessment, Development, and Evaluation
(GRADE) Working Group (2004). In addition, most studies
have been carried out in the USA, and it is unclear how well
mindfulness will translate to other countries with different
cultures and services systems. Therefore, stronger evi-
dence is needed before mindfulness could be confidently
recommended as routine practice with people with intellectual
Future studies need to be clear about the mindfulness
approach being evaluated. The mindfulness approaches
most commonly used with the general population are
mindfulness-based stress reduction and mindfulness-based
cognitive therapy. However, the mindfulness training pro-
grammes described in the reviewed studies include a myriad
of techniques, and it is not always clear how compatible
these are with more usual mindfulness approaches. Whilst
the programme delivered by Bazzano et al. (2010) was de-
scribed as a mindfulness-based stress reduction programme,
Chilvers et al. (2011) do not specify which mindfulness ap-
proach their training was based upon, and the majority of
studies included in the review describe and evaluate an ap-
proach to mindfulness, the Soles of the Feet (and more recent-
ly Mindful Observation of Thoughts), developed by Singh and
colleagues. The use of more typical mindfulness-based stress
reduction and mindfulness-based cognitive therapy pro-
grammes with people with intellectual disabilities and carers
needs to be explored and evaluated.
A number of studies were excluded from this review as
they reported on interventions which included components
other than mindfulness. Some studies explored interventions
based on acceptance and commitment therapy or dialectical
behaviour therapy, which include mindfulness as a compo-
nent (for example, Morrissey and Ingamells 2011; Noone
and Hastings 2010;Sakdalanetal.2010). Three studies
were excluded which suggested that introducing a mindful-
ness component into health promotion interventions may
help to support and maintain lifestyle changes such as
weight loss and stopping smoking (Singh et al. 2008a,
2011a,d). Another study concluded that providing mindful-
ness training after behavioural training to staff working in
group homes considerably improved their ability to manage
the aggressive behaviour and improve learning of residents
with intellectual disabilities (Singh et al. 2006b). It is im-
portant that future studies are designed so that it is clear
whether it is mindfulness or other components of an inter-
vention that are leading to change.
In addition to research evaluating the effectiveness of
mindfulness, further research is needed to develop a concep-
tual model that clarifies the mechanisms and processes leading
to any observed outcomes from mindfulness training and
practice. The perspectives of those who have received mind-
fulness training will be important in illuminating these pro-
cesses. The studies included in this review show that people
with intellectual disabilities feel that mindfulness training and
practice has provided them with a method of controlling their
own feelings, rather than being dependent on their behaviours
being managed by other people. Family members report that
mindfulness training and practice provides them with new
coping mechanisms and leads to a form of transformational
change in the way in which they perceive and respond to their
family member with intellectual disabilities. This appears to
lead to improved parentchild interactions and as a conse-
quence positive outcomes for the child with intellectual dis-
abilities. The included studies did not gather information from
staff about their perceptions of mindfulness training and prac-
tice and potential reasons for the reported outcomes. It is
possible that if they too are experiencing a similar form of
transformational change in the way in which they view and
respond to the people they are working with, this may result in
improvements in staffclient interactions, which in turn im-
prove outcomes for people with intellectual disabilities (for
example, improvements in behaviour, well-being and quality
of life).
Further research utilising controlled designs with both
larger sample sizes and random allocation to treatment or
comparison groups is therefore needed before reported
improvements can be more confidently attributed to mind-
fulness. Similarly, further research is needed to identify
which components of mindfulness lead to change and the
processes involved, whether mindfulness approaches are
more effective than other approaches or interventions and
to explore how factors such as facilitator characteristics,
Mindfulness (2013) 4:179189 187
Author's personal copy
support, communication needs and cognitive abilities impact
on the success of mindfulness. Research into whether mind-
fulness is best taught on a 1:1 basis or in a group setting is also
required to inform clinical practice. Methodologically robust
qualitative research could also explore the experiences of
those receiving mindfulness training, to identify what they
feel the impact of mindfulness has been and to identify which
components of mindfulness participants find most useful.
In conclusion, there is some evidence that mindfulness-
based approaches may have the potential to improve the
psychological well-being of people with intellectual disabil-
ities, but high-quality research conducted by independent
researchers is required before clear clinical recommenda-
tions can be made.
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... Patterson et al. (2020) added that research on DBT and adults with intellectual disabilities has typically focused on examining the effectiveness of the skills group only on pre-and postintervention measures. Chapman et al. (2013) and Hwang and Kearney's (2013) findings indicate that mindfulness-based interventions help adults with intellectual disabilities to reduce aggression and regulate deviant sexual arousal. More recently, Byrne and O'Mahony (2020) identified that ACT interventions are associated with reduced psychological stress and improved adaptive behaviour functioning in people with intellectual disabilities and/or autism spectrum conditions. ...
... Until now, systematic reviews have focused on summarising findings from the growing number of quantitative studies examining individual third-wave therapies with adults with intellectual disabilities(Byrne & O'Mahony, 2020;Chapman et al., 2013;Hwang & Kearney, 2013;McNair et al., 2017;Patterson et al., 2020). These reviews have established that adults with intellectual disabilities find these therapies accessible and acceptable. ...
Background: In recent years, third-wave therapies have risen to prominence. Research into adapting and evaluating third-wave therapies for adults with intellectual disabilities has identified that third-wave therapies are accessible, acceptable, and effective (improving a range of symptoms and skills). Method: This meta-ethnography followed Noblit and Hare's approach to synthesising findings from qualitative studies to examine how adults with intellectual disabilities experience third-wave therapy groups. A systematic review of three databases identified 13 studies that met our inclusion criteria. Results: We identified that third-wave therapy groups can be a 'Transformational' process for adults with intellectual disabilities that involves three stages: 'Concealment', 'Opening up' and 'Flourishing'. Conclusion: Findings highlight the importance of therapeutic processes; especially, working with defences, and developing and maintaining safety/trust. Recommendations include the development of an objective measure of group safety/trust.
... 11 A related condition is borderline intellectual functioning. People whose cognitive functioning falls one standard deviation below the population mean (ie, an IQ score of [70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85] have an increased risk for borderline intellectual functioning: a condition that is not included in current diagnostic systems as a separate diagnostic entity but is instead considered a health metacondition. 12 Borderline intel lectual functioning affects 11-13% of the population in high-income countries. ...
... 75 Some other psychological therapies are feasible and have attracted research interest, but they are not yet evidencebased practices (eg, eye movement desensitization and reprocessing for trauma, cognitive behavioural therapy for trauma, mindfulness for aggression or anger, psycho dynamic psychotherapy, and animal-assisted therapy). [75][76][77][78][79] The paucity of evidence for psychological therapies for mental health problems in children with intellectual disability (especially those with severe disabilities) 80 is mostly due to insufficient research in this area. ...
Intellectual disability ranks in the top ten causes of disease burden globally and is the top cause in children younger than 5 years. 2–3% of children have an intellectual disability, and about 15% of children present with differences consistent with an intellectual disability (ie, global developmental delay and borderline intellectual functioning). In this Review, we discuss the prevalence of mental health problems, interventions to address these, and issues of access to treatment and services. Where possible, we take a global perspective, given most children with intellectual disability live in low-income and middle-income countries. Approximately 40% of children with intellectual disability present with a diagnosable mental disorder, a rate that is at least double that in children without intellectual disability. Most risk factors for poor mental health and barriers to accessing support are not unique to people with intellectual disability. With proportionate universalism as the guiding principle for reducing poor mental health at scale, we discuss four directions for addressing the mental health inequity in intellectual disability.
... The effectiveness of mindfulness has been evaluated in different populations for managing various physical and psychological health problems, including stress, anxiety, depression, pain, and eating disorders [57][58][59]. However, the use of mindfulness remains scarce in the broader demographic of individuals with intellectual disabilities [60], where the most common therapeutic approach is based on cognitive behavioral therapy [61]. ...
Full-text available
Forest bathing practices benefit individuals’ physical and mental health. A growing number of published studies provide evidence of such effects in diverse populations and contexts. However, no literature has been found that evaluates the effects of forest bathing on people with intellectual disabilities. In this paper, we present a quasi-experimental pre–post protocol for assessing the preliminary efficacy and feasibility of a forest bathing intervention in a group of adults with intellectual disability. An 11-weekly session program will be applied in the forests of the Ollo Valley, Navarre (Spain). The preliminary efficacy outcomes will be blood pressure, psycho-physiological coherence parameters and quality of life. The feasibility of the intervention will be assessed through data on barriers and facilitators of the implementation process and indicators of environmental comfort (physiological equivalent temperature and thermic perception). This study offers an opportunity for people with intellectual disabilities to benefit from a forest bathing intervention and explore its effects not only on their quality of life, but also on the improvement in their physiological and psychological state. This feasibility study is an essential step to explore crucial aspects for a future full-scale trial.
Full-text available
Background: Outwardly directed aggressive behaviour in people with intellectual disabilities is a significant issue that may lead to poor quality of life, social exclusion and inpatient psychiatric admissions. Cognitive and behavioural approaches have been developed to manage aggressive behaviour but the effectiveness of these interventions on reducing aggressive behaviour and other outcomes are unclear. This is the third update of this review and adds nine new studies, resulting in a total of 15 studies in this review. Objectives: To evaluate the efficacy of behavioural and cognitive-behavioural interventions on outwardly directed aggressive behaviour compared to usual care, wait-list controls or no treatment in people with intellectual disability. We also evaluated enhanced interventions compared to non-enhanced interventions. Search methods: We used standard, extensive Cochrane search methods. The latest search date was March 2022. We revised the search terms to include positive behaviour support (PBS). Selection criteria: We included randomised and quasi-randomised trials of children and adults with intellectual disability of any duration, setting and any eligible comparator. Data collection and analysis: We used standard Cochrane methods. Our primary outcomes were change in 1. aggressive behaviour, 2. ability to control anger, and 3. adaptive functioning, and 4. Adverse effects: Our secondary outcomes were change in 5. mental state, 6. medication, 7. care needs and 8. quality of life, and 9. frequency of service utilisation and 10. user satisfaction data. We used GRADE to assess certainty of evidence for each outcome. We expressed treatment effects as mean differences (MD) or odds ratios (OR), with 95% confidence intervals (CI). Where possible, we pooled data using a fixed-effect model. Main results: This updated version comprises nine new studies giving 15 included studies and 921 participants. The update also adds new interventions including parent training (two studies), mindfulness-based positive behaviour support (MBPBS) (two studies), reciprocal imitation training (RIT; one study) and dialectical behavioural therapy (DBT; one study). It also adds two new studies on PBS. Most studies were based in the community (14 studies), and one was in an inpatient forensic service. Eleven studies involved adults only. The remaining studies involved children (one study), children and adolescents (one study), adolescents (one study), and adolescents and adults (one study). One study included boys with fragile X syndrome. Six studies were conducted in the UK, seven in the USA, one in Canada and one in Germany. Only five studies described sources of funding. Four studies compared anger management based on cognitive behaviour therapy to a wait-list or no treatment control group (n = 263); two studies compared PBS with treatment as usual (TAU) (n = 308); two studies compared carer training on mindfulness and PBS with PBS only (n = 128); two studies involving parent training on behavioural approaches compared to wait-list control or TAU (n = 99); one study of mindfulness to a wait-list control (n = 34); one study of adapted dialectal behavioural therapy compared to wait-list control (n = 21); one study of RIT compared to an active control (n = 20) and one study of modified relaxation compared to an active control group (n = 12). There was moderate-certainty evidence that anger management may improve severity of aggressive behaviour post-treatment (MD -3.50, 95% CI -6.21 to -0.79; P = 0.01; 1 study, 158 participants); very low-certainty evidence that it might improve self-reported ability to control anger (MD -8.38, 95% CI -14.05 to -2.71; P = 0.004, I2 = 2%; 3 studies, 212 participants), adaptive functioning (MD -21.73, 95% CI -36.44 to -7.02; P = 0.004; 1 study, 28 participants) and psychiatric symptoms (MD -0.48, 95% CI -0.79 to -0.17; P = 0.002; 1 study, 28 participants) post-treatment; and very low-certainty evidence that it does not improve quality of life post-treatment (MD -5.60, 95% CI -18.11 to 6.91; P = 0.38; 1 study, 129 participants) or reduce service utilisation and costs at 10 months (MD 102.99 British pounds, 95% CI -117.16 to 323.14; P = 0.36; 1 study, 133 participants). There was moderate-certainty evidence that PBS may reduce aggressive behaviour post-treatment (MD -7.78, 95% CI -15.23 to -0.32; P = 0.04, I2 = 0%; 2 studies, 275 participants) and low-certainty evidence that it probably does not reduce aggressive behaviour at 12 months (MD -5.20, 95% CI -13.27 to 2.87; P = 0.21; 1 study, 225 participants). There was low-certainty evidence that PBS does not improve mental state post-treatment (OR 1.44, 95% CI 0.83 to 2.49; P = 1.21; 1 study, 214 participants) and very low-certainty evidence that it might not reduce service utilisation at 12 months (MD -448.00 British pounds, 95% CI -1660.83 to 764.83; P = 0.47; 1 study, 225 participants). There was very low-certainty evidence that mindfulness may reduce incidents of physical aggression (MD -2.80, 95% CI -4.37 to -1.23; P < 0.001; 1 study; 34 participants) and low-certainty evidence that MBPBS may reduce incidents of aggression post-treatment (MD -10.27, 95% CI -14.86 to -5.67; P < 0.001, I2 = 87%; 2 studies, 128 participants). Reasons for downgrading the certainty of evidence were risk of bias (particularly selection and performance bias); imprecision (results from single, often small studies, wide CIs, and CIs crossing the null effect); and inconsistency (statistical heterogeneity). Authors' conclusions: There is moderate-certainty evidence that cognitive-behavioural approaches such as anger management and PBS may reduce outwardly directed aggressive behaviour in the short term but there is less certainty about the evidence in the medium and long term, particularly in relation to other outcomes such as quality of life. There is some evidence to suggest that combining more than one intervention may have cumulative benefits. Most studies were small and there is a need for larger, robust randomised controlled trials, particularly for interventions where the certainty of evidence is very low. More trials are needed that focus on children and whether psychological interventions lead to reductions in the use of psychotropic medications.
This eighth edition of Dr Reichel's formative text remains the go-to guide for practicing physicians and allied health staff confronted with the unique problems of an increasing elderly population. Fully updated and revised, it provides a practical guide for all health specialists, emphasizing the clinical management of the elderly patient with simple to complex problems. Featuring four new chapters and the incorporation of geriatric emergency medicine into chapters. The book begins with a general approach to the management of older adults, followed by a review of common geriatric syndromes, and proceeding to an organ-based review of care. The final section addresses principles of care, including care in special situations, psychosocial aspects of our aging society, and organization of care. Particular emphasis is placed on cost-effective, patient-centered care, including a discussion of the Choosing Wisely campaign. A must-read for all practitioners seeking practical and relevant information in a comprehensive format.
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Objectives: Approximately 10% of people with intellectual disability display aggressive challenging behaviour, usually due to unmet needs. There are a variety of interventions available, yet a scarcity of understanding about what mechanisms contribute to successful interventions. We explored how complex interventions for aggressive challenging behaviour work in practice and what works for whom by developing programme theories through contexts-mechanism-outcome (CMO) configurations. Methods: This review followed modified rapid realist review methodology and RAMESES-II standards. Eligible papers reported on a range of population groups (intellectual disability, mental health, dementia, young people and adults) and settings (community and inpatient) to broaden the scope and available data for review. Results: Five databases and grey literature were searched and a total of 59 studies were included. We developed three overarching domains comprising of 11 CMOs; 1. Working with the person displaying aggressive challenging behaviour, 2. Relationships and team focused approaches and 3. Sustaining and embedding facilitating factors at team and systems levels. Mechanisms underlying the successful application of interventions included improving understanding, addressing unmet need, developing positive skills, enhancing carer compassion and boosting staff self-efficacy and motivation. Conclusion: The review emphasises how interventions for aggressive challenging behaviour should be personalised and tailored to suit individual needs. Effective communication and trusting relationships between service users, carers, professionals, and within staff teams is essential to facilitate effective intervention delivery. Carer inclusion and service level buy-in supports the attainment of desired outcomes. Implications for policy, clinical practice and future directions are discussed. Prospero Registration Number: CRD42020203055.
Mindfulness helps people focus on what is happening right now. It can help people to have good mental health. A group of researchers from the USA created a mindfulness-based therapy for people with intellectual disabilities, called Soles of the Feet. Soles of the Feet teaches people with intellectual disabilities to focus on the soles of their feet, instead of focusing on difficult thoughts and feelings. This paper thinks about how Soles of the Feet works for people with intellectual disabilities.
The chromosome 22q11.2 deletion syndrome (22q11.2DS) is common. It is the most common cause of syndromic palatal anomalies, the second most common cause of congenital heart disease (CHD) and developmental differences after Down syndrome, and a more common cause of tetralogy of Fallot than Down syndrome. 22q11.2DS is not associated with advanced maternal age, so affected offspring are equally likely to be born to young mothers as to those with advanced maternal age. Although common, lack of recognition of the condition and/or lack of familiarity with genetic testing methods often delays diagnosis. Wide variability hampers early diagnosis, delaying interventions that could improve outcome, concurrently sending families and healthcare providers on a protracted diagnostic odyssey. Conversely, early diagnosis including in the prenatal or neonatal setting offers medical and emotional preparedness, simultaneously reducing costs medically, emotionally, and fiscally related to late or missed diagnoses. 22q11.2DS leads to significant morbidity and some mortality, with multiorgan system involvement including congenital anomalies such as CHD, medical issues including immune, endocrine, and gastrointestinal problems, variable cognitive deficits, and psychiatric illness, all requiring input from healthcare providers in numerous settings including pediatrics, adult medicine, oncology, fetal medicine, and newborn screening. The presence and severity of associated features vary by age, and the focus changes over time. Consequently, management requires a multidisciplinary approach across the lifespan including genetic counseling for the patient and family. Approaching the diagnosis, and related features, with a practical methodology reflecting published guidelines and general principles, as described herein, will support patients, families, and healthcare providers alike.
The unusually broad heterogeneity of physical, developmental, cognitive, and behavioral presentations among children diagnosed with 22q11.2 deletion syndrome (22q11DS) renders generalized predictions of outcomes and interventions impossible. Rather, each child’s unique array of strengths and weaknesses must be considered and periodically updated as new information becomes available. This information may come from the child, as they mature and gain (or fail to gain) new skills and abilities, or from the environment, as new medical treatments, behavioral interventions, and educational techniques become available. While this is generally true for all children with developmental disabilities, it is of critical importance among children with 22q11DS, who often experience more complex multidimensional deficiencies affecting numerous medical and behavioral domains and ultimately affecting quality of life.
Purpose This paper aims to assess the quality of systematic reviews on the effectiveness of psychological therapy for adults with intellectual disabilities (ID) and mental health difficulties. Design/methodology/approach Four electronic databases were used: Cochrane, PsycINFO, PubMed and Scopus. Studies were included if they were a systematic review focused primarily on psychological therapy for adults with ID and mental health difficulties. Systematic reviews focused on anger were also considered for inclusion. These reviews were rated for quality on the Amstar-2, a quality rating tool designed to evaluate systematic reviews. Findings Twelve relevant systematic reviews were identified, which included seven reviews focused primarily on cognitive behavioural therapy, two on psychodynamic therapy and three on third-wave therapies. The AMSTAR-2 indicated that all 12 reviews were of “critically low” quality. Thus, there are significant problems with the evidence base. Originality/value To the best of the authors’ knowledge, this is the first systematic review of systematic reviews of the effectiveness of psychological therapies for people who have ID. It provides an overview of the quality of the evidence base into one place.
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This briefing paper will assist Primary, Acute and Specialist NHS Trusts in fulfilling their responsibilities. In this report we summarise the most recent evidence from the UK on the health status of people with learning disabilities and the determinants of the health inequalities they face. Later in the autumn, IHaL will be producing a briefing for GP Commissioning Consortia and PCTs on practical commissioning actions to help address the issues identified in this report.
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There is a lack of research exploring the use of mindfulness groups for people with intellectual and developmental disabilities in a community setting. This paper explores the experiences of people with intellectual disabilities and carers who participated in Introduction to Mindfulness workshops. The mindfulness workshops consisted of an introduction to mindfulness and a body scan meditation. Participants were given a leaflet about mindfulness and an audio CD of mindfulness exercises. A questionnaire survey was conducted of people who attended the mindfulness workshops and qualitative interviews were carried out with six people with intellectual disabilities (three of whom were supported by paid or family carers). Feedback on the workshops was generally positive. Workshop participants valued the opportunity to talk to other people about their experiences and found the workshops, and in particular the body scan, very relaxing. Three of the people with intellectual disabilities who were interviewed had listened to the audio recording since the workshops and two of these had found it useful in aiding them to cope with phobias, stress and discrimination. Participants wanted further mindfulness sessions and felt that other people with intellectual disabilities could benefit from mindfulness training. The interviews revealed that people with intellectual disabilities may have very stressful lives. Mindfulness could be a useful way of helping people to manage such stress. The mindfulness workshops were clearly acceptable to people with intellectual disabilities, and further work is needed to develop and evaluate a group mindfulness program that is accessible to people with intellectual disabilities.
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Mindfulness is the practice of focusing attention effectively/purposefully, in a non-judgemental manner, on current circumstances (Kabat-Zinn, 2009; Crane, 2009). It has been increasingly used as a tool for managing a range of difficulties associated with personal suffering, including stress and chronic pain, as well as some aspects of mental disorder. In this study the practice of mindfulness was introduced to a medium secure ward for female patients with learning disabilities in the form of twice-weekly, 30-minute group sessions. Proxy measures of institutional aggression namely the number of observations (Obs), physical interventions (PI), and seclusions (Sec) were recorded at baseline (during the month prior to the introduction of the mindfulness sessions and at two months and six months following the introduction of the sessions). Friedman's Analysis of Variance and post-hoc analyses using Wilcoxon's Signed Ranks showed a significant reduction at six months. The potential influence of basic mindfulness practice sessions in reducing aggression is discussed.
Objective: Stress among parents and caregivers of children with developmental disabilities is pervasive and is linked to lower quality of life, unhealthy family functioning, and negative psychological consequences. Mindfulness based stress reduction (MBSR) is a method of reducing stress and improving well-being through letting go of stress by being in the moment. Our goal was to develop, implement, and evaluate the feasibility of an MBSR program designed for parents/caregivers in a community-based participatory setting. Methods: Parents/caregivers were equal partners with researchers in curriculum development, recruitment, implementation and evaluation. Two concurrent classes, evening and morning, were conducted twice weekly in English with Spanish translation over 8-weeks in Spring, 2008. Classes consisted of meditation practice, supported discussion of stressors affecting parents/caregivers and yoga. Pre- and post-scores on the Mindfulness Attention Awareness Scale (MAAS), Self-Compassion Scale (SCS), Scale of Psychological Well-Being (PWB), Perceived Stress Scale-10 (PSS10), Parental Stress Scale (PSS) were compared using paired t-tests. Results: Of 37 participants recruited, 29 (78%) attended six or more classes. Parents/caregivers reported significantly less stress after the program (PSS M=38.8, SD=10.1) than before (M=46.5, SD=10.6, p<0.05). The mean PSS-10 score decreased by 9.53 points (p<0.05). Parents/caregivers also reported significantly (p<0.05) increased mindfulness (MAAS), self-compassion (SCS) and well-being (PWB). Conclusions: A community-based MBSR program can be an effective intervention to reduce stress and improve psychological well-being for parents/caregivers of children with developmental disabilities. Future studies should include a community-based approach for larger, randomized controlled studies of MBSR programs with longer-term outcomes and for those with developmental disabilities.
Parental and professional caregivers of individuals with developmental disabilities (DD) often experience stress and hardship associated with their role, placing them in real danger of burnout and affecting their quality of care. Mindfulness practice is currently being applied to address these issues. We conducted a systematic literature review to explore the effects of mindfulness practice and analyse the intervention and methodological features used for eliciting these effects. An initial search produced 386 publications. Of these, seven met the selection criteria of intervention studies that applied mindfulness to parental and professional caregivers of individuals with DD. We found, from analysis of seven studies, direct effects of mindfulness practice for practitioners (i.e., parental and professional caregivers) and crossover effects for individuals with whom these practitioners interacted (i.e., their children and care recipients). The studies under review collectively suggest that the practice of mindfulness in everyday life over significant periods of time can both improve the experience of care providers and support them in providing a better standard of care for care recipients. Limitations of current mindfulness intervention studies and some implications for future studies are discussed to strengthen the application of mindfulness for individuals influenced by DD.
Individuals with Prader-Willi syndrome (PWS) are often overweight or obese because of their delayed satiety response. Three individuals with PWS participated in a long-term, multicomponent mindfulness-based health wellness program to reduce their obesity by changing their lifestyles. The components included (a) physical exercise, (b) food awareness, (c) mindful eating to manage rapid eating, (d) visualizing and labeling hunger, and (e) a mindfulness procedure used as a self-control strategy against temptation to eat between meals. The program was implemented within a changing criterion design. All 3 individuals reached their desired body weights, enhanced their lifestyles, and maintained their desired body weights during the 3-year maintenance period. This study suggests that mindfulness-based health wellness programs may be effective in producing sustained lifestyle changes in individuals who are obese, including those with a biological predilection for excessive eating due to delayed satiety response.