Investigative interviewing of children with intellectual disabilities

This research was designed to examine two broad issues in relation to the investigative interviewing of children (aged 9 to 13 years) with mild and moderate intellectual disabilities. First, how do children with intellectual disabilities perform (relative to children matched for chronological and mental age) when recalling an event in response to various questions? Second, what question types and interview strategies do police officers and caregivers use to elicit accurate and detailed accounts about an event from children with intellectual disabilities? The rationale for exploring each of these issues was to determine possible ways of improving the elicitation of evidence from children with intellectual disabilities. While children with intellectual disabilities constitute a high proportion of all child victims of abuse (Conway, 1994; Goldman, 1994; Morse, et ah, 1970), they rarely provide formal reports of abuse and of those incidents that are reported, few cases progress to court (Henry & Gudjonsson, 1999). Study 1 used a standard interview protocol containing a variety of questions and an interview structure commonly used in investigative interviews. Specifically, the memory and suggestibility of eighty children with either a mild and moderate intellectual disability (M age = 10.85 years) was examined when recalling an innocuous event that was staged at their school. The children's performance was compared with that of two control groups; a group of mainstream children matched for mental age and a group of mainstream children matched for chronological age. Overall, this study showed that children with both mild and moderate intellectual disabilities can provide accurate and highly specific event-related information hi response to questions recommended in best-practice guidelines. However, their recall was less complete and less clear in response to free-narrative prompts and less accurate in response to specific questions when compared to both mainstream age-matched groups. Study 2 provided an in-depth analysis of the types of questions and strategies used by twenty-eight police officers and caregivers when interviewing children with either mild or moderate intellectual disabilities (M age = 11.13 years) about a repeated event that was staged at their school. The results revealed that while the approach used by the police officers was generally consistent with best-practice recommendations (i.e., their interviews contained few leading, coercive or negative strategies), there were many ways in which their approach could be improved. This study also showed that the caregivers used a high proportion of direct and negative strategies to elicit information from their children. Even when caregivers used open-ended questions, their children provided less event-related information than they did to police interviewers. The results of both studies were discussed in relation to current 'best-practice' guidelines for interviewing children and recommendations were offered for improving the quality of field interviews with children who have intellectual disabilities.

Reinventing liberatory practice : how do we work with groups of which we are not a part?

The research that informed this paper asked: how can we work as allies of groups of which we are not a part? This question is particularly focused on work with people who have experienced colonisation by those who are aligned (by race, class, gender, culture or position) with the colonisers or oppressors. The research brings together literature in the fields of community work, adult education, and feminist and postcolonial theory, with Indigenous viewpoints and experience. An analysis of Indigenous viewpoints identified a range of key ideas about achieving social change.

These ideas are developed into several frameworks, two of which will be discussed here. The first framework offers a way of conceptualising work against oppression and proposes that it must involve a focus on fostering emancipatory agency. Emancipatory agency involves the capacity to know and to act towards social justice ends via meaning making which follows ethical criteria. An ethics of meaning making is proposed which includes a focus on: multiplicity and difference; the partial nature of all knowings; the context / situatedness of meaning; and the critical / reflective attitude in meaning making. This type of agency is dependent on the process of transformative dialogue which is inherently communal and is based on four micro processes: affirming the O/other; encountering, exploring and experiencing of multiple and partial views; moving between positions of self and others; and enacting meaning into the world. A second framework operationalises these ideas in the field of community development, and offers a method of practice.

An audit of clinical outcomes and client and referrer satisfaction with a mood and anxiety Disorders unit

Objective To evaluate outcome and client and referrer satisfaction with the service provided by a Mood and Anxiety Disorders Unit (MADU).

Method MADU was a specialized clinical service for the assessment and management of individuals suffering with affective and anxiety disorders. Clients were referred to MADU from a variety of health service providers. A telephone survey of 30 clients and 20 referrers who have used the services of MADU was conducted, investigating outcome satisfaction with the service provided by MADU.

Results Clients and referrers reported a high level of satisfaction with the service provided by MADU. There was a high degree of adherence to treatment recommendations. The mean Patient Global Impression of Improvement (PGI) rating by the clients before the MADU assessment was 2.74 (SD = 1.27). In comparison the mean PGI rating at the time of follow-up was 6.64 (SD = 1.91).

Conclusions Specialist mood disorders units are a useful and potentially cost-effective additional service included as a part of a mental health service.

Randomised controlled trials and 'unexpected' adverse events associated with newly released drugs : improvements in pharmacovigilance systems are necessary for real-time identification of patient safety risks

Adverse drug events are one of the major causes of morbidity in developed countries, yet the drugs involved in these events have been trialled and approved on the basis of randomised controlled trials (RCTs), regarded as the study design that will produce the best evidence.

Though the focus on adverse drug events has been primarily on processes and outcomes associated with the use of these approved drugs, attention needs to be directed to the way in which the RCT study design is structured. The implementation of controls to achieve internal validity in RCTs may be the very controls that reduce external validity, and contribute to the levels of adverse drug events associated with the release of a new drug to the wider patient population.

An examination of these controls, and the effects they can have on patient safety, underscore the importance of knowing about how the clinical trials of a drug are undertaken, rather than relying only on the recorded outcomes.

As the majority of new drugs are likely to be prescribed to older patients who have one or more comorbidities in addition to that targeted by a new drug, and as the RCTs of those drugs typically under-represent the elderly and exclude patients with multiple comorbidities, timely assessment of drug safety signals is essential.

It is unlikely that regulatory jurisdictions will undertake a reassessment of safety issues for drugs that are already approved. Instead, reliance has been placed on adverse drug event reporting systems. Such systems have a very low reporting rate, and most adverse drug events remain unreported, to the eventual cost to patients and healthcare systems.

This makes it essential for near real-time systems that can pick up safety signals as they occur, so that modifications to the product information (or removal of the drug) can be implemented.

Glaucomatous visual field progression with frequency-doubling technology and standard automated perimetry in a longitudinal prospective study

PURPOSE. To compare frequency-doubling technology (FDT) perimetry with standard automated perimetry (SAP) for detecting glaucomatous visual field progression in a longitudinal prospective study.

METHODS. One eye of patients with open-angle glaucoma was tested every 6 months with both FDT and SAP. A minimum of 6 examinations with each perimetric technique was required for inclusion. Visual field progression was determined by two methods: glaucoma change probability (GCP) analysis and linear regression analysis (LRA). For GCP, several criteria for progression were used. The number of locations required to classify progression with FDT compared with SAP, respectively, was 1:2 (least conservative), 1:3, 2:3, 2:4, 2:6, 2:7, 3:6, 3:7, and 3:10 (most conservative). The number of consecutive examinations required to confirm progression was 2-of-3, 2-of-2, and 3-of-3. For LRA, the progression criterion was any significant decline in mean threshold sensitivity over time in each of the following three visual field subdivisions: (1) all test locations, (2) locations in the central 10° and the superior and inferior hemifields, and (3) locations in each quadrant. Using these criteria, the proportion of patients classified as showing progression with each perimetric technique was calculated and, in the case of progression with both, the differences in time to progression were determined.

RESULTS. Sixty-five patients were followed for a median of 3.5 years (median number of examinations, 9). For the least conservative GCP criterion, 32 (49%) patients were found to have progressing visual fields with FDT and 32 (49%) patients with SAP. Only 16 (25%) patients showed progression with both methods, and in most of those patients, FDT identified progression before SAP (median, 12 months earlier). The majority of GCP progression criteria (15/27), classified more patients as showing progression with FDT than with SAP. Contrary to this, more patients showed progression with SAP than FDT, when analysed with LRA; e.g., using quadrant LRA 20 (31%) patients showed progression with FDT, 23 (35%) with SAP, and only 10 (15%) with both.

CONCLUSIONS. FDT perimetry detected glaucomatous visual field progression. However, the proportion of patients who showed progression with both FDT and SAP was small, possibly indicating that the two techniques identify different subgroups of patients. Using GCP, more patients showed progression with FDT than with SAP, yet the opposite occurred using LRA. As there is no independent qualifier of progression, FDT and SAP progression rates vary depending on the method of analysis and the criterion used.

Social and professional participation of individuals who are deaf : utilizing the psychosocial potential maximization framework

This article documents a strength-based understanding of how individuals who are deaf maximize their social and professional potential. This exploratory study was conducted with 49 adult participants who are deaf (n ¼ 30) and who have typical hearing (n ¼ 19) residing in America, Australia, England, and South Africa. The findings support a systematic and comprehensive framework of proactive psychosocial attributes and tactics. Statistical analysis showed no significant differences between the groups across four variables of psychosocial competencies. Qualitative data further suggests that participants who are deaf maximize their potential using two types of proactive psychosocial attributes and tactics: 1) skills that individuals with typical hearing use and 2) specialized skills for identifying, circumventing, or mastering deafness-related difficulties. These findings contribute to understandings of how individuals who are deaf can achieve social and professional success.

The conversational skills of school-aged children with cochlear implants

Children with cochlear implants have been shown to have language skills on a par with children with severe hearing losses who have hearing aids. Earlier implants, bilateral implantation, and focused intervention programmes may result in some children with cochlear implants displaying similar language skills to their hearing peers. The development of pragmatic skills is central to communication competence and underpins the development of friendships. Although some studies of pragmatic skills in children with cochlear implants have been reported, most have used a contrived referential communication task rather than free conversation.

Method: This study investigated the conversational skills of 20 children with cochlear implants, aged between 9 and 12 years, in free conversation with their hearing peers. The pragmatic skills of these 20 deaf/hearing pairs or dyads were compared with the pragmatic skills of 20 hearing/hearing dyads. Pragmatic skills were analysed in terms of conversational balance, conversational turn types, and conversational maintenance. The impact of the participants’ level of speech intelligibility was also investigated.

Results: Children with cochlear implants tend to dominate conversations with their hearing peers. They initiated more topics, took longer turns, asked more questions, and tended to make more personal comments while their hearing friends tended to use more conversational devices and minimal answers. In contrast, pairs of matched hearing children were very balanced in all of these aspects of conversation. Speech intelligibility did not appear to impact consistently on the pragmatic skills of the children with cochlear implants but all children had a relatively high level of speech intelligibility.

Discussion: Rather than being characterized by frequent conversational breakdown as in older studies, children with cochlear implants had a strong grasp of basic conversational rules. They conversed in a similar way to some deaf adults who also have been shown to take control of the conversation. Findings are discussed for their implications for intervention and future research.

Comparison of optimised MDI versus pumps with or without sensors in severe hypoglycaemia (the Hypo COMPaSS trial)

Background
Severe hypoglycaemia (SH) is one of the most feared complications of type 1 diabetes (T1DM) with a reported prevalence of nearly 40%. In randomized trials of Multiple Daily Injections (MDI) and Continuous Subcutaneous Insulin Infusion (CSII) therapy there is a possible benefit of CSII in reducing SH. However few trials have used basal insulin analogues as the basal insulin in the MDI group and individuals with established SH have often been excluded from prospective studies. In published studies investigating the effect of Real Time Continuous Glucose Monitoring (RT-CGM) benefit in terms of reduced SH has not yet been demonstrated. The primary objective of this study is to elucidate whether in people with T1DM complicated by impaired awareness of hypoglycaemia (IAH), rigorous prevention of biochemical hypoglycaemia using optimized existing self-management technology and educational support will restore awareness and reduce risk of recurrent SH.

Methods/design
This is a multicentre prospective RCT comparing hypoglycaemia avoidance with optimized MDI and CSII with or without RT-CGM in a 2×2 factorial design in people with type 1 diabetes who have IAH. The primary outcome measure for this study is the difference in IAH (Gold score) at 24 weeks. Secondary outcomes include biomedical measures such as HbA1c, SH incidence, blinded CGM analysis, self monitored blood glucose (SMBG) and response to hypoglycaemia in gold standard clamp studies. Psychosocial measures including well-being and quality of life will also be assessed using several validated and novel measures. Analysis will be on an intention-to-treat basis.

Discussion
Most existing RCTs using this study’s interventions have been powered for change in HbA1c rather than IAH or SH. This trial will demonstrate whether IAH can be reversed and SH prevented in people with T1DM in even those at highest risk by using optimized conventional management and existing technology.

Do we need both cognitive and behavioural components in interventions for depressed mood in people with mild intellectual disability?

 Background: A growing literature suggests that people with mild intellectual disability (ID) who have depressed mood may benefit from cognitive-behavioural interventions. There has been some speculation regarding the relative merit of the components of this approach. The aim of this study was to compare (i) cognitive strategies; (ii) behavioural strategies; and (iii) combined cognitive-behavioural (CB) strategies on depressed mood among a sample of 70 individuals with mild ID. Methods: Staff from three participating agencies received training in how to screen individuals with mild ID for depressive symptoms and risk factors for depression. Depressive symptoms and negative automatic thoughts were assessed prior to and at the conclusion of the intervention, and at 6-month follow-up. The interventions were run in groups by the same therapist. Results: A post-intervention reduction in depression scores was evident in participants of all three interventions, with no significant difference between groups. A significant reduction in negative automatic thoughts post-intervention was evident in the CB combination group and was maintained at follow-up. Examination of clinical effectiveness suggests some advantage of the CB combination in terms of improvement and highlights the possible short term impact of behavioural strategies in comparison with the longer-term potential of cognitive strategies. Conclusions: The findings support the use of group cognitive-behavioural interventions for addressing symptoms of depression among people with ID. Further research is necessary to determine the effectiveness of components. © 2013 John Wiley & Sons Ltd.

Excessive alcohol use and its association with risky sexual behaviour: a cross-sectional analysis of data from Victorian secondary school students

Objective
Estimate the prevalence of sexual behaviour and alcohol use and examine the association between excessive alcohol use and risky sexual behaviour in late secondary students in Victoria, Australia.

Method
The sample of Year 11 students from government and independent schools participating in the 2008 International Youth Development Study (n=450) was representative of the Victorian school population. Logistic regression analyses examined the associations between sexual behaviour, binge and compulsive drinking, adjusting for socio-demographic, school and family factors.

Results
Under half (44%) the students had experienced sex in the past year, half (50%) had engaged in binge drinking in the past two weeks and 26% reported compulsive drinking in the past year. Of those who reported sex in the past year (n=197), 34% had sex without a condom at the last sexual encounter and 28% later regretted sex due to alcohol. The likelihood of experiencing sex was increased by binge (OR=2.44, 95%CI 1.44-4.12) and compulsive drinking (OR=2.15, 95%CI 1.29-3.60). For those sexually active, binge drinking increased the risk of having three or more sexual partners (OR=3.37, 95%CI 1.11-10.26) and compulsive drinking increased the likelihood of regretted sex due to alcohol (OR=4.43, 95%CI 2.10-9.31). Excessive drinking was not associated with condom non-use.

Conclusion and implications
Risky sex – multiple sexual partners and regretted sex due to alcohol – and excessive drinking are highly prevalent and co-associated among Victorian late secondary students.

Living with suicidal thoughts

The dominant understandings of suicide have privileged the professional observations of health professionals and sociologists over the lived experiences of persons who have reported feeling suicidal. The current study explores what it is like to feel suicidal by examining comments posted voluntarily in an online forum. Adopting an inductive thematic analysis, a number of themes were uncovered which shed light on the following questions: Who has suicidal thoughts? What triggers suicidal thoughts? What is it like to feel suicidal? Also drawn from the data, was information relating to the types of treatments that people received, as well as ongoing survival strategies that people have relied on. The fi ndings indicated people with suicidal thoughts form a heterogeneous group with mixed opinions about the causes of suicidal thoughts. The findings also highlighted a variety of experiences, descriptions and means for survival highlighting the depth of insight that those with fi rst-hand experience have about suicidal thoughts, highlighting also the deep gap in knowledge and understanding in the existing literature about suicide and suicidal ideation. The recommendations for future direction in practice and research include, listening to, and valuing more, the voices and perspectives of suicidal people themselves.

Youth justice: challenges in responding to young people convicted of sexual offences

The clinical and criminological literature on adolescents who have committed sexual offences indicates that a pathologisation of young people and a labelling or overly punitive response is likely to be more harmful than rehabilitative. Accordingly, therapeutic counselling and diversionary schemes are seen as preferable to custodial terms in most instances. For adolescents convicted of sex offences, clinicians identify the benefits of comprehensive therapeutic care which involves family and is sensitive to the young person's context and culture. The benefits of this approach are documented and, although data are limited, indications are that recidivism is reduced where adolescents are provided with specialised counselling to encourage positive and non-abusive behaviours. Yet each jurisdiction experiences difficulties in ensuring the provision of equitable and comprehensive therapeutic services, particularly to regionally or remotely located youth. This paper draws on data from a national study of the services to children and adolescents with sexualised or sexual offending behaviours. With attention to the difficulty in providing services to regionally or remotely located adolescents, this paper identifies challenges around lengthy remand terms, the provision of pre-offence diversionary programs, and the provision of specialised services for young people serving community orders. For example, jurisdictions with the largest geographic service areas face enormous difficulties in providing specialised supervision for community-based orders. At present there are several jurisdictions where regionally and remotely located adolescents may serve the duration of a youth justice order without receiving sepcialised counselling to assist them in modifying their behaviours. The paper identifies the risks where specialised counselling cannot be provided, but also identifies specific initiatives designed to fill these gaps in service provision to youth justice clients. 

Improving access to the justice system for people with communication difficulties : a training program for people working in the justice system

This training package is provided as a guide and resource to promote awareness and understanding of people who have complex communication needs and give people who work in law and justice system strategies to facilitate successful communication interactions. Complex communication needs are defined as communication problems associated with a wide range of physical, sensory and environmental causes which restrict/limit an individual's ability to participate independently in society. They and their communication partners may benefit from using Alternative and Augmentative Communication (AAC) methods. Alternative and Augmentative Communication (AAC) is an approach or communication system that makes it possible for a person without speech to communicate. AAC includes gestures and sign language, picture and alphabet boards and high technology electronic communication devices that produce computerised speech. Many people with complex communication needs use a combination of AAC communication to express themselves. It is hoped that this package will facilitate access to the justice system for a group of people who may experience social disadvantage as a result of their complex communication needs. The information included in the package is not exhaustive. It is designed to : provide the trainer and staff with a general understanding of complex communication needs; challenge misconceptions about people who have little or no functional speech; provide practical strategies and guidelines to assist staff to more successfully communicate with people with complex communication needs.

Group cognitive behavioural therapy program shows potential in reducing symptoms of depression and stress among young people with ASD

We examined the efficacy of cognitive behavioural therapy (CBT) delivered in groups on the reduction of symptoms of depression, anxiety and stress in young people on the autism spectrum. Utilising a quasi-experimental design, comparisons were made between individuals allocated to a group intervention program and individuals allocated to a waitlist. Following the intervention program, participants who were initially symptomatic reported significantly lower depression and stress scores on the Depression Anxiety Stress Scales in comparison to individuals on the waitlist. There was no significant change in anxiety related symptoms. The benefits were maintained at 3 and 9 month follow-up. Our findings demonstrate the potential of CBT in a small group setting for assisting young people with ASD who have symptoms of depression and stress.

Looking for a needle in the haystack: arsonists with intellectual disability in Australia

Arson attracts substantial penalties in Australia, reflecting the serious consequences of the crime. It is often asserted that people with intellectual disability are particularly likely to commit arson offences, and yet it is difficult to establish the prevalence in this population. This study sought to describe the characteristics of those people appearing in Australian Courts who have an intellectual disability and have been charged with arson. A search of the AustLII, LexisNexisAU and WestLawAU databases over the 10-year period from 2003 to 2013 identified 50 arson convictions reported in case law. Of these, six involved an offender with an identified intellectual disability. These offenders were likely to have committed other crimes at the time, or to have prior offences and were likely to receive longer sentences of imprisonment than their non-intellectually disabled counterparts. These findings are discussed in terms of the barriers that exist to understanding more about this under-researched population.