Journal of Intellectual Disabilities

The following paper is a review of behavioural disorders that may be associated with tuberous sclerosis. Areas covered include its association with autism, attention deficit hyperactivity disorder and sleep disorders, as well as other less prevalent disorders. The relationships between these behavioural disorders and epilepsy/degrees of intellectual disability are discussed.

The role of the Registered Nurse Mental Handicap (RNLD) within multidisciplinary community support teams was explored within a single county in South Wales. A survey of six community support teams included all members with a professional background. The target population consisted of a total of 96 professionals including RNLDs, social workers, physiotherapists, speech and language therapists, Mencap support workers, psychiatrists and team managers. Each professional was issued with a pre-tested questionnaire that examined their perceptions of their own role and the role of the RNLD. Eighty (83%) completed questionnaires were returned. The results suggested that the RNLDs were seen to contribute five key roles: client based interventions; co-ordination and planning of care; training; care management; and health promotion. Fifty-four per cent of respondents indicated that the role of the RNLD could not be taken by another. The roles and skills of the RNLD and the implications of referral and record keeping methods were discussed.

This paper describes part of a larger study that involved interviewing clients, carers and service providers to investigate barriers to independent travel for people with severe learning disabilities. The initial part of the study, reported here, involved interviewing service providers. A purposive sample of 2I service providers involved in promotion of independent travel for people with learning disabilities in the South East of one of the major cities in Northern Ireland were interviewed. Aims were to identify the number of clients on travel programmes, perceived barriers and suggestions to promote independent travel. Analysis involved mainly quantitative methods, with a small qualitative input. Findings indicated that although independent travel was viewed as a valuable skill for people with learning disabilities to possess, there were relatively few who practised this. In a population of 890 people, 187 (21 %) were reported as being able to travel independently. In the remaining 703 people, 65 (9%) were involved in programmes to promote independent travel. This data was obtained from the respondents who collated the figures from notes and records in the establishments in which they were based. The most significant obstacles to independent travel were suggested to be clients' cognitive abilities, and the wishes of carers, who according to the study, often did not wish the client to be involved due to perceived risks. Recommendations are made regarding practices to promote independent travel.

The need to understand the role of communication in triggering, maintaining or exacerbating challenging behaviour is crucial when working with a client group with severe learning disabilities. Speech and language therapists are becoming increasingly involved in this process. The Royal College of Speech and Language Therapists (RCSLT 1996), recommend that the most appropriate form of intervention includes:

I. facilitating carers in the understanding of the nature and causes of challenging behaviour, particularly in relation to communication

2. facilitating carers in understanding the role of the environment and their own communication in relation to the clients challenging behaviour

3. facilitating carers in developing more appropriate ways of communicating with clients with challenging behaviour

4. Supporting carers in developing appropriate activities for the client (RCSLT I996)

This project used the above principles to investigate the effect of speech and language therapy on the communication environment in a home for people with learning disabilities and challenging behaviour. The results show an increase in: the length of interactions initiated by the staff with the service users; the use of non- verbal communication to support interactions and a decrease in the number of attempts the service users needed to make before a staff response was given. The author concludes that speech and language therapy was effective in improving the communication environment. The impact of the improved communication environment on challenging behaviours was not measured.

This report describes a comprehensive population-based study of people with learning disabilities aged 65 years or over, living in Leicestershire, UK (n = 134), compared with a randomly selected group of people with learning disabilities aged 20-64 years (n = 73). Older people with learning disabilities include equal numbers of men and women, unlike younger individuals where men predominate. This finding is in keeping with the general population, where women have a greater life span than men (i.e. women outlive men and so the ratio between men and women changes with age). The distribution of the degree of learning disabilities was more severe for younger as opposed to older people; this probably relates to a differential mortality rate. Differences were also found between the two groups with regard to the aetiology of learning disabilities. Fewer elderly people lived with relatives: the majority lived in residential care using both learning disabilities services and services designed for the general population of older people. The social networks of the older cohort were more restricted than those of the younger cohort, and they spent less time engaged in enjoyable social interactions and activities. This suggests that current services are not yet meeting the needs of this growing older population.

The 1990s have seen a rapid growth in the number of agencies offering supported employment for people with learning disabilities. Initially, many of these agencies saw their role as job coaching and support in the work place. However, with the implementation of the Disability Discrimination Act 1995 (DFEE 1996) some large employers have started to use these agencies as consultants in setting up their own supported employment schemes within the work place. This paper explores the growth and evolution of these schemes and considers the impact of the Disability Discrimination Act.