Editorial: New developments in psychological interventions

We are pleased to be able to present a special edition of the International Journal of Developmental Disabilities on developments in psychological interventions for people with developmental disabilities. In this issue, we have deliberately included a very broad range of interventions and have focussed on interventions that are either in the process of being developed or that may provide an impetus for new initiatives. While the interventions presented may not always meet the criterion of having an established an conclusive evidence base, new approaches and ideas need to start somewhere and we are hoping that the papers in this issue will lead to further research on their effectiveness.

The development of new psychological approaches is vitally important if we want to find better ways to support people with developmental disabilities and help them lead fulfilling and inclusive lives. This has been brought into sharp focus recently by NHS England’s new initiative called: ‘Stopping Over-Medication of People with a Learning Disability, Autism or Both’ (STOMP; England, NHS 2018). STOMP was initiated to address the widespread and harmful practice of over-prescribing psychotropic medication for people with developmental disabilities, often without their informed consent. Another recent initiative in England, the Transforming Care Agenda was developed in response to the discovery of abuse in a private hospital in England (Department of Health 2012), sets out an agenda for moving people with developmental disabilities from hospital settings into the community. Both of these initiatives require psychological interventions to support their implementation if they are going to be successful. Whilst there are already a number of well-established psychological approaches that can potentially decrease medication use for our service users, for example anger interventions (e.g. Willner et al. 2013) and positive behavioural support (Rose et al. 2014), it is important that new approaches are identified and developed so that a broader range of options are available.

We consider it important to develop a variety of psychological interventions, not just those that are aimed at reducing challenging behaviour. Interventions that can broaden the experiences, skills and knowledge of people with developmental disabilities are important as they can improve autonomy and hence quality of life. Vereenooghe and Westerman (2019) describe the development of a psycho-educational intervention aimed at improving the mental health of participants with developmental disabilities. Their paper describes a process that includes significant input from service users to design the content and format of the intervention. Co-design approaches of this type are likely to play an increasingly important part in the development of psychological interventions in the future.

Not all people with developmental disabilities are able to self-report due to the severity of their disability. However, it is important to try and understand their needs as well as we can. Adams and Jahoda (2019) report on a study which involved interviewing mothers of adults with severe or profound developmental disabilities who had sought mental health support for their offspring. The qualitative analysis of the interview data highlights some of the difficulties for this group to access appropriate psychological interventions. On the basis of their findings, the authors suggest developments and adaptations that could improve mental health services for people with severe developmental disabilities.

Pearson et al. (2019) evaluated the use of an educational DVD which focussed on the importance of early attachment behaviours. The DVD was shown to young adults with developmental disability who were not yet parents. The participants demonstrated significant improvements in their knowledge and understanding of attachment after watching and discussing the video, which suggests that this is a promising teaching method to prepare expectant parents for the challenges of parenthood. Lowry et al. (2019), report on a small controlled trial of an intervention whereby children with emotional and behavioural difficulties participate in twice-weekly drumming lessons. The children were assessed prior to and after the intervention and were found to have improved on a range of social and behavioural measures. The potential importance of film and music as modalities are highlighted by these two studies and are worthy of further application and investigation in order to consider how we can provide psychological interventions when spoken (and written) language is problematic for our service users. Clements (1997) draws our attention to the various modalities that people can employ to make sense of their environment– auditory, visual, olfactory, tactile, kinisthetic. People vary in what they attend to and how they experience the outside world. The focus of ‘talking therapies’ on higher order levels of verbal communication neglects other ways in which information is processed, beliefs are formed and skills are learned.

Poppi et al. (2019) describe a cross-national study which monitored the development of children with autism in the UK and Greece. While there were a number of similarities between the children’s rates of development, differences were noted over time. These differences appear to be related to the therapies that they were receiving. Participants receiving psychotherapy and occupational therapy recorded a larger decrease in stereotypical behaviour whilst those receiving speech therapy showed superior language development. Psychotherapy participants also recorded an increase in imagination. These results suggest that a range of early interventions (addressing different aspects of development) are beneficial for children with autism. Further research needs to be done in order to be able to assess their effectiveness in more detail.

Other papers in this special issue utilise more established psychological approaches but demonstrate how these can be adapted to different contexts. McLay et al. (2019) describe an application of functional behavioural assessment to sleep disturbance in children with autism. Two case studies are described where multiple individual interventions are designed (informed by the functional behavioural assessment) which are shown to have a positive impact on the sleep patterns of the two children. Many difficulties can be associated with the implementation of behavioural assessments and support plans. As most practitioners will be aware, the compliance of the carers and support workers who implement these plans can be a particular challenge. Thomas and Lafasakis (2019) describe a method that may help practitioners overcome some of these difficulties. They take an inclusive approach, in this case consisting of careful consultation with four classroom aides who were expected to carry out an intervention with a four-year old boy with autism. For the purpose of consultation, the authors introduced an acceptability questionnaire and used the responses to this questionnaire to redesign the intervention. After the consultation and the subsequent adaptations to the intervention plan, they achieved significantly greater compliance from the staff. Initiatives of this type are innovative and address one of the core barriers to successful clinical outcomes.

Finally Gray et al. (2019) report on the use of heart rate variability biofeedback as a possible intervention for sex offenders with a developmental disability. The participants were given a visual cue of a butterfly and an audio cue of a chime which were set to a regular (8 second) breathing pattern. Participants were also provided with data on heart rate and variability, thus allowing them to develop an awareness of and regulate their heart rate variability. Theory suggests that if individuals develop skills in self regulation in one area then this may generalise to other areas. The sample used was small and the impact on sexual offending difficult to judge due to the limited data set and circumstances of the participants. However, the intervention was acceptable to the participants and was valued by some. This paper establishes the feasibility of the methodology and suggests it could be trialled on a larger scale both with offenders and other service users.

We hope that these papers provide insight and inspiration to try out and evaluate new ways of implementing psychological interventions with people who have developmental disabilities. Embracing new ways of working will be key in improving quality of life and reducing the historical reliance on medication as a means of ‘managing’ people with developmental disabilities.

Note from the editors

The editors of the International Journal of Developmental Disabilities (IJDD) are proud of this special thematic issue devoted to developments in psychological interventions for people with developmental disabilities, conceived and organised by the guest editors, John Rose and Biza Stenfert Kroese. We thank John, Biza, as well as the individual contributors, authors, and reviewers for their hard work and commitment to making this special thematic issue a success.

Arturo Langa and Brian Salmons