Research suggests that individuals with autistic spectrum disorder (ASD) and learning disabilities (LD) experience difficulties in developing meaningful intimate relationships, and mainstream sex education is not adapted to meet their needs. However, ASD and LD frequently co-occur (ASD-LD), and findings suggest this population have unique needs, compared to those with ASD and LD. There is a paucity of research on how sex education should be adapted for individuals with ASD-LD. This study aimed to explore the views of 21 health and social care professionals, experienced in delivering sex education for adults with ASD-LD, on which characteristics of adults with ASD-LD should be considered when providing sex education, and what adaptations to sex education are thus required. To seek whether a group consensus between professionals could be gained, an electronic, three round, Delphi method was used. Findings showed that professionals agreed on the unique characteristics of adults with ASD-LD, and the various adaptations to sex education required, which differed for adults with ASD and LD. The most important characteristics and adaptations primarily related to; communication needs, cognitive and executive functions, social impairments, and sensory needs. The clinical and research implications of the findings are presented.

This study explored the application of Weiner’s attribution models of helping behaviour to care staff working with overweight people with learning disabilities. Staff were asked to have a client in mind who was significantly overweight and to complete self-reports of their attributions, affect, optimism and willingness to help the person with their weight. The study found that staff rated their clients’ weight as being attributed slightly more to internal factors than external factors, being low in controllability and high in stability. Staff reported low levels of positive and negative emotion but high levels of sympathy, optimism and willingness to help. No associations were found between attributions or affect and willingness to help. Only optimism was associated with willingness to help. The findings did not support the applicability of Weiner’s attribution models to staff supporting overweight people with learning disabilities. These findings contribute to the inconsistent literature on the applicability of Weiner’s model to staff helping in LD services. Future research should clarify whether willingness to help relates to effective health helping strategies and to explore this further in service contexts. The clinical implications for staff training include enhancing staff’s optimism in health change and providing skills in constructively engaging client’s in healthier behaviours.

Section A explores the insights offered by the qualitative literature to our understanding of staff responses to challenging behaviour within services for people with intellectual disabilities. The trustworthiness of the literature is examined. The studies are reviewed using the cognitive-emotional model as a guide and allowing for other themes to emerge. The review concludes with a discussion of the implications for future research and clinical practice. Section B reports on a pilot study investigating staff reactions to challenging behaviour within services for people with intellectual disabilities. This study sought to explore the development of staff cognitive, emotional and behavioural responses to challenging behaviour over the course of challenging interactions. Video elicitation interviews were conducted with six staff members responding to the challenging behaviour of two service users. Interview data were subject to content analysis and an attributional analysis in order to assess their cognitive and emotional responses as they were at the time. In addition, staff behaviour was subject to descriptive and sequential analyses to explore their relationship with cognitive-emotional variables. Results indicated that staff experienced a wide range of cognitions and emotions during challenging interactions. Cognitions varied over the course of an incident. A tentative relationship was found between internal attributions of challenging behaviour, negative emotions and verbal responses by staff. Staff members spontaneously made causal attributions of service user behaviour during challenging interactions. Rather than being a stable attribute of the staff member, attributions seem to vary to a degree across the course of an interaction. This has implications for both research and clinical practice.

There is a growing number of initiatives aiming to support people with intellectual disability (ID) to find romantic partners but minimal relevant research to inform these initiatives. The present study explored the ideal partner preferences of people with Down’s syndrome (DS); a genetic disorder resulting in ID. Adults with DS (5 male, 5 female) completed an interview incorporating the repertory grid from Personal Construct Psychology to explore their ideal partner preferences, explanations for these and how they relate to their perceptions of actual partners and self. Interview data was subjected to content analysis, thematic analysis and analysis using Idiogrid. Participants typically preferred partners who were good looking, warm, employed, nondisabled and similar to them with the exception of having no disability. Partner’s parental approval also appeared to be important. Explanations were grouped into five themes. Actual partners were typically dissimilar from ideal partners, including all but one having ID. Four participants’ more unique ways of thinking about people were also discussed. Five participants had a current partner. These relationships appeared to be maintained by valuing unconventional traits such as disability or managing expectations of a partner by making compromises or employing psychological defences. Initiatives aimed at facilitating relationships for people with DS may benefit from incorporating a service dedicated to helping them communicate their ideal partner preferences and process feelings linked with managing expectations. One area of future research could evaluate how best to facilitate these conversations.

This study investigated the antecedents and psychological processes inherent in firesetting within an adult intellectually disabled population. A qualitative methodology, grounded theory (GT) was employed to explore the experience of firesetting through verbal self-report. A sample of eight males with mild intellectual disabilities under the care of forensic learning disability services participated in interviews which ranged from 27 minutes 14 seconds to 1 hour 21 minutes 22 seconds. The data produced a preliminary GT which identified eight conceptual categories: Managing internal affect states, the experience of adversity, unsafe others, engagement in multiple offending behaviours, voice entitlement, experiences of fire, and mediators of risk and the function of firesetting. These conceptual categories were linked by an overarching core category of ‘powerlessness’ which was evident in several areas of the participants’ lives and experiences of firesetting. It was concluded that this sense of powerlessness along with the conceptual categories should be considered when risk assessing, delivering firesetting specific treatment and psychological interventions. The clinical implications are discussed and suggestions are made for replication of the current study with larger, more diverse samples and future directions for further research are proposed.

This thesis presents a study exploring the lived experience of becoming cared for from the perspective of women with Alzheimer's disease (AD). The objectives of the study were to reveal the experience of receiving assistance with instrumental activities of daily living (IADL's) from the perspective of women with AD, to explore the care relationship between women and their spouses and to examine the changing role and identity of those women. Interpretative Phenomenological Analysis (IPA) was used as the methodology to explore the meaning given to becoming cared for. This methodology promotes the recognition of the unique ways individuals experience the world and is regularly used to better understand how illness affects behaviour and lifestyles. Eight women with AD took part in two semi-structured interviews and their transcripts were analysed individually, before exploring convergences and divergences across cases. Three key experiences emerged from the final analysis; 'It's a togetherness', 'Me being me' and 'Seeing cobwebs'. The findings identify becoming cared for as a relational phenomenon for the women, influenced by their experience of ongoing connections with their husbands. Some participants attempted to maintain their sense of self and womanhood in relation to completing IADL's, comparing their past selves to the present. However, this experience was often negatively affected by how others treated them. Other women viewed the changes they experienced in a more positive way, accepting becoming cared for as a part of life. There was a clear sense of contentment in their evolving lives, seeing beauty where they had not seen it before. This adds an alternative view to current literature, as some women appear to embrace the change in themselves when becoming cared for, rather than experiencing a loss of identity. Humanisation theory provides a conceptual framework to aid change in healthcare professional's practice, by encouraging them to regard women with AD as holistic human beings. Whilst change may be viewed by healthcare professionals as a negative symptom of AD, it should be considered that becoming cared for may be experienced as a positive transition in life.

A literature review examines how mental health difficulties may differ for people with learning disabilities (PwLD) and the general population; with respect to their vulnerability to mental ill-health and the definition, presentation and treatment of mental health problems. Factors which have been found to positively impact on the mental health of PwLD are then explored. The review considers methodological limitations and gaps in our understanding, highlighting a need for further research focusing on mental health recovery for individuals with learning disabilities. Section B presents a study exploring what recovery means for people with learning disabilities and mental health difficulties. Interviews were conducted with nine individuals and Interpretative Phenomenological Analysis used. A model was developed which described participants’ entry to the therapeutic service and their progression towards recovery. The model firstly describes how participants felt entering the service, their Mental Health/Therapy Experience, and explains how these experiences were validated and the recovery process enabled through the therapeutic alliance. Once enabled, the second dimension of the model is detailed, that of the Client Recovery Experience which extends across three phases of recovery. The first phase, Feeling Better describes elements perceived as integral to improved mental health. The second phase, Recovery Ongoing identifies that more input is required. Thirdly, Attainability?: Reality, Ideals and Fantasy, reveals PwLD’s perceptions of recovery and the techniques used in striving to achieve this. Salient features of recovery specific to PwLD are recognised as important to clinical practice, and results suggest there is a need to openly discuss LD identity, and address idealisations surrounding a non-LD one. This would involve setting realistic goals and managing expectations accordingly and focussing on social integration as a way of enabling ongoing recovery.

There is a need for appropriate screening tools for the assessment of autism spectrum disorder (ASD) in those with learning disabilities (LD) given the co-occurrence of the two conditions. The AQ-10 is the screening tool recommended by NICE (2012) for the case identification of ASD in adults with a borderline or mild learning disability. However, the AQ-10 was not developed with this population in mind. A mixed-methods approach was used to investigate the utility of the AQ-10 in its original form as a case identification tool. The AQ-10 was then redesigned and piloted. Qualitative results revealed individuals found the AQ-10 too inaccessible in its current format. Following revision, the diagnostic validity of the revised measure (AQ-10-R) showed good sensitivity (0.85) and specificity (0.77), whereas the diagnostic validity of the original AQ-10 was poor. The internal consistency for the AQ-10-R was 0.67 and 0.30 for the AQ-10. These findings indicate that simple formatting and administration changes may be needed to the AQ-10 before clinicians consider using it when helping to make decisions regarding referral for diagnostic assessment in those with borderline or mild learning disabilities.

Section A explores capacity to consent to healthcare in adults with an intellectual disability in a broad context. It examines the legal understanding of capacity to consent as defined by the Mental Capacity Act (2005), before going on to use decision-making theory as a framework for exploring the psychological understanding of capacity to consent. It then examines the empirical literature on what influences capacity to consent to healthcare interventions and research in people with an intellectual disability, highlighting what further research is needed. Section B reports an empirical study, which follows up on some of the further research suggested by Section A. Background: Capacity to consent has been identified as one of the significant barriers to healthcare faced by people with intellectual disabilities. In order to improve understanding, the literature has attempted to investigate factors that influence capacity to consent to healthcare. Materials and Method: This study had 32 participants with learning disabilities, 22 carers and 3 nurse participants. It examined the correlations between verbal ability, decision-making opportunities and previous health experience, with capacity to consent to healthcare in people with learning disabilities, before exploring a regression model to show how the factors interacted. Results: Previous health experience and verbal ability significantly positively correlated with capacity to consent, whilst the correlation with decision-making opportunities was almost significant. However, the regression model showed that only verbal ability was a significant predictor. Conclusion: The study reveals the importance of looking at how factors that influence capacity to consent to healthcare interact with each other, rather than just acting individually. Further research is required to expand this model to include other variables. Section C provides a critical appraisal for the whole project, exploring what was learnt and what could have been improved on, as well as considering the implications for clinical practice and further research.

This thesis presents a critical disability discourse analysis. It examines the discursive construction of disability and the personal and political positioning of disabled people. Focusing on disclosure, identity, activism, theory and policy issues relating to disabled people, the naturalisation and invalidation of the disabled body is explored and critiqued. Organised in three parts, the thesis begins by considering some significant historical moments, the sociolegal context and the recent politicisation of both disabled people and disability research. Disability is argued as embedded in, and institutionalised by, political regulatory structures and research that risks de-politicisation of it is critiqued. Part two considers theories, methods and the text data collected for the research. This defines the theoretical orientation to discursive psychology, discourse analysis and critical disability studies. Disability is articulated as an object in, and for interaction and its construction linked to historical, social and political structures that regulate and sustain the human subject. The text data used in the thesis is then presented in terms of the collection process and the organisation of extracts within the current thesis. The forms of text data collected include transcriptions of discussion groups with disabled people, front line workers and senior managers, policy documents, publicity imagery and Hansard records of parliamentary debates. Part three then presents a critical disability discourse analysis using this text data. Drawing on the framework of discourse analysis as articulated by Potter and Wetherell (1987) the discursive function, construction and variation of disability talk and textwork is critically considered. This reveals dilemmas of positioning and ideology during moments of disability disclosure. Analytical commentary argues that disability identity is constructed by an interpretative repertoire embedded in the antithesis of desired and valued life. The construction of ‘barriers’ in social model texts are also explored in discussion groups and local policy documents. This shows the recent distortion and colonisation of the social model, and suggests that the metaphor of ‘barriers’ used to signify the structures that disable people has lost its once radical and resistive power. Hansard records are then used to explore implications and dilemmas which arise regarding agency, autonomy and the disabled body in relation to dominant discourses of individualism and the challenges this poses for an ‘independent living’ reform strategy. The thesis concludes by asserting a discursive mode of disablism. This is suggested as a useful driver for research and initiatives to expose and challenge everyday discourses and practises that perpetuate the invalidation of the disabled body.