This PhD study examines how people who are intellectually impaired are processed within the criminal justice system. In this context it analyses the understanding of intellectual disabilities, criminal justice decision-making processes, and the constructon of crime and punishment by professionals involved in criminal justice. Despite significant changes in mental health legislation and greater awareness by professionals of issues around intellectually disabled offenders, previous research has demonstrated that this population remains disadvantaged when coming into contact with the criminal justice system. The study focuses on how the criminal justice system maintains its traditional way of operating when engaging with people who are impaired in their intellectual capacities and who, therefore, often have difficulties in processing information and understanding complex situations. The study draws on qualitative data generated through thirty five unstructured interviews with custody sergeants, forensic examiners, prosecutors, magistrates, judges and probation officers from three regions in the North West of England: Cheshire, Merseyside and Greater Manchester. Through those interviews, the provision of support to alleged offenders is examined and the process of legal representation evaluated. By analysing decision-making processes around vulnerable defendants, two conflicting views that influence cimrinal justice professionals in their strategic behaviour were identified: protecting offenders' rights and protecting the public from criminal behaviour. It is argued that the criminal justice system draws its normative and enforcement powers from a 'discourse of truth' that concentrates on capacity and intent. Defendants who are classified as vulnerable because of impaired intellectual functioning whereby capacity to reason and intellectual disability are functionally separated. This way, an alleged offender's vulnerability becomes a manageable object within the criminal justice system and is integrated into a person's risk management. The disjointed discourse around intellectual disabilities increases the risk that people with an impaired level of intellectual functioning become drawn into the mainstream criminal justice system and, therefore, further compromises the empowerment and social inclusion of this population.

The notion of choice is emerging as fundamental to new approaches to the provision of housing for people with intellectual disabilities. Choice is raised as a central theme in debates about state-funding distribution practices, allocation priorities, location, design and model of new housing developments and the overall aims of disability policy. For its advocates, this ‘choice agenda’ counters paternalistic traditions within the welfare state by offering individuals with disability more choice of where, how and with whom they live, respected as self-determining individuals in society. For its critics, the choice agenda is a neoliberal policy strategy to decrease government funding and responsibility for the provision of welfare services. In between, choice could be dismissed as empty rhetoric. My thesis examines these interpretations, aiming to offer a more coherent and critical understanding of choice as a basis for theory, policy and practice in housing for people with intellectual disabilities. / Three main themes are considered, giving rise to a more critical conceptualization of choice. First, debates about civil-rights and redistribution are revisited and considered as sources from which competing discourses of choice emerge. Second, the individuality implied by choice is considered in light of the ‘community-care’ ethos. Third, an institutional perspective is applied to examine the role of ‘choice’ as a logic of practice within state administration. I examine these themes with a case study - housing for people with intellectual disabilities in the State of Victoria. Interviews were conducted with over fifty people, both users and providers of services in various positions and locations. Analysis explores the implications of the choice agenda on practices and decisions concerning the location and design of new housing developments, and on allocation of placements. The choice agenda has affected these practices in a way that reshapes the geography of housing for people with intellectual disabilities in Victoria.

Previous studies of autism spectrum disorder (ASD) have shown abnormalities in brain development, synaptic plasticity, and social and learning behavior. Our previous study has identified the X-linked gene KIAA2022, and its protein product KIDLIA, as the etiological factor in a particular group of patients with intellectual disability and ASD phenotypes. I found that KIDLIA is neuron specific and localized exclusively in the nucleus, indicating a possible role for KIDLIA in neuronal gene regulation. Using rat hippocampal neurons, I found that shRNA-mediated knockdown of KIDLIA resulted in a marked impairment of neurite outgrowth via the disruption of the N-cadherin/δ-catenin/RhoA signaling pathway. Additionally, I showed that loss of KIDLIA expression decreases synapse formation and synaptic transmission. To investigate the role of KIDLIA in vivo, I generated and characterized KIDLIA knockout (KO) mice. KIDLIA KO mice demonstrated significant impairments in social interactions, increased repetitive behaviors and deficits in learning and memory, consistent with symptoms observed in human ASD patients and validate this mouse line as a valuable new model for ASD. The KIDLIA KO mice showed reduced synapse formation and abnormal expression of synaptic components such as the GluA1 subunit of AMPA receptors. To understand the potential role of KIDLIA in gene regulation, I used RNAseq to identify major candidates involved in synapse formation and function and discovered the synapse-enriched Ca2+-mediated protein, neurogranin, as the most down-regulated synaptic transcript. I showed that over-expression of neurogranin can rescue KIDLIA-dependent structural and functional synaptic deficits. This study provides valuable insight into the cellular and molecular mechanisms underlying KIDLIA-dependent autism and intellectual disability phenotypes. / 2018-11-08T00:00:00Z

This thesis explored attachment in individuals with intellectual disability (ID). It investigated the role that attachment may have in presenting difficulties, including trauma symptoms, which has a growing body of literature, particularly in people without ID. Paper 1 describes a systematic review of the available literature relating to the psychological well-being of young people with ID in the UK who are 'looked after children' (LAC) or who live away from their birth families. Evidence suggests that both LAC and people with ID, may be vulnerable to developing mental health difficulties. However, there is a paucity of research investigating the psychological well-being of young people with ID who are LAC or who live away from birth families. 17 studies were reviewed, which ranged between 21% and 71% in quality as measured by the QATSDD (Sirriyeh, Lawton, Gardner, & Armitage, 2012). . Only one study was found that directly focused on the psychological well-being of LAC with an ID. The available studies offered some insights into the prevalence, characteristics of young people with ID who are LAC or who live away from their birth families and some of the psychological difficulties they encounter. However, given the methodological limitations of the included studies, no firm conclusions could be drawn. Paper 2 describes an empirical study that investigated the relationship between attachment security and trauma symptoms in adults with ID. 27 staff and service users participated in the research. Service user participants completed a self-report questionnaire regarding trauma symptoms with the researcher and staff participants provided demographic information and completed questionnaires that measured attachment security, trauma symptoms, depressive mood and traumatic events in relation to the service user. No relationship was found between attachment security and trauma symptoms. However, it provided tentative evidence with respect to the type of traumatic events experienced by people with ID and of the prevalence of mental health difficulties in people with ID. There were however several methodological limitations, including a small sample size. Implications for future research and clinical practice are outlined. Paper 3 provides a critical and personally reflective account of undertaking the systematic review and empirical study as outlined above. Strengths and limitations of the research are interwoven throughout. Recommendations for future research and implications for practice are also considered.

Magister Curationis - MCur / Cardiopulmonary resuscitation (CPR) is a core emergency skill in which all nurses need to be proficient to save the lives of patients. It is important for nurses working in psychiatric hospitals to administer CPR correctly should the need arise. However, they rarely perform CPR as the patients they care for are generally not physical ill, unlike patients admitted in general hospitals. Given the paucity of literature on CPR in psychiatric hospitals, this study aimed at investigating the attitudes towards CPR and the CPR competency of nurses working at a hospital for intellectually disabled people in the Western Cape, South Africa

Traditional conceptions of autonomy, which highlight the separation of the individual from the social forces around them, contradict a core assumption of sociological thought: that the individual is embedded in society. What then are we to make of autonomy’s cultural power to structure a person’s relationships and commitments? Moreover, how do people maintain autonomous social identities despite the dependencies that structure modern life? I explore these questions through ethnographic inquiry of the daily negotiation of carework and autonomy at an independent living community for adults with intellectual disability. I find that autonomous social identity emerges when autonomous actions are socially and temporally distanced from the actions of others. By framing dependence as a momentary state on the way to a more autonomous future, staff attribute autonomy to participants based on their progress toward future goals. The result is paradoxical. When daily productivity becomes the most salient indicator of autonomy, participants are obligated to be autonomous as a condition for their status as adults. I argue that this obligation to autonomy is a basic mechanism through which social institutions, like adulthood, induce self-governance as a mechanism of social control.

The purpose of this paper is to examine social systems theory as it relates to the inclusion of disenfranchised populations into the larger social system by enabling these populations to receive education and resources which can allow them to develop skills needed to achieve inclusion. Specifically this study is concerned with using elements of social systems theory to develop a sexual education program for a population identified with an Intellectually/ Developmentally Disability (ID/DD). In order to do this, it is necessary to work within the family or caregiver system where these individuals live and function. Caregivers must be helped to recognize the potential for inclusion in this area of life for this population, and educational tools appropriate to the developmental and cognitive levels of the participants must be made available. Acknowledgment of the individual's role within the system and understanding of the individual's experience of that systems interaction with the environment and with other systems is primary in developing effective programming which can increase the quality of the participants' interactions and relationships, making life a more productive and more satisfying experience.

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Book Summary:What is unique about the process in the discussion of healthcare and interventions to use when working with families? What assessment tools provide guidance for healthcare providers as they determine interventions for families in their care? What are the changing dimensions of contemporary family life, and what impact do those dimensions have on health promotion for families? How is family healthcare changing in terms of practices, delivery systems, costs and insurance coverage? Students are able to explore these questions and more in the Encyclopedia of Family Health. Approximately 350 signed articles written by experts from such varied fields as health and nursing, social and behavioral sciences, and policy provide authoritative, cross-disciplinary coverage. Entries examine theory, research and policy as they relate to family practice in a manner that is accessible and jargon-free. From ′Adolescent Suicide′ and ′Alternative Therapies′ to ′Visitation during Hospitalization′ and ′Weight Problems and Genetics′, this work provides coverage of a variety of issues within a family context. The Encyclopedia of Family Health provides a comprehensive summary of theory, research, practice, and policy on family health and wellness promotion for students and researchers.