Background Children with intellectual disabilities and behaviours that challenge (BtC) and their families require complex, multi-agency support. Despite policy commitments to strengthen community-based provision, including those arising from Transforming Care and the forthcoming Mental Health Bill (2025), there remains limited evidence on how these services are configured or what they cost to deliver. The National Institute for Health and Care Excellence (NICE, 2018) identified major evidence gaps in optimal service design, integration, and cost-effectiveness. Objective This research explores the structure and associated costs of community-based services in England that support children with intellectual disabilities and BtC. It aims to describe the configuration of local “service models”, identify cost drivers, and clarify data requirements for commissioning and evaluation. Methods Within the NIHR-funded MELD (Mapping and Evaluating Services for Children with Learning Disabilities and Behaviours that Challenge) programme, 278 services were identified across England. Using survey data (n=161), Latent Class Analysis and descriptive synthesis produced a typology of five community service models. Nineteen representative sites participated in a detailed costing study using a bespoke data collection instrument aligned with national unit-cost frameworks. Quantitative and narrative data on staffing, pathways, and overheads were analysed descriptively and thematically, with input from a Parent Advisory Group. Results Five distinct service models were identified: generic CAMHS, ID-CAMHS, Children and Young People’s Disability, Specialist BtC Support, and All-Age services. Costs were primarily driven by staffing mix, intensity of BtC support, and organisational structure. Considerable heterogeneity was observed in funding flows, eligibility, and waiting times. Conclusions This study provides the first national overview of community service configurations for children with intellectual disabilities and BtC. The findings highlight significant variation in organisation and cost, informing future economic evaluation and service-model optimisation in line with ongoing policy reform.

Teachers with high levels of burnout and reduced levels of wellbeing are twice as likely to leave the teaching profession. For those that stay, it can result in strained relationships with their pupils and a difficulty to effectively manage classroom behavior. This study focused on the emotional strain felt by teachers during periods of educational disruption and how his varied according to school size, school-level disadvantage and levels of pupil-reported bullying and victimization. Data were collected from 11,111 primary school pupils and their 748 teachers in 2020 before the pandemic lockdowns, and in the summer of 2021 when schools had re-opened. Teacher wellbeing and burnout levels (exhaustion, cynicism and professional efficacy) were collected. Teachers reported higher levels of burnout and reduced levels of wellbeing after the school disruption, and teachers of classrooms with the highest proportion of pupil bullying perpetration were found to have the lowest levels of teaching professional efficacy. This study identifies that suitable support needs to be in place for teachers during or following an educational disruption, especially for teachers struggling with challenging classroom dynamics, such as bullying. We suggest that a whole-school support network and program that equips schools to attend to the wellbeing needs for teaching staff could be developed.

Background:Children with intellectual disabilities and behaviours that challenge (BtC) and their families require complex, multi-agency support. Despite policy commitments to strengthen community-based provision, including those arising from Transforming Care and the forthcoming Mental Health Bill (2025), there remains limited evidence on how these services are configured or what they cost to deliver. The National Institute for Health and Care Excellence ( NICE, 2018) identified major evidence gaps in optimal service design, integration, and cost-effectiveness. Objective:This research explores the structure and associated costs of community-based services in England that support children with intellectual disabilities and BtC. It aims to describe the configuration of local "service models", identify cost drivers, and clarify data requirements for commissioning and evaluation. Methods:Within the NIHR-funded MELD (Mapping and Evaluating Services for Children with Learning Disabilities and Behaviours that Challenge) programme, 278 services were identified across England. Using survey data (n=161), Latent Class Analysis and descriptive synthesis produced a typology of five community service models. Nineteen representative sites participated in a detailed costing study using a bespoke data collection instrument aligned with national unit-cost frameworks. Quantitative and narrative data on staffing, pathways, and overheads were analysed descriptively and thematically, with input from a Parent Advisory Group. Results:Five distinct service models were identified: generic CAMHS, ID-CAMHS, Children and Young People's Disability, Specialist BtC Support, and All-Age services. Costs were primarily driven by staffing mix, intensity of BtC support, and organisational structure. Considerable heterogeneity was observed in funding flows, eligibility, and waiting times. Conclusions:This study provides the first national overview of community service configurations for children with intellectual disabilities and BtC. The findings highlight significant variation in organisation and cost, informing future economic evaluation and service-model optimisation in line with ongoing policy reform.

INTRODUCTION:The aim of this study was to examine factors associated with length of stay within a psychiatric hospital for patients with intellectual disabilities who have a forensic history. METHODS:Data about 111 patients were gathered retrospectively from historical records for the period of February 2011 to March 2021. Negative binomial regression was then used to examine the relationship between selected predictor variables and length of stay. RESULTS:Patients who were older upon admission and those who had received psychological therapies or positive behavioural support (PBS) had a significantly longer length of stay. Those with a diagnosis of a neurodevelopmental disorder had a significantly shorter length of stay. All other predictors were not statistically significant. CONCLUSIONS:There was evidence of a clinical improvement at discharge and those with autism or ADHD had a shorter length of stay. Similar studies with larger sample sizes should be completed across England.

BackgroundEvaluating the effectiveness of interventions relies on understanding what change in a main outcome is sufficient to be considered meaningful. Our aim was to estimate a Minimum Clinically Important Difference (MCID) for the Developmental Behaviour Checklist, parent-report (DBC-P)- a measure of behavioural and emotional problems in children and adolescents with intellectual disabilities.MethodsWe generated distribution-based estimates through meta-analysis of intervention evaluations using the DBC-P as an outcome measure. We also generated anchor-based estimates using case scenarios with 10 parent carers and 21 professionals working with people with intellectual disabilities.Results21 studies were included in the meta-analyses and indicated an average DBC total raw score decrease of 3.01 or 4.73 (depending on analytic methods) in randomised controlled trials, and an average decrease of 9.16 points in pre-post designs. Parent carers provided a median MCID estimate of 6 (IQR 4, 7) and professionals provided a median estimate of 8 (IQR 5, 14).ConclusionsThese findings contextualise DBC-P score changes in relation to outcomes from other interventions and parent carer and professional views. Which MCID value to choose depends on what factors are prioritised for an intervention.

Background Families of children with intellectual disabilities often experience increased adversity and inequalities. Despite this, parent-reported data suggest that these families experience significant barriers in accessing appropriate supports. Less research has characterised what service providers offer to families. Understanding usual support for these families is important when considering comparators in evaluation research. The purpose of the current study was to describe support as usual for families of children with intellectual disabilities as reported by professionals and service providers. Methods Data on supports available to parents, siblings, and young carers, were extracted from the Local Offer websites of 100 randomly selected Local Authorities in England. Survey data were also collected from 66 professionals, either working in UK Local Authority services and/or services commissioned by Local Authorities, about what programmes and/or interventions are currently offered to parents of children with intellectual disabilities. Data were analysed and summarised using content analysis and descriptive statistics. Results A wide range of support programmes and/or interventions were described as being available to parents of children with intellectual disabilities. Most supports available were primarily designed for parents of non-disabled children or parents of children generally with special educational needs and disabilities. Data extracted from Local Offer websites led to the identification of six broad categories of programmes for parents; relatively few Local Authorities provided supports available for siblings or young carers. Conclusion Our findings offer researchers and professionals (e.g., practitioners, commissioners) insights into usual support offered by Local Authorities to families of children with intellectual disabilities. Future research may draw upon these findings when designing evaluations of health and social care interventions in the UK. Additional research is also needed in terms of the relationship between what might be on offer for families in theory and what they are actually able to access.

The aim of this study was to examine whether the relationship between a set of risk and protective factors (e.g., self-esteem, stress, intolerance of uncertainty, autistic symptoms) and mental health problems differed between autistic and non-autistic undergraduates enrolled in UK universities across genders. Autistic and non-autistic undergraduates were invited to complete an online survey between November 2022 and June 2023. The sample included 226 autistic participants, mean age = 21.36, SD = 4.04, and 46.9%, and 521 non-autistic participants, mean age = 21.96, SD = 4.24, and 63.3%. Two-way ANOVA followed by post-hoc comparisons were used to examine gender differences in mental health problems and multiple regression models were used to identify the predictors of mental health problems among autistic participants in comparison to non-autistic participants. A higher number of autistic undergraduates self-reported having mental health diagnoses than non-autistic undergraduates. Autistic females and autistic and non-autistic individuals of genders other than male or female had increased suicidality—defined to include both suicidal ideation and behaviours — relative to some groups. There were no gender differences in anxiety and worry, and in behavioural symptoms of depression and anxiety. Moreover, for both autistic and non-autistic participants, intolerance of uncertainty was associated with higher levels of anxiety and worry, whereas resilience was associated with lower levels of suicidality and behavioural symptoms of depression and anxiety. While autistic undergraduates self-reported more mental health disorders, there were more similarities than differences between autistic and non-autistic undergraduate students in terms of mental health risk and protective factors.

BACKGROUND:Parents of children with developmental disabilities report higher levels of psychological distress. Parenting interventions may reduce parental psychological distress. Our aim was to investigate the psychological distress trajectories of parents receiving a parenting intervention. METHOD:Data were drawn from a state-wide trial of Stepping Stones Triple P (SSTP) in Queensland and Victoria, Australia (n = 365 parents). Growth mixture modelling was used to describe psychological distress trajectories of parents of children with developmental disabilities and examine associations with the level of SSTP intervention received, child characteristics and financial hardship. RESULTS:Three groups of parents/caregivers were identified, two of which presented a significant decline in psychological distress over time and one group presented no significant change. Additionally, higher child behavioural and emotional problems and lower adaptive skills were associated with poorer parent psychological distress over time. Level 4 of the SSTP intervention was also associated with steeper declines in psychological distress over time. CONCLUSIONS:Over a period of 18 months, with the implementation of the SSTP, parents' psychological distress tended to improve. Distinct groups of parents were identified based on different psychological distress trajectories. Findings indicate the significant role of child behavioural and emotional problems, children's adaptive behaviour and the level of SSTP in parent psychological distress trajectories.

BackgroundMothers of children with intellectual disabilities are more likely to show elevated psychological distress, with child behavioural and emotional problems being a significant risk factor. Family Resilience Theory suggests that family relationships are crucial in influencing adaptation to stressors. We investigated whether family functioning mediates or moderates the relationship between child behavioural and emotional problems and subsequent maternal psychological distress.MethodWe conducted mediation and moderation analyses on data from 324 mothers of children with intellectual disabilities in a United Kingdom (UK) prospective longitudinal cohort study.ResultsFamily functioning had a small mediating effect on the relationship between child behavioural and emotional problems and subsequent maternal psychological distress. Family functioning did not moderate the relationship between child behavioural and emotional problems and later maternal psychological distress.ConclusionsThe mechanism of the effect of child behavioural and emotional problems on maternal mental health may at least partially involve changes in family functioning.

The Psychopathy Checklist Short Version (PCL:SV) is a brief measure of psychopathy. This study aimed to assess the reliability and validity of the PCL:SV with autistic adults detained in inpatient psychiatric care. Data were collected from 282 autistic adults at two time points separated by 12-months. Reliability and validity were investigated using omega, regression, receiver operating characteristic curves, and correlational analysis. PCL:SV Total, Factor 1, and Factor 2 had satisfactory to high reliability and construct validity. Higher PCL:SV scores were associated with poorer treatment progress, a longer length of stay, and previous criminal offending. Factor 1 was associated with a forensic history, detention under Part III of the Mental Health Act, and a personality disorder diagnosis, while Factor 2 was also associated with the absence of a forensic history, detention under Part II of the Mental Health Act, but not a personality disorder diagnosis. It was thought that Factor 2 most likely captured data associated with autism and/or intellectual disabilities (e.g., behaviors that challenge). Those with intellectual disabilities were less likely to have convictions, a history of violent offending, or a forensic history. They were also more likely to be detained under Part II of the Mental Health Act, and were more likely to have had a positive transfer 12-months later to a ward with lesser security. The PCL-SV correlated as expected with the HCR-20 and the START. This study provides preliminary evidence to support the use of the PCL:SV with autistic adults, including those with intellectual disabilities, within inpatient psychiatric hospitals.

BACKGROUND:Using nationally available anonymised and aggregated English data, we examined specialist and nonspecialist psychiatric bed utilisation by people with intellectual disabilities and/or autism. METHODS:Using data about specialist psychiatric bed utilisation from the Assuring Transformation Dataset, from March 2015 to January 2024, we applied linear regression (with moving average or autoregressive errors) to explore the relationships between a set of outcome variables (e.g., number of inpatients and length of stay) and a set of sociodemographic, clinical and service-related predictor variables (e.g., age, ethnicity, admission source, legal status, admission source, discharge destination, Care (Education) and Treatment Reviews) over time. Comparisons were made with data from the Mental Health Services Data Set about nonspecialist psychiatric bed utilisation. RESULTS:Over time, there was an average reduction of 8.07 inpatients per month. This reduction was due to a reduction in the number with a length of stay longer than 2 years, and fewer inpatients with intellectual disabilities without autism over time, rather than fewer autistic inpatients without intellectual disabilities; instead, the number of autistic inpatients increased by 6.02 per month. However, overall, there were fewer inpatients in specialist psychiatric beds than in nonspecialist beds by an average of 877 patients, and the number in specialist beds reduced faster than the number in nonspecialist beds over time. We found that more hospital spells were associated with more inpatients older than 18, more detentions under Part III of the Mental Health Act, more inpatients not known to the local authority, and an increased number of White inpatients. More admissions were associated with fewer discharges, while those with a hospital stay longer than 2 years were less likely to have had a postadmission Care (Education) and Treatment Reviews and were more likely to use advocacy. CONCLUSIONS:The number of inpatients with intellectual disabilities in specialist psychiatric beds continues to decline over time, while the number of autistic inpatients without intellectual disabilities is increasing. Future research should utilise participant-level data to explore patient long-term trajectories.

BackgroundEvaluating the success of randomised controlled trials (RCTs) requires an understanding of the processes and experiences of those involved in implementation as much as an analysis of outcomes, particularly when conducted in real world settings. This implementation and process evaluation (IPE) explores the experiences of pupils and staff from special schools in England participating in an RCT examining whether Headsprout Early Reading® (HER®), an established on-line reading intervention shown to be effective at teaching early reading skills to pupils in mainstream schools, with additional support strategies and supervision, could be delivered successfully by school staff to pupils with intellectual disabilities.MethodsThe study used an embedded mixed methods approach within a RCT design, the results of which are reported elsewhere. It is the first study to include interviews with pupils with intellectual disabilities. With 55 schools (382 pupils in Key Stages 1 and 2) successfully recruited, it is also possibly the largest study of its kind to be conducted to date in special schools.ResultsIt was not possible for staff in the context at the time of the study (extreme pressures on staffing, meeting individual pupil needs, and pupil and staff absence, compounded by COVID-19) to comply with implementation and to deliver HER® to pupils with fidelity or to the dosage expected.ConclusionDespite implementation challenges, the study demonstrated an appetite among special schools to be included in research to find effective ways of teaching key skills to pupils with intellectual disabilities.

Implementation support is a key factor in the success of school-based well-being programmes. To assess the impact on children's well-being of providing additional implementation support for staff delivering a universal Acceptance and Commitment Therapy informed well-being curriculum ('Connect PSHE') compared to delivery without support. Twenty schools were recruited and randomised to deliver Connect PSHE with additional support (n =10; n = 323 children) or Connect PSHE with the standard support (n = 10; n = 422 children). A twoarm, parallel-group cluster-randomised (schools as clusters) controlled trial design was utilised. Additional implementation support had no impact on the primary well-being measure (Me and My Feelings scale) at posttest (beta = 0.22, 95 % CI [-0.59, 1.03], p = 0.59). Small improvements were observed in the additional support arm for two subscales of the Strengths and Difficulties Questionnaire. Overall, both trial arms were associated with improvements in children's well-being. Connect PSHE is a promising well-being programme suitable for testing in additional research.

BACKGROUND:Research concerning the impact of the COVID-19 pandemic on the mental health and well-being of adults with intellectual disabilities has been cross-sectional and small scale. We examined the trajectory of mental health and well-being across the pandemic period across the UK and the factors which predicted different mental health trajectories. METHOD:Adults with intellectual disabilities participated in co-designed structured interviews. Four waves of data were collected between December 2020 and late 2022. At Wave 1, 621 adults with intellectual disabilities participated, with 355 at Wave 4. Well-being, pandemic anxiety, depression, anxiety, anger and loneliness outcomes were measured. Latent class mixed modelling was used to identify subgroups and within-group trajectories. RESULTS:Well-being and pandemic anxiety remained relatively stable across time, but levels of anger, depression, anxiety and loneliness reduced gradually over time. Overall patterns masked trajectory subgroups, with differences in intercept and steepness of decline or increase in mental health problems. Different factors were generally influential for trajectory class membership and overall change across time for outcomes. Leaving the house for exercise or green spaces reported increasing well-being and reduced loneliness. Similarly, those working, volunteering or in education at Wave 1 were found to have increasing well-being and reduced loneliness, sadness and worry, and increasing wellbeing and reducing anger if they were working pre-pandemic. CONCLUSIONS:Social connection and engagement in purposeful activity were vital to maintaining the mental health and well-being of people with intellectual disabilities. Factors that were found to reduce mental well-being during the pandemic should be considered in planning for future major public health challenges and in promoting better mental well-being for people with intellectual disabilities in everyday life.

Thompson et al., 2023 (Generalized models for quantifying laterality using functional transcranial Doppler ultrasound. Human Brain Mapping, 44(1), 35-48) introduced generalised model-based analysis methods for determining cerebral lateralisation from functional transcranial Doppler ultrasound (fTCD) data which substantially decreased the uncertainty of individual lateralisation estimates across several large adult samples. We aimed to assess the suitability of these methods for increasing precision in lateralisation estimates for child fTCD data. We applied these methods to adult fTCD data to establish the validity of two child-friendly language and visuospatial tasks. We also applied the methods to fTCD data from 4- to 7-year-old children. For both samples, the laterality estimates from the complex generalised additive model (GAM) approach correlated strongly with the traditional methods while also decreasing individual standard errors compared to the popular period-of-interest averaging method. We recommend future research using fTCD with young children consider using GAMs to reduce the noise in their LI estimates.

Natural disasters happen across the world. The situations are different but the disruption to children's education and wellbeing is similar. This study focused on the school context changes caused by the COVID-19 global disaster, and the impact of these changes on children's mental health. The aim was to better understand the associations between any mental health changes and children's school level of deprivation and pre-disaster involvement in bullying. Cross-sectional data were collected from 4316 children aged 6–11 years old, from 57 schools across England and Wales. Data were collected before the national lockdowns, early 2020, and 3–5 months after the final return to school, summer 2021, when schools were operating under a range of context restrictions. Child data included bullying involvement at school and health-related quality of life; teacher data included reports of each child's internalising, externalising and prosocial behaviours. School-level disadvantage was determined by the proportion of children in each school eligible to receive free school meals (an indicator of family disadvantage). The results showed that victims of bullying pre-lockdown, and pupils from schools with a higher concentration of disadvantage, had significantly reduced externalising behaviours once back in the restricted school context. Victims had also increased their prosocial behaviours. It is possible that the restricted school context may have been a relief for the most vulnerable pupils. This study adds a new phase of understanding to the global disaster literature and the initial return to school when the environment is the same but the context has changed.

Background Within England, children and young people (CYP) who come into police custody are referred to Liaison and Diversion (L&D) teams. L&D teams have responsibility for liaising with healthcare and other support services while working to divert CYP away from the criminal justice system but have traditionally not provided targeted psychological interventions to CYP. Considering evidence that Solution Focused Brief Therapy (SFBT) leads to a reduction in internalising and externalising behaviour problems in CYP, the aim of this randomised controlled trial (RCT) was to determine whether there is a difference between services as usual (SAU) plus SFBT offered by trained therapists working within a L&D team, and SAU alone, in reducing offending behaviours in 10–17-year-olds presenting at police custody. Methods Design: two-arm individually RCT with internal pilot and process evaluation. Participants: N = approximately 448 CYP aged 10–17 years presenting at one of three police custody suites in the area served by Lancashire and South Cumbria NHS Foundation Trust (LSCFT) who are referred to the L&D team. Participants will be recruited and allocated to intervention:control on a 1:1 basis. Interviews will be performed with 30–40 CYP in the intervention arm, 15 CYP in the control arm, up to 20 parents/guardians across both arms, up to 15 practitioners, and up to 10 site staff responsible for screening CYP for the trial. Intervention and control: Those allocated to the intervention will be offered SAU plus SFBT, and control participants will receive SAU only. Primary outcome: CYP frequency of offending behaviours assessed through the Self-Report Delinquency Measure (SRDM) at 12 months post-randomisation. Secondary outcomes: criminal offence data (national police database); emotional and behavioural difficulties (self-report and parent/guardian reported); gang affiliation (self-report). Process evaluation: evaluation of acceptability and experiences of the CYP, parents/guardians, site staff and practitioners; fidelity of SFBT delivery. Discussion This two-arm individually RCT will evaluate the effectiveness of SFBT in reducing offending behaviours in CYP presenting at police custody suites within the area served by LSCFT. Our process evaluation will assess the fidelity of delivery of SFBT, the factors affecting implementation, the acceptability of SFBT in CYP aged 10–17 years and recruitment and reach. We will also examine systems and structures for future delivery, therefore assessing overall scalability. Trial registration ClinicalTrials.gov ISRCTN14195235 . Registered on June 16, 2023.

Longitudinal research is crucial to fully assess the putative impact of the COVID-19 pandemic on children with an intellectual disability in special school settings-ideally drawing on data pre-pandemic to be able to evaluate later impact. Data on challenging behaviour and adaptive skills were collected annually for 348 students in one special school across four time points pre-pandemic and one time point post-pandemic. Data were analysed using multilevel models with repeated observations over the five time points. There was a decrease in aggressive and destructive behaviours and a decrease in adaptive skills at the post-pandemic time point, after accounting for other important covariates. There was no evidence of a change in stereotyped or self-injurious challenging behaviours. Other research using longitudinal methods is rare, but the current findings are consistent with previous research reporting on the impact of COVID-19 on children and young people, particularly from parent reports. Future considerations for schools include adopting appropriate strategies to support learners to reintegrate back into education. Further research is needed to look at the longer-term impact of the pandemic on challenging behaviour in children with an intellectual disability.

Natural disasters happen across the world. The situations are different but the disruption to children's education and wellbeing is similar. This study focused on the school context changes caused by the COVID-19 global disaster, and the impact of these changes on children's mental health. The aim was to better understand the associations between any mental health changes and children's school level of deprivation and pre-disaster involvement in bullying. Cross-sectional data were collected from 4316 children aged 6-11 years old, from 57 schools across England and Wales. Data were collected before the national lockdowns, early 2020, and 3-5 months after the final return to school, summer 2021, when schools were operating under a range of context restrictions. Child data included bullying involvement at school and health-related quality of life; teacher data included reports of each child's internalising, externalising and prosocial behaviours. School-level disadvantage was determined by the proportion of children in each school eligible to receive free school meals (an indicator of family disadvantage). The results showed that victims of bullying pre-lockdown, and pupils from schools with a higher concentration of disadvantage, had significantly reduced externalising behaviours once back in the restricted school context. Victims had also increased their prosocial behaviours. It is possible that the restricted school context may have been a relief for the most vulnerable pupils. This study adds a new phase of understanding to the global disaster literature and the initial return to school when the environment is the same but the context has changed.

•Explores consensus in professional practice; why, when and what to assess.•Discusses the current assessment context for children with difficulties learning to read, spell and write.•Supports the ongoing use of the label dyslexia for persistent impairments in reading fluency and allied difficulties, such as spelling.•Suggests an assessment framework for the identification of dyslexia.•In the identification of dyslexia, highlights and discusses areas that require further research.