New Lenses on Intellectual Disabilities

Jennifer Clegg

• Publisher: Taylor & Francis
• Year: 2020
• eBook ISBN: 9781000439045
• Edition: 1
• Topic: Education
• Subtopic: Inclusive Education

This book gathers together recent international research in intellectual disability (ID), examining the diverse modes of existence that characterise living with intellectual disabilities in the 21st century.

Ranging from people with no speech and little mobility who need 24-hour care, to people who marry or hold down jobs, this book moves beyond the typical person with ID imagined by public policy: healthy, with mild ID and a supportive family, and living in a welcoming community. The book is divided into three sections. The first, 'A richer picture of people and relationships', expands our understanding of different people and lifestyles associated with ID. The second section, 'Where current policies fall short', finds that Supported Living provides just as 'mediocre' a form of care as group homes, and concludes that services for people with challenging behaviour are unrelated to need. The contributors' research identifies no effective employment support strategies, as well as technological and legal changes that prevent organisations from employing people with ID. With nearly a quarter of this population in poor health, the contributors reflect on whether 'social model' approaches should be allowed to trump medical considerations. The third section, 'New thinking about well-being', reveals that being old, poor, and living alone increases health risk, and that medication administration is significantly more complex for people with ID.

Moving beyond 20th century certainties surrounding intellectual disability, this book will be of interest to those studying contemporary issues facing those living with ID, as well as those studying public health policy more widely.

The chapters in this book were originally published in issues of the Journal of Intellectual & Developmental Disability.

Intellectual disability and attachment theory among adults: An early systematic review

Georgina Mullen

ABSTRACT

Background: The aim of this systematic review was to identify and critically appraise empirical research regarding attachment theory among adults with an intellectual disability.

Method: A systematic search was carried out in Psycinfo and CINHAL databases. Only five studies met selection criteria.

Results: Three main findings were identified: (1) there is a scarcity of empirical research regarding attachment concepts among adults with ID, related to a lack of established measures among this population; (2) there is some evidence that insecure attachment among adults with ID is associated with adverse early life experiences and current mental health difficulties; and (3) there is conflicting evidence that attachment behaviours may present as challenging to supporters.

Conclusions: Further research seeking valid and reliable measures is needed with greater numbers of participants with diverse levels of ID.

Almost half (47%) of adults with an intellectual disability (ID) also experience mental health difficulties (Lehotkay, 2009; Lin et al., 2014). Roughly a quarter of the general population experience mental health difficulties (World Health Organisation [WHO], 2001). One potential interpretation of this disparity is that there are gaps in understanding the needs for well-being among those with ID. Arguments within the disability rights movement have suggested that the social marginalisation of individuals with disabilities along with reduced access to societal structures may contribute to reduced well-being (Oliver, 2013). The social model of disability offers a framework through which to understand disability as arising due to a mismatch between a societal structures and attitudes, and an individual’s functioning. This framework has developed in response to the previous largely medical model of disability which aimed to use medical approaches to adjust factors within the individual in order to reduce disability (Martinez-Perez & Del Cura, 2016). In line with the social model of disability, researchers have emphasised the importance of creating inclusive research “with” participants rather than “on” participants (Walmsley & Johnson, 2003). In the area of ID this can present researchers with challenges due to differences in language and other cognitive functions between participant and researcher. Perhaps this is a contributing factor to the relatively smaller body of research regarding psychology and mental health among those with ID. It could be argued that researchers have focused on the development of cognitive functioning and neglected other aspects of psychology including intra- and inter-personality functioning among those with ID. One such area of psychological research that is considered a core theory in understanding human development in terms of intra-personal and interpersonal functioning, and mental health and ill health is attachment theory.

Attachment theory

Attachment theory developed from John Bowlby’s (1969/1982) observations of children who were separated from their caregivers, and Mary Ainsworth’s observations of infant–mother interactions (Ainsworth & Wittig, 1969). Bowlby (1969/1982) proposed that all humans are born with an innate psychobiological attachment system that motivates infants to seek proximity to or availability of a caregiver, in order to increase their likelihood of survival. Bowlby (1969/1982) suggested that individuals create internal working templates based on their experiences of being cared for, that then act as predictive models of future interactions, guiding present and future behaviour. From their observations, Ainsworth and Wittig (1969) suggested that infants used their mothers as a secure base which allowed them to explore their environment, but that this tendency varied along with quality of interaction. Ainsworth, Blehar, Waters, and Wall (1978) further explored these observations through the Strange Situation Procedure (SSP) during which infants were separated from their mother and their responses were coded and grouped to develop three suggested attachment classifications: secure, insecure-ambivalent and insecure-avoidant. Ainsworth et al. (1978) noted that children whose mothers were more sensitively responsive were more likely to be categorised as secure, suggesting that maternal or primary caregiver sensitivity is an important factor in developing secure attachment patterns. Later Main and Solomon (1990) suggested a third insecure classification of disorganised. A brief description of these categories is presented in Table 1. Classification on the SSP can be stable over time, or may change, with negative life events suggested to contribute to a change from secure to insecure classification (Waters, Merrick, Treboux, Crowell, & Albersheim, 2000). Despite its fundamental role in developing the empirical knowledge base regarding infant–caregiver attachment, there are limitations to the SSP. For example, Rutter (1995) has questioned whether a relatively brief observation could be a sufficient reflection of the entire attachment relationship, while Fraley and Spieker (2003) found statistical support for understanding attachment patterns as dimensional, rather than categorical. Ziv and Hotam (2015) make the argument that while the SSP may be a useful measure of one aspect of a wider phenomenon of attachment theory, it is unlikely that any single measurement protocol will comprehensively reflect a complex multifaceted psychological theory.

Table 1 Attachment styles as elicited by the strange situation (Ainsworth et al., 1978; Main & Solomon, 1990).

Attachment style	Infant’s behaviours	Associated parenting style
Secure	Child plays freely when the parent is present, is upset when the parent leaves, but pleased when they return.	Attachment figure generally available to the child and meets emotional needs enough of the time.
Insecure-avoidant	Child avoids or ignores the caregiver when they return. Shows little emotion and exploration. Considered a mask for distress (later supported by heart rate studies [Sroufe & Waters, 1977]).	Attachment figure may disapprove of closeness and expressions of need or vulnerability.
Insecure-ambivalent	Child shows high levels of distress and is difficult to sooth on the caregiver’s return, showing signs of resentment or helplessness.	Attachment figure is likely inconsistently responsive to child’s attachment behaviours.
Disorganised or disorientated	Child shows unexpected behaviours such as freezing, rocking, and both approaching and avoiding the caregiver.	The attachment figure may act as a source of both comfort and considerable stress, for example in cases of caregiver abuse and neglect.

In 1985, George, Kaplan and Main developed the Adult Attachment Interview (AAI) based on the SSP classifications. The AAI is a semi-structured interview which asks respondents to describe their early attachment relationships. Transcripts are coded based on the way in which respondents speak about and remember early attachment relationships, with a particular emphasis on coherence of discourse. From this coding participants can be classified as secure, preoccupied (similar to the ambivalent classification on the SSP), avoidant, or unresolved, or disorganised. Hamilton (2000) found associations between classifications made for individuals on the SSP as children and classifications made when they completed the AAI as adults. Fonagy, Steele, and Steele (1991) found that parental classifications on the AAI also corresponded with their children’s classifications on the SSP, suggesting transgenerational transmission of attachment patterns. George and West (1999) later developed the Adult Attachment Projective Picture System (AAP) which asked adults to tell a story in response to attachment related picture stimuli. Though the AAP was considered to measure a similar construct to the AAI (state of mind regarding early attachment memories), there have been mixed findings regarding agreement of classification on the AAP and AAI (Jones-Mason, Allen, Hamilton, & Weiss, 2015).

Alongside this stream of attachment research largely within the developmental psychology tradition, researchers largely within the social psychology tradition als...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Citation Information
• Notes on Contributors
• Acknowledgements
• Introduction: New lenses
• Part I: A richer picture of people and relationships
• Part II: Where current policies fall short
• Part III: New thinking about well-being
• Index