New assessment tools for people with Intellectual Disabilities : APC Meeting

1. New assessment tools for people with IntellectualDisabilities:APC Meeting Dr Karen Dodd & Dr Zillah Webb March 2014

2. Summary • sHALO • Surrey and Hampshire Assessment for Living with Others • BADS-ID • Behavioural Assessment of DisExecutive Syndrome – Intellectual Disabilities • MEP • Measure of Everyday Planning

3. HALO to sHALO • Devised by Shackleton- Bailey, Pidcock and Hampshire social services, 1980 &1982) • 10 main sections: self-care, domestic, community living, skills, communication,personalityand social adjustment, close personal relations, use of leisure, health/physical disability, group membership and employment. • HALO is a residential assessment with three main aims: • To help come to decisions about a client's future home needs. • To help make decisions about a clients teaching needs • To help service managers to plan residential resources

4. Issues with HALO • Dated – 33 years old • Items needed updating • Services / support needs changing • Scoring needed updating • Tracked down Mike Shackleton Bailey and got agreement from him and Hampshire Social Services to take over its development.

5. sHALO example page – domains 1 -3

6. Updated Behavioural Anchors SELF CARE 1.1 Eating / feeding Description of “full independence” Eats well, with good control over use of cutlery (including ability to cut food). Exhibits appropriate manners (ie. no spitting) and eats at an appropriate pace and without distraction. Eats an appropriate amount and does not steal other people’s food. Understands and complies with dietary requirements (eg. gluten free, vegetarian etc.)

7. sHALO – example page domain 4 - 9

8. Support needs • A = 0-2 hours daily or aggregated to weekly  - no night support • B = 3-5 hours daily – no night support • C = 24/7 support • D = 1:1 support • N = Nighttime support

9. Summary page for each section

10. Graphing • Simple • Put scores into Excel spreadsheet • Spreadsheet gives you graphs and summary page • Demonstration

11. Case Example and Discussion • These are the graphs for person K • Was undergoing a period of assessment and treatment in our inpatient service • Look at the graphs in groups – and see what these tell you about her needs • Discussion

12. Why are Executive Functions important? • There appears to be a general consensus that executive functions have a central role in human adaptive behaviour (Ardila & Surloff, 2004), enabling us to function and adapt within environments that are constantly changing (Miyake & Friedman, 2012). • Lezak(1982): “executive functions form the basis of many cognitive, emotional, and social skills” ◦ Volition, planning, purposeful action, & effective performance

13. Miyake et al • Evidence from research with healthy adults suggests executive functions are both “separable but also moderately related constructs” • This model, explained recently as the unity/diversity framework of executive functioning, has been frequently cited as the most comprehensive model of executive functions that is available at present • This model posits the importance of three specific, lower-level executive functions of: • Shifting – ability to switch between tasks. • Updating – a component of working memory involved in operating on incoming information. • Inhibition – ability to deliberately suppress automatic responses as necessary. Miyake and colleagues (2000) said that these lower-level functions are necessary for the successful initiation of higher level functions (such as executive processes of volition, planning, purposeful action and effective performance as suggested by Lezak in 1982).

14. Measuring EF in people with LD • There is little research examining the structure of executive functions in adults with a learning disability • However, based on the available findings from research conducted with adults with Downs’s syndrome and fragile X syndrome it appears that the structure of executive functions closely resembles the tripartite model. • The majority of research in this area tends to rely on using specific tests of executive function rather than administering more comprehensive test batteries. • As a result, there may be some ambiguity as to whether the narrow range of measures are actually measuring the functions of shifting, updating and inhibition or some other aspect of neuropsychological functioning.

15. BADS-ID • The behavioural assessment of the dysexecutive syndrome in adults with a learning disability (BADS-ID; Webb, 2008). • The BADS-ID is a modified version of the original behavioural assessment of the dysexecutive syndrome (BADS; Wilson, Alderman, Burgess, Emslie & Evans, 2000) • Takes approximately 60 minutes to complete. • Made up of six sub-tests

16. BADS v BADS-ID

17. Rule shift cards Participants were presented with red and black cards. Responses were determined by rules attached to each colour e.g. when a red card is shown the participant should say “no”. In the second test, the procedure was the same but the rule changed. There were six trials for each test and two practice trials. This subtest was timed. SAY YES TO RED Say yes if the card is the same colour as the last one. SAY NO TO BLACK Say no if the card is not the same colouras the last one.

18. Action programme Participants were instructed to remove a cork from a tube without touching the cork or the tube. Removal of the cork required the participant to use other materials provided. This subtest was timed and participants were given hints about how to progress every 2 minutes until completion.

19. Key Search Participants were asked to imagine that someone has lost their keys in a field. They were asked to use a pen to draw a continuous line to represent how they would search for the keys. This subtest was timed, but participants were told they could take as much time as was necessary for them to be confident they would find the keys.

20. Temporal judgement • Participants were asked to guess how long they thought it would take to do a number of everyday activities • How long does it take people to put their shoe on? • How long does it take people to have a shower? • How long is a TV show?

21. Supermarket Map

22. Supermarket map • Involved plotting or following a route through a map of a supermarket that did not contravene a set of rules. Their score was based on successful implementation of their plan. Penalties were imposed for rule breaks and lack of speed. • Task 1 – can collect the items in any order • Task 2 – have to collect the items in order

23. Modified four elements

24. Time to try!!!

25. Comparison of skills intended to be assessed

26. Psychometric properties • Has been used in 2 D Clin Psych MRP’s with total of 89 people (50.60% male) with a mean age of 42.91 (SD 12.68) • Mean FSIQ was 61.91, (SD 6.64) range 33-88. • The battery has excellent inter-rater reliability (.91), internal consistency (.87) and acceptable face, content and concurrent validity (Sunak, 2009). • Temporal estimation questions do not hold together as a single test • Has been compared to CEFA-EF (Ball et al. 2008). • Has lower floor than CEFA but similar ceiling • Covers wider range of executive functioning skills than CEFA (but still not comprehensive) • Less reliance on working memory

27. Factor structure • BADS-ID has 1 or 2 factor structure depending on the tests combined • Combined BADS-ID & CEFA-EF tests results in a 4 factor model • Each battery has items loading of factors 1 & 2 • Factor 3 (CEFA-EF only) Factor 4 BADS-ID only • Further statistical analysis to decide on final composition of the test battery

28. What next? • Currently writing up for publication • Have submitted application to Pearsons to make it available • Applying for permission to approach original participants to obtain test-retest data.

29. What is everyday planning? • The ability to independently organise self to undertake activities of daily living, for example: • Meeting basic needs for food and drink • Completing tasks with multiple elements • Getting to appointments on the right day with the right information • Getting to work on time • Planning for future events • Getting started on tasks • Seeing them through to conclusion • Tackling unexpected problems

30. Assessment • Tools are available to assess many of the factors that impact on everyday planning e.g. IQ assessments, assessments of executive functioning • However these require extrapolation to the actual situation • Other assessments are highly detailed and require specialist training e.g. AMPS • Some areas are not adequately addressed by existing assessments e.g. impact of emotional regulation and impulsivity

31. The tool • Comprises grids to rate: • Initiation • Planning / sequencing • Memory • Attention / concentration • Space to record qualitative information on: • Emotional Regulation • Impulsivity • Prepared grids on common tasks • Basic grid that can be adapted for any activity chosen by the assessor

32. Prepared grid:

33. Qualitative Information: Comments about emotional regulation: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… Comments about motivation: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… Any other comments: ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..…..

34. Presenting the results:

35. Example grid:

36. Group work • Use the example grid format and choose a task to try and complete the descriptors for that task. • Feedback on ease and practicality.

37. Any Questions?

38. Contact details Dr. Karen Dodd Surrey & Borders Partnership NHS Foundation Trust, Ramsay House, West Park, Epsom, Surrey KT19 8PB  DrKaren.dodd@sabp.nhs.uk • 01372 205767

39. Contact Details Dr. Karen Dodd Surrey & Borders Partnership NHS Foundation Trust, Ramsay House, West Park, Epsom, Surrey KT19 8PB  DrKaren.dodd@sabp.nhs.uk • 01372 205767 Dr. Zillah Webb Surrey & Borders Partnership NHS Foundation Trust, April Cottage Farmfield Charlwood Surrey RH6 0BN  zillah.webb@sabp.nhs.uk • 01293 774919