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New assessment tools - PPT Presentation

New assessment tools for people with Intellectual Disabilities APC Meeting Dr Karen Dodd amp Dr Zillah Webb March 2014 Summary sHALO Surrey and Hampshire Assessment for Living with Others BADSID ID: 768139

amp total functions executive total amp executive functions planning bads rule information assessment test everyday understanding ability required surrey

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

SummarysHALOSurrey and Hampshire Assessment for Living with OthersBADS-IDBehavioural Assessment of DisExecutive Syndrome – Intellectual Disabilities MEP Measure of Everyday Planning

HALO to sHALODevised by Shackleton- Bailey, Pidcock and Hampshire social services, 1980 &1982)10 main sections: self-care, domestic, community living, skills, communication,personality and 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

Issues with HALODated – 33 years oldItems needed updatingServices / support needs changingScoring needed updatingTracked down Mike Shackleton Bailey and got agreement from him and Hampshire Social Services to take over its development.

sHALO example page – domains 1 -3 SOURCE OF INFORMATION DO = Direct Observation RP = Role Play IP = Interviewed Person II = Interviewed Informant EA = unable to assess – ability estimated 1. SELF-CARE   SOURECE OF INFORMATION LEVEL OF INDEPENDENCE Is this an issue at night? Y/N Comments Give details of help required, with what components of the task and any factors which impact on the person’s abilities, eg. Are there any motivational issues? Where there is an ‘OR’ option please indicate which is applicable. Fully independent (no assistance required) Fairly independent (some help and/ or prompting needed) Some independence (much help and/ or prompting needed) Very little or no independence (full assistance required) 1.1 Eating/feeding   A B C D     1.2 Drinking   A B C D     1.3 Hand washing   A B C C     1.4 Managing in toilet   A B C D     1.5(a) Continence – day   A B C D     1.5(b) Continence – night   A B C C     1.6 Feminine hygiene/ managing periods   A B C D     1.7 Strip washing/ bathing/ showering   A B C D   Expected to do a minimum of one of these. 1.8 Hair washing and care of scalp   A B C D                   SUBTOTAL         Total A = Total N = Total B = Total DO = Total C =   Total D =  

Updated Behavioural AnchorsSELF CARE1.1 Eating / feedingDescription 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.) Description Level of Independence None (individual is capable of all the behaviours without any assistance) Fully independent Occasional prompting / verbal reminders or physical assistance Fairly independent Regular prompting / verbal reminders or physical help Some independence Full help required (individual either cannot or will not behave in any of the ways described without full assistance) Very little / no independence

sHALO – example page domain 4 - 9 SOURCE OF INFORMATION DO = Direct observation RP = Role play IP = Interviewed person II = Interviewed informant EA = unable to assess - ability estimated 4.      COMMUNICATION (COMM)   SOURCE OF INFORMATION Read all the statements under each item and choose the most appropriate. Is this an issue at night? Y/N Comments Give details of help required, with what components of the task and any factors which impact on the person’s abilities, eg. Are there any motivational issues? Where there is an ‘OR’ option please indicate which is applicable. 4.1 language understanding a) understands almost all of an everyday conversation; can indicate this by rephrasing, or signing back, what is said. Good understanding of TV and radio programmes, evidenced by relating back story, or giving correct responses to queries about story line, characters, etc.   A     b) moderate difficulties in understanding everyday conversation. If special allowance is made (e.g. simple words/short sentences/word repetition) can rephrase or sign back what is said with few errors. Can carry out most requests (e.g. “please get me a book” and “please get me a cup”) without accompanying gestures (eg. pointing).   B     c) difficulty in understanding everyday conversation. Special allowances must be made; requests, sentences, words must be simple and additional gestures used (e.g. “please get me a cup” whilst pointing to cup), otherwise cannot respond, rephrase, or sign back what is said.   B     d) great difficulty in understanding others; can only use one or two words at a time. Relies heavily on exaggerated gestures (e.g. overstated pointing), otherwise cannot sign back or respond to requests.   C     e) no apparent understanding of any language. Does not respond to requests.   C     SUBTOTAL           Total A =   Total N =     Total B =   Total DO =     Total C =         Total D =        

Support needsA = 0-2 hours daily or aggregated to weekly  - no night supportB = 3-5 hours daily – no night supportC = 24/7 supportD = 1:1 supportN = Nighttime support

Summary page for each section Summary Page for Self-Care Use this space for comments, descriptive assessment, Item Count noting strengths etc. Page no. A B C D N No Direct           Obs 1             2             3             Section total             Maximum obtainable 27 27 18 9 18 27 Number of items rated by Direct observation  

GraphingSimplePut scores into Excel spreadsheetSpreadsheet gives you graphs and summary pageDemonstration

Case Example and DiscussionThese are the graphs for person KWas undergoing a period of assessment and treatment in our inpatient serviceLook at the graphs in groups – and see what these tell you about her needsDiscussion

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

Miyake et alEvidence 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).

Measuring EF in people with LDThere 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.

BADS-IDThe 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 Sub test Skill tested Rule shift cards Perseveration Action programme Problem solving and rule maintenance Key search Planning and problem solving Temporal judgement Judgement and abstraction Supermarket map Planning and rule maintenance Modified four elements Time management, planning and rule maintenance

BADS v BADS-IDBADS BADS-ID Rule shift cards Rule shift cards Action programme Action programme Key search Key search Temporal judgement Temporal judgement Zoo map Supermarket map Modified six elements Modified four elements

Rule shift cardsParticipants 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 colour as the last one.

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.

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.

Temporal judgementParticipants were asked to guess how long they thought it would take to do a number of everyday activitiesHow 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?

Supermarket Map

Supermarket mapInvolved 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 orderTask 2 – have to collect the items in order

Modified four elements

Time to try!!!

Comparison of skills intended to be assessed Test Initiation Set shifting Verbal Set shifting Visual Rule mainten-ance Inhibition Abstract’ Common principles Novel problem solving Planning Monitor’ Prospect- ive memory Working memory Organis-ation of retrieval & recall Estimat - ion Follow plan CEFA   VF                             C&D                             SR                  WCS              ToL              SB              BADS-ID  RS              AP              KS              TJ              ZM1              ZM2              4P              

Psychometric propertiesHas 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

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

What next?Currently writing up for publicationHave submitted application to Pearsons to make it availableApplying for permission to approach original participants to obtain test-retest data.

What is everyday planning?The ability to independently organise self to undertake activities of daily living, for example:Meeting basic needs for food and drinkCompleting tasks with multiple elementsGetting 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

AssessmentTools are available to assess many of the factors that impact on everyday planning e.g. IQ assessments, assessments of executive functioningHowever these require extrapolation to the actual situationOther 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

The toolComprises grids to rate:InitiationPlanning / 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

Prepared grid:

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

Presenting the results:

Example grid:

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

Any Questions?

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

Contact DetailsDr. 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