Disabilities

Diagnoses of ADHD in adults continue to increase, and the number of college students with ADHD has risen in particular. Qualitative research on this population has been common, but it is not clear what conclusions can be drawn from this research base. We conducted a review of the qualitative research on college students with ADHD over a 20-year period (2002–2021). A systematic search yielded 41 papers that were reviewed in detail. Studies were grouped into four topic areas, with the most researched area being the college experience for these students. Most sample sizes were small, with a median of 10 participants, and most studies used students’ self-reports of having ADHD as the sole method of diagnosis identification/verification. Very few studies (7.3%) included a comparison group of students without disabilities. These results suggest that the qualitative research base on college students with ADHD has significant limitations, including difficulties with generalization, uncertainty regarding diagnostic accuracy, and an inability to make comparative statements about students with vs. without ADHD. Full article

People with disabilities experience significant health inequalities and inequities compared to people without disabilities. However, there is little evidence on the frequency of health conditions and their association with disability in the prison context. The aim of this study was to compare the proportions and associations between various health conditions and different disability indicators. A secondary analysis of existing data from the Ecuador Prison Census 2022 was conducted. The variable of interest was based on three disability indicators from the six-item Washington Group Short Set on Functioning. A cross-tabulation was carried out to estimate the proportion of prisoners with different disability indicators by gender. These proportions were also calculated for different health conditions. Moreover, we analyzed the association between each of the three disability indicators and the different health conditions using multivariable logistic regression. A total of 30,612 incarcerated persons were included in the analysis, revealing that 8% had disabilities. According to gender, a higher proportion of women had disabilities (10.7% vs. 8.5%), some difficulty functioning (33.8% vs. 28.0%), and multiple disabilities (2.4% vs. 2.0%) compared to men. Furthermore, people with disabilities had a higher proportion of health conditions compared to those without a disability. Strong and very strong evidence of associations were found between different disability indicators and several health conditions, while a lower odds of drug use was observed in people with disabilities and multiple disabilities compared to their counterparts, and no evidence of association was found with Human Immunodeficiency Virus (HIV) infection. Our results reflect the health inequalities and inequities experienced by prisoners with disabilities. This highlights the need to implement targeted policies within prisons and to include prisoners with disabilities in the country’s agenda. Full article

Helping people with intellectual and visual disabilities engage in activity and mobility is considered crucially important to promote constructive occupation and a basic form of physical exercise (i.e., objectives that are essential for the individuals’ wellbeing and in line with their rights). This study assessed two new programs aimed at helping eight participants with intellectual and visual disabilities (four in each program) to independently move through specific indoor destinations, collect and transport objects, and access stimulation events (e.g., music) with the support of technology systems involving a smartphone linked to mini cameras and speakers. The second program was more advanced than the first and (a) required the participants to discriminate the objects used and transport two (rather than one) of them before any stimulation event, and (b) included telephone calls to and stories from preferred communication partners among the stimulation events. Each program was implemented using a single-case research design (i.e., a non-concurrent multiple baseline design across participants). The results showed that both programs were effective in enabling the participants to collect, transport, and put away objects and access stimulation independently during 20-min sessions. Based on the results, both programs might be considered useful tools to help people with intellectual and visual disabilities manage independent activity and mobility. Full article

Aphasia is an acquired communication disorder caused by a cerebral lesion, such as a stroke. People with aphasia can experience various difficulties that may involve speaking, listening, reading, or writing. These difficulties have multiple impacts on their expression of their needs, interests, and opinions. Accordingly, people with aphasia often encounter barriers and facilitators when using local services, which reduces their participation. For instance, grocery shopping or going to a coffee house can be challenging for them. Hence, this systematic review was conducted to synthetize the barriers and facilitators for people with aphasia when using local services. Following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines, five databases and Google Scholar were searched for the literature published through April 2024. A total of nine studies were included in the present work. The results highlight that most of the barriers to communicational access to local services are environmental ones related to other people or society. A few environmental facilitators were mentioned, but these were mainly a reflection of the barriers. Personal facilitators were noted, but people with aphasia said that they were insufficient for counterbalancing environmental barriers. The results highlight the need to raise awareness of aphasia. Full article

Psychological assessment is an integral aspect of training in graduate school. Developing ecologically integrated and culturally sensitive diagnostic tools to support case conceptualization and differential diagnosis is critical to improving assessment practices. Nevertheless, there is a dearth of research on diagnostic training practices, particularly when integrating the cultural context into an assessment. The current study addressed this gap by evaluating four novel diagnostic tools used to guide doctoral externs (n = 11), including case conceptualization and differential diagnostic tables, an attention-deficit/hyperactivity disorder (ADHD) matrix, and a specific learning disorder (SLD) in reading matrix. These tools were designed to integrate a range of clinical data from an ecological context. The current study (1) evaluated extern perspectives on the use and benefit of the diagnostic tools in their training and (2) discussed tool adaptation based on extern feedback. Data were analyzed via frequencies of extern responses to items. The results demonstrated high extern acceptability of the diagnostic tools and that the tools supported their ability to integrate the clients’ ecological context into the diagnostic process. Adaptations of the tools in response to extern feedback are discussed. These tools can support culturally and ecologically sensitive assessment practices. Full article

This study explored conceptualizations of disability pertaining to peer relationships versus romantic relationships, as well as type of physical disability, using story-completion methods. Seventy-four graduate and undergraduate students from a Canadian university completed one of two versions of a story stem featuring an individual with a physical disability who was either a classmate or a potential romantic partner. Through the process of thematic analysis, three themes were generated as patterns across stories: (1) assumptions about disability present from first glance; (2) uncertainty in navigating negative assumptions of disability; and (3) from discomfort to acceptance of disability through social connection. Storylines differed depending on the type of relationship (i.e., peer or romantic) in both story length and outcome of the relationship. Findings suggest the usefulness of the relatively infrequently used method of story completion for assessing students’ narratives and discussion of meanings surrounding differing relationships with persons with a disability. This study further develops our understanding of cultural norms of disability, as well as highlights the importance of disability knowledge and interaction between persons with and without a disability, to foster positive change in representations and perceptions of disability. Full article

Access to communication is a primary challenge affecting the education of Autistic students who use augmentative and alternative communication devices. This is compounded by potential communication partners (e.g., teachers and classroom paraeducators) who have insufficient training and skills to meaningfully engage these students in communication. To address these deficits in skills and training, this feasibility study used a multiple probe across participants design to test the effects of using behavioral skills training on dyads of teachers and paraeducators in increasing teacher-delivered opportunities to respond and student communication responses. The results show that after training, teachers’ opportunities to respond and use student-specific strategies increased. Following the teachers’ implementation of the strategies, students’ prompted and unprompted communication increased. These results provide evidence that supports the use of behavioral skills training to support communication partner skill development and student communication needs. These methods showed positive social validity with participants and demonstrate a professional development method that is more feasible for use by school staff than individual training. The results of this study provide initial evidence of the effectiveness of these methods with dyads of participants as well as with licensed teachers, extending the extant research, which often focuses on the individual training of paraeducators. Full article

Arts and culture are central to the political struggles of people with disabilities and have the potential to transform how societies relate to disability and to realize the human rights model of disability enshrined in the Convention on the Rights of Persons with Disabilities. Yet, low levels of participation in arts by people with disabilities are reported in many countries. We also lack research to support policy making that promotes positive measures. This article presents some of the findings from a large qualitative study across 28 European countries addressing factors perceived as facilitative of cultural participation by people representing organizations of people with disabilities. Identifying these factors is a step in supporting the deployment of policies aiming to end the exclusion of people with disabilities from the cultural sphere both as audiences and artists and to realize the human rights model of disability. In particular, findings point to the need to change the knowledge base and ethos of cultural bodies and to reform, amongst other issues, funding mechanisms, governance structures, and consultation processes. We argue that making disability inclusion more intrinsic to cultural policy has the potential to enhance diversity and ultimately to foster the participation of people with disabilities in society more broadly. Full article

To improve inclusion of persons with disabilities (PWD), it is important to create suitable physical and social environments. This can be done by improving awareness about disability, specifically for employees working in the service and cultural sectors. Virtual reality (VR) simulation can be advantageous by providing an engaging experience highlighting physical accessibility issues, as well as social interactions with virtual avatars. This study’s objective was to validate the content of two disability awareness VR scenarios in museum employees and individuals with disabilities in terms of perceived usefulness. Five PWD and seven museum employees experienced two VR scenarios illustrating a museum visit for a person with low vision or using a wheelchair. The scenarios consisted of different scenes such as finding an accessible entrance and interacting with virtual employees. Participants were interviewed about their experience, with questions related to the realism of the scenarios and their perceived usefulness. Four main themes were identified specifically: emotions, experience, usefulness, and realism. Our scenarios were seen as useful in describing social and physical barriers experienced by PWD. VR can be a valid tool to promote disability awareness among employees in a sociocultural setting, representing a step towards the inclusion of PWD. Full article

Background: Visual impairment is a global problem and, regardless of the cause, it substantially impacts people’s daily lives. Navigating towns and cities can be one of the most difficult tasks for someone with a visual impairment. This is because our streetscapes are often inaccessible for navigating safely and independently by people with a visual impairment. Barriers include street clutter, bollards, pavement parking, and shared spaces. Methodology: Participants with varying levels of diabetic retinopathy (DR) and retinitis pigmentosa (RP) were recruited. Each participant completed a clinical visit and a 1-mile walk. Participants discussed confidence, anxiety, difficulty, and any barriers encountered while completing the walkaround. Participants completed quality of life (RetDQol), diabetes distress scales, and a study questionnaire. They also underwent retinal imaging and visual function testing. Retinal imaging and visual function results were compared with confidence, difficulty, and anxiety levels during the walkaround using Spearman’s correlation. Results: Thirty-three participants took part in the study, 22 with diabetes and 11 with RP. Results showed that average confidence was correlated with visual acuity, RetDQol, mean visual fields, and vertical peripheral diameter visual fields. Average difficulty was associated with visual acuity, RetDQol, dark adaptation, mean visual fields, percentage of the retina, and both horizontal and vertical diameter visual fields. In addition, some of the barriers discussed were pavement issues, bollards, parked cars, uneven pavements, alfresco dining, light levels, and street features such as tree roots, poles, A-boards, and street clutter. Conclusions: People with RP and treated DR faced common barriers while navigating the walkaround. The removal of these common barriers would make our streetscapes more accessible for all and will allow for more independence in those with visual impairments. Full article

Local Area Coordination (LAC) roles have been implemented in disability services in many countries, supporting people living with disability to connect with formal and informal support in the community. Embedded in the National Disability Insurance Scheme in Australia, the aspiration is that this LAC role will connect people with disability to supports and enable the generation of greater community capacity and inclusion. Yet, with only a limited evidence base that demonstrates the impact of this approach, a clear measurement framework is needed to provide evidence of the realization of this aspiration. We propose that this impact could be demonstrated by applying a Community Capitals Framework (CCF) as the theoretical base for the LAC role and other community capacity initiatives, such as service navigation within disability reform of disability services. The CCF is premised on seven ‘capitals’—social, natural, cultural, human, political, financial and built that intersect and interact with each other to create positive spirals of change in communities. In this critical literature review, we apply the CCF to map and synthesize existing research on the LAC’s role in building community capital and examine the utility of the CCF as a map for LAC and service navigation practices to enhance community inclusion. For this review, we analyzed peer-reviewed journal papers and grey literature that focused on LAC community capacity building for people with disability in a disability service context published between 2000 and August 2023. Of the 17 publications that met the inclusion criteria, there was no published evidence that comprehensively examined or measured community capacity building consistent with the tenets of the CCF. However, our analysis showed that all capitals, with the exception of natural capital, had been considered, with some indication that investment in these capitals (particularly social capital) could be connected in the positive spiraling way suggested by the CCF. Given the paucity of existing evidence to inform the LAC aspiration for community capacity building, research informed by consumer priorities is needed to inform LAC and service navigation practices to address community needs. The CCF has the potential to develop our understanding of LAC and other community capacity-building initiatives through the measurement of LAC and service navigation services and consumer outcomes, as well as by informing investment to target growth capitals in communities. Full article

Background: Despite an increased risk of visual impairment (V.I.) among adults from minority ethnic communities in the UK, limited research has explored their wider life experiences. Methods: A secondary analysis of V.I. Lives survey data explored priority issues among a sample of 46 Asian, 22 Black, and 77 White adults who have visual impairment A list of 24 issues were grouped into 10 life domains. Issue and domain mean importance scores were calculated for each to facilitate ranking of importance. Results: Kruskal–Wallis tests showed that there were statistically significant differences between the three groups for 7/10 domains and 19/24 issues. Post hoc comparisons showed that this largely reflected group differences between Asian and White participants. While there were no statistically significant differences between Asian and Black participants possibly due to small sample sizes, there were statistically significant differences between Asian and White participants in 7/10 domains and 14/24 issues. Additionally, there were significant differences between Black and White participants in 5/10 domains and 7/24 issues, specialist workplace equipment being the only issue with a significant difference between White and Black but not Asian participants. There were no group differences for confidence in ability to do everyday tasks and opportunities to take part in more sporting and leisure activities. Overall, White participants generally rated all issues as less important than Asian and Black participants. The top-three domains for Asian participants were ‘accessible environments’/‘finances’, ‘technology’, and ‘public attitudes’. The top-three issues were accessibility of public transport, employer attitudes, and reduction of street clutter. The top-three domains among Black participants were ‘employment’, ‘accessible environments’, and ‘emotional support’. The top-three issues were employer attitudes/specialised education for young people with V.I., specialist V.I. equipment in the workplace, and confidence in ability to do everyday tasks/accessibility of public transport. Conclusions: Differences in priorities between the groups suggest that the needs of individual communities may be lost when grouping culturally diverse communities together, highlighting the need for more research with different minority ethnic communities. Full article

Reflecting the neglect of childhood disability in transitions research, there is a notable dearth of research on the factors shaping self-determination in post-school decision-making for disabled young adults. To address this gap, we explore how early educational experiences, parental expectations, economic vulnerability, school context, and educational supports shape perceived school support in developing self-determination skills among disabled and non-disabled secondary school students in Ireland. Utilising data from the nationally representative Growing Up in Ireland study, descriptive analyses map post-school decision-making and self-determination skills development among disabled and non-disabled young adults at age 20. Multivariate analyses explore the experiences of students with different disabilities, investigating how family, school, and peer influences shape such skill development. Disparities are found between disabled and non-disabled students, as well as among disabled students in school support for this skills development, with gender, socioeconomic background, cultural capital, and early educational experiences also important in perceived support. Positive school engagement and student-teacher relationships, as well as high self-expectations, emerge as protective factors, indicating that fostering supportive environments and self-concept may enhance students’ self-determination skills. The findings underscore the importance of promoting causal agency, providing support for proxy agency, and taking action to create enriching opportunities and choices for all students. Full article

Introduction: Despite legislation mandating accommodation policies in higher education, support for learners with disabilities is often not implemented within health and human services (HHS) education programs, particularly in fieldwork settings. This paper will describe the protocol of a study aimed to (a) explore challenges and opportunities of current practices for supporting learners living with disabilities in a fieldwork context, across 10 HHS programs; and (b) develop, pilot and evaluate innovative accessibility practices to decrease existing barriers faced by educators and learners. Method: Using a critical disability studies framework, we designed a national, multi-profession, mixed methods design. Data are collected through interviews (qualitative) and an online survey (quantitative) that participants complete prior to the interview. Additionally, an online mapping diary is used to facilitate the understanding of accessibility in fieldwork education from the perspective of the learners. Participants include learners living with disabilities, academic fieldwork coordinators, fieldwork educators, accessibility advisors and professional organizations representatives. Implications: Learners living with disabilities navigate systemic barriers: (a) the additional “work of being a disabled learner”, during a rigorous academic program, and (b) absent or inadequate fieldwork accommodations. Exploring those systemic barriers as faced by all partners offers the potential to develop strategies and tools to foster inclusive and accessible HHS education. Full article

Background: Individuals with autism spectrum disorder (ASD) often lead sedentary lives, contributing to cardiovascular disease and muscular atrophy, requiring innovative therapeutic exercise approaches. Whole-body vibration (WBV) exercise training offers a unique option for those with limited motor control. This six-week pilot study aimed to assess the feasibility and effectiveness of WBV training in individuals with ASD. Methods: Six participants (age: 22.17 ± 2.14 years) underwent twice-weekly WBV sessions (10–24 min, 5–25 Hz). Cardiovascular biomarkers, including body composition, leg strength, blood pressure, waist/hip ratio, and body mass index (BMI), were measured. Qualitative outcomes on exercise tolerance, protocol completion, and perceived exertion were collected at each session. Data analyses, including measures of central tendencies and the Wilcoxon Signed Rank Test, evaluated the intervention’s effectiveness. Results: WBV training was safe and well-tolerated in adults with ASD. Despite no statistically significant improvements in cardiovascular and muscular strength indices, participants showed good adherence and tolerance to the protocol. Conclusion: Although WBV training had no significant impact on measured outcomes, it emerged as a feasible and well-tolerated exercise for individuals with ASD. It shows promise for addressing cardiovascular risk factors and reducing sedentary behaviors, suggesting the need for longer interventions to fully uncover its therapeutic potential. Full article

This paper focuses on the uncertainty and resentment that many persons with disabilities feel concerning their disability services in the welfare state of Finland. This paper elaborates on the theme through the lived citizenship of persons with disabilities using the key theory of disability tax as an analytical tool. The empirical data were collected through an online survey (n = 541) and six group interviews (n = 41) of persons with disabilities in 2023. The disability tax experiences are elaborated through four aspects: (1) rejected applications, (2) uncertain realisation, (3) laborious complaint mechanisms, and (4) the psycho–emotional effect. The findings of this study establish collective experiences of multi-layered disability tax throughout the disability services process. It concludes that disability services, which were originally planned to specifically ensure equal opportunities to participate in society for persons with disabilities, are increasingly becoming the very sources of burden as austerity has silently grown deeper over recent years and has become the clear policy of the current government. Full article

Transportation is integral to the employment accessibility and sustainability of people with disabilities. This study aims to identify barriers, facilitators, and solutions to commuting for people with disabilities, drawing from their perspectives as well as those of employers and transportation providers. Through semi-structured individual interviews, insights were gathered from sixteen individuals with disabilities, seven employers, two job integration agents, and four transporters. Qualitative analysis of the interview transcripts revealed factors influencing commuting, including personal attributes and environmental factors. This study underscores the significant impact of environmental factors, particularly the role of social networks and transport infrastructure in either supporting or hindering public transportation use for people with disabilities who commute to work. For example, employers’ limited awareness of their employees’ commuting challenges contrasts with their recognition of their potential role in supporting it. Training and disability awareness initiatives emerge as pivotal solutions to empower individuals within the social network, including transport personnel, fellow passengers, and employers, to facilitate public transportation use by people with disabilities for work commutes. Full article

The purpose of this mixed-method study was to (1) examine the effect of an adapted physical activity program, Fitness Access McGill (FAM), on leisure-time physical activity (LTPA), autonomous and controlled motivation, and the basic psychological needs of self-determination theory among university students/staff with a physical disability and/or chronic conditions, and (2) explore participants’ experiences after completing FAM. Nineteen participants completed validated questionnaires for all study outcomes pre- and post-FAM. Nine participants partook in a 30–60 min semi-structured interview conducted within three months of completing FAM. Quantitative data were analyzed using repeated measures effect size calculations. Qualitative data were analyzed using directed content analysis. Participants reported an increase in total LTPA (dRMpooled = 0.58), with the greatest positive change on strenuous intensity (dRMpooled = 0.81). Large effects were found for changes in autonomous motivation (dRMpooled = 0.52), autonomy (dRMpooled = 0.79), competence (dRMpooled = 0.79), and relatedness (dRMpooled = 0.89). Participants reported FAM being supportive towards their psychological needs, the development of a LTPA routine, and enhanced overall well-being. Future research can be built upon this study to develop a robust understanding as to how need-supportive, adapted LTPA programs could be implemented within community settings or out-patient rehabilitation to support exercise engagement, physical health and overall well-being among adults with disabilities. Full article

Background: Understanding self-concept in individuals with intellectual disabilities is crucial for tailored support and interventions. The research question driving this study is: What factors influence the self-concept of individuals with intellectual disabilities, and how is it assessed? Methods: Employing a systematic review following PRISMA guidelines, studies from 1993 to 2024, which used diverse assessment tools such as the Pictorial Scale of Perceived Competence and Acceptance, Myself as a Learner Scale, and other self-report questionnaires, were analysed. Results: Factors influencing self-concept include diagnosis, age, gender, perception of control, school placement, and socioeconomic status. Internal factors like perception of control and external factors like societal attitudes interact to shape self-concept trajectories. Assessments reveal nuanced dimensions of self-perception, facilitating targeted interventions. Conclusions: Assessing self-concept among individuals with intellectual disabilities requires diverse evaluation methods. Insights gained inform tailored interventions to enhance well-being. Further research is needed to validate assessment tools across diverse populations. Recognizing the interplay of internal beliefs, external perceptions, and societal structures is crucial for empowering individuals to embrace their unique identities. Full article