Conclusions

Although extensive in its scope, this review has not addressed all prominent interventions in the field of ID. We have confined ourselves to therapeutic interventions rather than macro-environmental interventions. There is no doubt that the most influential political development in the field has been that of deinstitutionalisation. This has led to massive programmes of relocation of individuals from large institutions to community settings. This 'practice' has been extensively evaluated and has a comprehensive, scientific evidence base (Cummins & Lau, 2003; Emerson et al., 2000; Felce, Lowe & Jones, 2002). As we outlined at the beginning, to review the whole field of ID and the evidence for the extensive range of practice is beyond the scope of a single chapter.

We have provided robust arguments that scientific integrity is not limited to randomised controlled trials but extends to well-controlled case studies. We have given several examples of such experimental rigour in individual case illustrations. As aresult we have demonstrated that there is an extensive evidence base to evaluate psychological treatment for people with intellectual disabilities. The position that therapies have not been evaluated and no guidance is available is untrue.

The evidence base to support the use of behaviour therapy is massive, comprehensive and superior to the evidence base supporting any other kind of therapy. Behavioural approaches have also addressed a very wide range of problems. There is also convergence from numerous sources that behavioural interventions based on functional assessment and that involve manipulation of contingencies are associated with larger effect sizes. Although there is evidence for the effectiveness of PBS, that evidence base is somewhat weaker because of the more modest size of the available database. Future work on behavioural interventions should vigorously pursue topics such as mental health needs, generalisation, maintenance, social validity, and dissemination of effective technologies.

Although there is the beginning of an evidence base for cognitive therapy with people with intellectual disabilities, especially for anger management, it is much more limited. The possibility that the effects of cognitive therapy merely reflect the behavioural procedures contained in most treatment packages labelled 'cognitive therapy' has yet to be addressed (Sturmey, 2004). There is currently no convincing evidence base to support the use of counselling or sensory therapies with people with intellectual disabilities.

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