| Summary: | The assessment and prediction of aggression has been the subject of considerable research attention among mainstream adult populations. With the inherent limitations and biases of unstructured clinical judgement, most attempts to assess risk are aided by use of structured measures. Clinicians and researchers working with mainstream populations have over 120 different structured risk assessments available to inform clinical assessment of violent and sexual offending (Singh & Fazel, 2010). Furthermore, numerous meta-analysis have been conducted comparing risk instruments with one another (see the meta-analytic review by Hanson & Morton-Bourgon, 2009) with the aim of guiding clinician's choice of which measure to use in practice. Knowledge and research regarding risk assessment procedures in the field of intellectual disability (ID) has been considerably slower to develop (Lindsay & Beail, 2004). One implication of the limited research is that professionals are unsure which assessments to use in clinical practice and research. For this reason, clinicians are likely to use measures developed for mainstream populations with unknown reliability and validity. Alternatively, clinicians may be inclined to develop their own idiosyncratic measures or modify established measures to be more in line with the characteristics of adults with ID. As a result, assessing the risk of adults with ID who engage in aggressive behaviour is likely to be inaccurate. The implications of such inaccuracies are costly for adults with ID, those involved in their care and the public. Without the ability to reliably predict who will engage in aggressive behaviour, clinicians may unnecessarily restrict the freedom of adults with ID out of concern for the safety of the individual and the public. Conversely, clinicians may unintentionally underestimate the adult's potential to harm others. A balance between the human rights and ethical implications of restricting liberty and the need to protect the human rights and safety of the public is paramount, particularly in community settings. Risk assessment measures offer increased transparency and reliability in estimating risk. This thesis describes two studies that aim to advance the literature in the ID field in order to assist clinicians and researchers in selecting, assessing and managing the risk assessment process. In Chapter 1, a meta-analysis reports on the predictive accuracy of risk assessment measures commonly used with adults with ID. Unlike previous reviews in this area, the present study is the first in the field to offer a meta-analysis in this area. Therefore, the research is more robust and offers greater validity for the performance of risk assessments in this population. The sub-group analysis offers insight into the accuracy of risk assessment measures with different orientations (i.e., static, dynamic and structured professional judgment). The empirical paper in chapter two assesses the predictive accuracy of two risk assessment measures: the Current Risk of Violence (CuRV; Lofthouse, Lindsay, Totsika, Hastings, & Roberts, 2014) and the Short Dynamic Risk Scale (SDRS; Quinsey, 2004) developed specifically for adults with ID. The study is novel in that it is one of the few in the field to include a community sample. UK policy (Department of Health, 2009) stipulates that adults with ID should receive services in the least restrictive environments, ideally in the community. Therefore, it is important for professionals in community services to be aware of which measures are suitable to use as part of the risk assessment process.
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