How effective are risk assessments/measures for predicting future aggressive behaviour in adults with intellectual disabilities (ID): A systematic review and meta-analysis

Situational Factors Impacting Harmful Behavior Towards Others Related to Mental Health in the Community and Their Associations: A Scoping Review Based on Systematic Reviews

BACKGROUND/OBJECTIVES

This study aimed to identify factors associated with harmful behavior toward others based on existing research.

METHODS

This scoping review focused on individuals at risk of harming others due to mental health issues, with the target population encompassing three settings: the community, inpatient facilities with frequent admissions and discharges, and healthcare settings where medical treatment is sought. A scoping review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The terms violence, aggression, problem behavior, and workplace violence were used to search for related literature, subsequently selecting systematic reviews.

RESULTS

A total of 24 papers were ultimately included. From the included papers, background factors (demographic, personal history, and clinical aspects); situational factors (social connection status, daily life status); psychological factors; antecedents of harmful behavior; and triggers of harmful behavior were extracted as factors associated with harmful behavior.

CONCLUSIONS

Our results indicate that background and situational factors lead to harmful behavior toward others, disruptions in the harmony between these factors cause disturbances in psychological processes, and harmful behavior toward others is triggered by stimuli that promote such behavior. Considering that all studies reviewed herein involved inpatients and forensic patients in medical settings, further research is required to identify the factors associated with harmful behaviors occurring in the community.

The predictive value of the dynamic risk outcome scales (DROS) for recidivism in (forensic) clients with mild intellectual disabilities or borderline intellectual functioning

BACKGROUND

The dynamic risk outcome scales (DROS) was developed to assess treatment progress of clients with mild intellectual disability or borderline intellectual functioning using dynamic risk factors. We studied the predictive value of the DROS on various classifications and severity levels of recidivism.

METHOD

Data of 250 forensic clients with intellectual disabilities were linked to recidivism data from the Judicial Information Service in the Netherlands. Receiver operating characteristics (ROC) analyses were used to determine the predictive values.

RESULTS

The DROS total score could not significantly predict recidivism. A DROS recidivism subscale predicted general, violent and other recidivism. These predictive values were comparable to those of a Dutch tool validated for risk assessment in the general forensic population.

CONCLUSIONS

The DROS recidivism subscale predicted various classifications of recidivism better than chance. At present, the DROS appears to have no added value beyond the HKT-30 for the purpose of risk assessment.

Prevalence of Challenging Behaviour in Adults with Intellectual Disabilities, Correlates, and Association with Mental Health

Purpose of Review

To summarise findings about the prevalence and correlates of challenging behaviour in adults with intellectual disabilities from robust research. We also describe findings on the interplay between challenging behaviour and mental health.

Recent Findings

Recent studies that have utilised psychometrically evaluated tools, with clear operational definitions, show similar findings on the prevalence of challenging behaviour of about 1 in every 5–6 adults known to services. We describe common correlates identified such as communication impairments, severity of intellectual disability, and living in institutional settings or congregate care. We also describe the complex and multifaceted relationship between challenging behaviour and mental health.

Summary

Based on recent studies, we propose a revised framework model to help understand challenging behaviour. We propose a number of areas where more research is required, particularly the development of risk tools clinicians can utilise in practice.

Predicting aggression in adults with intellectual disability: A pilot study of the predictive efficacy of the Current Risk of Violence and the Short Dynamic Risk Scale

BACKGROUND

Structured assessments have been shown to assist professionals to evaluate the risk of aggression in secure services for general offender populations and more recently among adults with intellectual disabilities. There is a need to develop intellectual disability sensitive measures for predicting risk of aggression in community samples, especially tools with a focus on dynamic variables.

METHODS

The study prospectively followed 28 participants for up to 2 months to test whether the Current Risk of Violence (CuRV) and Short Dynamic Risk Scale (SDRS) were able to predict verbal and physical aggression in a community sample of adults with intellectual disability.

RESULTS

CuRV and SDRS ratings significantly predicted verbal and physical aggression over a 2-month period.

CONCLUSIONS

The current study supports the use of the CuRV with adults with intellectual disability living in community settings. The CuRV and SDRS are worthy of future development and evaluation in independent investigations.

The use of test instruments in forensic report writing - Explorative research in Flanders

BACKGROUND

Forensic psychiatric reports have a profound impact on the life of a defendant, on society and on the mental health system. Good-quality reports are essential but are often criticized for their lack of thorough substantiation. The use of multiple methods to obtain information, test instruments (psychological and/or risk) and third-party information are recommended.

STUDY PURPOSE

To explore the use of test instruments and third-party information, as part of a multi-method approach, in forensic psychiatric evaluations. We examined 151 court-ordered expert reports in Flanders (Belgium).

RESULTS

A psychological test instrument was used in 61% of the cases, and a risk taxation instrument in 19% of the cases. Third-party information was used in 43% of the cases.

CONCLUSIONS

A multi-method approach is not common practice in forensic psychiatric evaluations. The use of validated test instruments and third-party information can be improved. The quality of forensic reports could be improved by the establishment of a forensic observation centre and the use of a standardized approach.