Treatment of hand mouthing in individuals with severe to profound developmental disabilities: a review of the literature

Functional analysis of challenging behavior in people with severe intellectual disabilities

Challenging behaviors exhibited by individuals with developmental disabilities often hinder the acquisition of academic, social, and life skills. Functional analysis has been useful for assessing challenging behavior in various settings. The purpose of this study was to implement an operant methodology for recognizing the functional properties of challenging behavior in people with intellectual disabilities. Four adults diagnosed with profound intellectual disability received assessment under several experimental conditions using a functional analysis methodology: social attention as positive reinforcement, negative reinforcement such as the termination of demands, positive tangible reinforcements, absence of social contingencies, and escape from noisy stimuli. Results showed that different types of reinforcement or avoiding contingencies affected the rate of aggression, self-injury, disruption, stereotypy, or socially offensive behaviors, and functional analysis may potentially be a viable alternative for identifying challenging behaviors.

The association between self-injurious behaviors and autism spectrum disorders

A key area of concern in children with autism spectrum disorders (ASDs) are self-injurious behaviors (SIBs). These are behaviors that an individual engages in that may cause physical harm, such as head banging, or self-biting. SIBs are more common in children with ASD than those who are typically developing or have other neurodevelopmental disabilities. Therefore, it is important that clinicians who work with children with ASD have a solid understanding of SIB. The purpose of this paper is to review the research on the epidemiology of SIB in children with ASD, factors that predict the presence of SIB in this population, and the empirically supported behavioral treatments available.

Treatments for the challenging behaviours of adults with intellectual disabilities

OBJECTIVE

To provide an overview and critical assessment of common problems and best evidence practice in treatments for the challenging behaviours (CBs) of adults with intellectual disabilities (IDs).

METHOD

Commonly observed problems that present obstacles to successful treatment plans are discussed, followed by an analysis of available research on the efficacy of behavioural and pharmacological therapies.

RESULTS

Behavioural and pharmacological interventions are most commonly used when addressing CBs in people with IDs. However, within each of these techniques, there are methods that have support in the literature for efficacy and those that do not. As clinicians, it is important to follow research so that we are engaging in best practices when developing treatment plans for CBs.

CONCLUSIONS

One of the most consuming issues for psychiatrists and other mental health professionals who work with people who evince developmental disabilities, such as IDs, are CBs. These problems are very dangerous and are a major impediment to independent, less restrictive living. However, there is a major gap between what researchers show is effective and much of what occurs in real-world settings.

Entwicklung und Validierung des Inventars zur funktionellen Erfassung selbstverletzenden Verhaltens (IfES) bei Menschen mit intellektueller Beeinträchtigung

Zusammenfassung. Das Inventar zur funktionellen Erfassung selbstverletzenden Verhaltens (IfES) ist der erste deutschsprachige, speziell für Menschen mit intellektueller Beeinträchtigung entwickelte und faktorenanalytisch überprüfte Fremdbeurteilungsfragebogen mit dem Auslöser und Funktionen des selbstverletzenden Verhaltens erfasst werden können. Ziel des Artikels ist die Beschreibung der Testkonstruktion und der psychometrischen Qualität. Die Untersuchung wurde an einer bundesweiten Stichprobe in Einrichtungen der Behindertenhilfe (n = 452) durchgeführt. Die faktorielle Validität wurde u.a. durch eine konfirmatorische Faktorenanalyse (CFA) überprüft und führte zu einer 5-faktoriellen Lösung mit 24 Items (u.a. RMSEA. .052). Die interne Konsistenz (Cronbachs a) der einzelnen Skalen liegt zwischen .57 und .83. Die Interrater Reliabilitäten (n = 125) für die Subskalen weisen Werte von .61 bis .84 auf. Die Test-Retest-Reliabilitäten (n = 138) liegen zwischen .74 bis .90. Die konvergente Validität wurde mittels eines Fragebogens aus dem angloamerikanischen Raum ermittelt und erwies sich für die einzelnen Subskalen als befriedigend bis sehr gut. Die praktische Eignung des neuen Instrumentes sowie dessen psychometrische Qualität werden diskutiert.

Self-injurious behavior in people with profound intellectual disabilities: a meta-analysis of single-case studies

The limitations people with profound intellectual disabilities experience in functioning contribute to a vulnerability to self-injurious behavior. Since this problem behavior has important negative consequences for people concerned, examining the effectiveness of treatments is important. In the current meta-analysis, single-case studies investigating non-aversive, non-intrusive forms of reinforcement were combined using hierarchical linear models. This analysis revealed that the average effect of treatment was relatively large and statistically significant. Further, significant variance was observed between both studies and participants. In addition, some evidence was found for a moderator effect of sensory impairment. Finally, no statistically significant moderator effects of medication, motor impairment, setting, age, gender, matching of treatment with behavioral function and contingency were found.

Cutoff scores, norms and patterns of feeding problems for the Screening Tool of fEeding Problems (STEP) for adults with intellectual disabilities

Independent living is a goal for everyone, but often persons with intellectual disabilities (ID) have major challenges in this respect. In fact, deficits in daily living skills are a hallmark of the condition. One of the most serious and potentially problematic of the independent living skills is difficulties or irregularities in eating. These problems can not only effect independence but they can result in more restrictive living conditions, poor nutrition, choking, aspiration, or even death. Given the serious nature of the disorder, it points to the need for adequate screening and diagnosis of such problems. The present study reports on the STEP and the development of cutoff scores and norms for the scale. Possible applications of these data for real world problems of person with ID are discussed.

The effects of intellectual functioning on the range of core symptoms of autism spectrum disorders

Autism spectrum disorders (ASD) are a class of conditions categorized by communication problems, ritualistic behaviors, and inappropriate social behaviors. While there is much evidence to support a genetic link for ASD, an identified genetic marker remains elusive. As such, practitioners place considerable emphasis on traditional measures of intelligence and adaptive behavior to aid in diagnosis. Despite the fact that these measures are commonplace, little research has been conducted to shed light on whether deficits in intellectual functioning affect the range of core symptoms for ASD. This study represents a first attempt to determine whether level of IQ has an effect on the expression of ASD symptoms in adults with intellectual disability (ID). Three hundred and six adults, 151 with both ASD and ID and 155 with ID alone, were evaluated with respect to the nature and extent of their ASD symptoms and intellectual functioning. Individuals with autism displayed a higher number of symptoms than those with pervasive developmental disorder-not otherwise specified (PDD-NOS) on all three domains of impairment (social, communication, repetitive behaviors). As expected, persons with ID alone evinced far fewer symptoms than both these groups. IQ level was found to be a moderator for expression of ASD symptoms for the entire sample but not for the autism group.

A review of behavioral treatments for self-injurious behaviors of persons with autism spectrum disorders

Autism spectrum disorders (ASD) are considered to be among the most serious of the mental health conditions. Concomitant with many cases of ASD is intellectual disability. Further compounding the disability is the fact that both conditions are known risk factors for self-injurious behavior (SIB). To date, the most effective intervention methods, based on the available data, appear to be variants of behavior modification. This article provides an overview of the current status of learning-based interventions for SIB in ASD and provides a review of specific studies. Although most studies describe some combination of reinforcement and punishment procedures, efforts are under way to develop more positively oriented strategies, such as functional assessment, to decrease the use of punishment. However, almost all the treatment studies employ single case designs, thus preventing a comparison of treatment efficacy. These issues are discussed along with other strengths, weaknesses, and future directions for clinical practice and treatment.