Depressive mood in students with mild intellectual disability: students' reports and teachers' evaluations

The effects of inclusion on academic achievement, socioemotional development and wellbeing of children with special educational needs

BACKGROUND

Considering the rapid global movement towards inclusion for students with special educational needs (SEN), there is a surprising lack of pedagogical or didactic theories regarding the ways in which inclusive education may affect students with SEN. Group composition within the educational setting may play a role in determining the academic achievement, socio-emotional development, and wellbeing of students with SEN. Proponents of inclusion propose that segregated educational placement causes stigmatisation and social isolation which may have detrimental effects on the self-concept and self-confidence of students with SEN. On the other hand, opponents of inclusion for all special needs students suggest that placement in general education classrooms may have adverse effects especially if the time and resources allocated for individualisation are not aligned with student needs. Since the 1980s, a number of reviews on the effects of inclusion have been published. Results are inconsistent, and several reviews point to a number of methodological challenges and weaknesses of the study designs within primary studies. In sum, the impact of inclusion on students with SEN may be hypothesised to be both positive and negative, and the current knowledge base is inconsistent.

OBJECTIVES

The objective was first: To uncover and synthesise data from contemporary studies to assess the effects of inclusion on measures of academic achievement, socio-emotional development, and wellbeing of children with special needs when compared to children with special needs who receive special education in a segregated setting.A secondary objective was to explore how potential moderators (gender, age, type and severity of special need, part or full time inclusive education, and co-teaching) relate to outcomes.

SEARCH METHODS

Relevant studies were identified through electronic searches in Academic Search Premier (EBSCO), APA PsycINFO (EBSCO), EconLit (EBSCO), ERIC (EBSCO), International Bibliography of the Social Sciences (ProQuest), Sociological Abstracts (ProQuest), Science Citation Index Expanded (Web Of Science), Social Sciences Citation Index (Web Of Science), and SocINDEX (EBSCO). The database searches were completed on 24 April 2021 and other resources: grey literature repositories, hand search in targeted journals and Internet search engines were searched in August/September 2021. The search was limited to studies reported after 2000.

SELECTION CRITERIA

The review included studies of children with special needs in grades K to 12 in the OECD countries. Children with all types of verifiable SEN were eligible. Inclusion refers to an educational setting with a mixture of children with and without SEN. Segregation refers to the separate education of children with SEN. All studies that compared inclusive versus segregated educational settings for children with SEN were eligible. Qualitative studies were not included.

DATA COLLECTION AND ANALYSIS

The total number of potentially relevant studies constituted 20,183 hits. A total of 94 studies met the inclusion criteria, all were non-randomised studies. The 94 studies analysed data from 19 different countries. Only 15 studies could be used in the data synthesis. Seventy-nine studies could not be used in the data synthesis as they were judged to be of critical risk of bias and, in accordance with the protocol, were excluded from the meta-analysis on the basis that they would be more likely to mislead than inform. The 15 studies came from nine different countries. Separate meta-analyses were conducted on conceptually distinct outcomes. All analyses were inverse variance weighted using random effects statistical models. Sensitivity analyses were performed to evaluate the robustness of pooled effect sizes across components of risk of bias.

MAIN RESULTS

The average baseline year of the interventions analysed in the 15 studies used for meta-analysis was 2006, ranging from 1998 to 2012. The average number of participants analysed in the interventions was 151, ranging from 10 to 1357, and the average number of controls was 261, ranging from 5 to 2752. The studies included children with multiple types of disabilities such as learning disorders/intellectual disabilities, autism spectrum disorders, ADHD, physical handicaps, visual impairments, and Down syndrome. At most, the results from eight studies could be pooled in any of the meta-analyses. All the meta-analyses showed a weighted average that favoured the intervention group. None of them were statistically significant. The random effects weighted standardised mean difference was 0.20 (95% confidence interval [CI]: -0.01 to 0.42) for overall psychosocial adjustment; 0.04 (95% CI: -0.27 to 0.35) for language and literacy learning outcomes, and 0.05 (95% CI: -0.16 to 0.26) for math learning outcomes. There were no appreciable changes in the results as indicated by the sensitivity analyses. There was some inconsistency in the direction and magnitude of the effect sizes between the primary studies in all analyses and a moderate amount of heterogeneity. We attempted to investigate the heterogeneity by single factor sub-group analyses, but results were inconclusive.

AUTHORS' CONCLUSIONS

The overall methodological quality of the included studies was low, and no experimental studies in which children were randomly assigned to intervention and control conditions were found. The 15 studies, which could be used in the data synthesis, were all, except for one, judged to be in serious risk of bias. Results of the meta-analyses do not suggest on average any sizeable positive or negative effects of inclusion on children's academic achievement as measured by language, literacy, and math outcomes or on the overall psychosocial adjustment of children. The average point estimates favoured inclusion, though small and not statistically significant, heterogeneity was present in all analyses, and there was inconsistency in direction and magnitude of the effect sizes. This finding is similar to the results of previous meta-analyses, which include studies published before 2000, and thus although the number of studies in the current meta-analyses is limited, it can be concluded that it is very unlikely that inclusion in general increases or decreases learning and psychosocial adjustment in children with special needs. Future research should explore the effects of different kinds of inclusive education for children with different kinds of special needs, to expand the knowledge base on what works for whom.

The Feasibility and Effectiveness of a Novel, On-Line Social Skills Intervention for Individuals With Prader-Willi Syndrome

INTRODUCTION

People with neurodevelopmental disabilities, including Prader-Willi syndrome (PWS), are at heightened risk for the negative sequalae of loneliness, including depression and anxiety. While societal factors such as stigma or limited social opportunities contribute to loneliness, so too do deficits in social cognition and social skills. People with PWS have specific difficulties recognizing affect in others, accurately interpreting social interactions, and taking the perspectives of others. These features, combined with hyperphagia, rigidity, and insistence on sameness conspire to impede the abilities of people with PWS to make and sustain friendships and reduce feelings of loneliness.

METHODS

We developed and administered an intervention, Building Our Social Skills (BOSS), that aimed to improve social skill deficits in PWS. The 10-week intervention was administered on-line via Zoom to 51 young people with PWS in the U.S. (M age = 20.8, SD = 6.42). Two clinicians co-led groups of 6-8 participants in 30-min sessions, 3 times per week, and also trained 4 graduate students to co-lead groups with high fidelity. We used a pre-post intervention and 3-month follow-up design, with no control group, and mitigated this design limitation by triangulating across informants and methodologies. Specifically, parents completed the widely used Social Responsiveness Scale (SRS) and Child Behavior Checklist (CBCL), and participants were individually interviewed about their friendships and loneliness. Interview responses were reliably coded by independent raters.

RESULTS

Repeated measure multivariate analyses, with baseline values entered as covariates, revealed significant pre-to post-test improvements in the SRS's social cognition, motivation and communication subscales (p's < 0.001), with large effect sizes ( n p 2 = 0.920, 0.270, and 0.204, respectively). Participant and parental reports of loneliness were correlated with the CBCL's Internalizing domain, specifically the Anxiety/Depressed subdomain. Over time, parents reported getting along better with peers, increased contact with friends, more friends and less loneliness. Participants also reported significantly less loneliness and more friends.

CONCLUSIONS

This mixed method, proof-of-concept study demonstrated the feasibility of delivering an on-line social skills intervention to young people with PWS. As no differences were found between clinician vs. graduate student outcomes, the BOSS curriculum holds considerable promise for wider dissemination and implementation in the PWS community.

Implementation of inclusive education for children with intellectual and developmental disabilities in African countries: a scoping review

Purpose: To advance understanding of practices that support inclusion of children with intellectual and developmental disabilities in inclusive education classrooms in Africa by conducting a review of the extant literature. Methods: Five academic databases were searched supplemented by a hand search of key journals and references of included studies. Two authors independently screened studies via a reference manager (Covidence) which allowed for blinding. A third author was consulted in cases of conflict. Results: Thirty articles that provided empirical evidence of inclusive education implementation were included. Eight articles highlighted practices that support inclusion of children with intellectual and developmental disabilities. Using Bronfenbrenner's bioecological framework, findings revealed that inclusive education implementation is influenced by factors on the bio level, micro level, meso level, and macro level. Recommendations for promoting inclusive education implementation are provided. Conclusions: Inclusion goes beyond teachers and requires strong commitment of other stakeholders such as families and governments. To guarantee the smooth inclusion of children with special education needs and particularly with intellectual and developmental disabilities, a set of practices validated through rigorous research as supportive and unique and that can be universal to Africa is wise. Implications for rehabilitation A number of strategies were identified that can improve the classroom inclusion of children with intellectual and developmental disabilities. Development of policies that support such strategies could improve implementation. Inclusion goes beyond teachers. Rehabilitation professionals (i.e. occupational therapists) and educational professionals should partner to identify practical solutions to the challenges of creating inclusive environments for children with special education needs. Committing more resources and time towards the development and implementation of special education policies can advance the successful inclusion of children with special education needs.

Beck's cognitive theory and the response style theory of depression in adolescents with and without mild to borderline intellectual disability

AIM

This study tests the validity of Beck's cognitive theory and Nolen-Hoeksema's response style theory of depression in adolescents with and without MBID.

METHODS

The relationship between negative cognitive errors (Beck), response styles (Nolen-Hoeksema) and depressive symptoms was examined in 135 adolescents using linear regression.

RESULTS

The cognitive error 'underestimation of the ability to cope' was more prevalent among adolescents with MBID than among adolescents with average intelligence. This was the only negative cognitive error that predicted depressive symptoms. There were no differences between groups in the prevalence of the three response styles. In line with the theory, ruminating was positively and problem-solving was negatively related to depressive symptoms. Distractive response styles were not related to depressive symptoms. The relationship between response styles, cognitive errors and depressive symptoms were similar for both groups.

CONCLUSION

The main premises of both theories of depression are equally applicable to adolescents with and without MBID. The cognitive error 'Underestimation of the ability to cope' poses a specific risk factor for developing a depression for adolescents with MBID and requires special attention in treatment and prevention of depression. WHAT THIS PAPER ADDS?: Despite the high prevalence of depression among adolescents with MBID, little is known about the etiology and cognitive processes that play a role in the development of depression in this group. The current paper fills this gap in research by examining the core tenets of two important theories on the etiology of depression (Beck's cognitive theory and Nolen-Hoeksema's response style theory) in a clinical sample of adolescents with and without MBID. This paper demonstrated that the theories are equally applicable to adolescents with MBID, as to adolescents with average intellectual ability. However, the cognitive bias 'underestimation of the ability to cope' was the only cognitive error related to depressive symptoms, and was much more prevalent among adolescents with MBID than among adolescents with average intellectual ability. This suggests that underestimating one's coping skills may be a unique risk factor for depression among adolescents with MBID. This knowledge is important in understanding the causes and perpetuating mechanisms of depression in adolescents with MBID, and for the development of prevention- and treatment programs for adolescents with MBID.

Psychometric properties of the Arabic self-report version of the strengths and difficulties questionnaire

Students in middle school tend to display emotional and behavioural difficulties (EBDs) compared to other forms of psychopathology. Early identification of EBDs is therefore a priority in order to prevent the chronic co-morbidity with other forms of psychopathology which may affect students' academic achievement. Assessment of EBDs has been traditionally undertaken via proxy reporting; but psychometrically rigorous instruments are needed so that children and adolescents can report on their own emotions and behaviours. Such need increases in the Omani context given the lack of EBDs adequate assessment instruments. In the current study the factor structure of the Arabic self-report version of the Strengths and Difficulties Questionnaire (A-SDQ) was examined in a sample of 815 middle school students (mean age=14 years). The study tested the SDQ original five-factor model which received considerable empirical support. Responses on the A-SDQ were compared to responses obtained via proxy reports from teachers and parents through confirmatory factor analyses (CFAs). Results showed a reasonable fit for the three informant forms. Nevertheless, there were differences in item loadings across the three informant forms. Additionally, participants' self-report responses were tested for invariance across gender. CFAs provided support to the invariance hypothesis for item loadings, indicating that the items were similarly valid indices of the five factors for males and females. Factor correlations, factor variances and item residuals were not invariant across gender.

WHAT THIS PAPER ADDS

This paper, to our knowledge, is the first research paper that provides empirical evidence on the Arabic self report version of the Strengths and Difficulties Questionnaire (A-SDQ) within a school-based sample. Though the focus was on the self-report version we collected data from the proxy versions for parents and teachers to provide additional evidence on the construct validity of the (A-SDQ) through cross informant data.

Study protocol: a randomised controlled trial testing the effectiveness of 'Op Volle Kracht' in Dutch residential care

BACKGROUND

Although adolescents are often referred to residential treatment centres because of severe externalizing behaviours, a vast majority demonstrated comorbid symptoms of depression and anxiety. Covert internalizing symptoms in these adolescents might be easily unrecognized and therefore untreated. Adolescents with mild intellectual disability (MID) are overrepresented among youth with both externalizing and internalizing problems. There are yet few treatment programs available for adolescents with both externalizing and internalizing problems.

METHODS/DESIGN

The CBT-based resiliency program, Op Volle Kracht (OVK), which is based on the US Penn Resiliency Program (PRP), was adapted to suit the needs of adolescents with both externalizing and internalizing problems, either with or without MID, in Dutch residential treatment centres. The effectiveness of this group intervention program of eight sessions will be tested in a randomised controlled trial (RCT) with N = 182 adolescents aged 12-16, allocated to either the target intervention plus treatment as usual (OVK + TAU) or treatment as usual only (TAU). The main outcome variables include depressive symptoms (primary), anxiety, behavioural problems, and group therapeutic climate. Cognitive styles and coping styles will be included as possible mediators. Assessments take place at baseline (T1), one week before the start of the program (T2), immediately after the program (T3), and at three months follow-up (T4).

DISCUSSION

The program assets include its wide implementation possibilities due to low costs, the short duration of the program and the delivery by group care workers, and its suitability for adolescents with MID. Further strengths of the present study design include its robust method (RCT), the ecological validity, and the inclusion of possible mediators of treatment effect. The program emphasizes individual risk factors for depression rather than social and family factors. Implications for practice and future research are discussed.

TRIAL REGISTRATION

Dutch Trial Register NTR4836.

Examining the psychometrics of the Psychopathology Inventory for Mentally Retarded Adults-II for individuals with mild and moderate intellectual disabilities

With growing recognition of the occurrence of psychological disorders in individuals with intellectual disability (ID), researchers and clinicians alike have placed emphasis on developing measures to assess for psychopathologies in this population. Despite an increased interest in the topic, there is still a dearth of psychometrically robust measures available to assess for psychopathology in adults with mild and moderate ID. The purpose of this study was to examine the psychometric properties of a revised measure for psychopathology in individuals with mild and moderate ID, the Psychopathology Inventory for Mentally Retarded Adults - second edition (PIMRA-II). Internal consistency, inter-rater reliability, and test-retest reliability were investigated. Validity was studied via convergent validity by comparing the PIMRA-II to the Assessment of Dual Diagnosis (ADD) and via discriminate validity by comparing the PIMRA-II to the Social Performance Survey Schedule (SPSS) prosocial scores. Lastly, an exploratory factor analysis was conducted to determine the factor structure of the scale.

Factor analysis of the self-report version of the strengths and difficulties questionnaire in a sample of children with intellectual disability

The rate of emotional and behavioural disturbance in children with intellectual disability (ID) is up to four times higher than that of their typically developing peers. It is important to identify these difficulties in children with ID as early as possible to prevent the chronic co-morbidity of ID and psychopathology. Children with ID have traditionally been assessed via proxy reporting, but appropriate and psychometrically rigorous instruments are needed so that children can report on their own emotions and behaviours. In this study, the factor structure of the self-report version of the Strengths and Difficulties Questionnaire (SDQ) was examined in a population of 128 children with ID (mean age=12 years). Exploratory and Confirmatory Factor Analysis showed a three factor model (comprising Positive Relationships, Negative Behaviour and Emotional Competence) to be a better measure than the original five factor SDQ model in this population.

The Center for Epidemiologic Studies Depression Scale: factor validity and reliability in a French sample of adolescents with Intellectual Disability

The purpose of this study was to test the factor validity and reliability of the Center for Epidemiologic Studies Depression Scale (CES-D) within a sample of adolescents with mild to moderate Intellectual Disability (ID). A total sample of 189 adolescents (121 boys and 68 girls), aged between 12 and 18 years old, with mild to moderate ID were involved in two studies. In study 1, the content, phrasing and answering format of the CES-D were adapted for adolescents with ID. This instrument was renamed CES-D for ID (CES-D-ID) and two different versions based on two alternative answer scales (Likert and Likert-graphical) were developed and their psychometric properties were verified in study 2. The results provided support for the factor validity, reliability and invariance across gender and age of a 14-item version of the CES-D-ID based on a Likert-graphical answer scale.

Women with and without intellectual disability and psychiatric disorders: an examination of the literature

This article examines the literature on women with and without intellectual disability and psychiatric disorders, using a gender social model of health. Relevant empirical studies, international literature reviews and policies between 1980 and 2007 were identified from electronic databases, journals and secondary sources. Three areas were examined: psychiatric disorders, their contextual background, and their clinical presentation. There are minimal levels of research into women with intellectual disability and psychiatric disorders. However, this article hypothesizes that women with intellectual disability have higher rates of psychiatric disorders than women without. This may result from greater vulnerability related both to internal factors (;intra': cognitive deficits, poorer communication skills, limited social skills) and to the external world (;inter': lack of opportunities, stigma, poor social support networks). The article argues that such women require gender-sensitive mental health services. However, more empirical evidence is required to support this claim and to inform development and delivery of services.

Loneliness and living arrangements

Adults with ID/DD live in increasingly small community settings, where the risk of loneliness may be greater. We examined self-reported loneliness among 1,002 individuals with ID/DD from 5 states in relation to community residence size, personal characteristics, social contact, and social climate. One third reported being lonely sometimes and one sixth said they were often lonely, but loneliness was not more common for people living alone or in very small settings. More loneliness was reported by residents of larger community living settings of 7 to 15 people. More social contact and liking where one lives were associated with less loneliness. Social climate variables, such as being afraid at home or in one's local community, were strongly associated with greater loneliness.

Self-reports on mental health problems of youth with moderate to borderline intellectual disabilities

OBJECTIVE

To determine the extent to which the Youth Self-Report (YSR) can be used to assess emotional and behavioral problems in adolescents with intellectual disabilities (IDs).

METHOD

In 2003, 281 11- to 18-year-olds with IDs (IQ > or =48) completed the YSR in an interview, and in 1993, 1,047 non-ID adolescents completed the YSR themselves. Parents completed the Child Behavior Checklist (CBCL). The ID sample was split into lower (IQ 48-69) and higher (IQ > or =70) IQ groups. Cronbach's alpha values of the YSR scales and (intraclass) correlation coefficients between and within YSR and CBCL scale scores were calculated to determine parent-adolescent agreement and YSR construct validity, which were compared between samples. Mean YSR scale scores were compared between adolescents with ID with and without psychiatric symptoms.

RESULTS

Cronbach's alpha, parent-adolescent agreement, and indications of construct validity were about similar in all samples, although discriminant validity was somewhat weaker in the lower IQ group. Mean scale scores were 1.5 to 2.0 times higher for ID adolescents with psychiatric symptoms.

CONCLUSIONS

The YSR seems applicable in youth with an IQ > or =48. Further research is needed to refine and confirm these findings and the factor structure of the YSR in adolescents with ID and to differentiate between adolescents with moderate and mild IDs.

Psychiatric co-morbidity and gender differences in intellectual disability

BACKGROUND

Although gender differences in psychopathology among the general psychiatric population appear to be well documented, such differences have been either ignored or inconsistently investigated among people with intellectual disability (ID).

METHODS

The study examined psychiatric co- morbidity in 295 men and 295 women with ID and significant social impairments living in community settings. The sample was drawn from consecutive clinical referrals to a specialist mental heath service of South-East London. Psychiatric diagnoses were based on ICD-10 criteria.

RESULTS

Personality disorder was more common among men, although dementia and adjustment reaction were more common among women. There were also gender differences in marital status, with a larger percentage of women being either married or in a stable relationship. Gender differences in the source of referral were also observed, with more women being referred through primary care and more men being referred through generic mental health services.

CONCLUSIONS

Female patients seem to have at some extent different mental health needs from male patients. Such differences should be taken into account in the design and delivery of clinical service for people with ID.

Diagnosis and treatment of depression in patients with mental retardation

Depression in mentally retarded individuals is not uncommon and usually is treatable. However, studies of the diagnosis and treatment of psychiatric illnesses in general and depression specifically in this population are relatively rare. Although Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria can be applied to mildly and moderately retarded individuals, the diagnosis of depression in those with intelligence quotients below 35 is challenging. However, the diagnosis of depression in the latter group is possible using modified criteria emphasizing observational data. Criteria include symptoms such as sadness, irritability, decreased social interaction, regression of skills, sleep disturbances, diurnal variation, and aggression. Furthermore, there is a growing body of evidence that antidepressant treatments, especially administration of selective serotonin reuptake inhibitors, are effective in treating depression in mentally retarded patients. This article reviews numerous studies elaborating on the diagnosis, phenomenology, and treatment of depression in mentally retarded individuals.

Social and psychological characteristics of Greek secondary school students with learning difficulties

In Greece there is an almost total lack of special education after the primary school (6th grade). This is a descriptive study that aimed to examine social, academic and psychological characteristics of secondary school students with a history of special placement during primary school. It compared 86 students with a placement (group A) with their 1284 schoolmates with no such placement history (group B) with respect to scores on School Adjustment Scale, Academic Motivation Self-Rating Inventory and Youth Self-Report. Group A presented more family social, academic and psychological problems such as: One-parent family, lower socioeconomic status, poor adjustment, low motivation and (especially for boys) high internalizing and externalizing scores. The high rates of failure and dropout of these students indicate that in Greece there is a need to set up appropriate services to help secondary school students with learning difficulties.