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

Measurement issues in longitudinal studies of mental health problems in children with neurodevelopmental disorders

PURPOSE

To develop and test an approach for assessing the risk of bias in four measurement-related domains key to the study of mental health problem trajectories in children with neurodevelopmental disorders (NDD): (1) conceptual overlap between mental health problems and NDD diagnostic criteria, (2) over-reliance on a single informant, (3) unwarranted omission of the child's perspective, and (4) the use of instruments not designed for or adapted to the population.

METHODS

Building upon a previous systematic review, this study established supplementary criteria for assessing the risk of bias domains. Following this, the criteria were applied to measures used in 49 longitudinal studies of mental health problems in children with NDD.

RESULTS

The general risk of bias across domains was rated as high in 57.1% of the 49 included studies. The highest risk of bias was seen in domain four (rated as high in 87.8% of studies) and the lowest in domain three (24.5%).

CONCLUSIONS

The risk of bias items enhance our understanding of the quality of the evidence about mental health problem trajectories in children with NDD. The methodological quality of future research can be increased by selecting conceptually clear scales developed for the population - preferably in the form of cognitively accessible self-report scales - and adopting a multi-informant approach.

Internalizing Psychiatric Symptoms in People With Mosaicism for Trisomy 21

People with mosaicism for trisomy 21 have been shown to exhibit many of the same phenotypic traits present in people with non-mosaic Down syndrome, but with varying symptom severity. However, the behavioral phenotype of people with mosaic Down syndrome (mDS) has not been well characterized. This study aimed to examine the prevalence of self-report and caregiver-report symptoms of depression and anxiety among a sample of 62 participants with mDS aged 12-46 and assess their association with the percentage of trisomy 21 in blood and/or buccal mucosa cells. The overall MANCOVA revealed a significant effect of trisomy on the set of internalizing scales, controlling for age and gender (p = 0.038, partial eta2 = 0.22). However, follow-up univariate analyses showed that the initial significant effect of trisomy on fear (p = 0.049, partial eta2 = 0.08) did not survive correction for multiple comparisons (adjusted p = 0.300). No other effects were significant. This study highlights the high occurrence of depression and anxiety symptoms in individuals with mDS and the need for routine assessment to optimize their care. It also demonstrates the ability of people with mDS to complete these evaluations, thereby supporting their inclusion in research studies/clinical trials.

Internalizing Psychiatric Symptoms in People with Mosaicism for Trisomy 21

People with mosaicism for trisomy 21 have been shown to exhibit the many of same phenotypic traits present in people with non-mosaic Down syndrome, but with varying symptom severity. However, the behavioral phenotype of people with mosaic Down syndrome (mDS) has not been well characterized. This study aimed to examine the prevalence of self-report and caregiver-report symptoms of depression and anxiety among a sample of 62 participants with mDS aged 12 - 46, and assess their association with the percentage of trisomy 21 in blood and/or buccal mucosa cells. The results showed that 53% of the participants reported clinically significant depression symptoms and 76% reported clinically significant anxiety symptoms. No clear associations were observed between the percentage of trisomic cells and total anxiety or depression, but a significant positive association between the proband-reported specific fears subscale and the percentage of trisomic cells in buccal specimens was detected (r = .43, p = .007). This study highlights the high occurrence of depression and anxiety symptoms in individuals with mDS and the need for routine assessment to optimize their care. It also demonstrates the ability of people with mDS to complete these evaluations, thereby supporting their inclusion in research studies/clinical trials.

General Measurement Tools for Assessing Mental Health Problems Among Children and Adolescents with an Intellectual Disability: A Systematic Review

There is a need for more knowledge of valid and standardized measures of mental health problems among children and adolescents with intellectual disability (ID). In this study, we systematically reviewed and evaluated the psychometric properties of instruments used to assess general mental health problems in this population. Following PRISMA guidelines, we reviewed empirical research published from 1980 through February 2020 with an updated search in March 2021 in Medline, Embase, PsycINFO, Health and Psychological Instruments, CINAHL, ERIC, and Web of Science databases. Forty-nine empirical articles were included in this review. Overall, the review indicated consistently better documentation of the reliability and validity of instruments designed for the ID population compared to instruments developed for the general child population.

Proxy-report in individuals with intellectual disability: A scoping review

BACKGROUND

Views can be collected from individuals (self-report) or others on their behalf (proxy-report).

OBJECTIVE

We aimed to review the literature on methods and statistical approaches used to evaluate observer versus self-report responses from individuals with intellectual disability or Down syndrome.

METHODS

A series of key questions related to statistical approaches and data collection methods were formulated a priori to inform the search strategy and review process. These addressed the topics of self-report in individuals with intellectual disability, including Down syndrome. Using the National Library of Medicine database, PubMed, detailed literature searches were performed. The quality of available evidence was then evaluated, the existing literature was summarised, and knowledge gaps and research needs were identified.

RESULTS

Fifty relevant original articles were identified which addressed at least one key question. Study details, including: research design, internal validity, external validity, and relevant results are presented. Review of studies of individuals with intellectual disability which used a variety of statistical approaches showed mixed agreement between self-report and proxy-report.

CONCLUSION

Few studies identified to-date have used self-report from individuals with Down syndrome, but lessons from the existing intellectual disability literature can guide researchers to incorporate self-report from individuals with Down syndrome in the future.

Protocol for a systematic review exploring the psychometric properties of self-report health-related quality of life and subjective wellbeing measures used by adolescents with intellectual disabilities

BACKGROUND

Whilst there are studies that have systematically reviewed the psychometric properties of quality of life measures for children and young people with intellectual disabilities, these narrowly focus on disease or health conditions. The objective of this planned systematic review is therefore to collate, summarise, and critically appraise the psychometric properties of self-report health-related quality of life (HRQoL) and subjective wellbeing measures used by adolescents (aged 11-16) with an intellectual disability.

METHODS

We designed and registered a study protocol for a systematic review of studies which explores the psychometric properties of self-report HRQoL and subjective wellbeing measures used by adolescents with intellectual disabilities. Electronic databases including PsycINFO, CINAHL, MEDLINE, and ERIC will be searched using predefined search terms to identify relevant studies. Quantitative and mixed-methods studies, and studies published in peer-reviewed journals or grey literature, will be included. Review papers, editorials, and case studies will be excluded. Eligible studies should identify self-report measures which assess HRQoL and subjective wellbeing among adolescents with intellectual disabilities. The methodological quality of the included studies will be assessed by applying the COSMIN Risk of Bias checklist. The quality of the evidence (i.e. the total body of evidence used for the overall ratings on each psychometric property of an instrument) will be evaluated in accordance with the modified GRADE guidelines.

DISCUSSION

This systematic review will be among the first to systematically explore the psychometric properties of self-report HRQoL and subjective wellbeing measures used by adolescents with intellectual disabilities. By providing evidence-based knowledge about measures being used in HRQoL and subjective wellbeing research amongst this population, and more importantly how reliable and valid these measures are, the most suitable for use will be identified. Our findings will be of potential interest to clinicians, researchers, and service providers who need information about the methodological quality and the characteristics of measures to make informed decisions about the most reliable and valid tool for a specific purpose. The findings from this study will contribute to the knowledge surrounding available and appropriate measures to use for measuring HRQoL and subjective wellbeing of adolescents with intellectual disabilities, which are necessary to inform intervention development and future health policy.

SYSTEMATIC REVIEW REGISTRATION

The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO). The registration number is CRD42021231697 .

Evaluating the Use of Self-reported Measures in Autistic Individuals in the Context of Psychiatric Assessment: A Systematic Review

The current review examined the use of self-report measures in autistic individuals in the context of psychiatric assessments. It focused on inter-rater agreement, internal consistency, test-retest reliability, and criterion validity with clinical diagnoses. It also gathered information on constructs measured, the nature of the samples, and the quality of the studies. Thirty-six out of 10,557 studies met inclusion criteria. We found that the majority of studies (1) targeted young people with average or above average cognitive abilities, (2) measured anxiety symptoms, and (3) evaluated parent-child agreement. More studies are needed on individuals with lower cognitive abilities, adults, and other constructs. Studies assessing criterion validity and test-retest reliability are also needed.

Experiences of ward atmosphere in inpatients with intellectual disability and mental illness: clinical implications for mental health nursing

Background: Patients with intellectual disability in psychiatric services are rarely asked about their experiences when admitted to inpatient units. Aim: To enhance the understanding of ward atmosphere for inpatients with co-occurring intellectual disabilities (ID) and mental illness by exploring patients' experiences from a specialised mental health inpatient unit. Methods: A selected sample of 10 adults with comorbid mental illness and ID were recruited for a qualitative interview study based on Gunderson's conceptualisation of therapeutic components in mental health wards. The patients were interviewed by two experienced clinicians and interviews were analysed using directed content analysis. Results: Patients' experience of their relationships with ward staff seemed central to their experiences of several aspects of mental health nursing. Feeling safe, contained, and validated, were further important aspects. However, the patients seemed to have little influence on treatment choices and did not report participating in shared decision-making. Conclusions: The patients' answers in this study are in line with previous research on ward atmosphere for patients in the general population. However, more research is necessary to inform future mental health nursing for patients with ID, both in inpatient and ambulatory services.

Treatment Approach and Sequence Effects in Cognitive Behavioral Therapy Targeting Emotion Regulation Among Adolescents with Externalizing Problems and Intellectual Disabilities

Background

Over the past years, it has become clear that adapted cognitive behavior therapy can be effective for adolescents with externalizing problems and mild intellectual disabilities or borderline intellectual functioning (MID–BIF). Most adapted treatment protocols consist, however, of a combined cognitive and behavioral approach, even though it is actually unclear which approach is most suitable for these adolescents. This experimental study aimed to examine which treatment approach (cognitive versus behavioral) and which treatment sequence (cognitive–behavioral versus behavioral–cognitive) is most effective.

Methods

Participating adolescents (N = 42, 50% boys, Mage = 15.52, SD = 1.43) consecutively received a cognitive and behavioral emotion regulation training module, but were randomly assigned to a different module sequence condition. Emotion regulation and externalizing problems were measured before and after the modules, and with continuing weekly assessments.

Results

Results indicated that the cognitive module, by itself, was more effective than the behavioral module. In addition, the results indicated that it is most effective to include behavioral exercises after (rather than before) cognitive training.

Conclusions

These findings highlight the importance of cognitive treatment approaches for adolescents with MID–BIF, and show that treatment approaches may have different effects, depending on the order in which they are presented.

Psychometric evaluation of the Rosenberg Self-Esteem Scale in primary school students with mild intellectual disability: First evidence

BACKGROUND

Although the Rosenberg Self-Esteem Scale (RSES) is the most widely used measure of self-esteem, the evidential basis to confirm the RSES factor validity and reliability in children with intellectual disabilities (ID) has not been previously addressed. The purpose of this study was to evaluate the psychometric properties of the Greek version of the RSES into a sample consisting of primary school students with mild ID, bearing in mind the aspect of multidimensionality. In addition, gender differences were also investigated.

METHODS

The participants were 103 primary school students with mild ID aged 9-12 years old. Fifty-four (52.4 %) of the participants were boys and forty-nine were girls (47.6 %). Using the LISREL software, six different models of factor structure were estimated. The psychometric properties of the RSES, including internal consistency, content validity, convergent and discriminant validity as well as confirmatory factor analysis, were assessed.

RESULTS

The findings of this study provide some preliminary support to the robustness of the bifactor model, with a general self-esteem factor and two method effect factors that capture the direction of positive and negative item wording.

CONCLUSIONS

Although it is inappropriate to conclude that the results will be extended to all other populations and cultures, it can be assumed that bifactor models, which specify method effects due to wording, fit better than strictly unidimensional or two factor models.

Psychological interventions for depression in children and young people with an intellectual disability and/or autism: systematic review

BACKGROUND

Children and young people with intellectual disability and/or Autism Spectrum Disorder (autism) experience higher rates of mental health problems, including depression, than their typically developing peers. Although international guidelines suggest psychological therapies as first-line intervention for children and young people, there is limited evidence for psychological therapy for depression in children and young people with intellectual disability and/or autism.

AIMS

To evaluate the current evidence base for psychological interventions for depression in children and young people with intellectual disability and/or autism, and examine the experiences of children and young people with intellectual disability and/or autism, their families and therapists, in receiving and delivering psychological treatment for depression.

METHOD

Databases were searched up to 30 April 2020 using pre-defined search terms and criteria. Articles were independently screened and assessed for risk of bias. Data were synthesised and reported in a narrative review format.

RESULTS

A total of 10 studies met the inclusion criteria. Four identified studies were clinical case reports and six were quasi-experimental or experimental studies. All studies were assessed as being of moderate or high risk of bias. Participants with intellectual disability were included in four studies. There was limited data on the experiences of young people, their families or therapists in receiving or delivering psychological treatment for depression.

CONCLUSIONS

Well-designed, randomised controlled trials are critical to develop an evidence base for psychological treatment for young people with intellectual disability and/or autism with depression. Future research should evaluate the treatment experiences of young people, their families and therapists.

Exploring the role of emotional and behavioral problems in a personality-targeted prevention program for substance use in adolescents and young adults with intellectual disability

BACKGROUND

Adolescents and young adults with a mild intellectual disability or borderline intellectual functioning (MID-BIF) are at risk for problematic substance use and are more likely to have emotional and behavioral problems than peers without MID-BIF. A personality-targeted prevention program called Take it Personal! effectively reduces substance use in adolescents and young adults with MID-BIF.

AIMS

The program's effectiveness was examined on its secondary goal: reducing emotional and behavioral problems. The potentially moderating role of these problems on the program's effectiveness with substance use was also explored.

METHODS AND PROCEDURES

Substance use and emotional and behavioral problems were compared between participants in Take it Personal! (n = 34) and those in the control condition (n = 32) in a quasi-experimental pre-posttest study with a three-month follow-up. Effectiveness and moderation were assessed with multilevel models.

OUTCOMES AND RESULTS

Take it Personal! seems to reduce rule breaking. There were no significant effects on anxiety, withdrawal, and aggression. None of the problem domains moderated the program's effectiveness on substance use frequency.

CONCLUSIONS AND IMPLICATIONS

Take it Personal! may effectively reduce rule breaking. Moreover, adolescent and young adults with different levels of emotional and behavioral problems benefit equally in terms of reduced substance use.

Emotion regulation and angry mood among adolescents with externalizing problems and intellectual disabilities

BACKGROUND AND AIMS

Cognitive behavior therapy targeting emotion regulation is found to be effective in decreasing externalizing problems, but little is known about the emotion regulation capacities of adolescents with externalizing problems and Mild Intellectual Disabilities or Borderline Intellectual Functioning (MID-BIF). Therefore, the aim of this study was to compare emotion (i.e., anger) regulation capacities, angry mood level and angry mood variability between two groups: adolescents with externalizing problems and MID-BIF and adolescents with externalizing problems and average intelligence (AIQ).

METHODS AND PROCEDURES

Participants in the MID-BIF (n = 42, M_age = 15.52, SD = 1.43) and AIQ (n = 39, M_age = 13.67, SD = 1.06) group completed questionnaires about emotion regulation difficulties, emotion regulation strategies, and angry mood.

OUTCOMES AND RESULTS

Adolescents in the MID-BIF group reported fewer emotion regulation difficulties, fewer maladaptive regulation strategies, and lower levels of angry mood than adolescents in the AIQ group. No between-group differences in angry mood variability were found. Lastly, adolescents in the MID-BIF group reported to use more behavioral than cognitive regulation strategies.

CONCLUSIONS AND IMPLICATIONS

These findings provide a starting point in understanding emotion regulation and angry mood of adolescents with externalizing problems and MID-BIF and show that it is important to consider differences between cognitive and behavioral regulation processes.

Effectiveness of a life story intervention for adults with intellectual disability and depressive and trauma-related complaints

Introduction

People with intellectual disability have a higher chance of developing mental disorders than the general population. Yet, few evidence‐based interventions exist. This article evaluates My Lifestory, a narrative intervention tailored to people with intellectual disability and depressive or trauma‐related complaints.

Method

A quasi‐experimental research design was adopted with an experimental condition (My Lifestory) and a matched control condition (care as usual). Measurements took place before the intervention, at the end of the intervention and at follow‐up two months later. Measurements focused on psychiatric complaints, well‐being, life satisfaction, mastery, and purpose in life.

Results

Participants in the intervention condition improved more in psychiatric complaints, well‐being, life satisfaction, and purpose in life, but not in mastery, than participants in the control condition. Effect sizes were large in the intervention condition and small in the control condition.

Discussion

Despite some limitations, this study adds to the evidence base of this narrative intervention.

Differentiating care for persons with mild intellectual disability or borderline intellectual functioning: a Delphi study on the opinions of primary and professional caregivers and scientists

BACKGROUND

The demand for support for persons with mild intellectual disability or borderline intellectual functioning is growing rapidly. These persons often encounter individual and familial limitations that influence their human functioning, and often have difficulty coping with the demands of modern society. Although in the areas of policy, research and practice, people with mild intellectual disability or borderline intellectual functioning are generally approached as one group, important differences between them have been reported. Current support seems to be both suboptimal and insufficiently differentiated.

METHODS

In this Delphi study we aimed to explore the need for appropriate and differentiated support for individuals with mild intellectual disability or borderline intellectual functioning. The study was based on five unique profiles of persons with mild intellectual disability or borderline intellectual functioning that are associated with individual and environmental variables. The opinions of expert primary caregivers, professional caregivers and scientists were analysed for potentially appropriate types of support for each of the five profiles.

RESULTS

A total of 174 statements, divided over the five profiles, were presented to the participants. For 74 statements, consensus was reached between the expert groups. For each profile, these consensual statements represented specific items (e.g. concrete personal goals) and non-specific items (e.g. the attitude towards persons with mild intellectual disability or borderline intellectual functioning, and the coordination of health care) related to the support needs.

CONCLUSION

This Delphi-based study generated consensual opinions contributing to a more differentiated system of support for individuals with mild intellectual disability or borderline intellectual functioning. Although these findings need additional investigation, they address actions that might enhance the support programmes for these individuals into more personalized support.

Social information processing skills link executive functions to aggression in adolescents with mild to borderline intellectual disability

Executive Functions (EFs) have been associated with aggression in children and adolescents. EFs as higher-order cognitive abilities are assumed to affect cognitive functions such as Social Information Processing (SIP). We explored SIP skills as a mediating mechanism linking EFs to aggression in adolescents with mild to borderline intellectual disability (MBID with IQ from 50-84), a high risk group for aggressive behaviors and EF impairments. A total of 153 adolescents (M_age = 15.24, SD = 1.35; 54% male) with MBID participated. Focused attention, behavioral inhibition, and working memory were tested with multiple neurocognitive tasks to define latent EF constructs. Participants responded to a video-based SIP task. A latent construct for aggression was defined by caretaker, teacher, and adolescent self-reports of aggression (Child Behavior Check List, Teacher Report Form, and Youth Self Report). Structural equation modeling was performed to test mediation. Results were consistent with mediation of the relation between focused attention and aggression by SIP, namely via hostile interpretations and self-efficacy for aggression. Behavioral inhibition was linked to aggression, but this relation was not mediated by SIP. The relation between working memory and aggression was mediated by SIP, namely via hostile interpretations, aggressive response generation and via self-efficacy for aggressive responses. Bearing the cross-sectional design in mind, support was found for SIP skills as a mechanism linking EFs, in particular focused attention and working memory, to aggression, providing a viable explanation for the high vulnerability of adolescents with MBID for aggression.

Self-reported psychological wellbeing in adolescents: the role of intellectual/developmental disability and gender

BACKGROUND

The Wellbeing in Special Education Questionnaire was developed to assess subjective wellbeing in young persons with intellectual and developmental disabilities (ID/DD) as this perspective is rarely included in research. The present study explored how ID/DD and gender are related to self-reported wellbeing among adolescents.

METHOD

Students with (n = 110) or without (n = 110) ID/DD, aged 12-16 years, completed the Wellbeing in Special Education Questionnaire. Analyses of the effects of gender and disability status on peer relations and conflict, mental health, mental ill-health, school environment and family relations were carried out.

RESULTS

The experiences of the school environment and of positive mental health aspects did not differ between students with and without ID/DD, but those with ID/DD reported more mental health problems and less positive experiences of peer relations and family. Generally, boys reported more positive experiences of school and less mental health problems than girls.

CONCLUSIONS

Including the subjective perspective of young persons with ID/DD through self-reports can provide essential information about wellbeing that cannot be gained from proxy ratings. The results suggest both differences and similarities in self-reported wellbeing between boys and girls with and without ID/DD and potentially also in how they perceived the concepts measured.

Identifying classes of persons with mild intellectual disability or borderline intellectual functioning: a latent class analysis

BACKGROUND

Persons with mild intellectual disability or borderline intellectual functioning are often studied as a single group with similar characteristics. However, there are indications that differences exist within this population. Therefore, the aim of this study was to identify classes of persons with mild intellectual disability or borderline intellectual functioning and to examine whether these classes are related to individual and/or environmental characteristics.

METHODS

Latent class analysis was performed using file data of 250 eligible participants with a mean age of 26.1 (SD 13.8, range 3-70) years.

RESULTS

Five distinct classes of persons with mild intellectual disability or borderline intellectual functioning were found. These classes significantly differed in individual and environmental characteristics. For example, persons with a mild intellectual disability experienced fewer problems than those with borderline intellectual disability.

CONCLUSIONS

The identification of five classes implies that a differentiated approach is required towards persons with mild intellectual disability or borderline intellectual functioning.

Protection and restriction: A mixed-methods study of self-reported well-being among youth with intellectual disabilities

BACKGROUND

As most mental health studies of school-aged children with intellectual and developmental disabilities (IDD) are based on proxy ratings, the subjective views of these young persons are rarely explored. The present study explores experiences of well-being, mental ill-health, family, school, and peer relations in students in special education.

METHODS

Ten students in special education, aged 13-16 years, answered the Wellbeing in Special Education Questionnaire (WellSEQ) and participated in semi-structured interviews. Data were analyzed using a mixed methods phenomenological research approach.

RESULTS

The general agreement between questionnaire responses and interview accounts appears to be good, and the students emphasized mainly positive emotions and good mental health. Students described their school environment and family relations as inclusive contexts experienced as both protective and restrictive.

CONCLUSION

Using well-adapted research instruments enables students with IDD to communicate subjective experiences of well-being and how it relates to aspects of their everyday environment.

Young People with Intellectual Disability Transitioning to Adulthood: Do Behaviour Trajectories Differ in Those with and without Down Syndrome?

Background

Young people with intellectual disability exhibit substantial and persistent problem behaviours compared with their non-disabled peers. The aim of this study was to compare changes in emotional and behavioural problems for young people with intellectual disability with and without Down syndrome as they transition into adulthood in two different Australian cohorts.

Methods

Emotional and behavioural problems were measured over three time points using the Developmental Behaviour Checklist (DBC) for those with Down syndrome (n = 323 at wave one) and compared to those with intellectual disability of another cause (n = 466 at wave one). Outcome scores were modelled using random effects regression as linear functions of age, Down syndrome status, ability to speak and gender.

Results

DBC scores of those with Down syndrome were lower than those of people without Down syndrome indicating fewer behavioural problems on all scales except communication disturbance. For both groups disruptive, communication disturbance, anxiety and self-absorbed DBC subscales all declined on average over time. There were two important differences between changes in behaviours for these two cohorts. Depressive symptoms did not significantly decline for those with Down syndrome compared to those without Down syndrome. The trajectory of the social relating behaviours subscale differed between these two cohorts, where those with Down syndrome remained relatively steady and, for those with intellectual disability from another cause, the behaviours increased over time.

Conclusions

These results have implications for needed supports and opportunities for engagement in society to buffer against these emotional and behavioural challenges.

Assessing posttraumatic stress disorder in children with mild to borderline intellectual disabilities

BACKGROUND

Evidence suggests that children with mild to borderline intellectual disabilities (MBID; IQ 50-85) have an elevated risk for both being exposed to potentially traumatic events and developing a posttraumatic stress disorder (PTSD). In this target group, PTSD often remains undiscovered due to a lack of diagnostic instruments. Valid instruments for the assessment of PTSD in children with MBID are therefore needed.

OBJECTIVE

The aim of the current study was to validate the adapted PTSD section of the Anxiety Disorders Interview Schedule for Children (ADIS-C) for the assessment of PTSD in children with MBID according to DSM-IV-TR and DSM-5 criteria.

METHOD

Eighty children (aged 6-18 years) with MBID who were referred to an outpatient psychiatric service and their primary caregivers were interviewed using the adapted ADIS-C.

RESULTS

The adapted ADIS-C PTSD section has excellent interrater reliability and good convergent validity. PTSD symptoms described spontaneously by children with MBID and their caregivers closely matched those included in the DSM-IV-TR and DSM-5. Many of the children who met Criterion A did not meet PTSD symptom criteria. Conversely, children meeting the full PTSD criteria were more likely than other children with MBID to have been exposed to at least one traumatic event meeting Criterion A and to a higher total number of potentially traumatic events.

CONCLUSIONS

The results support the reliability and validity of the adapted ADIS-C PTSD section for assessing PTSD in children with MBID. The use of this clinical interview helps to improve detection of PTSD and subsequent access to trauma-focused interventions for this at risk target group.

Informant agreement for youth with autism spectrum disorder or intellectual disability: a meta-analysis

This study investigated informant agreement on emotional and behavior problems and social skills in youth with autism spectrum disorder or intellectual disability using meta-analytic methods. Forty-nine studies were included, consisting of 107 effect sizes. The mean weighted effect size across all raters and all behaviors was .36, reflecting moderate agreement. Consistent with meta-analyses in typically developing youth, pairs of similar informants (e.g., parent-parent) demonstrated higher agreement compared to pairs of different raters (e.g., parent-teacher). With all rater pairs combined, agreement was significantly higher for externalizing problems (r = .42) than either internalizing problems (r = .35) or social skills (r = .30). Several factors appear to moderate the level of agreement among informants, including the youth's diagnosis, age, and IQ.

Evaluating a selective prevention program for substance use and comorbid behavioral problems in adolescents with mild to borderline intellectual disabilities: Study protocol of a randomized controlled trial

BACKGROUND

Substance use and abuse is a growing problem among adolescents with mild to borderline intellectual disabilities (ID). Substance use patterns in general population are similar to patterns among non-disabled peers, but substance use has more negative consequences for adolescents with mild to borderline ID, and they are at an increased risk for developing a substance use disorder. Nevertheless, effective and evidence based prevention programs for this groups are lacking. The study described in this protocol tested the effectiveness of a selective intervention aimed at reducing substance use in adolescents with mild to borderline ID and behavioral problems. In the intervention, participants acquire competences to deal with their high-risk personality traits.

METHODS

A randomized controlled trial will be conducted among 14-21-year old adolescents with mild to borderline ID and behavioral problems admitted to treatment facilities in the Netherlands. Inclusion criteria are previous substance use and personality risk for substance use. Participants will be individually randomized to the intervention (n = 70) or control (n = 70) groups. The intervention group will be exposed to six individual sessions and five group sessions carried out by two qualified trainers over six-week period. Primary outcomes will be the percentage reduction in substance use (for alcohol: percentage decrease of binge drinking, weekly use and problematic use, for cannabis: the percentage decrease of lifetime cannabis use and weekly use and for hard drug: the percentage decrease of lifetime use). Secondary outcomes will be motives for substance use, intention to use, and internalizing and externalizing behavioral problems. All outcome measures will be assessed after two, six, and twelve months after the intervention.

DISCUSSION

This study protocol describes the design of an effectiveness study of a selective prevention program for substance use in adolescents with mild to borderline ID and behavioral problems. We expect a significant reduction in alcohol, cannabis and hard drug use among adolescents in the intervention group compared with the control group.

TRIAL REGISTRATION

This trial is registered in the Dutch Trial Register (Cochrane Collaboration) as NTR5037 registered at 15 April 2015.

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.

Anxiety disorders in children and adolescents with intellectual disability: Prevalence and assessment

Children and adolescents with intellectual disability are known to experience mental health disorders, but anxiety disorders in this population have received relatively little attention. Firstly, this paper provides a review of published studies reporting prevalence rates of anxiety disorders in children and adolescents with intellectual disability. Secondly, the paper reviews measures of anxiety that have been evaluated in children/adolescents with intellectual disability, and details the associated psychometric properties. Seven studies reporting prevalence rates of anxiety disorders in this population were identified, with reported rates varying from 3% to 22%. Two-one studies evaluating a measure of anxiety in a sample of children/adolescents with intellectual disability were identified. While these studies indicate that several measures show promise, further evaluation studies are needed; particularly those that evaluate the capacity of measures to screen for anxiety disorders, not only measure symptoms.

Borderline intellectual functioning: a systematic literature review

The literature related to people with borderline intellectual functioning (BIF) was systematically reviewed in order to summarize the present knowledge. Database searches yielded 1,726 citations, and 49 studies were included in the review. People with BIF face a variety of hardships in life, including neurocognitive, social, and mental health problems. When adults with BIF were compared with the general population, they held lower-skilled jobs and earned less money. Although some risk factors (e.g., low birth weight) and preventive factors (e.g., education) were reported, they were not specific to BIF. The review finds that, despite the obvious everyday problems, BIF is almost invisible in the field of research. More research, societal discussion, and flexible support systems are needed.

Day occupation is associated with psychopathology for adolescents and young adults with Down syndrome

BACKGROUND

Young adults with Down syndrome experience increased rates of emotional and behavioural problems compared with the general population. Most adolescents with Down syndrome living in Western Australia participate in sheltered employment as their main day occupation. Relationship between day occupation and changes in behaviour has not been examined. Therefore, the aim of this research was to explore any relationship between post school day occupations and changes in the young person's behaviour.

METHODS

The Down syndrome Needs Opinion Wishes database was used for case ascertainment of young adults aged 15 to 32 years with Down syndrome. Families of 118 young people in this population-based database completed questionnaires in 2004, 2009 and 2011. The questionnaires addressed both young person characteristics such as age, gender, presence of impairments, behaviour, functioning in activities of daily living, and family characteristics such as income and family functioning. Post-school day occupations in which the young people were participating included open and sheltered employment, training and day recreation programs. Change in behaviour of young adults who remained in the same post-school day occupation from 2009 to 2011 (n = 103) were examined in a linear regression model adjusting for confounding variables including age, gender, prior functioning and behaviour in 2004 and family income.

RESULTS

In comparison to those young adults attending open employment from 2009 to 2011, those attending day recreation programs were reported to experience worsening in behaviour both in the unadjusted (effect size -0.14, 95% CI -0.24, -0.05) and adjusted models (effect size -0.15, 95% CI -0.29, -0.01).

CONCLUSIONS

We found that the behaviour of those participating in open employment improved compared to those attending other day occupations. Further examination of the direction of this association is required.

Developing a new assessment procedure of social information processing in adolescents within secure residential care

The purpose of the present study was to develop a new assessment procedure of social information processing (SIP) for adolescents, to explore its validity and to examine whether it differentiated between IQ groups. Ninety-four adolescents within secure residential care were administered the SIP instrument, the Youth Self Report and two subtests of the WISC/WAIS. Results showed that the constructs underlying the items of the instrument were associated with profiles from the SIP theory, the subsequent SIP steps were correlated, and several SIP steps were correlated to self-reported behavior. No differences were found between IQ groups. These first results have implications for adjustment of the instrument. Further research should confirm construct validity and psychometric qualities of the scales.

Mother-child agreement on behavioral ratings in Tourette syndrome: a controlled study

In Tourette syndrome, motor and phonic tics are associated with a spectrum of psychiatric disorders. As proxy report instruments are commonly used to assess children with Tourette syndrome, we investigated the relationship between child and mother ratings of behavioral problems. We enrolled 28 children with Tourette syndrome (25 males; mean age, 13.9 years) and 61 gender- and age-matched healthy controls (55 males; mean age, 14.7 years). Clinicians completed measures of tic severity, and all children completed the Youth Self-Report version of the Child Behavior Checklist, while their mothers completed the Child Behavior Checklist. In the clinical group, Youth Self-Report scores were significantly lower than mothers' Child Behavior Checklist scores across the majority of subscales (especially affect and somatization). In contrast, for the control group, mother and child ratings only differed for the externalizing behavior subscales. Clinicians should be aware of these differences between self and mother ratings for specific behavioral problems in Tourette syndrome.

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.

Translation, adaptation, and preliminary validation of the Brazilian version of the Behavior Problems Inventory (BPI-01)

Introduction: Children with atypical development often present behavior problems that impair their psychosocial adaptation. Objective: To describe the cultural adaptation to Brazilian Portuguese of the Behavior Problems Inventory (BPI-01), as well as preliminary indicators of instrument reliability and validity. Methods: The process involved translation, back-translation, and cultural adaptation of the instrument. Psychometric properties (reliability and validity) were assessed comparing scores obtained with the BPI-01, the Wechsler Intelligence Scales for Children and Adults, the Child Behavior Checklist for Ages 6-18 (CBCL/6-18), and the Autism Screening Questionnaire (ASQ). The sample comprised 60 children (30 typically developing and 30 atypically developing). Results: The cultural adaptation process was considered adequate. Internal consistency of the BPI-01 was satisfactory, with a Cronbach's alpha of 0.65 for the self-injurious behavior scale, 0.82 for stereotyped behaviors, and 0.91 for aggressive/destructive behaviors. Considering a mean frequency of 0.5, the receiver operating characteristic (ROC) curve revealed 80% sensitivity and 3% specificity in the stereotyped behavior scale, 50 and 10% in aggressive/destructive behaviors, and 76 and 6% in self-injurious behaviors, respectively. Low-to-moderate correlations were observed between BPI-01, ASQ, and CBCL/6-18 scores. Conclusion: BPI-01 showed good psychometric properties, with satisfactory preliminary indicators of reliability, convergent validity, and sensitivity for the diagnosis of atypical development.

Suicide risk in youth with intellectual disabilities: the challenges of screening

Children and adolescents with intellectual disabilities (IDs), often diagnosed with comorbid psychiatric disorders, are a vulnerable population who may be at risk for developing suicidal thoughts and behaviors. Previous research has demonstrated that direct suicide screening can rapidly and effectively detect suicide risk and facilitate further clinical evaluation and management. Currently, there are no measures that screen for suicide risk designed specifically for individuals with ID. A review of the literature was conducted to (1) estimate the prevalence of suicidal thoughts, behaviors, and deaths by suicide in children and adolescents with ID; (2) describe associations between youth with ID and suicide risk; and (3) identify the limitations of commonly used suicide screening measures developed for non-ID youth. The literature review confirms that suicide risk exists in this population; youth with ID think about, attempt, and die by suicide. Standardized suicide risk screening is challenged by the lack of measures developed for this population. A summary of the findings is followed by a discussion of the practical clinical considerations surrounding the assessment of suicide risk in youth with ID.

Self-report computer-based survey of technology use by people with intellectual and developmental disabilities

Advancements of technologies in the areas of mobility, hearing and vision, communication, and daily living for people with intellectual and developmental disabilities has the potential to greatly enhance independence and self-determination. Previous research, however, suggests that there is a technological divide with regard to the use of such technologies by people with intellectual and developmental disabilities when compared with the use reported by the general public. To provide current information with regard to technology use by people with intellectual and developmental disabilities by examining the technology needs, use, and barriers to such use experienced by 180 adults with intellectual and developmental disabilities, we used QuestNet, a self-directed computer survey program. Results suggest that although there has been progress in technology acquisition and use by people with intellectual and developmental disabilities, an underutilization of technologies across the population remains.

Examining reports of mental health in adults with Williams syndrome

Prior research suggests that individuals with Williams syndrome (WS) have a disposition towards anxiety. Information regarding this is typically derived from parents and carers. The perspectives of the individuals with WS are rarely included in research of this nature. We examined the mental health of 19 adults with WS using explicit (psychiatric interview) and implicit (modified Stroop task) measures and compared informant (parents/carers) and respondent (adults with WS) reports of psychiatric symptoms. Informants and respondents both reported more symptoms of anxiety (n=7-9) than depression (n=2). Strong positive correlations were found between informant and respondent reports of symptoms of mental health problems. Compared to informants, respondents reported significantly more symptoms overall and somewhat more symptoms of anxiety. Results from the Stroop task indicated that the adults with WS were more vigilant to anxiety-related words than to depression-related words. The adults with WS provided reliable information regarding their mental health, thus providing further evidence that anxiety is part of the behavioural phenotype of the syndrome.

[Psychopathology in youths with intellectual disabilities--prevalence and prevention]

A survey of epidemiological findings suggests a significantly increased level of emotional and behavioural problems in children and youth with intellectual disabilities. Some biological and social factors are presented which contribute to this elevated risk for psychopathology. Assessment and intervention planning needs to acknowledge genetic dispositions, and limitations of the capacity of information processing which characterise children with intellectual disabilities. Early intervention may help to prevent emotional and behavioural problems by supporting a positive parent-child relationship, increasing the parents' educational competence and assisting preschool teachers in supporting positive relationships with peers, and promoting social competence.

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.

The mental health of young children with intellectual disabilities or borderline intellectual functioning

OBJECTIVE

To determine within a nationally representative sample of young Australian children: (1) the association amongst intellectual disability, borderline intellectual functioning and the prevalence of possible mental health problems; (2) the association amongst intellectual disability, borderline intellectual functioning and exposure to social disadvantage; (3) the extent to which any between-group differences in the relative risk of possible mental health problems may be attributable to differences in exposure to disadvantageous social circumstances.

METHODS

The study included a secondary analysis of a population-based child cohort of 4,337 children, aged 4/5 years, followed up at age 6/7 years. The main outcome measure was the scoring within the 'abnormal' range at age 6/7 years on the parent-completed Strengths and Difficulties Questionnaire.

RESULTS

When compared to typically developing children, children identified at age 4/5 years as having intellectual disability or borderline intellectual functioning: (1) showed significantly higher rates of possible mental health problems for total difficulties and on all five SDQ subscales at age 6/7 years (OR 1.98-5.58); (2) were significantly more likely to be exposed to socio-economic disadvantage at age 4/5 and 6/7 years. Controlling for the possible confounding effects of exposure to socio-economic disadvantage (and child gender) significantly reduced, but did not eliminate, between-group differences in prevalence.

CONCLUSIONS

Children with limited intellectual functioning make a disproportionate contribution to overall child psychiatric morbidity. Public health and child and adolescent mental health services need to ensure that services and interventions fit to the purpose and are effective for children with limited intellectual functioning, and especially those living in poverty, as they are for other children.

Young people with intellectual disabilities and mental health needs

PURPOSE OF REVIEW

This review focuses on the risk factors for increased mental health problems, and the types of psychopathology and their therapeutic management, in young people with intellectual disabilities.

RECENT FINDINGS

Recent studies indicate that this population presents significantly more emotional and behavioural problems than their peers without intellectual disabilities. These problems are not adequately detected and treated by mental health professionals; the children's families are overburdened, psychosocially and economically disadvantaged and in need of specialist support and counselling.

SUMMARY

The mental health needs of children and adolescents with intellectual disabilities are multiple, complex, persistent and costly, and for various reasons they are not adequately met. Prevention of mental health problems or early recognition through better screening followed by appropriate treatment are essential, in order to ensure better psychosocial adaptation of young people with intellectual disabilities. Inequalities in the provision of services must be addressed, and families helped through support and counselling, along with psychotherapeutic and psychopharmacological interventions for the children, as appropriate.