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Patel M, Lee JY, Scior K. Psychometric properties of measures designed to assess common mental health problems and wellbeing in adults with intellectual disabilities: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:397-414. [PMID: 36808653 DOI: 10.1111/jir.13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Multiple measures of mental health problems and mental wellbeing for adults with intellectual disabilities are available, but investigations into their reliability and validity are still in the early stages. The aim of this systematic review was to provide an update to previous evaluations of measures of common mental health problems and wellbeing in adults with mild to moderate intellectual disabilities (ID). METHODS A systematic search was performed across three databases (MEDLINE, PsycINFO and SCOPUS). The literature search was limited to the years from 2009 to 2021 and to the original English versions. Ten papers evaluating nine measures were reviewed, and the psychometric properties of these measures were discussed using the Characteristics of Assessment Instructions for Psychiatric Disorders in Persons with Intellectual Developmental Disorders as a framework. RESULTS Four measures had at least one rating of 'good' across both dimensions of reliability and at least one dimension of validity and were deemed to have promising psychometric properties: the Clinical Outcomes in Routine Evaluation-Learning Disabilities, Impact of Events Scale-Intellectual Disabilities, Lancaster and Northgate Trauma Scales and Self-Assessment and Intervention (self-report section). Additionally, these measures were developed through consultations with mental health professionals and/or people with IDs and thus were deemed to have good content validity. CONCLUSIONS This review informs measurement choice for researchers and clinicians while highlighting a need for continued research efforts into the quality of measures available for people with IDs. The results were limited by incomplete psychometric evaluations of measures available. A paucity of psychometrically robust measures of mental wellbeing was observed.
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Affiliation(s)
- M Patel
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - J Y Lee
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - K Scior
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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de Boer A, Vermeulen K, Egger JIM, Janzing JGE, de Leeuw N, Veenstra-Knol HE, den Hollander NS, van Bokhoven H, Staal W, Kleefstra T. EHMT1 mosaicism in apparently unaffected parents is associated with autism spectrum disorder and neurocognitive dysfunction. Mol Autism 2018; 9:5. [PMID: 29416845 PMCID: PMC5784506 DOI: 10.1186/s13229-018-0193-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023] Open
Abstract
Background Genetic mosaicism is only detected occasionally when there are no obvious health or developmental issues. Most cases concern healthy parents in whom mosaicism is identified upon targeted testing of a genetic defect that was initially detected in their children. A germline genetic defect affecting the euchromatin histone methyltransferase 1 (EHMT1) gene causes Kleefstra syndrome, which is associated with the typical triad of distinct facial appearance, (childhood) hypotonia, and intellectual disability. A high degree of psychopathology is associated with this syndrome. A few parents with a mosaic EHMT1 mutation have been detected upon testing after a child was diagnosed with a germline EHMT1 defect. At first glance, carriers of a mosaic EHMT1 mutation appeared to function normally. However, recent studies have shown that de novo, postzygotic mutations in important developmental genes significantly contribute to autism spectrum disorder (ASD). Therefore, we hypothesized that EHMT1 mosaicism could cause neuropsychiatric defects. To investigate this, we performed a detailed investigation of cognitive neuropsychiatric parameters in parents identified with EHMT1 mosaicism. Methods Three adults (two males, one female) with a genetically confirmed diagnosis of EHMT1 mosaicism were examined by means of a battery of tests and observational instruments covering both neurocognitive and psychiatric features. The battery included the following instruments: the Autism Diagnostic Observation Schedule (ADOS), the mini Psychiatric Assessment Schedules for Adults with Developmental Disabilities (mini PAS-ADD), the Vineland Adaptive Behavior Scales (VABS), and the Cambridge Neuropsychological Test Automated Battery (CANTAB). These measures were compared with our previously reported data from Kleefstra syndrome patients with confirmed (germline) EHMT1 defects. Results All three subjects achieved maximum total scores on the VABS, indicative of adequate (adaptive) functioning. In all, scores above cutoff were found on the ADOS for ASD and on the mini PAS-ADD for major depressive disorder (lifetime). Finally, results on the CANTAB showed impaired cognitive flexibility in all subjects. Conclusion Individuals with EHMT1 mosaicism seem to have increased vulnerability for developing severe psychopathology, especially ASD and mood disorders. Although at first glance they appear to be well-adapted in their daily functioning, they may experience significant psychiatric symptoms and show reduced cognitive flexibility in comparison to the general population.
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Affiliation(s)
- Anneke de Boer
- 1Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands.,3Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Karlijn Vermeulen
- 1Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands.,2Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University, Nijmegen, the Netherlands.,3Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jos I M Egger
- 4Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands.,5Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.,6Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University, Nijmegen, the Netherlands
| | - Joost G E Janzing
- 3Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nicole de Leeuw
- 7Department of Human Genetics, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Hermine E Veenstra-Knol
- 8Department of Genetics, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Hans van Bokhoven
- 2Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University, Nijmegen, the Netherlands.,7Department of Human Genetics, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Wouter Staal
- 1Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands.,2Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University, Nijmegen, the Netherlands.,3Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands.,10Faculty of Social Sciences, Leiden University, Leiden, the Netherlands.,11Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Tjitske Kleefstra
- 2Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University, Nijmegen, the Netherlands.,7Department of Human Genetics, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
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Flynn S, Vereenooghe L, Hastings RP, Adams D, Cooper SA, Gore N, Hatton C, Hood K, Jahoda A, Langdon PE, McNamara R, Oliver C, Roy A, Totsika V, Waite J. Measurement tools for mental health problems and mental well-being in people with severe or profound intellectual disabilities: A systematic review. Clin Psychol Rev 2017; 57:32-44. [DOI: 10.1016/j.cpr.2017.08.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/27/2017] [Accepted: 08/09/2017] [Indexed: 11/29/2022]
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4
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Vermeulen K, de Boer A, Janzing JGE, Koolen DA, Ockeloen CW, Willemsen MH, Verhoef FM, van Deurzen PAM, van Dongen L, van Bokhoven H, Egger JIM, Staal WG, Kleefstra T. Adaptive and maladaptive functioning in Kleefstra syndrome compared to other rare genetic disorders with intellectual disabilities. Am J Med Genet A 2017; 173:1821-1830. [PMID: 28498556 DOI: 10.1002/ajmg.a.38280] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 04/10/2017] [Indexed: 11/11/2022]
Abstract
Detailed neurobehavioural profiles are of major value for specific clinical management, but have remained underexposed in the population with intellectual disabilities (ID). This was traditionally classified based on IQ level only. Rapid advances in genetics enable etiology based stratification in the majority of patients, which reduces clinical heterogeneity. This paper illustrates that specific profiles can be obtained for rare syndromes with ID. Our main aim was to study (mal)adaptive functioning in Kleefstra Syndrome (KS) by comparing and contrasting our findings to three other subgroups: Koolen-de Vries Syndrome, GATAD2B-related syndrome, and a mixed control group of individuals with ID. In total, we studied 58 individuals (28 males, 30 females) with ID; 24 were diagnosed with KS, 13 with Koolen-de Vries Syndrome, 6 with the GATAD2B-related syndrome, and 15 individuals with undefined neurodevelopmental disorders. All individuals were examined with a Vineland Adaptive Behavior Scale, mini PAS-ADD interview, and an Autism Diagnostic Observation Schedule to obtain measures of adaptive and maladaptive functioning. Each of the three distinctive genetic disorders showed its own specific profile of adaptive and maladaptive functioning, while being contrasted mutually. However, when data of the subgroups altogether are contrasted to the data of KS, such differences could not be demonstrated. Based on our findings, specific management recommendations were discussed for each of the three syndromes. It is strongly suggested to consider the genetic origin in individuals with congenital neurodevelopmental disorders for individual based psychiatric and behavioral management.
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Affiliation(s)
- Karlijn Vermeulen
- Karakter Child and Adolescent Psychiatry, University Centre, Nijmegen, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Nijmegen, The Netherlands.,Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anneke de Boer
- Karakter Child and Adolescent Psychiatry, University Centre, Nijmegen, Nijmegen, The Netherlands.,Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost G E Janzing
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David A Koolen
- Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud university medical Center, Nijmegen, The Netherlands
| | - Charlotte W Ockeloen
- Department of Human Genetics, Radboud university medical Center, Nijmegen, The Netherlands
| | - Marjolein H Willemsen
- Department of Human Genetics, Radboud university medical Center, Nijmegen, The Netherlands
| | - Floor M Verhoef
- Karakter Child and Adolescent Psychiatry, University Centre, Nijmegen, Nijmegen, The Netherlands
| | - Patricia A M van Deurzen
- Karakter Child and Adolescent Psychiatry, University Centre, Nijmegen, Nijmegen, The Netherlands
| | - Linde van Dongen
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
| | - Hans van Bokhoven
- Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud university medical Center, Nijmegen, The Netherlands
| | - Jos I M Egger
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Nijmegen, The Netherlands
| | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry, University Centre, Nijmegen, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Nijmegen, The Netherlands.,Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tjitske Kleefstra
- Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud university medical Center, Nijmegen, The Netherlands
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Melville CA, Johnson PCD, Smiley E, Simpson N, McConnachie A, Purves D, Osugo M, Cooper SA. Statistical modelling studies examining the dimensional structure of psychopathology experienced by adults with intellectual disabilities: Systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 53-54:1-10. [PMID: 26852278 DOI: 10.1016/j.ridd.2016.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 12/22/2015] [Accepted: 01/25/2016] [Indexed: 06/05/2023]
Abstract
Diagnosing mental ill-health using categorical classification systems has limited validity for clinical practice and research. Dimensions of psychopathology have greater validity than categorical diagnoses in the general population, but dimensional models have not had a significant impact on our understanding of mental ill-health and problem behaviours experienced by adults with intellectual disabilities. This paper systematically reviews the methods and findings from intellectual disabilities studies that use statistical methods to identify dimensions of psychopathology from data collected using structured assessments of psychopathology. The PRISMA framework for systematic review was used to identify studies for inclusion. Study methods were compared to best-practice guidelines on the use of exploratory factor analysis. Data from the 20 studies included suggest that it is possible to use statistical methods to model dimensions of psychopathology experienced by adults with intellectual disabilities. However, none of the studies used methods recommended for the analysis of non-continuous psychopathology data and all 20 studies used statistical methods that produce unstable results that lack reliability. Statistical modelling is a promising methodology to improve our understanding of mental ill-health experienced by adults with intellectual disabilities but future studies should use robust statistical methods to build on the existing evidence base.
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Affiliation(s)
- C A Melville
- Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom.
| | - P C D Johnson
- Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom
| | - E Smiley
- Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom
| | - N Simpson
- Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom
| | - A McConnachie
- Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom
| | - D Purves
- Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom
| | - M Osugo
- Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom
| | - S-A Cooper
- Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom
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Psychiatric comorbidity and medication use in adults with autism spectrum disorder. J Autism Dev Disord 2015; 44:3063-71. [PMID: 24958436 DOI: 10.1007/s10803-014-2170-2] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to investigate comorbid psychiatric disorders and psychotropic medication use among adults with autism spectrum disorder (ASD) ascertained as children during a 1980's statewide Utah autism prevalence study (n = 129). Seventy-three individuals (56.6 %) met criteria for a current psychiatric disorder; 89 participants (69.0 %) met lifetime criteria for a psychiatric disorder. Caregivers reported a psychiatric diagnosis in 44 participants (34.1 %). Anxiety disorder had the highest current and lifetime prevalence (39.5 and 52.7 %, respectively). Participants with intellectual disability (n = 94, 72.8 %) were significantly less likely to have community-based diagnoses of anxiety (χ(2) = 5.37, p = 0.02) or depression (χ(2) = 13.18, p < 0.001) reported by caregivers. Seventy-six participants (58.9 %) were taking ≥1 psychotropic medication. Comorbid psychiatric disorders occur frequently in adults with ASD, though identifying these disorders poses a challenge in community settings. A greater understanding of the presentation of these conditions within this population will increase assessment validity and the potential for efficacious intervention.
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Kapoor S. The Close Relationship between Sleep Disorders and Reproductive Dysfunction in Endocrinology. Front Endocrinol (Lausanne) 2012; 3:117. [PMID: 23087671 PMCID: PMC3471267 DOI: 10.3389/fendo.2012.00117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 09/14/2012] [Indexed: 12/02/2022] Open
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