Exploring attachment security in a sample of Lebanese adolescents: The validation of the Arabic IPPA-R

Despite growing evidence supporting the importance of the quality of attachment during adolescence, no studies have been conducted to date in the Arab world due to an absence of valid and reliable tools to measure this construct in Arabic. The Inventory of Parent and Peer Attachment-Revised (IPPA-R) was devised as a self-report questionnaire in English to assess the quality of adolescent attachment to mother, father, and peers, each scale consisting of 25 items. The current study sets out to determine the psychometric properties of the Arabic IPPA-R and to explore attachment styles in Lebanon in a sample of 765 Lebanese adolescents. Results suggested a modified three-factor structure to reach satisfactory reliability of the Arabic IPPA-R, resulting in a modified questionnaire consisting of 19 items for each of mother (α = .82) and father (α = .85), and 21 items for peers (α = .89). Strict measurement invariance across gender was achieved for the IPPA-R parental forms, while only scalar invariance was achieved for the IPPA-R peers form. Overall, there were significant differences in attachment scores to mother and father, with adolescents scoring higher on attachment to mother, with both scores being significantly lower than attachment to peers. Gender differences were found on the peer scale with girls scoring significantly higher than boys. Results are interpreted from a cultural lens, emphasizing the importance of accounting for cultural, religious, and socio-economic factors in understanding adolescent attachment. This study is the first conducted in the Arab region and provides a road map to understanding gender-roles, parental expectations and adolescent perceived parenting, and their impact on adolescent attachment scores.

Outcomes for children with autism spectrum disorder and their families after two years of school based early intensive behavioural intervention

The effectiveness of a school based Early Intensive Behavioural Intervention (EIBI) program was assessed over a two-year period for a cohort of 16 pre-school children with autism spectrum disorder (ASD) and their families. Children with a mean age of 40 months, were assessed prior to intervention, after 1 year of intervention, and again after 2 years. Significant improvements were observed on measures of adaptive behaviour, communication ability and challenging behaviour. Parents of children attending the program also reported increased familial quality of life, specifically improved emotional and physical well-being and increased parenting capacity over the duration of the program. The current study suggests that EIBI for young children with ASD can be effective in facilitating improvements in communication ability, reducing challenging behaviours and improving quality of life for families. Children's pre-intervention adaptive skills appeared to be the strongest predictor of post intervention gains as initial level of adaptive ability was positively related to improved post-intervention outcomes.

Religious coping and levels of posttraumatic stress disorder symptomatology after the Beirut explosion

OBJECTIVE

Religious coping has implications for the development of psychopathology in the aftermath of traumatic events. This study explored the relationship between religious coping (positive and negative) and posttraumatic stress disorder (PTSD) symptomology among survivors of a large industrial explosion that devastated parts of Beirut in August of 2020.

METHOD

Three months after the disaster, 996 residents of Beirut and Lebanon completed validated measures of religious coping (RCOPE) and PTSD symptomatology (Impact of Events Scale-Revised) in either English or Arabic. The majority of participants were young adults aged between 18 and 25 years.

RESULTS

Results indicated that higher levels of negative religious coping were a significant predictor of higher levels of PTSD symptomatology and were associated with a two-fold risk of meeting the criteria for probable PTSD. Other significant predictors included female gender, being a resident of Beirut at the time of the explosion, having personally sustained an injury, or knowing a person injured in the explosion. Effects sizes ranged from .34 to .68.

CONCLUSIONS

Higher scores on measures of negative religious coping were associated with higher levels of PTSD symptomatology. However, negative religious coping may be better construed as a set of religious-based appraisals of event causality and may represent a form of peritraumatic appraisal in the wake of traumatic events. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Prevalence and correlates of mental health difficulties following the beirut port explosion: The roles of mentalizing and resilience

OBJECTIVE

Research has consistently highlighted an increased prevalence of mental health problems, such posttraumatic stress disorder (PTSD), depression, and anxiety, following both man-made and natural disasters. Mentalizing and resilience have been previously identified as potential protective factors against the onset of mental health difficulties following such events.

METHOD

This study first identified the prevalence of PTSD symptoms, depression, anxiety, and stress and subsequently assessed mentalizing abilities and resilience as predictors of PTSD symptomatology in a sample of 521 Lebanese participants following the Beirut Port explosion on August 4, 2020.

RESULTS

Findings were consistent with existing literature highlighting elevated rates of PTSD, depression, and anxiety subsequent to man-made disasters, with higher rates of mental health symptoms observed among women, those with a preexisting diagnosis of psychiatric disorder (1.5 times more likely to meet the PTSD Checklist for DSM-5 [PCL-5] cutoff score), and those who had to move houses (over 2 times more likely to meet PCL-5 cutoff) as a consequence of the explosion. Higher mentalizing capacities were positively correlated with higher resilience scores and lower indices of mental health difficulties. Each unit increase in resilience scores was associated with a 3% reduction in meeting PCL-5 cutoff, and poorer mentalizing abilities was associated with a 2-fold increase in the risk of meeting PCL-5 cutoff.

CONCLUSIONS

Presence of a previous psychiatric diagnosis, having to move houses, lower mentalizing capacities, and lower resilience scores were found to predict elevated PCL-5 scores. Findings are discussed within the framework of recommendations for interventions targeting people affected by traumatic events. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Generalized Anxiety Mediates the Relationship Between Loneliness and Sleep Quality Amongst Young Adults During the COVID-19 Pandemic

Since the outbreak of COVID-19, restrictions to minimize its spread have had a profound effect. Government instigated restrictions, such as social isolation, have affected millions worldwide, and the downstream consequences of perceived loneliness upon mental health and sleep are largely unknown. A total of 1662 individuals participated in an online survey. Loneliness, anxiety, and sleep quality were assessed using the UCLA Loneliness Scale, the Generalized Anxiety Disorders scale, and the Pittsburgh Sleep Quality Index, respectively. Higher levels of perceived loneliness, as well as each one-unit increase in anxiety, were independent predictors of poor sleep quality, where OR = 1.16 (95% CI: 1.03-1.31) and 1.16 (1.11-1.21), respectively, and after adjustment. In our path analysis, we revealed significant direct effects between loneliness and sleep quality (β = 0.25, p < .001), as well as generalized anxiety and sleep quality (β = 0.28, p < .001), and generalized anxiety mediated the relationship between loneliness and sleep quality (β = 0.33, p < .001). Heightened anxiety and perceived loneliness appear to be significant drivers of poor sleep quality during the COVID-19 pandemic. Digital media platforms that encourage support groups for those experiencing social isolation are encouraged, along with self-help and meditative practices, which may minimize an increase of mental health and sleep disorder diagnoses post COVID-19.

The Influence of Multiple Community Level Traumatic Event Types on Mental Health Outcomes

Lebanon witnessed three large-scale negative community level events in 2020; a severe economic crisis, the COVID-19 pandemic, and an explosion in the port of the capital city, Beirut, which resulted in the deaths of 218 individuals and several thousand injured. The current study examined the relationship between the number of community level events individuals identified as personally impactful and corresponding levels of anxiety, depression, and symptoms of PTSD. The study also examined the roles of specific protective factors including perceived social support, resilience, and religious coping. A total of 406 participants aged between 18 to 64 years completed validated self-report measures online in February 2021. Results indicated elevated levels of mental health difficulties within the sample with over half of the participants reporting moderate to severe anxiety and moderate to severe depression and meeting the cut-off for probable PTSD. Females had significantly higher scores on measures of depression, anxiety, and PTSD. Individuals reporting all three events as negatively impactful were 47% more likely to meet the cut-off for PTSD than individuals identifying a single event. Resilience appeared to be the strongest protective factor against elevated scores on all three mental health outcomes. Higher scores on negative religious coping were also associated with elevated PTSD scores. Low levels of resilience, higher negative religious coping, and being a female were identified as significant predictors of reaching the PTSD cut-off using binary logistic regression analysis.

Early screening for post-stroke depression, and the effect on functional outcomes, quality of life and mortality: a protocol for a systematic review and meta-analysis

INTRODUCTION

Post-stroke depression (PSD) is a severe complication of cerebrovascular stroke affecting about one-third of stroke survivors. Moreover, PSD is associated with functional recovery and quality of life (QOL) in stroke survivors. Screening for PSD is recommended. There are, however, differences in the literature on the impact of early screening on functional outcomes. In this systematic review, we synthesise the currently available literature regarding the associations between timing and setting of PSD screening and mortality, QOL and functional outcomes in stroke survivors.

METHODS AND ANALYSIS

We will systematically search electronic databases including PubMed, Embase, APA PsycINFO, Web of Science, Scopus and CINAHL from inception to August 2021. Four reviewers will screen the title and abstract and full-text level records identified in the search in a blinded fashion to determine the study eligibility. Any selection disagreements between the reviewers will be resolved by the study investigator. Data extraction of eligible studies will be conducted by two reviewers using a predefined template. We will complete the quality assessment of included articles independently by two reviewers using the Newcastle Ottawa Scale. Eventual discrepancies will be resolved by the principal investigator.

ETHICS AND DISSEMINATION

Due to the nature of the study design, ethical approval is not required. The systematic review and meta-analysis findings will be published and disseminated in a peer-reviewed journal. Our results will also be disseminated through posters and presentations at appropriate scientific conferences.

PROSPERO REGISTRATION NUMBER

CRD42021235993.

Poor sleep efficiency and daytime napping are risk factors of depersonalization disorder in female university students

Objectives

Depersonalization is characterized by feelings of detachment from reality and has been associated with anxiety and depression, both of which have a bi-directional relationship with sleep. To date, few studies have directly examined the potential relationship between sleep and depersonalization, which was the primary objective of our study.

Design/methods

A cross-sectional study of female, Emirati, university students (n = 100) was conducted. Participants completed the Pittsburgh Sleep Quality Index (PSQI), the Cambridge Depersonalization Scale (CDS) and the Hospital Anxiety and Depression Scale (HADS). Additionally, 36 of the 100 participants wore wrist actigraphy for two consecutive weekdays. Average sleep duration, and average sleep efficiency (SE; %) across the two nocturnal sleep episodes were calculated. Total number of sleep episodes were obtained from wrist actigraphy and sleep logs.

Results

A significant, positive relationship was observed between PSQI global score and CDS total score (r = 0.21, p = 0.04). Actigraphy-estimated average nocturnal sleep duration was not significantly associated with the CDS. Compared to nocturnal sleepers only, those who undertook daytime naps had almost three times the risk of meeting the criteria for depersonalization disorder (OR = 2.95, 95% CI: 1.04–8.41), after adjustment. For each 1% increase in SE a 23% decreased risk of depersonalization was observed (OR = 0.77, 95% CI: 0.61–0.96), after adjustment.

Conclusions

Sleep screening in young adults may help to ensure better detection and management of psychological health outcomes. Our findings need to be confirmed prospectively in larger samples and amongst different populations but reiterate the importance of sleep habits pertaining to mental health.

•

We show a novel relationship between depersonalization and sleep in a non-clinical sample.

•

Actigraphy determined poor sleep efficiency was significantly associated with subjective reports of depersonalization.

•

Daytime nappers were ~3 times more likely to report depersonalization symptoms and meet the diagnositic criteria.

The role of perceived social support on depression and sleep during the COVID-19 pandemic

The aim of the present study was to examine the role of perceived social support pertaining to a range of psychological health outcomes amongst individuals undergoing social isolation and social distancing during COVID-19. A total of 2,020 participants provided responses to an online cross-sectional survey comprised of validated instruments including the Multidimensional Scale of Perceived Social Support (MSPSS), the Generalized Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire (PHQ-9), the Brief Irritability Test (BITe) and the UCLA Loneliness Scale (UCLA-LS). Individuals experiencing self-isolation had significantly higher rates of depression, irritability and loneliness compared to those who were not. The risk for elevated levels of depression symptoms was 63% lower in individuals who reported higher levels of social support compared to those with low perceived social support. Similarly, those with high social support had a 52% lower risk of poor sleep quality compared to those with low social support. Social support was found to be significantly associated with elevated risk for depression and poorer sleep quality. The results contribute to our understanding of differential psychological outcomes for individuals experiencing anti-pandemic measures.

The prevalence of psychological consequences of COVID-19: A systematic review and meta-analysis of observational studies

A systematic review and a meta-analysis were conducted to examine the overall prevalence of psychological health outcomes during COVID-19. Seven databases were systematically searched to include studies reporting on at least one psychological outcome. The pooled prevalence of primary psychological outcomes was 26% (95%CI: 21-32). Pooled prevalence for symptoms of PTSD was 33% (0-86), anxiety 28% (21-36), stress 27% (14-43), and depression 22% (13-33). The prevalence of psychological outcomes was similar in healthcare workers and in the general population (34% [24-44] and 33% [27-40] respectively). High prevalence figures support the importance of ensuring adequate provision of resources for mental health.

Health behaviour changes during COVID-19 and the potential consequences: A mini-review

The COVID-19 pandemic has brought about profound changes to social behaviour. While calls to identify mental health effects that may stem from these changes should be heeded, there is also a need to examine potential changes with respect to health behaviours. Media reports have signalled dramatic shifts in sleep, substance use, physical activity and diet, which may have subsequent downstream mental health consequences. We briefly discuss the interplay between health behaviours and mental health, and the possible changes in these areas resulting from anti-pandemic measures. We also highlight a call for greater research efforts to address the short and long-term consequences of changes to health behaviours.

The Mental States Task (MST): Correlates and New Perspectives on Mentalizing in a Lebanese Student Sample

Mentalizing is defined as one's capacity to think in terms of mental states underlying one's own and others' behaviors. It has been posited to develop within the context of a secure attachment relationship and has been linked to a myriad of psychological adjustment variables. Given the scarcity of research on mentalizing in Lebanon, this study aimed to investigate mentalizing in a sample of 293 Lebanese undergraduate students using a novel tool, the Mental State Task (MST). Higher mentalizing scores were found to be positively correlated with self-esteem, neurotic defenses, authenticity and adaptive emotion regulation strategies, as well as negatively correlated with psychological symptomatology. This study also provided descriptions of the six mental states measured by the MST continuum based on their correlations with related constructs. Findings diverge with the literature in relation to the association between defense styles and MST scores, which were posited to reflect cultural specificities of this sample.

Perceived Risk and Protection From Infection and Depressive Symptoms Among Healthcare Workers in Mainland China and Hong Kong During COVID-19

Psychological health among healthcare workers (HCWs) has become a major concern since the COVID-19 outbreak. HCWs perceived risks of contracting COVID-19, in relation to depression were investigated. It was hypothesized that perceived high risk of contracting COVID-19 (close contact with cases, inadequate provision of personal protective equipment, insufficient infection control training, and presence of symptoms) would be significant predictors of depression. Our cross-sectional survey was completed by HCWs across three regions (Hubei, Guangdong, Hong Kong) between March 9 to April 9 2020 using convenience sampling. Depression was assessed using the 9-item Patient Health Questionnaire (PHQ-9). Prevalence of depression was 50.4% (95% CI: 44.5-56.2), 15.1% (10.1-21.9) and 12.9% (10.3-16.2) for HCWs in Hong Kong, Hubei and Guangdong, respectively. The strongest significant risk factors for depression, after adjustment, were HCWs who reported the greatest extent of feeling susceptible to contracting COVID-19 and those who reported the greatest difficulty obtaining face masks. HCWs whose family/peers greatly encouraged face mask use had lower prevalence of depression. Access to adequate supplies of personal protective equipment is essential for the psychological health of HCWs working in stressful environments, through potentially easing their perceptions of vulnerability to COVID-19.

The impact of behavioural skills training on the knowledge, skills and well-being of front line staff in the intellectual disability sector: a clustered randomised control trial

BACKGROUND

Staff with varying backgrounds and educational qualifications can be effectively trained to implement procedures in line with evidence-based practice. Behavioural skills training (BST) is a competency-based training model used to effectively educate a broad selection of professionals, including front line staff, in a range of work-related skills. However, BST has yet to be evaluated in a large group-based experiment.

METHODS

This study involved a parallel cluster randomised control trial. Six service sites, with a total of 54 participants, were randomised to the intervention condition using the 'coin toss' method. The intervention condition used BST to coach intellectual disability staff in reinforcement, systematic prompting, functional communication training and task analysis. Six service sites, with a total of 50 participants, were also randomised to a control condition in which generalised training in behavioural interventions was restricted. Recruited service sites were randomly assigned to the intervention condition (N = 6, n = 54) or the control condition (N = 6, n = 50) at one point in time, immediately after recruitment and before baseline testing took place. Allocations were stratified by service type (residential or day) and geographical region. One member of the research team allocated service sites using the 'coin toss' method, and another member, blind to the allocations, decided which experimental arm would receive the intervention and which would be designated as control. It was not possible to mask the intervention from participants, but they were recruited prior to randomisation.

RESULTS

Participants in the intervention condition demonstrated statistically significant improvements in their knowledge scores over the study period. Participants in the control condition showed no change or a statistically significant decrease in their knowledge scores. No statistically significant changes to well-being were observed for either group. There was clear evidence of knowledge maintenance, as well as skill acquisition and subsequent generalisation to the workplace environment, among participants in the intervention condition. Participants also evaluated the BST intervention positively.

CONCLUSIONS

Results support BST as a method for disseminating evidence-based practice to front line staff working with adults with intellectual and developmental disabilities.

Parental satisfaction with early intensive behavioral intervention

Research related to parental satisfaction with early intensive behavioral intervention (EIBI) remains limited. A 35-item questionnaire called the parental satisfaction scale-EIBI (PSS-EIBI) was developed with four subdomains (child outcomes, family outcomes, quality of the model, and relationship with the team). Study 1 assessed levels of satisfaction for 48 parents with their child's EIBI program after approximately 1 year of intervention. Study 2 examined the relationship between parental satisfaction, length of child participation in EIBI, and the relationship between parental satisfaction and actual outcomes for their child as assessed by the Verbal Behavior Milestones Assessment and Placement Program after approximately 2 years. Results indicate that parental satisfaction with EIBI was consistently high in all four domains of the PSS-EIBI in both studies. Parental satisfaction was found to be associated with gains in child functioning after 1 year of intervention.

The Use of Differential Reinforcement of Other Behaviours to Establish Inhibitory Stimulus Control for the Management of Vocal Stereotypy in Children with Autism

OBJECTIVE

This study examined the efficacy of an inhibitory stimulus control procedure (ISCP) for the management of vocal stereotypy in three children with autism.

METHOD

During discrimination training, implemented within a changing criterion design, participants were taught that there were no consequences for vocal stereotypy in the absence of an inhibitory stimulus but that differential reinforcement procedures were in effect in the presence of the stimulus. Functional control of the inhibitory stimulus was subsequently assessed within a reversal design.

RESULTS

Inhibitory stimulus control was established during discrimination training, with participants inhibiting vocal stereotypy for 30 min periods in the presence of the inhibitory stimulus. Reductions in vocal stereotypy were maintained in the presence of the inhibitory stimulus and in the absence of further programmed consequences.

DISCUSSION

This study extends current knowledge by demonstrating the efficacy of ISCPs paired with reinforcement only, and illustrating the functional control of the inhibitory stimulus.

An evaluation of positive behavioural support for children with challenging behaviour in community settings

This study employs a multiple baseline across individual design to describe the implementation of positive behavioural supports for seven children and adolescents in residential community settings over a period of 24 months. These individuals with intellectual disability are residing in one county with long-standing challenging behaviour resulting in home breakdown and serious physical injury. Four types of outcome are presented: rates of behaviour, rates of medication, psychiatric symptomatology and quality of life (QoL). Behaviours reduced to lower levels for the majority of participants following the implementation of positive behavioural supports, and improvements were largely sustained. The use of psychotropic medications reduced or stabilized for the majority of individuals over the same period. QoL Questionnaire scores improved substantially for four participants. The results are discussed in the context of a framework for supporting children with severe challenging behaviours in the community.

National Identity, Implicit In-Group Evaluation, and Psychological Well-Being Among Emirati Women

A sense of connectedness, and belonging to a valued social group (social identity processes), has been found to promote psychological well-being. This study, using implicit and explicit assessments, extends the exploration of social identity and well-being to citizens of the United Arab Emirates (Emiratis). In this cross-sectional correlational study, Emirati college women ( N = 210), all of them bilingual (English/Arabic), performed an affective priming task designed to assess, implicitly, in-group (Emirati) preference (a positive bias toward the in-group relative to an out-group). Participants also completed the Multicomponent In-Group Identification Scale (MIIS), a measure of in-group identification and self-report measures of English/Arabic language proficiency. Participants also reported their psychological well-being using the World Health Organization’s well-being index. Implicit in-group preference and self-reported Arabic language dominance were independently predictive of higher levels of psychological well-being. The implicit measure was the strongest, most robust, predictor. Interventions aimed at maintaining or increasing a positive sense of a shared social identity may be a useful objective of public mental health strategy.

Holy anorexia: Eating disorders symptomatology and religiosity among Muslim women in the United Arab Emirates

There is a substantial body of literature reporting a negative association between religiosity and psychiatric symptoms. In the context of eating disorders, however, this relationship appears to be reversed. The few studies exploring the relationship between religiosity and eating disorders have mostly focused on the Judeo-Christian religious traditions in Western nations. The present study examines this relationship among Muslim college women from the United Arab Emirates (UAE). All participants (N = 1069) independently completed the religious commitment inventory (RCI-10) and the eating attitudes test (EAT-26). As hypothesised, there was a positive association between religiosity and eating disorders symptoms. Furthermore, those scoring above the EAT-26 cut-off reported significantly greater levels of religiosity. These findings suggest that heightened religiosity among young Emirati women may represent a vulnerability factor for eating disorders. Preventative initiatives in the UAE should consider focusing on religiosity.

Reasons for referral, intervention approaches and demographic characteristics of clients with intellectual disability attending adult psychiatric outpatient services in the Kingdom of Bahrain

BACKGROUND

Relatively little information is available regarding the use of psychiatric services by individuals with intellectual disability (ID) in Arab countries. The current study aimed to identify (1) the reasons for referral; (2) demographic characteristics of individuals referred; (3) previous contact with child psychiatric services; (4) psychiatric diagnoses; (5) level of ID; (6) nature of interventions; and (7) patterns of medication usage in individuals attending a specialist psychiatric service for individuals with an ID in the Kingdom of Bahrain.

METHOD

Case file analysis was used. Files that recorded attendance at the specialist service within a specific calendar year were selected. A total of 537 files were available for review and 79 contained records indicating the individual had been seen within the year.

RESULTS

The primary referral reason to adult psychiatric services was the presence of behavioural disturbance. Pharmacological intervention was the dominant treatment choice and no individual was recommended for psychological/behavioural intervention. Psychiatric diagnosis was not recorded in over 90% of cases.

CONCLUSION

Services in the Kingdom of Bahrain for individuals with ID rely exclusively on pharmacological approaches for the treatment of behavioural disorders. Implications for best practice guidelines are discussed.

Thermal expansion of monoclinic natrojarosite

Jarosites and related minerals are of great interest to a range of mineral processing and research applications. In some industrial settings jarosite formation is encouraged; for example to aid the removal of iron species from solutions in hydrometallurgical processes. In other environments such as bioleaching, jarosite formation can hinder the process by creating a kinetic barrier, in the form of a passivation layer, to the desired reaction. Jarosites are a major component of acidic soils and are present in significant amounts in acid mine drainage environments. There has been a recent resurgence in interest in jarosite minerals since their detection on Mars by the MER rover Opportunity. In this context, the presence of jarosite has been recognised as a likely indicator of the presence of water on Mars in the past. It is hoped that study of their formation mechanisms, stability and thermoelastic properties will provide insight into the environmental history of Mars as well as informing terrestrial industrial concerns. To this end we are engaged in a program to study jarosites and their formation and stability behaviour over a range of conditions. This contribution describes in situ powder diffraction experiments to determine the thermal expansion of a deuterated natrojarosite. Data were collected on the HRPD beamline at the ISIS spallation source where the natrojarosite sample was heated from 10–700K, and at the powder diffraction beamline at the Australian synchrotron where the sample was heated from 80-700K. Isothermal neutron and synchrotron datasets were refined simultaneously. Analysis of the lattice parameter variation with temperature shows that all cell edges increase smoothly to ~500 K where there is a discontinuity. This discontinuity represents the initially non-stoichiometric monoclinic jarosite converting to a stoichiometric, rhombohedral phase, shortly after which FeOHSO4 peaks become visible. Thermal expansion coefficients have been fitted from 10-470K and show that there is most variation in the monoclinic c-axis. This direction is normal to the layers of sulphate tetrahedra and iron octahedra within the jarosite structure and contains more flexible hydrogen bond linkages which more easily accommodate expansion than the more rigid polyhedra. Details of the combined neutron-synchrotron diffraction approach will also be discussed.

A component analysis of positive behaviour support plans

BACKGROUND

Positive behaviour support (PBS) emphasises multi-component interventions by natural intervention agents to help people overcome challenging behaviours. This paper investigates which components are most effective and which factors might mediate effectiveness.

METHOD

Sixty-one staff working with individuals with intellectual disability and challenging behaviours completed longitudinal competency-based training in PBS. Each staff participant conducted a functional assessment and developed and implemented a PBS plan for one prioritised individual. A total of 1,272 interventions were available for analysis. Measures of challenging behaviour were taken at baseline, after 6 months, and at an average of 26 months follow-up.

RESULTS

There was a significant reduction in the frequency, management difficulty, and episodic severity of challenging behaviour over the duration of the study. Escape was identified by staff as the most common function, accounting for 77% of challenging behaviours. The most commonly implemented components of intervention were setting event changes and quality-of-life-based interventions.

CONCLUSION

Only treatment acceptability was found to be related to decreases in behavioural frequency. No single intervention component was found to have a greater association with reductions in challenging behaviour.

An evaluation of an intervention sequence outline in positive behaviour support for people with autism and severe escape-motivated challenging behaviour

BACKGROUND

Positive behaviour support emphasises the impact of contextual variables to enhance participation, choice, and quality of life. This study evaluates a sequence for implementing changes to key contextual variables for 4 individuals. Interventions were maintained and data collection continued over a 3-year period.

METHOD

Functional assessments were conducted with 4 individuals with exceptionally severe challenging behaviours. Interventions were based on the multi-element model of behavioural support (LaVigna & Willis, 2005a). Dependent variables were behavioural ratings of (1) frequency, (2) episodic severity, (3) episodic management difficulty, and measures of (4) mental health status, and (5) quality of life. The intervention sequence was low arousal environment, rapport building, predictability, functionally equivalent skills teaching, and differential reinforcement strategies.

RESULTS

Substantial reductions in target behaviours were observed, along with incremental improvement in mental health scores and quality-of-life scores.

CONCLUSION

The study demonstrates the efficacy of positive behaviour support for people with exceptionally severe behaviour in individually designed services.

FC28-05 - Prevalence of psychiatric diagnoses and challenging behaviours in a community based population of individuals with intellectual disability

Introduction

Previous research has suggested substantial variation in prevalence rates of psychiatric disorders in individuals with intellectual disability and also differential patterns of associations between psychiatric disorders and challenging behaviours in people with intellectual disabilities. The aim of this study was to determine with the prevalence rate of specific psychiatric disorders and challenging behaviours and the relationship between them in a community based sample of individuals with intellectual disability.

Method

A community based sample of 159 adults primarily with mild and moderate intellectual disabilities was surveyed for the presence of psychiatric disorders and challenging behaviour using the Behaviour Problem Inventory (BPI) and the Psychiatric Assessment Schedule (PAS-ADD). Individuals who met threshold on the PAS-ADD were subsequently evaluated using the Mini- PAS-ADD Interview.

Results

Screening for psychiatric disorder using the PAS-ADD indicated a prevalence rate of 10%. There was a large discrepancy between the overall rate of challenging behaviour (45%) and the rate of psychiatric disorders identified by the Mini PAS-ADD Interview (6%). However, the rate of more severe behaviour problems (8%) was closer to the rate of psychiatric disorders (6%). Thirty one percent of people with severe challenging behaviours also were rated as having psychiatric disorders and odd ratio analysis indicates that individuals with severe challenging behaviour are substantially more likely to present with a psychiatric disorder. However, there does not appear to be a relationship between different topographies of challenging behaviour and discrete diagnostic categories of psychiatric disorder.

Using a Time Timer to increase appropriate waiting behavior in a child with developmental disabilities

This study aimed to examine the use of a predictive stimulus (Time Timer) and delayed reinforcement to increase appropriate waiting behavior in a child with developmental disabilities and problem behavior maintained by access to tangible items and activities. The study employed a changing criterion design across settings to gradually increase reinforcement delay from 1s to 10 min. Firstly a baseline phase was conducted to measure the duration of appropriate waiting behavior to access tangible reinforcers/activities. Phase 2 involved the use of a red cue card and the verbal instruction "wait". Phase 3 involved the introduction of the Time Timer with the cue card attached, and the verbal instruction "wait". Finally, Phase 4 utilised the Time Timer without the cue card. This method was an effective strategy for increasing appropriate waiting behavior with this participant in a school setting. The role of adding a concurrent activity during the reinforcement delay, using cues to predict reinforcement, future generalization, maintenance and the teaching of functionally equivalent skills are discussed.

Person Focused Training: a model for delivering positive behavioural supports to people with challenging behaviours

BACKGROUND

Person Focused Training is introduced as a model of service delivery for people with severe challenging behaviours. It is defined as training and supporting staff to conduct functional assessments and to design and implement positive behavioural support for specific individuals with challenging behaviours.

METHOD

Longitudinal outcome data are presented from 138 behaviour support plans developed by staff over a seven year period were analysed to determine reductions in frequency of challenging behaviours. Degree of behaviour change was determined across topography of behaviour, gender, age, level of disability, location of residence and role of course participant.

RESULTS

Results indicate that the implementation by staff of behaviour support plans are associated with significant improvement in 77% of cases at an average follow-up of 22 months after implementation of support plans. Only location of residence was identified as related to reduction in challenging behaviours with large residential centres being associated with lower rates of behavioural improvement.

CONCLUSIONS

It is argued that Person Focused training may represent an alternative to existing models of supporting individuals with challenging behaviours. The implications of front-line staff designing and implementing behaviour support plans for the organisation of services and the role of the clinical psychologist are considered.

Early neonatal hypocalcemia in extremely preterm infants. High incidence, early onset, and refractoriness to supraphysiologic doses of calcitriol

Nineteen preterm infants born at or before 32 weeks of gestation were studied to determine the dose of calcitriol that would be effective in the prophylaxis of early neonatal hypocalcemia (serum calcium level, less than 7.0 mg/dL [less than 1.75 mmol/L]). In these infants the course of early neonatal hypocalcemia was not modified by calcitriol administration. Serum 1,25-dihydroxyvitamin D level rose in response to intramuscular administration of calcitriol. The incidence of hypocalcemia in these infants was 37% by 12 hours, 83% by 24 hours, and 89% by 36 hours. Thus, in extremely preterm infants, the incidence of early neonatal hypocalcemia is higher and the onset earlier than in larger preterm infants; furthermore, in these infants the hypocalcemia is refractory even to high doses of calcitriol.