Reliability and validity of the dynamic risk outcome scales-short version for clients with mild intellectual disabilities or borderline intellectual functioning

INTRODUCTION

This study investigated the reliability and validity of the dynamic risk outcome scales-short version (DROS-SV). This instrument is developed to monitor treatment progress using dynamic risk factors in clients with mild intellectual disabilities or borderline intellectual functioning and behavioural and/or mental health problems.

METHOD

Data were collected from 264 clients who received Flexible Assertive Community Treatment (FACT), a form of intensive outpatient treatment.

RESULTS

A principal component analysis showed that there were six components explaining 73.9% of the variance. Furthermore, the DROS-SV showed good internal consistency of its subscales and total score (α > 0.78). Correlating the DROS-SV with the Historical and Clinical subscales of the Historical, Clinical and Future-30 indicated convergent and divergent validity.

DISCUSSION

The DROS-SV has good psychometric properties for measuring dynamic risk factors in clients with mild intellectual disabilities or borderline intellectual functioning in FACT teams.

Psychometric analysis of the Group Climate Inventory-Revised in adults with mild intellectual disability or borderline intellectual functioning in a secure residential facility

BACKGROUND

In secure residential facilities, group climate perceptions of clients with mild intellectual disability or borderline intellectual functioning are systematically assessed for quality improvement. A valid and reliable measure may ensure that this process is consistent. The Group Climate Inventory-Revised (GCI-R) is a new measure to assess group climate perceptions.

METHOD

Confirmatory factor analysis was conducted in 148 adult clients (79% male) with mild intellectual disability or borderline intellectual functioning in a secure facility to examine internal structure validity and internal consistency reliability of the GCI-R.

RESULTS

The results indicate support for the five-factor structure of the GCI-R ('Support', 'Growth', 'Repression', 'Peer interactions', and 'Physical environment'). The internal consistency reliability of its scales ranged from acceptable to good (α: .72-.87; ω: .76-.86).

CONCLUSION

The GCI-R demonstrates evidence of psychometric adequacy when applied to adult clients with mild intellectual disability or borderline intellectual functioning in secure residential facilities.

Experienced support at work, team climate and collaboration in teams working with people with mild intellectual disabilities and severe challenging behaviour in residential care: a cross-sectional study

BACKGROUND

This study explored the perceptions of staff for people with mild intellectual disabilities or borderline intellectual functioning and severe challenging behaviour in relation to the support they received at work from four groups of professionals (i.e. team leaders, managers, psychologists and other staff members). The team climate, such as the workplace having clearly defined goals for staff, was also explored. In addition, the associations between the support from each of the professionals and team climate with the well-being and job satisfaction of staff were examined. We hypothesised that staff would perceive higher levels of support from professionals around a team (i.e. team leaders, managers and psychologists) and a more positive team climate when professionals around a team experience more positive mutual collaboration.

METHODS

An online questionnaire about support at work, team climate, well-being and job satisfaction was completed by 201 staff members from 32 teams at 10 residential service organisations. In addition, professionals surrounding these teams rated their mutual collaboration.

RESULTS

Both support received at work from all four groups of professionals and team climate showed significant small to moderate positive associations with job satisfaction. Well-being was associated with support from team leaders, psychologists and other staff members in the team, as well as with team climate. We did not find support for the hypotheses that staff would perceive higher levels of support or a more positive team climate when professionals around a team experience more positive mutual collaboration.

CONCLUSIONS

This study highlights the importance of investing in staff support and creating a positive team climate for promoting staff well-being and job satisfaction. Implications for future research regarding staff support, team climate and the collaboration between professionals around a team are discussed.

Relationships between dynamic risk factors for externalising problem behaviour and group climate in adults with mild intellectual disability in forensic treatment

BACKGROUND

Relationships between dynamic risk factors for externalising problem behaviour and group climate were investigated in 151 adult in-patients with mild intellectual disability or borderline intellectual functioning in a Dutch secure residential facility.

METHOD

Regression analysis was used to predict total group climate score and Support, Growth, Repression, and Atmosphere subscales of the 'Group Climate Inventory'. Predictor variables were Coping Skills, Attitude towards current treatment, Hostility, and Criminogenic attitudes subscales of the 'Dynamic Risk Outcome Scales'.

RESULTS

Less hostility predicted a better overall group climate, better support and atmosphere, and less repression. A positive attitude towards current treatment predicted better growth.

CONCLUSION

Results indicate relationships of hostility and attitude towards current treatment with group climate. A focus on both dynamic risk factors and group climate may provide a basis for improving treatment for this target group.

The predictive value of the dynamic risk outcome scales (DROS) for recidivism in (forensic) clients with mild intellectual disabilities or borderline intellectual functioning

BACKGROUND

The dynamic risk outcome scales (DROS) was developed to assess treatment progress of clients with mild intellectual disability or borderline intellectual functioning using dynamic risk factors. We studied the predictive value of the DROS on various classifications and severity levels of recidivism.

METHOD

Data of 250 forensic clients with intellectual disabilities were linked to recidivism data from the Judicial Information Service in the Netherlands. Receiver operating characteristics (ROC) analyses were used to determine the predictive values.

RESULTS

The DROS total score could not significantly predict recidivism. A DROS recidivism subscale predicted general, violent and other recidivism. These predictive values were comparable to those of a Dutch tool validated for risk assessment in the general forensic population.

CONCLUSIONS

The DROS recidivism subscale predicted various classifications of recidivism better than chance. At present, the DROS appears to have no added value beyond the HKT-30 for the purpose of risk assessment.

[The predictive value of the Dynamic Risk Outcome Scales (DROS) for predicting recidivism in (forensic) patients with mild intellectual disabilities or borderline intellectual functioning]

The Dynamic Risk Outcome Scales (DROS) was developed to assess treatment progress of patients with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and severe behavioral and/or psychiatric problems. Because of the focus on dynamic risk factors, practitioners also see this instrument as a tool for risk assessment.<br/> AIM: To investigate the predictive value of the DROS on different classifications and severities of recidivism.<br/> METHOD: DROS data from the routine outcome monitoring (ROM) of 250 forensic patients with MID-BIF who were discharged between 2007 and end of 2014 were linked to recidivism data from the Judicial Information Service.<br/> RESULTS: The DROS total score predicted general, violence and sexual recidivism better than chance (AUCs > 0.58), although the effect was small. A DROS-recidivism subscale predicted general, violence and other recidivism with a medium to large effect (AUCs > 0.67). The predictive values of the DROS total score and DROS-recidivism subscale were comparable to those of the Historic, Clinical, Future (in Dutch: HKT)-30.<br/> CONCLUSION: The DROS total score and DROS-recidivism subscale predict different classifications of recidivism better than chance. However, for risk assessment the DROS appears to have no added value to the HKT-30.

[Suicide in individuals with mild intellectual disabilities]

Little is known about suicide among individuals with mild intellectual disabilities (mid).<br/> AIM: To explore risk factors for suicide among a small group of clients with mid who committed suicide.<br/> METHOD: Case files of 11 clients with mid were analysed using the Integrated Motivational Volitional model.<br/> RESULTS: Most suicides seem to have taken place impulsively and not on the basis of a predetermined plan. Most clients had comorbid mental health problems, predominantly trauma-related, impulse control and externalizing behavioural problems. The (imminent) loss of contact, such as in the case of transfer from one ward to another ward or to a facility, seems an important risk factor for suicide. <br/> CONCLUSION: Clients with mid residing in a treatment facility may have an increased risk of suicide because of an interaction between client characteristics and treatment context.

Flexible assertive community treatment for individuals with a mild intellectual disability or borderline intellectual functioning: results of a longitudinal study in the Netherlands

BACKGROUND

Assertive community treatment (ACT) and Flexible assertive community treatment (FACT) are organisation models for intensive assertive outreach that were originally developed for individuals with severe mental illness. The models are increasingly applied to people with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and challenging behaviour or mental illness. Research on these types of care for this population is limited. To gain experience in FACT MID/BIF in the Netherlands and to obtain insight in its outcomes, four organisations specialised in the treatment of individuals with MID/BIF and challenging behaviour participated in a 6-year implementation and research project.

METHODS

A longitudinal study was set up to investigate outcomes over time. Outcome measures concerned admissions to (mental) health care, social and psychological functioning, (risk of) challenging and criminal behaviour, social participation and client satisfaction. Data were analysed using descriptive statistics and linear mixed models.

RESULTS

Over time, clients showed improvement in their social and psychiatric functioning and living circumstances. The number of admissions to (mental) health care diminished as well as the number of contacts with police and justice, the level of social disturbance and the risk factors for challenging and criminal behaviour. Problems related to finances, work and substance abuse remained unchanged.

CONCLUSIONS

The results are encouraging and give rise to continued development of and broader research on FACT MID/BIF.

Psychometric properties of the Group Climate Instrument (GCI) in individuals with mild intellectual disability or borderline intellectual functioning

BACKGROUND

This study examined the psychometric properties of the Group Climate Instrument (GCI) in a sample of N = 189 adults (79% men) with mild intellectual disability or borderline intellectual functioning who were residents of a treatment facility in the Netherlands.

METHOD

Construct validity of the GCI was examined by means of confirmatory factor analysis. Also, reliability and convergent validity of the GCI were examined. We also examined the variability in perception of the living group climate between and within living groups by computing intraclass correlation coefficients.

RESULTS

The model contained four first-order factors (support, growth, group atmosphere and repression) and a second-order factor overall climate, providing preliminary support for construct validity of the GCI. Reliability coefficients were good for all factors. Preliminary evidence for convergent validity was found in significant moderate associations between subscales and single item ratings for the factors of group climate. The intraclass correlation coefficients indicated that a considerate proportion of variance can be attributed to between-group differences.

CONCLUSIONS

The GCI might be used to assess perception of the living group climate for individuals with mild intellectual disability or borderline intellectual functioning in psychiatric and forensic care settings, although further development of the GCI and replication of our findings seem necessary.

Attentional bias in problematic drinkers with and without mild to borderline intellectual disability

BACKGROUND

Problematic drinkers favour the processing of alcohol-related stimuli at the cost of other stimuli and also find it difficult to disengage their attention from these stimuli. This is indicative of an attentional bias towards alcohol. The goal of this study was to examine this bias in problematic drinkers with and without mild to borderline intellectual disability (MBID) using both eye tracking methodology and behavioural data (i.e. reaction time (RT) data).

METHOD

Participants (N = 133) were divided into four groups based on (estimated) full scale intelligence quotient (IQ) and severity of alcohol use-related problems. The severity of substance use-related problems was assessed with the Alcohol Use Disorder Identification Test (AUDIT). The visual dot probe task was used to measure the attentional bias. We analysed both eye tracking data and behavioural data (i.e. RT data) of the visual dot probe task.

RESULTS

Problematic drinkers were not more likely than light drinkers to direct their attention towards pictures of alcoholic beverages, did not look at these pictures longer than light drinkers and did also not respond faster than light drinkers to probes replacing pictures of alcoholic beverages. However, the strength of the attentional bias varied profusely.

CONCLUSION

Taking the large variability in the strength of the attentional bias and the poor psychometric qualities of the measures into consideration, it is concluded that the use of these measures for clinical purposes is discouraged.

Small Hand-Closure Movements Used as a Response through Microswitch Technology by Persons with Multiple Disabilities and Minimal Motor Behavior

This study assessed small hand-closure movements as a potential response for microswitch activation with two participants with profound multiple disabilities of 5.2 and 20.6 yr. of age. The microswitch consisted of a two-membrane thin pad fixed to the palm of the hand and a control system. The outer membrane (the one facing the fingers) was a touch-sensitive layer; the inner membrane was activated if the participant applied a pressure of over 20 gm. The activation of either membrane triggered an electronic control system, which in turn activated one or more preferred stimuli for 6 sec. except in baseline phases. Each participant received an ABAB sequence, in which A represented baseline and B intervention phases, and a 1-mo. postintervention check. Analysis showed both participants increased their responding during the intervention phases and maintained that responding at the postintervention check. Implications of the findings are discussed.

The addicted brain: cognitive biases in problematic drinkers with mild to borderline intellectual disability

BACKGROUND

Substance use disorders (SUD) are associated with several neurobiological disruptions, including biases in attention and approach/avoidance behaviour. The aims of this study were to compare the strength of cognitive biases between light and problematic drinkers, to explore the role of IQ on the cognitive biases and to study the psychometric qualities of the measures.

METHOD

Participants (N = 130) were divided into four groups based on IQ and severity of alcohol use-related problems: light (n = 28) and problematic drinkers (n = 25) with (sub)average IQ and light (n = 33) and problematic drinkers (n = 44) with mild to borderline intellectual disability (MBID). All participants performed the visual dot probe task and the approach avoidance task to measure the strength of cognitive biases.

RESULTS

In contrast with the hypothesis, no cognitive biases were found in problematic drinkers. Full scale IQ nor level of craving influenced the strength of the cognitive biases in light and problematic drinkers, although IQ did influence task performance (i.e. large intra-individual, trial-to-trial variation in reaction time). The internal consistency of the visual dot probe task was good, whereas the internal consistency of the approach avoidance task was poor.

CONCLUSION

Cognitive biases seem to vary within the group of problematic drinkers as a whole. The psychometric qualities of the measures are problematic, especially in relation to the intra-individual variability in reaction time found in participants with MBID. Until the implications of this variability on the validity of implicit measures and establishing bias scores are more clear, the use of these measures in individuals with MBID calls for scrutiny.

Clinical assessment of PTSD in children with mild to borderline intellectual disabilities: a pilot study

OBJECTIVE

There are few studies regarding assessment and treatment of trauma-related disorders in people with intellectual disabilities (ID). The aims of this study were to determine (1) the feasibility of an adapted version of a post-traumatic stress disorder (PTSD)-clinical interview and (2) to what extent manifestation of PTSD in a sample of children with mild to borderline ID corresponds with four existing PTSD algorithms.

METHOD

Fifteen children who visited a special need school were interviewed.

RESULTS

In all children, the full interview could be completed. Potentially traumatic events (A1 criterion), and PTSD symptoms for children with mild to borderline ID were similar to those observed in children without ID.

CONCLUSIONS

The manifestation of PTSD in children with mild to borderline ID corresponds with the manifestation of PTSD in children without ID. The data provide no reason to broaden PTSD criterion A1 for children with mild to borderline ID.

CYP1A2 polymorphisms in slow melatonin metabolisers: a possible relationship with autism spectrum disorder?

BACKGROUND

In some of our patients with intellectual disabilities (ID) and sleep problems, the initial good response to melatonin disappeared within a few weeks after starting treatment. In these patients melatonin levels at noon were extremely high (>50 pg/ml). We hypothesise that the disappearing effectiveness is associated with slow metabolisation of melatonin because of a single nucleotide polymorphism (SNP) of CYP1A2.

METHOD

In this pilot study we analysed DNA extracted from saliva samples of 15 consecutive patients with disappearing effectiveness of melatonin. Saliva was collected at noon and 4 pm for measuring melatonin levels.

RESULTS

In all patients' salivary melatonin levels at noon were >50 or melatonin half time was > 5 h. A SNP was found in eight of 15 patients. The allele 1C was found in two patients and in six patients the 1F allele was found.

CONCLUSIONS

Of 15 patients with disappearing effectiveness of melatonin, seven were diagnosed with autism spectrum disorder, and in four of them a SNP was found. The other eight patients were known with a genetic syndrome. In six of them behaviour was considered to be autistic-type and in three of them a SNP was found. This finding may give a new direction for research into the genetic background of autism.

The Behavior Problems Inventory-Short Form for individuals with intellectual disabilities: part I: development and provisional clinical reference data

BACKGROUND

The Behavior Problems Inventory-01 (BPI-01) is an informant-based behaviour rating instrument that was designed to assess maladaptive behaviours in individuals with intellectual disabilities (ID). Its items fall into one of three sub-scales: Self-injurious Behavior (14 items), Stereotyped Behavior (24 items), and Aggressive/Destructive Behavior (11 items). Each item is rated on a frequency scale (0 = never to 4 = hourly), and a severity scale (0 = no problem to 3 = severe problem). The BPI-01 has been successfully used in several studies and has shown acceptable to very good psychometric properties. One concern raised by some investigators was the large number of items on the BPI-01, which has reduced its user friendliness for certain applications. Furthermore, researchers and clinicians were often uncertain how to interpret their BPI-01 data without norms or a frame of reference.

METHODS

The Behavior Problems Inventory-Short Form (BPI-S) was empirically developed, based on an aggregated archival data set of BPI-01 data from individuals with ID from nine locations in the USA, Wales, England, the Netherlands, and Romania (n = 1122). The BPI-S uses the same rating system and the same three sub-scales as the BPI-01, but has fewer items: Self-injurious Behavior (8 items), Stereotyped Behavior (12 items), and Aggressive/Destructive Behavior (10 items). Rating anchors for the severity scales of the Self-injurious Behavior and the Aggressive/Destructive Behavior sub-scales were added in an effort to enhance the objectivity of the ratings.

RESULTS

The sensitivity of the BPI-S compared with the BPI-01 was high (0.92 to 0.99), and so were the correlations between the analogous BPI-01 and the BPI-S sub-scales (0.96 to 0.99). Means and standard deviations were generated for both BPI versions in a Sex-by-age matrix, and in a Sex-by-ID Level matrix. Combined sex ranges are also provided by age and level of ID.

CONCLUSION

In summary, the BPI-S is a very useful alternative to the BPI-01, especially for research and evaluation purposes involving groups of individuals.

The Behavior Problems Inventory-Short Form for individuals with intellectual disabilities: part II: reliability and validity

BACKGROUND

The Behavior Problems Inventory-01 (BPI-01) is an informant-based behaviour rating instrument for intellectual disabilities (ID) with 49 items and three sub-scales: Self-injurious Behavior, Stereotyped Behavior and Aggressive/Destructive Behavior. The Behavior Problems Inventory-Short Form (BPI-S) is a BPI-01 spin-off with 30 items.

METHODS

The psychometric properties of these two versions of the scale were computed using aggregated archival data from nine different sites in the USA, Wales, England, the Netherlands and Romania with a total of 1122 cases with a BPI-01 total score >0.

RESULTS

The internal consistency of the BPI-01 and the BPI-S ranged from fair to excellent with the BPI-01 showing slightly stronger reliability. Construct validity (confirmatory and discriminant) was computed by comparing BPI sub-scale scores with the scores of four other behaviour rating scales (the Aberrant Behavior Checklist, the Diagnostic Assessment for the Severely Handicapped-II, the Nisonger Child Behavior Rating Form and the Inventory for Client and Agency Planning). Strong evidence for confirmatory and discriminant validity was found for both the BPI-01 and the BPI-S. Confirmatory fit indices for the BPI and the BPI-S were comparable and suggesting that the factor structures fit the data well.

CONCLUSION

In summary, both BPI versions were found to be equally sound psychometrically and can be endorsed for future use. However, independent future studies are needed to replicate the psychometrics of the BPI-S with new data.

Sleep disturbances and behavioural problems in adults with Prader-Willi syndrome

BACKGROUND

Individuals with Prader-Willi syndrome (PWS) are at risk of sleep disturbances, such as excessive daytime sleepiness (EDS) and sleep apnoea, and behavioural problems. Sleep disturbances and their relationship with other variables had not been researched extensively in adults with PWS.

METHOD

Sleep disturbances and behavioural problems were investigated in adults with genetically confirmed PWS using standardised questionnaires. Results of adults with paternal deletion (n=45) were compared with those of adults with maternal uniparental disomy (n=33).

RESULTS

Eleven adults with PWS (i.e. 15%) had a current sleep problem, mostly night waking problems. Twenty-six adults with PWS (i.e. 33%) suffered from severe EDS. No differences in prevalence of sleep disturbances between genetic subtypes were found. Seventeen adults with deletion (i.e. 38%) and 17 adults with maternal uniparental disomy (i.e. 52%) had behavioural problems. No significant relationships were found between sleep disturbances and behavioural problems.

CONCLUSIONS

In adults with PWS, EDS is the most common type of sleep disturbance. Men and individuals with relative high body mass index are at increased risk for EDS. More research, aimed at developing a suitable screening instrument for sleep apnoea in adults with PWS, is necessary. Clinical implications of the findings are discussed.

Melatonin decreases daytime challenging behaviour in persons with intellectual disability and chronic insomnia

BACKGROUND

Persons with intellectual disability (ID) and sleep problems exhibit more daytime challenging behaviours than persons with ID without sleep problems. Several anecdotal reports suggest that melatonin is not only effective in the treatment of insomnia, but also decreases daytime challenging behaviour. However, the effect of melatonin treatment on daytime challenging behaviour in persons with ID has not been investigated in a randomised controlled trial.

METHOD

We investigated the effects of melatonin on challenging behaviour using data from two randomised controlled trials on the efficacy of melatonin on sleep problems in 49 persons (25 men, 24 women; mean age 18.2 years, SD = 17.1) with ID and chronic insomnia. Participants received either melatonin 5 mg (<6 years 2.5 mg) or placebo during 4 weeks. Daytime challenging behaviour was measured by the Storend Gedragsschaal voor Zwakzinnigen - Maladaptive Behaviour Scale for the Mentally Retarded (SGZ; Kraijer & Kema, 1994) at baseline week and the end of the fourth treatment week. Salivary dim light melatonin onset (DLMO) was measured at baseline and the last day of the fourth treatment week. Sleep logs were used to gather information on sleep parameters.

RESULTS

Melatonin treatment significantly reduced SGZ scores, sleep latency, and number and duration of night wakes, and treatment increased total sleep time and advanced DLMO. However, after 4 weeks of treatment, change in SGZ scores did not significantly correlate with change in sleep parameters, nor with change in DLMO. Relatively strong correlations were found between change in SGZ scores, change in DLMO and number of night wakes.

CONCLUSIONS

Melatonin treatment in persons with ID and chronic insomnia decreases daytime challenging behaviour, probably by improving sleep maintenance or by improving circadian melatonin rhythmicity.

Sleep in individuals with Cri du Chat syndrome: a comparative study

BACKGROUND

Sleep problems are common in individuals with intellectual disability. Little is known about sleep in children and adults with Cri du Chat syndrome (CDC).

METHOD

Sleep was investigated in 30 individuals with CDC using a sleep questionnaire. Sleep problems and sleep behaviours in individuals with CDC were compared with individuals with non-specific intellectual disabilities (NS) (n = 30) and Down's syndrome (DS) (n = 30).

RESULTS

Nine individuals with CDC (i.e. 30%) had a sleep problem, compared with seven individuals with NS (i.e. 23%) and three individuals with DS (i.e. 10%). Though there were few differences between diagnostic groups, night waking problems were most common in CDC. Individuals with CDC frequently showed behaviours related to disordered breathing and poor-quality sleep. Several behaviours related to sleep had a higher occurrence in CDC than in DS (P < 0.05) but not in NS.

CONCLUSIONS

It is concluded that individuals with CDC do not have an increased probability of sleep problems as compared with other individuals who share similar demographic characteristics. Hypotheses about causes of night waking problems in CDC are generated and suggestions for future research of sleep in individuals with CDC are given.

Communicative functioning in individuals with Angelman syndrome: a comparative study

PURPOSE

To assess expressive communication in individuals with Angelman syndrome.

METHOD

Communicative functioning of individuals with Angelman syndrome (AS) (n = 109) was compared with individuals with mixed etiologies (n = 117) using the Verbal Behaviour Assessment Scale (VerBAS).

RESULTS

Within-group analyses of those with AS revealed that the communicative function of manding was significantly more developed than tacting and echoing, and that tacting was significantly more developed than echoing. Low mean total VerBAS-scores were found with individuals who had epilepsy and used anticonvulsant medication, and with those who had profound developmental disabilities. In the comparison group, the function of manding was significantly more developed than both tacting and echoing, while tacting did not differ from echoing. Between-groups analyses revealed that individuals with AS had significantly lower scores on tacting and echoing, but not on manding.

CONCLUSION

The overall pattern of VerBAS scores for individuals with AS suggests a possible communicative phenotype.

Self-management treatment of drooling: a case series

Behavioral treatment of drooling is advocated widely, but evidence of its effectiveness is lacking. In a center-based case-series study, 10 participants with severe drooling were taught self-management skills to reduce drooling. Following treatment, all participants remained dry for intervals of 30-60 min, while being engaged in daily activities. Generalization to the classroom occurred in each participant. For three participants, maintenance of treatment effect was established at 6 and 24 weeks. Seven participants failed to maintain self-management skills at follow-up. Although the self-management procedure showed promising results, further adaptations are required to improve efficacy, generalization, and maintenance.

Contextual variables affecting aggressive behaviour in individuals with mild to borderline intellectual disabilities who live in a residential facility

BACKGROUND

Aggression is a common type of problem behaviour in clients with mild to borderline intellectual disability who live in a residential facility. We explored contextual events that elicit aggressive behaviour and variables that were associated with such events.

METHOD

Respondents were 87 direct-care staff members of 87 clients with aggressive behaviour who lived in a residential facility. Staff members completed the Contextual Assessment Inventory (CAI) and a questionnaire on demographic information and types, frequency and severity of aggressive behaviour. Internal consistency of the total CAI was excellent (alpha = 0.95), and Cronbach alpha's for the CAI sub-scales ranged from 0.75 to 0.93. Inter-rater agreement for the CAI could be considered good (mean intra-class correlation coefficient = 0.63).

RESULTS

Both social and task-related events were reported to evoke aggressive behaviour of clients most often. Negative interactions, task characteristics and daily routines relatively often evoked aggressive behaviour while an uncomfortable environment, medication, illness and physiological states (i.e. physical and biological events) evoked aggressive behaviour least often. Mean CAI sub-scale scores were significantly related to gender, IQ and frequency of aggressive behaviour.

CONCLUSION

The present study extends our knowledge regarding events that are associated with an increased probability of aggressive behaviour. Knowledge of these contextual variables may be helpful in designing programmes (e.g. applied behaviour analysis, social skills training and cognitive behavioural therapies) for the management and prevention of aggressive behaviour in clients with mild to borderline intellectual disability who live in a residential facility.

Promoting step responses of children with multiple disabilities through a walker device and microswitches with contingent stimuli

Children with severe or profound intellectual and motor disabilities often present problems of balance and locomotion and spend much of their time sitting or lying, with negative consequences for their development and social image. This study provides a replication of recent (pilot) studies using a walker (support) device and microswitches with preferred stimuli to promote locomotion in two children with multiple disabilities. One child used an ABAB design; the other only an AB sequence. Both succeeded in increasing their frequencies of step responses during the B (intervention) phase(s). These findings support the positive evidence already available on the effectiveness of this intervention in motivating and promoting children's locomotion.

Behavioural flexibility in individuals with Angelman syndrome, Down syndrome, non-specific intellectual disability and Autism spectrum disorder

BACKGROUND

Little is known about behavioural flexibility in children and adults with Angelman syndrome and whether people with this syndrome have more or less problems in being behaviourally flexible as compared with other people.

METHOD

Behavioural flexibility scores were assessed in 129 individuals with Angelman syndrome using 11 items from the Behavioural Flexibility Rating Scale-Revised (Green et al. 2007). Level of behavioural flexibility scores in individuals with Angelman syndrome (N = 129) was compared with that of people with non-specific intellectual disability (ID) (N = 90), Down syndrome (N = 398) and Autism spectrum disorder (N = 235).

RESULTS

Comparative analyses show that individuals with Angelman syndrome were more flexible than those with non-specific ID (P < 0.001) and those with Autism spectrum disorder (P < 0.01). There were no differences in behavioural flexibility scores between individuals with Angelman syndrome and those with Down syndrome (P = 0.94).

CONCLUSION

It is concluded that individuals with Angelman syndrome are comparatively flexible in their behaviour.

Melatonin treatment in individuals with intellectual disability and chronic insomnia: a randomized placebo-controlled study

BACKGROUND

While several small-number or open-label studies suggest that melatonin improves sleep in individuals with intellectual disabilities (ID) with chronic sleep disturbance, a larger randomized control trial is necessary to validate these promising results.

METHODS

The effectiveness of melatonin for the treatment of chronic sleep disturbance was assessed in a randomized double-blind placebo-controlled trial with 51 individuals with ID. All of these individuals presented with chronic ideopatic sleep disturbance for more than 1 year. The study consisted of a 1-week baseline, followed by 4 weeks of treatment. Parents or other caregivers recorded lights off time, sleep onset time, night waking, wake up time and epileptic seizures. Endogenous melatonin cycle was measured in saliva before and after treatment.

RESULTS

Compared with placebo, melatonin significantly advanced mean sleep onset time by 34 min, decreased mean sleep latency by 29 min, increased mean total sleep time by 48 min, reduced the mean number of times the person awoke during the night by 0.4, decreased the mean duration of these night waking periods by 17 min and advanced endogenous melatonin onset at night by an average of 2.01 h. Lights off time, sleep offset time and the number of nights per week with night waking did not change. Only few minor or temporary adverse reactions and no changes in seizure frequency were reported.

CONCLUSIONS

Melatonin treatment improves some aspects of chronic sleep disturbance in individuals with ID.

Sleep problems in individuals with 11q terminal deletion disorder (Jacobsen syndrome)

Characteristics of sleep and sleep problems were investigated in 43 individuals with 11q terminal deletion disorder (Jacobsen syndrome). Data were collected using a sleep questionnaire. Ten individuals (23%) had a sleep problem. Settling problems, frequent night waking and early waking occurred in 2 (4%), 7 (16%) and 2 (6%) individuals, respectively. Twenty-two individuals (54%) had a history of sleep problems. Twenty-five individuals (60%) showed restless sleep and 23 individuals (54%) slept in an unusual position. Apart from frequent coughs, no significant relationships were found between the presence of a sleep problem and other variables, such as age, level of ID, breathing problems, heart defects, constipation, daytime activity and behavioral diagnosis, restless sleep and sleeping in an unusual positions.

Behavioural treatment of severe food refusal in five toddlers with developmental disabilities

BACKGROUND

Young children with developmental disabilities are at risk of food refusal. In case of severe food refusal, children are being fed by nasal or gastrostomy tube. Behavioural treatment may be effective in establishing oral food intake.

METHODS

A behavioural treatment package was implemented in an outpatient setting for the treatment of severe food refusal in five toddlers with developmental disabilities. During the course of treatment, treatment principles were generalized to parents in the home setting.

RESULTS

Treatment resulted in oral acceptance of a variety of food items in each child and was successfully generalized. Treatment effects were maintained during follow-up between 3 and 12 months. Tube feeding was discontinued in each child and health status of each child improved.

CONCLUSIONS

Behavioural treatment may be highly effective in establishing oral food intake in children with developmental disabilities (in the absence of organic causes). As a side-effect of this treatment, tube-feeding may be discontinued and general heath status improved.

Preferences in individuals with Angelman syndrome assessed by a modified Choice Assessment Scale

BACKGROUND

Individuals with Angelman syndrome (AS) seem to have a strong preference for water-related items. Until present, preference assessment in AS has not been reported.

METHODS

An adapted Dutch version of the Choice Assessment Scale (CAS) was administered by parents and other caregivers to 105 individuals with AS. The CAS was adapted by adding several items related to water and by adding a sub-scale describing activities and materials that individuals may avoid or escape.

RESULTS

The five sub-scales and total scale of the modified CAS had good internal consistency. Water-related items were more often scored as preferred than non-water-related items. No associations were found between sub-scale and total scale scores and demographic characteristics (e.g. genetic subtype, age).

CONCLUSIONS

This study shows that people with AS often have strong preferences for water-related items. The modified CAS is a reliable and sensitive instrument to assess client preferences.

Sleep problems and daytime problem behaviours in children with intellectual disability

BACKGROUND

Sleep problems are common among children with intellectual disability (ID).

METHOD

The present study assessed the prevalence of severe sleep problems in a sample of children (n=286) with mild to profound ID who lived at home with their parents(s) in the Netherlands. It also explored relationships between severe sleep problems, and family and child variables. Demographic information, data on children's sleep behaviours and parent variables were collected using questionnaires.

RESULTS

Severe settling problems, night waking and early waking were present in 4.2%, 10.8% and 4.2% of cases, respectively; 16.1% of children had at least one type of sleep problem. Children with a severe sleep problem had more severe levels of ID, used medication more often, had a greater frequency of epilepsy, were younger, had a greater frequency of cerebral palsy, and showed more daytime drowsiness and daytime napping than children without a severe sleep problem. Furthermore, children with a severe sleep problem showed more severe levels of daytime problem behaviours; for example, aggression, non-compliance and hyperactivity.

CONCLUSION

The results of the present study are discussed with regard to the assessment and treatment of sleep problems in children with ID.

A review of the nature and treatment of sleep disorders in individuals with developmental disabilities

This paper describes research on the prevalence, correlates, and treatment of sleep disorders in individuals with developmental disabilities. A significant number of individuals with developmental disabilities have disordered sleep, although prevalence estimates vary from 13% to 86%. Constitutional variables, including age, presence of physical and sensory impairments, and certain genetic syndromes and medical conditions appear to be related to sleep disturbance, but the evidence is mainly correlational and therefore cannot be said to show a causal relation. While a number of behavioral interventions have proven effective in the treatment of sleep disturbance, and drug therapy involving melatonin appears promising, epidemiologic work on the correlates of sleep disorders appear to have had little impact on treatment. Consideration of the nature of sleep disorders may enhance treatments for individuals with developmental disabilities.

The blocking effect of pictorial prompts on sight-word reading

This study replicates and extends previous work showing that pictorial prompts can interfere with the learning of sight words by students with moderate mental retardation. Effects of training with 6 students were assessed during five conditions using an alternating treatments design. In four conditions, words were presented either alone or with a corresponding picture. In a fifth condition, pictures were used to provide feedback. The results showed that acquisition was achieved fastest during the word-alone conditions with 5 students.

Assessing needs for interdisciplinary team training in children's rehabilitation: a pilot study

Although ideally children's rehabilitation is a matter of teamwork, in actual practice its quality may differ widely between teams. This study describes the first step in a procedure for the improvement of interdisciplinary team functioning. In this step, assessment of team members' specific needs for additional training is conducted. Detailed information about training needs of a nonoptimally functioning rehabilitation team is given. Key concepts concerning team development, such as role extension, role exchange, and role release, are discussed.

Management of sleeping problems in Wolf-Hirschhorn syndrome: a case study

Sleeping problems are common among children with Wolf-Hirschhorn syndrome. Extinction may be effective if sleeping problems have been shaped and are positively reinforced by parental attention. The present study shows that extinction was effective in the treatment of severe sleeping problems in a six-year old girl with Wolf-Hirschhorn syndrome. Effects were maintained during follow-up.

Functional assessment and treatment of sleeping problems with developmentally disabled children: six case studies

Sleeping problems are common among developmentally disabled children of young age and they may have adverse effects on the well-being of both child and parents. In the present study, results from functional assessment with four children suggested that sleeping problems were reinforced by parental attention whilst an undiagnosed seizure disorder was associated with nighttime crying with one child. Conditioned anxiety resulted in problems in settling to sleep with a sixth child. Behavioral (i.e., extinction, desensitization) and pharmacological (i.e., anticonvulsant) treatment resulted in a substantial reduction in sleeping problems with all children. Follow-up data indicate that effects were maintained.

Meta-analytic study on treatment effectiveness for problem behaviors with individuals who have mental retardation

Meta-analysis of 482 empirical studies on treatment of problem behaviors of individuals with mental retardation was conducted. A metric of treatment effectiveness was computed for 1,451 comparisons between baselines and treatments, 34 topographies of problem behavior, and 64 treatment procedures. Analysis of variance with percentage of nonoverlapping data as the dependent variable and comparison as the basic unit of analysis revealed that treatment of externally destructive behaviors had significantly lower mean percentage of nonoverlapping data scores than did treatment of socially disruptive and internally maladaptive behaviors. Response contingent procedures were significantly more effective than were other procedures. No significant interactions were found. Results of a stepwise regression showed that only performing a functional analysis made a significant contribution. These results may lead to more objective assignment of treatment procedures to problem behaviors.