Betsey A. Benson

Aggressive challenging behaviour and intellectual disability.

Purpose of review The aim of this article is to review reports of aggressive challenging behaviour in individuals with intellectual disability from September 2006 to March 2008. Recent findings Studies continued to demonstrate the prevalence and significance of aggressive challenging behaviour in persons with intellectual disability. Over half of the population engages in some form of aggression, but only a small number is responsible for frequent or severe acts. A publication that identified aggression profiles offered a promising new approach. Aggressive behaviour in adults often has multiple functions. The most frequently studied interventions were either behavioural or somatic. Parents learned skills to effectively intervene with their aggressive preschool child. Reviews of medication efficacy studies concluded that there was insufficient evidence to recommend a single medication. Psychiatrists agreed that medication should not be the first treatment option. In one study, a class of medication was found to reduce aggression, but not aggression with self-injury, or self-injury alone. Summary Research on aggressive challenging behaviour requires assessment instruments that address the topography and severity of aggression. Identifying aggression types may clarify mixed results of previous research and improve treatment effectiveness. Greater access to effective, nonmedication treatments is needed.

Behavioral Phenotypes in Children with Down Syndrome, Prader-Willi Syndrome, or Angelman Syndrome

This study investigated the concept of behavioral phenotypes by comparing behavior ratings of 91 children with Down syndrome, 28 children with Prader-Willi syndrome, 68 children with Angelman syndrome, and 24 children with nonspecific mental retardation. Results supported distinctive behavioral profiles for the syndrome groups. The Down syndrome group showed good social skills and low ratings of problem behaviors including hyperactivity. Children with Prader-Willi syndrome exhibited a pattern of externalizing, obsessive–compulsive, anxious, and overly sensitive behaviors. A profile of a happy disposition, hand clapping, mouthing behaviors, and severe levels of hyperactivity and attention problems emerged for children with Angelman syndrome. Implications for clinical practice and future research were discussed.

Use of Differential Reinforcement to Reduce Behavior Problems in Adults with Intellectual Disabilities: A Methodological Review.

The least-restrictive-alternative guideline for providing treatment emphasizes the use of non-aversive procedures to reduce maladaptive behaviors in individuals with intellectual disability (ID). Differential reinforcement (DR) is an excellent example of such a non-aversive, reinforcement based behavioral intervention. The purpose of this literature review was to summarize and provide a methodological analysis of studies, conducted between 1980 and 2009, using a DR contingency to reduce problem behaviors in adults with ID. A total of 31 studies were located that met the inclusion criteria. Of these, 15 reported DR to be an effective intervention when used independently. Of the remaining, 10 studies found DR to be useful as part of a treatment package, and six found a DR contingency used independently to be ineffective, and only observed treatment effects when an aversive component was added. Very few studies assessed the use of DR in older adults and in individuals with mild ID; these reflect areas of future research. A methodological analysis found that several studies did not report information on key methodological variables; for example, conducting a functional analysis and a stimulus preference assessment to guide choice of treatment and reinforcers, thinning very dense DR schedules, assessing collateral behaviors, generalization of behavior change across settings and implementers, and following up treatment outcomes over time. The overall positive findings about the effectiveness of DR are encouraging; however, more methodologically robust studies would serve to make such findings more conclusive and practically relevant for implementation in natural settings for adults with ID.

Reliability of Ratings of Consumers With Mental Retardation and Their Staff on Multiple Measures of Social Support

Reliability of self-reports of social support with staff ratings was compared through determining the internal consistency of the measures, consistency across measures, and consistency across raters. Fifty adults with mild mental retardation and their staff in supported living residential settings were interviewed. Self-report ratings had moderate internal consistency, were consistent across rating scales, and were significantly correlated with staff ratings, although staff members tended to agree more with each other than with consumers. Results suggest that individuals with mild mental retardation can be reliable reporters about their own social support. Further, examining self-informant agreement for specific support sources can illuminate discrepancies between self- and informant-obtained ratings.

Social Circles of Adults with Mental Retardation as Viewed by Their Caregivers

The Social Circles Questionnaire was developed for caregivers to rate the social support provided to adults with mental retardation from their families, workers, friends, and romantic partners. The questionnaire had good internal consistency and test-retest reliability as well as adequate interrater agreement. Results based on caregiver ratings of 121 adults with mental retardation indicate that there is a paucity of social support for individuals in many residential settings, across functioning levels. Caregivers responded with greater uncertainty to questions about friends and partners than they did to questions about staff and family. Results suggest that surveying only secondary sources may provide an incomplete view of the social support system of individuals with mental retardation.

Staff and self-reports of health behaviours, somatic complaints, and medications among adults with mild intellectual disability

Surprisingly little research has examined self-reports of health among adults with intellectual disability (ID), despite the fact that adults with ID are at a higher risk for health problems than the general population. The present study compared self-reports of 77 adults with mild ID with reports from designated residential staff regarding health behaviours, somatic complaints, and medication usage. Adults with ID and the staff agreed about many health behaviours as well as major medical disorders, but the staff tended to report fewer minor symptoms of illness. Medication usage was common (85%), although not everyone could list their medications, explain their function or report when they took them. The results suggest the utility of both self-reports and staff reports among adults with mild ID for identifying areas of health concern as well as targeting areas for further health promotion efforts.

Psychometric Evaluation of a Self-Report Measure of Depression for Individuals with Mental Retardation.

The psychometric properties of the Self-Report Depression Questionnaire (SRDQ) were evaluated, extending a previous assessment of this instrument. Data from two independent studies (Esbensen, 2004; Seltzer & Krauss, 1989) were pooled to generate a sample of 192 individuals with primarily mild or moderate mental retardation. Reliability estimates of this questionnaire were good to excellent and corroborated prior findings. In addition, the measure was found to have sound validity as evidenced by convergent validity, discriminant validity, and predictive validity and by comparing individuals with and without clinical diagnoses of depression. Thus, the SRDQ appears to be a reliable and valid measure of depressive symptomatology for individuals with mild or moderate mental retardation. Screening procedures are suggested.

Disruptive behavior disorders in children with mental retardation.

In discussing Disruptive Behavior Disorders (DBD) in mental retardation (MR), it is well to be aware that MR does not have one etiology but a nearly infinite number of etiologies. Indeed, insofar as individual genetic inheritance is a factor (and it often is) the mix of etiologies is enormous. Most workers agree that the presence of MR is the consequence of an array of factors that fall under the rubrics of biological, social, and psychological risk factors (Aman, Hammer, & Rojahn, 1993). Each of these factors may have different impacts on the various DBD. Examples of organic causes are genetic abnormalities, chromosomal abnormalities, and a multitude of congenital infections and maternal diseases that may harm the fetus. Subsequent to birth, encephalitis, meningitis, head trauma, toxemia, malnutrition, cerebrovascular accidents, and degenerative diseases are capable of causing MR.

Psychological interventions for people with intellectual disability and mental health problems

Purpose of review This paper focuses on reviews and reports of psychological interventions for individuals with dual diagnosis (intellectual disability and mental health problems) from March 2003 to March 2004. Recent findings Two reviews that evaluated the psychological treatment outcome literature, but spanned different time periods, arrived at different conclusions regarding the progress of the research efforts to date. They agreed, however, on many of the limitations of the research. Case-studies of psychological treatment of aggression, elective mutism, dog phobia, bereavement, borderline personality disorder, and sleep problems appeared in the literature. Intervention techniques represented behavioral, cognitive behavioral, psychodynamic, and psycho-educational approaches. One group intervention for womens health combined psycho-educational and coping skills training. When ongoing service delivery in the community was examined, interventions were found to be non-specific. A report that detailed characteristics of treatment provided in the community was an impetus for the promulgation of standards of care in one region. A measure of sex-offending cognitions was developed and preliminary validation efforts completed. There continues to be a need for assessment instruments designed for persons with intellectual disability. The publication of a psychiatric diagnostic classification system for persons with intellectual disability may improve the reliability of diagnoses, which, in turn, will improve the quality of psychotherapy outcome research. Summary Depending on the review period and the evaluation criteria, authors proclaimed the glass either half empty or half full, that is, some progress or no progress being made in psychological interventions with persons with intellectual disability. Case-studies continue to dominate the literature and offer considerable variety in terms of the problems treated and the intervention techniques used. A significant development in psychiatric diagnosis (Diagnostic Criteria for Psychiatric Disorder for Use with Adults with Learning Disabilities) will guide future progress in intellectual disability research. Continued advances are also needed in assessment.

A Factor Analysis of Emotional Disorders in Mentally Retarded People

A factor analytic study of a symptom checklist was conducted with 131 emotionally disturbed, mentally retarded people who were outpatients at a developmental disabilities mental health clinic in Chicago, Illinois. Item loadings of .40 or greater were used as the criterion for inclusion in factors. Scores reflecting the frequency of significant occurrences of each symptom also were computed. The results of the study add statistical detail to previous clinical reports on the symptoms of emotional disturbances in mentally retarded people.