C.G.C. Janssen

People with Mental Retardation and Psychopathology: Stress, Affect Regulation and Attachment: A Review

Publisher Summary Developmental psychopathology is gaining prominence as an overarching approach to developing theoretical explanations for problem behavior and mental health problems in children as well as adults. In this theoretical framework, individuals are perceived to develop in transaction with their environment and research is done analyzing this developing transactional relation. Within this framework the abundant research into attachment relationships and into the development of physiological and biopsychological stress or affect regulation is found to be successful and may also be relevant for understanding the high risk for psychopathology in people with mental retardation (MR). This chapter discusses the interrelated processes of affect regulation and attachment. Research pertaining to affect regulation and attachment in persons with MR is reviewed in the chapter. People with MR are at risk for developing psychopathology because of exposure to chronic dysregulated affective arousal. Under stressful circumstances, they may have insufficient resources to deal with stressors on their own; the fall‐back option of turning to attachment figures as a safe haven may however also be less available because people with MR may be more often insecurely attached.

Supporting affect regulation in children with multiple disabilities during psychotherapy: A multiple case design study of therapeutic attachment

In a controlled multiple case design study, the development of a therapeutic relationship and its role in affect regulation were studied in 6 children with visual disabilities, severe intellectual disabilities, severe challenging behavior, and prolonged social deprivation. In the 1st phase, children had sessions with an experimental therapist stimulating therapeutic attachment, alternating with a control therapist providing positive personal attention only. In the 2nd phase, both therapists applied behavior therapy. Clients sought more proximity to the experimental therapist compared with the control therapist. Psychophysiological arousal (respiratory sinus arrhythmia and pre-ejection period) was lower when the experimental therapist applied behavior modification than when the control therapist did. Despite prolonged social deprivation, the attachment behavioral system appeared responsive to stimulation. The effects on affect regulation may explain the synergy between psychotherapy based on interpersonal and behavior modification approaches.

Course of health-related quality of life in 9-16-year-old children with cerebral palsy: associations with gross motor abilities and mental health

Purpose. To chart the 3-year course of health-related quality of life (HRQoL) of 9–13-year-old children with cerebral palsy (CP), and to determine its relationship with gross motor abilities and mental health. Methods. Children (n = 91; 58 boys, mean age 11 years, age ranging from 8 years and 6 months to 13 years and 8 months) and parents were assessed annually with the TNO-AZL questionnaires for childrens health-related quality of life as a dependent variable, and the gross motor function measure for children with CP and the child behaviour check list as independent variables. Results. The children reported lower HRQoL compared with children in the general population, but reported a higher HRQoL than their parents. The HRQoL remained fairly stable over the 3 years, except for an increase in the autonomy domain. The HRQOL was moderately associated with gross motor abilities, and negatively associated with internalising mental health problems. Externalising problems were only negatively associated with parent-reported HRQoL. Conclusions. Children with CP are more resilient and positive about their HRQoL than their parents think they are. In general, mental health in children with CP appeared to be important in understanding their perceived QoL, in addition to the severity of the CP itself.

Perspectives of Employees with Intellectual Disabilities on Themes Relevant to Their Job Satisfaction. An Explorative Study using Photovoice

BACKGROUND This study explored the perspectives of people with intellectual disabilities on themes relevant to their job satisfaction in integrated and sheltered employment. METHOD The photovoice method was used. Nine participants with moderate to mild intellectual disabilities, working in integrated and sheltered employment, took pictures of aspects related to their job satisfaction. Each participant was subsequently interviewed about his/her pictures. Interview transcripts were content analysed to distinguish themes. RESULTS Nine themes were found: the nature of the work itself, working conditions, experienced job demands, social relations at work, received support, perceived autonomy, opportunities for using competencies, opportunities for growth and development and meaningfulness. All themes were applicable in integrated and sheltered employment. CONCLUSIONS From the perspective of people with intellectual disabilities, various themes relate to their job satisfaction, either in positive or negative ways. Photovoice appeared to be a valuable approach, facilitating participants in expressing their views and providing in-depth information.

Developing a therapeutic relationship with a blind client with a severe intellectual disability and persistent challenging behaviour

Purpose. A blind, severely intellectually impaired boy aged 17 with Down syndrome and persistent serious challenging behavior received attachment-based behavior modification treatment. The aim was to study the effect of the treatment and the development of the therapeutic attachment relationship. Method. In a single-case study, attachment therapy sessions alternated with control sessions. Treatment started with attachment therapy (phase 1), followed by behavior modification (phase 2). The instruments used were: Residential observation lists for challenging behavior, video analyses of attachment behavior in therapy sessions and physiological indicators of affect regulation measuring the pre-ejection period (PEP) and respiratory sinus arrhythmia (RSA) as indices of cardiac sympatho-vagal activity. Results. The client exhibited less frequent and less intensely challenging behavior. The data indicated more appropriate replacement behavior and less PEP arousal during the behavior modification treatment given by the attachment therapist compared to the control therapist who used the same protocol. The client showed more active and longer-lasting attachment behavior, especially proximity seeking, towards the attachment therapist than towards the control therapist. Conclusions. Attachment-based psychotherapy proved successful in eliciting attachment behavior in a severely intellectually disabled, socially deprived, behaviorally and affectively dysregulated adolescent. The resulting relationship proved to be a therapeutic platform conducive to behavior change.

Gehechtheid, stress, gedragsproblemen en psychopathologie bij mensen met een lichte verstandelijke beperking: aanzetten voor interventie

In prevalentiestudies onder mensen met een lichte verstandelijke beperking (LVB) blijkt dat ongeveer 57% van hen een of andere vorm van psychopathologie, vooral gedragsstoornissen (45%) en depressie (22%), of gedragsproblemen vertoont (Dekker e.a., dit boek; Dykens, 2000). Wat is de oorzaak van deze hoge prevalentie? Hoe ontwikkelen zich dergelijke gedragsproblemen? Immers, zicht op de ontstaansgeschiedenis is van belang voor de vormgeving en inhoud van preventie en interventie. Het is moeilijk om de oorzaak van de gedragsproblemen in verband te brengen met de oorzaak van de beperking,want slechts bij ongeveer 20-24% van de mensen met LVB is deze bekend (Murphy e.a., 1998). Duidelijk is wel dat de groep mensen met LVB zich kenmerkt door gebrekkige kennis en vaardigheden, waarbij deze tekorten op de een of andere manier gerelateerd zijn aan de gedragsproblemen.