Erik A. Mayville

Relationships Between Psychiatric Conditions and Behavior Problems Among Adults With Mental Retardation

Adults with predominantly severe and profound mental retardation (N = 180) who lived in a developmental center were assessed with the Behavior Problems Inventory and the Diagnostic Assessment for the Severely Handicapped-II. Individuals with self-injurious, stereotyped, or aggressive/destructive behavior had generally higher psychopathology scores than individuals without, and the presence of behavior problems increased the likelihood of almost all psychiatric conditions up to three-fold. Factor analysis revealed that behavior problems tended to be associated with psychiatric conditions conventionally linked with behavior problems. A Self-Injury and Aggression/Destruction factor was related to impulse control and conduct problems, and a Stereotyped Behavior factor was linked to pervasive developmental disabilities and somewhat less so to schizophrenia. Stereotyped Behavior factor was independent of the Self-Injury/Aggression/Destruction factor.

The Aberrant Behavior Checklist and the Behavior Problems Inventory: convergent and divergent validity

This study was designed to compare and cross-validate two rating instruments [the Aberrant Behavior Checklist (ABC) and the Behavior Problems Inventory (BPI)] for assessing maladaptive behavior. The BPI assesses three types of behavior problems: Self-Injurious Behavior (SIB), Stereotyped Behavior and Aggressive/Destructive Behavior. The ABC assesses five domains including these three. We collected data on 226 adults, mostly with severe or profound mental retardation, from a medium-sized developmental center. Individuals with elevated BPI scores generally had higher ABC scores; however, the extent of covariation differed across subscales. Similarly, multiple regression analyses showed that BPI subscales significantly but selectively predicted ABC subscale scores. Measures of differential diagnostic value (positive and negative predictive power, sensitivity, specificity and overall correct diagnostic efficiency) confirmed the anticipated partial overlap between instruments. Both instruments were used to rate participants with and without a Diagnosis of Stereotyped Movement Disorder. BPI, SIB and Stereotypy subscale composite had stronger positive predictive power than the ABC Stereotypy scale, while the ABC had higher negative predictive power and greater overall diagnostic efficiency. Thus, the ABC and the BPI cross-validated one another where expected, and they diverged for subscales thought to have little relationship.

Reliability of the Matson Evaluation of Drug Side Effects scale (MEDS)

The potential negative effects of psychoactive medication are well documented. Given the high rate of their use in persons with mental retardation, the need to assess and identify these negative effects is great. The Matson Evaluation of Drug Side Effects (MEDS) was designed to evaluate commonly identified side effects with a psychometrically sound checklist. The initial psychometric properties of this scale are presented and discussed. An examination of interrater reliability and internal consistency revealed that the MEDS has excellent consistency across raters and good internal consistency. Potential uses for the scale and directions for future research are reviewed as well.

Changing societal attitudes toward persons with severe mental illness

Persons with severe mental illness are often stigmatized as a result of their psychiatric condition, which likely contributes to their difficulties in interpersonal relations, occupational functioning, and self-esteem. Given the pervasive effects of stigma on the adjustment of persons with severe mental illness, it is necessary to identify potential strategies for reducing barriers that interfere with their acceptance into the community. In this article, we briefly review research on the stigma of severe mental illness, followed by suggestions on how mental health professionals might best approach the problem of reducing the stigma associated with severe mental illness. Potential strategies of stigma reduction include education about severe mental illness, promoting contact between the community and persons with severe mental illness, and “value self-confrontation,” a technique used to reduce prejudice toward persons in ethnic minorities. The article concludes with a discussion of future directions for research in this area.

A Comparison of Social and Adaptive Functioning in Persons with Psychosis, Autism, and Severe or Profound Mental Retardation

Despite the findings that persons with mental retardation are several times more likely to experience mental health disorders than are persons of normal intelligence, relatively little is known about the nature of these disorders and related social and adaptive deficits. This situation is especially true for persons with severe and profound impairment who experience psychotic disorders. The purpose of this research was to examine the adaptive and social behavior of individuals with severe and profound mental retardation (MR) who are diagnosed with a psychotic disorder. Scores on measures of adaptive and social behavior for these individuals were compared to those of 2 other groups, both of whom had severe or profound MR, and who experienced mental health conditions commonly confused with psychotic disorders (e.g., autism/PDD, nondiagnostic behavior problems). Individuals in the psychotic disorders group displayed significantly higher levels of some social and many adaptive skills than did individuals in both control groups, with the most striking differences appearing between the psychotic disorders and autism/PDD groups. Results underscore the need to consider social and adaptive variables during the diagnostic and treatment planning process.

The Relationship of Functional Variables and Psychopathology to Aggressive Behavior in Persons With Severe and Profound Mental Retardation

A number of hypotheses have emerged regarding the etiology of physical aggression in persons with mental retardation. Although a multicomponent model is appropriate, results of functional analysis-based studies have yielded promising results in identifying instigating and maintaining factors of aggression. However, the relationship between functional variables and conditions such as psychiatric diagnosis to aggressive behavior has yet to be investigated in persons with mental retardation. We conducted a study examining the prevalence of environmental or physical factors in aggressive behavior in mentally retarded persons with and without psychiatric disturbance. One hundred and thirty-five individuals with mental retardation who exhibited physical aggression were assessed with the Questions About Behavior Function Scale (QABF) to identify environmental or physical contribution to aggressive behavior. One or more behavioral functions were identified for 75% of the participants. Additionally, of 66 of the participants scoring above the clinical cutoff on an assessment for dual diagnosis, 75% met criteria for an environmental or physical function for aggression. No significant differences in number of participants with an identifiable function of aggression were found between the no dual diagnosis and dual diagnosis groups. Our findings underscore the importance of identifying functions underlying aggressive behavior in persons with mental retardation, and the need to consider functional variables regardless of psychiatric condition in treatment planning efforts for such individuals.

The relationship of social skills as measured by the MESSIER to rumination in persons with profound mental retardation

Fifty-two persons with profound mental retardation; 26 people with rumination and 26 controls were studied. The Matson Evaluation of Social Skills for Individuals with sEvere Retardation (MESSIER) was administered to all subjects. Groups were compared across each of six subcategories; positive verbal, positive nonverbal, general positive, negative verbal, negative nonverbal, and general negative items. Controls scored significantly better on the general positive subscale than persons with rumination, although no differences in negative behaviors was noted across groups. Implications of these data are discussed.

The Development of a Reinforcer Choice Assessment Scale for Persons with Severe and Profound Mental Retardation

Reinforcement is a cornerstone for treating adaptive skills and eliminating problem behaviors for persons evincing mental retardation. To effectively use reinforcement, professionals must find reinforcers that are most effective for each individual. Establishing reinforcers is particularly important for persons functioning in the severe and profound ranges of mental retardation as reinforcers are often difficult to identify in this population. The current study aimed at developing a reinforcer rating scale that-would have applicability on a broad clinical basis, looking specifically at the psychometric properties of the scale.

An analysis of side-effect profiles of anti-seizure medications in persons with intellectual disability using the Matson Evaluation of Drug Side Effects (MEDS)

We investigated the side-effect profiles of anti-seizure medications in persons diagnosed with a seizure disorder and intellectual disability. The majority of the 124 participants receiving anti-epileptic medication were white female, and were receiving only one anti-epileptic medication. The side-effect profiles of these participants were contrasted with a matched group of 124 individuals not taking any anti-epileptic or psychotropic medications. Using the Matson Evaluation of Drug Side Effects (MEDS), significant differences were found among the two groups on the central nervous system—general and endocrine/genitourinary subscales. Overall, participants taking anti-epileptic medications were experiencing relatively few side-effects as measured by the MEDS; between-group differences for side-effects were found on the general central nervous system effects and endocrine/genitourinary subscales. Implications of the present findings are discussed.

Tardive dyskinesia associated with metoclopramide in persons with developmental disabilities.

Metoclopramide is an anti-emetic medication that has been associated with movement disorders such as extra-pyramidal reactions and tardive dyskinesia (TD). Reports of these reactions have been documented in the general population, but investigations of side effects in persons with mental retardation are scant. Given the high incidence of gastrointestinal disturbance in persons with mental retardation, and the popularity of this medication to treat such problems, these individuals could be at risk for developing movement disorders resulting from metoclopramide use. We compared incidence rates of TD over a 1-year period in developmentally disabled individuals taking either metoclopramide, typical antipsychotics, or no psychotropic medications (Table 1). Assessment was completed using the Dyskinesia Identification System--Condensed User Scale (DISCUS), a standardized measure of TD found to be reliable and valid for persons with mental retardation. No significant differences in DISCUS scores between the metoclopramide and antipsychotic treated groups were noted across four measurements taken during the course of 1 year. Additionally, no difference was found between these two groups for a number of participants who met criteria for probable TD on at least one of the DISCUS administrations. Comparisons between all three groups on one testing occasion revealed a significant difference between groups. The no psychotropic control group showed significantly less TD symptomology than the antipsychotic or metoclopramide groups.