Giulia Balboni

The Construct of Adaptive Behavior: Its Conceptualization, Measurement, and Use in the Field of Intellectual Disability

This article updates the current conceptualization, measurement, and use of the adaptive behavior construct. Major sections of the article address an understanding of the construct, the current approaches to its measurement, four assessment issues and challenges related to the use of adaptive behavior information for the diagnosis of intellectual disability, and two future issues regarding the relations of adaptive behavior to multidimensional models of personal competence and the distribution of adaptive behavior scores. An understanding of the construct of adaptive behavior and its measurement is critical to clinicians and practitioners in the field because of its role in understanding the phenomenon of intellectual disability, diagnosing a person with intellectual disability, providing a framework for person-referenced education and habilitation goals, and focusing on an essential dimension of human functioning.

Discriminant validity of the Vineland Scales: Score profiles of individuals with mental retardation and a specific disorder

Utility of the Vineland Adaptive Behavior Scales-Expanded Form to discriminate among areas of adaptive behavior was substantiated by comparing profiles of scores obtained by three groups of individuals with mental retardation and either a communication, social behavior, or motor abilities disorder with those of matched individuals with mental retardation but no other disorder. Individuals with social behavior disorders obtained lower scores only in the Socialization domain; those with motor disorders, in the Motor domain and in the Personal and Domestic subscales that require motor competencies; and those with communication disorders, lower scores in the Communication domain and in the Community and Interpersonal Relationships subscales requiring expressive competencies. The utility of the Vineland Scales in obtaining an ecological evaluation of individuals with mental retardation is discussed.

The Psychopathology Inventory for Mentally Retarded Adults: factor structure and comparisons between subjects with or without dual diagnosis

Whether the Psychopathology Inventory for Mentally Retarded Adults (PIMRA) could detect specific psychopathological disorders was investigated in 652 subjects with different levels of mental retardation living in the community or in residential facilities. An exploratory factor analysis was carried out to check the scale organization of PIMRA. The Anxiety, Adjustment Disorder, Somatoform Disorder, and Soundness Scales were confirmed by 4 corresponding factors; the Psychosexual Disorder Scale was replaced by a factor specific to gender identity problems, and the Schizophrenia Scale by two factors concerning isolation and bizarre behaviors, respectively. The items of the Depression Scale were distributed over the three factors concerning anxiety, adjustment, and psychosomatic disorders, while the items of the Personality Disorder Scale were scattered over almost all the factors. Moreover, 55 subjects with anxiety disorders and 49 with depression were compared to 50 control subjects of the same age, intelligence level, and gender ratio but without dual diagnosis and obtained significantly higher factorial scores both on the overall scale and on the factors specifically related to their disorders. PIMRA has been found to show good construct validity. These results could be considered particularly valid as they were obtained from a large sample comprising different levels of mental retardation and thus showing all possible psychopathological behaviors.

Concurrent and Predictive Validity of the Raven Progressive Matrices and the Naglieri Nonverbal Ability Test

The concurrent and predictive validities of the Naglieri Nonverbal Ability Test (NNAT) and Raven’s Colored Progressive Matrices (CPM) were investigated in a large group of Italian third-and fifth-grade students with different sociocultural levels evaluated at the beginning and end of the school year. CPM and NNAT scores were related to math and reading comprehension tests. The CPM and NNAT concurrent and predictive validity coefficients were moderate, and there were no differences between concurrent and predictive validities with reading scores. The mutual incremental concurrent validity of the NNAT with the math test was significantly higher than the corresponding CPM validity. Finally, via step-down hierarchical regression analysis, the authors found that the predictive validity of both nonverbal tests is independent from the participants’ sociocultural level. These two relatively simple nonverbal tests are commonly used to assess general ability; however, the present study shows that they can also provide useful information for predicting the academic performance of students with different sociocultural levels.

School Adjustment and Academic Achievement: Parental Expectations and Socio‐cultural Background

Primary school pupils adjustment and academic achievement and the effects of their socio‐cultural background on their parents expectations were conducted on a group of 216 high or low status Italian children, used to speaking Italian or in dialect at home. The parental forecast was expressed in October using the same scale as adopted by the teachers in June, aimed at evaluating both dimensions. A significant relationship emerged indicating that there is a significant similarity between adjustment and achievement; moreover, it appears that the parents, compared to the teaching staff, were considerably more indulgent in judging their childrens achievement compared to their capacity to adjust. For both, however, the agreement limits between initial expectations and final judgements were higher in the case of upper class pupils or those speaking Italian as opposed to lower class ones or those speaking in dialect. Parental influence on the capacity to adjust and academic achievement is discussed.

The Vineland-II in Preschool Children with Autism Spectrum Disorders: An Item Content Category Analysis

We investigated which item subsets of the Vineland-II can discriminate low-functioning preschoolers with ASD from matched peers with other neurodevelopmental disorders, using a regression analysis derived from a normative sample to account for cognitive and linguistic competencies. At variance with the typical profile, a pattern with Communication more impaired than Socialization was observed. The source of the frequently reported Socialization delay in ASD appears to be in Playing and Imitating skills only, not in other social adaptive behavior skills. The combination of item subsets Playing, Following instructions, Beginning to talk, and Speech skills provided the best discrimination between the two clinical groups. Evaluation of the Vineland-II score on item content categories is a useful procedure for a more efficient clinical description.

The Diagnostic Adaptive Behavior Scale: Evaluating its diagnostic sensitivity and specificity

The Diagnostic Adaptive Behavior Scale (DABS) was constructed with items across three domains--conceptual, social, and practical adaptive skills--and normed on a representative sample of American individuals from 4 to 21 years of age. The DABS was developed to focus its assessment around the decision point for determining the presence or absence of significant limitations of adaptive behavior for the diagnosis of Intellectual Disability (ID). The purpose of this study, which was composed of 125 individuals with and 933 without an ID-related diagnosis, was to determine the ability of the DABS to correctly identify the individuals with and without ID (i.e., sensitivity and specificity). The results indicate that the DABS sensitivity coefficients ranged from 81% to 98%, specificity coefficients ranged from 89% to 91%, and that the Area Under the Receiver Operating Characteristic Curve were excellent or good. These results indicate that the DABS has very good levels of diagnostic efficiency.

Selective cognitive empathy deficit in adolescents with restrictive anorexia nervosa

Background A growing, but conflicting body of literature suggests altered empathic abilities in subjects with anorexia nervosa-restricting type (AN-R). This study aims to characterize the cognitive and affective empathic profiles of adolescents with purely AN-R. Methods As part of a standardized clinical and research protocol, the Interpersonal Reactivity Index (IRI), a valid and reliable self-reported instrument to measure empathy, was administered to 32 female adolescents with AN-R and in 41 healthy controls (HC) comparisons, matched for age and gender. Correlational analyses were performed to evaluate the links between empathy scores and psychopathological measures. Results Patients scored significantly lower than HC on cognitive empathy (CE), while they did not differ from controls on affective empathy (AE). The deficit in CE was not related to either disease severity nor was it related to associated psychopathology. Conclusion These results, albeit preliminary, suggest that a dysfunctional pattern of CE capacity may be a stable trait of AN-R that should be taken into account not only for the clinical management, but also in preventive and therapeutic intervention.

The impact of internalizing symptoms on autistic traits in adolescents with restrictive anorexia nervosa

Background Although previous studies indicated a positive association between restrictive anorexia-nervosa (AN-R) and autistic traits, the potential interference of psychiatric internalizing comorbidity on this association is not yet fully investigated. Materials and methods The aim of this study was to explore autistic traits and internalizing psychopathology in adolescents (age range: 11.7–17.2 years) with AN-R. Twenty-five patients referred to two tertiary-care hospitals were compared to a large control group (N=170) with no differences in age and sex. AN-R patients and controls filled out instruments assessing autistic traits (autism spectrum quotient [AQ]), psychopathology (youth self-report [YSR] 11–18), and eating patterns (eating attitude test [EAT]). In order to disentangle the possible mediating role of internalizing symptoms on autistic traits, two separate control groups (called True and False healthy control, both composed of 25 eating-problem-free participants) were derived from the whole control group on the basis of the presence or absence of internalizing problems in the YSR. Results AN-R patients scored significantly higher on AQ compared to the whole control group and to controls without internalizing problems (True HC), but these differences disappeared when only controls with internalizing problems (False HC) were considered. Conclusion Autistic traits in AN-R individuals may have been overestimated and may partly be due to comorbid internalizing symptoms in investigated patients.

Development and standardization of the diagnostic adaptive behavior scale: Application of item response theory to the assessment of adaptive behavior

The Diagnostic Adaptive Behavior Scale (DABS) was developed using item response theory (IRT) methods and was constructed to provide the most precise and valid adaptive behavior information at or near the cutoff point of making a decision regarding a diagnosis of intellectual disability. The DABS initial item pool consisted of 260 items. Using IRT modeling and a nationally representative standardization sample, the item set was reduced to 75 items that provide the most precise adaptive behavior information at the cutoff area determining the presence or not of significant adaptive behavior deficits across conceptual, social, and practical skills. The standardization of the DABS is described and discussed.