Johannes Rojahn

The Behavior Problems Inventory: An Instrument for the Assessment of Self-Injury, Stereotyped Behavior, and Aggression/Destruction in Individuals with Developmental Disabilities

The Behavior Problems Inventory (BPI-01) is a 52-item respondent-based behavior rating instrument for self-injurious, stereotypic, and aggressive/destructive behavior in mental retardation and other developmental disabilities. Items are rated on a frequency scale and a severity scale. The BPI-01 was administered by interviewing direct care staff of 432 randomly selected residents from a developmental center between the ages of 14 to 91 years. For 73% of those selected, at least one problem was endorsed on the BPI-01. A total of 43% showed self-injury, 54% stereotyped behavior, and 38% aggressive/destructive behavior. Confirmatory factor analysis and item-total correlations supported the three a priori factors. Analyses of variance (ANOVA) showed that of the variables age, sex, and level of mental retardation, only the latter had a significant effect on the BPI-01 total score, the SIB subscale score, and the Stereotyped Behavior subscale score. Aggression/destruction was not significantly related to any of the three variables. Individuals with a diagnosis of pervasive developmental disorder had higher scores on all three subscales than those without, whereas residents with a diagnosis of stereotyped movement disorder had higher Stereotyped Behavior scale scores than those without. The BPI-01 was found to be a reliable (retest reliability, internal consistency, and between-interviewer-agreement) and valid (factor and criterion validity) behavior rating instrument for problem behaviors in mental retardation and developmental disabilities with a variety of potentially useful applications. Strengths and limitations of the instrument are discussed.

The Nisonger CBRF : a Child Behavior Rating Form for children with developmental disabilities

Although the rate of behavior and emotional problems of children with mental retardation is considerably higher than the rate among typically developing children, there is a shortage of tools for assessing persons with mental retardation. The Child Behavior Rating Form (CBRF) was modified by altering instructions and adding new items describing behavior problems known to occur in children with mental retardation. The adapted scale was named the Nisonger CBRF. Three hundred sixty-nine children being assessed at a University Affiliated Program for MR/DD were rated on the CBRF by their parents and teachers. Independent factor analyses of parent and teacher ratings produced two Social Competence subscales and six Problem Behavior subscales. These results were largely consistent across rater types and similar to prior findings with the CBRF. Internal consistency was generally high, parent-teacher agreement was satisfactory, and subscales from the Nisonger CBRF correlated highly with analogous subscales from the Aberrant Behavior Checklist. The Nisonger CBRF appears to be a promising new tool for assessing behavioral and emotional problems in children with mental retardation; however, further psychometric work is warranted.

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.

Reliability and Validity of an Assessment Instrument for Anxiety, Depression, and Mood Among Individuals with Mental Retardation

A review of the literature revealed that there was no adequate assessment instrument available that screens comprehensively for anxiety and depression in persons with mental retardation. The purpose of this research was to develop the Anxiety, Depression, and Mood Scale (ADAMS), an instrument intended to fill this gap. We developed a preliminary rating scale that included 55 symptom items. We examined the factor structure of these items by an exploratory factor analysis of behavior ratings on 265 individuals. A five-factor solution emerged that was both statistically sound and clinically meaningful. These factors were labeled “Manic/Hyperactive Behavior,” “Depressed Mood,” “Social Avoidance,” “General Anxiety” and “Compulsive Behavior.” We validated this solution by conducting a confirmatory factor analysis on ratings of 268 additional individuals. Model fit was acceptable. Internal consistency of the subscales and retest reliability for both the total scale and the subscales was high. Interrater reliability was satisfactory. The validity of the ADAMS was assessed with a clinical sample of 129 individuals with mental retardation who were seen in a psychiatric clinic; this provided additional support for the subscales. The ADAMS appears to be a psychometrically sound instrument for screening anxiety, depression and mood disorders among individuals with mental retardation.

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.

The Nisonger Child Behavior Rating Form" Age and Gender Effects and Norms

The Nisonger CBRF is a new informant behavior rating scale that was adapted for assessing children and adolescents with mental retardation. A total of 369 children referred to interdisciplinary diagnostic clinics for children with developmental disabilities were rated on the Nisonger Child Behavior Rating Form by their parents and teachers. Normative data (means, T scores, and percentiles) are presented Subscale scores were analyzed as a function of age and gender. Age influenced 3 of 8 subscales on the parent ratings and 1 subscale on the teacher ratings. Gender did not influence subscale scores. Age and gender results are discussed in relation to previous studies of subject variables.

The association between psychiatric diagnoses and severe behavior problems in mental retardation.

To investigate the relationship between psychiatric disorders and severe behavior problems in mental retardation, statewide client databases from developmental disabilities services in California (N = 89,419) and New York (N = 45,683) were analyzed and juxtaposed. The study focussed on nine major DSM-III-R psychiatric categories (or their equivalents), and severe forms of aggressive behavior, property destruction, self-injurious behavior, and stereotyped behavior in individuals 45 years old and younger with mental retardation of all levels of severity. In California, 3.9% had at least one psychiatric diagnosis; in New York, 5.4%. The rate of specific psychiatric diagnoses was variable across states, suggesting local preferences in diagnostic practices. Severe behavior problems occurred in 22.1% in California and in 41.4% in New York. This difference in rates can be attributed in part to different recording criteria for behavior problems. With regard to the association between psychiatric diagnoses and problem behaviors the results were consistent across databases: No compelling correlations were found. This means that neither aggression, self-injury, destruction, nor stereotypies determine whether a person receives a psychiatric diagnosis or not.

Construct Validity of the PASS Theory and CAS: Correlations With Achievement.

The relationship among Planning, Attention, Simultaneous, and Successive (PASS) processing scores of the Cognitive Assessment System (CAS) and the Woodcock-Johnson Revised Tests of Achievement (WJ-R) were examined with a sample of 1,559 students aged 5-17 years. Participants were part of the CAS standardization sample and closely represented the U.S. population on a number of important demographic variables. Pearson product-moment correlation between CAS Full Scale and the WJ-R Skills cluster was .71 for the Standard and .70 for the Basic CAS Battery scores, providing evidence for the construct validity of the CAS. The CAS correlated with achievement as well if not better than tests of general intelligence. The amount of variance in the WJ-R scores the CAS accounted for increased with age between 5- to 13-year-olds. The 4 PASS scale scores cumulatively accounted for slightly more of the WJ-R variance than the CAS Full Scale score.

Facial emotion recognition by persons with mental retardation: a review of the experimental literature.

This paper provides an exhaustive review of emotion research in mental retardation, namely the recognition of facial emotion expressions. 21 experimental studies were identified and reviewed for methodological characteristics. The literature was further explored for evidence concerning the relationships between emotion recognition skills and the severity of mental retardation, gender, chronological age, and concurrent mental illness.

The aberrant behavior checklist with children and adolescents with dual diagnosis

The Aberrant Behavior Checklist (ABC; Aman, Singh, Stewart, & Field, 1985a, 1985b) is a 58-item third-party informant rating scale originally developed for institutionalized, low-functioning adolescents and adults. The present study investigated the appropriateness of the scale for youngsters with dual diagnosis of mental retardation and psychiatric disturbance. Over a period of 2 1/2 years, 204 patients (199 after data reduction) from a child psychiatry unit were rated twice daily by direct care staff. Data analysis addressed internal consistency, interrater reliability, criterion validity, and robustness of the factor structure. Internal consistency was satisfactory with alpha coefficients ranging from. 82 to .94. Interrater reliability varied between subscales but was relatively low (Pearson correlations between .39 to .61). In terms of its criterion validity, the ABC was sensitive to psychiatric diagnoses and age and the original 5-factor structure was robust (congruence coefficients ranged between .80 to .89). Yet, only a relatively small proportion of the variance (31.5%) was explained by factor analysis indicating possible limitations of the ABC for this population. Given the paucity of assessment instruments for this particular population and the difficulty involved in developing new population-specific instruments, the ABC can be recommended for children and adolescents with dual diagnosis.