P.S. Sterkenburg

Self-controlled technologies to support skill attainment in persons with an autism spectrum disorder and/or an intellectual disability: a systematic literature review.

Abstract Persons with an autism spectrum disorder and/or intellectual disability have difficulties in processing information, which impedes the learning of daily living skills and cognitive concepts. Technological aids support learning, and if used temporarily and in a self-controlled manner, they may contribute to independent societal participation. This systematic review examines the studies that applied self-controlled technologies. The 28 relevant studies showed that skills and concepts are learned through prompting, interaction with devices, and practicing in (realistic) virtual environments. For attaining cognitive concepts, advanced technologies such as virtual reality are effective. Five studies focussed on cognitive concepts and two on emotion concepts. More research is necessary to examine the generalization of results and effect of using technology for learning cognitive and emotional concepts. Implications for Rehabilitation Persons with a moderate to mild intellectual disability and/or with autism can use self-controlled technology to learn new activities of daily living and cognitive concepts (e.g. time perception and imagination). Specific kinds of technologies can be used to learn specific kinds of skills (e.g. videos on computers or handheld devices for daily living skills; Virtual Reality for time perception and emotions of others). For learning new cognitive concepts it is advisable to use more advanced technologies as they have the potential to offer more features to support learning.

Attachment, Intellectual Disabilities and Mental Health: Research, Assessment and Intervention

BACKGROUND Attachment theory is highly influential in child and adult mental health research and practice. Research and practice have started now to explore the potential value of an attachment perspective for understanding and alleviating the challenges that persons with intellectual disabilities face in mental health and social participation. MATERIALS AND METHODS Research on attachment and intellectual disabilities is reviewed on its importance for knowledge, assessment and intervention. RESULTS Progress was found in understanding and distinguishing attachment behaviours, attachment relationships, attachment representations, attachment styles and attachment disorders and their respective implications for assessment and intervention. CONCLUSIONS Of the various attachment-related concepts, insights into attachment behaviours and relationships showed the most promise for practical applications in the field of intellectual disabilities. Findings on representations, styles and disorders were inconclusive or preliminary. Attachment-informed research and practice can be part of emerging developmental understanding of functioning with intellectual disabilities.

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.

Children with disrupted attachment histories: Interventions and psychophysiological indices of effects

Diagnosis and treatment of children affected by disruptions of attachment (out of home placement, multiple changes of primary caregiver) is an area of considerable controversy. The possible contribution of psychobiological theories is discussed in three parts. The first part relates the attachment theoretical perspective to major psychobiological theories on the developmental associations of parent-child relationships and emotional response. The second part reviews studies of autonomic reactivity and HPA-axis activity with foster children, showing that foster children show more reactivity within physiological systems facilitating fight or flight behaviours rather than social engagement, especially foster children with atypical attachment behaviour. The third part is focused on treatment of children suffering from the consequences of disrupted attachment, based on a psychotherapy study with psychophysiological outcome measures. Implications are discussed for theory, diagnosis, and intervention.

Psychiatric diagnostic screening of social maladaptive behaviour in children with mild intellectual disability: differentiating disordered attachment and pervasive developmental disorder behaviour

BACKGROUND Children with intellectual disability (ID) are at risk for maladaptive development of social relatedness. Controversy exists whether Pervasive Developmental Disorder (PDD) takes precedence over disordered attachment for describing maladaptive social behaviour. The aim of this study was to assess the prevalence of disordered attachment symptoms in children with ID referred for mental health diagnosis, and to study the potential diagnostic overlap between symptoms of disordered attachment and PDD symptoms. METHOD Children (n = 102) in the age of 5-11 with IDs (borderline or mild; IQ 50-85) referred for psychiatric consultation were recruited. Parents were administered a screening interview for disturbances of attachment and teachers were administered a screening questionnaire for PDD. RESULTS Behavioural symptoms of disordered attachment were reported for 42%* of the children, with 16%* showing symptoms of inhibited and 37%* showing symptoms of disinhibited attachment disorder. In 11% both types of symptoms were noted. Attachment disorder symptoms were not significantly associated with gender, ethnic background or age. Positive screening for PDD occurred for 27%. Positive screening for PDD was not significantly associated with symptoms of attachment disorder. CONCLUSIONS Among children with ID referred for psychiatric consultation, Reactive Attachment Disorder (RAD) and PDD symptoms were both highly prevalent. RAD and PDD symptoms appear as distinct, but sometimes comorbid, forms of aberrant social relatedness.

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.

Linkages between HIV/AIDS, HIV/AIDS-psychoses and parenting: A systematic literature review

In 2010, 30% of South African women who were pregnant had HIV. In addition to possible loss of their mother in the future, children may also be affected by the secondary symptoms of AIDS. Psychotic symptoms are one such consequence that might disrupt the attachment relationship with children. This study was aimed to examine the published evidence on the linkages between HIV, psychosis and parenting. Databases were searched for studies on HIV/AIDS, psychosis and parenting; 51 relevant empirical studies were reliably identified and coded. No study simultaneously linked HIV/AIDS, psychosis and parenting. Twenty-three studies reported on the links between HIV infection and parenting, yielding various protective and risk factors, but not psychosis. Thirteen studies reported on the links between HIV and psychosis, with psychosis being a secondary outcome of later stages of AIDS, a side effect of medication or a comorbid disease because of common risk factors. Fourteen studies reported associations between psychosis and parenting. The impact of HIV infection of mothers on their parenting is beginning to be understood, but many underlying factors are still unknown. Psychosis appears to be a potent, but overlooked factor in supporting families affected by HIV/AIDS.

Screening for ASD in adults with ID—moving toward a standard using the DiBAS-R and the ACL

BACKGROUND Identification of Autism Spectrum Disorder (ASD) in persons with intellectual disability (ID) is challenging but essential to allow adequate treatment to be given. This study examines whether the combination of two ASD screening instruments specifically developed for persons with ID, namely, the Diagnostic Behavioral Assessment for ASD-Revised (DiBAS-R) and the Autism Checklist (ACL), improves diagnostic accuracy when used in combination compared to the application of the single instrument. METHOD A clinical sample of adults with ID who are suspected of having ASD (N =148) was assessed using two ID specific screening scales (DiBAS-R and ACL). The diagnostic validity of the single instruments and of their combination was assessed. RESULTS While both instruments showed acceptable diagnostic validity when applied alone (DiBAS-R/ACL: sensitivity: 75%/91%; specificity: 75%/75%; overall agreement: 75%/83%), specificity increased when two positive screening results were used (88%), and sensitivity increased (95%) when at least one positive screening result was used. CONCLUSIONS Different combinations of the ASD screening instruments DiBAS-R and ACL lead to improvements in sensitivity and specificity. The complementary use of the ACL in addition to the sole use of the DiBAS-R improves overall accuracy.Background: Identification of Autism Spectrum Disorder (ASD) in persons with intellectual disability (ID) is challenging but essential to allow adequate treatment to be given. This study examines whether the combination of two ASD screening instruments specifically developed for persons with ID, namely, the Diagnostic Behavioral Assessment for ASD-Revised (DiBAS-R) and the Autism Checklist (ACL), improves diagnostic accuracy when used in combination compared to the application of the single instrument. Method: A clinical sample of adults with ID who are suspected of having ASD (N =148) was assessed using two ID specific screening scales (DiBAS-R and ACL). The diagnostic validity of the single instruments and of their combination was assessed. Results: While both instruments showed acceptable diagnostic validity when applied alone (DiBAS-R/ACL: sensitivity: 75%/91%; specificity: 75%/75%; overall agreement: 75%/83%), specificity increased when two positive screening results were used (88%), and sensitivity increased (95%) when at least one positive screening result was used. Conclusions: Different combinations of the ASD screening instruments DiBAS-R and ACL lead to improvements in sensitivity and specificity. The complementary use of the ACL in addition to the sole use of the DiBAS-R improves overall accuracy.

The effectiveness of VIPP-V parenting training for parents of young children with a visual or visual-and-intellectual disability: study protocol of a multicenter randomized controlled trial

BackgroundVisual or visual-and-intellectual disabilities of children make daily interactions more difficult for their parents and may impact the quality of the parent-child relationship. To support these parents, an existing intervention (Video-feedback Intervention to promote Positive Parenting; VIPP; Juffer F, Bakermans-Kranenburg MJ, van IJzendoorn MH, 2008. Promoting positive parenting; an attachment-based intervention. Mahwah, NJ: Lawrence Erlbaum Associates; 2008) was adapted for use with parents of children with a visual or visual-and-intellectual disability (VIPP-V). This attachment-based intervention was hypothesized to support parents’ interpretation and understanding of the behavior of their child with a visual or visual-and-intellectual disability and respond to their child’s signals in a sensitive way to improve parent-child interaction quality.Methods/DesignA randomized controlled trial (RCT) will be conducted to assess the effectiveness of the adapted intervention VIPP-V (Video-feedback Intervention to promote Positive Parenting in parents of children with Visual or visual-and-intellectual disabilities). Parent-child dyads will be randomized into two groups: 50 dyads will receive VIPP-V in combination with care-as-usual and 50 dyads will receive care-as-usual. Families with a child (1–5 years of age) with a visual or visual-and-intellectual disability will be recruited for participation in the study. Primary outcome measures are parental sensitivity and the quality of parent-child interaction. Secondary outcome measures are parental self-efficacy, and parenting stress. To assess feasibility of implementation of the intervention the experiences of early intervention workers with regard to using VIPP-V are assessed. Moderator variables are the child’s developmental age, working alliance between parent and VIPP-V intervention worker and empathy of the VIPP-V intervention worker. Data will be collected approximately one week before the intervention starts (T1), one week (T2) and three months (T3) after the intervention. Parent-child dyads in the care-as-usual-only condition will be assessed at the same time points. Both intention-to-treat and completer analyses will be performed.DiscussionDescriptive findings in pilot cases suggest benefits from VIPP-V, and compatibility with existing services for parents of children with a visual or visual-and-intellectual disability. The current study will provide insight into the effectiveness of this intervention for parents of children with a visual or visual-and-intellectual disability, and, if the intervention is effective, prepare the field for broad-scale implementation.Trial registrationNederlands Trial Register NTR4306 (registered 5 December 2013).

Caregiver-mediated therapy for an adult with visual and intellectual impairment suffering from separation anxiety.

BACKGROUND Separation anxiety among intellectually disabled (ID) persons with comorbid visual impairment could be rooted in a weak sense of person permanence. Technology-assisted Therapy for Separation Anxiety (TTSA) was used to address this problem. AIMS The primary aim was to determine whether technology alone or including caregivers was the best option, and whether TTSA decreased separation anxiety and challenging behaviour. Also, how the caregivers and the client experienced TTSA. METHODS AND PROCEDURES A pre-experimental, quantitative approach (AB1C1B2C2D) was used for this single-subject study. The frequency of the clients text messages was recorded daily. The variables were monitored with standardised instruments and caregivers rated the intensity and frequency of the clients anxious and challenging behaviour. The social validity was evaluated by means of questionnaires. OUTCOMES AND RESULTS There was a significant decrease in the anxious and angry messages sent, and in anxious and challenging behaviour, in the phase in which the caregivers were included, compared with the phase in which technology alone was used. The client and the caregivers were positive about TTSA. CONCLUSION AND IMPLICATION Technology and the caregivers reactions reduces the anxiety and challenging behaviour. It might also aid the acquisition of the concept of person permanence.