R.C.M.E. Engels

Substance use disorders in individuals with mild to borderline intellectual disability: Current status and future directions

Knowledge regarding substance use (SU) and substance use disorder (SUD) in individuals with mild to borderline intellectual disabilities (ID) has increased over the last decade, but is still limited. Data on prevalence and risk factors are fragmented, and instruments for screening and assessment and effective treatment interventions are scarce. Also, scientific developments in other fields are insufficiently incorporated in the care for individuals with ID and SUD. In this selective and critical review, we provide an overview of the current status of SU(D) in ID and explore insights on the conceptualisation of SUD from other fields such as addiction medicine and general psychiatry. SU(D) turns out to be a chronic, multifaceted brain disease that is intertwined with other physical, psychiatric and social problems. These insights have implications for practices, policies and future research with regard to the prevalence, screening, assessment and treatment of SUD. We will therefore conclude with recommendations for future research and policy and practice, which may provide a step forward in the care for individuals with ID and SUD.

Cognitive biases in individuals with mild to borderline intellectual disability and alcohol use-related problems

The primary aim of the present pilot study was to examine cognitive biases in individuals with mild to borderline ID and alcohol use-related problems. Participants (N=57) performed the approach avoidance task, picture rating task and visual dot probe task, which was combined with eye-tracking methodology. They were admitted to a forensic setting and were all abstinent and undergoing treatment at the time of testing. Three groups were formed based on the severity of alcohol use-related problems as measured by the AUDIT. In line with the expectations, no differences were found between participants based on the severity of their alcohol use-related problems. In addition, three groups were formed based on IQ to assess the relationship between IQ and the strength of the cognitive biases. There were also no differences between individuals with mild or borderline ID and individuals with (below) average IQ on any of the variables. It is concluded that computer tasks such as these can be used in individuals with mild to borderline ID. As the results suggest no influence of IQ on the strength of cognitive biases, this study opens up new opportunities for future research on the application of measuring cognitive biases in screening, diagnosing and treating individuals with mild to borderline ID and alcohol use-related problems.

Psychometric qualities of a tetrad WAIS-III short form for use in individuals with mild to borderline intellectual disability

Abstract Objective: To investigate the reliability and validity of a Wechsler Abbreviated Scale of Intelligence-based Wechsler Adult Intelligence Scale – third edition (WAIS-III) short form (SF) in a sample of individuals with mild to borderline intellectual disability (MBID) (Nu2009=u2009117; MIQu2009=u200971.34; SDIQu2009=u20098.00, range: 52–85). Methods: A full WAIS-III was administered as a standard procedure in the diagnostic process. Results: The results indicate an excellent reliability (ru2009=u20090.96) and a strong, positive correlation with the full WAIS-III (ru2009=u20090.89). The SF correctly identified ID in general and the correct IQ category more specifically in the majority of cases (97.4% and 86.3% of cases, respectively). In addition, 82.1% of the full scale IQ (FSIQ) estimates fell within the 95% confidence interval of the original score. Conclusions: We conclude that the SF is a reliable and valid measure to estimate FSIQ. It can be used in clinical and research settings when global estimates of intelligence are sufficient.

The addicted brain: cognitive biases in problematic drinkers with mild to borderline intellectual disability

BACKGROUNDnSubstance use disorders (SUD) are associated with several neurobiological disruptions, including biases in attention and approach/avoidance behaviour. The aims of this study were to compare the strength of cognitive biases between light and problematic drinkers, to explore the role of IQ on the cognitive biases and to study the psychometric qualities of the measures.nnnMETHODnParticipants (Nu2009=u2009130) were divided into four groups based on IQ and severity of alcohol use-related problems: light (nu2009=u200928) and problematic drinkers (nu2009=u200925) with (sub)average IQ and light (nu2009=u200933) and problematic drinkers (nu2009=u200944) with mild to borderline intellectual disability (MBID). All participants performed the visual dot probe task and the approach avoidance task to measure the strength of cognitive biases.nnnRESULTSnIn contrast with the hypothesis, no cognitive biases were found in problematic drinkers. Full scale IQ nor level of craving influenced the strength of the cognitive biases in light and problematic drinkers, although IQ did influence task performance (i.e. large intra-individual, trial-to-trial variation in reaction time). The internal consistency of the visual dot probe task was good, whereas the internal consistency of the approach avoidance task was poor.nnnCONCLUSIONnCognitive biases seem to vary within the group of problematic drinkers as a whole. The psychometric qualities of the measures are problematic, especially in relation to the intra-individual variability in reaction time found in participants with MBID. Until the implications of this variability on the validity of implicit measures and establishing bias scores are more clear, the use of these measures in individuals with MBID calls for scrutiny.

Executive control in long-term abstinent alcoholics with mild to borderline intellectual disability: The relationship with IQ and severity of alcohol use-related problems

Deficits in executive control might be related to alcohol abuse in individuals with mild to borderline intellectual disability (MBID). The goal of the present study was to test the relationship between executive control (i.e., working memory capacity, inhibitory control and delay discounting), IQ and chronic alcohol use. Participants (N=40) were divided into four groups based on IQ and severity of alcohol use-related problems (heavy and light drinkers with and without MBID). They were all admitted to a psychiatric treatment facility and long-term abstinent at the time of testing. Contrary to the expectations, executive control was not consistently impaired among individuals with MBID. Results showed that working memory capacity did seem to be impaired, whereas inhibitory control and delay discounting did not. Moreover, there were no differences between heavy and light drinkers on any of the parameters and having a dual diagnosis (heavy drinkers with MBID) did not result in additive negative effects on executive control. It is suggested that alcohol-related cognitive impairment is temporary and decreases over time after cessation of drinking.

Problematic alcohol use and mild intellectual disability: Standardization of pictorial stimuli for an alcohol cue reactivity task

The present study focused on the first step in developing a cue reactivity task for studying cognitive biases in individuals with mild to borderline intellectual disability (ID) and alcohol use-related problems: the standardization of pictorial stimuli. Participants (N=40), both with and without a history of alcohol use-related problems and varying in IQ, were admitted to a forensic setting and were all abstinent. They were asked to rate familiarity, complexity, valence and attractiveness of pictures portraying both alcoholic and non-alcoholic beverages. There was a tendency to rate non-alcoholic beverages as more pleasant and attractive than alcoholic beverages. In participants with mild to borderline ID, this difference reached statistical significance, even when controlling for alcohol use-related problems in the past. The overall result of the study is a large database of 255 pictures portraying both alcoholic and non-alcoholic beverages that will be used to validate an implicit measure of cognitive biases for alcohol in individuals with mild to borderline ID.

The Role of Executive Control and Readiness to Change in Problematic Drinkers with Mild to Borderline Intellectual Disability.

BACKGROUNDnProblematic alcohol use is associated with neuropsychological consequences, including cognitive biases. The goal of the study was to explore the moderating role of executive control and readiness to change on the relationship between alcohol use and cognitive biases in light and problematic drinkers with and without mild to borderline intellectual disability (MBID).nnnMETHODnParticipants (Nxa0=xa0112) performed the visual dot probe task to measure the strength of the cognitive biases. Executive control was measured using two computerised tasks for working memory capacity (Corsi block-tapping task) and inhibitory control (Go/No-go task). Readiness to change was measured using the Readiness to Change Questionnaire.nnnRESULTSnNo cognitive biases or executive dysfunctions were found in problematic drinkers. Working memory capacity and inhibitory control were impaired among individuals with MBID, irrespective of severity of alcohol use-related problems. Executive control and readiness to change did not moderate the relationship between alcohol use and cognitive biases.nnnCONCLUSIONnThe results fail to support the dual-process models of addiction, but results need to be treated with caution given the problematic psychometric qualities of the visual dot probe task. Implementing axa0neurocognitive assessment and protocols in thexa0treatment of substance use disorders seems premature.

Everybody Is…Drinking! Interpretation Bias in Problematic Drinkers With and Without Mild to Borderline Intellectual Disability

ABSTRACT Background: Problematic alcohol use is characterized by disrupted associative processing of environmental clues, where problematic drinkers interpret ambiguous, alcohol-relevant clues in an alcohol-related way. The present study examined the strength of this interpretation bias in a large sample (N = 230) of light and problematic drinkers with and without mild to borderline intellectual disability (MBID, IQ 50–85). Method: All participants were asked to finish 24 open-ended, ambiguous scenarios with their first, spontaneous response. Results: Consistent with the hypothesis, problematic drinkers with and without MBID were found to have an interpretation bias toward alcohol. The difference in the strength of the bias between light and problematic drinkers was strongest for negative scenarios. Participants with MBID showed a stronger interpretation bias compared to participants without MBID, especially on the negative scenarios. Conclusion: Problematic drinkers tend to interpret ambiguous, alcohol-relevant clues in an alcohol-related way and this tendency increases with higher levels of alcohol use–related problems. These results extend our knowledge on substance use disorder and provide new lines of inquiry for the assessment and treatment of problematic alcohol use in individuals with MBID.

Cognitive deficits in problematic drinkers with and without mild to borderline intellectual disability

We examined cognitive deficits in problematic drinkers with and without mild to borderline intellectual disability (MBID). Problematic drinkers were expected to show a significantly lower estimated performance IQ (PIQ), but not a lower estimated verbal IQ (VIQ), compared to light drinkers. Participants (N = 474) were divided into four groups based on IQ and severity of alcohol use-related problems. IQ was estimated using (a short form of) the Wechsler Adult Intelligence Scale third edition. Severity of alcohol use-related problems was assessed using the Alcohol Use Disorder Identification Test. Overall, there were no significant differences between light and problematic drinkers on estimated VIQ. Within the group without MBID, estimated PIQ was significantly lower. Estimated PIQ was not lower in problematic drinkers with MBID compared to light drinkers with MBID. The results are indicative of cognitive deficits in problematic drinkers without MBID. Screening for cognitive deficits with additional instruments is advised.

The efficacy of an e-learning prevention program for substance use among adolescents with intellectual disabilities: A pilot study

BACKGROUND AND AIMSnAdolescents with Intellectual Disability (ID) are at risk for tobacco and alcohol use, yet little or no prevention programs are available for this group. Prepared on time is an e-learning program based on the attitude - social influence - efficacy model originally developed for fifth and sixth grades of mainstream primary schools. The goals of this study were (1) to examine the lifetime use of tobacco and alcohol among this target group and (2) to gain a first impression of the efficacy of Prepared on time among 12-16-year old students with moderate or mild ID (MMID).nnnMETHODS AND PROCEDURESnStudents form three secondary special-needs schools were assigned to the experimental (e-learning) group (n=37) or the control group (n=36). Pre-intervention and follow-up data (3 weeks after completion) were gathered using semi-structured interviews inquiring about substance use among students with MMID and the behavioral determinants of attitude, subjective norm, modelling, intention, and knowledge.nnnRESULTSnThe lifetime tobacco use and alcohol consumption rates in our sample were 25% and 59%, respectively. The e-learning program had a positive effect on the influence of modelling of classmates and friends. No significant effects were found on other behavioral determinants and knowledge.nnnCONCLUSIONS AND IMPLICATIONSnA substantial proportion of adolescents with MMID in secondary special-needs schools use tobacco or alcohol. This study showed that an e-learning prevention program can be feasible for adolescents with MMID.