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Scala M, Chiera M, Bortolotti B, Rodriguez-Jimenez R, Menchetti M. Aggressive behaviour and diabetes: A clinical case of atypical metabolic improvement during clozapine treatment. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024:17446295241266897. [PMID: 39041426 DOI: 10.1177/17446295241266897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Aggressive and violent behaviour is a challenging psychiatric emergency to manage, especially among vulnerable categories such as patients with Intellectual Developmental Disorder. Although there is some evidence that clozapine may be useful as an anti-violence compound, its use is limited by common metabolic complications. An adult patient presented with obesity, type II diabetes mellitus, compulsive food intake, severe Intellectual Developmental Disorder, and a treatment-resistant aggressive behaviour. Clozapine was administered resulting in reduced aggressive behaviour. Unexpectedly, a reduction in the food craving as well as a sustained improvement in both anthropometric parameters and glycemic control were observed during the clozapine treatment. Our case report, describes these findings for the first time, highlighting the need for more clinical research to investigate both the efficacy of clozapine in the Intellectual Developmental Disorder populations and its long-term effects with special regard to the metabolic outcomes in this type of patients.
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Affiliation(s)
- Mauro Scala
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum-University of Bologna, Italy
- Institute for Health Research Hospital Universitario 12 de Octubre, (imas12), Madrid, Spain
- Complutense University of Madrid (UCM), Madrid, Spain
| | - Martina Chiera
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum-University of Bologna, Italy
| | - Biancamaria Bortolotti
- Department of Mental Health and Pathological Dependencies, Local Health Authority of Bologna, Italy
| | - Roberto Rodriguez-Jimenez
- Institute for Health Research Hospital Universitario 12 de Octubre (imas12), Madrid, Spain
- Complutense University of Madrid (UCM), Madrid, Spain
- CIBERSAM-ISCIII (Biomedical Research Networking Centre in Mental Health), Madrid, Spain
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum-University of Bologna, Italy
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Bilder DA, Mthembu M, Worsham W, Aguayo P, Knight JR, Deng SW, Singh TP, Davis J. Developing and Implementing a Web-Based Branching Logic Survey to Support Psychiatric Crisis Evaluations of Individuals With Developmental Disabilities: Qualitative Study and Evaluation of Validity. JMIR Ment Health 2024; 11:e50907. [PMID: 38551644 PMCID: PMC11015367 DOI: 10.2196/50907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Individuals with developmental disabilities (DD) experience increased rates of emotional and behavioral crises that necessitate assessment and intervention. Psychiatric disorders can contribute to crises; however, screening measures developed for the general population are inadequate for those with DD. Medical conditions can exacerbate crises and merit evaluation. Screening tools using checklist formats, even when designed for DD, are too limited in depth and scope for crisis assessments. The Sources of Distress survey implements a web-based branching logic format to screen for common psychiatric and medical conditions experienced by individuals with DD by querying caregiver knowledge and observations. OBJECTIVE This paper aims to (1) describe the initial survey development, (2) report on focus group and expert review processes and findings, and (3) present results from the survey's clinical implementation and evaluation of validity. METHODS Sources of Distress was reviewed by focus groups and clinical experts; this feedback informed survey revisions. The survey was subsequently implemented in clinical settings to augment providers' psychiatric and medical history taking. Informal and formal consults followed the completion of Sources of Distress for a subset of individuals. A records review was performed to identify working diagnoses established during these consults. RESULTS Focus group members (n=17) expressed positive feedback overall about the survey's content and provided specific recommendations to add categories and items. The survey was completed for 231 individuals with DD in the clinical setting (n=161, 69.7% men and boys; mean age 17.7, SD 10.3; range 2-65 years). Consults were performed for 149 individuals (n=102, 68.5% men and boys; mean age 18.9, SD 10.9 years), generating working diagnoses to compare survey screening results. Sources of Distress accuracy rates were 91% (95% CI 85%-95%) for posttraumatic stress disorder, 87% (95% CI 81%-92%) for anxiety, 87% (95% CI 81%-92%) for episodic expansive mood and bipolar disorder, 82% (95% CI 75%-87%) for psychotic disorder, 79% (95% CI 71%-85%) for unipolar depression, and 76% (95% CI 69%-82%) for attention-deficit/hyperactivity disorder. While no specific survey items or screening algorithm existed for unspecified mood disorder and disruptive mood dysregulation disorder, these conditions were caregiver-reported and working diagnoses for 11.7% (27/231) and 16.8% (25/149) of individuals, respectively. CONCLUSIONS Caregivers described Sources of Distress as an acceptable tool for sharing their knowledge and insights about individuals with DD who present in crisis. As a screening tool, this survey demonstrates good accuracy. However, better differentiation among mood disorders is needed, including the addition of items and screening algorithm for unspecified mood disorder and disruptive mood dysregulation disorder. Additional validation efforts are necessary to include a more geographically diverse population and reevaluate mood disorder differentiation. Future study is merited to investigate the survey's impact on the psychiatric and medical management of distress in individuals with DD.
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Affiliation(s)
- Deborah A Bilder
- University of Utah Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Mariah Mthembu
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Whitney Worsham
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Patricia Aguayo
- University of Utah Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Jacob R Knight
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Steven W Deng
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Tejinder P Singh
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - John Davis
- University of Utah, Salt Lake City, UT, United States
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Baksh RA, Sheehan R, Hassiotis A, Smith J, Strydom A. Identifying individuals with intellectual disability who access mental health support and are at high risk for adverse clinical outcomes: cohort study. BJPsych Open 2023; 9:e183. [PMID: 37813547 PMCID: PMC10594232 DOI: 10.1192/bjo.2023.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/07/2023] [Accepted: 08/31/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND People with intellectual disability often experience aggressive challenging behaviour and mental health issues. It can be difficult to identify those who are at higher risk of adverse clinical outcomes when in clinical care. AIMS To characterise potential subgroups in adults with intellectual disability referred to mental health services in those presenting with aggressive behaviour or common mental disorders (CMDs). METHOD There were 836 adults (≥18 years) with intellectual disability and a record of aggressive challenging behaviour, and 205 patients with intellectual disability and CMDs, who were seen in specialist mental health services over a 5-year period. Cluster analysis was used to define patient characteristics associated with clinical outcome. RESULTS Distinct patient groups with differentiated profiles were observed in people with intellectual disability displaying aggressive challenging behaviour, and in those presenting with CMDs. Characteristics of the aggressive behaviour group who experienced adverse outcomes included being <30 years old, being male, more mentions of aggression and agitation in their clinical record, a diagnosis of pervasive developmental disorder and prescription of psychotropic medication. Characteristics of the CMD cluster that experienced adverse clinical outcomes were being older, being a White male, having a mild intellectual disability and physical health concerns. CONCLUSIONS People with intellectual disability who experience adverse clinical outcomes can be identified with a cluster analysis approach of common features, but differ by clinical presentation. This could be used not only to stratify this clinically heterogeneous population in terms of response to interventions, but also improve precision in the development of tailored interventions.
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Affiliation(s)
- R. Asaad Baksh
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK; and The LonDowns Consortium, London, UK
| | - Rory Sheehan
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Angela Hassiotis
- Division of Psychiatry, University College London, UK; and Camden Learning Disabilities Service, London, UK
| | - James Smith
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Andre Strydom
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; The LonDowns Consortium, London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
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Greer BD. Barriers to Accessing Effective Treatments for Destructive Behavior. POLICY INSIGHTS FROM THE BEHAVIORAL AND BRAIN SCIENCES 2023; 10:68-74. [PMID: 38840711 PMCID: PMC11150915 DOI: 10.1177/23727322221144653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
The field of applied behavior analysis has developed and refined a comprehensive methodology for the assessment and successful treatment of destructive behavior: An individualized approach emphasizes (a) function of responding (or its cause) over its form; (b) objective and reliable measurement of behavior; (c) systematic procedures and their application; (d) rigorous, single-case experimental designs; and (e) determinations of successful intervention judged by improvements in the same individual's performance. Outcomes of this approach are often dramatic and reliably surpass those obtained by alternative means. However, significant barriers limit the accessibility of this proven therapy. Too few intensive behavioral intervention units, diagnosis- and age-dependent insurance authorization and reimbursement practices, long waitlists and slow approval processes, and the possibility of treatment relapse represent a few such barriers. This article describes these barriers and suggests some potential solutions.
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Affiliation(s)
- Brian D. Greer
- Rutgers Brain Health Institute
- Children’s Specialized Hospital–Rutgers
University Center for Autism Research, Education, and Services
(CSH–RUCARES)
- Department of Pediatrics, Rutgers Robert Wood Johnson
Medical School
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Yan H, Elkaim LM, Venetucci Gouveia F, Huber JF, Germann J, Loh A, Benedetti-Isaac JC, Doshi PK, Torres CV, Segar DJ, Elias GJB, Boutet A, Cosgrove GR, Fasano A, Lozano AM, Kulkarni AV, Ibrahim GM. Deep brain stimulation for extreme behaviors associated with autism spectrum disorder converges on a common pathway: a systematic review and connectomic analysis. J Neurosurg 2022; 137:699-708. [PMID: 35061980 DOI: 10.3171/2021.11.jns21928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 11/16/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Individuals with autism spectrum disorder (ASD) may display extreme behaviors such as self-injury or aggression that often become refractory to psychopharmacology or behavioral intervention. Deep brain stimulation (DBS) is a surgical alternative that modulates brain circuits that have yet to be clearly elucidated. In the current study the authors performed a connectomic analysis to identify brain circuitry engaged by DBS for extreme behaviors associated with ASD. METHODS A systematic review was performed to identify prior reports of DBS as a treatment for extreme behaviors in patients with ASD. Individual patients' perioperative imaging was collected from corresponding authors. DBS electrode localization and volume of tissue activated modeling were performed. Volumes of tissue activated were used as seed points in high-resolution normative functional and structural imaging templates. The resulting individual functional and structural connectivity maps were pooled to identify networks and pathways that are commonly engaged by all targets. RESULTS Nine patients with ASD who were receiving DBS for symptoms of aggression or self-injurious behavior were identified. All patients had some clinical improvement with DBS. Connectomic analysis of 8 patients (from the systematic review and unpublished clinical data) demonstrated a common anatomical area of shared circuitry within the anterior limb of the internal capsule. Functional analysis of 4 patients identified a common network of distant brain areas including the amygdala, insula, and anterior cingulate engaged by DBS. CONCLUSIONS This study presents a comprehensive synopsis of the evidence for DBS in the treatment of extreme behaviors associated with ASD. Using network mapping, the authors identified key circuitry common to DBS targets.
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Affiliation(s)
- Han Yan
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
- 2Division of Neurosurgery, The Hospital for Sick Children, Toronto
- 3Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario
| | - Lior M Elkaim
- 4Division of Neurosurgery, McGill University, Montreal, Quebec
| | | | - Joelene F Huber
- 6Divisions of Paediatric Medicine and Developmental Paediatrics, Department of Paediatrics, The Hospital for Sick Children, Toronto
| | | | - Aaron Loh
- 7University Health Network, Toronto, Ontario, Canada
| | - Juan Carlos Benedetti-Isaac
- 8Stereotactic and Functional Neurosurgery Division, International Misericordia Clinic, Barranquilla, Colombia
| | - Paresh K Doshi
- 9Department of Stereotactic and Functional Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, India
| | - Cristina V Torres
- 10Department of Neurosurgery, University Hospital La Princesa, Madrid, Spain
| | - David J Segar
- 11Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Alexandre Boutet
- 7University Health Network, Toronto, Ontario, Canada
- 12Joint Department of Medical Imaging, University of Toronto
| | - G Rees Cosgrove
- 11Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alfonso Fasano
- 13Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto
- 14Division of Neurology, University of Toronto
- 15Krembil Brain Institute, Toronto
| | - Andres M Lozano
- 7University Health Network, Toronto, Ontario, Canada
- 12Joint Department of Medical Imaging, University of Toronto
| | - Abhaya V Kulkarni
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
- 2Division of Neurosurgery, The Hospital for Sick Children, Toronto
- 3Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario
| | - George M Ibrahim
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
- 2Division of Neurosurgery, The Hospital for Sick Children, Toronto
- 16Institute of Biomedical Engineering, University of Toronto; and
- 17Institute of Medical Science, University of Toronto, Ontario, Canada
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Heiden P, Weigel DT, Loução R, Hamisch C, Gündüz EM, Ruge MI, Kuhn J, Visser-Vandewalle V, Andrade P. Connectivity in deep brain stimulation for self-injurious behavior: multiple targets for a common network? Front Hum Neurosci 2022; 16:958247. [PMID: 36092644 PMCID: PMC9448926 DOI: 10.3389/fnhum.2022.958247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Self-injurious behavior (SIB) is associated with diverse psychiatric conditions. Sometimes (e.g., in patients with autism spectrum disorder or acquired brain injuries), SIB is the most dominant symptom, severely restricting the psychosocial functioning and quality of life of the patients and inhibiting appropriate patient care. In severe cases, it can lead to permanent physical injuries or even death. Primary therapy consists of medical treatment and if implementable, behavioral therapy. For patients with severe SIB refractory to conventional therapy, neuromodulation can be considered as a last recourse. In scientific literature, several successful lesioning and deep brain stimulation targets have been described that can indicate a common underlying neuronal pathway. The objectives of this study were to evaluate the short- and long-term clinical outcome of patients with severe, therapy refractory SIB who underwent DBS with diverse underlying psychiatric disorders and to correlate these outcomes with the activated connectivity networks. We retrospectively analyzed 10 patients with SIB who underwent DBS surgery with diverse psychiatric conditions including autism spectrum disorder, organic personality disorder after hypoxic or traumatic brain injury or Tourette syndrome. DBS targets were chosen according to the underlying disorder, patients were either stimulated in the nucleus accumbens, amygdala, posterior hypothalamus, medial thalamus or ventrolateral thalamus. Clinical outcome was measured 6 months after surgery and at long-term follow-up after 10 or more years using the Early Rehabilitation Barthel index (ERBI) and time of restraint. Connectivity patterns were analyzed using normative connectome. Based on previous literature the orbitofrontal cortex, superior frontal gyrus, the anterior cingulate cortex, the amygdala and the hippocampus were chosen as regions of interest. This analysis showed a significant improvement in the functionality of the patients with DBS in the short- and long-term follow-up. Good clinical outcome correlated with higher connectivity to the amygdala and hippocampus. These findings may suggest a common pathway, which can be relevant when planning a surgical procedure in patients with SIB.
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Affiliation(s)
- Petra Heiden
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Daniel Tim Weigel
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ricardo Loução
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christina Hamisch
- Department of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Enes M. Gündüz
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maximilian I. Ruge
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic, Johanniter Hospital Oberhausen, Oberhausen, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Pablo Andrade
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- *Correspondence: Pablo Andrade
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Translating Quantitative Theories of Behavior into Improved Clinical Treatments for Problem Behavior. Behav Processes 2022; 198:104639. [PMID: 35405305 PMCID: PMC10088503 DOI: 10.1016/j.beproc.2022.104639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 12/15/2022]
Abstract
The most important advancement in the treatment of destructive behavior has been the development of the functional analysis, which is used to prescribe effective treatments like functional communication training. Although this approach can be highly effective, extinction bursts and forms of treatment relapse commonly occur when function-based treatments are implemented by caregivers in natural community settings. In recent years, researchers have increasingly applied quantitative theories of behavior like behavioral momentum theory (BMT) and the temporally weighted matching law (TWML) to understand, prevent, or mitigate extinction bursts and treatment relapse. In this paper, we describe BMT and TWML and selectively review the basic, translational, and applied research supporting and opposing each theory. Then, we describe how function-based treatments may be refined based on these theories to improve the effectiveness, generality, and durability of function-based treatments for individuals with autism spectrum and related disorders who display problem behavior.
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8
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Scibelli J, Scibelli F, Luiselli JK, Hrdina J, Anglin K, Orchanian S. Clinical Safety and Treatment of Severe Aggression: Behavioral-Pharmacological Intervention Evaluation in a Young Adult With Autism Spectrum Disorder. Clin Case Stud 2022. [DOI: 10.1177/15346501221081254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This case study concerned clinical safety and behavioral-pharmacological intervention with an 18-year-old man who had autism spectrum disorder and high-frequency aggression toward care providers at a specialized school. A multicomponent behavior support plan included antecedent, differential reinforcement, environmental modification, and physical management procedures subsequently combined with psychotropic medication (aripiprazole). Clinical safety components emphasized comprehensive care provider training, continuous supervision, function-based treatment, and prevention-focused strategies. The behavioral-pharmacological intervention eliminated implementation of aggression-contingent physical restraint and was associated with increased transition compliance during the school day. Throughout the 7.5 months duration of the study, there were no injuries to the participant or other students and a single injury was sustained by one care provider. Intervention effects were long-standing, and care providers rated their training, implementation fidelity, and therapeutic outcome favorably.
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Gómez LE, Navas P, Verdugo MÁ, Tassé MJ. Empirically supported psychological treatments: The challenges of comorbid psychiatric and behavioral disorders in people with intellectual disability. World J Psychiatry 2021; 11:1039-1052. [PMID: 34888172 PMCID: PMC8613764 DOI: 10.5498/wjp.v11.i11.1039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/17/2021] [Accepted: 10/18/2021] [Indexed: 02/06/2023] Open
Abstract
This paper reviews the current state of knowledge on psychological interventions with empirical evidence of efficacy in treating common psychiatric and behavioral disorders in people with intellectual disability (ID) at all stages of their life. We begin with a brief presentation of what is meant by psychiatric and behavioral disorders in this population, along with an explanation of some of the factors that contribute to the increased psychosocial vulnerability of this group to present with these problems. We then conduct a review of empirically supported psychological therapies used to treat psychiatric and behavioral disorders in people with ID. The review is structured around the three generations of therapies: Applied behavior analysis (e.g., positive behavior support), cognitive behavioral therapies (e.g., mindfulness-based cognitive therapy), and contextual therapies (e.g., dialectical behavior therapy). We conclude with some recommendations for professional practice in the fields of ID and psychiatry.
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Affiliation(s)
- Laura E Gómez
- Department of Psychology, University of Oviedo, Oviedo 33011, Asturias, Spain
| | - Patricia Navas
- Department of Personality, Evaluation and Psychological Treatments, Institute on Community Integration, University of Salamanca, Salamanca 37005, Salamanca, Spain
| | - Miguel Ángel Verdugo
- Department of Personality, Evaluation and Psychological Treatments, Institute on Community Integration, University of Salamanca, Salamanca 37005, Salamanca, Spain
| | - Marc J Tassé
- Department of Psychology and Psychiatry, The Ohio State University Nisonger Center-UCEDD, Columbus, OH 43210-1257, United States
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Avery SK, Akers JS. The Use of Demand Assessments: A Brief Review and Practical Guide. Behav Anal Pract 2021; 14:410-421. [PMID: 34150456 DOI: 10.1007/s40617-020-00542-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 11/29/2022] Open
Abstract
It is important for practitioners to first conduct an indirect demand assessment to identify appropriate stimuli to include during the direct demand assessment. Information obtained from an indirect demand assessment is useful not only for identifying which demands to evaluate during the direct assessment but also for selecting stimuli associated with each demand. Conducting an indirect demand assessment with caregivers provides practitioners the opportunity to identify whether specific demand stimuli are associated with more challenging behavior (e.g., writing with a pen vs. a pencil) and whether demand presentation may be an establishing operation for challenging behavior (e.g., presenting one math problem at a time vs. presenting an entire math worksheet). The purpose of this article is to review the current literature on demand assessment procedures and to provide practitioners with a practical guide for conducting demand assessments in clinical settings. We provide a summary of our findings along with a brief description of the procedures used for implementing the indirect and direct demand assessments. Further, we created a decision-making guide to help practitioners select which type of demand assessment to conduct with their clients.
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Affiliation(s)
- Suzannah K Avery
- Department of Educational Psychology, Baylor University, Waco, TX USA
| | - Jessica S Akers
- Department of Educational Psychology, Baylor University, Waco, TX USA
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Rizzi M, Gambini O, Marras CE. Posterior hypothalamus as a target in the treatment of aggression: From lesioning to deep brain stimulation. HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:95-106. [PMID: 34266615 DOI: 10.1016/b978-0-12-819973-2.00007-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Intermittent explosive disorder can be described as a severe "affective aggression" condition, for which drugs and other supportive therapies are not fully effective. In the first half of the 19th century, experimental studies progressively increased knowledge of aggressive disorders. A neurobiologic approach revealed the posterior hypothalamic region as a key structure for the modulation of aggression. In the 1960s, patients with severe aggressive disorder, frequently associated with intellectual disability, were treated by bilateral stereotactic lesioning of the posterior hypothalamic area, with efficacy. This therapy was later abandoned because of issues related to the misuse of psychosurgery. In the last 2 decades, however, the same diencephalic target has been selected for the reversible treatment by deep brain stimulation, with success. This chapter presents a comprehensive approach to posterior hypothalamic surgery for the treatment of severely aggressive patients and discusses the experimental steps that allowed this surgical target to be selected. Surgical experiences are reported, together with considerations on target features and related encephalic circuits.
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Affiliation(s)
- Michele Rizzi
- "C.Munari" Epilepsy Surgery Center, Department of Neuroscience, ASST GOM Niguarda, Milan, Italy.
| | - Orsola Gambini
- Department of Health of Sciences, University of Milan, Milan, Italy; CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Milan, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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van den Akker N, Kroezen M, Wieland J, Pasma A, Wolkorte R. Behavioural, psychiatric and psychosocial factors associated with aggressive behaviour in adults with intellectual disabilities: A systematic review and narrative analysis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:327-389. [PMID: 33073443 PMCID: PMC7894289 DOI: 10.1111/jar.12809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 08/07/2020] [Accepted: 08/30/2020] [Indexed: 12/28/2022]
Abstract
Background Aggressive behaviour is prevalent in people with intellectual disabilities. To understand the aetiology, it is important to recognize factors associated with the behaviour. Method A systematic review was conducted and included studies published between January 2002 and April 2017 on the association of behavioural, psychiatric and psychosocial factors with aggressive behaviour in adults with intellectual disabilities. Results Thirty‐eight studies were included that presented associations with 11 behavioural, psychiatric and psychosocial factors. Conflicting evidence was found on the association of these factors with aggressive behaviour. Conclusions The aetiology of aggressive behaviour is specific for a certain person in a certain context and may be multifactorial. Additional research is required to identify contributing factors, to understand causal relationships and to increase knowledge on possible interaction effects of different factors.
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Affiliation(s)
- Natalie van den Akker
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Marieke Kroezen
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Jannelien Wieland
- Cordaan, Center for Excellence on Mental Health and Mild Intellectual Disability, Amsterdam, The Netherlands
| | - Annelieke Pasma
- Department of Rheumatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Ria Wolkorte
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Buono S, Zagaria T, Recupero M, Elia M, Kerr M, Di Nuovo S, Ferri R. The evolution of self-injurious behaviors in people with intellectual disability and epilepsy: A follow-up study. Seizure 2020; 82:99-104. [PMID: 33045542 DOI: 10.1016/j.seizure.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Longitudinal studies of the evolution of Self-Injurious Behaviors (SIBs) in people with Intellectual Disability (ID) and epilepsy are not common. This study aimed to analyze the evolution (in terms of remission and persistence) and changes in the type, localization, frequency, and intensity of SIBs. METHODS SIBs were assessed in a sample of 52 people with ID and epilepsy, and re-evaluated after a seven-year interval, using the "Scale for the Assessment of Self-Injurious Behaviors". The scale was administered to caregivers (parents or health professionals) through a semi-structured interview conducted by a specifically trained psychologist. RESULTS The most frequent types of SIBs identified were: self-biting, self-hitting with objects, self-hitting with hand, object-finger in cavities. The main localizations of SIBs were: hands, mouth, head and cheeks. SIBs were found to be maintained after seven years, for type, localization, frequency, and intensity, in 90.4% of the sample. SIB types were stable over time, as were the affected areas. Global SIB frequency and intensity scores were found to be unchanged. Finally, a positive correlation was found between the frequency of SIBs and levels of intellectual disability. SIBs (frequency and intensity) and seizure frequency showed no correlation. CONCLUSION Given the negative impact of SIBs on the adaptation and quality of life of people with ID and epilepsy, we believe that further studies on biological, psychological and environmental aspects are needed in order to identify any potential factors that might explain the persistence of SIBs and to find effective interventions to reduce them.
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Affiliation(s)
- Serafino Buono
- Unit of Psychology, Oasi Research Institute-IRCCS, Troina, Italy.
| | - Tommasa Zagaria
- Unit of Psychology, Oasi Research Institute-IRCCS, Troina, Italy
| | | | - Maurizio Elia
- Unit of Neurology, Oasi Research Institute-IRCCS, Troina, Italy
| | - Mike Kerr
- Institute of psychological medicine and clinical neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Santo Di Nuovo
- Department of Education, University of Catania, Catania, Italy
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Ho RTH, Chan CKP, Fong TCT, Lee PHT, Lum DSY, Suen SH. Effects of Expressive Arts–Based Interventions on Adults With Intellectual Disabilities: A Stratified Randomized Controlled Trial. Front Psychol 2020; 11:1286. [PMID: 32595569 PMCID: PMC7300289 DOI: 10.3389/fpsyg.2020.01286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/15/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rainbow T. H. Ho
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
- Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong
- *Correspondence: Rainbow T. H. Ho,
| | - Caitlin K. P. Chan
- Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ted C. T. Fong
- Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong
| | - Pandora H. T. Lee
- Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong
| | - Derek S. Y. Lum
- Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong
| | - S. H. Suen
- Madam Lo Lee Pui Ching Memorial Workshop, Yan Chai Hospital, Tsuen Wan, Hong Kong
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Mitteer DR, Randall KR, Van Winkle LJ, Greer BD. Incorporating discriminative stimuli into functional communication training with augmentative and alternative communication devices: a tutorial. Augment Altern Commun 2020; 36:63-70. [PMID: 32238004 DOI: 10.1080/07434618.2020.1731761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Functional communication training (FCT) is a commonly used and effective treatment for problem behavior maintained by social reinforcement (e.g., an individual engages in self-injurious behavior to gain access to adult attention). FCT involves teaching an individual to emit an appropriate communication response to access the reinforcer maintaining problem behavior (e.g., pressing a "Play, please" symbol on a device to gain the communication partner's attention) and withholding that reinforcer following problem behavior (e.g., the communication partner minimizes attention-following problem behavior and waits for a communication response). Techniques such as incorporating discriminative stimuli (e.g., differently colored cards) can make FCT more practical for caregivers by teaching individuals when reinforcement is and is not available for communication responses while simultaneously mitigating treatment relapse. Despite the effectiveness of FCT with discriminative stimuli, no studies have leveraged the capabilities of augmentative and alternative communication (AAC) devices by embedding discriminative stimuli within AAC software (e.g., by coloring communication symbols or grids). Our tutorial provides a comprehensive overview of how practitioners can incorporate FCT with discriminative stimuli into practice and includes video models of how to design these treatments on two common AAC apps.
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Affiliation(s)
- Daniel R Mitteer
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kayla R Randall
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Leslie J Van Winkle
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Brian D Greer
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
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dosReis S, N'Dri L, Ross M, Camelo Castillo W, Reeves G, Butler B. Care Management for Youth With Comorbid Developmental and Mental Health Conditions: A Discrete Choice Experiment Pilot Study. Acad Pediatr 2020; 20:241-249. [PMID: 31128382 DOI: 10.1016/j.acap.2019.05.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/25/2019] [Accepted: 05/18/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Caregivers of a child with a coexisting cognitive/intellectual and an emotional/behavior/developmental disability have difficult decisions regarding care management options for their child. This study aimed to pilot and refine an instrument to elicit caregivers' preferences in managing their child's care needs. METHODS Subjects were 38 caregivers of a child aged 21 and younger with a coexisting cognitive/intellectual and an emotional/behavior/developmental disability. A mixed-methods design was used to develop and pilot a discrete choice experiment (DCE) to elicit care management preferences for their child. Six attributes of care management decisions were tested in the DCE: medication use, parental custody, time cost, social interactions, medication effects, and school placement. Subjects completed a paper-and-pencil survey after which a debriefing discussion was held to obtain feedback that would aid in refining the attribute descriptions. Conditional logistic regression generated mean scores for each attribute. Comments from the debriefing sessions were audio-recorded and used to modify the attribute descriptions. RESULTS The majority (84%) of subjects were aged 40 years or older and a female caregiver. Common diagnoses of the children were autism spectrum disorder (55%) and attention-deficit/hyperactivity disorder (76%). Subjects preferred using fewer medications and maintaining decision-making authority as opposed to delegating authority to a third party. Medication effects on the child's mood were more important than effects on personality or body weight. CONCLUSIONS The DCE was sensitive to caregivers' preferences for managing their child's coexisting cognitive/intellectual and emotional/behavior/developmental disability. Findings may help providers gauge treatment in a broader context of health outcomes.
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Affiliation(s)
- Susan dosReis
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore (S dosReis, WC Castillo).
| | - Laetitia N'Dri
- University of Maryland School of Pharmacy, Baltimore (L N'Dri)
| | - Melissa Ross
- Patient-Centered Research, Evidera, Bethesda (M Ross)
| | - Wendy Camelo Castillo
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore (S dosReis, WC Castillo)
| | - Gloria Reeves
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore (G Reeves)
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Saini V, Cox A. Functional Behavior Assessment Practices Used by Canadian Behavioral Health Practitioners. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2020. [DOI: 10.1111/jppi.12327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Valdeep Saini
- Department of Applied Disability StudiesBrock University St. Catharines ON Canada
| | - Alison Cox
- Department of Applied Disability StudiesBrock University St. Catharines ON Canada
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Friedman C, Crabb C. Restraint, Restrictive Intervention, and Seclusion of People With Intellectual and Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2018; 56:171-187. [PMID: 29782229 DOI: 10.1352/1934-9556-56.3.171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Restraint, restrictive interventions, and seclusion are hotly contested practices with inconclusive evidence of their effectiveness. Because the use of restraint and seclusion on people with intellectual and developmental disabilities (IDD) is controversial and its effectiveness doubtable, this study was conducted to explore if and how they were permitted in Medicaid HCBS 1915(c) waivers, the largest providers of long-term services and supports (LTSS) for people with IDD. To do so, 111 fiscal year 2015 IDD waivers from across the nation were examined to determine if and how states permitted restraint, restrictive interventions, and seclusion. Findings revealed an overwhelming majority of waivers permitted the use of restraint (78.4%) and restrictive interventions (75.7%). A smaller proportion (24.3%) allowed the use of seclusion.
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Affiliation(s)
- Carli Friedman
- Carli Friedman, The Council on Quality and Leadership; and Caitlin Crabb, Department of Disability and Human Development, University of Illinois at Chicago
| | - Caitlin Crabb
- Carli Friedman, The Council on Quality and Leadership; and Caitlin Crabb, Department of Disability and Human Development, University of Illinois at Chicago
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Yoo A, Kim M, Ross MM, Vaughn-Lee A, Butler B, dosReis S. Engaging Caregivers in the Treatment of Youth with Complex Developmental and Mental Health Needs. J Behav Health Serv Res 2018. [DOI: 10.1007/s11414-018-9604-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Rizzi M, Trezza A, Messina G, De Benedictis A, Franzini A, Marras CE. Exploring the brain through posterior hypothalamus surgery for aggressive behavior. Neurosurg Focus 2017; 43:E14. [DOI: 10.3171/2017.6.focus17231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neurological surgery offers an opportunity to study brain functions, through either resection or implanted neuromodulation devices. Pathological aggressive behavior in patients with intellectual disability is a frequent condition that is difficult to treat using either supportive care or pharmacological therapy. The bulk of the laboratory studies performed throughout the 19th century enabled the formulation of hypotheses on brain circuits involved in the generation of emotions. Aggressive behavior was also studied extensively. Lesional radiofrequency surgery of the posterior hypothalamus, which peaked in the 1970s, was shown to be an effective therapy in many reported series. As with other surgical procedures for the treatment of psychiatric disorders, however, this therapy was abandoned for many reasons, including the risk of its misuse. Deep brain stimulation (DBS) offers the possibility of treating neurological and psychoaffective disorders through relatively reversible and adaptable therapy. Deep brain stimulation of the posterior hypothalamus was proposed and performed successfully in 2005 as a treatment for aggressive behavior. Other groups reported positive outcomes using target and parameter settings similar to those of the original study. Both the lesional and DBS approaches enabled researchers to explore the role of the posterior hypothalamus (or posterior hypothalamic area) in the autonomic and emotional systems.
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Affiliation(s)
- Michele Rizzi
- 1Functional Neurosurgery Unit, Department of Neurosurgery, IRCCS Foundation “Istituto Neurologico Carlo Besta,” Milan
- 3“Claudio Munari” Center for Epilepsy Surgery, Niguarda Hospital, Milan
| | - Andrea Trezza
- 4Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome; and
- 5Division of Neurosurgery, Department of Surgery and Translational Medicine, Milan Center for Neuroscience, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Messina
- 1Functional Neurosurgery Unit, Department of Neurosurgery, IRCCS Foundation “Istituto Neurologico Carlo Besta,” Milan
| | - Alessandro De Benedictis
- 4Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome; and
| | - Angelo Franzini
- 1Functional Neurosurgery Unit, Department of Neurosurgery, IRCCS Foundation “Istituto Neurologico Carlo Besta,” Milan
| | - Carlo Efisio Marras
- 4Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome; and
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21
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Devinsky O, Asato M, Camfield P, Geller E, Kanner AM, Keller S, Kerr M, Kossoff EH, Lau H, Kothare S, Singh BK, Wirrell E. Delivery of epilepsy care to adults with intellectual and developmental disabilities. Neurology 2015; 85:1512-21. [PMID: 26423430 PMCID: PMC4631073 DOI: 10.1212/wnl.0000000000002060] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/28/2015] [Indexed: 11/15/2022] Open
Abstract
Epilepsy is common in people with intellectual and developmental disabilities (IDD). In adulthood, patients with IDD and epilepsy (IDD-E) have neurologic, psychiatric, medical, and social challenges compounded by fragmented and limited care. With increasing neurologic disability, there is a higher frequency of epilepsy, especially symptomatic generalized and treatment-resistant epilepsies. The causes of IDD-E are increasingly recognized to be genetic based on chromosomal microarray analysis to identify copy number variants, gene panels (epilepsy, autism spectrum disorder, intellectual disability), and whole-exome sequencing. A specific genetic diagnosis may guide care by pointing to comorbid disorders and best therapy. Therapy to control seizures should be individualized, with drug selection based on seizure types, epilepsy syndrome, concomitant medications, and comorbid disorders. There are limited comparative antiepileptic drug data in the IDD-E population. Vagus nerve and responsive neural stimulation therapies and resective surgery should be considered. Among the many comorbid disorders that affect patients with IDD-E, psychiatric and sleep disorders are common but often unrecognized and typically not treated. Transition from holistic and coordinated pediatric to adult care is often a vulnerable period. Communication among adult health care providers is complex but essential to ensure best care when these patients are seen in outpatient, emergency room, and inpatient settings. We propose specific recommendations for minimum care standards for people with IDD-E.
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Affiliation(s)
- Orrin Devinsky
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN.
| | - Miya Asato
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Peter Camfield
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Eric Geller
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Andres M Kanner
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Seth Keller
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Michael Kerr
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Eric H Kossoff
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Heather Lau
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Sanjeev Kothare
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Baldev K Singh
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
| | - Elaine Wirrell
- From New York University School of Medicine (O.D., H.L., S.K.), New York; Children's Hospital of Pittsburgh of UPMC (M.A.), PA; IWK Heath Centre and Dalhousie University (P.C.), Halifax, Canada; Saint Barnabas Medical Center (E.G.), Livingston, NJ; University of Miami Miller School of Medicine (A.M.K.), FL; Advocare Neurology of South Jersey (S.K.), Lumberton, NJ; Welsh Centre for Learning Disabilities (M.K.), Cardiff University, Cathays, Cardiff, UK; Johns Hopkins Hospital (E.H.K.), Baltimore, MD; New York Medical College (B.K.S.), New York; and Mayo Clinic Hospital (E.W.), Rochester, MN
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Cimera RE, Avellone L, Feldman-Sparber C. An investigation of the outcomes achieved by individuals with intellectual disabilities and mental illnesses. JOURNAL OF VOCATIONAL REHABILITATION 2015. [DOI: 10.3233/jvr-150762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Willner P. The neurobiology of aggression: implications for the pharmacotherapy of aggressive challenging behaviour by people with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:82-92. [PMID: 24467721 DOI: 10.1111/jir.12120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2013] [Indexed: 06/03/2023]
Abstract
AIM The aim of this review is to summarise current understanding of the neurobiology of aggression and within this context to consider the evidence base for the pharmacotherapy of aggressive challenging behaviour by people with intellectual disabilities (ID). EVIDENCE Aggressive encounters involve a variety of psychological processes and progress has been made in understanding the brain mechanisms involved. However, the role in aggression of the neurotransmitters serotonin, dopamine and γ-aminobutyric acid is no longer as clear as it once appeared, with the result that predictions cannot be made with confidence about drug effects on aggression. There have been relatively few controlled trials of pharmacotherapy for aggression in people with ID, or, indeed, in the general population, and their outcomes have largely been negative. CONCLUSION With the possible exception of risperidone, there is no reliable evidence that antidepressant, neuroleptic or anticonvulsant drugs are effective treatments for aggression by people with ID.
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Affiliation(s)
- Paul Willner
- Department of Psychology, Swansea University, Swansea, UK
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24
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Fisher WW, Greer BD, Querim AC, DeRosa N. Decreasing excessive functional communication responses while treating destructive behavior using response restriction. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:2614-2623. [PMID: 25036315 DOI: 10.1016/j.ridd.2014.06.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 06/25/2014] [Indexed: 06/03/2023]
Abstract
Functional communication training (FCT) is an established treatment for destructive behavior that missucceeds in about 37% of cases when the reinforcement schedule for the functional communication response (FCR) is thinned using multiples schedules (mult FCT; Hagopian, Boelter, & Jarmolowicz, 2011). In this investigation, we evaluated the use of response restriction FCT (RR FCT) in a cohort of patients with poorly differentiated responding of the FCR during mult FCT. Results showed that (a) RR FCT maintained high rates of correct FCRs during the reinforcement component of RR FCT without increasing destructive behavior; (b) children displayed highly discriminated FCRs when an FCR card and a control card were simultaneously available during the reinforcement component of RR FCT; and (c) near-zero rates of destructive behavior were observed during the last five sessions of the terminal reinforcement schedule. Results are discussed relative to differences between mult FCT and RR FCT and successive and simultaneous discriminations.
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Affiliation(s)
- Wayne W Fisher
- University of Nebraska Medical Center's Munroe-Meyer Institute, 985450 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Brian D Greer
- University of Nebraska Medical Center's Munroe-Meyer Institute, 985450 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Angie C Querim
- University of Nebraska Medical Center's Munroe-Meyer Institute, 985450 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Nicole DeRosa
- University of Nebraska Medical Center's Munroe-Meyer Institute, 985450 Nebraska Medical Center, Omaha, NE 68198, USA
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25
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Chaïb LS, Crocker AG. The role of personality in aggressive behaviour among individuals with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:1015-1031. [PMID: 23701467 DOI: 10.1111/jir.12032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/02/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Aggressive behaviour is associated with certain personality traits in both the general population and among individuals with mental health problems, but little attention has been paid to the relationship between aggressive behaviour and personality among individuals with intellectual disabilities (ID). The aim of this study was to circumscribe personality profiles associated with aggressive behaviour among individuals with ID. METHOD In this cross-sectional study of 296 adults with mild or moderate ID, information on mental health, personality and aggressive behaviour was gathered through structured interviews with the ID participants and their case manager, and a review of client files. RESULTS The results of the Reiss Profile were submitted to hierarchical cluster analysis method. Subsequently, the distribution of aggressive behaviour, sociodemographic characteristics and clinical characteristics across personality profiles was analysed. The analyses yielded seven distinct personality profiles in relation to patterns of aggressive behaviour: Pacifists, Socials, Confidents, Altruists, Conformists, Emotionals and Asocials. CONCLUSION The identification of distinct personality profiles sheds light on the risk factors for aggressive behaviour, and suggests new approaches to improving diagnostic and intervention strategies.
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Affiliation(s)
- L S Chaïb
- Douglas Hospital Research Centre, Montreal, Quebec, Canada; Département de Psychologie, Université de Sherbrooke, Quebec, Canada
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Campbell M, Robertson A, Jahoda A. Psychological therapies for people with intellectual disabilities: comments on a matrix of evidence for interventions in challenging behaviour. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:172-188. [PMID: 23106865 DOI: 10.1111/j.1365-2788.2012.01646.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/15/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Psychological therapies with a proven efficacy in the general population are being adapted for use with people who have intellectual disabilities in community settings. METHODS A systematic review of peer-reviewed literature published between 1980 and 2010 was carried out, to identify the evidence base for effective psychological interventions in challenging behaviour. Relevant databases were searched using applied key terms. Evidence was graded, according to the quality of the research. A best-evidence Matrix was produced to improve guidance for service providers and practitioners in the range, volume and quality of psychological interventions. RESULTS There is a limited amount of efficacy research that meets the most stringent standards of empirical evidence. CONCLUSIONS It is important to broaden the evidence base and consider the context of psychological interventions, alongside the values underpinning care and treatment.
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Affiliation(s)
- M Campbell
- School of Psychology & Neuroscience, University of St. Andrews, St. Andrews, Fife, UK
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Brown JF, Brown MZ, Dibiasio P. Treating Individuals With Intellectual Disabilities and Challenging Behaviors With Adapted Dialectical Behavior Therapy. JOURNAL OF MENTAL HEALTH RESEARCH IN INTELLECTUAL DISABILITIES 2013; 6:280-303. [PMID: 23914278 PMCID: PMC3725667 DOI: 10.1080/19315864.2012.700684] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Approximately one third of adults with intellectual and developmental disabilities have emotion dysregulation and challenging behaviors (CBs). Although research has not yet confirmed that existing treatments adequately reduce CBs in this population, dialectical behavior therapy (DBT) holds promise, as it has been shown to effectively reduce CBs in other emotionally dysregulated populations. This longitudinal single-group pilot study examined whether individuals with impaired intellectual functioning would show reductions in CBs while receiving standard DBT individual therapy used in conjunction with the Skills System (DBT-SS), a DBT emotion regulation skills curriculum adapted for individuals with cognitive impairment. Forty adults with developmental disabilities (most of whom also had intellectual disabilities) and CBs, including histories of aggression, self-injury, sexual offending, or other CBs, participated in this study. Changes in their behaviors were monitored over 4 years while in DBT-SS. Large reductions in CBs were observed during the 4 years. These findings suggest that modified DBT holds promise for effectively treating individuals with intellectual and developmental disabilities.
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Affiliation(s)
- Julie F. Brown
- Justice Resource Institute-Integrated Clinical Services, Warwick, Rhode Island
| | | | - Paige Dibiasio
- Justice Resource Institute, Supports to Empower People (STEP), Cranston, Rhode Island
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Heyvaert M, Maes B, Van den Noortgate W, Kuppens S, Onghena P. A multilevel meta-analysis of single-case and small-n research on interventions for reducing challenging behavior in persons with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:766-780. [PMID: 22100975 DOI: 10.1016/j.ridd.2011.10.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 10/11/2011] [Indexed: 05/31/2023]
Abstract
The effectiveness of different interventions for challenging behavior (CB) in persons with intellectual disabilities (ID) was reviewed by means of a two-phase study. First, a systematic review of 137 meta-analyses and reviews on group-study interventions for CB in persons with ID was conducted. Based on this review, hypotheses concerning the effectiveness of divergent interventions for CB and concerning the impact of variables moderating treatment effectiveness were systematically generated. Second, these hypotheses were tested by means of a multilevel meta-analysis of single-case and small-n research. Two hundred and eighty-five studies reporting on 598 individuals were examined. The average treatment effect was large and statistically significant. However, this effect varied significantly over the included studies and participants. Compared to the meta-analyses and reviews focusing on group-studies in this research domain, the results of the present multilevel meta-analysis of single-case and small-n intervention research provided more detailed knowledge on which specific CB and intervention components moderate the interventions' effectiveness.
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Affiliation(s)
- M Heyvaert
- Faculty of Psychology and Educational Sciences, Katholieke Universiteit Leuven, Belgium.
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Scheifes A, Stolker JJ, Egberts ACG, Nijman HLI, Heerdink ER. Representation of people with intellectual disabilities in randomised controlled trials on antipsychotic treatment for behavioural problems. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2011; 55:650-664. [PMID: 21155914 DOI: 10.1111/j.1365-2788.2010.01353.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Behavioural problems are common in people with intellectual disability (ID) and are often treated with antipsychotics. AIM To establish the frequency and characteristics of people with ID included in randomised controlled trials (RCTs) on antipsychotic treatment for behavioural problems, and to investigate the quality of these RCTs. METHODS A literature search in EMBASE, PubMed and Cochrane was performed and reviewed. RESULTS People with ID participated in 27 of the 100 included RCTs. The RCTs were of good quality but smaller compared with trials in patients with dementia or schizophrenia (average sample sizes = 55, 124 and 374). In 13/27 trials no clear definition of ID was given. Over 25 different outcome measures were used to assess behavioural problems. CONCLUSIONS Studies in which people with ID are included are of a sufficient quality, but of a small size. The heterogeneity in the characteristics of the ID population included as well as in the applied assessment instruments makes performing meta-analyses unfeasible.
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Affiliation(s)
- A Scheifes
- Altrecht Institute for Mental Health Care, Den Dolder, the Netherlands
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Heyvaert M, Maes B, Onghena P. A meta-analysis of intervention effects on challenging behaviour among persons with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2010; 54:634-649. [PMID: 20492347 DOI: 10.1111/j.1365-2788.2010.01291.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Persons with intellectual disabilities (ID) often show challenging behaviour. We review distinct interventions that are applied to treat these challenging behaviours, and analyse intervention effects and moderating variables. METHODS A literature search was conducted using the databases ERIC, PsycINFO, Web of Science and Medline. A random-effects meta-analysis was carried out, supplemented with sensitivity, subgroup, meta-regression and publication bias analyses. RESULTS Eighty potential articles were identified, from which 30 contained sufficient data to enable statistical meta-analysis. From these 30 studies, 18 described a biological, 13 a psychotherapeutic and nine a contextual intervention, either applied alone or combined. The overall standardised mean difference was 0.671 (SD = 0.051). As shown by sensitivity analysis, this summary effect size is robust. Assessed through subgroup and meta-regression analysis, all tested moderators showed no statistically significant association with the treatment effects. After applying a funnel plot-, a fail-safe N-, and Duval's and Tweedie's trim and fill-analysis, we conclude that our meta-analysis does not suffer much from publication bias effects. CONCLUSIONS Several biological, psychotherapeutic and contextual interventions effectively reduce challenging behaviours among persons with ID.
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Affiliation(s)
- Mieke Heyvaert
- Centre for Methodology of Educational Research, Department of Educational Sciences, Katholieke Universiteit Leuven, Belgium.
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Sarà M, Pistoia F. Defining consciousness: lessons from patients and modern techniques. J Neurotrauma 2009; 27:771-3. [PMID: 19323609 DOI: 10.1089/neu.2008-0804] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marco Sarà
- Istituto San Raffaele, Post-Coma Intensive and Rehabilitation Care Unit, Cassino, Italy
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