Patterns of intellectual, adaptive and behavioral functioning in individuals with mild mental retardation

The effects of easy goals versus difficult goals on acquisition and retention of a sport skill in children with intellectual disability

The purpose of the present study was to examine the effects of easy goals versus difficult goals on acquisition and retention of basketball free throws in children with intellectual disability. Twenty-one children with intellectual disability were randomly assigned to an easy goals or difficult goals group. The participants were required to improve their basketball free throws according to their own scores in the previous exercise session. More difficult goals were set for the difficult goals group than for the easy goals group. The groups exercised the task for nine sessions. Both groups performed pretest, acquisition, and retention tests. Results showed that participants with easy goals improved their performance while the participants with difficult goals failed to improve their performance. These findings indicate that providing children with intellectual disability with easy goals facilitates the process of sport skill learning.

The reliability and validity of the Adaptive Functioning Assessment Tool in UK custodial settings

Adaptive functioning (AF) has been overlooked in the assessment of intellectual disability within the UK Prison Service, primarily because there are no reliable and valid measures of AF suitable for use with prison populations. This position is incompatible with the obligation of Her Majesty's Prison and Probation Service to provide specialist interventions for individuals with intellectual disabilities. This study assessed the psychometric properties of the Adaptive Functioning Assessment Tool (AFAT), a new measure of AF developed for use in prisons. The AFAT was completed on 61 participants (mean age 41, standard deviation 11.8). Internal consistency was tested using Cronbach's α. Construct validity was assessed using linear regression and a Receiver Operator Characteristic analysis. The findings provide evidence to support the AFAT being a reliable and valid measure of AF in prison populations.

The Game of Life soccer program: Effect on skills, physical fitness and mobility in persons with intellectual disability and autism spectrum disorder

BACKGROUND

Soccer is the world's most popular sport. The present authors evaluated the effect of the Game of Life (GOL) soccer initiative on soccer skills, fitness and mobility of adults with intellectual disability (ID) and autism spectrum disorder (ASD).

METHODS

The programme is comprised of once-weekly sessions.

OUTCOMES

soccer skills, fitness and mobility. Effectiveness was evaluated using within-/between-group analyses (e.g. effect size, ES).

RESULTS

Fifty adults with intellectual disability and 19 with ASD (age = 31.80 ± 10.11) participated in this study. From pre-test to post-test, the intellectual disability group improved their soccer skills (ES = 0.437); physical fitness-the intellectual disability group presented trivial ESs, whereas the ASD group showed moderate-to-large ESs; Mobility-only the ASD group presented a significant improvement (ES=-0.435), and the intellectual disability group presented better ability in most outcomes in pre- and post-tests.

CONCLUSION

The findings indicated differences in entry-level performance and training impact between the two groups. This should be considered when developing training programmes for soccer players.

Identifying Needs-Based Groupings Among People Accessing Intellectual Disability Services

There is increasing emphasis on needs-led service provision for people with intellectual disability (ID). This study outlines the statistical cluster analysis of clinical data from 1,692 individuals accessing secondary care ID services in the United Kingdom (U.K.) Using objective needs assessment data from a newly developed ID assessment tool, six clusters were identified. These had clinical face validity and were validated using six concurrently (but independently) rated tools. In keeping with previous studies, the clusters varied in terms of overall level of need as well as specific clinical features (autism spectrum disorder, mental health problems, challenging behaviors and physical health conditions). More work is now needed to further develop these clusters and explore their utility for planning, commissioning and optimizing needs-led services.

Meeting the support needs of persons with mild intellectual disability or borderline intellectual functioning: still a long way to go

BACKGROUND

Among persons with a mild intellectual disability or borderline intellectual functioning, differences in their characteristics imply that a differentiated approach is required to meet their needs. This retrospective study examined whether the history of support/treatment programs and the type of healthcare providers involved matched the specific support needs of persons with a mild intellectual disability or borderline intellectual functioning.

METHOD

Five (previously identified) profiles of persons with a mild intellectual disability or borderline intellectual functioning were used to investigate to what extent the support needs of this group had been met. For the 250 persons with mild intellectual disability or borderline intellectual functioning who matched these five profiles, data were collected retrospectively from their case files.

RESULTS

Persons with mild intellectual disability or borderline intellectual functioning received a very similar amount and type of support/treatment programs. Differences between the profiles were found for non-verbal therapy, residential treatment and contacts with social work. Regarding the type of healthcare providers involved, differences between the profiles emerged for specialised intellectual disability services, youth services and specialised addiction services.

CONCLUSIONS

The support programs for a heterogeneous population of persons with mild intellectual disability or borderline intellectual functioning seem to be suboptimal, indicating that more differentiation is required in the services offered to these individuals.

Identifying classes of persons with mild intellectual disability or borderline intellectual functioning: a latent class analysis

BACKGROUND

Persons with mild intellectual disability or borderline intellectual functioning are often studied as a single group with similar characteristics. However, there are indications that differences exist within this population. Therefore, the aim of this study was to identify classes of persons with mild intellectual disability or borderline intellectual functioning and to examine whether these classes are related to individual and/or environmental characteristics.

METHODS

Latent class analysis was performed using file data of 250 eligible participants with a mean age of 26.1 (SD 13.8, range 3-70) years.

RESULTS

Five distinct classes of persons with mild intellectual disability or borderline intellectual functioning were found. These classes significantly differed in individual and environmental characteristics. For example, persons with a mild intellectual disability experienced fewer problems than those with borderline intellectual disability.

CONCLUSIONS

The identification of five classes implies that a differentiated approach is required towards persons with mild intellectual disability or borderline intellectual functioning.

Challenging behavior, functioning difficulties, and quality of life of adults with intellectual disabilities

Objective: The current study aimed at examining the correlations between challenging behaviors, difficulties in functioning, and quality of life in institutionalized adults with intellectual disabilities. Methods: A sample of 53 people with intellectual disabilities and challenging behavior who resided in a large institutional care facility was recruited. The research questionnaire included the following instruments: (1) The challenging behavior scale; (2) The World Health Organization Disability Assessment Schedule 2.0; and (3) The Personal Well-Being Index. Results: No significant correlation was found between challenging behavior and quality of life. However, more challenging behavior found to be correlated with greater difficulties in functioning. Furthermore, a weak correlation was found between difficulties in functioning and quality of life. Participants who had greater difficulty functioning tended to exhibit lower levels of quality of life. No significant associations were found between the sample's personal characteristics (gender, age, and the severity of intellectual disability) and challenging behavior, difficulties in functioning, and quality of life. Conclusion: Empowering personal functioning of people with intellectual disabilities is important in planning rehabilitation interventions. Such interventions are likely to promote a higher quality of life. There is the need for future research to further investigate the relationship found in this study.

Adaptive profiles in autism and other neurodevelopmental disorders

We investigated the influence of specific autism spectrum disorder (ASD) deficits in learning adaptive behaviour, besides intelligence quotient (IQ). Participated 217 school-aged: ASD (N = 115), and other neurodevelopmental disorders (OND) groups (N = 102) matched by Full-Scale IQ. We compared standard scores of Vineland Adaptive Behaviour Scale (VABS) in communication, daily living skills, socialization and adaptive behaviour composite. Pearson-correlation analysis was performed between each domain of VABS and Full-Scale, Verbal and Performance IQ, and chronological age (CA). Results indicated that impairment in adaptive behaviour within the domain of socialization skills remains a distinctive factor of ASD versus OND, independently of intellectual disability (ID). Co-occurring ID result in further debilitating effects on overall functioning, especially in ASD. CA is negatively associated with VABS scores.

The diagnostic adaptive behavior scale: evaluating its diagnostic sensitivity and specificity

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

The role of personality in aggressive behaviour among individuals with intellectual disabilities

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.

More than intelligence: distinct cognitive/behavioral clusters linked to adaptive dysfunction in children

Impairments in adaptive functioning are frequently associated with intellectual disability (ID); however, adaptive dysfunction can be seen in many individuals with a variety of neurological conditions without ID. The extent to which other variables may be associated with adaptive dysfunction is unclear. In a mixed clinical sample of children (n = 348) consecutively referred for neuropsychological evaluation, the majority were rated as showing weak adaptive skills (ABAS-II, >1 SD below the mean; 71%), with a substantial proportion evidencing frank impairment (>2 SD below the mean, 45%). We examined patterns of scores on measures of intelligence (WISC-IV) and behavioral/affective dysregulation (BRIEF and BASC-2). Using hierarchical cluster analysis, a four cluster model yielded the most appropriate fit and adaptive functioning was subsequently examined across clusters. As expected, adaptive functioning was most intact in the cluster characterized by average IQ and minimal behavioral dysregulation. Other clusters were marked by adaptive dysfunction and distinguished by sub-average intellectual functioning and varying behavioral/emotional dysregulation. In contrast to traditional views associating low IQ with adaptive dysfunction, adaptive impairment was comparable between the cluster characterized by low intelligence and the cluster with average intelligence but significant behavioral dysregulation. These data suggest that adaptive functioning should be considered across various cognitive/behavioral conditions.

An examination of specific daily living skills deficits in adults with profound intellectual disabilities

While some researchers have investigated daily living skills deficits in individuals with intellectual disability (ID) as a whole, research on specific daily living skills in a profound ID population is limited. Two hundred and four adults with profound ID residing in two large developmental centers in the southeast portion of the United States were studied. Data were collected on these individuals' daily living skills, utilizing the Vineland Adaptive Behavior Scales (VABS). Three dependent t-tests were conducted comparing the proportion of items endorsed by informants on each of the three subdomains of daily living skills on the VABS (personal, domestic, and community). A significantly larger proportion of Personal Subdomain items were endorsed compared to Domestic or Community Subdomain items. Additionally, participants exhibited a significantly larger proportion of Domestic Skills Subdomain items compared to Community Skills Subdomain items which is consistent with theoretical models suggesting that institutional living may curb broader community skill sets. No gender differences were found in daily living skills. Lastly, individuals between the ages 30 and 39 exhibited significantly more Personal Subdomain skills than individuals who were 60 or older, while participants between the ages 30 and 39 exhibited significantly more Domestic Subdomain skills than individuals between the ages 60 and 69.

An examination of specific communication deficits in adults with profound intellectual disabilities

Previous research has shown that adults with intellectual disability (ID) evince communication deficits. These communication problems can be divided into problems with receptive, expressive, and written domains. While much research has been devoted to investigating communication deficits in ID in general, scant research has been conducted on communication skills in specific levels of ID. This study examined 204 adults with profound ID residing in two large supports and services centers in the southeastern region of the United States. Data was collected on these individuals' receptive, expressive, and written communication skills using the Vineland Adaptive Behavior Scales (VABS). Three dependent t-tests were conducted comparing the proportion of items endorsed by informants on each of the three communication subdomains (receptive, expressive, and written) with one another. Participants displayed a significantly larger proportion of receptive subdomain items than expressive subdomain items, t(203) = 20.00, p < 0.01, and written subdomain items, t(203) = 20.53, p < 0.01. Additionally, it was found that the individuals exhibited a significantly larger proportion of expressive subdomain items than written subdomain items, t(203) = 10.80, p < 0.01. The implications of these findings are discussed.

Pathways to Care of Individuals With Mild Intellectual Disability

This study investigated whether clinical profiles in individuals with mild intellectual disability (MID) could be defined in terms of their histories (e.g., behavioral, social-environmental, educational, and service use characteristics). The clinical psychologists administered the Diagnostic Interview for Social and Communication Disorders to the (substitute) parents and analyzed the clinical records of individuals with MID. Four subtypes of individuals with MID with specific clinical profiles participated in this study. The results of this study, which used discriminant analysis of the individuals’ histories, supported two discriminant functions. The first discriminant function differentiated clinical profiles largely based on developmental disorders from clinical profiles based on personality disorders. The second function differentiated clinical profiles based on personality disorders and externalizing behavioral problems from other clinical profiles. The characteristics in the histories of individuals with MID can be very different and need to be assessed for further understanding of their unique needs.

The relationship between psychopathology symptom clusters and the presence of comorbid psychopathology in individuals with severe to profound intellectual disability

In the typically developing population, comorbid psychopathology refers to the co-occurrence of two different psychopathologies other than cognitive impairments. With respect to individuals with intellectual disability, comorbidity is often described as cognitive deficits and one additional psychopathology manifesting together. However, just as within the typically developing population, individuals with intellectual disability may also present with symptoms of two or more additional disorders. The presentation of these symptom clusters may similarly correlate. Therefore, the current study used the Diagnostic Assessment for the Severely Handicapped-II in order to examine relationships between psychopathological symptom clusters in adults with severe to profound intellectual disability. Additionally, we assessed comorbid presentation of disorders other than cognitive impairments in these same adults. Several symptom clusters were identified as being related with moderate to strong positive correlations. Furthermore, elevations on the Impulse subscale were noted to be the most prevalent in the current sample, with comorbid elevations most commonly occurring along the Mood, Mania, and Anxiety subscales. The significance of these findings is discussed.

What is the evidence for environmental causes of challenging behaviors in persons with intellectual disabilities and autism spectrum disorders?

An extensive literature on the causes of challenging behaviors has been developed, primarily in the applied behavior analysis literature. One hundred and seventy-three empirical studies were reviewed where functional assessment serves as the primary method of identifying these causes. Most of the studies were able to identify a clear function or functions. Most commonly established causes were attention, the efforts to acquire tangibles, negative reinforcement in the form of escape from tasks or environments, and sensory stimulation, also described as an alone condition. Examples are provided regarding how these conditions are investigated across studies. Biological and cognitive causes have also been demonstrated. However, to date the empirical literature is limited with the bulk of studies being correlational. Considerably more research is needed, but some causes and methods to identify them are beginning to emerge.

Incidence and trends in psychopathology symptoms over time in adults with severe to profound intellectual disability

Individuals with intellectual disability (ID) have a high risk for developing comorbid psychopathology. While researchers have shown that symptoms of psychopathology remain relatively stable in children with ID over time, little research has been conducted to demonstrate symptom stability for adults with ID. Incidence of psychopathology symptoms was examined in 124 adults with severe to profound ID. Then, trends in symptoms of psychopathology over time were studied in 74 of those individuals who had data collected quarterly over the span of one year. Data from the Diagnostic Assessment for the Severely Handicapped-Second Edition (DASH-II) were evaluated for each of the 13 subscales, as well as the total DASH-II score. For all of the scales except PDD/Autism, symptoms did not fluctuate significantly over the one year period. The PDD/Autism scale revealed a significant change in symptoms from Time 1 to Time 3. The implications of these results are discussed.

Assessment of toileting difficulties in adults with intellectual disabilities: an examination using the profile of toileting issues (POTI)

A lack of toileting skills is one of many impairments that individuals with intellectual and developmental disabilities experience. Unfortunately, little research has focused on problems in this area including assessment, function, and treatment. A newly developed checklist, the Profile of Toileting Issues (POTI), is being considered for use to screen for toileting issues in this population, and to identify potential functions to target in treatment. The purpose of the current study was to examine the reliability of the POTI. Internal consistency was sound (α = .83) and interrater reliability was significant. The implications of these findings are included.

The use of clozapine among individuals with intellectual disability: a review

Clozapine has been approved in the United States since 1990 for refractory or treatment resistant schizophrenia in the general population. However, as with many other antipsychotic medications, it is being prescribed for reasons other than those indicated. Among individuals with intellectual disabilities, clozapine is increasingly being prescribed to treat behavioral problems, although the empirical evidence for such a practice is lacking. This review was undertaken as an attempt to summarize the available studies regarding the use of clozapine for behavioral purposes among individuals with intellectual disabilities. Findings of our review suggest that the effectiveness of clozapine in targeting challenging behaviors among individuals with intellectual disabilities is relatively inconclusive at present. We discuss reasons why these limitations exist and offer some solutions to help alleviate these limitations.

Examination of adaptive behavior differences in adults with autism spectrum disorders and intellectual disability

Autism spectrum disorders (ASD) and intellectual disabilities (ID) are high prevalence developmental disabilities that co-occur at high rates. Furthermore, Axis I psychopathology is known to occur more frequently in individuals with ID than the general population. The problems are lifelong and can be major impediments to independent living. Despite this, little research with adults is available to determine the effects of these disabilities on specific adaptive skills. In this study, 337 adults were evaluated using the Vineland Adaptive Behavior Scale to assess the effects of these disabilities on looking at an ID, ID plus ASD, and ID and ASD plus Axis I psychopathology group. Adaptive skills were greatest for the ID group followed by the ID plus ASD, and ID and ASD plus psychopathology. Thus, the more handicapping conditions, the greater the skills deficits observed, particularly where psychopathology was concerned. As such, accurately identifying the causes of adaptive skill deficits will likely result in more precise and effective treatment.