A critical item analysis of the QABF: development of a short form assessment instrument

Psychosocial interventions for older people with intellectual disabilities and the role of support staff: A systematic review

Background

The life expectancy of people with intellectual disabilities has increased. The implications of ageing have resulted in changes in their support needs and challenges to support staff. Access to evidence based strategies for support staff providing care to elderly with intellectual disabilities remains scarce. A systematic review was conducted to provide an overview of available psychosocial interventions.

Methods

Four databases were searched and assessed according to the PRISMA guidelines. A narrative, integrative method of analysis was conducted to synthesise quantitative and qualitative data.

Results

The 36 studies included in the review reported on interventions aimed at either identifying and meeting the needs or perceptions of older individuals or at improving their behaviour and skills. Furthermore, the role of support staff in the implementation of interventions was either active, assisting or undefined.

Conclusions

This overview of studies could contribute to the existing body of knowledge and help to optimise psychosocial support for a growing population.

Comprehensive Assessment of Triggers for Behaviours of Concern Scale (CATS): Initial Development

Challenging behaviour displayed by people with intellectual disabilities (ID) can be difficult to manage if caregivers do not understand the reasons for the behaviour. Identifying the contextual variables/triggers for the behaviour is likely to help undertake a functional analysis leading to a person-centred positive behaviour support plan. Currently, a limited number of checklists are available for trigger assessment and none were developed using an interview with the family caregivers. This article describes the development and contents of the comprehensive assessment of triggers for behaviours of concern scale (CATS). CATS was developed in two stages. Stage 1 used a ‘bottom-up’ approach, in which caregivers of adults with ID who show aggressive behaviour were interviewed to identify the triggers for aggression. In stage two, using a ‘top-down’ approach, a comprehensive literature review was conducted to gather items from existing trigger checklists. Trigger items from both stages were combined and the duplicates were removed. The final list in CATS consists of 333 contextual triggers categorised under five main domains and 12 subdomains. CATS can be used by caregivers to identify triggers or antecedents of challenging behaviour. Further work is needed to test its psychometric properties, utility, and acceptability.

Enhancing the Lives of Foster Youth with Behavioral Interventions

As members of state-funded team to monitor psychotropic medication use and examine cost-effective methods for behavioral treatment in foster care, the authors review behavioral studies on interventions for foster youth who engage in challenging behavior. Four behavioral technologies-preference assessments, teaching procedures, functional behavioral assessment and intervention, and parent training-are discussed. Four case studies and behavioral data for foster youth treated using these technologies are provided. Finally, pediatric providers are encouraged to recommend a practitioner with specialized training in behavior analysis to foster parents if a child displays disruptive behavior.

A data-driven method for identifying shorter symptom criteria sets: the case for DSM-5 alcohol use disorder

BACKGROUND

Although the DSM is a widely used diagnostic guide, lengthy criteria sets can be problematic and provide the primary motivation to identify short-forms. Using the 11 diagnostic criteria provided by the DSM-5 for alcohol use disorder (AUD), the present study develops a data-driven method to systematically identify subsets and associated cut-offs that yield diagnoses as similar as possible to use all 11 criteria.

METHOD

Relying on data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III), our methodology identifies diagnostic short-forms for AUD by: (1) maximizing the association between the sum scores of all 11 criteria with newly constructed subscales from subsets of criteria; (2) optimizing the similarity of AUD prevalence between the current DSM-5 rule and newly constructed diagnostic short-forms; (3) maximizing sensitivity and specificity of the short-forms against the current DSM-5 rule; and (4) minimizing differences in the accuracy of the short-form across chosen covariates. Replication is shown using NESARC-Wave 2.

RESULTS

More than 11 000 diagnostic short-forms for DSM-5 AUD can be created and our method narrows down the optimal choices to eight. Results found that 'Neglecting major roles' and 'Activities given up' could be dropped with practically no change in who is diagnosed (specificity = 100%, sensitivity ⩾ 99.6%) or the severity of those diagnosed (κ = 0.97).

CONCLUSIONS

With a continuous improvement model adopted by the APA for DSM revisions, we offer a data-driven tool (a SAS Macro) that identifies diagnostic short-forms in a systematic and reproducible way to help advance potential improvements in future DSM revisions.

RETRACTED: Functional variables of challenging behavior in individuals with intellectual disabilities

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor in Chief, after review by an independent panel of experts, due to evidence of a compromised peer review process and the failure of one author to disclose significant conflicts of interest. An independent peer-review process is a cornerstone of scientific integrity that allows for research to be scrutinized before publication to ensure that conclusions are anchored in sound methodology and objective interpretation of the results. Equally important is that the readership of research is fully informed about any potential competing interests that may have influenced the research process. This article is being retracted because it did not include a declaration of a conflict of interest of one author in relation to diagnostic tools which the paper endorses. The same author was also the Editor in Chief of the journal at the time of publication and evidence indicates that the paper was accepted without any independent peer review by external reviewers. The article is therefore retracted in accordance with the ethical guidelines of Elsevier: https://www.elsevier.com/about/policies/publishing-ethics and the Committee on Publication Ethics (COPE) https://publicationethics.org/files/retraction-guidelines.pdf.

Antecedent events as predictive variables for behavioral function

Challenging behavior is one of the largest barriers to ensuring that people with intellectual disabilities (ID) are able to participate in the community. These difficulties have become one of the main causes of social exclusion. The research into and treatment of challenging behavior has usually involved the identification of its function and the manipulation of the events or environmental conditions that influence its occurrence (antecedent variables). The present research explores the relationship between antecedents and behavioral function and the extent to which antecedent variables may act as predictors of behavioral function. This relationship is explored using two standardized instruments: Questions About Behavioral Function and Contextual Assessment Inventory. Data from the validation of these instruments for the Spanish population involved 300 participants with ID and 328 challenging behaviors. The results suggest that social/cultural variables are most related to challenging behavior, whereas biological variables seem to only be related to physically maintained behavior.

RETRACTED: Questions About Behavioral Function (QABF): adaptation and validation of the Spanish version

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor in Chief, after review by an independent panel of experts, due to evidence of a compromised peer review process and the failure of one author to disclose significant conflicts of interest. An independent peer-review process is a cornerstone of scientific integrity that allows for research to be scrutinized before publication to ensure that conclusions are anchored in sound methodology and objective interpretation of the results. Equally important is that the readership of research is fully informed about any potential competing interests that may have influenced the research process. This article is being retracted because it did not include a declaration of a conflict of interest of one author in relation to diagnostic tools which the paper endorses. The same author was also the Editor in Chief of the journal at the time of publication and evidence indicates that the paper was accepted without any independent peer review by external reviewers. The article is therefore retracted in accordance with the ethical guidelines of Elsevier: https://www.elsevier.com/about/policies/publishing-ethics and the Committee on Publication Ethics (COPE) https://publicationethics.org/files/retraction-guidelines.pdf.

Autism spectrum disorders and motor skills: the effect on socialization as measured by the Baby And Infant Screen For Children with aUtIsm Traits (BISCUIT)

PURPOSE

To examine the effects of ASD diagnosis and motor skills on socialization in young children.

METHODS

Two samples were used: gross motor skills sample (n = 408) and fine motor skills sample (n = 402). The Battelle Developmental Inventory-Second Edition assessed motor skills, while the Baby and Infant Screen for Children with aUtIsm Traits, Part 1 assessed socialization.

RESULTS

A main effect of diagnosis was found for both samples on socialization such that those with autism exhibited the most severe deficits followed by those with PDD-NOS and then atypically developing children. There was a main effect for gross motor skills, with high gross motor skills showing less social impairment. The interaction term was only significant in regards to fine motor skills.

CONCLUSIONS

The individual effects of ASD diagnosis and motor impairment as well as the interaction have implications for the assessment and treatment in these individuals.

The relationship between race and challenging behaviours in infants and toddlers with autistic disorder and pervasive developmental disorder-not otherwise specified

OBJECTIVE

To examine the contributions of race and diagnostic category to endorsement rates of challenging behaviours in infants and toddlers with autism, PDD-NOS and atypical development without ASD, using the Baby and Infant Screen for Children with aUtIsm Traits, Part-3 (BISCUIT Part-3).

DESIGN

Multivariate analyses of variance (MANOVAs) on each sub-scale of the BISCUIT Part-3. Follow-up univariate analyses and post-hoc tests as needed.

METHODS

Scores on the BISCUIT Part-3 were compared for 453 Caucasian and 409 African-American infants and toddlers, grouped by race and diagnosis.

RESULTS

Significant differences between races were found on five out of 10 aggressive behaviours, while no significant differences were found on self-injurious or stereotypic behaviours. Significant differences between diagnostic groups were found on all behaviours.

CONCLUSION

Cultural factors should be taken into account when examining challenging behaviours in infants and toddlers with ASD.

Symptoms of psychopathology in adults with intellectual disability and seizures

Seizures are more common in individuals with intellectual disabilities than in the general population. As a result, differences in functioning for individuals with intellectual disability with and without seizures have been evaluated. Research on differences in psychopathology for individuals with intellectual disability with and without seizures has been mixed. The purpose of this study was to examine differences in subscale scores on the Diagnostic Assessment for the Severely Handicapped-II (DASH-II) between individuals with intellectual disability with and without seizures. In this study, 321 individuals from two large developmental centers in the southeastern United States were administered the DASH-II. Researchers found that the seizure group endorsed significantly more symptoms on the mood subscale than the group without seizures. No other group differences were found to be significant. Implications of these results are discussed.

The relationship between autism spectrum disorders and symptoms of conduct problems: the moderating effect of communication

OBJECTIVE

To examine the relationship between ASD diagnosis (i.e. Autism, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and atypical developing control) and tantrum/conduct symptoms in infants and toddlers. Then examine the moderating role of communication.

DESIGN

Analysis of Covariance was conducted for study 1 followed by hierarchical regression analyses for study 2.

METHODS

The Baby and Infant Screen for Children with aUtIsm Traits, Part 2 was administered to the caregivers of 774 infants and toddlers.

RESULTS

Those with autism exhibited the greatest tantrum/conduct symptoms followed by those with PDD-NOS and then atypical controls, F(3, 771) =94.42, p=0.003. Communication was not a significant moderator.

CONCLUSIONS

Those with Autistic Disorder exhibited greater symptoms of tantrum/conduct problems, which is consistent with previous research. It seems that the relationship with communication as a moderator may differ in young children as their language skills are still in the early stages of development.

Feeding Therapy in a Child With Autistic Disorder: Sequential Food Presentation

The authors describe a feeding intervention for a 9-year-old male diagnosed with autistic disorder and mild mental retardation (also known as intellectual disability) who experienced food refusal related to food selectivity. Based on the results of a functional behavioral assessment, food refusal was found to be maintained by escape and tangible functions. Therefore, an intervention using escape extinction (i.e., nonremoval of nonpreferred foods with physical guidance as a secondary procedure), positive reinforcement (i.e., preferred foods and toys), and sequential food presentation was implemented. The child was successful in eating many novel foods both within the clinic and home environments. A 1-year follow-up found the effects of treatment to be maintained with significant increases in number of foods eaten and significant decreases in mealtime-related behavioral challenges. The treatment implications, recommendations to clinicians, and areas of future research are 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.

Behaviors and corresponding functions addressed via functional assessment

One-hundred seventy-three studies that employed functional assessment were evaluated with respect to types of challenging behaviors studied and the functions identified that maintained those behaviors. For most studies, two to three behaviors were targeted. Of the 38 different challenging behaviors identified, self-injurious behavior (SIB) and aggression were by far the most studied. Other commonly studied behaviors were tantrums, stereotypies, property destruction, bizarre/inappropriate speech/vocalizations, and disruptive behaviors. The most commonly identified functions for both SIB and aggressions were attention and escape/demands. The implications of these and other data complied on target behaviors and maintaining variables are discussed.

Replacement behaviors for identified functions of challenging behaviors

Functional assessment has become a major feature of learning-based research. A critical element of the majority of these studies includes not only methods and procedures to identify the cause of the challenging behavior, but to establish replacement treatment methods. By far the most common intervention in the 176 studies we reviewed was reinforcement. Noncontingent reinforcement (NCR) was the most common reinforcement method, followed by differential reinforcement of other behavior (DRO). Reinforcement plus extinction was the second most commonly employed treatment followed by functional communication training with or without reinforcement. Researchers proved to be very creative. Forty different treatment methods were employed. The implications of these data are discussed.

Decreasing Work Refusals in an Adult With Intellectual Disability

The authors describe an intervention for work refusals in a 49-year-old man with mild mental retardation, more commonly referred to as mild intellectual disability, and other comorbid Axis I diagnoses. Following a behavioral functional assessment, Intervention A, contingent reinforcement of work attendance with cigarettes and edibles was implemented to increase work attendance. A modified reversal to baseline (Intervention B) retained the contingent reinforcement with edibles but not cigarettes. Following Intervention B, a third intervention (Intervention C) reintroduced contingent reinforcement of work attendance with cigarettes and edibles in addition to a response cost procedure. Contingent reinforcement using the most preferred reinforcer was found to be an effective intervention in increasing work attendance; however, this intervention combined with response cost was found to be superior. Overall, a 45.4% decrease in work refusals was seen from baseline following implementation of contingent reinforcement using cigarettes and edibles (Intervention A), whereas a 65.1% decrease was seen between baseline and contingent reinforcement using cigarettes and edibles combined with response cost (Intervention C). Such decrease in work refusals was maintained during follow-up. Factors responsible for intervention success and implications for clinicians are discussed.

An Examination of Psychotropic Medication Side Effects: does taking a greater number of psychotropic medications from different classes affect presentation of side effects in adults with ID?

This study examined whether the number of psychotropic medications an individual is taking across classes influences side effects among adults with Intellectual Disability (ID). Participants were 80 adults diagnosed with ID. Dependent variables were the composite score and domain scores of the Matson Evaluation of Drug Side-effects (MEDS), which is an instrument used to assess side effects. There were three levels of the independent variable: Group 1--those taking zero psychotropic medications, Group 2--those taking one psychotropic medication, and Group 3--those taking two psychotropic medications across different medication classes. There was a significant main effect regarding number of psychotropic medication classes prescribed. Further analysis revealed that four of the nine MEDS domains had significantly different mean scores for number of psychotropic medication classes. For the majority of MEDS domains, such as Central Nervous System-General, Parkinsonism/Dyskinesia, and Behavioral/Akathesia domains, participants in the no psychotropic medication group had significantly lower mean scores than those in the one and two psychotropic medication groups. Only two MEDS domains, Cardiovascular and Hematologic Effects as well as Skin, Allergies, and Temperature, were significantly different between participants taking one psychotropic medication as compared with two psychotropic medications from different classes. Implications of these findings and recommendations for future research are discussed.

Compliance Training in an Adult With Dementia of the Alzheimer’s Type and Down Syndrome

The authors describe the treatment of noncompliance and public stripping in a 53-year-old man with Down syndrome and dementia. On the basis of a review of the relevant literature and a comprehensive functional behavioral analysis, an intervention procedure utilizing contingent reinforcement of compliance is conducted. Compliance with requests to allow assistance getting dressed is reinforced with a combination of verbal praise, physical contact, and edible reinforcers. Noncompliance decreases by 85.22% at follow-up. Factors responsible for intervention success and implications for clinicians are discussed.

Compliance Training in an Adult With Dementia of the Alzheimer’s Type and Down Syndrome

The authors describe the treatment of noncompliance and public stripping in a 53-year-old man with Down syndrome and dementia. Based on a review of the relevant literature and a comprehensive functional behavioral analysis, an intervention procedure utilizing contingent reinforcement of compliance was conducted. Compliance with requests to allow assistance getting dressed was reinforced with a combination of verbal praise, physical contact, and edible reinforcers. Noncompliance had decreased by 85.22% at follow-up. Factors responsible for intervention success and implications for clinicians are discussed.