Carer reports of the efficacy of cognitive behavioral interventions for anger

Non-pharmacological interventions for challenging behaviours of adults with intellectual disabilities: A meta-analysis

BACKGROUND

Non-pharmacological interventions are recommended for the treatment of challenging behaviours in individuals with intellectual disabilities by clinical guidelines. However, evidence for their effectiveness is ambiguous. The aim of the current meta-analysis is to update the existing evidence, to investigate long-term outcome, and to examine whether intervention type, delivery mode, and study design were associated with differences in effectiveness.

METHOD

An electronic search was conducted using the databases Medline, Eric, PsychINFO and Cinahl. Studies with experimental or quasi-experimental designs were included. We performed an overall random-effect meta-analysis and subgroup analyses.

RESULTS

We found a significant moderate overall effect of non-pharmacological interventions on challenging behaviours (d = 0.573, 95% CI [0.352-0.795]), and this effect appears to be longlasting. Interventions combining mindfulness and behavioural techniques showed to be more effective than other interventions. However, this result should be interpreted with care due to possible overestimation of the subgroup analysis. No differences in effectiveness were found across assessment times, delivery modes or study designs.

CONCLUSIONS

Non-pharmacological interventions appear to be moderately effective on the short and long term in reducing challenging behaviours in adults with intellectual disabilities.

Examining the psychometrics of the Psychopathology Inventory for Mentally Retarded Adults-II for individuals with mild and moderate intellectual disabilities

With growing recognition of the occurrence of psychological disorders in individuals with intellectual disability (ID), researchers and clinicians alike have placed emphasis on developing measures to assess for psychopathologies in this population. Despite an increased interest in the topic, there is still a dearth of psychometrically robust measures available to assess for psychopathology in adults with mild and moderate ID. The purpose of this study was to examine the psychometric properties of a revised measure for psychopathology in individuals with mild and moderate ID, the Psychopathology Inventory for Mentally Retarded Adults - second edition (PIMRA-II). Internal consistency, inter-rater reliability, and test-retest reliability were investigated. Validity was studied via convergent validity by comparing the PIMRA-II to the Assessment of Dual Diagnosis (ADD) and via discriminate validity by comparing the PIMRA-II to the Social Performance Survey Schedule (SPSS) prosocial scores. Lastly, an exploratory factor analysis was conducted to determine the factor structure of the scale.

An evaluation of an emotion regulation programme for people with an intellectual disability

Purpose

– The purpose of this paper is to examine the effectiveness of the Transformers programme on individual's use of appropriate emotion regulation strategies.

Design/methodology/approach

– Five people with an intellectual disability participated in the Transformers programme and took part in the current study. The intervention was evaluated using the Profile of Anger Coping Skills (PACS) and incident reports. The PACS was completed by participants and their caregivers.

Findings

– The majority of participants demonstrated increases in self- and caregiver-reported use of appropriate emotion regulation strategies following their involvement in the Transformers programme. However, treatment gains were not always maintained at follow-up. Three of the participants also exhibited fewer incidents of challenging behaviour after taking part in the programme.

Originality/value

– Overall, the results provide preliminary support for the continued use of the Transformers programme with people with an intellectual disability who have emotion regulation difficulties. It is recommended that further research be carried out with a larger sample size, a control group, and a longer follow-up period.

Pica in persons with developmental disabilities: approaches to treatment

Pica is a very serious problem in which an individual ingests substances without nutrition value, such as paper and paint. As this behavior is often life-threatening resulting in surgery, pica has received attention from researchers for several decades. During that time, a number of interventions have been devised, such as behavioral methods (e.g., aversive stimuli, overcorrection, time-out, reinforcement) and biological interventions (e.g., pharmacotherapy, nutritional supplements). This paper is a broad review of the research on treatment studies for this problem, with a focus on persons with autism and/or intellectual disability (ID), which constitutes almost all of the published treatment papers. In addition, strengths and weaknesses of different pica treatments are discussed. Upon review, applied behavior analysis (ABA) was found to have the most robust empirical support to treat this behavior. Most clinicians are drifting away from aversive techniques and relying on more positive procedures to guide their treatment plans. The implications of current status and future directions for research are also addressed.

Client characteristics, organizational variables and burnout in care staff: the mediating role of fear of assault

A broad range of factors have been identified as having an impact on burnout and performance. To improve our understanding of how these factors interact, a model of carer stress is tested. Staff were surveyed in residential units, assessments included burnout, organizational factors, staff cognitions and ratings of resident challenging behavior. The relationship between challenging behavior and emotional exhaustion was fully mediated by fear of assault. The relationship between emotional exhaustion and experienced safety (an organizational variable) was also fully mediated by fear of assault. The use of the model with staff is supported and it suggests that staff burnout can be reduced by influencing either staff cognitions, organizational factors or challenging behavior or a combination of these factors.

A Preliminary Investigation into the Influence of Therapist Experience on the Outcome of Individual Anger Interventions for People with Intellectual Disabilities

Background: There is a developing literature into Anger Management interventions for people with intellectual disability. While initial reports suggest that these interventions are effective there are few evaluations examining what aspects of the therapeutic process contribute to effectiveness. Method: Individuals with an intellectual disability and anger control difficulties who were referred to community psychology services were allocated to either experienced clinical psychologists or a less experienced assistant psychologist who followed the same intervention framework. Results: Significant reductions in self-reported anger intensity were reported; however, the group who were treated by more experienced therapists reported more change and more individuals reported clinically significant change. Conclusions: While effective change was reported by both groups, these results suggest that clinical experience and training may be an important variable in determining the magnitude of change. This has implications for the design of intellectual disability mental health services.

Scaling methods to measure psychopathology in persons with intellectual disabilities

Psychopathology prior to the last four decades was generally viewed as a set of problems and disorders that did not occur in persons with intellectual disabilities (ID). That notion now seems very antiquated. In no small part, a revolutionary development of scales worldwide has occurred for the assessment of emotional problems in persons with ID. The first standardized test to emerge was the Psychopathology Instrument for Mentally Retarded Adults (PIMRA) in 1984. Since that time, an impressive number of measures of general psychopathology have emerged for adults and children as well as for persons across the full range of levels of ID. The purpose of this review was to provide a description of available measures, to review papers published on these measures, and to discuss emerging trends in test development. The trends in this body of information for enhancing differential diagnosis of psychopathology in persons with ID are discussed.

The effects of diagnostic group and gender on challenging behaviors in infants and toddlers with cerebral palsy, Down syndrome or seizures

Challenging behaviors are frequently studied in individuals with various developmental disabilities, although specific conditions are rarely compared to one another. Such data would be informative to clinicians who assess and develop treatment plans for children with these disabilities. For that reason, the current study's aim was to analyze problem behavior deficits in infants and toddlers diagnosed with cerebral palsy (CP), Down syndrome (DS), and a history of seizures/seizure disorder. Seventy six children participated in this study and were administered the Baby and Infant Screen for Children with aUtIsm Traits-Part 2 (BISCUIT-Part 2). Inspection of the Tantrum/Conduct Behavior subscale of this measure revealed that children with a history of seizures/seizure disorder exhibited significantly higher scores, indicating greater impairment, than those with CP or DS. Children with DS and those diagnosed with CP did not significantly differ from one another. Additionally, there was no significant main effect by gender. The CP and DS groups also had fewer endorsements on all 18 items of the subscale as compared to the seizures group. Implications of these results are discussed.

The effects of gender and age on repetitive and/or restricted behaviors and interests in adults with autism spectrum disorders and intellectual disability

Frequency of repetitive and/or restricted behaviors and interests (RRBIs) was assessed in 140 adults with autism spectrum disorders (ASDs) and severe or profound intellectual disability (ID). The associations of gender and age range were analyzed with RRBI frequency which was obtained using the Stereotypies subscale of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II). A significant main effect of gender was found. Male participants had higher frequency of RRBIs than females regardless of age range. There was not a significant main effect of age range or a significant interaction between gender and age range. Results and implications are discussed.

Comorbidity of physical and motor problems in children with autism

Autism and the related pervasive developmental disorders are a heavily researched group of neurodevelopmental conditions. In addition to core symptoms, there are a number of other physical and motor conditions that co-occur at high rates. This paper provides a review of factors and behaviors that correlate highly with disorders on the autism spectrum. Among these conditions are premature birth, birth defects, gross and fine motor skills, and obesity. Each of these topics is addressed, and what researchers have found are presented. These data have important implications for the types of collateral behaviors that should be assessed and treated, along with the core symptoms of autism.

The relationship among side effects associated with anti-epileptic medications in those with intellectual disability

Seizures are fairly common in those with intellectual disabilities. In order to treat these seizures, antiepileptic drugs (AEDs) are often used and in many cases are effective. However, these medications often create a variety of associated side effects. In order to monitor these side effects, measures such as the SEIZES-B have been used. While many side effects have been found to occur with the use of AEDs, research has not explored if certain side effects are more likely to co-occur. For the current study, 281 people with intellectual disability were administered the SEIZES-B to monitor side effects associated with AEDs. Correlations between side effect subscales were then computed. Several subscales were found to be significantly correlated: hepatic disturbance with dermatological changes and cognitive disturbance; respiratory disturbance with dermatological changes, sedation, and electrolyte disturbance; and cognitive disturbance with sedation and dermatological disturbance. Possible implications of these findings are discussed.

How do staff psychological factors influence outcomes for people with developmental and intellectual disability in residential services?

PURPOSE OF REVIEW

A broad range of organizational issues can have an impact on client outcomes in residential services for people with intellectual disabilities, and staff psychological factors are increasingly being recognized as important. This review explores some of the recent literature on staff attitudes, attributions, well being and other factors that may impact on outcomes for residents.

RECENT FINDINGS

Staff beliefs are associated with the relationship between challenging behaviour and burnout experienced by staff; resident outcomes such as placement breakdown may also be influenced by staff attributions. There is also a body of evidence emerging that suggests staff psychological factors may influence the quality of physical healthcare received by people with intellectual disabilities.

SUMMARY

Sufficient evidence exists to suggest that clinicians should routinely consider assessing and evaluating staff psychological factors in clinical interventions in order to assess their potential impact on client care. Further research is required, particularly, to evaluate the specific impact of staff psychological factors on resident outcome.

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.

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.