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Delforterie MJ, Turhan A, Driessen M, Neijmeijer L, Hesper B, Didden R. Reliability and validity of the dynamic risk outcome scales-short version for clients with mild intellectual disabilities or borderline intellectual functioning. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13212. [PMID: 38382539 DOI: 10.1111/jar.13212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 12/15/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION This study investigated the reliability and validity of the dynamic risk outcome scales-short version (DROS-SV). This instrument is developed to monitor treatment progress using dynamic risk factors in clients with mild intellectual disabilities or borderline intellectual functioning and behavioural and/or mental health problems. METHOD Data were collected from 264 clients who received Flexible Assertive Community Treatment (FACT), a form of intensive outpatient treatment. RESULTS A principal component analysis showed that there were six components explaining 73.9% of the variance. Furthermore, the DROS-SV showed good internal consistency of its subscales and total score (α > 0.78). Correlating the DROS-SV with the Historical and Clinical subscales of the Historical, Clinical and Future-30 indicated convergent and divergent validity. DISCUSSION The DROS-SV has good psychometric properties for measuring dynamic risk factors in clients with mild intellectual disabilities or borderline intellectual functioning in FACT teams.
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Affiliation(s)
- M J Delforterie
- Trajectum, Zwolle, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - A Turhan
- Trajectum, Zwolle, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | | | - L Neijmeijer
- Indigo Midden Nederland, Hilversum, The Netherlands
| | - B Hesper
- Trajectum, Zwolle, The Netherlands
| | - R Didden
- Trajectum, Zwolle, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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2
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Turhan A, Delforterie MJ, Roest JJ, Van der Helm GHP, Neimeijer EG, Didden R. Relationships between dynamic risk factors for externalising problem behaviour and group climate in adults with mild intellectual disability in forensic treatment. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:641-652. [PMID: 36883307 DOI: 10.1111/jar.13088] [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: 08/29/2022] [Revised: 12/21/2022] [Accepted: 01/31/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Relationships between dynamic risk factors for externalising problem behaviour and group climate were investigated in 151 adult in-patients with mild intellectual disability or borderline intellectual functioning in a Dutch secure residential facility. METHOD Regression analysis was used to predict total group climate score and Support, Growth, Repression, and Atmosphere subscales of the 'Group Climate Inventory'. Predictor variables were Coping Skills, Attitude towards current treatment, Hostility, and Criminogenic attitudes subscales of the 'Dynamic Risk Outcome Scales'. RESULTS Less hostility predicted a better overall group climate, better support and atmosphere, and less repression. A positive attitude towards current treatment predicted better growth. CONCLUSION Results indicate relationships of hostility and attitude towards current treatment with group climate. A focus on both dynamic risk factors and group climate may provide a basis for improving treatment for this target group.
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Affiliation(s)
- A Turhan
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Trajectum, Zwolle, The Netherlands
| | - M J Delforterie
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Trajectum, Zwolle, The Netherlands
| | - J J Roest
- Research group Residential Youth care, Leiden University of Applied Sciences, Leiden, The Netherlands
| | - G H P Van der Helm
- Research group Residential Youth care, Leiden University of Applied Sciences, Leiden, The Netherlands.,Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | | | - R Didden
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Trajectum, Zwolle, The Netherlands
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Delforterie MJ, Hesper BL, Nijman HLI, Korzilius HPLM, Turhan A, Didden R. The predictive value of the dynamic risk outcome scales (DROS) for recidivism in (forensic) clients with mild intellectual disabilities or borderline intellectual functioning. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023. [PMID: 36883334 DOI: 10.1111/jar.13090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND The dynamic risk outcome scales (DROS) was developed to assess treatment progress of clients with mild intellectual disability or borderline intellectual functioning using dynamic risk factors. We studied the predictive value of the DROS on various classifications and severity levels of recidivism. METHOD Data of 250 forensic clients with intellectual disabilities were linked to recidivism data from the Judicial Information Service in the Netherlands. Receiver operating characteristics (ROC) analyses were used to determine the predictive values. RESULTS The DROS total score could not significantly predict recidivism. A DROS recidivism subscale predicted general, violent and other recidivism. These predictive values were comparable to those of a Dutch tool validated for risk assessment in the general forensic population. CONCLUSIONS The DROS recidivism subscale predicted various classifications of recidivism better than chance. At present, the DROS appears to have no added value beyond the HKT-30 for the purpose of risk assessment.
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Affiliation(s)
- M J Delforterie
- Trajectum, Specialized and Forensic Care, Zwolle, the Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - B L Hesper
- Trajectum, Specialized and Forensic Care, Zwolle, the Netherlands
| | - H L I Nijman
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.,Fivoor, Specialized and Forensic Care, Utrecht, the Netherlands
| | - H P L M Korzilius
- Institute for Management Research, Radboud University, Nijmegen, the Netherlands
| | - A Turhan
- Trajectum, Specialized and Forensic Care, Zwolle, the Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - R Didden
- Trajectum, Specialized and Forensic Care, Zwolle, the Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
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Gast DAA, Didden R, Westera JJ, van de Rest O, van Hemert AM, Giltay EJ. Dietary supplements for aggressive behaviour in people with intellectual disabilities: A randomised controlled crossover trial. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 36:122-131. [PMID: 36224110 PMCID: PMC10092216 DOI: 10.1111/jar.13041] [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: 05/12/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Aggressive incidents are common in people with intellectual disabilities. Therefore, we aimed to assess whether supplementation of multivitamins, minerals, and omega-3 fatty acids (FA) reduces aggressive incidents. METHODS We conducted a randomised, triple blind, placebo controlled, single crossover intervention trial. People with intellectual disabilities or borderline intellectual functioning, between 12 and 40 years of age, and showing aggressive behaviour were included. Participants received either a daily dose of dietary supplements, or placebo. Primary outcome was the number of aggressive incidents, measured using the Modified Overt Aggression Scale (MOAS). RESULTS there were 113 participants (placebo, n = 56), of whom 24 (placebo, n = 10) participated in the crossover phase of the trial. All 137 trajectories were included in the analyses. There was no significant difference in mean number of aggressive incidents per day between those assigned to supplements and those who received placebo (rate ratio = 0.93: 95% Confidence Interval [CI] = 0.59-1.45). CONCLUSION In this pragmatic trial, we did not find significant differences in the outcomes between the supplement and placebo arms. The COVID-19 pandemic started midway through our trial, this may have affected the results.
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Affiliation(s)
- David A A Gast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Gemiva-SVG Group, Gouda, The Netherlands
| | - Robert Didden
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Trajectum, Zwolle, The Netherlands
| | | | - Ondine van de Rest
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Aggressive behaviour of psychiatric patients with mild and borderline intellectual disabilities in general mental health care. PLoS One 2022; 17:e0272502. [PMID: 36190995 PMCID: PMC9529125 DOI: 10.1371/journal.pone.0272502] [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: 12/28/2021] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Little is known about the associations between mild intellectual disability (MID), borderline intellectual functioning (BIF) and aggressive behaviour in general mental health care. The study aims to establish the association between aggressive behaviour and MID/BIF, analysing patient characteristics and diagnoses. METHOD 1174 out of 1565 consecutive in-and outpatients were screened for MID/BIF with the Screener for Intelligence and Learning Disabilities (SCIL) in general mental health care in The Netherlands. During treatment, aggressive behaviour was assessed with the Staff Observation Aggression Scale-Revised (SOAS-R). We calculated odds ratios and performed a logistic and poisson regression to calculate the associations of MID/ BIF, patient characteristics and diagnoses with the probability of aggression. RESULTS Forty-one percent of participating patients were screened positive for MID/BIF. Patients with assumed MID/BIF showed significantly more aggression at the patient and sample level (odds ratio (OR) of 2.50 for aggression and 2.52 for engaging in outwardly directed physical aggression). The proportion of patients engaging in 2-5 repeated aggression incidents was higher in assumed MID (OR = 3.01, 95% CI 1.82-4.95) and MID/BIF (OR = 4.20, 95% CI 2.45-7.22). Logistic regression showed that patients who screened positive for BIF (OR 2,0 95% CL 1.26-3.17), MID (OR 2.89, 95% CI 1.87-4.46), had a bipolar disorder (OR 3.07, 95% CI 1.79-5.28), schizophrenia (OR 2.75, 95% CI 1.80-4.19), and younger age (OR 1.69, 95% CI 1.15-2.50), were more likely to have engaged in any aggression. Poisson regression underlined these findings, showing a SCIL of 15 and below (β = 0.61, p<0.001) was related to more incidents. CONCLUSIONS We found an increased risk for aggression and physical aggression in patients with assumed MID/BIF. We recommend screening for intellectual functioning at the start of treatment and using measures to prevent and manage aggressive behaviour that fits patients with MID/BIF.
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de Bles NJ, Gast DAA, van der Slot AJC, Didden R, van Hemert AM, Rius-Ottenheim N, Giltay EJ. Lessons learned from two clinical trials on nutritional supplements to reduce aggressive behaviour. J Eval Clin Pract 2022; 28:607-614. [PMID: 35040231 PMCID: PMC9543803 DOI: 10.1111/jep.13653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/14/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Setting up and conducting a randomised controlled trial (RCT) has many challenges-particularly trials that include vulnerable individuals with behavioural problems or who reside in facilities that focus on care as opposed to research. These populations are underrepresented in RCTs. APPROACH In our paper, we describe the challenges and practical lessons learned from two RCTs in two care settings involving long-stay psychiatric inpatients and people with intellectual disabilities. We describe five main difficulties and how these were overcome: (1) multisite setting, (2) inclusion of vulnerable participants, (3) nutritional supplements and placebos, (4) assessment of behavioural outcomes, and (5) collecting bio samples. CONCLUSIONS By sharing these practical experiences, we hope to inform other researchers how to optimally design their trials, while avoiding and minimising the difficulties that we encountered, and to facilitate the implementation of a trial. Both trials were registered in the Clinical Trials Register (RCT A: NCT02498106; RCT B: NCT03212092).
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Affiliation(s)
- Nienke J de Bles
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - David A A Gast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Gemiva-SVG Group, Gouda, The Netherlands
| | - Abe J C van der Slot
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert Didden
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Trajectum, Zwolle, The Netherlands
| | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Khalifa N, Hawken ER, Bickle A, Cabrera M, Heath T, Drury A, Jones J, Ayub M. The use of transcranial direct current stimulation (tDCS) to reduce impulsivity and aggression in adults with mild intellectual developmental disabilities: the tDCS-RIADD randomised controlled trial protocol. Trials 2022; 23:431. [PMID: 35606826 PMCID: PMC9125841 DOI: 10.1186/s13063-022-06350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 04/25/2022] [Indexed: 11/22/2022] Open
Abstract
Background Challenging behaviours, in particular aggressive behaviours, are prevalent among people with intellectual developmental disabilities. Predictors of challenging behaviours are numerous, including past history of aggression, poor coping skills and impulsivity. Factors like motor or rapid-response impulsivity (RRI) have neurobiological underpinnings that may be amenable to change via neuromodulation using non-invasive brain stimulation techniques like transcranial direct current stimulation (tDCS). Methods This study aims to determine the efficacy of anodal tDCS in reducing RRI and incidents of aggression in people with intellectual developmental disabilities (IDD) in residential or hospital settings. Using a single blind, randomised, sham-controlled trial design, adults with IDD, with a history of impulsivity leading to aggression, will be randomised to receive either repetitive anodal or sham tDCS applied to the left dorsolateral prefrontal cortex. Outcome measures assessing impulsivity and aggression will be collected for up to 1 month following the last tDCS session. Discussion The results of this study may pave the way for developing targeted interventions for impulsivity and aggressive behaviours in people with IDD.
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Affiliation(s)
- Najat Khalifa
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada. .,Providence Care Hospital, Kingston, Ontario, Canada.
| | - Emily R Hawken
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.,Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Andrew Bickle
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.,Providence Care Hospital, Kingston, Ontario, Canada
| | - Mariel Cabrera
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Travis Heath
- Providence Care Hospital, Kingston, Ontario, Canada
| | - Andrew Drury
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Jessica Jones
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.,Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Muhammad Ayub
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.,University College London, London, UK
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Girasek H, Nagy VA, Fekete S, Ungvari GS, Gazdag G. Prevalence and correlates of aggressive behavior in psychiatric inpatient populations. World J Psychiatry 2022; 12:1-23. [PMID: 35111577 PMCID: PMC8783168 DOI: 10.5498/wjp.v12.i1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/18/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Aggressive behavior in patients with psychiatric disorders is attracting increasing research interest. One reason for this is that psychiatric patients are generally considered more likely to be aggressive, which raises a related question of whether diagnoses of psychiatric disorders predict the prevalence of aggressive behavior. Predicting aggression in psychiatric wards is crucial, because aggressive behavior not only endangers the safety of both patients and staff, but it also extends the hospitalization times. Predictions of aggressive behavior also need careful attention to ensure effective treatment planning. This literature review explores the relationship between aggressive behavior and psychiatric disorders and syndromes (dementia, psychoactive substance use, acute psychotic disorder, schizophrenia, bipolar affective disorder, major depressive disorder, obsessive-compulsive disorder, personality disorders and intellectual disability). The prevalence of aggressive behavior and its underlying risk factors, such as sex, age, comorbid psychiatric disorders, socioeconomic status, and history of aggressive behavior are discussed as these are the components that mostly contribute to the increased risk of aggressive behavior. Measurement tools commonly used to predict and detect aggressive behavior and to differentiate between different forms of aggressive behavior in both research and clinical practice are also reviewed. Successful aggression prevention programs can be developed based on the current findings of the correlates of aggressive behavior in psychiatric patients.
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Affiliation(s)
- Hunor Girasek
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Vanda Adél Nagy
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Szabolcs Fekete
- Department of Psychiatry, National Institute of Forensic Psychiatry, Budapest 1108, Hungary
- School of PhD Studies, Semmelweis University, Budapest 1085, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley 6009, Australia
- Section of Psychiatry, University of Notre Dame, Fremantle 6160, Australia
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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9
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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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Lofthouse RE, Golding L, Totsika V, Hastings RP, Lindsay WR. Predicting aggression in adults with intellectual disability: A pilot study of the predictive efficacy of the Current Risk of Violence and the Short Dynamic Risk Scale. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:702-710. [PMID: 31496038 DOI: 10.1111/jar.12665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 04/05/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Structured assessments have been shown to assist professionals to evaluate the risk of aggression in secure services for general offender populations and more recently among adults with intellectual disabilities. There is a need to develop intellectual disability sensitive measures for predicting risk of aggression in community samples, especially tools with a focus on dynamic variables. METHODS The study prospectively followed 28 participants for up to 2 months to test whether the Current Risk of Violence (CuRV) and Short Dynamic Risk Scale (SDRS) were able to predict verbal and physical aggression in a community sample of adults with intellectual disability. RESULTS CuRV and SDRS ratings significantly predicted verbal and physical aggression over a 2-month period. CONCLUSIONS The current study supports the use of the CuRV with adults with intellectual disability living in community settings. The CuRV and SDRS are worthy of future development and evaluation in independent investigations.
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Affiliation(s)
- Rachael E Lofthouse
- Specialist Learning Disability Services, Mersey Care NHS Foundation Trust, Lancashire, UK
| | - Laura Golding
- Clinical Psychology Programme, University of Liverpool, Liverpool, UK
| | - Vasiliki Totsika
- Division of Psychiatry, University College London, London, UK.,Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, Vic., Australia
| | - Richard P Hastings
- Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, Vic., Australia.,CEDAR and Centre for Education Studies (CES), University of Warwick, Coventry, UK
| | - William R Lindsay
- Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, Vic., Australia.,The Danshell Group, UK
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11
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de Looff P, Noordzij ML, Moerbeek M, Nijman H, Didden R, Embregts P. Changes in heart rate and skin conductance in the 30 min preceding aggressive behavior. Psychophysiology 2019; 56:e13420. [PMID: 31184379 DOI: 10.1111/psyp.13420] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 11/28/2022]
Abstract
Aggressive behavior of inpatients threatens the safety and well-being of both mental health staff members and fellow patients. It was investigated whether heart rate and electrodermal activity can be used to signal imminent aggression. A naturalistic study was conducted in which 100 inpatients wore sensor wristbands during 5 days to monitor their heart rate and electrodermal activity while staff members recorded patients' aggressive incidents on the ward. Of the 100 patients, 36 displayed at least one aggressive incident. Longitudinal multilevel models indicated that heart rate, skin conductance level, and the number of nonspecific skin conductance responses per minute rose significantly in the 20 min preceding aggressive incidents. Although psychopathy was modestly correlated with displaying aggression, it was not a significant predictor of heart rate and skin conductance preceding aggression. The current findings may provide opportunities for the development of individual prediction models to aid acute risk assessment and to predict aggressive incidents in an earlier stage. The current results on the physiological indicators of aggression are promising for reducing aggression and improving both staff as well as patient safety in psychiatric mental health institutions.
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Affiliation(s)
- Peter de Looff
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Wier, Specialized and Forensic Care, Den Dolder, The Netherlands.,De Borg, National Expertcentre Specialized and Forensic Care, Den Dolder, The Netherlands
| | - Matthijs L Noordzij
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Mirjam Moerbeek
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Henk Nijman
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Wier, Specialized and Forensic Care, Den Dolder, The Netherlands.,De Borg, National Expertcentre Specialized and Forensic Care, Den Dolder, The Netherlands
| | - Robert Didden
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,De Borg, National Expertcentre Specialized and Forensic Care, Den Dolder, The Netherlands.,Trajectum, Specialized and Forensic Care, Zwolle, The Netherlands
| | - Petri Embregts
- Department of Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
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12
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Delforterie M, Hesper B, Didden R. Psychometric properties of the Dynamic Risk Outcome Scales (DROS) for individuals with mild intellectual disability or borderline intellectual functioning and externalizing behaviour problems. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 33:662-672. [PMID: 30460720 DOI: 10.1111/jar.12546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 07/25/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The present study examined the psychometric properties of the Dynamic Risk Outcome Scales (DROS), an instrument developed to measure dynamic risk factors in individuals with mild intellectual disabilities or borderline intellectual functioning (MID-BIF) and externalizing (including offending-like) behaviour problems. METHOD The sample consisted of 606 clients (86% male) from inpatient treatment wards at a facility for individuals with MID-BIF and externalizing behaviour problems. RESULTS The DROS showed an acceptable factor structure, good internal consistency, significant test-retest reliability and fair to excellent inter-rater reliabilities for most subscales and total score. Compared to the Adult Behavior Checklist (ABCL; Achenbach & Rescorla, 2003 Manual for the ASEBA adult forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families), the DROS showed convergent and divergent validity, concurrent and longitudinal validity. CONCLUSIONS The DROS is a reliable and valid instrument to measure dynamic risk factors in clients with MID-BIF. Future research on the DROS will focus on the assessment of recidivism and the inclusion of internalizing problems.
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Affiliation(s)
| | | | - Robert Didden
- Trajectum, Zwolle, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
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13
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Malda Castillo J, Smith I, Morris L, Perez-Algorta G. Violent incidents in a secure service for individuals with learning disabilities: Incident types, circumstances and staff responses. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31:1164-1173. [PMID: 29953700 DOI: 10.1111/jar.12490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 04/09/2018] [Accepted: 05/23/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The issue of violence in secure services has long been recognized both in the UK and worldwide. However, there is currently scarce literature available about violence within learning disability (LD) secure settings. METHODS Secondary data analysis was conducted on violent incidents, using information routinely collected by the staff over a 1-year period. RESULTS Physical assaults were the most frequent type of incident, and the distribution in terms of days or months was homogenous and incidents were concentrated in the corridors, lounges and dining rooms of secure facilities. Antipsychotic medication was not regularly prescribed. Generalized linear modelling analyses revealed significant predictors that increased the chances of seclusion and physical restraint, such as being female or directing the violence towards staff. CONCLUSIONS These findings can inform staff training on violence prevention and suggest that increased ward-based supervision and enhanced use of psychological formulations may help in reducing violence within this service context.
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Affiliation(s)
- Javier Malda Castillo
- Furness College, Lancaster University, Lancaster, England.,Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College, Lancaster, England
| | - Ian Smith
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College, Lancaster, England
| | - Lucy Morris
- Mersey Care NHS Foundation Trust, Lancaster, England
| | - Guillermo Perez-Algorta
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College, Lancaster, England
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14
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Lofthouse R, Golding L, Totsika V, Hastings R, Lindsay W. How effective are risk assessments/measures for predicting future aggressive behaviour in adults with intellectual disabilities (ID): A systematic review and meta-analysis. Clin Psychol Rev 2017; 58:76-85. [PMID: 29066047 DOI: 10.1016/j.cpr.2017.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Risk assessments assist professionals in the identification and management of risk of aggression. The present study aimed to systematically review evidence on the efficacy of assessments for managing the risk of physical aggression in adults with intellectual disabilities (ID). METHODS A literature search was conducted using the databases PsycINFO, EMBASE, MEDLINE, Web of Science, and Google Scholar. Electronic and hand searches identified 14 studies that met the inclusion criteria. Standardised mean difference effect sizes Area Under Curve (AUC) were calculated for studies. Random effects subgroup analysis was used to compare different types of risk measures (Actuarial, Structured Professional Judgment and dynamic), and prospective vs. catch-up longitudinal study designs. RESULTS Overall, evidence of predictive validity was found for risk measures with ID populations: (AUC)=0.724, 95% CI [0.681, 0.768]. There was no variation in the performance of different types of risk measures, or different study design. CONCLUSIONS Risk assessment measures predict the likelihood of aggression in ID population and are comparable to those in mainstream populations. Further meta-analysis is necessary when risk measures are more established in this population.
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Affiliation(s)
- Rachael Lofthouse
- The Harbour, Blackpool, Preston New Road, Blackpool FY4 4FE, United Kingdom.
| | | | - Vasiliki Totsika
- CEDAR and Centre for Education Studies (CES), University of Warwick, United Kingdom; Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Monash University, United Kingdom
| | - Richard Hastings
- CEDAR and Centre for Education Studies (CES), University of Warwick, United Kingdom; Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Monash University, United Kingdom
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15
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Hounsome J, Whittington R, Brown A, Greenhill B, McGuire J. The Structured Assessment of Violence Risk in Adults with Intellectual Disability: A Systematic Review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 31:e1-e17. [PMID: 27891723 DOI: 10.1111/jar.12295] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND While structured professional judgement approaches to assessing and managing the risk of violence have been extensively examined in mental health/forensic settings, the application of the findings to people with an intellectual disability is less extensively researched and reviewed. This review aimed to assess whether risk assessment tools have adequate predictive validity for violence in adults with an intellectual disability. METHODS Standard systematic review methodology was used to identify and synthesize appropriate studies. RESULTS A total of 14 studies were identified as meeting the inclusion criteria. These studies assessed the predictive validity of 18 different risk assessment tools, mainly in forensic settings. All studies concluded that the tools assessed were successful in predicting violence. Studies were generally of a high quality. CONCLUSIONS There is good quality evidence that risk assessment tools are valid for people with intellectual disability who offend but further research is required to validate tools for use with people with intellectual disability who offend.
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Affiliation(s)
- J Hounsome
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - R Whittington
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.,Brøset Centre for Research & Education in Forensic Psychiatry, St. Olav's Hospital, Trondheim, Norway.,Department of Neuroscience, Norwegian University of Science & Technology (NTNU), Trondheim, Norway
| | - A Brown
- Mersey Care NHS Trust, Merseyside, UK
| | - B Greenhill
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.,Mersey Care NHS Trust, Merseyside, UK
| | - J McGuire
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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