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Jonker J, Zuidema SU, de Kuijper GM. Challenging behaviour, the application of restrictive measures and psychotropic drug prescription in people with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 153:104824. [PMID: 39178564 DOI: 10.1016/j.ridd.2024.104824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 07/16/2024] [Accepted: 08/13/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Prescribing of psychotropic drugs (PDs) and applying restrictive measures are both frequently used in managing challenging behaviour of people with intellectual disabilities (ID), which is not always according to guidelines or good clinical practice. AIMS This study aimed to investigate the potential triangular relationship between challenging behaviour, the application of restrictive measures and PD prescription. METHODS AND PROCEDURES In this cross-sectional study, data on challenging behaviour, PD prescription and restrictive measures were collected. We defined and compared four mutually exclusive groups of participants. OUTCOMES AND RESULTS Challenging behaviour in the group in whom one or more PD were prescribed as a restrictive measures (PDRM) was more severe than in the other three groups. More severe challenging behaviour, a higher number of antipsychotics, antidepressants and anxiolytics/hypnotics prescriptions, a lower dosage, and more application of domotics as restrictive measure was shown in the PDRM compared to the group in whom PDs were prescribed according to guidelines (PDNRM). CONCLUSIONS AND IMPLICATIONS We did not find indications for a triangular relationship of challenging behaviour, the application of restrictive measures and PD prescriptions. Future longitudinal research is needed to better understand this complex relationship and should investigate the indication and the effect of treatment. WHAT THIS PAPER ADDS?: This study is a first exploration of the potential triangular relationship between symptoms of challenging behaviour, psychotropic drug (PD) prescription, and the application of restrictive measures. Prescribing PDs and applying restrictive measures are two interventions which are commonly used to manage challenging behaviour in people with intellectual disabilities. Both have been subject of research separately in recent years. However, it is conceivable that the PD prescription in treatments for challenging behaviour could be a substitute for another form of a restrictive measure, for example a physical or mechanical restraint. For this purpose, we defined and compared four mutually exclusive groups of participants. We found no indication for this triangular relationship. On the other hand, we found the highest severity of challenging behaviour in the group who used PDs as restrictive measure next to other restrictive measures. Our results may suggest that both prescribing PDs and applying non-pharmacological restrictive measures are used simultaneously in managing challenging behaviour, are not sufficiently implemented or effective.
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Affiliation(s)
- Josien Jonker
- GGZ Drenthe, Department of Centre for Intellectual Disability and Mental Health, P.O. Box 30007, Assen 9400 RA, the Netherlands.
| | - Sytse Ulbe Zuidema
- University of Groningen, University Medical Centre Groningen, Department of Primary and Long-term Care, P.O. Box 196, Groningen 9700 AD, the Netherlands.
| | - Gerda Margaretha de Kuijper
- GGZ Drenthe, Department of Centre for Intellectual Disability and Mental Health, P.O. Box 30007, Assen 9400 RA, the Netherlands; University Medical Centre Groningen, Department of Psychiatry, P.O. Box 30.001, Groningen 9700 RB, the Netherlands.
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Kloosterman IEM, Haenen AI, Poortvliet-Koedam ELGE, Lazeron RHC, Schelhaas HJ, van Ool JS. Psychogenic non-epileptic (functional) seizures in adults with intellectual disability and epilepsy: A matched case-control study. Epilepsia 2024. [PMID: 39120123 DOI: 10.1111/epi.18085] [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: 03/28/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To describe the characteristics of psychogenic non-epileptic (functional) seizures (PNES) in adults with epilepsy and intellectual disability (ID) and to establish differences and risk factors regarding psychosocial functioning between individuals with and without PNES. METHODS Adults with ID and epilepsy living in epilepsy care facilities in The Netherlands were screened for PNES by a neurologist. A control group consisting of people with epilepsy and ID, without PNES, was matched according to age, sex, and level of ID. Objective data were retrieved retrospectively from clinical notes of the resident. Standardized questionnaires and tests, adjusted for people with ID, were obtained from participants and their nursing staff. Differences were analyzed using paired t tests, Wilcoxon signed-rank tests, or McNemar's tests, appropriate for matched case-control studies. Conditional logistic regression identified PNES risk factors. RESULTS Five hundred forty individuals were screened, of which 42 had PNES (point prevalence 7.8%). In total, 35 cases and 35 controls gave consent. Proxy reports indicated that PNES impacted daily life in 79% by adjusting the individual's schedule, and caused minor injuries in one-third. Those with PNES were mainly female (69%); had a mild (46%) or moderate (37%) level of ID; showed more symptoms of depression (p = .024), anxiety (p = .030), self-injurious behavior (p = .015); and experienced more negative life events (p < .001). Clinically relevant predictors of PNES were the number of negative life events (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.12-2.53) and self-injurious behaviors (OR 5.27, 95% CI .97-28.81). SIGNIFICANCE Previously, PNES in individuals with ID and epilepsy were described mainly as a reinforced behavioral pattern, due to limited associations with psychiatric disorders. Our results demonstrate that this population does show individual psychosocial vulnerabilities when measured with instruments adjusted for this population, as indicated by proxy reports from daily caregivers. Viewing PNES as an involuntary response, especially for stress-prone individuals with ID, could reduce stigma and improve treatment.
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Affiliation(s)
- Iris E M Kloosterman
- Residential Care Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Alexandra I Haenen
- Department of Residential Care, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
| | - Esther L G E Poortvliet-Koedam
- Residential Care Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
- Epilepsy Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | | | - Helenius J Schelhaas
- Epilepsy Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Jans S van Ool
- Department of Residential Care, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
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de Kuijper G, Jonker J, Kouwer K, Hoekstra PJ, de Bildt A. Integrative Care for Challenging Behaviors in People with Intellectual Disabilities to Reduce Challenging Behaviors and Inappropriate Psychotropic Drug Prescribing Compared with Care as Usual: A Cluster-Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:950. [PMID: 39063526 PMCID: PMC11277020 DOI: 10.3390/ijerph21070950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
People with intellectual disabilities (IDs) often present with challenging behaviors (CBs) mostly due to inappropriate environments and mental and physical disorders. Integrative care is recommended to address CBs. However, in clinical practice, psychotropic drugs are often prescribed off-label for CBs, although the effectiveness is unclear, and side effects frequently occur. We conducted a cluster-randomized controlled study to investigate the effect of integrative care provided by a collaboration of an ID specialized mental healthcare team and participants' own ID service providers' care team on reducing CBs and inappropriate off-label psychotropic drug prescriptions compared with care as usual. Participants (N = 33, aged 19-81 years) had a moderate, severe, or profound intellectual disability and used off-label psychotropic drugs. The primary outcome measures were the Aberrant Behavior Checklist and the total dose of psychotropic drug prescriptions. At the study endpoint of 40 weeks, we found no effect of the intervention on the total ABC score and on the total dose of psychotropic drug prescriptions. In the intervention group, however, the psychotropic drug dose decreased significantly, while CBs did not change. The small sample size and not-completed interventions due to organizational problems may have affected our findings. This study illustrates the difficulties in the implementation of integrative care.
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Affiliation(s)
- Gerda de Kuijper
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.J.); (P.J.H.)
- Mental Healthcare Drenthe, Department Centre for intellectual Disability and Mental Health, Middenweg 19, 9404 LL Assen, The Netherlands
| | - Josien Jonker
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.J.); (P.J.H.)
- Mental Healthcare Drenthe, Department Centre for intellectual Disability and Mental Health, Middenweg 19, 9404 LL Assen, The Netherlands
| | - Karlijn Kouwer
- Mental Healthcare Drenthe, Department Centre for intellectual Disability and Mental Health, Middenweg 19, 9404 LL Assen, The Netherlands
- Department of Biological and Medical Psychology, University of Bergen, Jonas Lies Vei 91, 5009 Bergen, Norway
| | - Pieter J. Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.J.); (P.J.H.)
- Accare Child Study Center, Lübeckweg 2, 9723 HE Groningen, The Netherlands
| | - Annelies de Bildt
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.J.); (P.J.H.)
- Accare Child Study Center, Lübeckweg 2, 9723 HE Groningen, The Netherlands
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Tournier T. "Connectedness" between people with intellectual disabilities and challenging behaviour and support staff: Perceptions of psychologists and support staff. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:121-137. [PMID: 35086364 PMCID: PMC9941799 DOI: 10.1177/17446295211056820] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 06/14/2023]
Abstract
The tacit practical knowledge of psychologists and support staff to foster a real connection between support staff and people with intellectual disabilities and challenging behaviour was explored. Therefore, six dyads comprising individuals with intellectual disabilities and challenging behaviour and their support staff were video recorded during joint engagement in an activity. To tap into the implicit knowledge of professionals about when staff have 'a real connection' with a person with an intellectual disability, 10 psychologists and 10 support staff were asked to pinpoint these moments in the pre-recorded video compilation. They also shared their interpretations about what they considered to be a real connection. The results displayed that participants designated real connections as occurring when they noticed concrete interactions taking place. Based on thematic analysis of the data, four themes were identified that encapsulated what professionals deemed to be a real connection. In conclusion: joint engagement in an activity appears to be a context that fosters opportunities for real connection. Furthermore, support staff should adopt a sensitive attitude and create a safe atmosphere, to establish real connections.
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Affiliation(s)
- T Tournier
- T Tournier, Tranzo, Tilburg School of
Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, Tilburg 5000
LE, The Netherlands.
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Reyes-Martín J, Simó-Pinatella D, Font-Roura J. Assessment of Challenging Behavior Exhibited by People with Intellectual and Developmental Disabilities: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8701. [PMID: 35886552 PMCID: PMC9324269 DOI: 10.3390/ijerph19148701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
Abstract
The assessment of challenging behavior exhibited by people with intellectual and developmental disabilities is essential for the planning of prevention and intervention programs. This review aimed to identify and analyze the standardized instruments that exclusively focus on the assessment of challenging behavior. We identified and organized 141 articles into four categories: original instrument studies, validation studies, relational studies, and intervention studies. The results identified 24 instruments that generally show high-quality psychometric properties and other utilities beyond the observation of the presence of challenging behavior and diagnostic categorization. Age, level of adaptive behavior, disability, presence of autism spectrum disorder, and medication are some of the variables that were found to be possibly related to the occurrence of challenging behavior. Additionally, the results suggest that interventions focused on supporting positive behavior or providing training on behavior to professionals and caregivers significantly reduced the occurrence of these behaviors. Instruments that help us to understand and measure the challenging behavior exhibited by people with intellectual and developmental disabilities are essential for the design of effective evaluation and intervention protocols.
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Affiliation(s)
- Juliana Reyes-Martín
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport, Blanquerna, Ramon Llull University, 08022 Barcelona, Spain;
- Fundació Vallparadís, Mutua Terrassa, 08221 Barcelona, Spain
| | - David Simó-Pinatella
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport, Blanquerna, Ramon Llull University, 08022 Barcelona, Spain;
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Inoue M, Inada N, Gomi Y, Aita C, Shiga T. Reliability and validity of the Japanese version of the Behavior Problem Inventory-Short Form. Brain Dev 2021; 43:673-679. [PMID: 33589317 DOI: 10.1016/j.braindev.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/01/2021] [Accepted: 01/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Behavior Problems Inventory-Short Form (BPI-S), which assesses behavior problems in individuals with intellectual disabilities (ID), is a shorter version of the BPI-01. This study investigated the reliability and validity of the BPI-S Japanese version (BPI-S-J) for adolescents/adults with ID and behavior problems. METHODS The test-retest reliability included participants with ID and behavioral problems who were enrolled in welfare services. For test-retest reliability, 42 caregivers independently responded to the BPI-S-J every two weeks. Inter-rater reliability was independently assessed using the BPI-S-J by two caregivers who were familiar with the 42 participants. The participants of the validity assessment were 227 students from special needs schools or patients with ID admitted to medical institutions. The total frequency total score was compared based on the degree of ID. To examine the criterion-related validity, we analyzed the total frequency score, the total score of the Criteria for Determining Severe Problem Behavior (CDSPB) and the total score of the Aberrant Behavior Checklist-Japanese version (ABC-J). RESULTS The BPI-S-J of test-retest reliability was satisfactory (intra-class correlation; ICC) = 0.954), and the total score significantly (ICC = 0.721) represented good inter-rater reliability. For the validity, the BPI-S-J score of participants who had severe and profound ID was significantly higher than those who had mild and moderate ID. Significant correlations were observed between the BPI-S-J score and CDSPB score (r = 0.499), and the ABC-J score (r = 0.699), indicating adequate criterion-related validity. CONCLUSION This study showed the utility of the BPI-S-J to assess behavior problems in the Japanese ID population.
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Affiliation(s)
- Masahiko Inoue
- Tottori University Graduate School of Medical Sciences, Japan.
| | - Naoko Inada
- Teikyo University Department of Psychology, Faculty of Liberal Arts, Japan
| | - Yoichi Gomi
- Gunma University Student Service Center, Japan
| | - Chie Aita
- National Hospital Organization Hizen Psychiatric Center, Japan
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Cross-sectional investigation of relationships between the organisational environment and challenging behaviours in support services for residents with intellectual disabilities. Heliyon 2020; 6:e04751. [PMID: 32904309 PMCID: PMC7452499 DOI: 10.1016/j.heliyon.2020.e04751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/09/2020] [Accepted: 08/17/2020] [Indexed: 11/22/2022] Open
Abstract
Background This study was conducted to assess relationships between the organisational environment and three types of challenging behaviour (self-injurious, aggressive/destructive and stereotypical) in support services for residents with intellectual disabilities using ecological theory. Method A cross-sectional questionnaire-based design was used to identify relationships between ecological system aspects at multiple levels (micro-, meso-, exo-, macro- and chronosystems) and challenging behaviours of residents. A questionnaire was distributed to care professionals and managers working in specialised Dutch service organisations for residents with intellectual disabilities and challenging behaviour. The data were examined by Pearson correlation and multivariate regression analyses. Results The questionnaire was completed by 922 respondents from 21 organisations. Responses revealed that organisational aspects at the micro-, meso-, exo- and macrosystem levels play roles in residents' challenging behaviour. These aspects range from staff members' ability to sensitively interact with residents to grouping of residents with challenging behaviour, and staff turnover. Conclusions In the prevention and management of challenging behaviour of residents with intellectual disabilities, the consideration of ecological aspects at all system levels in the organisational environment is required.
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van Ool JS, Snoeijen-Schouwenaars FM, Tan IY, Jurgen Schelhaas H, Aldenkamp AP, Hendriksen JGM. Challenging behavior in adults with epilepsy and intellectual disability: An analysis of epilepsy characteristics. Epilepsy Behav 2018; 86:72-78. [PMID: 30153936 DOI: 10.1016/j.yebeh.2018.06.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/28/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The study aimed to describe the frequency and severity of self-injurious, stereotyped, and aggressive/destructive behavior in adults with both epilepsy and intellectual disability (ID) who reside at a tertiary epilepsy center and to investigate the associations between challenging behavior and epilepsy and ID characteristics. METHOD The frequency and severity of self-injurious, (motoric) stereotyped, and aggressive/destructive behavior among 189 patients was assessed using the Behavior Problem Inventory. Comparisons were made with an adult reference population with ID, based on gender, to determine whether the behavior was clinically deviant. Epilepsy characteristics, including age at onset, epilepsy type, seizure types, seizure frequency, and use of antiepileptic drugs (AEDs), were retrieved from patient files. The level of ID was classified using the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) and an ID domain discrepancy was allocated if there was a substantial difference between two domains of adaptive behavior within a subject. RESULTS Self-injurious behavior was present in 35% of subjects, stereotyped behavior in 60%, and aggressive/destructive behavior in 63%. The behavior exceeded clinical norms in 7%, 18%, and 12%, respectively. Aggression was the behavior evaluated most often as being problematic, despite its reported frequency being the lowest. When adjusting for level of ID and use of psychotropic medication, logistic regression analyses showed that self-injurious behavior was significantly associated with a lower number of AEDs (odds ratio (OR) = 0.4); that stereotyped behavior was significantly associated with a higher number of seizure types (OR = 1.4) and a lower number of AEDs (OR = 0.4); and that aggression was significantly associated with the presence of an ID domain discrepancy (OR = 3.1). CONCLUSION Challenging behavior is a serious issue among adults with epilepsy and ID. Although some of the epilepsy and ID characteristics seemed to contribute independently to these types of challenging behavior, the effects of epilepsy-related characteristics are modest when compared with ID.
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Affiliation(s)
- Jans S van Ool
- Department of Residential Care, Kempenhaeghe Epilepsy Center, PO Box 61, 5590AB Heeze, the Netherlands.
| | | | - In Y Tan
- Department of Residential Care, Kempenhaeghe Epilepsy Center, PO Box 61, 5590AB Heeze, the Netherlands
| | - H Jurgen Schelhaas
- Department of Neurology, Academic Center for Epileptology Kempenhaeghe, PO Box 61, 5590AB Heeze, the Netherlands
| | - Albert P Aldenkamp
- Department of Behavioral Sciences, Kempenhaeghe Epilepsy Center, PO Box 61, 5590AB Heeze, the Netherlands; Department of Neurology, Maastricht University Medical Center, PO Box 616, 6200MD, Maastricht, the Netherlands; Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium; Department of Electrical Engineering, University of Technology, PO Box 513, Eindhoven, the Netherlands
| | - Jos G M Hendriksen
- Department of Behavioral Sciences, Kempenhaeghe Epilepsy Center, PO Box 61, 5590AB Heeze, the Netherlands; Department of Neurology, Maastricht University Medical Center, PO Box 616, 6200MD, Maastricht, the Netherlands; Center of Neurological Learning Disabilities Kempenhaeghe, PO Box 61, 5590AB Heeze, the Netherlands
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Psychogenic nonepileptic seizures in adults with epilepsy and intellectual disability: A neglected area. Seizure 2018; 59:67-71. [DOI: 10.1016/j.seizure.2018.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/30/2018] [Accepted: 05/04/2018] [Indexed: 11/23/2022] Open
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Flynn S, Vereenooghe L, Hastings RP, Adams D, Cooper SA, Gore N, Hatton C, Hood K, Jahoda A, Langdon PE, McNamara R, Oliver C, Roy A, Totsika V, Waite J. Measurement tools for mental health problems and mental well-being in people with severe or profound intellectual disabilities: A systematic review. Clin Psychol Rev 2017; 57:32-44. [DOI: 10.1016/j.cpr.2017.08.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/27/2017] [Accepted: 08/09/2017] [Indexed: 11/29/2022]
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Poppes P, van der Putten A, Post W, Frans N, Ten Brug A, van Es A, Vlaskamp C. Relabelling behaviour. The effects of psycho-education on the perceived severity and causes of challenging behaviour in people with profound intellectual and multiple disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:1140-1152. [PMID: 27189898 DOI: 10.1111/jir.12299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 03/09/2016] [Accepted: 04/19/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Prevalence rates of challenging behaviour are high in children and adults with profound intellectual and multiple disabilities (PIMD). Moreover, many of these behaviours are observed daily. Direct support staff report that most challenging behaviour identified has little impact on the person with PIMD and attribute challenging behaviour in children and adults with PIMD mainly to a biomedical model. The purpose of this study was to evaluate whether an intervention (psycho-education) had any effect on direct support staff's assessment of challenging behaviour in terms of its severity and their biomedical causal explanations (attributions) for this behaviour. METHOD A stepped wedge study design was used to evaluate the effects of a psycho-education intervention on the perceived severity and the attributions offered for challenging behaviour of people with PIMD by 198 direct support staff. We used questionnaires assessing the perceived severity of challenging behaviour and staff views of its causes. Data on the dependent variables were collected at four 1-month intervals. RESULTS The intervention was found to have an effect on the perceived severity of challenging behaviour identified in people with PIMD in the sense that staff generally scored challenging behaviour as more severe in its consequences after the intervention. However, this effect was very small. No significant effects were found in terms of reduction in the biomedical scale scores. CONCLUSION No evidence for the effectiveness of a psycho-educational approach on the assessment of challenging behaviour in terms of severity and the biomedical attributions for behaviour was found. More research is required to explore further the effects of more elaborate training using methods to enable direct support staff to reflect on the behaviour of people with PIMD and on their own behaviour.
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Affiliation(s)
- P Poppes
- University of Groningen, Department of Special Needs Education and Youth Care, Groningen, The Netherlands
| | - A van der Putten
- University of Groningen, Department of Special Needs Education and Youth Care, Groningen, The Netherlands
| | - W Post
- University of Groningen, Department of Special Needs Education and Youth Care, Groningen, The Netherlands
| | - N Frans
- University of Groningen, Department of Special Needs Education and Youth Care, Groningen, The Netherlands
| | - A Ten Brug
- University of Groningen, Department of Special Needs Education and Youth Care, Groningen, The Netherlands
| | - A van Es
- University of Groningen, Department of Special Needs Education and Youth Care, Groningen, The Netherlands
| | - C Vlaskamp
- University of Groningen, Department of Special Needs Education and Youth Care, Groningen, The Netherlands
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Poppes P, van der Putten AJJ, Post WJ, Vlaskamp C. Risk factors associated with challenging behaviour in people with profound intellectual and multiple disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:537-552. [PMID: 26939905 DOI: 10.1111/jir.12268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 01/13/2016] [Accepted: 01/28/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Several factors that correlate with the onset or continuation of challenging behaviour are mentioned in research. These are factors related to persons with ID, but also to direct support professionals and the context. Although many of these factors seem to affect the onset or continuation of challenging behaviour in people with ID in general, results are often inconclusive and have little focus on people with profound intellectual and multiple disabilities (PIMD). The present study aimed to assess the extent to which known factors related to challenging behaviour are also applicable to a group of 198 people with PIMD. METHOD To determine which factors were associated with challenging behaviour, univariate analyses on associations between known risk factors and challenging behaviour were conducted. The associated factors were then subject to a regression analysis to determine the extent to which they explain the prevalence of challenging behaviour and can thus be seen as factors associated with challenging behaviour. RESULTS The results show that, in particular, factors concerning the personal characteristics of people with PIMD, such as sleeping problems and auditory problems, were related to the variance in mean frequency of challenging behaviour. Only one factor related to the direct support professionals was found: when these professionals had been offered training on the subject of challenging behaviour in people with intellectual disabilities in general, they identified significantly more withdrawn behaviour. We found no contextual factors related to challenging behaviour. CONCLUSION These findings are generally consistent with findings reported in other studies, especially concerning the personal characteristics of people with PIMD. Further research should focus on the effects of providing safe auditory environments and appropriate sleep schedules for people with PIMD on the occurrence of challenging behaviour.
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Affiliation(s)
- P Poppes
- Department of Special Needs Education and Youth Care, University of Groningen, Groningen, The Netherlands
- Heeren Loo Zorggroep, Amersfoort, The Netherlands
| | - A J J van der Putten
- Department of Special Needs Education and Youth Care, University of Groningen, Groningen, The Netherlands
- Heeren Loo Zorggroep, Amersfoort, The Netherlands
| | - W J Post
- Department of Special Needs Education and Youth Care, University of Groningen, Groningen, The Netherlands
| | - C Vlaskamp
- Department of Special Needs Education and Youth Care, University of Groningen, Groningen, The Netherlands
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Schaap P, Kekana E. The structural validity of the Experience of Work and Life Circumstances Questionnaire (WLQ). SA JOURNAL OF INDUSTRIAL PSYCHOLOGY 2016. [DOI: 10.4102/sajip.v42i1.1349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Orientation: Best practice frameworks suggest that an assessment practitioner’s choice of an assessment tool should be based on scientific evidence that underpins the appropriate and just use of the instrument. This is a context-specific validity study involving a classified psychological instrument against the background of South African regulatory frameworks and contemporary validity theory principles.Research purpose: The aim of the study was to explore the structural validity of the Experience of Work and Life Circumstances Questionnaire (WLQ) administered to employees in the automotive assembly plant of a South African automotive manufacturing company.Motivation for the study: Although the WLQ has been used by registered health practitioners and numerous researchers, evidence to support the structural validity is lacking. This study, therefore, addressed the need for context-specific empirical support for the validity of score inferences in respect of employees in a South African automotive manufacturing plant.Research design, approach and method: The research was conducted using a convenience sample (N = 217) taken from the automotive manufacturing company where the instrument was used. Reliability and factor analyses were carried out to explore the structural validity of the WLQ.Main findings: The reliability of the WLQ appeared to be acceptable, and the assumptions made about unidimensionality were mostly confirmed. One of the proposed higher-order structural models of the said questionnaire administered to the sample group was confirmed, whereas the other one was partially confirmed.Practical/managerial implications: The conclusion reached was that preliminary empirical grounds existed for considering the continued use of the WLQ (with some suggested refinements) by the relevant company, provided the process of accumulating a body of validity evidence continued.Contribution/value-add: This study identified some of the difficulties that assessment practitioners might face in their quest to comply with South Africa’s regulatory framework and the demands of contemporary test validity theory.
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An X, Rojahn J, Curby TW, Ding Y. Psychometric properties of the Chinese Behavior Problems Inventory-01 in children and adolescents with or at risk for intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:256-263. [PMID: 25462486 DOI: 10.1016/j.ridd.2014.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/02/2014] [Indexed: 06/04/2023]
Abstract
As the world's most populous country, China is likely to have the highest number of people with intellectual disabilities (ID) in the world. As many people with ID are susceptible to serious and persistent behavior problems, research by Chinese scientists on this public health issue is needed. However, there are only very few reliable Chinese-language behavior assessment instruments for problem behaviors. To fill this gap we translated the Behavior Problems Inventory-01 (BPI-01; Rojahn, Matson, Lott, Esbensen, & Smalls, 2001) into Chinese. The BPI-01 is an informant-based behavior rating instrument that was designed to assess self-injurious behavior (SIB), stereotyped behavior, and aggressive/destructive behavior in individuals with ID. We then assessed the behavior of 222 children and young adults (age range 1.5-21.5 years) with or at risk for ID from three special needs service programs in mainland China. Teachers or staff members, respectively, served as respondents. The Chinese version of the BPI-01 showed good reliability (internal consistency) and good factor validity tested by confirmatory factorial analysis. We conclude that the Chinese version of the BPI-01 can be used for research and clinical evaluation of Chinese children and adolescents with ID.
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