Self-Concept, Self-Esteem and Psychopathological Symptoms in Persons with Intellectual Disability

Active music making and leisure activities for people with intellectual disabilities: A cluster randomized pilot study

AIM

A pilot cluster randomized controlled trial was performed to evaluate the effects of a music group intervention and a leisure activities group intervention on well-being, self-esteem, social acceptance, challenging behaviour and three components of executive functions (inhibitory control, cognitive flexibility and visual working memory) of adults with intellectual disabilities (ID).

METHOD

Twenty-nine participants living in four residential facilities for people with ID were randomized into a music or a leisure activities group intervention. Sixteen weekly sessions of one hour were performed with six to eight participants per group. Measurements were carried out at baseline, post-intervention and 11 weeks follow- up. Results were analysed with linear mixed models.

RESULTS

The leisure activities group intervention improved more than the music group intervention on internalizing behaviour overall and on inhibitory control at post-intervention. However, further analyses showed that this improvement was only significant in one of the two leisure activities facilities.

CONCLUSION

A leisure activities group intervention seems a promising intervention to improve internalizing behaviour and inhibitory control of younger adults with mild ID. Implications for the delivery of leisure activities group interventions and especially music group interventions are discussed.

WHAT THIS PAPER ADDS

Involvement in leisure activities of people with ID is associated with better well-being, an improvement in social skills and a reduction in emotional and behavioural problems. Active music making, as a specific form of leisure activities, seems to improve well-being, social acceptance and challenging behaviour (CB) as well. Moreover, in different (non-clinical) groups a significant effect of active music making has been found on self-esteem and executive functioning (EF). So far, little attention has been paid to the possible positive effects of active music making on adults with ID. In the current paper, a randomized controlled trial (RCT) was conducted to compare the post-intervention and follow-up measurements with baseline measurements between a music group intervention and a leisure activities group intervention on well-being, self-esteem, social acceptance, CB and EF in adults with ID. Multilevel models were used to detect possible intervention effects of 16 weekly sessions. Overall, inhibitory control and internalizing behaviour improved more amongst the participants of the leisure activities group than amongst the participants of the music group. This was mainly the case for younger participants who had mild ID. These effects are discussed and recommendations regarding the improvement of a music intervention for people with ID are presented.

Self-esteem and its relationship with depression and anxiety in adults with intellectual disabilities: a systematic literature review

BACKGROUND

In the general population, low self-esteem has been linked with poorer mental and physical health. This systematic literature review aimed to summarise and evaluate the findings of studies that examined self-esteem in adults with intellectual disabilities and links with mental health outcomes.

METHOD

A systematic search of PsycINFO, Web of Science and CINAHL was conducted to identify studies published between 1990 and 2021. The studies were appraised using the QualSyst tool.

RESULTS

Twenty-six articles were identified of which two studies were removed from the review due to low quality. Studies reported mixed evidence regarding levels of self-esteem compared with the general population. Engagement in activities appeared to be linked with positive self-esteem, and perception of negative interpersonal life events as having a negative impact was associated with lower self-esteem. There was evidence of co-occurrence of low self-esteem and depression, but no studies examined the relationship between self-esteem and anxiety.

CONCLUSION

Reviewed studies provided mixed evidence on levels of self-esteem in this population, suggesting that factors such as engagement in life were related to higher self-esteem and demonstrating the co-occurrence of low self-esteem and depression. However, clear causal links have yet to be identified, and more research is needed using longitudinal designs to answer questions about trajectory.

Positive parenting style and positive health beyond the authoritative: Self, universalism values, and protection against emotional vulnerability from Spanish adolescents and adult children

Introduction

Recent research is fully questioning whether the combination of parenting warmth and strictness (the authoritative style) is always identified as positive parenting across the globe. This study analyzes parenting styles and the positive health of adolescents and adult children.

Methods

The sample was 2,090 Spanish children (59.9% women), from four age groups: 600 adolescents, 591 young adults, 507 middle-aged adults, and 392 older adults. Parenting styles (indulgent, authoritative, authoritarian, and neglectful) were obtained by warmth and strictness measures. Children's positive health was measured by self (family self-concept, self-esteem, and negative self-efficacy), universalism values, and emotional vulnerability.

Results

The main results showed that the indulgent parenting style was associated with equal and even better scores than the authoritative style, whereas the authoritarian and neglectful styles were consistently associated with low scores in positive health indicators for all age groups. However, two triple interactions of sex by age group by parenting style showed that women children from neglectful families reported the lowest family self-concept in old age and the highest emotional vulnerability in middle age.

Discussion

The study findings question the universal benefits of the so-called positive parenting (the authoritative style) for positive health.

Increased openness to external influences in adolescents with intellectual disability: Insights from an experimental study on social judgments

BACKGROUND

Making appropriate social judgments about one's peers helps avoid negative influences from peers, yet the cognitive and adaptive difficulties experienced by adolescents with an intellectual disability (ID) may create challenges in this regard.

PROCEDURE

This study used a computer-based task to investigate how adolescents with ID (n = 34, M = 14.89 years, SD = 1.38) and comparison groups of chronological age-matched adolescents without ID (n = 34, M = 14.68, SD = 1.16) and mental age-matched children (n = 34, M = 7.88, SD = .62) make social judgments of photos of adolescents, and the degree to which they are influenced by non-social and social cues in performing this task.

RESULTS

Analyses showed adolescents with ID made significantly more polarizing judgments and showed a positivity bias compared to adolescents without ID. This judgment pattern was similar to that of younger mental age-matched children. Adolescents with ID were also significantly more influenced by non-social cues and peer opinions than adolescents from the control group.

IMPLICATIONS

The results provide new perspectives for future research and support of adolescents with ID.

The relationship between adverse interpersonal experiences and self-esteem in people with intellectual disabilities: The role of shame, self-compassion and social support

BACKGROUND

People with intellectual disabilities are reported to have low self-esteem and to experience high rates of adverse interpersonal experiences (AIEs). This study aimed to investigate whether shame and self-compassion mediate the relationship between AIEs and self-esteem for people with intellectual disabilities and whether perceived social support moderates this relationship.

METHOD

This study employed a cross-sectional design, involving between-group comparisons. Forty-seven people with intellectual disabilities and 50 people without intellectual disabilities completed self-report questionnaires measuring shame, self-compassion, self-esteem, early AIEs and social support.

RESULTS

Shame and self-compassion were found to mediate the relationship between AIEs and self-esteem for people with intellectual disabilities. There was no evidence for a moderating effect of social support and no difference between groups in shame or self-compassion.

CONCLUSIONS

The findings suggest shame and self-compassion are important concepts for people with intellectual disabilities. Clinical and research implications are discussed.

Experiences of shame and intellectual disabilities: Two case studies

Shame is a trans-diagnostic phenomenon that underlies a variety of mental health difficulties. People with intellectual disabilities (IDs) are reported to be one of the most stigmatized and excluded groups in society and are more likely to experience mental health problems than the general population. Consequently, this group may be at a significant risk of shame-related distress. However, there is a lack of research that investigates the experience of shame in people with ID, and there is currently a lack of interventions targeting shame in people with ID. Two case studies were undertaken to document the experiences of stigma, discrimination, and shame in people with ID and to explore how shame may present in this population. Shame was found to be a significant barrier to social inclusion and to contribute towards poor psychological health in people with ID. The development of interventions that specifically target shame in this population is recommended.

Protective and Risk Factors for Adolescent Substance Use in Spain: Self-Esteem and Other Indicators of Personal Well-Being and Ill-Being

Although self-esteem has traditionally been considered as an important correlate of psychosocial adjustment, some empirical studies have found a positive relationship between some domains of self-esteem and drug use among adolescents. The present study analyzes self-esteem and other adjustment personal indicators as protective or risk factors for substance use. Participants were 644 Spanish adolescents aged 12–17 years. Substance use (cigarettes, alcohol, marijuana, and other illicit drugs), multidimensional self-esteem (academic, social, emotional, family, and physical), and other indicators of adolescents’ well-being and ill-being (psychological problems, behavior problems, and parenting) were measured. We observed, on the one hand, that substance use had a significant negative relationship with academic, family, and physical self-esteem. On the other hand, we also observed a significant positive relationship between drug use and social self-esteem. However, this significant relationship disappeared after statistically controlling for sex and age, using both partial correlation analyses and covariance analysis. Interestingly, beyond the importance of each factor related to drugs, prevention science should first of all be able to identify whether the main psychological variables (e.g., social or physical self-esteem) are risk or protective factors for drug use.

The Rasch Analysis of Rosenberg Self-Esteem Scale in Individuals With Intellectual Disabilities

Background

The purpose of this study was to examine the psychometric properties of the Rosenberg Self-Esteem Scale for individuals with intellectual disabilities (ID) using the Rasch model and to determine whether the scale is valid and reliable for use with this population.

Methods

Rasch analysis was carried out on data from 223 respondents to the 8th Panel Survey on Employment for the Disabled conducted by the Korea Employment Agency for the Disabled. The validity and reliability of scale items were verified through analyses of item fit, item difficulties, the rating scale, and separation indices.

Results

Item infit mean square values were found to range between 0.71 and 1.25, and item outfit mean square values between 0.71 and 1.26. Additionally, item difficulties were appropriate; Item 4 was the most difficult item, while Item 10 was the easiest item. The 4-point rating scale was appropriate, and the separation indices were at an acceptable level.

Conclusion

Based on these results, the validity and reliability of the Rosenberg Self-Esteem Scale for use with individuals with ID were verified. Thus, this scale can be regarded as a useful tool for evaluating the level of self-esteem of individuals with ID.

The Role of Parenting Styles on Behavior Problem Profiles of Adolescents

Parental behavior is one of the most influential factors on the development of adolescent externalizing and internalizing behavior problems. These behavioral problems are closely related and often co-occur. The objectives of this work were: (i) to identify adolescents profiles according to their behavior problems; (ii) to explore individual, family, and social characteristics associated with these profiles; and (iii) to analyze the potential role of parenting styles in belonging to adolescents’ profiles. A total of 449 Spanish adolescents (223 from families declared at-risk and enrolled in Child Welfare Services and 226 from families from the general population) participated in this study. The analyses revealed three profiles of adolescents based on external and internal behavior problems (adjusted, external maladjustment, and internal maladjustment). Parenting styles explained the adolescents’ belonging to different profiles, in which the indulgent style was the most favorable in general terms. The distinctive role of parenting styles on two types of maladjustment profiles was confirmed. The relationship between parenting styles and adolescent adjustment is a key component that should be included in interventions according to adolescents’ behavior problem profiles. Furthermore, the results shed light on the need that family interventions are complemented with individualized interventions with adolescents that accumulate stressful life events.

Psychiatric diagnoses in relation to severity of intellectual disability and challenging behaviors: a register study among older people

OBJECTIVE

To investigate the possible association between severity of intellectual disability (ID) and presence of challenging behavior, respectively, on diagnoses of psychiatric disorders among older people with ID.

METHODS

People with a diagnosis of ID in inpatient or specialist outpatient care in 2002-2012 were identified (n = 2147; 611 with mild ID, 285 with moderate ID, 255 with severe or profound ID, and 996 with other/unspecified ID). Moreover, using impairment of behavior as a proxy for challenging behavior, 627 people with, and 1514 without such behavior were identified.

RESULTS

Severe/profound ID was associated with lower odds of diagnoses of psychotic, affective, and anxiety disorders than was mild/moderate ID. People with moderate ID had higher odds than those with mild ID of having diagnoses of affective disorders. Diagnoses of psychotic, affective, and anxiety disorders, and dementia were more common among people with challenging behavior than among those without.

CONCLUSIONS

People with severe/profound ID had lower odds of receiving psychiatric diagnoses than those with mild and moderate ID. Whether this is a result of differences in prevalence of disorders or diagnostic difficulties is unknown. Further, challenging behaviors were associated with diagnoses of psychiatric disorders. However, the nature of this association remains unclear.

Relaxation therapy and anxiety, self-esteem, and emotional regulation among adults with intellectual disabilities: A randomized controlled trial

This pilot study is a randomized controlled trial on the effects of relaxation on anxiety, self-esteem, and emotional regulation in adults with intellectual disabilities (ID) working in a center of supported employment in France. We studied 30 adults with mild or moderate ID who were split at random into a relaxation group (RG, 15 subjects), who completed 10 sessions of relaxation therapy, and a control group (CG, 15 subjects), who were on a waiting list. The method used is the pretest and posttest. Variables were assessed by the State-Trait Anxiety Inventory form Y scale, the Rosenberg Self-Esteem scale, and the Emotion Regulation Questionnaire. We found that in the RG, relaxation significantly reduced state anxiety, t(14, 15) = 17.8***, d = -0.72, and improved self-esteem, t(14, 15) = -7.7***, d = 1.03, and cognitive reappraisal, t(14, 15) = -6.3***, d = 1.3, while the CG showed no change for these variables. We conclude that relaxation seems to be an interesting therapeutic option for reducing anxiety in people with ID in a supported employment setting.

Functional outcome in bipolar disorder: the big picture

Previous research on functional outcome in bipolar disorder (BD) has uncovered various factors that exacerbate psychosocial disability over the course of illness, including genetics, illness severity, stress, anxiety, and cognitive impairment. This paper presents an integrated view of these findings that accounts for the precipitous decline in psychosocial functioning after illness onset. The proposed model highlights a number of reciprocal pathways among previously studied factors that trap people in a powerful cycle of ailing forces. The paper discusses implications to patient care as well as the larger social changes required for shifting the functional trajectory of people with BD from psychosocial decline to growth.