Assessing anger in people with intellectual disability

The use of proxy measurement of internal states in people with intellectual disability: A scoping review

BACKGROUND

The measurement of internal states of people with an intellectual disability is challenging. Given these difficulties, proxy respondents are sometimes used. However, the literature provides some caution about the validity of the use of proxy respondents.

AIMS

This review aims to identify the available evidence regarding the use of proxy respondents in the measurement of internal states of people with intellectual disabilities.

METHOD

The Arksey and O'Malley scoping review framework was used for this review, refined with the Joanna Briggs Institute Methodology.

RESULTS

Results indicate there are some differences in the findings reported with respect to the efficacy of the use of proxy respondents. These may be due to a number of inconsistencies and weaknesses in examinations of their utility.

CONCLUSIONS

If proxy-reports are to be useful in understanding the internal states of people with intellectual disability, researchers need to address the shortcomings revealed by this review.

Reliability of a method for establishing the capacity of individuals with an intellectual disability to respond to Likert scales

BACKGROUND

The study reported here was an examination of the reliability of a method for determining acquiescent responding and the capacity to respond to items using a Likert scale response format by adults with an intellectual disability.

METHOD

Reliability of the outcomes of these procedures was investigated using a test-retest design. Associations with receptive vocabulary were examined.

RESULTS

The majority of the participants did not demonstrate acquiescent responding. Individuals' responses to the Likert-type discrimination tasks were consistent, although this varied somewhat depending upon the abstractness of the task. There was some association between receptive language age equivalence scores and respondent performance.

CONCLUSION

It is recommended that the pretest protocol (a) be modified to improve its reliability, and (b) this modified version be used with study participants who have an intellectual disability to ascertain the appropriate level of choice to be used for items that use a Likert response format.

The impact of staff initiated referral and intervention protocols on symptoms of depression in people with mild intellectual disability

It has been estimated that people with ID experience the same and possibly higher levels of depression than the general population. Referral to a General Medical Practitioner (GP) for primary care is recommended practice for people with depression and cognitive behavioural (CB) therapy is now an accepted evidence based intervention. A growing body of literature indicates that people with ID and depression may benefit from CB strategies. The aim of the current study was to compare (i) CB group intervention strategies with referral to a GP; (ii) CB group intervention strategies only; and (iii) referral to a GP only on symptoms of depression among people with mild ID. Staff from six participating agencies received training in (a) how to identify and screen individuals with mild ID for depressive symptoms and risk factors for depression, and (b) supportive referral of identified individuals to GPs for mental health services. In addition, staff from four of the agencies undertook (c) training on how to deliver group CB intervention strategies. Eighty-two participants were allocated to one of the three intervention groups. Depressive symptoms and negative automatic thoughts were assessed prior to the intervention, at the conclusion of the intervention, and at eight months follow-up. Compared to GP referral alone, those participants who received CB strategies both with and without GP referral displayed significant reductions in depressive symptoms. The use of CB strategies only also resulted in a significant reduction in frequency of negative automatic thoughts. The findings of this study support routine screening of individuals with mild ID for depression and the delivery of group CB intervention programmes by trained staff within community-based disability agencies.

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

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

Feasibility, reliability and validity of the Dutch translation of the Anxiety, Depression And Mood Scale in older adults with intellectual disabilities

BACKGROUND

The informant-based Anxiety, Depression And Mood Scale was translated into Dutch and its feasibility, reliability and validity in older adults (aged ≥ 50 years) with intellectual disabilities (ID) was studied.

METHOD

Test-retest (n = 93) and interrater reliability (n = 83), and convergent (n = 202 and n = 787), discriminant (n = 288) and criterion validity (n = 288) were studied. Convergent and criterion validity were studied for the Depressed mood and General anxiety subscales. Subgroups based on level of ID and autism have been made to study the criterion validity. Psychiatric diagnoses based on the PAS-ADD Interview were used as gold standard.

RESULTS

All subscales had good internal consistency (α ≥ 0.80), excellent test-retest reliability (ICC ≥ 0.75) and good interrater reliability (ICC ≥ 0.74), except for the Social avoidance subscale (ICC = 0.57). The Depressed mood subscale showed low correlation (r = 0.44) with the self-report Inventory of Depressive Symptomatology, high correlation with the informant-report Signalizing Depression List for people with ID (r = 0.71) and no correlation with the PAS-ADD's sleep disorders subscale (r = 0.15). Its sensitivity ranged from 73 to 80%, and its specificity from 71 to 79%. The General anxiety subscale showed low correlation with the self-report scales: Glasgow Anxiety Scale (r= 0.37) and Hospital Anxiety and Depression Scale (r = 0.41), and no correlation with the sleep disorder subscale (r = 0.02). Its sensitivity ranged from 67 to 100%, and its specificity from 48 to 81%.

CONCLUSIONS

The Dutch translation of the ADAMS is reliable and sufficiently valid to screen for anxiety and depression in older people with ID.

Intelligent diagnosing of intellectual disabilities in offenders: food for thought

Research on offenders with intellectual disabilities (IDs) in the criminal justice arena is on the rise, reflected by a growing number of relevant publications each year. However, there is a long recognized methodological problem that hampers the comparability of empirical studies and that raises doubts about the accuracy of prevalence rates, comorbidities, and various correlates and characteristics. In this paper we will argue that the crux of the problem can, on the one hand, be found in the plurality of assessment methods for intelligence and adaptive functioning, which are not all sufficiently reliable and valid. On the other hand, assessment of IQ in criminal justice and mental health-related areas appears to be informed more by practical aspects and needs rather than grounded in a solid theoretical model. Hence, we suggest that the Cattell-Horn-Carroll (CHC) model of intelligence has potential value in this regard, and deserves a closer look. Finally, we will discuss its incorporation into, and possible implications for, criminal justice practice and future study designs.

Carer reports of the efficacy of cognitive behavioral interventions for anger

Anger resulting in Aggression can be a significant problem for some people with Intellectual Disabilities. Carers were asked to complete a provocation inventory and an attribution scale before and after a group cognitive behavioral intervention aimed for anger and at similar points in time for a waiting list control. When compared using an analysis of variance results suggest that staff perceive a significant reduction in aggressive responses for participants who took part in the intervention. A regression analysis of factors that may influence the amount of change observed suggests that greater change was achieved if participants were accompanied by carers and had been attributed by carers as having an emotional cause for their behavior.