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Kanthasamy S, Miskon N, Barlas J, Marsh NV. Family Caregiver Adaptation during the Transition to Adulthood of Individuals with Intellectual Disabilities: A Scoping Review. Healthcare (Basel) 2024; 12:116. [PMID: 38201021 PMCID: PMC10779180 DOI: 10.3390/healthcare12010116] [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: 09/22/2023] [Revised: 12/08/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
During the transition to adulthood, individuals diagnosed with intellectual disability (ID) and their family caregivers have unique experiences. This scoping review studies the sources of the family caregiver's objective burden, support, coping mechanisms, positive caregiving, and quality of life to understand the caregiver's adaptation process when the individual with ID transits to adulthood, according to Joanna Briggs Institute (JBI) Scoping Review methodology guidelines. The inclusion criteria included studies of family caregivers of any age who provide unpaid care and live with individuals diagnosed with ID who are transitioning to adulthood. Of 2875 articles identified, 12 published studies were included. The main themes included caregivers reporting dissatisfaction with the available adult services and exhaustion from being a caregiver. Overall, a vicious cycle of likely increased demands during the transition, with caregivers not being prepared to cope with these demands while concurrently being dissatisfied with the adult services system, leads the caregivers to develop a pervasive sense of helplessness. Future studies would benefit from recruiting caregivers from sources other than adult-only service centres and using qualitative (to identify the broad aspects of the key factors) and quantitative (to identify the significant differences between the key factors) methodologies.
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Affiliation(s)
- Shivasangarey Kanthasamy
- School of Social and Health Sciences, James Cook University, Singapore 387380, Singapore; (S.K.); (J.B.)
- Department of Psychology, Institute of Mental Health, Singapore 539747, Singapore;
| | - Nazleen Miskon
- Department of Psychology, Institute of Mental Health, Singapore 539747, Singapore;
| | - Joanna Barlas
- School of Social and Health Sciences, James Cook University, Singapore 387380, Singapore; (S.K.); (J.B.)
| | - Nigel V. Marsh
- School of Social and Health Sciences, James Cook University, Singapore 387380, Singapore; (S.K.); (J.B.)
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Baksh RA, Sheehan R, Hassiotis A, Smith J, Strydom A. Identifying individuals with intellectual disability who access mental health support and are at high risk for adverse clinical outcomes: cohort study. BJPsych Open 2023; 9:e183. [PMID: 37813547 PMCID: PMC10594232 DOI: 10.1192/bjo.2023.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/07/2023] [Accepted: 08/31/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND People with intellectual disability often experience aggressive challenging behaviour and mental health issues. It can be difficult to identify those who are at higher risk of adverse clinical outcomes when in clinical care. AIMS To characterise potential subgroups in adults with intellectual disability referred to mental health services in those presenting with aggressive behaviour or common mental disorders (CMDs). METHOD There were 836 adults (≥18 years) with intellectual disability and a record of aggressive challenging behaviour, and 205 patients with intellectual disability and CMDs, who were seen in specialist mental health services over a 5-year period. Cluster analysis was used to define patient characteristics associated with clinical outcome. RESULTS Distinct patient groups with differentiated profiles were observed in people with intellectual disability displaying aggressive challenging behaviour, and in those presenting with CMDs. Characteristics of the aggressive behaviour group who experienced adverse outcomes included being <30 years old, being male, more mentions of aggression and agitation in their clinical record, a diagnosis of pervasive developmental disorder and prescription of psychotropic medication. Characteristics of the CMD cluster that experienced adverse clinical outcomes were being older, being a White male, having a mild intellectual disability and physical health concerns. CONCLUSIONS People with intellectual disability who experience adverse clinical outcomes can be identified with a cluster analysis approach of common features, but differ by clinical presentation. This could be used not only to stratify this clinically heterogeneous population in terms of response to interventions, but also improve precision in the development of tailored interventions.
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Affiliation(s)
- R. Asaad Baksh
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK; and The LonDowns Consortium, London, UK
| | - Rory Sheehan
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Angela Hassiotis
- Division of Psychiatry, University College London, UK; and Camden Learning Disabilities Service, London, UK
| | - James Smith
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Andre Strydom
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; The LonDowns Consortium, London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
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Shelley L, Waite J, Tarver J, Oliver C, Crawford H, Richards C, Bissell S. Behaviours that Challenge in SATB2-associated Syndrome: Correlates of Self-injury, Aggression and Property Destruction. J Autism Dev Disord 2023:10.1007/s10803-023-06123-2. [PMID: 37751087 DOI: 10.1007/s10803-023-06123-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/27/2023]
Abstract
SATB2-associated syndrome (SAS) is a genetic syndrome characterised by intellectual disability, severe speech delay, and palatal and dental problems. Behaviours that challenge (BtC) are reported frequently; however, there is limited research on specific forms of BtC and the correlates of these behaviours. The current study explores correlates of well-defined BtC, self-injury, aggression, and property destruction, in SAS. Eighty-one parents/caregivers of individuals with SAS (53.1% male, Mage 10.12 years) completed questionnaire measures of health, behavioural, emotional, and autism characteristics. Individuals with SAS were grouped based on caregiver responses to the presence or absence of self-injury, aggression, and property destruction on the Challenging Behaviour Questionnaire. Rates of self-injury, aggression and property destruction were 42%, 77% and 49%, respectively. Between-group comparisons were conducted to compare characteristics between behaviour groups. Significantly differing characteristics were entered into separate hierarchical logistic regressions for each form of BtC. Behavioural comparisons indicated variation in the characteristics associated with each behaviour. All hierarchical logistic regression models were significant (p < .001): self-injury (χ2(5) = 38.46, R2 = 0.571), aggression (χ2(4) = 25.12, R2 = 0.414), property destruction (χ2(4) = 23.70, R2 = 0.346), explaining between 34.6% and 57.1% of the variance in behaviour presence. This is the first study to identify correlates of self-injury, aggression, and property destruction in SAS. Variability in the characteristics associated with each behaviour highlights the importance of specificity when examining BtC. Understanding correlates of specific forms of BtC has important implications for informing SAS-associated pathways to behavioural outcomes and the implementation of tailored behavioural interventions.
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Affiliation(s)
- Lauren Shelley
- College of Health and Life Sciences, Aston University, Birmingham, UK.
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK.
| | - Jane Waite
- College of Health and Life Sciences, Aston University, Birmingham, UK
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
| | - Joanne Tarver
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Chris Oliver
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Hayley Crawford
- Mental Health and Wellbeing Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
| | - Stacey Bissell
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
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Wolstencroft J, Srinivasan R, Hall J, van den Bree MBM, Owen MJ, Raymond FL, Skuse D. Mental health impact of autism on families of children with intellectual and developmental disabilities of genetic origin. JCPP ADVANCES 2023; 3:e12128. [PMID: 37431317 PMCID: PMC10241472 DOI: 10.1002/jcv2.12128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/10/2022] [Indexed: 01/15/2023] Open
Abstract
Background Many children with an intellectual or developmental disability (IDD) have associated autism spectrum disorders (ASD), as well as an increased risk of mental health difficulties. In a cohort with IDD of genetic aetiology, we tested the hypothesis that excess risk attached to those with ASD + IDD, in terms of both children's mental health and parental psychological distress. Methods Participants with a copy number variant or single nucleotide variant (5-19 years) were recruited via UK National Health Service. 1904 caregivers competed an online assessment of child mental health and reported on their own psychological wellbeing. We used regression to examine the association between IDD with and without co-occurring ASD, and co-occurring mental health difficulties, as well as with parental psychological distress. We adjusted for children's sex, developmental level, physical health, and socio-economic deprivation. Results Of the 1904 participants with IDD, 701 (36.8%) had co-occurring ASD. Children with both IDD and ASD were at higher risk of associated disorders than those with IDD alone (ADHD: OR = 1.84, 95% confidence interval [CI] 1.46-2.32, p < 0.0001; emotional disorders: OR = 1.85, 95%CI 1.36-2.5, p < 0.0001; disruptive behaviour disorders: OR = 1.79, 95%CI 1.36-2.37, p < 0.0001). The severity of associated symptoms was also greater in those with ASD (hyperactivity: B = 0.25, 95%CI 0.07-0.34, p = 0.006; emotional difficulties: B = 0.91, 95%CI 0.67 to 1.14, p < 0.0001; conduct problems: B = 0.25, 95%CI 0.05 to 0.46, p = 0.013). Parents of children with IDD and ASD also reported greater psychological distress than those with IDD alone (β = 0.1, 95% CI 0.85 to 2.21, p < 0.0001). Specifically, in those with ASD, symptoms of hyperactivity (β = 0.13, 95% CI 0.29-0.63, p < 0.0001), emotional difficulties (β = 0.15, 95% CI 0.26-0.51, p < 0.0001) and conduct difficulties (β = 0.07, 95% CI 0.07-0.37, p < 0.004) all significantly contributed to parental psychological distress. Conclusions Among children with IDD of genetic aetiology, one third have co-occurring ASD. Not only do those with co-occurring ASD present with a wider range of associated mental health disorders and more severe mental health difficulties than those with IDD alone, but their parents also experience more psychological distress. Our findings suggest that the additional mental health and behavioural symptoms in those with ASD contributed to the degree of parental psychological distress.
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Affiliation(s)
- Jeanne Wolstencroft
- UCL NIHR BRC Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Ramya Srinivasan
- UCL NIHR BRC Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
- UCL Division of PsychiatryUniversity College LondonLondonUK
| | - Jeremy Hall
- Medical Research Council Centre for Neuropsychiatric Genetics and GenomicsDivision of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
- Neuroscience and Mental Health Research InstituteCardiff UniversityCardiffUK
| | - Marianne B. M. van den Bree
- Medical Research Council Centre for Neuropsychiatric Genetics and GenomicsDivision of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
- Neuroscience and Mental Health Research InstituteCardiff UniversityCardiffUK
| | - Michael J. Owen
- Medical Research Council Centre for Neuropsychiatric Genetics and GenomicsDivision of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
- Neuroscience and Mental Health Research InstituteCardiff UniversityCardiffUK
| | | | - F. Lucy Raymond
- School of Clinical MedicineUniversity of CambridgeCambridgeUK
- Cambridge University Hospitals NHS Foundation TrustCambridge Biomedical CampusCambridgeUK
- NIHR BioresourceCambridge Biomedical CampusCambridgeUK
| | - David Skuse
- UCL NIHR BRC Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
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Wolstencroft J, Hull L, Warner L, Akhtar TN, Mandy W, Skuse D. 'We have been in lockdown since he was born': a mixed methods exploration of the experiences of families caring for children with intellectual disability during the COVID-19 pandemic in the UK. BMJ Open 2021; 11:e049386. [PMID: 34593495 PMCID: PMC8487017 DOI: 10.1136/bmjopen-2021-049386] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This study aimed to explore the experiences of parents caring for children with intellectual and developmental disabilities (IDD) during the UK national lockdown in spring 2020, resulting from the COVID-19 pandemic. DESIGN Participants were identified using opportunity sampling from the IMAGINE-ID national (UK) cohort and completed an online survey followed by a semistructured interview. Interviews were analysed using thematic analysis. SETTING Interviews were conducted over the telephone in July 2020 as the first UK lockdown was ending. PARTICIPANTS 23 mothers of children with intellectual and developmental disabilities aged 5-15 years were recruited. RESULTS Themes reported by parents included: managing pre-existing challenges during a time of extreme change, having mixed emotions about the benefits and difficulties that arose during the lockdown and the need for appropriate, individualised support. CONCLUSIONS Our findings confirm observations previously found in UK parents of children with IDD and provide new insights on the use of technology during the pandemic for schooling and healthcare, as well as the need for regular check-ins.
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Affiliation(s)
- Jeanne Wolstencroft
- The Great Ormond Street Institute of Child Health, University College London, London, England
| | - Laura Hull
- Division of Psychology and Language Sciences, University College London, London, England
| | - Lauren Warner
- The Great Ormond Street Institute of Child Health, University College London, London, England
| | - Tooba Nadeem Akhtar
- The Great Ormond Street Institute of Child Health, University College London, London, England
| | - William Mandy
- Division of Psychology and Language Sciences, University College London, London, England
| | - David Skuse
- The Great Ormond Street Institute of Child Health, University College London, London, England
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Müller CM, Cillessen AHN, Egger S, Hofmann V. Peer influence on problem behaviors among students with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 114:103994. [PMID: 34020411 DOI: 10.1016/j.ridd.2021.103994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Students with intellectual disabilities (ID) exhibit increased rates of problem behaviors compared to those without ID. AIMS Given the evidence of peer influence in typical development, we examined the impact of classmates' characteristics on problem behaviors of students with ID. We expected higher levels of problem behaviors in special needs classrooms will influence individual development of such behaviors. METHODS A longitudinal design with measurements at the beginning and the end of a school year was applied. Staff reported on problem behaviors of 1125 students with ID (69 % boys; age 11.30 years,SD = 3.75) attending 16 Swiss special needs schools. RESULTS The peer influence hypothesis was not supported for an overall problem behavior score. However, exploratory analyses suggested that peer influence did occur for the domains anxiety, problems in relating socially, and communication disturbances (not disruptive/antisocial, self-absorbed and other types of problem behaviors). The influence of classmates on anxiety was lower when there was more variability in anxiety within the classroom. The development of communication skills benefitted from attending a classroom that was heterogeneous in the level of communication problems. CONCLUSION Our results suggest that the influence of peers on problem behaviors in special needs schools is not universal but varies between domains and depends on classroom characteristics.
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Affiliation(s)
| | | | - Sara Egger
- Department of Special Education, University of Fribourg, Switzerland
| | - Verena Hofmann
- Department of Special Education, University of Fribourg, Switzerland
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Levavi K, Menashe-Grinberg A, Barak-Levy Y, Atzaba-Poria N. The role of parental playfulness as a moderator reducing child behavioural problems among children with intellectual disability in Israel. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 107:103793. [PMID: 33260012 DOI: 10.1016/j.ridd.2020.103793] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Playfulness is well known to be vital for child development. However, not much is known regarding parental playfulness. We set out to investigate the role of parental playfulness in children with intellectual disabilities (ID) and typical development (TD) living in Israel. Specifically, we examined 1) differences in parental playfulness between groups and 2) parental playfulness as a moderator in the link between developmental status and behavioural problems (BP). METHOD One hundred forty-two families living in Israel and their children (48 % with ID) aged 4-7 years participated in the study. Parent-child play interaction was videotaped and coded for parental playfulness. Parents reported on child BP using the CBCL questionnaire. RESULTS Parents in the ID group showed lower levels of playfulness compared to parents in the TD group. Father's playfulness acted as a moderator in the link between developmental status and child BP. CONCLUSIONS These results highlight the unique role of father's playfulness in the developmental status of a child diagnosed with ID.
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Affiliation(s)
- Kinneret Levavi
- Department of Psychology, Ben-Gurion University of the Negev, Israel.
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8
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Collateral Effects of Behavioral Treatment for Problem Behavior on Caregiver Stress. J Autism Dev Disord 2020; 51:2852-2865. [PMID: 33104925 DOI: 10.1007/s10803-020-04694-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
When individuals with autism and intellectual and developmental disabilities exhibit severe problem behavior, assessment and treatment are often warranted. Parents of such individuals are at high risk for developing parenting stress. In this study, 194 parents completed the Parenting Stress Index-Short Form at their child's time of admission to and discharge from inpatient or outpatient treatment for severe problem behavior. Parent stress was examined in relation to rate and function of child problem behavior as determined via functional analysis. Repeated measures analyses of variance were conducted, and differential effects were observed when child participants exhibited an attention, automatic, or mands function for problem behavior. These findings highlight the importance of considering function of problem behavior in relation to parenting stress.
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Laverty C, Oliver C, Moss J, Nelson L, Richards C. Persistence and predictors of self-injurious behaviour in autism: a ten-year prospective cohort study. Mol Autism 2020; 11:8. [PMID: 31988707 PMCID: PMC6971887 DOI: 10.1186/s13229-019-0307-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/18/2019] [Indexed: 12/27/2022] Open
Abstract
Background Self-injurious behaviours, such as head banging, hair pulling, skin picking and scratching, are common in individuals with autism. Despite high prevalence rates, there is a paucity of longitudinal research to refine models of risk and mechanism and inform service planning. In this longitudinal study, we investigated self-injury in a cohort of individuals with autism over 10 years to identify behavioural and demographic characteristics associated with persistent self-injury. Methods Carers of 67 individuals with autism completed questionnaires relating to the presence of self-injury and relevant risk markers at T1 (mean [SD] age in years 13.4 [7.7]) and T3 (mean [SD] age in years 23.9 [7.7]) 10 years later. Forty-six of these also took part at T2 (3 years after initial participation). Analysis assessed demographic and behavioural risk markers for self-injury, as well as the predictive value of items assessed at T1and T2. Results Self-injury was persistent in 44% of individuals over the 10-year period, with behavioural characteristics of impulsivity (p < .001) and overactivity (p = .002), identified as risk markers for persistence. A predictive model of self-injury was derived from LASSO analysis, with baseline impulsivity, interest and pleasure, stereotyped behaviour, social communication and adaptive functioning predicting self-injury over 10 years. Conclusions In this unique longitudinal investigation into the persistence of self-injury in a non-clinical sample of individuals with autism over a 10 year period, we have identified a novel, robust and stable profile of behavioural characteristics associated with persistent self-injury. Findings support an early intervention strategy targeted towards individuals identified to be at a higher risk of developing self-injurious behaviour.
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Affiliation(s)
- Catherine Laverty
- School of Psychology, University of Birmingham, Birmingham, B15 2TT UK
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT UK
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT UK
| | - Jo Moss
- School of Psychology, University of Surrey, Guildford, Surrey GU2 7XH UK
| | - Lisa Nelson
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Birmingham, B15 2TT UK
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT UK
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Examining the Links Between Received Network Support and Marital Quality Among Mothers of Children with ASD: A Longitudinal Mediation Analysis. J Autism Dev Disord 2019; 50:960-975. [PMID: 31853756 DOI: 10.1007/s10803-019-04330-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Employing a cohort sequential design and multilevel modeling, the direct and indirect effects (via depressed mood, emotional wellbeing, and perceived support) of received network support on marital quality were assessed over a 7-year period (child age 7-14) on 96 married or cohabiting mothers of children with ASD. Findings indicated several significant direct and indirect effects affecting change within mothers over time, with effects varying by whether the support source was a spouse or partner, family members, or friends. In addition, one moderated mediation effect was noted, with the indirect effect of received spousal support on marital quality via perceived spousal support retaining significance only at low and moderate levels of child problem behavior severity. Study strengths, limitations, and clinical implications are discussed.
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Gallagher S, Pilch M, Hannigan A. Prior depressive symptoms and persistent child problem behaviours predict future depression in parents of children with developmental disabilities: The growing up in Ireland cohort study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 80:170-179. [PMID: 30032060 DOI: 10.1016/j.ridd.2018.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 06/15/2018] [Accepted: 07/04/2018] [Indexed: 06/08/2023]
Abstract
Predictors of depression over time were examined in parental carers of children with developmental disabilities (DD) and parents of typically developing children (controls) who participated in the Growing up in Ireland Study. Parents completed measures of depression, the Centre for Epidemiological Depression Scale (CES-D) and child problem behaviours, the Strength and Difficulties Questionnaire when the children were aged 9 (Wave 1) and 13 (Wave 2). Using CES-D cut-off scores to indicate probable depression, caregivers were more likely to be depressed at both waves compared to controls with a Wave 1 rate of depression of 14.6% vs. 7.9% (p < 0.001, Cramer`s V = 0.059) and Wave 2 (14.8% vs. 10%, p = 0.003, Cramer`s V = 0.038). While overall rates of depression were stable for caregivers, a shifting pattern emerged; 59.6% of those who were depressed at Wave 1, were not at Wave 2; similarly, 10.9% who were not depressed at Wave 1, were at Wave 2. Parents of children with DD were also more likely to report greater problem behaviours in their children compared to controls at both waves. Depression in caregivers at Wave 1 and persistent child problem behaviours were significant predictors of depression at Wave 2. In conclusion, while overall rates of depression remain stable in caregivers, there are shifting patterns evident with prior depression and persistent behaviour problems predictive of ongoing depression.
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Affiliation(s)
- Stephen Gallagher
- Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, Dept. of Psychology, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Monika Pilch
- Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, Dept. of Psychology, University of Limerick, Limerick, Ireland
| | - Ailish Hannigan
- Health Research Institute, University of Limerick, Limerick, Ireland; Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
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Richards C, Davies L, Oliver C. Predictors of Self-Injurious Behavior and Self-Restraint in Autism Spectrum Disorder: Towards a Hypothesis of Impaired Behavioral Control. J Autism Dev Disord 2017; 47:701-713. [PMID: 28070787 DOI: 10.1007/s10803-016-3000-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Self-injury is common in autism spectrum disorder (ASD); however few studies have investigated correlates of self-injury or the putative associations with self-restraint. Questionnaire data on self-injury, self-restraint, health conditions, overactivity/impulsivity and repetitive/restricted behavior were collected on 208 children and 216 adults with ASD (mean age = 24.10, range 6-61). Self-injury and self-restraint were frequent and significantly associated in both children (45.7% and 40.9%, p < 0.001) and adults (49.1, and 42.6%, p < 0.001). Severe self-injury was predicted by lower ability, health conditions and overactivity/impulsivity in children (p < 0.001) and repetitive/restricted behavior and overactivity/impulsivity in adults (p < 0.001). These data provide preliminary support for a developmental model of self-injury and self-restraint in which painful health conditions and compromised behavioral control influence the presence and trajectory of self-injury in ASD.
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Affiliation(s)
- Caroline Richards
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, B15 2TT, UK.
| | - Louise Davies
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, B15 2TT, UK.,Forward Thinking Birmingham Learning Disability Team, Oaklands Centre, Raddlebarn Road, Selly Oak, B29 6JB, UK
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, B15 2TT, UK
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Melville CA, Johnson PCD, Smiley E, Simpson N, Purves D, McConnachie A, Cooper SA. Problem behaviours and symptom dimensions of psychiatric disorders in adults with intellectual disabilities: An exploratory and confirmatory factor analysis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 55:1-13. [PMID: 27018744 DOI: 10.1016/j.ridd.2016.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/26/2016] [Accepted: 03/14/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The limited evidence on the relationship between problem behaviours and symptoms of psychiatric disorders experienced by adults with intellectual disabilities leads to conflict about diagnostic criteria and confused treatment. This study examined the relationship between problem behaviours and other psychopathology, and compared the predictive validity of dimensional and categorical models experienced by adults with intellectual disabilities. METHODS Exploratory and confirmatory factor analyses appropriate for non-continuous data were used to derive, and validate, symptom dimensions using two clinical datasets (n=457; n=274). Categorical diagnoses were derived using DC-LD. Severity and 5-year longitudinal outcome was measured using a battery of instruments. RESULTS Five factors/dimensions were identified and confirmed. Problem behaviours were included in an emotion dysregulation-problem behaviour dimension that was distinct from the depressive, anxiety, organic and psychosis dimensions. The dimensional model had better predictive validity than categorical diagnosis. CONCLUSIONS International classification systems should not include problem behaviours as behavioural equivalents in diagnostic criteria for depression or other psychiatric disorders. Investigating the relevance of emotional regulation to psychopathology may provide an important pathway for development of improved interventions. WHAT THIS PAPER ADDS There is uncertainty whether new onset problem behaviours or a change in longstanding problem behaviours should be considered as symptoms of depression or other types of psychiatric disorders in adults with intellectual disabilities. The validity of previous studies was limited by the use of pre-defined, categorical diagnoses or unreliable statistical methods. This study used robust statistical modelling to examine problem behaviours within a dimensional model of symptoms. We found that problem behaviours were included in an emotional dysregulation dimension and not in the dimension that included symptoms that are typical of depression. The dimensional model of symptoms had greater predictive validity than categorical diagnoses of psychiatric disorders. Our findings suggest that problem behaviours are a final common pathway for emotional distress in adults with intellectual disabilities so clinicians should not use a change in problem behaviours as a diagnostic criterion for depression, or other psychiatric disorders.
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Affiliation(s)
- Craig A Melville
- University of Glasgow, Institute of Health and Wellbeing, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, Scotland, UK.
| | - Paul C D Johnson
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medicine Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.
| | - Elita Smiley
- Learning Disabilities Psychiatry, NHS Greater Glasgow and Clyde, Glasgow, G78 1AA, Scotland, UK.
| | - Neill Simpson
- Learning Disabilities Psychiatry, NHS Greater Glasgow and Clyde, Glasgow, G78 1AA, Scotland, UK.
| | - David Purves
- Department of Statistics, Strathclyde University, 16 Richmond St, Glasgow G1 1XQ, Scotland, UK.
| | - Alex McConnachie
- University of Glasgow, Institute of Health and Wellbeing, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, Scotland, UK.
| | - Sally-Ann Cooper
- University of Glasgow, Institute of Health and Wellbeing, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, Scotland, UK.
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14
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Richards C, Moss J, Nelson L, Oliver C. Persistence of self-injurious behaviour in autism spectrum disorder over 3 years: a prospective cohort study of risk markers. J Neurodev Disord 2016; 8:21. [PMID: 27158272 PMCID: PMC4858900 DOI: 10.1186/s11689-016-9153-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/24/2016] [Indexed: 12/27/2022] Open
Abstract
Background There are few studies documenting the persistence of self-injury in individuals with autism spectrum disorder (ASD) and consequently limited data on behavioural and demographic characteristics associated with persistence. In this longitudinal study, we investigated self-injury in a cohort of individuals with ASD over 3 years to identify behavioural and demographic characteristics associated with persistence. Methods Carers of 67 individuals with ASD (Median age of individuals with ASD in years = 13.5, Interquartile Range = 10.00–17.00), completed questionnaires relating to the presence and topography of self-injury at T1 and three years later at T2. Analyses were conducted to evaluate the persistence of self-injury and to evaluate the behavioural and demographic characteristics associated with persistence of self-injury. Results At T2 self-injurious behaviour had persisted in 77.8 % of individuals. Behavioural correlates of being non-verbal, having lower ability and higher levels of overactivity, impulsivity and repetitive behaviour, were associated with self-injury at both time points. Risk markers of impulsivity (p = 0.021) and deficits in social interaction (p = 0.026) at T1 were associated with the persistence of self-injury over 3 years. Conclusions Impulsivity and deficits in social interaction are associated with persistent self-injury in ASD and thus may act as behavioural risk markers. The identification of these risk markers evidences a role for behaviour dysregulation in the development and maintenance of self-injury. The findings have clinical implications for proactive intervention; these behavioural characteristics may be utilised to identify ‘at risk’ individuals for whom self-injury is likely to be persistent and therefore those individuals for whom early intervention may be most warranted.
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Affiliation(s)
- Caroline Richards
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, B15 2TT UK
| | - Jo Moss
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, B15 2TT UK ; Institute of Psychiatry, King's College London, London, UK
| | - Lisa Nelson
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, B15 2TT UK
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, B15 2TT UK
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15
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Woodman AC, Mawdsley HP, Hauser-Cram P. Parenting stress and child behavior problems within families of children with developmental disabilities: Transactional relations across 15 years. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:264-276. [PMID: 25462487 PMCID: PMC4425632 DOI: 10.1016/j.ridd.2014.10.011] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 10/06/2014] [Indexed: 05/21/2023]
Abstract
Parents of children with developmental disabilities (DD) are at increased risk of experiencing psychological stress compared to other parents. Children's high levels of internalizing and externalizing problems have been found to contribute to this elevated level of stress. Few studies have considered the reverse direction of effects, however, in families where a child has a DD. The present study investigated transactional relations between child behavior problems and maternal stress within 176 families raising a child with early diagnosed DD. There was evidence of both child-driven and parent-driven effects over the 15-year study period, spanning from early childhood (age 3) to adolescence (age 18), consistent with transactional models of development. Parent-child transactions were found to vary across different life phases and with different domains of behavior problems.
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Affiliation(s)
- Ashley C Woodman
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Tobin Hall 509, 135 Hicks Way, Amherst, MA 01003, USA.
| | - Helena P Mawdsley
- College of Education, University of Florida, 618 SW 12th Street, Norman Hall, Gainesville, FL, 32601, USA.
| | - Penny Hauser-Cram
- Lynch School of Education, Boston College, 140 Commonwealth Avenue, Campion Hall, Room 239B, Newton, MA 02467, USA.
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16
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Gilmore L, Cuskelly M. Vulnerability to Loneliness in People with Intellectual Disability: An Explanatory Model. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2014. [DOI: 10.1111/jppi.12089] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Linda Gilmore
- Queensland University of Technology; Brisbane Qld Australia
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17
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Campbell M, Robertson A, Jahoda A. Psychological therapies for people with intellectual disabilities: comments on a matrix of evidence for interventions in challenging behaviour. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:172-188. [PMID: 23106865 DOI: 10.1111/j.1365-2788.2012.01646.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/15/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Psychological therapies with a proven efficacy in the general population are being adapted for use with people who have intellectual disabilities in community settings. METHODS A systematic review of peer-reviewed literature published between 1980 and 2010 was carried out, to identify the evidence base for effective psychological interventions in challenging behaviour. Relevant databases were searched using applied key terms. Evidence was graded, according to the quality of the research. A best-evidence Matrix was produced to improve guidance for service providers and practitioners in the range, volume and quality of psychological interventions. RESULTS There is a limited amount of efficacy research that meets the most stringent standards of empirical evidence. CONCLUSIONS It is important to broaden the evidence base and consider the context of psychological interventions, alongside the values underpinning care and treatment.
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Affiliation(s)
- M Campbell
- School of Psychology & Neuroscience, University of St. Andrews, St. Andrews, Fife, UK
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18
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Tirosh E, Jaffe M. Global Developmental Delay and Mental Retardation-A Pediatric Perspective. ACTA ACUST UNITED AC 2013; 17:85-92. [DOI: 10.1002/ddrr.1103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/05/2012] [Indexed: 12/31/2022]
Affiliation(s)
- Emanuel Tirosh
- The Hannah Khoushy Child Development Center and The Bruce Rappaport Faculty of Medicine; The Technion, The Israeli Institute of Technology; Haifa; Israel
| | - Michael Jaffe
- The Hannah Khoushy Child Development Center and The Bruce Rappaport Faculty of Medicine; The Technion, The Israeli Institute of Technology; Haifa; Israel
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19
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Gray K, Keating C, Taffe J, Brereton A, Einfeld S, Tonge B. Trajectory of behavior and emotional problems in autism. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2012; 117:121-133. [PMID: 22515827 DOI: 10.1352/1944-7588-117-2.121] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
High rates of behavior and emotional problems have been consistently reported in children and adolescents with autism. Elevated rates of mental health problems have also been reported in adults with autism. Little is known, however, about the longitudinal development of behavior and emotional problems in autism. This study followed a cohort of children and adolescents over 18 years. Outcomes were evaluated in terms of behavior and emotional problems and autism symptomatology. The role of childhood factors (age, gender, IQ, behavior, and emotional problems) and the environment (socioeconomic disadvantage) were considered in terms of adult outcomes. Overall, improvements in comorbid behavior and emotional problems and autism symptomatology were observed. However, rates of comorbid behavior and emotional problems in adulthood remained high.
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Affiliation(s)
- Kylie Gray
- Monash University, Clayton, Victoria, Australia
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20
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Smith LE, Barker ET, Seltzer MM, Abbeduto L, Greenberg JS. Behavioral phenotype of fragile X syndrome in adolescence and adulthood. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2012; 117:1-17. [PMID: 22264109 PMCID: PMC3388941 DOI: 10.1352/1944-7558-117.1.1] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The present study explored the behavioral profile of individuals with fragile X syndrome during adolescence and adulthood. Individuals with both fragile X syndrome and autism (n = 30) were compared with (a) individuals diagnosed with fragile X syndrome (but not autism; n = 106) and (b) individuals diagnosed with autism (but not fragile X syndrome; n = 135) on measures of autism symptoms, adaptive functioning, behavior problems, and psychological symptoms. Results indicated that individuals dually diagnosed with fragile X syndrome and autism displayed greater communication and social reciprocity impairments than individuals with fragile X syndrome only. Individuals in the dually diagnosed group also exhibited higher levels of repetitive and challenging behaviors than either comparison group, suggesting a unique profile of vulnerability for those diagnosed with both fragile X syndrome and autism.
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Affiliation(s)
- Leann E Smith
- University of Wisconsin-Madison, Waisman Center, 1500 Highland Ave., Madison, WI 53705, USA.
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21
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Heyvaert M, Maes B, Onghena P. A meta-analysis of intervention effects on challenging behaviour among persons with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2010; 54:634-649. [PMID: 20492347 DOI: 10.1111/j.1365-2788.2010.01291.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Persons with intellectual disabilities (ID) often show challenging behaviour. We review distinct interventions that are applied to treat these challenging behaviours, and analyse intervention effects and moderating variables. METHODS A literature search was conducted using the databases ERIC, PsycINFO, Web of Science and Medline. A random-effects meta-analysis was carried out, supplemented with sensitivity, subgroup, meta-regression and publication bias analyses. RESULTS Eighty potential articles were identified, from which 30 contained sufficient data to enable statistical meta-analysis. From these 30 studies, 18 described a biological, 13 a psychotherapeutic and nine a contextual intervention, either applied alone or combined. The overall standardised mean difference was 0.671 (SD = 0.051). As shown by sensitivity analysis, this summary effect size is robust. Assessed through subgroup and meta-regression analysis, all tested moderators showed no statistically significant association with the treatment effects. After applying a funnel plot-, a fail-safe N-, and Duval's and Tweedie's trim and fill-analysis, we conclude that our meta-analysis does not suffer much from publication bias effects. CONCLUSIONS Several biological, psychotherapeutic and contextual interventions effectively reduce challenging behaviours among persons with ID.
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Affiliation(s)
- Mieke Heyvaert
- Centre for Methodology of Educational Research, Department of Educational Sciences, Katholieke Universiteit Leuven, Belgium.
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