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Smeets GJJ, Volkers KM, Scherder EJA, Moonen XMH. Active music making and leisure activities for people with intellectual disabilities: A cluster randomized pilot study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 142:104606. [PMID: 37827006 DOI: 10.1016/j.ridd.2023.104606] [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: 12/23/2022] [Revised: 07/23/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
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.
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Affiliation(s)
- Gerianne J J Smeets
- Philadelphia Care Foundation, PO box 1255, 3800 BG Amersfoort, the Netherlands.
| | - Karin M Volkers
- Philadelphia Care Foundation, PO box 1255, 3800 BG Amersfoort, the Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University Amsterdam, van der Boechorstraat 7, 1081 BT Amsterdam, the Netherlands
| | - Xavier M H Moonen
- Research Institute of Child Development and Education, University of Amsterdam, Postbus 15776, 1001 NG Amsterdam, the Netherlands
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Salzner J, Dall M, Weber C, Holzinger D, Fellinger J. Deaf Residents With Intellectual Disabilities During the First Covid-19 Associated Lockdown. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2021; 26:556-559. [PMID: 34185050 PMCID: PMC8344832 DOI: 10.1093/deafed/enab019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 06/13/2023]
Abstract
Two indicators for stress (mood and aggressive behavior) were evaluated in order to investigate the effect of the restrictions taken against the spread of the coronavirus on people who are deaf and hard of hearing (DHH) and have intellectual disabilities (ID). In three therapeutic living communities, specifically designed for the visual communication needs of people who are DHH and have ID, the mood of the residents is routinely assessed by staff members and every aggressive incident is recorded with the Staff Observation of Aggressions Scale-Revised (SOAS-R). For the 38 residents who were present 8 weeks before the first lockdown (t1) and the following 8 weeks (t2), mood ratings and ratings of aggressive behavior were compared between the two time periods. In contrast to our hypothesis the mood ratings of the residents had a slight significant improvement, whereas the incidents and severity of aggressive behavior did not change significantly. These results suggest that with proper communicative support, individuals who are DHH and have ID can cope effectively with significant restrictions imposed by a pandemic-caused lockdown.
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Affiliation(s)
- Julia Salzner
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, Linz, Austria
| | - Magdalena Dall
- Research Institute for Developmental Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Christoph Weber
- Research Institute for Developmental Medicine, Johannes Kepler University Linz, Linz, Austria
- Pädagogische Hochschule OÖ, Linz, Austria
| | - Daniel Holzinger
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, Linz, Austria
- Research Institute for Developmental Medicine, Johannes Kepler University Linz, Linz, Austria
- Department of Linguistics, Karl-Franzens-University Graz, Graz, Austria
| | - Johannes Fellinger
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, Linz, Austria
- Research Institute for Developmental Medicine, Johannes Kepler University Linz, Linz, Austria
- Department of Social Psychiatry, Medical University Vienna, Vienna, Austria
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van den Bogaard KJHM, Nijman HLI, Palmstierna T, Embregts PJCM. Self-Injurious Behavior in People with Intellectual Disabilities and Co-Occurring Psychopathology using the Self-Harm Scale: A Pilot Study. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2018; 30:707-722. [PMID: 30220833 PMCID: PMC6132616 DOI: 10.1007/s10882-018-9614-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Self-injurious behavior (SIB) is one of the most detrimental behaviors for the person showing it, as well as for their environment. Nevertheless, structured clinical assessments of SIB are scarce. Staff completed a Self-Harm Scale (SHS) every time they witnessed SIB in clients with an intellectual disability (ID) and co-occurring psychopathology (N = 33). Descriptive statistics were conducted to explore the nature of the incidents of SIB and the characteristics of the people involved in the incidents. In 41 weeks, 104 SIB incidents were reported for 8 out of 33 clients (24%). Incidents were most prevalent on Mondays (23%). As far as the methods of SIB concerned, cutting was the most used method (63%). Clients who showed SIB differed significantly from clients who did not on gender, having a personality disorder and communicative abilities. This study was one of the few that used an incident-based record form to report SIB by direct observation. It is hoped that the SHS helps to gain more information about SIB, to improve individualized interventions. Further research is necessary to determine the psychometric properties and clinical utility of the scale.
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Affiliation(s)
- Kim J. H. M. van den Bogaard
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Prof. Cobbenhagenlaan 125, 5037DB Tilburg, The Netherlands
- Dichterbij Science and Innovation, Gennep, The Netherlands
| | - Henk L. I. Nijman
- Behavioural Science Institute (BSI), Radboud University, Nijmegen, The Netherlands
- Aventurijn – Fivoor, Forensic Psychiatric Institute, Den Dolder, The Netherlands
| | - Tom Palmstierna
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- St. Olav’s University Hospital, Center for Research and Education in Forensic Psychiatry, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Petri J. C. M. Embregts
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Prof. Cobbenhagenlaan 125, 5037DB Tilburg, The Netherlands
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Palix J, Akselrod M, Cungi C, Giuliani F, Favrod J. Changes in Heart Rate Variability Recorded in Natural Situation with T-Shirt Integrated Sensors and Level of Observed Behavioral Excitation: A Pilot Study of Patients with Intellectual Disabilities and Psychiatric Disorders. Front Psychiatry 2017; 8:4. [PMID: 28203208 PMCID: PMC5285363 DOI: 10.3389/fpsyt.2017.00004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 01/11/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The present study investigates the possibilities of using heart rate variability (HRV) parameters as physiological markers that precede increase in observed behavioral excitation of intellectually disabled individuals. The ability to recognize or predict such patterns, especially in patients showing unpredictable reactions and language deficiencies, might be a major step forward in clinical research. METHOD Thirteen volunteers with intellectual disabilities, who had suffered of at least one event of overt aggression in the preceding 3 months, participated to the study. The protocol consists in the acquisition of continuous electrocardiogram (ECG) throughout approximately two times of 8 h in natural situation, using a T-shirt integrated with sensors. Simultaneously, an observer evaluates the patient's level of overt excitation from calm (level 1) to extremely tense (level 5) and send online via Bluetooth these triggers into the ECG signals. The HRV indexes were then estimated offline on the basis of the inter-beat intervals recorded by the ECG, independently for the 30 min preceding each behavioral tension marking point, averaged, and compared through non-parametric Wilcoxon matched-pairs test. Of these, the RMSSD and LF/HF calculations were used to observe the fluctuations of inhibitory activity and cardiovagal balance through different tension states. RESULTS Seven individuals have sufficient reliable data for analysis. They have reached at least a level 3 of behavioral excitation (moderately tense) or more (very to extremely tense, level 4 and 5) and have been retained for further analysis. In sum, a total of 197 periods of tension were kept, made up of 46 periods of slight excitation (level 2), 18 of moderate excitation (level 3), 10 of high excitation (level 4), and 5 of extreme agitation (level 5). Variations in the HRV as a function of degree of excitation are observed for RMSSD index only (inhibitory parasympathetic activity). The changes from calm to increasing levels of excitation are characterized by a significant downfall in RMSSD index when patients were evaluated to be in a very high level of tension (level 4). CONCLUSION The presence of precursors to agitation, reflected in the falling-off of parasympathetic activity, offers potentially interesting prospects for therapeutic development.
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Affiliation(s)
- Julie Palix
- School of Nursing Sciences, La Source, University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland; Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Michel Akselrod
- Ecole Polytechnique Fédérale de Lausanne , Lausanne , Switzerland
| | | | - Fabienne Giuliani
- Department of Psychiatry, Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
| | - Jérôme Favrod
- School of Nursing Sciences, La Source, University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland; Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Greydanus DE, Apple RW. The relationship between deliberate self-harm behavior, body dissatisfaction, and suicide in adolescents: current concepts. J Multidiscip Healthc 2011; 4:183-9. [PMID: 21811385 PMCID: PMC3141836 DOI: 10.2147/jmdh.s11569] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Deliberate self-harm (DSH) is a common though often hidden condition in children and adolescents that may result in suicide. This discussion covers several aspects of DSH including its prevalence, etiology, and management. The relationships of DSH to body dissatisfaction and suicide are specifically considered. Even though most cases of DSH do not end in overt suicide, DSH reflects that potential underlying psychological pathophysiology, and likelihood of eventual death from self-murder, cannot always be predicted or prevented. It is important to take all acts of DSH as serious, and to offer comprehensive management to prevent future acts of DSH and potential suicide.
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Affiliation(s)
- Donald E Greydanus
- Pediatrics and Human Development; College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Oliver-Africano P, Murphy D, Tyrer P. Aggressive behaviour in adults with intellectual disability: defining the role of drug treatment. CNS Drugs 2009; 23:903-13. [PMID: 19845412 DOI: 10.2165/11310930-000000000-00000] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
A complex form of aggression, commonly expanded as 'aggressive challenging behaviour', is reported in one in four adults with intellectual disability and is often treated with antipsychotics, mood stabilizers and antidepressants. Psychological treatments, including anger and behavioural management, person-centred planning and manipulation of the environment (nidotherapy), have also been used when available but to a lesser extent. In this article, the evidence for efficacy for each intervention is examined, with data from randomized controlled trials given primacy. Very little evidence, based on limited data, can be found for the interventions of anger and behavioural management and also for the atypical antipsychotic drug, risperidone; the data available on these interventions come primarily from studies conducted in children in whom the behaviour is part of the autistic spectrum. Antipsychotic drugs, particularly the atypical group, have been the most commonly used interventions in recent years, but a recent independent randomized trial showed no benefits for either risperidone or haloperidol compared with placebo, with some evidence of a better response to placebo than either active drug in the reduction of aggression. In the light of this uncertainty, the clinician must return to the task of collecting a careful history and mental state examination, including awareness of the setting in which the behaviour is shown, which will help with diagnosis and appropriate intervention. The choice of intervention should not be a casual one and is not likely to be chosen well if the clinician relies only on standard guidelines. The paucity of randomized trial evidence is preventing progress in the treatment of persistent aggressive behaviour. On present evidence, the use of drug treatment should be much more sparing and reserved for those patients who are putting themselves and others at particular risk as a consequence of their behaviour; such treatment should be regarded as temporary and as adjunctive to other forms of management. There is an urgent need for larger, randomized studies of psychological interventions, which at present appear to have a higher benefit-risk ratio than drug treatment but that also have a poor evidence base. More care should be taken to avoid the term 'aggressive challenging behaviour' being used as a portmanteau diagnostic pseudonym when it merely represents a diverse oppositional repertoire of many aetiologies.
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Diagnosis and treatment of aggression in individuals with developmental disabilities. Psychiatr Q 2008; 79:225-47. [PMID: 18726157 DOI: 10.1007/s11126-008-9080-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 08/04/2008] [Indexed: 12/28/2022]
Abstract
Aggressive behavior is a common referral problem for individuals with developmental disabilities (DD), placing them at risk for institutionalization, social isolation, physical restraint, over-use of medication to treat behavior problems, exclusion from services, and becoming a victim of abuse. Aggression strains relationships between individuals being supported and their caregivers, whether professionals or family members. The treatment of aggression is persons with DD, with or without comorbid mental illness, remains a controversial area and changes in practice have been slow to come. The evidence related to pharmacotherapy and psychological treatment is, in general, either lacking or poor. This does not suggest that these treatments are necessarily ineffective but that there is not enough good quality evidence to support their usefulness. This review considers the prevalence and correlates of aggression, as well as possible causative factors. The relationship between mental illness, intellectual disability and aggression is explored. The psychopharmacological and psychological treatment literature is reviewed with implications for clinical care and future research.
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