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Yoshida K, Lunsky Y, Müller DJ, Desarkar P. Prevalence of Psychotropic Medication Use and Psychotropic Polypharmacy in Autistic Adults With or Without Intellectual Disability. J Autism Dev Disord 2024:10.1007/s10803-023-06208-y. [PMID: 38219270 DOI: 10.1007/s10803-023-06208-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 01/16/2024]
Abstract
The aim of this study was to compare the rates of psychotropic medication use and psychotropic polypharmacy between autistic adults with and without intellectual disability (ID) and to examine factors associated with psychotropic medication use and psychotropic polypharmacy in autistic adults, stratified by the presence of ID. We conducted a retrospective medical chart review of outpatients with an autism diagnosis aged 18 years and older. The rates of psychotropic medication use and psychotropic polypharmacy were compared between autistic adults with and without ID. Subsequently, logistic regression analyses were performed to identify factors associated with psychotropic medication use and psychotropic polypharmacy in autistic adults with ID and those without ID, respectively. The rates of prevalence of psychotropic medication use and polypharmacy were significantly higher in participants with ID than those without ID (78.6% vs. 58.8% and 49.3% vs. 31.2%; p-values < 0.05). Age, gender, race, residence, presence of mood disorders, presence of schizophrenia, absence of anxiety disorder, number of psychiatric comorbidities, and presence of behaviors that challenge were significantly associated with these outcomes, depending on the presence/absence of ID. The need to optimize pharmacotherapy in autistic adults, stratifying by the presence of ID, is highlighted.
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Affiliation(s)
- Kazunari Yoshida
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel J Müller
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Pushpal Desarkar
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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Kim D. Latent Class Analysis on Types of Challenging Behavior in Persons with Developmental Disabilities: Focusing on Factors Affecting the Types of Challenging Behavior. Behav Sci (Basel) 2023; 13:879. [PMID: 37998626 PMCID: PMC10669221 DOI: 10.3390/bs13110879] [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: 08/28/2023] [Revised: 09/27/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
This study sought to analyze the latent classes of challenging behaviors among persons with developmental disabilities and examine the effects of related variables. To this end, the Korea Employment Agency for Persons with Disabilities collected data from the Survey on the Work and Life of Persons with Developmental Disabilities from 3000 households that included at least one family member with a developmental disability aged ≥15 years, surveying the persons themselves as well as their caregivers. As a result of the analysis, four latent classes were derived based on the types of challenging behavior and named as follows: overall challenging behavior, aggressive behavior, socially inappropriate behavior, and no challenging behavior. The main disability, disability grade, presence of multiple disabilities, disability status, activities of daily living, reading skills, writing skills, and situational awareness were significant factors affecting each latent class in the type of challenging behavior. Significant factors differed among the groups. This study identified the types of challenging behaviors and their influencing factors in a large sample of individuals with developmental disabilities and analyzed the correlation between their challenging behaviors and activities of daily living.
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Affiliation(s)
- Daeyong Kim
- Department of Behavior Analysis and Intervention, Konyang Cyber University, 158, Gwanjeodong-ro, Seo-gu, Daejeon 35365, Republic of Korea
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3
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de Kuijper G, Fokkema T, Jansen M, Hoekstra PJ, de Bildt A. Difficulties in Addressing Diagnostic, Treatment and Support Needs in Individuals with Intellectual Disability and Persistent Challenging Behaviours: A Descriptive File Study of Referrals to an Expertise Centre. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6365. [PMID: 37510597 PMCID: PMC10378833 DOI: 10.3390/ijerph20146365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/23/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
Service providers may experience difficulties in providing appropriate care to optimize the functioning of individuals with intellectual disability and challenging behaviour. External consultation to identify and address the unmet support needs underlying the behaviour may be beneficial. Applying the multidimensional American Association Intellectual and Developmental Disabilities (AAIDD) model may facilitate this approach. We aimed to describe the content and outcomes of consultation for individuals with intellectual disability and challenging behaviour referred to the Dutch Centre for Consultation and Expertise in relation to the AAIDD model. Interventions were based on the clients' diagnostic, treatment, and support needs and were categorized according to the five dimensions of the AAIDD model. Outcomes of the consultations were assessed based on reports in the file and rated as 'clear improvement', 'improvement' or 'no improvement or deterioration'. In two-thirds of the 104 studied files, consultees were satisfied with the improvement in functioning. Interventions targeted the difficulties of the service providers in supporting their clients and were most often applied within the Health and Context dimensions of the AAIDD model. We may conclude that consultation of an expert team may be valuable to support the care providers, and the use of the AAIDD model may be helpful to address the unmet needs to improve the functioning of individuals with challenging behaviour.
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Affiliation(s)
- Gerda de Kuijper
- GGZ Drenthe/Department Centre for intellectual Disability and Mental Health, Middenweg 19, 9404 LL Assen, The Netherlands
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Tryntsje Fokkema
- GGZ Drenthe/Department Centre for intellectual Disability and Mental Health, Middenweg 19, 9404 LL Assen, The Netherlands
| | - Martine Jansen
- Centre for Consultation and Expertise, Australielaan 14, 3526 AB Utrecht, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Accare Child Study Center, Groningerstraat 352, 9402 LT Assen, The Netherlands
| | - Annelies de Bildt
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Accare Child Study Center, Groningerstraat 352, 9402 LT Assen, The Netherlands
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Fenati G, Youssoffi S, Phan D, McManus K, Dong F, Neeki MM. Stress-Induced Auto-Cannibalism in Patients With a History of Moderate Traumatic Brain Injury. Cureus 2023; 15:e41232. [PMID: 37529515 PMCID: PMC10387508 DOI: 10.7759/cureus.41232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
A traumatic brain injury (TBI) is a significant factor in injury-related deaths in the United States and may lead to complex psychological disorders. Auto-cannibalism as a sequela of a TBI has yet to be reported in the literature. The current literature regarding such behavior is often associated with psychosis, intellectual disability, or substance use. A 35-year-old male had a past medical history significant for a TBI a decade ago. He was transferred to the emergency department due to a self-inflicted wound. The patient had been scratching his arms and legs for the last few months and displayed an intense new pattern of self-destructive behavior in the past week. He went through surgical wound debridement and psychiatric evaluation before he was discharged home. This case depicts the importance of regular, long-term psychiatric, and neurological follow-up for patients sustaining TBIs, regardless of whether or not they were previously deemed stable. A greater understanding of many factors leading to self-destructive behavior following TBIs is needed to improve patient outcomes.
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Affiliation(s)
- Gregory Fenati
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Santana Youssoffi
- Emergency Medicine, California University of Science and Medicine, Colton, USA
| | - Dustin Phan
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | | | - Fanglong Dong
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Michael M Neeki
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
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Tilley E, Jordan J, Larkin M, Vseteckova J, Ryan S, Wallace L. Transitions for older people with intellectual disabilities and behaviours that challenge others: A rapid scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:207-229. [PMID: 36433739 PMCID: PMC10098666 DOI: 10.1111/jar.13054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 09/09/2022] [Accepted: 10/31/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND People with intellectual disabilities and behaviours that challenge others are living longer. This review aimed to explore what is known about the health and social care needs, experiences, service interventions and resources of and for this population as they transition to different care contexts in the UK. METHOD A rapid scoping review of published and unpublished literature was conducted based on collaborative working with key stakeholders and using systematic methods of data searching, extraction and analysis. RESULTS Consistent social work support, skilled staff, suitable accommodation, creative engagement with individuals and families to plan ahead, and timely access to quality healthcare are all required to promote successful transitions as people age, and to avoid unwanted/inappropriate transitions at points of crisis. CONCLUSIONS More research is needed to assess the types of services that this population can and do access as they age, the quality of those services, and the extent to which local commissioners are planning ahead for people with intellectual disabilities and behaviours that challenge others.
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Affiliation(s)
- Elizabeth Tilley
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | - Joanne Jordan
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | - Mary Larkin
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | - Jitka Vseteckova
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | - Sara Ryan
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Louise Wallace
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
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Davenport S, Zolnikov TR. Understanding mental health outcomes related to compassion fatigue in parents of children diagnosed with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:624-636. [PMID: 34027745 DOI: 10.1177/17446295211013600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Parenting a child diagnosed with intellectual disability includes a variety of stressors. The degree to which stress affects these parents has been given little emphasis. Compassion fatigue includes experiencing an emotional response to being unable to relieve the suffering of a loved one, burnout, strain and stress on the caregiver. Compassion fatigue develops in parents of children diagnosed with intellectual disability due to their caregiving roles. METHOD A phenomenological qualitative study was conducted using 25 semi-structured interviews to understand the mental health outcomes of parents caring for a child diagnosed with intellectual disability. RESULTS The results showed that initial emotional reactions after receiving their child's diagnosis was a combination of anxiety, depression and compassion satisfaction. This study's findings suggest that parents of children diagnosed with intellectual disability experience moderate levels of compassion fatigue in the caring of their child. CONCLUSIONS This research provides evidence that the caregiving of a child diagnosed with intellectual disability comes with a myriad of stressors that can lead to compassion fatigue.
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Affiliation(s)
- Stacy Davenport
- California Southern University, USA; California State University, USA
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7
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Thomas AT, Waite J, Williams CA, Kirk J, Oliver C, Richards C. Phenotypic characteristics and variability in CHARGE syndrome: a PRISMA compliant systematic review and meta-analysis. J Neurodev Disord 2022; 14:49. [PMID: 36045324 PMCID: PMC9429597 DOI: 10.1186/s11689-022-09459-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 08/15/2022] [Indexed: 12/01/2022] Open
Abstract
Background CHARGE syndrome (OMIM #214800) is a phenotypically complex genetic condition characterised by multi-system, multi-sensory impairments. Behavioural, psychological, cognitive and sleep difficulties are not well delineated and are likely associated with biopsychosocial factors. Methods This meta-analysis investigated the prevalence of clinical features, physical characteristics and conditions, behavioural, psychological, cognitive and sleep characteristics in CHARGE syndrome, and statistically evaluated directional associations between these characteristics. Pooled prevalence estimates were calculated using reliable, prespecified quality weighting criteria, and meta-regression was conducted to identify associations between characteristics. Results Of the 42 eligible studies, data could be extracted for 1675 participants. Prevalence estimates were highest for developmental delay (84%), intellectual disability (64%), aggressive behaviour (48%), self-injurious behaviour (44%) and sleep difficulties (45%). Meta-regression indicated significant associations between intellectual disability and choanal atresia, intellectual disability and inner ear anomalies, sleep difficulties and growth deficiency, and sleep difficulties and gross motor difficulties. Conclusions Our comprehensive review of clinical features, behavioural, psychological, cognitive and physical characteristics, conditions and comorbidities in CHARGE syndrome provides an empirically based foundation to further research and practice. Supplementary Information The online version contains supplementary material available at 10.1186/s11689-022-09459-5.
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Affiliation(s)
- Andrea T Thomas
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK. .,Cerebra Network for Neurodevelopmental Disorders, Birmingham, UK.
| | - Jane Waite
- Cerebra Network for Neurodevelopmental Disorders, Birmingham, UK.,Aston University, Birmingham, UK
| | - Caitlin A Williams
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - Jeremy Kirk
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Chris Oliver
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK.,Cerebra Network for Neurodevelopmental Disorders, Birmingham, UK
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Dimian AF, Symons FJ. A systematic review of risk for the development and persistence of self-injurious behavior in intellectual and developmental disabilities. Clin Psychol Rev 2022; 94:102158. [PMID: 35580423 PMCID: PMC10229071 DOI: 10.1016/j.cpr.2022.102158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 02/13/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022]
Abstract
Self-injurious behavior (SIB) by individuals with intellectual and developmental disabilities including autism (I/DD) is among the most clinically disturbing, socially costly, and scientifically challenging behavior disorders. Forty years of clinical research has produced a knowledge base supporting idiographic behavioral assessment and treatment approaches. Despite the treatment progress, from a public health and population perspective, we argue it is less clear that we have reduced the disorder's burden. The developmental course of the disorder is mostly unknown and empirically informed population-level models of risk are absent. In this review, we systematically examined the published scientific literature specific to risk for SIB in the I/DD population. We reviewed study methodology in detail intentionally informed by an epidemiological perspective with a set of questions intended to test the quality of the inferences about risk. Results are discussed in terms of conceptual, methodological, and translational issues with respect to what needs to be done to create credible and useful clinical models for SIB risk in the I/DD population.
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Affiliation(s)
- Adele F Dimian
- Institute on Community Integration, University of Minnesota(,) Minneapolis, MN, USA.
| | - Frank J Symons
- Dept. of Educational Psychology, University of Minnesota(,) Minneapolis, MN, USA
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9
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Thompson TJ, Walker MW, LeBoeuf JB, Simeonsson RJ, Karakul E. Chronicity of Challenging Behaviors in Persons with Severe/Profound Intellectual Disabilities Who Received Active Treatment During a 20‐Year Period. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2021. [DOI: 10.1111/jppi.12395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | - Eda Karakul
- University of North Carolina Chapel Hill NC USA
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10
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Kildahl AN, Oddli HW, Helverschou SB. Potentially traumatic experiences and behavioural symptoms in adults with autism and intellectual disability referred for psychiatric assessment. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 107:103788. [PMID: 33091711 DOI: 10.1016/j.ridd.2020.103788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/21/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Individuals with autism spectrum disorder (ASD) and intellectual disability (ID) more frequently experience potentially traumatic events (PTEs), and may be more vulnerable to trauma-related symptoms. However, it is unclear how such symptoms are captured on tools used for behavioural and psychiatric assessment in this population. AIMS To explore whether and how PTEs are associated with symptom reports in adults with ASD and ID. METHODS AND PROCEDURES Associations and group differences for death of a close relative and serious disease/injury in a close relative/caregiver/friend were explored in a clinical sample of 171 adults with ASD and ID referred for psychiatric assessment. Symptoms were measured using Aberrant Behavior Checklist (ABC) and Psychopathology in Autism Checklist (PAC). OUTCOMES AND RESULTS Disease/injury was associated with higher scores on ABC irritability, ABC hyperactivity and self-injurious behaviour. Death was associated with lower scores on ABC lethargy and ABC stereotypic behaviour. Some associations reached significance only when controlling for ASD, ID, or verbal language skills, but the identified associations were not robust. No associations were found for PAC. CONCLUSIONS AND IMPLICATIONS There is a risk of under-appreciating the impact of PTEs in this population unless ASD, ID and verbal language skills are taken into account.
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Affiliation(s)
- Arvid Nikolai Kildahl
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway; NevSom - Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway.
| | | | - Sissel Berge Helverschou
- NevSom - Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
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van den Akker N, Kroezen M, Wieland J, Pasma A, Wolkorte R. Behavioural, psychiatric and psychosocial factors associated with aggressive behaviour in adults with intellectual disabilities: A systematic review and narrative analysis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:327-389. [PMID: 33073443 PMCID: PMC7894289 DOI: 10.1111/jar.12809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 08/07/2020] [Accepted: 08/30/2020] [Indexed: 12/28/2022]
Abstract
Background Aggressive behaviour is prevalent in people with intellectual disabilities. To understand the aetiology, it is important to recognize factors associated with the behaviour. Method A systematic review was conducted and included studies published between January 2002 and April 2017 on the association of behavioural, psychiatric and psychosocial factors with aggressive behaviour in adults with intellectual disabilities. Results Thirty‐eight studies were included that presented associations with 11 behavioural, psychiatric and psychosocial factors. Conflicting evidence was found on the association of these factors with aggressive behaviour. Conclusions The aetiology of aggressive behaviour is specific for a certain person in a certain context and may be multifactorial. Additional research is required to identify contributing factors, to understand causal relationships and to increase knowledge on possible interaction effects of different factors.
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Affiliation(s)
- Natalie van den Akker
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Marieke Kroezen
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Jannelien Wieland
- Cordaan, Center for Excellence on Mental Health and Mild Intellectual Disability, Amsterdam, The Netherlands
| | - Annelieke Pasma
- Department of Rheumatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Ria Wolkorte
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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12
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Buono S, Zagaria T, Recupero M, Elia M, Kerr M, Di Nuovo S, Ferri R. The evolution of self-injurious behaviors in people with intellectual disability and epilepsy: A follow-up study. Seizure 2020; 82:99-104. [PMID: 33045542 DOI: 10.1016/j.seizure.2020.09.009] [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: 07/29/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Longitudinal studies of the evolution of Self-Injurious Behaviors (SIBs) in people with Intellectual Disability (ID) and epilepsy are not common. This study aimed to analyze the evolution (in terms of remission and persistence) and changes in the type, localization, frequency, and intensity of SIBs. METHODS SIBs were assessed in a sample of 52 people with ID and epilepsy, and re-evaluated after a seven-year interval, using the "Scale for the Assessment of Self-Injurious Behaviors". The scale was administered to caregivers (parents or health professionals) through a semi-structured interview conducted by a specifically trained psychologist. RESULTS The most frequent types of SIBs identified were: self-biting, self-hitting with objects, self-hitting with hand, object-finger in cavities. The main localizations of SIBs were: hands, mouth, head and cheeks. SIBs were found to be maintained after seven years, for type, localization, frequency, and intensity, in 90.4% of the sample. SIB types were stable over time, as were the affected areas. Global SIB frequency and intensity scores were found to be unchanged. Finally, a positive correlation was found between the frequency of SIBs and levels of intellectual disability. SIBs (frequency and intensity) and seizure frequency showed no correlation. CONCLUSION Given the negative impact of SIBs on the adaptation and quality of life of people with ID and epilepsy, we believe that further studies on biological, psychological and environmental aspects are needed in order to identify any potential factors that might explain the persistence of SIBs and to find effective interventions to reduce them.
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Affiliation(s)
- Serafino Buono
- Unit of Psychology, Oasi Research Institute-IRCCS, Troina, Italy.
| | - Tommasa Zagaria
- Unit of Psychology, Oasi Research Institute-IRCCS, Troina, Italy
| | | | - Maurizio Elia
- Unit of Neurology, Oasi Research Institute-IRCCS, Troina, Italy
| | - Mike Kerr
- Institute of psychological medicine and clinical neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Santo Di Nuovo
- Department of Education, University of Catania, Catania, Italy
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Olivier-Pijpers VC, Cramm JM, Nieboer AP. Residents' and resident representatives' perspectives on the influence of the organisational environment on challenging behaviour. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 100:103629. [PMID: 32142969 DOI: 10.1016/j.ridd.2020.103629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 01/28/2020] [Accepted: 02/28/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study explored the perspectives of residents of residential disability service organisations and resident representatives on the influence of the organisational environment on challenging behaviour in people with intellectual disabilities (ID). METHOD Sixteen residents and representatives from four specialised Dutch disability service organisations were interviewed. Data were analysed using a grounded theory approach, with a sensitising frame based on Bronfenbrenner's ecological theory. RESULTS Some organisational factors (e.g. staff turnover, insufficient finances) can have negative effects on interactions among residents and staff and family members, resulting in more challenging behaviour, but other organisational factors (e.g. shared vision, values and expectations, competent staff) can positively influence staffs' attitudes and actions, which in turn helps to manage challenging behaviour in people with ID. CONCLUSIONS Residents' and representatives' perspectives provide a better understanding of the positive and negative influences of the organisational environment on challenging behaviour in people with ID.
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Affiliation(s)
- V C Olivier-Pijpers
- Centre for Consultation and Expertise, Australielaan 14, 3526AB, Utrecht, The Netherlands.
| | - J M Cramm
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | - A P Nieboer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
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14
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Weber N, Duville C, Loizeau V, Morvillers JM. [Intellectual disabitily, challenging behavior, and care: A systematic literature review]. Rech Soins Infirm 2020; 138:18-28. [PMID: 31959238 DOI: 10.3917/rsi.138.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction and background : People with intellectual disabilities present difficult behaviors, also called problem behaviors or challenging behaviors.Objective : The objective of this study was to describe the state of knowledge in nursing about challenging behaviors in people with intellectual disabilities.Methodology : We performed a systematic literature review based on the use of the keywords "challenging behavior," "intellectual disability," "nurs*," and "problem behavior" on the PubMed and Web of Science websites between 2008 and 2018.Results : Individuals with intellectual disabilities frequently present challenging behaviors, which can give rise to the abuse of psychotropic medication. These behaviors are also stressful for staff. Solutions in terms of staff training exist, as well as assistance in the identification of associated diagnoses that may sometimes be responsible for challenging behaviors. No publications in French on this topic were found.Conclusion : Nurses who work with people with intellectual disabilities should be encouraged to become involved in research so that they can contribute to developing knowledge on challenging behaviors and improve the quality of their care. This will also enable them to further develop their collaboration within the multidisciplinary team in order to promote good practice in terms of the management of challenging behaviors and in particular in terms of promoting a move away from prescribing psychotropic drugs.
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Psychotropic Medication in Intellectual and Developmental Disabilities: Patterns of Use and Recommendations for Monitoring Effects. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2019. [DOI: 10.1007/s40474-019-00179-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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16
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Inoue M. Assessments and Interventions to Address Challenging Behavior in Individuals with Intellectual Disability and Autism Spectrum Disorder in Japan: A Consolidated Review. Yonago Acta Med 2019; 62:169-181. [PMID: 31320821 PMCID: PMC6584262 DOI: 10.33160/yam.2019.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/03/2019] [Indexed: 11/05/2022]
Abstract
Intellectual disability and autism spectrum disorder are neurodevelopmental disorders that emerge during the developmental period. A significant barrier that impedes the social adaptation of individuals with these disorders is the exhibition of problem behaviors, such as self-injurious, stereotyped, and aggressive/destructive behaviors. In recent years, these problem behaviors have been collectively referred to as "challenging behavior," in accordance with the contention that they result from an interaction between the individual and his or her social environment. Evidence-based psychosocial interventions that adopt the functional approach to treating challenging behavior are increasing. However, in order to effectively implement such interventions in educational settings and welfare facilities, it is essential to develop staff training programs and usable psychometric assessments. Accordingly, a brief overview of research studies on challenging behavior that have been conducted in Japan, as well as the various support systems that are available to individuals who exhibit challenging behavior, are presented in this article. The discussion makes it apparent that, in order to improve treatment systems in Japan that are aimed at addressing challenging behavior, it is necessary to establish not only better staff training programs, but also reliable and valid assessments measuring challenging behavior that can be readily used by teachers and parents. On the basis of this discussion, it is proposed that technological advancements must be applied to psychosocial approaches in the study of problem behaviors, in order to develop assessment system using software applications and automatic measurement system of target behaviors using sensing technology.
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Affiliation(s)
- Masahiko Inoue
- Department of Clinical Psychology, Tottori University Graduate School of Medical Sciences, Yonago 683-8503, Japan
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Doody O, Bailey ME. Understanding pain physiology and its application to person with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2019; 23:5-18. [PMID: 28502222 DOI: 10.1177/1744629517708680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The issue of pain warrants attention as, by virtue of having an intellectual disability, a person may have associated medical or physical conditions and associated factors increasing their risk of pain disorders. People with intellectual disability experiencing pain need to be provided with the best possible care. The focus of this article is on the exploration of pain: physiology and types; manifestations and responses in the context of intellectual disability in order to promote effective, knowledgeable assessment and management of pain for this client group. Pain is a subjective, complex, physiological and psychological phenomenon that can be acute or chronic and may be classified according to its cause. Within the experience of pain, the concept of total pain describes the physical, psychological, social and spiritual factors that influence the experience of pain.
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Stewart SL, Poss JW, Thornley E, Hirdes JP. Resource Intensity for Children and Youth: The Development of an Algorithm to Identify High Service Users in Children's Mental Health. Health Serv Insights 2019; 12:1178632919827930. [PMID: 30828248 PMCID: PMC6390227 DOI: 10.1177/1178632919827930] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/27/2018] [Indexed: 11/25/2022] Open
Abstract
Children’s mental health care plays a vital role in many social, health care, and
education systems, but there is evidence that appropriate targeting strategies
are needed to allocate limited mental health care resources effectively. The aim
of this study was to develop and validate a methodology for identifying children
who require access to more intense facility-based or community resources.
Ontario data based on the interRAI Child and Youth Mental Health instruments
were analysed to identify predictors of service complexity in children’s mental
health. The Resource Intensity for Children and Youth (RIChY) algorithm was a
good predictor of service complexity in the derivation sample. The algorithm was
validated with additional data from 61 agencies. The RIChY algorithm provides a
psychometrically sound decision-support tool that may be used to inform the
choices related to allocation of children’s mental health resources and
prioritisation of clients needing community- and facility-based resources.
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Affiliation(s)
| | - Jeff W Poss
- University of Waterloo, Faculty of Applied Health Sciences, Waterloo, ON, Canada
| | | | - John P Hirdes
- University of Waterloo, Faculty of Applied Health Sciences, Waterloo, ON, Canada
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Olivier-Pijpers VC, Cramm JM, Nieboer AP. Influence of the organizational environment on challenging behaviour in people with intellectual disabilities: Professionals' views. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:610-621. [PMID: 30585379 PMCID: PMC7379987 DOI: 10.1111/jar.12555] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/19/2018] [Accepted: 11/22/2018] [Indexed: 12/04/2022]
Abstract
Background We examined the influence of the organizational environment on challenging behaviour in people with intellectual disabilities to increase understanding of the quality of support services for people with intellectual disabilities. Method Twenty‐one professionals and managers from four specialized Dutch disability service organizations were interviewed. Data were analysed with a grounded theory approach, using Bronfenbrenner's ecological theory as a sensitizing frame. Results The organizational environment (i.e., vision, values, sufficient resources) is related via the support service (i.e., providing stability, constant awareness) to residents’ challenging behaviour and is also linked directly to challenging behaviour (e.g., living environment, values). Organizations are restricted by national regulations, negative media attention and changing societal values, which negatively influence quality of support. Conclusions The creation of a supportive organizational environment for staff, who in turn can provide quality support services to residents with demanding care needs, was found to prevent challenging behaviour in people with intellectual disabilities.
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Affiliation(s)
- Vanessa C Olivier-Pijpers
- Centre for Consultation and Expertise, Utrecht, The Netherlands.,Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jane M Cramm
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anna P Nieboer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Folch A, Cortés MJ, Salvador-Carulla L, Vicens P, Irazábal M, Muñoz S, Rovira L, Orejuela C, Haro JM, Vilella E, Martínez-Leal R. Risk factors and topographies for self-injurious behaviour in a sample of adults with intellectual developmental disorders. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:1018-1029. [PMID: 29607562 DOI: 10.1111/jir.12487] [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: 01/31/2017] [Revised: 11/14/2017] [Accepted: 03/04/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Self-injurious behaviour (SIB) is a prevalent form of challenging behaviour in people with intellectual developmental disorders (IDD). Existing research has yielded conflicting findings concerning the major risk factors involved, and in addition, SIB shows multiple topographies and presentations. Although presence of autism spectrum disorders (ASD) and severity of intellectual disability (ID) are known risk factors for SIB, there are no studies comparing SIB topographies by severity degrees of ID and ASD. The purpose of the present paper has been to identify risk factors and topographies for SIB in a representative, stratified and randomised sample of adults with IDD. METHOD This study was conducted on the basis of data collected by the POMONA-ESP project, in a sample of 833 adults with IDD. Data concerning demographic and health information, ASD symptoms, psychopathology and ID, have been analysed to determine the presence of risk factors for SIB among participants and to explore the occurrence and topographies of SIB across different severity levels of ID and ASD symptoms. RESULTS Self-injurious behaviour prevalence in the sample was 16.2%. Younger age, oral pain, greater severity of ID, presence of dual diagnosis, psychiatric medication intake and higher scores on Childhood Autism Rating Scale were risk factors for SIB among participants, whereas number of areas with functioning limitations, place of residence, diagnosis of epilepsy and sex were not. SIB was more frequent in participants with ASD symptoms regardless of its severity level, and they displayed a higher number of different topographies of SIB. People with profound ID without co-morbid ASD symptoms showed similar results concerning SIB prevalence and topographies. CONCLUSIONS Knowledge on risk factors and topographies of SIB might play a vital role in the development of prevention strategies and management of SIB in people with IDD. The mere presence of ASD symptoms, regardless of its severity level, can be a crucial factor to be taken into account in assessing SIB. Accordingly, the presence of SIB in people with ID, especially when presented with a varied number of topographies, might provide guidance on ASD differential diagnosis.
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Affiliation(s)
- A Folch
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, Reus, Spain
- Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
| | - M J Cortés
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, Reus, Spain
- Centre of Biomedical Research Network on Mental Health (CIBERSAM), Spain
| | - L Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - P Vicens
- Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
- Research Center in Behavioral Assessment (CRAMC), Universitat Rovira i Virgili, Tarragona, Spain
- Laboratory of Toxicology and Environmental Health, Universitat Rovira i Virgili, Tarragona, Spain
| | - M Irazábal
- Parc Sanitari Sant Joan de Déu, Spain
- Faculty of Education, Universitat de Barcelona, Barcelona, Spain
| | - S Muñoz
- Plena Inclusión España, Madrid, Spain
| | - L Rovira
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - C Orejuela
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - J M Haro
- Centre of Biomedical Research Network on Mental Health (CIBERSAM), Spain
- Parc Sanitari Sant Joan de Déu, Spain
- Department of Psychiatry and Clinical Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - E Vilella
- Centre of Biomedical Research Network on Mental Health (CIBERSAM), Spain
- Institut Pere Mata, University Psychiatric Hospital, Reus, Spain
| | - R Martínez-Leal
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, Reus, Spain
- Centre of Biomedical Research Network on Mental Health (CIBERSAM), Spain
- Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
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Vagenas D, Totsika V. Modelling correlated data: Multilevel models and generalized estimating equations and their use with data from research in developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 81:1-11. [PMID: 29786528 DOI: 10.1016/j.ridd.2018.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/19/2018] [Accepted: 04/12/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The use of Multilevel Models (MLM) and Generalized Estimating Equations (GEE) for analysing clustered data in the field of intellectual and developmental disability (IDD) research is still limited. METHOD We present some important features of MLMs and GEEs: main function, assumptions, model specification and estimators, sample size and power. We provide an overview of the ways MLMs and GEEs have been used in IDD research. RESULTS While MLMs and GEEs are both appropriate for longitudinal and/or clustered data, they differ in the assumptions they impose on the data, and the inferences made. Estimators in MLMs require appropriate model specification, while GEEs are more resilient to misspecification at the expense of model complexity. Studies on sample size seem to suggest that Level 1 coefficients are robust to small samples/clusters, with any higher-level coefficients less so. MLMs have been used more frequently than GEEs in IDD research, especially for fitting developmental trajectories. CONCLUSIONS Clustered data from research in the IDD field can be analysed flexibly using MLMs and GEEs. These models would be more widely used if journals required the inclusion of technical specification detail, simulation studies examined power for IDD study characteristics, and researchers developed core skills during basic studies.
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Affiliation(s)
- Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia.
| | - Vasiliki Totsika
- Centre for Educational Development, Appraisal, and Research (CEDAR) and Centre for Education Studies (CES), University of Warwick, UK; Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Monash University, Australia
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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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Erturk B, Machalicek W, Drew C. Self-Injurious Behavior in Children With Developmental Disabilities: A Systematic Review of Behavioral Intervention Literature. Behav Modif 2017; 42:498-542. [PMID: 29179569 DOI: 10.1177/0145445517741474] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We reviewed single-case research studies examining the effects of behavioral interventions for self-injurious behavior (SIB) in young children with autism and developmental disabilities. Systematic searches of electronic databases, journals, and reference lists identified 46 studies (66 participants younger than the age of 12) meeting inclusion criteria. Studies were examined based on (a) participant demographics, (b) topography and function of SIB, (c) type of functional behavior assessment (FBA), (d) intervention procedures and outcomes, and (e) experimental design and measurement. Intervention strategies were categorized as antecedent manipulations, teaching behavior, consequence-based procedures, and/or extinction procedures. Positive outcomes were reported for 78% of participants in the reviewed studies and 88% of the participants were diagnosed with autism. Results suggest the effectiveness of behavioral interventions to decrease SIB for young children with disabilities; however, the frequent use of packaged interventions without component analysis limits the conclusiveness of any treatment recommendation. Suggestions for future research are discussed.
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Stewart SL, Falah Hassani K, Poss J, Hirdes J. The determinants of service complexity in children with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:1055-1068. [PMID: 29024219 DOI: 10.1111/jir.12423] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 08/15/2017] [Accepted: 08/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND To date, little is known about the predictors of healthcare service utilisation in children with intellectual disability (ID). The aim of this study was to identify the factors associated with service complexity in children with ID in Ontario, Canada. METHODS The population of this cross-sectional study consisted of 330 children with ID ages 4 to 18 years who accessed mental health services from November of 2012 to June of 2016 in four agencies. All participants completed the interRAI Child and Youth Mental Health and Developmental Disability Assessment Instrument, which is a semi-structured clinician-rated assessment that covers a range of common issues in children with ID. The outcome of this study was a service complexity variable based on (1) mental health service utilisation including any services provided to the child and (2) the management involved in providing that care. Eight individual items were summed, resulting in a scale that ranged from 0 to 8. Scores were then dichotomised into two groups: a score of 0-2 identified children with a low service complexity and a score of 3 or higher identified children with a high service complexity. RESULTS After adjustment for other covariates, gender was not associated with service complexity. Children aged 11-14 years and children with autism spectrum disorder used over twofold higher levels of service complexity than children aged equal to or less than 10 years or children with other causes of ID. Moreover, victims of bullying, high scores on the family functioning scale or learning or communication disorder were associated with greater service complexity. CONCLUSIONS The findings of this study indicate that a variety of factors are related to service complexity ranged from children's nonclinical (age and experiences of bullying) to clinical (e.g. aggression, learning/communication problems and autism spectrum disorder) characteristics.
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Affiliation(s)
- S L Stewart
- Faculty of Education, Western University, London, Ontario, Canada
| | - K Falah Hassani
- Faculty of Education, Western University, London, Ontario, Canada
| | - J Poss
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - J Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Monir ZM, El-Din EMS, El-Alameey IR, Yamamah GA, Megahed HS, Salem SM, Ibrahim TS. Academic Achievement and Psychosocial Profile of Egyptian Primary School Children in South Sinai. Open Access Maced J Med Sci 2016; 4:624-629. [PMID: 28028402 PMCID: PMC5175510 DOI: 10.3889/oamjms.2016.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/20/2016] [Accepted: 09/23/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Population of South Sinai has suffered from negligence for many years. Solving educational problems of this population is the main concern nowadays. AIM To assess academic achievement in primary school children in South Sinai in relation to intelligence and psychosocial profile. SUBJECTS AND METHODS A descriptive cross-sectional survey was conducted on 407 Bedouin and urban students randomly selected from twelve public primary schools in six cities in South Sinai. Intelligence was assessed using Goodenough-Harris test. The midyear Arabic language and Arithmetic scores were used to assess academic achievement. The teachers completed a Pediatric-Symptom Checklist for evaluation of children behaviour. RESULTS A statistically significant difference in academic achievement (P < 0.001), total psychosocial scores, (P < 0.05), and externalization (P < 0.05) was found between urban and Bedouin students with significant gender differences (P < 0.05). Highly significant positive correlations were observed between IQ percentile and mid-year Arabic language scores and Arithmetic scores (P < 0.001), and significant negative correlations with the total score of PSCL and its subscale scores (externalising, inattention, and internalising behaviour) (P < 0.001) among the students. CONCLUSION Comorbid academic and psychosocial dysfunction in primary school children were observed in South Sinai. A national strategy to minimise the educational gap between Bedouin and urban areas should be implemented.
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Affiliation(s)
- Zeinab M. Monir
- Child Health Department, Medical Division, National Research Centre, Cairo, Egypt
| | | | - Inas R. El-Alameey
- Child Health Department, Medical Division, National Research Centre, Cairo, Egypt
| | - Gamal A. Yamamah
- Pediatric Department, Medical Division, National Research Centre, Cairo, Egypt
| | - Hala S. Megahed
- Child Health Department, Medical Division, National Research Centre, Cairo, Egypt
| | - Samar M. Salem
- Child Health Department, Medical Division, National Research Centre, Cairo, Egypt
| | - Tarek S. Ibrahim
- Child Health Department, Medical Division, National Research Centre, Cairo, Egypt
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Griffith GM, Jones R, Hastings RP, Crane RS, Roberts J, Williams J, Bryning L, Hoare Z, Edwards RT. Can a mindfulness-informed intervention reduce aggressive behaviour in people with intellectual disabilities? Protocol for a feasibility study. Pilot Feasibility Stud 2016; 2:58. [PMID: 27965874 PMCID: PMC5154058 DOI: 10.1186/s40814-016-0098-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 10-20 % of adults with intellectual disabilities engage in challenging behaviours such as aggression, destructiveness, and self-injury, which are often accompanied by feelings of anger. The inability to manage anger can reduce quality of life. For example, aggression is a strong predictor of out-of-area placements and is a risk variable for abuse. Recent research suggests that mindfulness-based therapies (specifically, Singh's Soles of the Feet meditation) can help people with intellectual disabilities manage angry emotions, with resultant reductions in challenging behaviour. However, previous research has been single-case design studies, and no group studies have been published with people with intellectual disabilities and aggressive behaviour. METHODS/DESIGN For this feasibility study, a UK protocol will be developed for use by health professionals within National Health Service (NHS) Intellectual Disability (ID) teams, based upon Singh's Soles of the Feet manual. Twenty adults with intellectual disabilities and identified problems with anger control will be recruited and six sessions will be delivered by a trained ID clinician. The study will monitor participant's aggressive behaviour, health-related quality of life, anxiety, depression, and use of support services (medication, hospital appointments etc.). These will be measured at three time points: (1) Baseline (within 2 weeks prior to the first session of the intervention), (2) 2 months post-baseline, and (3) 6 months post-baseline. Qualitative interviews will be conducted with participants, their carers, and the therapists who delivered the intervention. In order to help design an economic evaluation alongside a future full trial, we will cost the intervention and test the acceptability and validity of health economics measures to record resource use and health-related quality of life outcomes. DISCUSSION The data from this study will inform the feasibility of the project protocol and intervention, which will help develop future research and to determine whether a larger, randomised controlled trial with concurrent economic evaluation is feasible. TRIAL REGISTRATION UKCERN: 16743.
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Affiliation(s)
- Gemma Maria Griffith
- Centre for Mindfulness Research and Practice (CMRP), Bangor University, Bangor, UK
| | - Robert Jones
- School of Psychology, Bangor University, Brigantia Building, Penrhalt Road, Bangor, LL57 2AS UK
| | - Richard Patrick Hastings
- Centre for Educational Development, Appraisal and Research: (CEDAR) University of Warwick, Coventry, UK
| | - Rebecca S Crane
- Centre for Mindfulness Research and Practice (CMRP), Bangor University, Bangor, UK
| | - Judith Roberts
- School of Psychology, Bangor University, Brigantia Building, Penrhalt Road, Bangor, LL57 2AS UK
| | - Jonathan Williams
- Denbighshire Complex Disabilities Team, North Wales, North Wales, UK
| | - Lucy Bryning
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
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Gur A. Challenging behavior, functioning difficulties, and quality of life of adults with intellectual disabilities. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2016; 64:45-52. [PMID: 34141290 PMCID: PMC8115461 DOI: 10.1080/20473869.2016.1221233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objective: The current study aimed at examining the correlations between challenging behaviors, difficulties in functioning, and quality of life in institutionalized adults with intellectual disabilities. Methods: A sample of 53 people with intellectual disabilities and challenging behavior who resided in a large institutional care facility was recruited. The research questionnaire included the following instruments: (1) The challenging behavior scale; (2) The World Health Organization Disability Assessment Schedule 2.0; and (3) The Personal Well-Being Index. Results: No significant correlation was found between challenging behavior and quality of life. However, more challenging behavior found to be correlated with greater difficulties in functioning. Furthermore, a weak correlation was found between difficulties in functioning and quality of life. Participants who had greater difficulty functioning tended to exhibit lower levels of quality of life. No significant associations were found between the sample's personal characteristics (gender, age, and the severity of intellectual disability) and challenging behavior, difficulties in functioning, and quality of life. Conclusion: Empowering personal functioning of people with intellectual disabilities is important in planning rehabilitation interventions. Such interventions are likely to promote a higher quality of life. There is the need for future research to further investigate the relationship found in this study.
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Affiliation(s)
- Ayelet Gur
- Faculty of Social Welfare and Health Sciences, School of Social Work, University of Haifa, Haifa, Israel
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Lakhan R, Kishore MT. Behaviour Problems in Children with Intellectual Disabilities in a Resource-Poor Setting in India - Part 1: Association with Age, Sex, Severity of Intellectual Disabilities and IQ. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 31:43-50. [PMID: 27457025 DOI: 10.1111/jar.12278] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Behaviour problems are most common in people with intellectual disabilities. Nature of behaviour problems can vary depending upon the age, sex and intellectual level (IQ). OBJECTIVES This study examined the distribution of behaviour problems across intellectual disability categories and their association with IQ age and sex in children with intellectual disabilities. METHODS This is a cross-sectional study design. A total of 104 participants (57 males and 47 females), aged 3-18 years, with intellectual disabilities were administered The Behavioural Assessment Scale for Indian Children with Mental Retardation (BASIC-MR). RESULTS It was found that violent and destructive, temper tantrum and self-injurious behaviours were differently distributed with reference to intellectual disability levels (P > 0.05) but cumulative scores per se problem behaviours did not vary with the level of intellectual disabilities. IQ showed a significant positive correlation with destructive and violent and misbehaves with other; and a significant negative correlation with temper tantrums and self-injurious behaviours. Age was significantly, positively associated with violent and destructive, odd, and hyperactive behaviours and inversely with self-injurious problem behaviours. There was no significant relationship between the sex of the child and problem behaviours. There was no significant interactive effect of sex and level of intellectual disabilities of the child on problem behaviours. CONCLUSION Behaviour problems, in general, are not equally distributed in all categories of intellectual disabilities. Relationship between behaviour problems and age, sex and IQ may not be uniform. But specific behaviours are more associated with specific age group and intellectual disability levels.
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Affiliation(s)
- Ram Lakhan
- Department of Epidemiology, School of Public Health, Jackson State University, Jackson, MS, USA
| | - M Thomas Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Woodman AC, Mailick MR, Greenberg JS. Trajectories of internalizing and externalizing symptoms among adults with autism spectrum disorders. Dev Psychopathol 2016; 28:565-81. [PMID: 26612272 PMCID: PMC4828272 DOI: 10.1017/s095457941500108x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Individuals with autism spectrum disorder (ASD) experience higher rates of psychopathology than their typically developing peers or peers with other intellectual or developmental disabilities. Little is known about the developmental course of psychiatric symptoms such as internalizing and externalizing behaviors in this population. Individual characteristics and aspects of the family environment may explain variability in outcomes for adults with ASD. The present study extends our current understanding of psychopathology among individuals with ASD by examining group-based trajectories of internalizing and externalizing symptoms in adulthood. Overall, the results showed that symptoms became less severe over time. Distinct patterns of change in psychopathology were observed and associated with differential profiles of psychotropic medication use, comorbid mental health diagnoses, and residential placement. The likelihood of following each developmental trajectory was estimated based on characteristics of the adults with ASD (gender, adaptive behavior, and autistic symptoms) and maternal expressed emotion (criticism and warmth). Maternal criticism and warmth were identified as key risk and protective factors, respectively, with important implications for future research and intervention for individuals with ASD.
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Rojahn J, Barnard-Brak L, Medeiros K, Schroeder SR. Stereotyped behaviours as precursors of self-injurious behaviours: a longitudinal study with infants and toddlers at risk for developmental delay. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:156-166. [PMID: 26381073 DOI: 10.1111/jir.12224] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 07/29/2015] [Accepted: 08/06/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND The notion that stereotypic behaviours may be precursors of self-injurious behaviour (SIB) has been considered in the past, but the available empirical evidence is still inconsistent and ambiguous. METHOD In a longitudinal study, we collected data on stereotypic behaviour and SIB from 160 infants and toddlers who were at-risk for developmental delay. Interviews were conducted with parents at three time points during a one-year span using the Behaviour Problems Inventory-01 which contains subscales for SIB and stereotyped behaviour. We used growth modelling to estimate linear trends in several models. Model fit was evaluated according to a combination of fit statistics as is recommended in structural equation or latent variable modelling approaches such as latent growth modelling. RESULTS In examining the relationship between stereotyped behaviours and SIB across time, the model that represented earlier stereotyped behaviour as predicting later SIB fit the data better than the other models. CONCLUSIONS The findings corroborate the notion that stereotyped behaviour can be a precursor of SIB. If replicated by other studies, it makes a case for considering early intervening with stereotyped behaviour as a SIB prevention strategy.
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Affiliation(s)
- J Rojahn
- George Mason University, Psychology, Fairfax, VA, United States
| | - L Barnard-Brak
- Texas Tech University, Burkhart Center for Autism, Lubbock, TX, United States
| | - K Medeiros
- George Mason University, Psychology, Fairfax, VA, United States
| | - S R Schroeder
- University of Kansas, Kansas University Center on Development Disabilities, Schiefelbusch Institute for Life Span Institute Lawrence, Kansas, United States
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Gormez A, Rana F, Varghese S. Pharmacological interventions for self-injurious behaviour in adults with intellectual disabilities: Abridged republication of a Cochrane systematic review. J Psychopharmacol 2014; 28:624-32. [PMID: 24785762 DOI: 10.1177/0269881114531665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We aimed to determine clinical effectiveness of pharmacological interventions for self-injurious behaviour in adults with intellectual disability. We searched the following databases: CENTRAL; MEDLINE; EMBASE; PsycINFO; CINAHL; SCI; SSCI; Conference Proceedings Citation Index - Science; Conference Proceedings Citation Index - Social Science and Humanities; ZETOC; World Cat .We also searched ClinicalTrials.gov,ICTRP and the reference lists of included trials. We included randomised controlled trials that examined drug interventions versus placebo for self-injurious behaviour. We found five double-blind, placebo-controlled trials, which included a total of 50 people. Four trials compared the effects of naltrexone versus placebo and one trial clomipramine versus placebo. We did not identify any relevant placebo-controlled trials for other drugs. We presented a narrative summary, as meta-analysis was not appropriate due to differences in study designs, differences between interventions and heterogeneous outcome measures. There was weak evidence in included trials that any active drug was more effective than placebo for people with intellectual disability demonstrating self-injurious behaviour. Due to sparse data, an absence of power and statistical significance, and high risk of bias for four of the included trials, we are unable to reach any definite conclusions about the relative benefits of naltrexone or clomipramine compared to placebo.
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Affiliation(s)
- A Gormez
- Southern Health NHS Foundation Trust, Psychiatry of Intellectual Disability, Oxford, UK
| | - F Rana
- Southern Health NHS Foundation Trust, Psychiatry of Intellectual Disability, Oxford, UK
| | - S Varghese
- Black Country Partnership NHS Foundation Trust, Psychiatry of Intellectual Disability, Wolverhampton, UK
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Abstract
Mental retardation (MR) deems an individual more vulnerable to psychopathologies. The individual may develop an array of behavioral disturbances manifesting themselves in the form of aggressive and destructive conduct, violent fits of anger, stereotyped, or self-injuring behavior. Self-injurious behavior is heterogeneous in nature ranging from mild to severe variant. We report a case of a 7-year-old boy with MR with self-inflicted severe oral injuries of cannibalistic nature presenting as cleft lip and palate. A more extensive research is needed on the problem behaviors in mentally retarded patients for early detection and effective and timely intervention leading to a better outcome.
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Affiliation(s)
- Rohit Verma
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Shaily Mina
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Ankur Sachdeva
- Department of Psychiatry, Vardhman Mahavir Medical College, Safdarjung Hospital, New Delhi, India
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Minshawi NF, Hurwitz S, Fodstad JC, Biebl S, Morriss DH, McDougle CJ. The association between self-injurious behaviors and autism spectrum disorders. Psychol Res Behav Manag 2014; 7:125-36. [PMID: 24748827 PMCID: PMC3990505 DOI: 10.2147/prbm.s44635] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A key area of concern in children with autism spectrum disorders (ASDs) are self-injurious behaviors (SIBs). These are behaviors that an individual engages in that may cause physical harm, such as head banging, or self-biting. SIBs are more common in children with ASD than those who are typically developing or have other neurodevelopmental disabilities. Therefore, it is important that clinicians who work with children with ASD have a solid understanding of SIB. The purpose of this paper is to review the research on the epidemiology of SIB in children with ASD, factors that predict the presence of SIB in this population, and the empirically supported behavioral treatments available.
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Affiliation(s)
- Noha F Minshawi
- Department of Psychiatry, Indiana University School of Medicine, Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Sarah Hurwitz
- School of Education, Indiana University, Bloomington, IN, USA
| | - Jill C Fodstad
- Department of Psychiatry, Indiana University School of Medicine, Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Sara Biebl
- Child and Adolescent Behavioral Health, Sanford Health, Fargo, ND, USA
| | | | - Christopher J McDougle
- Departments of Psychiatry and Pediatrics, Lurie Center for Autism, Massachusetts General Hospital and MassGeneral Hospital for Children, Harvard Medical School, Boston, MA, USA
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Crotty G, Doody O, Lyons R. Aggressive behaviour and its prevalence within five typologies. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2014; 18:76-89. [PMID: 24189373 DOI: 10.1177/1744629513511356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Crucial to understanding an individual, presenting with intellectual disability and the management of their challenging behaviours, is the knowledge of the types of those specific behaviours. The term aggressive behaviour is a universal term that embraces many aspects of behaviour that vary in terms of severity, frequency and seriousness for the individual and those around them. Hence, greater consideration regarding intervention, management, person-centred strategies and prevalence and frequency rates are required in service provision for individuals with intellectual disability and aggressive behaviour. This review presents the context of aggressive behaviour and its prevalence within the five typologies of aggressive behaviour: verbal aggression, aggression against others, sexually inappropriate behaviour, self-injurious behaviour and aggression against property, as identified by Crocker et al. (2007). The focus of this review is to report on the prevalence of aggressive behaviour reported for individuals with intellectual disability and consider the ambiguity in defining aggressive behaviour.
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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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Griffith GM, Hutchinson L, Hastings RP. "I'm not a patient, I'm a person": The experiences of individuals with intellectual disabilities and challenging behavior—A thematic synthesis of qualitative studies. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/cpsp.12053] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Medeiros K, Curby TW, Bernstein A, Rojahn J, Schroeder SR. The progression of severe behavior disorder in young children with intellectual and developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3639-3647. [PMID: 24012587 PMCID: PMC4453924 DOI: 10.1016/j.ridd.2013.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/05/2013] [Accepted: 08/05/2013] [Indexed: 06/02/2023]
Abstract
Behavior disorders, such as self-injurious, stereotypic, and aggressive behavior are common among individuals with intellectual or developmental disabilities. While we have learned much about those behaviors over the past few decades, longitudinal research that looks at developmental trajectory has been rare. This study was designed to examine the trajectory of these three forms of severe behavior disorders over a one year time period. The behaviors were measured on two dimensions: frequency of occurrence and severity. Participants were 160 infants and toddlers at risk for developmental delays in Lima, Peru. Using structural equation modeling, we found that the frequency of self-injury and stereotypic behavior and the severity of aggressive behavior remained stable over the 12-month period. Uni-directional structural models fit the data best for self-injurious and aggressive behavior (with frequency being a leading indicator of future severity of self-injury and severity being a leading indicator of future frequency for aggression). For stereotypic behavior, a cross-lagged autoregressive model fit the data best, with both dimensions of frequency and severity involved as leading indicators of each other. These models did not vary significantly across diagnostic groups, suggesting that toddlers exhibiting behavior disorders may be assisted with interventions that target the specific frequencies or severities of behaviors, regardless of diagnostic category.
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Griffith GM, Hastings RP. ‘He's hard work, but he's worth it’. The Experience of Caregivers of Individuals with Intellectual Disabilities and Challenging Behaviour: A Meta-Synthesis of Qualitative Research. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2013; 27:401-19. [DOI: 10.1111/jar.12073] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2013] [Indexed: 11/30/2022]
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Barron DA, Molosankwe I, Romeo R, Hassiotis A. Urban adolescents with intellectual disability and challenging behaviour: costs and characteristics during transition to adult services. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:283-292. [PMID: 23398559 DOI: 10.1111/hsc.12015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Young persons with intellectual disabilities and challenging behaviour in transition usually have complex needs, which may not be served well within existing resources. In this article, we present a survey of all the young people, between 16 and 18 years of age with intellectual disabilities and challenging behaviour identified in one inner London borough. They were in transition to adult services at the time of the study (between 2006 and 2008). The objective was to examine their socio-demographic and clinical characteristics, pattern of service use and associated costs of care. An assessment toolkit was devised to measure the mental and physical health, challenging behaviour and service use of the sample. Instruments within the toolkit included the Strengths and Difficulties Questionnaire, challenging behaviour scale, Client Service Receipt Inventory (CSRI) and socio-demographic data form. Twenty-seven individuals in transition to adult services had challenging behaviour, 23 of whom had mental health diagnoses and 18 of whom had physical diagnoses. Severity of challenging behaviour did not correlate with cost of care. Informal care accounted for the highest proportion of the total cost of care (66%) with education being the second largest contributor at 22%. Evidence on transition outcomes for young people with complex needs and intellectual disabilities and associated costs is lacking. This article illustrates some of the relevant issues in this area. Further research is required to investigate these aspects and guide commissioning of appropriate services.
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Affiliation(s)
- Diana A Barron
- Research Department of Mental Health Sciences, University College London Medical School, London, UK.
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Rana F, Gormez A, Varghese S. Pharmacological interventions for self-injurious behaviour in adults with intellectual disabilities. Cochrane Database Syst Rev 2013:CD009084. [PMID: 23633366 DOI: 10.1002/14651858.cd009084.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Self-injurious behaviour among people with intellectual disability is relatively common and often persistent. Self-injurious behaviour continues to present a challenge to clinicians. It remains poorly understood and difficult to ameliorate despite advances in neurobiology and psychological therapies. There is a strong need for a better evidence base in prescribing and monitoring of drugs in this population, especially since none of the drugs are actually licensed for self-injurious behaviour. OBJECTIVES To determine clinical effectiveness of pharmacological interventions in management of self-injurious behaviour in adults with intellectual disability. SEARCH METHODS We searched the following databases on 19 February 2012: CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, Science Citation Index, Social Science Citation Index, Conference Proceedings Citation Index - Science, Conference Proceedings Citation Index - Social Science and Humanities, ZETOC and WorldCat. We also searched ClinicalTrials.gov, ICTRP and the reference lists of included trials. SELECTION CRITERIA We included randomised controlled trials that examined drug interventions versus placebo for self-injurious behaviour (SIB) in adults with intellectual disability. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias for each trial using a data extraction form. We present a narrative summary of the results is presented. We did not consider meta-analysis was appropriate due to differences in study designs, differences between interventions and heterogeneous outcome measures. MAIN RESULTS We found five double-blind placebo-controlled trials that met our inclusion criteria. These trials assessed effectiveness and safety of drugs in a total of 50 people with intellectual disability demonstrating SIB. Four trials compared the effects of naltrexone versus placebo and one trial compared clomipramine versus placebo.One of the naltrexone versus placebo trials reported that naltrexone had clinically significant effects (≥ 33% reduction) on the daily rates of three of the four participants' most severe form of SIB and modest to substantial reductions in SIB for all participants; however, this study did not report on statistical significance. Another trial reported that naltrexone attenuated SIB in all four participants, with 25 mg and 50 mg doses producing a statistically significant decrease in SIB (P value < 0.05). Another trial (eight people) indicated that naltrexone administration was associated with significantly fewer days of high frequency self injury and significantly more days with low frequency self injury. Naltrexone had different effects depending on the form and location of self injury. Another trial with only 26 participants found that neither single-dose (100 mg) nor long-term (50 and 150 mg) naltrexone treatment had any therapeutic effect on SIB.Comparison of clomipramine versus placebo found no statistically significant benefit for any outcome measure, which included SIB rate and intensity, stereotypy and adverse events. However, it showed clinically significant improvement in the rate and intensity of SIB and stereotypy.There were very few noteworthy adverse events to report in any of the four trials in which these were reported.All trials were at high risk of bias, apart from one trial (Lewis 1996), which was probably at low risk of bias. The short period of follow-up was a significant drawback in the design of all five trials, as it did not allow long-term assessment of behaviour over time.We were unable to examine the efficacy of antidepressants other than clomipramine, antipsychotics, mood stabilisers or beta-blockers as we did not identify any relevant placebo-controlled trials. AUTHORS' CONCLUSIONS There was weak evidence in included trials that any active drug was more effective than placebo for people with intellectual disability demonstrating SIB. Due to sparse data, an absence of power and statistical significance, and high risk of bias for four of the included trials, we are unable to reach any definite conclusions about the relative benefits of naltrexone or clomipramine compared to placebo.
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Affiliation(s)
- Fareez Rana
- Psychiatry of Intellectual Disability, Southern Health NHS Foundation Trust, Oxford, UK.
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Oliver C, Petty J, Ruddick L, Bacarese-Hamilton M. The association between repetitive, self-injurious and aggressive behavior in children with severe intellectual disability. J Autism Dev Disord 2012; 42:910-9. [PMID: 21720724 DOI: 10.1007/s10803-011-1320-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We evaluated the independent association between adaptive behavior, communication and repetitive or ritualistic behaviors and self-injury, aggression and destructive behavior to identify potential early risk markers for challenging behaviors. Data were collected for 943 children (4-18 years, M = 10.88) with severe intellectual disabilities. Odds ratio analyses revealed that these characteristics generated risk indices ranging from 2 to 31 for the presence and severity of challenging behaviors. Logistic regressions revealed that high frequency repetitive or ritualistic behavior was associated with a 16 times greater risk of severe self-injury and a 12 times greater risk of showing two or more severe challenging behaviors. High frequency repetitive or ritualistic behaviors independently predict challenging behavior and have the potential to be early risk markers for self-injury and aggression of clinical significance.
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Affiliation(s)
- Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Matson JL, Turygin NC. How do researchers define self-injurious behavior? RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1021-1026. [PMID: 22502826 DOI: 10.1016/j.ridd.2012.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 01/13/2012] [Indexed: 05/31/2023]
Abstract
Self-injurious behavior is commonly observed among persons with intellectual disabilities. However, a second parallel use of this term is used in the general mental health field for self-mutilation. The authors describe these two disorders and how they differ. Characteristics of what we refer to as repetitive self-injurious behavior among persons with intellectual disabilities and risk factors for these behaviors are discussed. We also describe different assessment/testing methods which aid in defining this phenomenon. The implications of these data for research and clinical practice are discussed.
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Furniss F, Biswas AB. Recent research on aetiology, development and phenomenology of self-injurious behaviour in people with intellectual disabilities: a systematic review and implications for treatment. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:453-475. [PMID: 22369696 DOI: 10.1111/j.1365-2788.2012.01534.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Behavioural interventions conceptualise self-injurious behaviour (SIB) as developing from early repetitive behaviours through acquisition of homeostatic functions in regulating stimulation and subsequent shaping into SIB through socially mediated or automatic operant reinforcement. Despite high success rates, such interventions rarely completely eliminate SIB, and overall effectiveness has not increased since the 1960s. METHODS Research (excluding studies of single genetic syndromes) on the early development, functional properties and phenomenology of SIB in persons with intellectual disabilities (IDs) published from 1999 to 2010 inclusive is reviewed. RESULTS Despite evidence to support the operant shaping hypothesis, in some cases tissue-damaging SIB, especially head-banging, emerges at a similar or younger age than stereotyped behaviours or 'proto-SIB', often associated with tantrums following frustrative non-reward and/or abrupt situational transitions. Many young children show undifferentiated patterns of responding in functional analyses of SIB, and SIB is associated with aggression and impulsivity as well as with repetitive behaviour. CONCLUSIONS One dynamic in the development of SIB may be Pavlovian conditioning of aggression, originally elicited by aversive events or frustrative non-reward, to stimuli associated with such situations. Integration into operant technology of interventions based on Pavlovian principles such as graduated exposure (with or without counterconditioning) to aversive stimuli may enhance the effectiveness of behavioural interventions.
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Gerber F, Bessero S, Robbiani B, Courvoisier DS, Baud MA, Traoré MC, Blanco P, Giroud M, Galli Carminati G. Comparing residential programmes for adults with autism spectrum disorders and intellectual disability: outcomes of challenging behaviour and quality of life. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2011; 55:918-932. [PMID: 21806693 DOI: 10.1111/j.1365-2788.2011.01455.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Owing to methodological issues, little research has been conducted to examine quality of life (QoL) as a treatment outcome in autism spectrum disorders (ASD) and intellectual disabilities (ID). This study was conducted to combine QoL measures and objective observations of challenging behaviours (CB) in order to evaluate changes over time in adults with ASD and ID who were treated in two different residential programmes; we hypothesised that a decrease in CB would be related to an improved QoL. METHOD In a longitudinal study (45 months), we followed 31 adults with ASD and ID who had been integrated into two residential programmes [Autism Programme with a Structured Method (PAMS) vs. traditional programme for ID (No-PAMS)] for 2-19 years. QoL [Quality of Life Inventory in a Residential Environment (IQVMR)] and severity of autistic features (Childhood Autism Rating Scales) were evaluated annually. CB, as measured by the Aberrant Behaviour Checklist (ABC), including stereotypic behaviour and inappropriate speech, were repeatedly assessed every 3 months. RESULTS Observed separately, the groups' results were different. In the PAMS programme, stereotypic behaviour and inappropriate speech (ABC scores) significantly decreased, and the IQVMR total score increased; in contrast, in the comparison group, ABC scores did not change and the IQVMR total score decreased. In all, three mixed-effect ANCOVAs partially confirmed that the PAMS programme had an effect on CB and that QoL improvement did not directly depend on the type of programme but on reducing CB as measured by the ABC. CONCLUSION The PAMS programme has a positive and indirect influence on QoL by reducing CB.
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Affiliation(s)
- F Gerber
- Psychiatric Unit of Mental Development (UPDM), Department of Psychiatry, University Hospitals of Geneva (HUG) - University of Geneva, Geneva, Switzerland.
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Kim NH, Hoyek GE, Chau D. Long-term care of the aging population with intellectual and developmental disabilities. Clin Geriatr Med 2011; 27:291-300. [PMID: 21641512 DOI: 10.1016/j.cger.2011.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aging population with intellectual and developmental disabilities (I/DD) deserves appropriate health care and social support. This population poses unique medical and social challenges to the multidisciplinary team that provides care. In the past, long-term care (LTC) facilities played an essential role in the livelihood of this population. The likelihood that the geriatric LTC system must prepare for adequately caring for this population is high. This article conveys the need to prepare for the inclusion of the growing aging population with I/DD into long-term care with the general elderly population in the near future.
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Affiliation(s)
- Nae-Hwa Kim
- Department of Internal Medicine, Resident PGY 2, University of Nevada School of Medicine, Reno, NV 89502, USA
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de Winter CF, Jansen AAC, Evenhuis HM. Physical conditions and challenging behaviour in people with intellectual disability: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2011; 55:675-698. [PMID: 21366751 DOI: 10.1111/j.1365-2788.2011.01390.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Challenging behaviour is a major problem among people with intellectual disabilities. Physical factors may be an important cause. The aim of the present systematic review was to determine the physical conditions associated with challenging behaviour. METHODS A literature search was conducted in PubMed and the Cochrane systematic review database for empirical studies published between 1990 and 2008. The quality of all the studies that met the inclusion criteria was assessed using the SIGN-50 methodology checklists. RESULTS The search identified 45 studies, which looked at general medical conditions, motor impairment, epilepsy, sensory impairment, gastrointestinal disease, sleep disorders, dementia and others. There were four high-quality observational studies, seven well-conducted observational studies, 21 observational studies of low methodological quality and 13 non-analytical studies. There were significant and independent associations between challenging behaviours and urinary incontinence, pain related to cerebral palsy and chronic sleep problems, and between self-injurious behaviour and visual impairment. No association was found with hearing impairment, bowel incontinence, mobility impairment or epilepsy. Many other physical conditions were not addressed at all. CONCLUSION Medical conditions can play a role in challenging behaviour, and this should be evaluated in the clinical setting. So far, the level of evidence is generally low, and longitudinal studies are completely lacking. We recommend a systematic approach to research examining the role of physical conditions in challenging behaviour, the ultimate aim being to establish a basis for the development of clinical guidelines.
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Affiliation(s)
- C F de Winter
- Reinaerde, Organisation for People with Intellectual Disability, Den Dolder, the Netherlands.
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McKenzie K. Providing services in the United Kingdom to people with an intellectual disability who present behaviour which challenges: a review of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:395-403. [PMID: 21190810 DOI: 10.1016/j.ridd.2010.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 12/02/2010] [Indexed: 05/30/2023]
Abstract
There is ongoing debate about the best model of service provision for people with an intellectual disability who present severe behavioural challenges. The present paper reviewed research which evaluated a range of UK service provision in terms of impact on challenging behaviour and other quality of life indices. A literature search was carried out for English language papers from 1990 to 2010 using a range of databases. Secondary searches were carried out from references of relevant papers. Very few evaluations were found. The available research indicates that, on the whole, specialist congregate services for individuals with challenging behaviour appear to use more restrictive approaches which have limited effect on reducing challenging behaviour. The evidence for peripatetic teams is somewhat unclear. The two studies reviewed showed positive outcomes, but both had limitations that made it difficult to generalize the results. A similar limitation was found with the sole evaluation of a community based service. It is unlikely that one model of service provision will meet the needs of all individuals, however, more robust evaluations are required of existing service models to allow commissioners, service users, their families and carers to make fully informed choices about effective services for those who challenge.
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Affiliation(s)
- Karen McKenzie
- University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
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49
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Taylor L, Oliver C, Murphy G. The Chronicity of Self-Injurious Behaviour: A Long-Term Follow-Up of a Total Population Study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1468-3148.2010.00579.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Reviewing risk for individuals with developmental disabilities. Clin Psychol Rev 2010; 31:472-7. [PMID: 21146273 DOI: 10.1016/j.cpr.2010.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 11/04/2010] [Accepted: 11/16/2010] [Indexed: 11/22/2022]
Abstract
There are many categories of risky behaviors that are of interest to individuals, agencies, and institutions interested in care for developmentally disabled persons. These include challenging behaviors such as aggression and self-injury, psychiatric diagnoses, medical problems, criminal behaviors, and victimization. The literature in this area is difficult to digest due to a number of methodological problems. This paper reviews the research on one of these behaviors, self-injury, and provides a framework that can be applied to other research on predicting risk. Additionally, it attempts to organize the findings in such a way as to maximize the utility to providers and suggest useful directions for future research.
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