Impulse control and aggressive response generation as predictors of aggressive behaviour in children with mild intellectual disabilities and borderline intelligence

Social information processing, normative beliefs about aggression and parenting in children with mild intellectual disabilities and aggressive behavior

BACKGROUND

High levels of aggressive behavior in children with mild intellectual disabilities to borderline intellectual functioning (MID-BIF) are associated with deviant social information processing (SIP) steps. The current study investigated deviant SIP as a mediating mechanism linking both children's normative beliefs about aggression and parenting to aggressive behavior in children with MID-BIF. Additionally, the mediating role of normative beliefs about aggression in linking parenting and deviant SIP was investigated.

METHODS

140 children with MID-BIF in community care in the Netherlands, their parent(s) or caretaker(s), and their teacher participated in this cross-sectional study. Structural equation modeling was performed to test mediations. Models were run separately for parent and teacher reports of aggression, and included three deviant SIP steps (interpretation, response generation, response selection).

RESULTS

A total indirect effect through deviant SIP steps was found from normative beliefs about aggression to teacher-reported aggression, but not to parent-reported aggression. An indirect effect was found from positive parenting through normative beliefs about aggression to deviant SIP.

CONCLUSION

The results of this study suggest that, next to deviant SIP and parenting, normative beliefs about aggression may be a relevant intervention target for children with MID-BIF and aggressive behavior.

Risk Factors for Sexual Offenses Committed by Men With or Without a Low IQ: An Exploratory Study

Although risk factors associated with offending and recidivism are relatively well-established for mainstream sexual offenses, much less is known about men with a low IQ who have sexually offended (MIQSO), let alone those with forensic involvement. In this exploratory study, 137 convicted for the commission of at least one sexual offense and found not criminally responsible because a mental disorder were recruited in a maximum-security hospital. They were all assessed with the SORAG (static risk factors) and the RSVP (dynamic risk factors). Compared with MIQSO (N = 76), men with an average or higher IQ who have sexually offended (MSO, N = 61) obtained significantly higher scores on static factors related with general delinquency (histories of alcohol abuse, non-violent criminality, violent criminality, and sexual offense) and dynamic factors related with sexual delinquency, paraphilia, and recidivism (chronicity, psychological coercion, escalation, sexual deviance, and substance abuse). In contrast, MIQSO obtained significantly higher scores on major mental illness, problems with planning and problems with self-awareness. Logistic regressions revealed that both the SORAG and RSVP were useful to predict group membership. It is concluded that risk factors related with general and sexual delinquency better describe offenses committed by MSO, whereas risk factors related with mental disorder, lack of insight and contextual impulsivity better describe offenses committed by MIQSO.

Neurocognitive functioning of children with mild to borderline intellectual disabilities and psychiatric disorders: profile characteristics and predictors of behavioural problems

BACKGROUND

The aim of the current study was twofold: first, to uncover a neurocognitive profile of normative and relative strengths and weaknesses that characterises an extremely vulnerable group of children with mild to borderline intellectual disabilities (MBID) and co-morbid psychiatric disorders, and second, to investigate the relevance of these neurocognitive functions explaining internalising and externalising symptoms.

METHOD

We recruited 45 children (M_age  = 9.5, SD_age  = 1.7; range 6-13 years) with MBID (Full-Scale IQ 50-85) and at least one psychiatric disorder. Neurocognitive functioning was examined utilising the Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V) indices and the Cognitive Task Application (COTAPP), a comprehensive computerised self-paced task designed in such a manner that 'g' (an overall tendency of children with MBID to execute tasks with a slower reaction time and a higher error rate) has been corrected for in the administration of the task (i.e. completely self-paced) and in the operationalisation of outcome measures. Behavioural problems were measured using the CBCL and TRF. One-sample t-tests and binomial tests were carried out to compare performance with normative data. Regression analyses were used to examine the relationship between neurocognitive parameters and mental health.

RESULTS

Compared with normative data, very small to very large effect sizes were found, indicating clear heterogeneity amongst neurocognitive domains relevant for children with MBID. Two prominent neurocognitive weaknesses emerged: processing speed - characterised by slowness and unstableness combined with a high drift rate and delayed processing of the previous trial, particularly under higher cognitive demands - and working memory - in terms of a weaker central executive and 'slave' systems to temporarily store information. Both domains were not clearly predictive of internalising or externalising problems.

CONCLUSION

Children with MBID and psychiatric disorders are hampered by a strongly diminished processing speed and working memory capacity, together resulting in an overall limited processing capacity that may underlie the general developmental delays on domains that depend on fast and parallel processing of information (i.e. language, reading, mathematics and more complex forms of social cognition). Neurocognitive vulnerabilities are neither necessary nor sufficient to explain internalising and externalising problems; rather, a mismatch between the support needs and adaptations these children need, arising from their diminished processing capacity, and the inadequacy of the environment to compensate for this vulnerability may be of relevance.

Addressing Aggression in the Residential Setting for Juveniles with Mild Intellectual Disability through Training in Non-Violent Resistance

Background

Levels of aggression are high in residential settings for juveniles with Mild Intellectual Disability (MID). As a result, treatment is less effective, aggression causes injury, traumatic experiences and longer inhabitation for juveniles. Additionally, inpatient aggression has been linked to burnout and stress among group workers, which has negative consequences such as less job satisfaction or poorer work performance

Objective

Therefore, it is crucial to diminish aggressive incidents in these settings and to find a way for staff how to respond to aggression properly.

Methods

As there is no intervention method which tackles all of the referred problems efficiently, a new method Non-violent Resistance for MID was introduced into three residential settings for juveniles with MID, in a quasi-experimental stepped wedge design. Reports of aggressive incidents were assessed seven times before, during and after the training in NVR-MID on group level. Multilevel analyses were carried out in order to assess the development of the aggressive incidents over time.

Results

Aggressive incidents decreased significantly in time during and after training in NVR-MID, this decrease is seen in all three institutions. Thus, regardless of resident’s age, gender or IQ, NVR-MID seemed successful in diminishing aggressive incidents. Furthermore, a significant interaction effect was found between institution and time, indicating that regardless if incidents of aggression were relatively high at baseline, decrease in incidents was similar to institutions where incidents were relatively low on baseline.

Conclusions

Implementing NVR-MID into residential settings for juveniles with MID and comorbid behavioral problems might help to decrease aggressive incidents.

Resilience in the face of adversity in adults with an intellectual disability: A literature review

Background

Persons with an intellectual disability are at a higher risk of experiencing adversities. The concept of resilience offers promising insights into facilitating personal growth after adversity. The current study aims at providing an overview of the current research on resilience and the way this can contribute to quality of life in people with intellectual disability.

Method

A literature review was conducted in the databases PsycINFO and Web of Science. To evaluate the quality of the studies, the Mixed Method Appraisal Tool (MMAT) was used.

Results

The themes, autonomy, self‐acceptance and physical health, were identified as internal sources of resilience. External sources of resilience can be found within the social network and daily activities.

Conclusion

The current overview shows promising results to address resilience in adults with intellectual disability. More research is needed to identify the full range of resiliency factors.

Social information processing skills link executive functions to aggression in adolescents with mild to borderline intellectual disability

Executive Functions (EFs) have been associated with aggression in children and adolescents. EFs as higher-order cognitive abilities are assumed to affect cognitive functions such as Social Information Processing (SIP). We explored SIP skills as a mediating mechanism linking EFs to aggression in adolescents with mild to borderline intellectual disability (MBID with IQ from 50-84), a high risk group for aggressive behaviors and EF impairments. A total of 153 adolescents (M_age = 15.24, SD = 1.35; 54% male) with MBID participated. Focused attention, behavioral inhibition, and working memory were tested with multiple neurocognitive tasks to define latent EF constructs. Participants responded to a video-based SIP task. A latent construct for aggression was defined by caretaker, teacher, and adolescent self-reports of aggression (Child Behavior Check List, Teacher Report Form, and Youth Self Report). Structural equation modeling was performed to test mediation. Results were consistent with mediation of the relation between focused attention and aggression by SIP, namely via hostile interpretations and self-efficacy for aggression. Behavioral inhibition was linked to aggression, but this relation was not mediated by SIP. The relation between working memory and aggression was mediated by SIP, namely via hostile interpretations, aggressive response generation and via self-efficacy for aggressive responses. Bearing the cross-sectional design in mind, support was found for SIP skills as a mechanism linking EFs, in particular focused attention and working memory, to aggression, providing a viable explanation for the high vulnerability of adolescents with MBID for aggression.

Psychological and Cognitive Aspects of Borderline Intellectual Functioning

Abstract. Borderline Intellectual Functioning (BIF) refers to a global IQ ranging from 71 to 84, and it represents a condition of clinical attention for its association with other disorders and its influence on the outcomes of treatments and, in general, quality of life and adaptation. Furthermore, its definition has changed over time causing a relevant clinical impact. For this reason, a systematic review of the literature on this topic can promote an understanding of what has been studied, and can differentiate what is currently attributable to BIF from that which cannot be associated with this kind of intellectual functioning. Using Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria, we have conducted a review of the literature about BIF. The results suggest that this condition is still associated with mental retardation, and only a few studies have focused specifically on this condition.

Effectiveness of an Intervention for Children with Externalizing Behavior and Mild to Borderline Intellectual Disabilities: A Randomized Trial

This study evaluated the effectiveness of Standing Strong Together (SST), a combined group based parent and child intervention for externalizing behavior in 9-16 year-old children with mild to borderline intellectual disabilities (MBID). Children with externalizing behavior and MBID (IQ from 55 to 85) (N = 169) were cluster randomly assigned to SST combined with care as usual or to care as usual only. SST led to a significant benefit on teacher reported but not on parent reported externalizing behavior. SST had significant effects on parent rated positive parenting and the parent-child relationship. The present study shows that a multicomponent group based intervention for children with MBID is feasible and has the potential to reduce children's externalizing behavior and improve both parenting behavior and the parent-child relationship.

Intellectual disability is associated with increased risk for obesity in a nationally representative sample of U.S. children

BACKGROUND

Data on obesity prevalence in children with intellectual disability (ID) are scarce.

OBJECTIVE

We estimated rates of obesity among children aged 10-17 years with and without ID in a nationally representative dataset that included measures of child weight and ID status, as well as family meal frequency, physical activity, and sedentary behavior.

METHODS

Chi-square tests compared prevalence of obesity, demographic and behavioral characteristics between children with and without ID as reported in the 2011 National Survey of Children's Health. Tests for interaction in logistic regression models determined whether associations between obesity and behavioral characteristics were different between children with/without ID.

RESULTS

Obesity prevalence for children with ID was 28.9% and 15.5% for children without ID. After adjusting for age, sex, race/ethnicity and poverty level, the odds ratio was significantly 1.89 times greater among children with ID than among those without ID (95% CI: 1.14 to 3.12). Among children with ID, 49.8% ate at least one meal with family members every day compared to 35.0% without ID (p < 0.002), and 49.5% with ID participated in frequent physical activity compared to 62.9% (p < 0.005). Prevalence of obesity was higher among all children who ate family meals every day compared to fewer days per week, and the effect was significantly more pronounced among those with ID (p = 0.05).

CONCLUSIONS

Prevalence of obesity among youth with ID was almost double that of the general population. Prospective studies are needed in this population to examine the impact of consistent family mealtimes and infrequent physical activity.

Prevalence and risk factors of inpatient aggression by adults with intellectual disabilities and severe challenging behaviour: a long-term prospective study in two Dutch treatment facilities

Over five years, various types of aggressive incidents by 421 intellectually disabled inpatients were recorded on a daily basis, using an adapted version of the Modified Overt Aggression Scale. Stable patient characteristics (e.g., gender, intelligence, DSM IV classification at the start of treatment) and pre-treatment scores of two treatment outcome measures (e.g., Adult Behavior Checklist and Dynamic Risk Outcome Scale) were used to predict aggression during the treatment. At an overall average of one incident per patient per week, about ten times more aggression occurred on admission compared to resocialisation wards, and the 20% most aggressive individuals caused 50% of the verbal and 80% of the physical incidents. The best predictor of aggressive behaviour was aggression early in treatment, followed by coping skills deficits and impulsiveness. The relevance of the results for the treatment of aggressive behaviour and methodological issues in the recording of inpatient aggression are discussed.

Demystifying moderators and mediators in intellectual and developmental disabilities research: a primer and review of the literature

BACKGROUND

Intellectual and developmental disability (IDD) researchers have been relatively slow to adopt the search for moderators and mediators, although these variables are key in understanding how and why relationships exist between variables. Although the traditional method of causal steps is useful for describing and understanding moderators and mediators, it is not sufficient for statistical analysis.

METHODS

The theoretical and statistical processes of evaluating moderators and mediators are explained in terms familiar to IDD psychologists, using examples from IDD literature. Moderator and mediator analyses in five leading IDD journals are assessed for patterns of usage.

RESULTS

Although the number of publications in the past decade exceeds previous years, the field is still behind others in both the quantity and quality of the use of moderators and mediators.

CONCLUSION

The field as a whole will advance if the recent theoretical and technical advances outlined in this paper are employed.

(Social) Cognitive skills and social information processing in children with mild to borderline intellectual disabilities

The purpose of this study was to examine the unique contributions of (social) cognitive skills such as inhibition, working memory, perspective taking, facial emotion recognition, and interpretation of situations to the variance in social information processing in children with mild to borderline intellectual disabilities. Respondents were 79 children with mild to borderline intellectual disabilities in the age of 8-12 who were given tasks on social cognitive skills and social information processing. The results from the present study show that emotion recognition, interpretation, working memory and inhibition skills predict social information processing skills. It is concluded that especially emotion recognition and interpretation skills are important cognitive skills that predict social information processing, and therefore should be the focus of treatment.

[Mental retardation and ADHD]

Hyperactivity syndromes and disorders (ADHD and HKD) include the symptoms of overactivity, inattention, and impulsivity, which occur in many other mental disorders as well, including mental retardation (MR). It is not surprising that symptoms of ADHD occur significantly higher in children with learning disabilities. Dekker and Koot (2003) found a prevalence of 14.8 % for ADHD in Dutch children attending special schools, and Emerson (2003) reported rates of 8.7 % for HKD in children with global learning disability, representing a 10-fold increased risk compared to the prevalence of hyperactivity (0.9 %) in the general population sample. Yet only very few studies have been published concerning ADHD in children with mental retardation. Several features distinguish the diagnoses of ADHD and MR. In contrast to the limited knowledge about the differences and similarities of ADHD and MR, many studies considered stimulant medication as a pharmacological management strategy for children suffering from ADHD, MR, or both. According to these studies, psychostimulants may improve the target symptoms of hyperactivity, impulsivity, disinhibition, and inattention, albeit with caveats: ADHD symptoms in patients with MR may be less responsive to medical treatment than in patients without MR. Moreover, people with MR may be more susceptible to side effects.

Emotion regulation and aggressive behavior in preschoolers: the mediating role of social information processing

This study examined whether the relation between maladaptive emotion regulation and aggression was mediated by deviant social information processing (SIP). Participants were 193 preschool children. Emotion regulation and aggression were rated by teachers. Deviant SIP (i.e., attribution of hostile intent, aggressive response generation, aggressive response evaluation and decision) was measured from children's responses to hypothetical social conflicts. Findings revealed that the relation between maladaptive emotion regulation and aggression was direct and not mediated by SIP biases (i.e., aggressive response generation, aggressive response evaluation and decision). Results are discussed from a theoretical and methodological perspective.

Pathways to Care of Individuals With Mild Intellectual Disability

This study investigated whether clinical profiles in individuals with mild intellectual disability (MID) could be defined in terms of their histories (e.g., behavioral, social-environmental, educational, and service use characteristics). The clinical psychologists administered the Diagnostic Interview for Social and Communication Disorders to the (substitute) parents and analyzed the clinical records of individuals with MID. Four subtypes of individuals with MID with specific clinical profiles participated in this study. The results of this study, which used discriminant analysis of the individuals’ histories, supported two discriminant functions. The first discriminant function differentiated clinical profiles largely based on developmental disorders from clinical profiles based on personality disorders. The second function differentiated clinical profiles based on personality disorders and externalizing behavioral problems from other clinical profiles. The characteristics in the histories of individuals with MID can be very different and need to be assessed for further understanding of their unique needs.

The development of a diagnostic instrument to measure social information processing in children with mild to borderline intellectual disabilities

A growing interest exists in the measuring of social adaptive functioning in children with mild to borderline intellectual disabilities (MBID), but valid instruments to measure this construct are lacking. The aim of the present study was to develop such an instrument and to examine it on its discriminate validity. In 141 children aged 8-12 years a new test battery was examined in four groups either with MBID, behaviour problems or both, and typically developing peers. The results show that children with either MBID or behaviour problems or both show more hostile intent attributions, set more internal revenge goals, generate more aggressive and fewer assertive responses, feel more confident in inadequate responses en select fewer assertive responses, than their typically developing peers. Children with MBID are characterized by relying on earlier experiences in encoding information, a small response repertoire, positive evaluation of submissive but not assertive responses, and the selection of aggressive responses. In addition, they have more problems with perspective taking, problem recognition, interpretation in general, inhibition, working memory, and emotion recognition, than their typically developing peers. Further, children with MBID and behaviour problems have more difficulties in social information processing when the information in social situations is more complex. It is concluded that the tasks of the test battery can discriminate between groups, and after further development of the material, can be used to obtain information on the competencies and disabilities in social information processing and social cognitive skills, in order to be able to offer adequate treatment to these children.

Social reasoning skills in adults with Down syndrome: the role of language, executive functions and socio-emotional behaviour

BACKGROUND

Although the prevalence of mental illness and behaviour problems is lower in adults with Down syndrome (DS) than in other populations with intellectual disabilities, they do present emotional and relational problems, as well as social integration difficulties. However, studies reporting on specific competences known to be central in developing appropriate social relationships (e.g. social reasoning, emotion processing, theory of mind) remain rare in the adult DS population and the mechanisms underlying these people's emotional and relational difficulties are unclear.

METHOD

The present study investigated the ability to understand the appropriateness of others' social behaviour in 34 adults with DS, using the Social Resolution Task (SRT). Their results were compared with those of 34 typically developing (TD) children matched for gender and receptive vocabulary. The relationships among the SRT experimental task, cognitive competences (receptive and productive vocabulary, non-verbal reasoning, inhibition, selective attention) and a caregiver-rated measure of socio-emotional behaviour were examined in the DS group.

RESULTS

The DS participants' global SRT scores did not differ from those of the controls. However, analyses of the SRT subscores revealed that the DS group identified significantly fewer inappropriate situations than the control group. Nevertheless, when they correctly identified the behaviour as inappropriate, they were as well as the controls to explain the rules underlying their responses. Regression analyses showed that receptive vocabulary and selective attention and a specific dimension of the socio-emotional profile (social relating skills) constituted the best predictors of the DS adults' performance on the SRT.

CONCLUSIONS

The main findings show that the DS participants demonstrate relatively good social reasoning skills in comparison with TD children matched for verbal age. However, the two groups present distinctions in their response patterns, and the influence of cognitive variables on success on the SRT also appears different. While selective attention skills are found to be significant predictors for both groups, the influence of receptive vocabulary level is much stronger in the DS group. The implications of particular cognitive and socio-emotional factors for success on the SRT in this group are considered in more detail.

In the eye of the beholder: eye-tracking assessment of social information processing in aggressive behavior

Acording to social information processing theories, aggressive children are hypersensitive to cues of hostility and threat in other people's behavior. However, even though there is ample evidence that aggressive children over-interpret others' behaviors as hostile, it is unclear whether this hostile attribution tendency does actually result from overattending to hostile and threatening cues. Since encoding is posited to consist of rapid automatic processes, it is hard to assess with the self report measures that have been used so far. Therefore, we used a novel approach to investigate visual encoding of social information. The eye movements of thirty 10-13 year old children with lower levels and thirty children with higher levels of aggressive behavior were monitored in real time with an eyetracker, as the children viewed ten different cartoon series of ambiguous provocation situations. In addition, participants answered questions concerning encoding and interpretation. Aggressive children did not attend more to hostile cues, nor attend less to non-hostile cues than non-aggressive children. Contrary, aggressive children looked longer at non-hostile cues, but nonetheless attributed more hostile intent than their non-aggressive peers. These findings contradict the traditional bottom-up processing hypotheses that aggressive behavior would be related with failure to attend to non-hostile cues. The findings seem best explained by topdown information processing, where aggressive children's pre-existing hostile intent schemata (1) direct attention towards schema inconsistent non-hostile cues, (2) prevent further processing and recall of such schema-inconsistent information, and (3) lead to hostile intent attribution and aggressive responding, disregarding the schema-inconsistent non-hostile information.