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Rouleaux M, Peters-Scheffer N, Lindauer R, Mevissen L, Didden R. Stressful life events, post-traumatic stress disorder symptoms and mental health in individuals with intellectual disabilities: a scoping review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024. [PMID: 39129191 DOI: 10.1111/jir.13178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 07/10/2024] [Accepted: 07/19/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Stressful life events are events that do not fulfil the A criterion of PTSD in the DSM-5(TR) but are perceived as negative by the person. There is an ongoing debate about the usefulness of the A criterion as a gate criterion for PTSD, and especially regarding which events qualify as traumatic or stressful life events. This debate is particularly important for individuals with intellectual disabilities (ID) or borderline intellectual functioning (BIF), as they seem to be more likely to experience traumatic and stressful life events than their peers without ID-BIF and appear to be more susceptible to the disruptive effects of these events. As a result, people with ID-BIF are more likely to develop mental health and behavioural problems. There is insufficient knowledge about how the relationship between stressful life events and PTSD symptoms should be interpreted, how traumatic and stressful life events are defined and distinguished in people with ID, and whether the A criterion should be broadened for individuals with ID-BIF. The aim of this scoping review was to understand stressful life events and their relationship with PTSD symptoms, other mental health and/or behavioural problems in individuals with ID-BIF. METHODS The scoping review was conducted in accordance with the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). RESULTS Thirty-eight studies were included. Five studies focused on stressful life events and PTSD symptoms. The other studies examined associations between stressful life events and other mental health and/or behavioural problems. Most of the studies did not clearly differentiate between stressful and traumatic events according to the A criterion of PTSD in the DSM-IV (TR) or DSM-5(TR). Of the six studies in which stressful life events were specified and could be distinguished from traumatic events, one found a positive association between PTSD symptoms and stressful life events and five showed weak to strong positive associations with other mental health and/or behavioural problems. CONCLUSIONS PTSD symptoms following stressful life events in individuals with ID-BIF are underrepresented in the literature. The lack of a clear definition of stressful life events leads to a gap in the knowledge on whether and how stressful life events may lead to PTSD symptoms, other mental health and/or behavioural problems in individuals with ID-BIF. Therefore, no general conclusions or recommendations can be made regarding the appropriateness of the PTSD A criterion for individuals with ID-BIF. Further research is needed to establish the role of stressful life events in relation to PTSD symptoms and to inform the assessment and effective treatment in people with ID-BIF, as expert clinical experience studies suggest that broadening the PTSD A criterion should be considered for people with ID-BIF.
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Affiliation(s)
- M Rouleaux
- Department of Advisium, 's Heeren Loo Advisium, Amersfoort, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - N Peters-Scheffer
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Driestroom, Elst, The Netherlands
| | - R Lindauer
- Department Child and Adolescent Psychiatry, Levvel, Amsterdam, The Netherlands
- Department Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - L Mevissen
- Liesbeth Mevissen Psychotrauma Practice, Rha, The Netherlands
| | - R Didden
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Department of Research and Development, Trajectum, Zwolle, The Netherlands
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Kildahl AN, Helverschou SB. Post-traumatic stress disorder and experiences involving violence or sexual abuse in a clinical sample of autistic adults with intellectual disabilities: Prevalence and clinical correlates. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1075-1089. [PMID: 37609889 PMCID: PMC11067401 DOI: 10.1177/13623613231190948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
LAY ABSTRACT Post-traumatic stress disorder is a mental health disorder that may be triggered by the experience of events perceived as terrifying or overwhelming. Examples of such events include being the victim of violence or sexual abuse. Compared with other people, autistic people have increased risk of being exposed to violence or sexual abuse. In addition, autistic people may be more vulnerable to developing post-traumatic stress disorder following such exposure. However, knowledge is limited concerning the prevalence of experiences involving violence and sexual abuse, and post-traumatic stress disorder, in autistic people with co-occurring intellectual disabilities. Detection of these experiences, and identification of post-traumatic stress disorder, may be challenging in these individuals, and previous research indicates that post-traumatic stress disorder symptoms may be overlooked or misinterpreted. In this study, we examined prevalence of post-traumatic stress disorder, violence and sexual abuse in a clinical sample of 88 autistic adults with intellectual disabilities referred for mental health assessment. Only 3.4% were diagnosed with post-traumatic stress disorder, even if experiences involving violence (34.1%) or sexual abuse (17.0%) were common. Anxiety and affective disorders were common diagnoses among participants with these experiences. Controlling for autism characteristics, level of intellectual disability and communication skills, experiences of violence/sexual abuse were found to be associated with a measure of 'challenging' behaviours. These results indicate that potentially traumatic experiences are common in autistic adults with intellectual disabilities referred for mental health assessment, and that post-traumatic stress disorder may be under-recognised. The findings highlight the importance of trauma screening and post-traumatic stress disorder assessment, as well as the importance of trauma-informed care, in this population.
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Hauser MJ, Kohn R. Forensic psychiatric issues in intellectual disability. BEHAVIORAL SCIENCES & THE LAW 2024; 42:205-220. [PMID: 38459744 DOI: 10.1002/bsl.2653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 03/10/2024]
Abstract
Forensic psychiatrists and neuropsychiatrists are likely to encounter individuals with intellectual disability as they are over-represented in the judicial system. These individuals may have the full range of mental illnesses and comorbid conditions, including physical infirmity, sensory deficits, language impairment, and maladaptive behaviors. They are frequently disadvantaged in the judicial system due to lack of comprehension, lack of accommodations, and stigmatization. Decision making capacity may need to be assessed for health care, sexual autonomy, marriage, financial management, making a will, and need for guardianship. The usual approach to conducting an evaluation needs adaptation to fit the unique characteristics and circumstances of the individual with intellectual disability. The forensic consultant can assist attorneys, defendants, and victims in recommending accommodations and the expert witness can provide education to juries.
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Affiliation(s)
- Mark J Hauser
- Department of Psychiatry, Harvard Medical School, Newton, Massachusetts, USA
| | - Robert Kohn
- Brown University School of Public Health, Providence, Rhode Island, USA
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McKillop E, Spencer A, Marrington C. Clinicians' experiences of learning to use eye movement desensitisation and reprocessing therapy with people with intellectual disabilities: A qualitative study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13206. [PMID: 38332432 DOI: 10.1111/jar.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 11/29/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Eye Movement Desensitisation and Reprocessing therapy (EMDR) is a NICE recommended treatment for post-traumatic stress disorder within the general population. Ongoing research is now investigating the use of EMDR for individuals with intellectual disability. Alongside quantitative research efforts, it is beneficial to explore the qualitative experience of clinicians adopting EMDR in their practice. The current study interviewed newly trained EMDR therapists working in intellectual disability services. METHOD Participants (six Clinical Psychologists from an NHS learning disability service) had recently undertaken EMDR training as part of a wider randomised control trial (Trauma-AID). Interviews were qualitatively analysed using thematic analysis. RESULTS Three themes emerged; learning EMDR, conducting EMDR and external factors, with respect to clinicians' experiences. CONCLUSIONS Further research is needed to provide guidance and reassurance for clinicians currently using or hoping to use this therapy with people with intellectual disabilities.
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Affiliation(s)
- Eleanor McKillop
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Alison Spencer
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
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Björne P, McGill P, Deveau R, Hofvander B. Organisational impact on the use of restrictive measures: The perspective of Swedish front-line managers. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1025-1033. [PMID: 37151147 DOI: 10.1111/jar.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Restrictive measures (RM) are prevalent in services for people with intellectual disabilities. This study investigates managerial awareness of RM and the nature of organisational supports required to reduce their use. METHOD A survey asked front-line managers and staff what (RM) were used, their purpose, impact and importance (10-item Likert scales) and what organisational changes were required (free text). Responses were analysed using descriptive methods and content analysis. RESULTS Managers reported a lower use of RM, compared with staff. According to managers, RM were mainly used to keep service users from harm, their use having a significant impact. Opportunities to change practices were limited by a lack of resources and organisational support. CONCLUSION Front-line managers seem to lack the capacity to address the use of RM due to organisational drift; limited manager time and opportunity to allocate resources; inadequate environments; and lack of skilled staff, knowledge and relevant professional input.
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Affiliation(s)
- Petra Björne
- Department for Disability Support, City of Malmö, Malmö, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Peter McGill
- Tizard Centre, University of Kent, Canterbury, UK
| | - Roy Deveau
- Tizard Centre, University of Kent, Canterbury, UK
| | - Björn Hofvander
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Forensic Psychiatry, Region Skåne, Sweden
- Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
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Bryant E, Broomfield C, Burrows J, McLean S, Marks P, Maloney D, Touyz S, Maguire S. Gaining consensus on clinical quality outcomes for eating disorders: Framework for the development of an Australian national minimum dataset. BMJ Open 2023; 13:e071150. [PMID: 37076147 PMCID: PMC10124290 DOI: 10.1136/bmjopen-2022-071150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES Eating disorders (EDs) are complex psychiatric illnesses requiring multidisciplinary care across both mental and medical healthcare settings. Currently, no nationally comprehensive, consistent, agreed on or mandated data set or data collection strategy exists for EDs in Australia: thus, little is known about the outcomes of care nor treatment pathways taken by individuals with EDs. InsideOut Institute was contracted by the Australian Government Department of Health to develop a minimum dataset (MDS) for the illness group with consideration given to data capture mechanisms and the scoping of a national registry. DESIGN A four-step modified Delphi methodology was used, including national consultations followed by three rounds of quantitative feedback by an expert panel. SETTING Due to social distancing protocols throughout the global SARS-CoV-2 pandemic, the study was conducted online using video conferencing (Zoom and Microsoft Teams) (Step 1), email communication and the REDCap secure web-based survey platform (Steps 2-4). PARTICIPANTS 14 data management organisations, 5 state and territory government departments of health, 2 Aboriginal and Torres Strait Islander advising organisations and 28 stakeholders representing public and private health sectors across Australia participated in consultations. 123 ED experts (including lived experience) participated in the first quantitative round of the Delphi survey. Retention was high, with 80% of experts continuing to the second round and 73% to the third. MAIN OUTCOME MEASURES Items and categories endorsed by the expert panel (defined a priori as >85% rating an item or category 'very important' or 'imperative'). RESULTS High consensus across dataset items and categories led to the stratification of an identified MDS. Medical status and quality of life were rated the most important outcomes to collect in an MDS. Other items meeting high levels of consensus included anxiety disorders, depression and suicidality; type of treatment being received; body mass index and recent weight change. CONCLUSIONS Understanding presentation to and outcomes from ED treatment is vital to drive improvements in healthcare delivery. A nationally agreed MDS has been defined to facilitate this understanding and support improvements.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Catherine Broomfield
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Jennifer Burrows
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Sian McLean
- Department of Psychology, Counselling and Therapy, La Trobe University, Melbourne, Victoria, Australia
- Australia and New Zealand Academy for Eating Disorders, Castlecrag, New South Wales, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Danielle Maloney
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
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Internet Risk Perception: Development and Validation of a Scale for Adults. Eur J Investig Health Psychol Educ 2022; 12:1581-1593. [DOI: 10.3390/ejihpe12110111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Despite the importance of Internet risk perception, no instrument currently exists that measures this awareness in the Spanish population. The goal of this study was to provide information on studies of the validity and reliability of the Internet Risk Perception (IRP) Scale for adult Spanish citizens. We began with a literature review and validation using a mixed panel with 20 participants. We analyzed the degree to which the subjects agreed or disagreed with the criteria evaluated, including contributions for improving the instrument, and performed a pilot test with 517 adults aged 18 to 77. Construct reliability and validity were analyzed using various statistical analyses. The results from the confirmatory factor analysis showed a sufficient accuracy of the data with parameters that indicated an excellent fit for all items. The Spanish version of the scale for adults is a reliable and valid instrument for use in studies that investigate Internet risk perception in people over 18 years of age.
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Wigham S, Hatton C, Taylor JL. Short report and initial evaluation of the factor structure of the Lancaster and Northgate Trauma Scales (LANTS). RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 112:103914. [PMID: 33631599 DOI: 10.1016/j.ridd.2021.103914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 02/01/2021] [Accepted: 02/13/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Research suggests exposure to adverse life events is elevated in people with intellectual disabilities. We developed the Lancaster and Northgate Trauma Scales (LANTS) to address the limited availability of screening questionnaires for people with intellectual disabilities affected by adverse traumatic experiences. AIMS The aims of this study were to (i) evaluate the factor structure of the self-report LANTS and (ii) assess compatibility with the International Classification of Diseases Eleventh Revision (ICD-11) criteria for complex PTSD. METHODS AND PROCEDURE Ninety-eight people with mild to moderate intellectual disability (86 % men; mean age 41 years) completed the self-report LANTS. Exploratory factor analysis was undertaken using a polychoric correlation matrix, appropriate for the LANTS ordinal response options. OUTCOMES AND RESULTS Seven items including self-harm and anger were non-normal in distribution and excluded from the analysis; a four-factor structure was identified for the 22 remaining items. We make suggestions for correspondence of LANTS items to ICD-11 criteria for complex PTSD. CONCLUSIONS AND IMPLICATIONS This is the first exploratory factor analysis of the LANTS. Items pertaining to anger and self-harm may be prone to response bias and development of these items using qualitative methods would be useful. The findings require replication with a larger group of people with intellectual disabilities, including more women.
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Affiliation(s)
- Sarah Wigham
- Population Health Science Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - Chris Hatton
- Department of Social Care and Social Work, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK
| | - John L Taylor
- Northumbria University, Coach Lane Campus-East, Benton, Newcastle upon Tyne, NE7 7XA, UK; Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, UK
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McNally P, Taggart L, Shevlin M. Trauma experiences of people with an intellectual disability and their implications: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:927-949. [PMID: 33772975 DOI: 10.1111/jar.12872] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/14/2021] [Accepted: 02/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with an intellectual disability are more vulnerable to psychological trauma compared with the general population. The aim of this scoping review was to identify the current status of the literature on trauma that is specific to the experiences of adults with an intellectual disability, living in community settings. METHODS A scoping review was conducted using the Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19) framework. Forty-one international papers were reviewed spanning 2000-2020, and their quality assessed using the MMAT. FINDINGS (1) Aggressive behaviours can be symptoms of trauma, (2) there are appropriate assessment tools for the impact of trauma, (3) evidence-based interventions for trauma may be effective, and (4) factors associated with disability can be experienced as traumatic. CONCLUSION There is a growing body of literature highlighting assessment needs and potential interventions for people with an intellectual disability who have experienced psychological trauma. Further research is needed to develop trauma-informed pathways.
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Affiliation(s)
- Paddy McNally
- Institute of Nursing and Health Science, Ulster University, Newtownabbey, UK
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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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Rittmannsberger D, Yanagida T, Weber G, Lueger‐Schuster B. The association between challenging behaviour and symptoms of post-traumatic stress disorder in people with intellectual disabilities: a Bayesian mediation analysis approach. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:538-550. [PMID: 32378249 PMCID: PMC7317343 DOI: 10.1111/jir.12733] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/25/2020] [Accepted: 04/09/2020] [Indexed: 05/03/2023]
Abstract
BACKGROUND A preponderance of behavioural symptoms is assumed to be the main difference in the manifestation of symptoms of post-traumatic stress disorder (PTSD) in people with intellectual disability (ID). However, no study so far has assessed the relationship between challenging behaviour (CB) and PTSD. The present study aims to explore this relationship by exploring whether CB is directly related to trauma exposure or whether this relationship is mediated through core symptoms of PTSD. METHODS Trauma exposure and current symptoms of PTSD were assessed in 43 adults with mild to moderate ID. Parallel versions were administered to 43 caregivers, including the Aberrant Behaviour Checklist to measure CB. Bayesian mediation analyses were conducted using self-rated and informant-rated data. RESULTS The self-report data showed no associations of CB with trauma exposure or PTSD symptoms. The association between informant-rated trauma exposure and irritability was mediated by severity and frequency of PTSD symptoms. The associations between informant-reported trauma exposure and the Aberrant Behaviour Checklist subscales hyperactivity and inappropriate speech were mediated by PTSD symptom severity. CONCLUSIONS The relationship between trauma exposure and CB was mediated by PTSD symptoms. PTSD core symptoms should be considered as underlying causes of CB, highlighting the necessity to explore trauma biography and symptoms of PTSD. The improvement of self-report assessment in people with ID is an important task for future studies.
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Affiliation(s)
- D. Rittmannsberger
- Department of Clinical and Health PsychologyFaculty of Psychology, University of ViennaViennaAustria
| | - T. Yanagida
- Department of Developmental and Educational PsychologyFaculty of Psychology, University of ViennaViennaAustria
| | - G. Weber
- Department of Clinical and Health PsychologyFaculty of Psychology, University of ViennaViennaAustria
| | - B. Lueger‐Schuster
- Department of Clinical and Health PsychologyFaculty of Psychology, University of ViennaViennaAustria
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Rittmannsberger D, Weber G, Lueger-Schuster B. Applicability of the post-traumatic stress disorder gate criterion in people with mild to moderate intellectual disabilities: Do additional adverse events impact current symptoms of Post Traumatic Stress Disorder in people with intellectual disabilities? JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1100-1112. [PMID: 32316075 PMCID: PMC7496863 DOI: 10.1111/jar.12732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 03/08/2020] [Accepted: 03/16/2020] [Indexed: 12/05/2022]
Abstract
Background Diagnostic manuals provide a strict definition of the PTSD gate criterion. Research on the adequacy of this definition in people with intellectual disabilities is lacking. This study aims to test the adequacy of the gate criterion for this population. Method Fourty nine adults with mild to moderate intellectual disabilities and 43 caregivers were questioned. Traumatic events included in the gate criterion definition and adverse events going beyond it were assessed. It was tested whether adverse events affect symptoms of PTSD additionally to traumatic events. Results The current data showed ambiguous findings in self‐ and informant report. Informant data suggested an additional impact of adverse events on PTSD symptoms. Self‐report data suggested the contrary. Conclusion Adverse events seem to have an impact on externalizing behavioural symptoms, such as hyperarousal. Self‐report assessment of more specific, intrapsychic PTSD symptoms, such as intrusions and avoidance, should be addressed in future studies.
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Affiliation(s)
- Doris Rittmannsberger
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Germain Weber
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Brigitte Lueger-Schuster
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Vienna, Austria
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Kildahl AN, Helverschou SB, Bakken TL, Oddli HW. "If we do not look for it, we do not see it": Clinicians' experiences and understanding of identifying post-traumatic stress disorder in adults with autism and intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1119-1132. [PMID: 32285568 DOI: 10.1111/jar.12734] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/09/2020] [Accepted: 03/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Individuals with autism spectrum disorder (ASD) and intellectual disability (ID) are at increased risk of potentially traumatic events and may be at increased risk of post-traumatic stress disorder (PTSD). However, knowledge regarding identification of PTSD in this population is limited. The aim of this study was to investigate clinical experience regarding PTSD and trauma assessment in individuals with co-occurring ASD and ID. METHOD Interpretative phenomenological analysis was used to explore experiences of identifying PTSD in this population among 18 mental health clinicians working with ASD and ID. RESULTS Informants viewed PTSD in individuals with ASD and ID as equivalent to PTSD in the general population, but with causes and expressions potentially differing. Several factors were described to contribute to challenges in identification. CONCLUSIONS Trauma may have severe impact in individuals with ASD and ID. Multidimensional, individualized assessment strategies seem necessary to recognize PTSD or trauma-related symptoms in this population.
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Affiliation(s)
- Arvid Nikolai Kildahl
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway.,NevSom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Sissel Berge Helverschou
- NevSom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
| | - Trine Lise Bakken
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway.,Oslo Metropolitan University, Oslo, Norway
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