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de Kuijper G, Jonker J, Kouwer K, Hoekstra PJ, de Bildt A. Integrative Care for Challenging Behaviors in People with Intellectual Disabilities to Reduce Challenging Behaviors and Inappropriate Psychotropic Drug Prescribing Compared with Care as Usual: A Cluster-Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:950. [PMID: 39063526 PMCID: PMC11277020 DOI: 10.3390/ijerph21070950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
People with intellectual disabilities (IDs) often present with challenging behaviors (CBs) mostly due to inappropriate environments and mental and physical disorders. Integrative care is recommended to address CBs. However, in clinical practice, psychotropic drugs are often prescribed off-label for CBs, although the effectiveness is unclear, and side effects frequently occur. We conducted a cluster-randomized controlled study to investigate the effect of integrative care provided by a collaboration of an ID specialized mental healthcare team and participants' own ID service providers' care team on reducing CBs and inappropriate off-label psychotropic drug prescriptions compared with care as usual. Participants (N = 33, aged 19-81 years) had a moderate, severe, or profound intellectual disability and used off-label psychotropic drugs. The primary outcome measures were the Aberrant Behavior Checklist and the total dose of psychotropic drug prescriptions. At the study endpoint of 40 weeks, we found no effect of the intervention on the total ABC score and on the total dose of psychotropic drug prescriptions. In the intervention group, however, the psychotropic drug dose decreased significantly, while CBs did not change. The small sample size and not-completed interventions due to organizational problems may have affected our findings. This study illustrates the difficulties in the implementation of integrative care.
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Affiliation(s)
- Gerda de Kuijper
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.J.); (P.J.H.)
- Mental Healthcare Drenthe, Department Centre for intellectual Disability and Mental Health, Middenweg 19, 9404 LL Assen, The Netherlands
| | - Josien Jonker
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.J.); (P.J.H.)
- Mental Healthcare Drenthe, Department Centre for intellectual Disability and Mental Health, Middenweg 19, 9404 LL Assen, The Netherlands
| | - Karlijn Kouwer
- Mental Healthcare Drenthe, Department Centre for intellectual Disability and Mental Health, Middenweg 19, 9404 LL Assen, The Netherlands
- Department of Biological and Medical Psychology, University of Bergen, Jonas Lies Vei 91, 5009 Bergen, Norway
| | - Pieter J. Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.J.); (P.J.H.)
- Accare Child Study Center, Lübeckweg 2, 9723 HE Groningen, 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; (J.J.); (P.J.H.)
- Accare Child Study Center, Lübeckweg 2, 9723 HE Groningen, The Netherlands
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Müller K, Helmes A, Kleischmann A, Graser J, Bengel J. Screening for depression: Psychometric properties of the German version of the Glasgow depression scale for people with a learning disability (individual and carer version). JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13157. [PMID: 37700605 DOI: 10.1111/jar.13157] [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: 06/24/2022] [Revised: 06/22/2023] [Accepted: 08/21/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Adults with intellectual disabilities should participate in the diagnostics of their mental health. The Glasgow Depression Scale for people with a Learning Disability (GDS-LD) and its Carer Supplement (GDS-CS) were translated into German and tested. METHODS Internal consistency, criterion validity and inter-test reliability were tested in 64 adults with borderline, mild or moderate intellectual disabilities and their carers. Convergent validity was analysed in 57 adults without intellectual disabilities. RESULTS Internal consistency was good (α = 0.81) for GDS-LD and acceptable (α = 0.72) for GDS-CS. The GDS-LD did not differentiate between groups with and without depression. The GDS-CS significantly differentiated between these groups. Convergent validity of the GDS-LD was high. The correlation of GDS-LD and GDS-CS was non-significant. CONCLUSIONS In its present form the German version of the GDS-LD does not meet the psychometric properties to be used in clinical practice. This leads to the broader question, how to measure depression in people with learning disabilities with the knowledge of the fallibility of existing measures when utilised with this clinical cohort. Also, future studies need to investigate the role of self-rating.
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Affiliation(s)
- Katrin Müller
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Almut Helmes
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Annika Kleischmann
- Faculty of Health, Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Johannes Graser
- Faculty of Health, Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
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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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Royston R, Naughton S, Hassiotis A, Jahoda A, Ali A, Chauhan U, Cooper SA, Kouroupa A, Steed L, Strydom A, Taggart L, Rapaport P. Complex interventions for aggressive challenging behaviour in adults with intellectual disability: A rapid realist review informed by multiple populations. PLoS One 2023; 18:e0285590. [PMID: 37200247 DOI: 10.1371/journal.pone.0285590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/27/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES Approximately 10% of people with intellectual disability display aggressive challenging behaviour, usually due to unmet needs. There are a variety of interventions available, yet a scarcity of understanding about what mechanisms contribute to successful interventions. We explored how complex interventions for aggressive challenging behaviour work in practice and what works for whom by developing programme theories through contexts-mechanism-outcome configurations. METHODS This review followed modified rapid realist review methodology and RAMESES-II standards. Eligible papers reported on a range of population groups (intellectual disability, mental health, dementia, young people and adults) and settings (community and inpatient) to broaden the scope and available data for review. RESULTS Five databases and grey literature were searched and a total of 59 studies were included. We developed three overarching domains comprising of 11 contexts-mechanism-outcome configurations; 1. Working with the person displaying aggressive challenging behaviour, 2. Relationships and team focused approaches and 3. Sustaining and embedding facilitating factors at team and systems levels. Mechanisms underlying the successful application of interventions included improving understanding, addressing unmet need, developing positive skills, enhancing carer compassion, and boosting staff self-efficacy and motivation. CONCLUSION The review emphasises how interventions for aggressive challenging behaviour should be personalised and tailored to suit individual needs. Effective communication and trusting relationships between service users, carers, professionals, and within staff teams is essential to facilitate effective intervention delivery. Carer inclusion and service level buy-in supports the attainment of desired outcomes. Implications for policy, clinical practice and future directions are discussed. PROSPERO REGISTRATION NUMBER CRD42020203055.
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Affiliation(s)
- Rachel Royston
- Division of Psychiatry, University College London, London, United Kingdom
| | - Stephen Naughton
- Division of Psychiatry, University College London, London, United Kingdom
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Andrew Jahoda
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Afia Ali
- Division of Psychiatry, University College London, London, United Kingdom
| | - Umesh Chauhan
- School of Medicine, University of Central Lancashire, Lancashire, United Kingdom
| | - Sally-Ann Cooper
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Athanasia Kouroupa
- Division of Psychiatry, University College London, London, United Kingdom
| | - Liz Steed
- Wolfson Institute of Population Health, Queen Mary, University of London, London, United Kingdom
| | - Andre Strydom
- Forensic & Neurodevelopmental Sciences, King's College London, London, United Kingdom
| | - Laurence Taggart
- School of Nursing and Paramedic Science, Ulster University, Northern Ireland, United Kingdom
| | - Penny Rapaport
- Division of Psychiatry, University College London, London, United Kingdom
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Laermans P, Morisse F, Lombardi M, Gérard S, Vandevelde S, de Kuijper G, Audenaert K, Claes C. Aligning quality of life and guidelines for off-label psychotropic drugs in adults with intellectual disabilities and challenging behaviour. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2023; 69:398-413. [PMID: 37213586 PMCID: PMC10197992 DOI: 10.1080/20473869.2023.2195721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 05/23/2023]
Abstract
Introduction Adults with intellectual disabilities have an increased vulnerability to mental health problems and challenging behaviour. In addition to psychotherapeutic or psychoeducational methods, off-label pharmacotherapy, is a commonly used treatment modality. Objective The aim of this study was to establish evidence-based guideline recommendations for the responsible prescription of off-label psychotropic drugs, in relation to Quality of Life (QoL). Method A list of guidelines was selected, and principles were established based on international literature, guideline review and expert evaluation. The Delphi method was used to achieve consensus about guideline recommendations among a 58-member international multidisciplinary expert Delphi panel. Thirty-three statements were rated on a 5-point Likert-scale, ranging from totally disagree to totally agree, in consecutive Delphi rounds. When at least 70% of the participants agreed (score equal or higher than 4), a statement was accepted . Statements without a consensus were adjusted between consecutive Delphi rounds based on feedback from the Delphi panel. Results Consensus was reached on 4 general:the importance of non-pharmaceutical treatments, comprehensive diagnostics and multidisciplinary treatment. Consensus was reached in 4 rounds on 29 statements. No consensus was reached on 4 statements concerning: freedom-restricting measures, the treatment plan, the evaluation of the treatment plan, and the informed consent. Conclusion The study led to recommendations and principles for the responsible prescription - aligned with the QoL perspective - of off-label psychotropic drugs for adults with intellectual disabilities and challenging behaviour. Extensive discussion is needed regarding the issues on which there was no consensus to furthering the ongoing development of this guideline.
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Affiliation(s)
- P. Laermans
- EQUALITY//ResearchCollective, University College Ghent, Ghent, Belgium
- Correspondence to: Pauline Laermans, EQUALITY//ResearchCollective, University College Ghent.
| | - F. Morisse
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - M. Lombardi
- EQUALITY//ResearchCollective, University College Ghent, Ghent, Belgium
| | - S. Gérard
- Superior Health Council, Brussels, Belgium
| | - S. Vandevelde
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - G. de Kuijper
- Centre for Intellectual Disabilities & Mental Health, Mental Healthcare Drenthe, the Netherlands
| | - K. Audenaert
- Department of Psychiatry, Ghent University, Ghent, Belgium
| | - C. Claes
- EQUALITY//ResearchCollective, University College Ghent, Ghent, Belgium
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Chiang YJ, Lee LH, Chen SL, Yang CI. Healthcare workers' experiences of caring for patients diagnosed with intellectual disability co-occurrent with psychiatric disorders. J Psychiatr Ment Health Nurs 2022; 29:842-851. [PMID: 34854163 DOI: 10.1111/jpm.12811] [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] [Received: 05/13/2021] [Revised: 10/19/2021] [Accepted: 11/25/2021] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Intellectual disability (ID) involves problems with general mental abilities and affects intellectual functioning and adaptive functioning. People diagnosed with ID present higher levels of functional disability, which means they usually have difficulty or the inability to independently perform basic activities of daily living. Little to no attention has been paid to the issues of the mental health of people diagnosed with ID. Specifically, healthcare workers' experiences of caring for patients with IDPD have been neglected. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The findings increase our understanding and partially address the knowledge gap regarding the situations and circumstances faced by healthcare workers in caring for patients diagnosed with intellectual disability co-occurrent with psychiatric disorders (IDPD). In cases of insufficient staffing, healthcare workers may be forced to ignore the individualized needs of patients so as to facilitate management. Healthcare workers may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. They adapt by adjusting their expectations of their patients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in-service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them. The government department responsible for the management of ID patient care institutions should be able to regularly monitor the overall staffing and quality of care in these institutions. ABSTRACT: Introduction When intellectual disability co-occurs diagnosed with psychiatric disorders (IDPD), the impact of the burden of illness on the affected individuals, their caregivers, their family and friends, and the services that provide for them is particularly high. The issues of the mental health of people diagnosed with ID have received little, if any, attention. One specific area of neglect is healthcare workers' experiences of caring for patients diagnosed with IDPD. Aim The aim of this study was to understand healthcare workers' experiences of caring for patients diagnosed with IDPD. Methods A qualitative descriptive research approach and semi-structured interviews were used in this study. We interviewed 15 participants who had experience in caring for patients diagnosed with a dual diagnosis of IDPD. Findings Four themes were found, as follows: (1) Negative impacts of insufficient staffing on the quality of care, (2) Constantly worrying about harmful incidents, (3) Discovering effective ways to provide individual patient care and (4) Adjusting expectations and attitudes towards patients. Participants' experiences revealed that they perceived the importance and effectiveness of providing individualized care for IDPD patients. However, when staffing is insufficient, they may be forced to ignore the individualized needs of patients so as to facilitate management. They may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. In addition, they adapt by adjusting their expectations of the patients. Discussion The findings from this research help to fill the knowledge gap in our understanding of healthcare workers' experiences of and their perspectives on caring for patients diagnosed with IDPD. Implications for Practice Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in-service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them. The government department overseeing the management of institutions providing ID patient care should be empowered to conduct regular monitoring of the overall staffing and quality of care in such institutions.
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Affiliation(s)
- Ya-Ju Chiang
- Department of Nursing, Da-Yeh University, Changhua, Taiwan
| | - Li-Hung Lee
- Department of Nursing, Da-Yeh University, Changhua, Taiwan
| | - Shu-Ling Chen
- Department of Nursing, HungKuang University, Taichung, Taiwan
| | - Cheng-I Yang
- Department of Nursing, Da-Yeh University, Changhua, Taiwan
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Charlot LR, Hodge SM, Holland AL, Frazier JA. Psychiatric diagnostic dilemmas among people with intellectual and developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:805-816. [PMID: 35974452 DOI: 10.1111/jir.12972] [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] [Received: 02/09/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Research regarding the accuracy of co-morbid psychiatric diagnoses in individuals with intellectual and developmental disabilities (IDD) is sparse. Yet correct diagnostic assignment is vital so that effective and appropriate treatment can be implemented, especially for the large numbers of individuals requiring expensive and restrictive behavioural health crisis services. METHOD A retrospective review of de-identified data from multidisciplinary specialty team assessments completed for 50 individuals with ID (IntellectualDisability) with and without ASD and unresolved behavioural health challenges was conducted. The accuracy and reliability of the psychiatric diagnoses upon referral were compared with the diagnoses after the comprehensive team evaluation, and within-individual diagnostic agreement was calculated. The agreement between the Mood and Anxiety Semi-Structured interview tool (MASS) and the full team evaluation was also calculated. The influence of demographic and clinical characteristics on diagnostic agreement was explored. RESULTS The most common chief complaints upon referral were aggression to others and self-injurious behaviour. Individuals were taking a median of six medications (interquartile range: 5 to 7); 80% were taking an antipsychotic medication. The most common medical conditions were constipation (70%) and gastroesophageal reflux disease (52%). Measures of interrater reliability of the referral diagnoses with the team assessment were below 0.5 (kappa range: -0.04 to 0.39), with the exception of ruling out dementia (kappa = 0.85). The interrater reliability estimates for the MASS evaluations for depression and anxiety were higher (kappa = 0.69 and 0.64) and reflected higher sensitivity and PPV. The odds of any referral diagnosis being confirmed by team evaluation were low: 0.25 (range: 0 to 0.67). The level of diagnostic agreement for each patient was not significantly attributable to demographic or clinical characteristics, although effect sizes indicate a possible positive relationship to age and the number of prescribed psychotropic medications at referral. CONCLUSION Individuals in the current study had serious psychiatric and behavioural problems despite psychiatric care in their communities. The majority of psychiatric diagnoses provided upon referral were not supported by the multidisciplinary specialty team's assessment. In addition to possible diagnostic inaccuracy, the group in the study suffered from multiple medical co-morbidities and were exposed to polypharmacy. Results emphasise the importance of multidisciplinary evaluation by clinicians with expertise in neurodevelopmental disabilities when people with ID with and without ASD have complex behavioural health needs that are unresponsive to usual care. In addition, based on agreement with the full team evaluation, the MASS shows promise as an assessment tool, especially with regards to identifying anxiety and depression.
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Affiliation(s)
- L R Charlot
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - S M Hodge
- Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - A L Holland
- Department of Pediatric psychiatry/neuropsychiatry, Mayo Clinic Health System/Mayo Clinic, Eau Claire, WI, USA
| | - J A Frazier
- Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Vostrý M, Lanková B, Pešatová I, Fleischmann O, Jelínková J. Nonpharmacological Compensation of Aggressive Behavior of Individuals with Moderate Intellectual Disability and Behavioral Disorders-A Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159116. [PMID: 35897479 PMCID: PMC9368589 DOI: 10.3390/ijerph19159116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/17/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023]
Abstract
The article discusses issues associated with the manifestations of aggressive behavior in an individual diagnosed with moderate intellectual disability and behavioral disorders (according to ICD-10; F7; F711—moderate intellectual disability, significant impairment of behavior requiring attention or treatment). In the research survey, we focused on a client corresponding with relevant features. The research was carried out at the beginning of hospitalization, ongoing hospitalization, and the end of hospitalization, followed by a recommendation to limit the legal capacity of the client and his placement in a residential care home. The case study points out individual approaches to special education and psychology and outlines the key steps in the cooperation of selected helping professions suggesting conclusions and recommendations for practice regarding these selected issues. Upon the termination of our investigation, there was a rapid deterioration of the client being admitted to the intensive care unit with a follow-up treatment in a long-term intensive care unit.
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Affiliation(s)
- Michal Vostrý
- Research Center, Faculty of Health Studies, University J. E. Purkyně in Ústí nad Labem, 40096 Ústí nad Labem, Czech Republic
- Department of Special and Social Education, Faculty of Education, University J. E. Purkyně, Ústí nad Labem in Ústí nad Labem, 40096 Ústí nad Labem, Czech Republic;
- Correspondence:
| | - Barbora Lanková
- Department of Primary and Pre-Primary Education, Faculty of Education, University J. E. Purkyně in Ústí nad Labem, 40001 Ústí nad Labem, Czech Republic;
| | - Ilona Pešatová
- Department of Special and Social Education, Faculty of Education, University J. E. Purkyně, Ústí nad Labem in Ústí nad Labem, 40096 Ústí nad Labem, Czech Republic;
| | - Otakar Fleischmann
- Department of Psychology, Faculty of Education, University J. E. Purkyně in Ústí nad Labem, 40096 Ústí nad Labem, Czech Republic;
| | - Jaroslava Jelínková
- Department of Languages, Faculty of Education, University J. E. Purkyně in Ústí nad Labem, 40096 Ústí nad Labem, Czech Republic;
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Reyes-Martín J, Simó-Pinatella D, Font-Roura J. Assessment of Challenging Behavior Exhibited by People with Intellectual and Developmental Disabilities: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148701. [PMID: 35886552 PMCID: PMC9324269 DOI: 10.3390/ijerph19148701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
Abstract
The assessment of challenging behavior exhibited by people with intellectual and developmental disabilities is essential for the planning of prevention and intervention programs. This review aimed to identify and analyze the standardized instruments that exclusively focus on the assessment of challenging behavior. We identified and organized 141 articles into four categories: original instrument studies, validation studies, relational studies, and intervention studies. The results identified 24 instruments that generally show high-quality psychometric properties and other utilities beyond the observation of the presence of challenging behavior and diagnostic categorization. Age, level of adaptive behavior, disability, presence of autism spectrum disorder, and medication are some of the variables that were found to be possibly related to the occurrence of challenging behavior. Additionally, the results suggest that interventions focused on supporting positive behavior or providing training on behavior to professionals and caregivers significantly reduced the occurrence of these behaviors. Instruments that help us to understand and measure the challenging behavior exhibited by people with intellectual and developmental disabilities are essential for the design of effective evaluation and intervention protocols.
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Affiliation(s)
- Juliana Reyes-Martín
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport, Blanquerna, Ramon Llull University, 08022 Barcelona, Spain;
- Fundació Vallparadís, Mutua Terrassa, 08221 Barcelona, Spain
- Correspondence:
| | - David Simó-Pinatella
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport, Blanquerna, Ramon Llull University, 08022 Barcelona, Spain;
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Hassiotis A, Rudra S. Behaviours that challenge in adults with intellectual disability: overview of assessment and management. BJPSYCH ADVANCES 2022. [DOI: 10.1192/bja.2022.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Up to a fifth of people with intellectual disabilities display challenging behaviour that has a significant impact on their health and quality of life. Psychotropic medication does not appear to confer any clinical benefits beyond risk reduction in acute situations. However, very few non-pharmacological treatments have clear evidence of clinical and cost-effectiveness and there is therefore often a dearth of advice as to which components or interventions would be helpful. To our knowledge no single model has been developed to provide a clear path from understanding the behaviour to the implementation of a therapeutic approach for such a complex clinical problem. In this article we describe a stepped-care model that needs to be further operationalised in the assessment and management of behaviours that challenge in adults with intellectual disabilities.
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Girasek H, Nagy VA, Fekete S, Ungvari GS, Gazdag G. Prevalence and correlates of aggressive behavior in psychiatric inpatient populations. World J Psychiatry 2022; 12:1-23. [PMID: 35111577 PMCID: PMC8783168 DOI: 10.5498/wjp.v12.i1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/18/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Aggressive behavior in patients with psychiatric disorders is attracting increasing research interest. One reason for this is that psychiatric patients are generally considered more likely to be aggressive, which raises a related question of whether diagnoses of psychiatric disorders predict the prevalence of aggressive behavior. Predicting aggression in psychiatric wards is crucial, because aggressive behavior not only endangers the safety of both patients and staff, but it also extends the hospitalization times. Predictions of aggressive behavior also need careful attention to ensure effective treatment planning. This literature review explores the relationship between aggressive behavior and psychiatric disorders and syndromes (dementia, psychoactive substance use, acute psychotic disorder, schizophrenia, bipolar affective disorder, major depressive disorder, obsessive-compulsive disorder, personality disorders and intellectual disability). The prevalence of aggressive behavior and its underlying risk factors, such as sex, age, comorbid psychiatric disorders, socioeconomic status, and history of aggressive behavior are discussed as these are the components that mostly contribute to the increased risk of aggressive behavior. Measurement tools commonly used to predict and detect aggressive behavior and to differentiate between different forms of aggressive behavior in both research and clinical practice are also reviewed. Successful aggression prevention programs can be developed based on the current findings of the correlates of aggressive behavior in psychiatric patients.
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Affiliation(s)
- Hunor Girasek
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Vanda Adél Nagy
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Szabolcs Fekete
- Department of Psychiatry, National Institute of Forensic Psychiatry, Budapest 1108, Hungary
- School of PhD Studies, Semmelweis University, Budapest 1085, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley 6009, Australia
- Section of Psychiatry, University of Notre Dame, Fremantle 6160, Australia
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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12
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McLaren JL, Lichtenstein JD, Metcalfe JD, Charlot LR, Drake RE, Beasley JB. Psychotropic Use Among Youths With Intellectual and Developmental Disabilities. Psychiatr Serv 2021; 72:988-997. [PMID: 33882691 DOI: 10.1176/appi.ps.201900465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the prevalence and correlates of psychotropic medication prescribing among outpatient youths with intellectual and developmental disabilities. METHODS The authors reviewed cross-sectional data on medications for 1,333 youths (ages 5-21 years) with intellectual and developmental disabilities who were referred to a community-based mental health crisis service. Descriptive statistics and regression analysis were used to describe the study group and to identify correlates of psychotropic polypharmacy, antipsychotic use, and anticonvulsant use in the absence of a seizure disorder. RESULTS Most youths were taking psychotropic medications (N=1,139, 86%), often three or more medications (N=733, 55%) from two or more drug classes (N=919, 69%). Most youths received antipsychotics (N=863, 65%), and a third (N=432, 32%) were taking anticonvulsants in the absence of a seizure disorder. Greater severity (number of psychiatric diagnoses and recent psychiatric hospitalization), older age, and living in a group home were significantly correlated with these practices. CONCLUSIONS Polypharmacy, antipsychotic use, and anticonvulsant use in the absence of seizure disorders were common among youths with intellectual and developmental disabilities referred to the crisis service. Older age, number of psychiatric diagnoses, living in a group home, and psychiatric hospitalization correlate with these prescribing practices. These elevated prescribing rates in a very vulnerable population warrant further study.
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Affiliation(s)
- Jennifer L McLaren
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire (McLaren, Lichtenstein); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (McLaren, Lichtenstein); Lebanon Westat, Lebanon, New Hampshire (Metcalfe, Drake); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Charlot); Center for START Services, University of New Hampshire Institute on Disabilities, Concord (McLaren, Beasley)
| | - Jonathan D Lichtenstein
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire (McLaren, Lichtenstein); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (McLaren, Lichtenstein); Lebanon Westat, Lebanon, New Hampshire (Metcalfe, Drake); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Charlot); Center for START Services, University of New Hampshire Institute on Disabilities, Concord (McLaren, Beasley)
| | - Justin D Metcalfe
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire (McLaren, Lichtenstein); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (McLaren, Lichtenstein); Lebanon Westat, Lebanon, New Hampshire (Metcalfe, Drake); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Charlot); Center for START Services, University of New Hampshire Institute on Disabilities, Concord (McLaren, Beasley)
| | - Lauren R Charlot
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire (McLaren, Lichtenstein); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (McLaren, Lichtenstein); Lebanon Westat, Lebanon, New Hampshire (Metcalfe, Drake); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Charlot); Center for START Services, University of New Hampshire Institute on Disabilities, Concord (McLaren, Beasley)
| | - Robert E Drake
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire (McLaren, Lichtenstein); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (McLaren, Lichtenstein); Lebanon Westat, Lebanon, New Hampshire (Metcalfe, Drake); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Charlot); Center for START Services, University of New Hampshire Institute on Disabilities, Concord (McLaren, Beasley)
| | - Joan B Beasley
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire (McLaren, Lichtenstein); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (McLaren, Lichtenstein); Lebanon Westat, Lebanon, New Hampshire (Metcalfe, Drake); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Charlot); Center for START Services, University of New Hampshire Institute on Disabilities, Concord (McLaren, Beasley)
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13
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Charlot LR, Doerfler LA, McLaren JL. Psychotropic medications use and side effects of individuals with intellectual and developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:852-863. [PMID: 32959471 DOI: 10.1111/jir.12777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Many people with intellectual and developmental disabilities (IDD) are treated with psychotropic medications, and polypharmacy is common. Although few studies address psychotropic side effects in the population, people with IDD have been found more likely to experience side effects than others who do not have IDD. Because many individuals with IDD may not report side effects reliably, there is risk that side effects may be missed. METHODS Psychotropic use and side effects of 71 adults with IDD admitted for a 30-day crisis stay to a Systemic, Therapeutic, Assessment, Resources, and Treatment (START) Resource Center were reviewed. START is a specialised behavioural health outreach, training and crisis programme for individuals with IDD. During crisis stays, centre nurses administer the Matson Evaluation of Drug Side Effects screen, a psychometrically established psychotropic medication side effects screen developed for use with people with IDD. Data reviewed were de-identified data used to inform day-to-day practices and assess outcomes for individuals START served. RESULTS The average age was 28 years, and 56% of the sample was male. All individuals were taking at least one psychotropic, while 79% were taking three or more. The average number of psychotropics used was 3.94. Antipsychotics were the most commonly prescribed medications taken by 85% of the sample; 49% of whom were not reported to have psychosis. Although the overall number of psychotropics did not correlate with Matson Evaluation of Drug Side Effects scores, the average scale scores for all participants was high in contrast to prior studies of people with IDD not taking psychotropics, with central nervous system side effects being the most commonly reported. CONCLUSION In the present study, data for individuals experiencing a crisis were reviewed and indicated high rates of psychotropic polypharmacy and side effects rates higher than previously reported for people with IDD not taking psychotropics. Prospective study in larger samples is needed to determine if missed or under-appreciated psychotropic side effects may play a role in behavioural health challenges of some people with IDD.
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Affiliation(s)
- L R Charlot
- Center for START Services, Institute on Disability UCED, University of New Hampshire, Concord, NH, USA
| | - L A Doerfler
- Department of Psychology, Assumption College and Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - J L McLaren
- Department of Psychiatry, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth College, Hanover, NH, USA
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14
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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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15
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Mazza MG, Rossetti A, Crespi G, Clerici M. Prevalence of co-occurring psychiatric disorders in adults and adolescents with intellectual disability: A systematic review and meta-analysis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:126-138. [PMID: 31430018 DOI: 10.1111/jar.12654] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 07/23/2019] [Accepted: 07/31/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Subjects with intellectual disability (ID) are vulnerable to experience psychiatric disorders. The present authors performed a systematic review and meta-analysis to estimate the prevalence of co-occurring psychiatric disorders, excluding co-occurring autism spectrum disorders, in subjects with intellectual disability. METHOD The present authors performed a random-effects meta-analysis of the prevalence of psychiatric disorders in adults and adolescents with intellectual disability. RESULTS Twenty-two studies were included. The pooled prevalence of any co-occurring psychiatric disorders in intellectual disability was 33.6% (95% CI: 25.2%-43.1%) with high heterogeneity but no publication bias. Prevalence was lower in population-based studies, in studies that used ICD criteria for the psychopathology and in studies with low risk of bias. The prevalence was higher in mild, moderate and severe intellectual disability than in profound intellectual disability. CONCLUSIONS Psychiatric disorders are common in subjects with intellectual disability, and the present authors found that clinical and methodological moderators affect the pooled prevalence.
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Affiliation(s)
- Mario G Mazza
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Aurora Rossetti
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | | | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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16
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Verberg F, Helmond P, Otten R, Overbeek G. Mindset and perseverance of adolescents with intellectual disabilities: Associations with empowerment, mental health problems, and self-esteem. RESEARCH IN DEVELOPMENTAL DISABILITIES 2019; 91:103426. [PMID: 31252179 DOI: 10.1016/j.ridd.2019.103426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 05/08/2019] [Accepted: 06/03/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Mindset refers to the implicit assumptions about the malleability of attributes such as intelligence, behavior, and personality. Previous research has shown that people endorsing a growth mindset show better academic and mental health outcomes than those with a fixed mindset. However, little is known about the mindset of youth with intellectual disabilities (ID) and its association with mental health. METHODS Adolescents with (n = 247) and without (n = 96) mild to borderline ID completed questionnaires about mindset and perseverance, empowerment, mental health problems, and self-esteem. RESULTS Adolescents with ID endorse a more fixed mindset of emotion and behavior than adolescents without ID. No significant differences were found for mindset of intelligence and perseverance. In addition, within the group of youth with ID some differences in mindset and perseverance were found based on level of intellectual disability, gender, and comorbidities, but not for age. Finally, a growth mindset of emotion and behavior and perseverance, but not mindset of intelligence, were negatively related to mental health problems in youth with ID. CONCLUSION AND IMPLICATIONS Overall, findings indicate that teaching youth with ID a growth mindset of emotion and behavior and perseverance may be a potentially successful endeavour to improve mental health in adolescents with ID.
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Affiliation(s)
- Fenneke Verberg
- Pluryn Research & Development, P.O. Box 53, 6500 Nijmegen, the Netherlands; Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15776, 1001 Amsterdam, the Netherlands.
| | - Petra Helmond
- Pluryn Research & Development, P.O. Box 53, 6500 Nijmegen, the Netherlands; Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15776, 1001 Amsterdam, the Netherlands
| | - Roy Otten
- Pluryn Research & Development, P.O. Box 53, 6500 Nijmegen, the Netherlands; Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 Nijmegen, the Netherlands; REACH Institute, Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Geertjan Overbeek
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15776, 1001 Amsterdam, the Netherlands
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17
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Esler A, Hewitt A, Hall-Lande J, Pettingell SL, Houseworth J. Psychotropic Medication Use for Adults with Autism Spectrum Disorder who Receive Services and Supports Through Adult Developmental Disability Services in the United States. J Autism Dev Disord 2019; 49:2291-2303. [PMID: 30706350 DOI: 10.1007/s10803-019-03903-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Individuals with autism spectrum disorder (ASD) have higher rates of co-occurring diagnoses and use of psychotropic medication prescriptions than people with other developmental disabilities. Few studies have examined these trends in samples of people with intellectual and developmental disabilities (IDD) with and without ASD. Using a random sample of 11,947 adult IDD service users from 25 states, co-occurring diagnoses and psychotropic medication use were compared for those with and without ASD. Regardless of diagnosis, individuals with ASD had higher percentages of psychotropic medication use. Controlling for co-occurring condition, age, gender, and ID level, a diagnosis of ASD predicted number of medications used. Further research is needed to understand why individuals with ASD are prescribed more medication, more often, than similarly functioning groups of individuals without ASD.
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Affiliation(s)
- Amy Esler
- Department of Pediatrics, University of Minnesota, 717 Delaware St SE, Minneapolis, MN, 55414, USA.
| | - Amy Hewitt
- Institute on Community Integration, University of Minnesota, 150 Pillsbury Dr SE, Minneapolis, MN, 55455, USA
| | - Jennifer Hall-Lande
- Institute on Community Integration, University of Minnesota, 150 Pillsbury Dr SE, Minneapolis, MN, 55455, USA
| | - Sandra L Pettingell
- Institute on Community Integration, University of Minnesota, 150 Pillsbury Dr SE, Minneapolis, MN, 55455, USA
| | - James Houseworth
- Institute on Community Integration, University of Minnesota, 150 Pillsbury Dr SE, Minneapolis, MN, 55455, USA
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18
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O'Dwyer C, McCallion P, Burke É, Carroll R, O'Dwyer M, McCarron M. Prevalence and associated factors of problem behaviours among older adults with intellectual disabilities in Ireland. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 80:192-204. [PMID: 29880319 DOI: 10.1016/j.ridd.2018.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 05/10/2018] [Accepted: 05/13/2018] [Indexed: 06/08/2023]
Abstract
A growing number of adults with intellectual disabilities (ID) are reaching old age, however, little is known about epidemiology of problem behaviours (PBs) in this population. The aim was to identify the prevalence and associated factors of PBs among older adults with ID in Ireland. Data was generated from Wave 2 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a nationally representative sample of adults with ID aged ≥40. Data on PBs was available for 683 (98.3%) of individuals. Over half (53%; n = 362) reported displaying any PB (verbal aggression, physical aggression, destruction, self-injury, or "other" PB). Multivariate analyses indicated PBs were independently associated with moderate or severe/profound ID, living in a community group home or residential centre, experiencing a greater number of life events in the last year, taking psychotropic medication, and reporting a doctor's diagnosis of a psychiatric problem. A considerable number of older adults with ID in Ireland display PBs, which may hinder their opportunities to engage in community based activities and form meaningful social connections. High rates of psychotropic medication and doctor's diagnosis of psychiatric conditions and their associations with PBs were highlighted. Future research should examine mechanisms underlying these linkages.
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Affiliation(s)
- Claire O'Dwyer
- School of Nursing and Midwifery, 2 Clare Street, Trinity College Dublin, Ireland.
| | - Philip McCallion
- School of Social Work, College of Public Health, Temple University, Philadelphia, USA
| | - Éilish Burke
- School of Nursing and Midwifery, 2 Clare Street, Trinity College Dublin, Ireland
| | - Rachael Carroll
- School of Nursing and Midwifery, 2 Clare Street, Trinity College Dublin, Ireland
| | - Máire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
| | - Mary McCarron
- School of Nursing and Midwifery, 2 Clare Street, Trinity College Dublin, Ireland; Faculty of Health Sciences, Trinity College Dublin, Ireland
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19
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Clegg J, Bigby C. Debates about dedifferentiation: twenty-first century thinking about people with intellectual disabilities as distinct members of the disability group. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23297018.2017.1309987] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Jennifer Clegg
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Christine Bigby
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
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20
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Florez IA, Bethay JS. Using Adapted Dialectical Behavioral Therapy to Treat Challenging Behaviors, Emotional Dysregulation, and Generalized Anxiety Disorder in an Individual With Mild Intellectual Disability. Clin Case Stud 2017. [DOI: 10.1177/1534650116687073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Individuals with intellectual disability (ID) are at increased risk of presenting challenging behaviors and comorbid mental illness. Preliminary findings show decreased challenging behaviors and overall increased functioning in individuals with ID and mental health problems who receive adapted dialectical behavior therapy (DBT). However, more research and documentation on how to adapt DBT in this population is warranted given that DBT is a promising intervention in individuals with ID. This article presents the case of an individual with mild ID who received adapted DBT for the treatment of challenging behaviors, emotional dysregulation, and generalized anxiety disorder. Treatment lasted 1 year and was conducted in a residential facility for individuals with ID. Improvement of symptoms and decrease in frequency of challenging behaviors were observed throughout the case. This case study demonstrates the potential utility of adapted DBT for individuals with ID and underscores the importance of teaching skills to clients with ID to help them become agents of their own change.
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21
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Singh NN, Lancioni GE, Karazsia BT, Myers RE. Caregiver Training in Mindfulness-Based Positive Behavior Supports (MBPBS): Effects on Caregivers and Adults with Intellectual and Developmental Disabilities. Front Psychol 2016; 7:98. [PMID: 26903906 PMCID: PMC4746712 DOI: 10.3389/fpsyg.2016.00098] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/18/2016] [Indexed: 01/09/2023] Open
Abstract
Caregivers often manage the aggressive behavior of individuals with intellectual and developmental disabilities that reside in community group homes. Sometimes this results in adverse outcomes for both the caregivers and the care recipients. We provided a 7-day intensive Mindfulness-Based Positive Behavior Support (MBPBS) training to caregivers from community group homes and assessed the outcomes in terms of caregiver variables, individuals' behaviors, and an administrative outcome. When compared to pre-MBPBS training, the MBPBS training resulted in the caregivers using significantly less physical restraints, and staff stress and staff turnover were considerably reduced. The frequency of injury to caregivers and peers caused by the individuals was significantly reduced. A benefit-cost analysis showed substantial financial savings due to staff participation in the MBPBS program. This study provides further proof-of-concept for the effectiveness of MBPBS training for caregivers, and strengthens the call for training staff in mindfulness meditation.
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Affiliation(s)
- Nirbhay N Singh
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University Augusta, GA, USA
| | - Giulio E Lancioni
- Department of Neuroscience and Sense Organs, University of Bari Bari, Italy
| | - Bryan T Karazsia
- Department of Psychology, The College of Wooster Wooster, OH, USA
| | - Rachel E Myers
- WellStar School of Nursing, Kennesaw State University Kennesaw, GA, USA
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22
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Hellenbach M, Karatzias T, Brown M. Intellectual Disabilities Among Prisoners: Prevalence and Mental and Physical Health Comorbidities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:230-241. [PMID: 26775928 DOI: 10.1111/jar.12234] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Limited evidence suggests that people with ID (ID) are overrepresented in prisons although prevalence rates of ID among prisoners vary significantly across studies, making it difficult to identify prevalence and assess existing need. METHOD A systematic review of relevant literature was conducted, and results were organized and compared in relation to study aims, design, measures used to screen for ID, sample, limitations and key findings. RESULTS Existing international data suggest a prevalence of prisoners with ID between 7 and 10%. Most frequent coexisting health issues among this population are hearing and vision impairments, obesity, diabetes and a range of mental health disorders, notably anxiety and personality and conduct disorders. CONCLUSION More research is required on prevalence rates and associated comorbidities of ID within prison settings, taking into account the heterogeneity of the population with ID.
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Affiliation(s)
- Mike Hellenbach
- Faculty of Health, Life and Social Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Thanos Karatzias
- Faculty of Health, Life and Social Sciences, Edinburgh Napier University, Edinburgh, UK.,The Rivers Centre, Royal Edinburgh Hospital, NHS Lothian, Edinburgh, UK
| | - Michael Brown
- Faculty of Health, Life and Social Sciences, Edinburgh Napier University, Edinburgh, UK.,Learning Disability Service, NHS Lothian, Edinburgh, UK
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23
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O'Shea LE, Picchioni MM, McCarthy J, Mason FL, Dickens GL. Predictive validity of the HCR-20 for inpatient aggression: the effect of intellectual disability on accuracy. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:1042-1054. [PMID: 25683589 DOI: 10.1111/jir.12184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/19/2014] [Accepted: 12/07/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND People with intellectual disability (ID) account for a large proportion of aggressive incidents in secure and forensic psychiatric services. Although the Historical, Clinical, Risk Management 20 (HCR-20) has good predictive validity in inpatient settings, it does not perform equally in all groups and there is little evidence for its efficacy in those with ID. METHOD A pseudo-prospective cohort study of the predictive efficacy of the HCR-20 for those with ID (n = 109) was conducted in a UK secure mental health setting using routinely collected risk data. Performance of the HCR-20 in the ID group was compared with a comparison group of adult inpatients without an ID (n = 504). Analysis controlled for potential covariates including security level, length of stay, gender and diagnosis. RESULTS The HCR-20 total score was a significant predictor of any aggression and of physical aggression for both groups, although the area under the curve values did not reach the threshold for a large effect size. The clinical subscale performed significantly better in those without an ID compared with those with. The ID group had a greater number of relevant historical and risk management items. The clinicians' summary judgment significantly predicted both types of aggressive outcomes in the ID group, but did not predict either in those without an ID. CONCLUSIONS This study demonstrates that, after controlling for a range of potential covariates, the HCR-20 is a significant predictor of inpatient aggression in people with an ID and performs as well as for a comparison group of mentally disordered individuals without ID. The potency of HCR-20 subscales and items varied between the ID and comparison groups suggesting important target areas for improved prediction and risk management interventions in those with ID.
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Affiliation(s)
- L E O'Shea
- Academic Department, St. Andrew's, Northampton, UK
- Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - M M Picchioni
- Academic Department, St. Andrew's, Northampton, UK
- Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - J McCarthy
- Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - F L Mason
- Academic Department, St. Andrew's, Northampton, UK
| | - G L Dickens
- Academic Department, St. Andrew's, Northampton, UK
- School of Social and Health Sciences, Abertay University, Dundee, UK
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24
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Rice LJ, Gray KM, Howlin P, Taffe J, Tonge BJ, Einfeld SL. The developmental trajectory of disruptive behavior in Down syndrome, fragile X syndrome, Prader-Willi syndrome and Williams syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2015; 169:182-7. [PMID: 25983069 DOI: 10.1002/ajmg.c.31442] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The aim of this study was to investigate the developmental trajectories of verbal aggression, physical aggression, and temper tantrums in four genetic syndrome groups. Participants were part of the Australian Child to Adult Development Study (ACAD), which collected information from a cohort of individuals with an intellectual disability at five time points over 18 years. Data were examined from a total of 248 people with one of the four following syndromes: Down syndrome, Fragile X syndrome, Prader-Willi syndrome, or Williams syndrome. Changes in behaviors were measured using validated items from the Developmental Behavior Checklist (DBC). The results indicate that, while verbal aggression shows no evidence of diminishing with age, physical aggression, and temper tantrums decline with age before 19 years for people with Down syndrome, Fragile X syndrome, and William syndrome; and after 19 years for people with Prader-Willi syndrome. These findings offer a somewhat more optimistic outlook for people with an intellectual disability than has previously been suggested. Research is needed to investigate the mechanisms predisposing people with PWS to persistence of temper tantrums and physical aggression into adulthood.
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