The Stereotyped Behavior Scale for adolescents and adults with mental retardation

Assessment of Challenging Behavior Exhibited by People with Intellectual and Developmental Disabilities: A Systematic Review

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.

Measuring repetitive behaviors as a treatment endpoint in youth with autism spectrum disorder

Restricted interests and repetitive behaviors vary widely in type, frequency, and intensity among children and adolescents with autism spectrum disorder. They can be stigmatizing and interfere with more constructive activities. Accordingly, restricted interests and repetitive behaviors may be a target of intervention. Several standardized instruments have been developed to assess restricted interests and repetitive behaviors in the autism spectrum disorder population, but the rigor of psychometric assessment is variable. This article evaluated the readiness of available measures for use as outcome measures in clinical trials. The Autism Speaks Foundation assembled a panel of experts to examine available instruments used to measure restricted interests and repetitive behaviors in youth with autism spectrum disorder. The panel held monthly conference calls and two face-to-face meetings over 14 months to develop and apply evaluative criteria for available instruments. Twenty-four instruments were evaluated and five were considered “appropriate with conditions” for use as outcome measures in clinical trials. Ideally, primary outcome measures should be relevant to the clinical target, be reliable and valid, and cover the symptom domain without being burdensome to subjects. The goal of the report was to promote consensus across funding agencies, pharmaceutical companies, and clinical investigators about advantages and disadvantages of existing outcome measures.

Validation of the repetitive and restricted behaviour scale in autism spectrum disorders

Repetitive and restricted behaviours represent a common problem for various psychiatric syndromes, especially in autistic spectrum disorders, and they include a wide range of heterogeneous behavioural manifestations. An accurate and standardized description of these behaviours is needed to advance the understanding of this complex and heterogeneous clinical dimension of autism. The present article reports the reliability and validity studies of a new assessment scale: the repetitive and restricted behaviour scale. 145 subjects with autism spectrum disorders were assessed using the RRB scale. The RRB scale has good interrater reliability, internal consistency and content validity. Factorial analysis produced four clinically meaningful factors, i.e. "sensorimotor stereotypies", "reaction to change", "restricted behaviours" and "modulation insufficiency". The RRB scale has good psychometric qualities and constitutes a real breakthrough towards a neurofunctional approach to autistic disorders. It should be valuable for research and treatment, and in clinical practice.

Long-term effectiveness of the response restriction method for establishing diurnal bladder control

The long-term effectiveness of the response restriction method for establishing diurnal bladder control was assessed with 48 participants with intellectual disabilities. Intervals of assessment ranged from 28 to 66 months across the individuals following initial baseline. Difference scores in terms of the mean number of toileting accidents per hour were related to participants' stereotypic behaviour and their housing conditions, as these were hypothesized to differentially influence the maintenance of diurnal bladder control. It was found that (a) across all participants there was a statistically significant decrease of the mean number of toileting accidents during follow-up as compared to initial baseline (b) stereotypic behaviour failed to be related to maintenance of bladder control, and (c) housing condition was significantly related to the above dependent variable, in that those living in a residential facility were more likely to wear a diaper again as compared to those living with their family. Implications for the clinical practice are discussed.

The prevalence and phenomenology of repetitive behavior in genetic syndromes

We investigated the prevalence and phenomenology of repetitive behavior in genetic syndromes to detail profiles of behavior. The Repetitive Behaviour Questionnaire (RBQ) provides fine-grained identification of repetitive behaviors. The RBQ was employed to examine repetitive behavior in Angelman (N = 104), Cornelia de Lange (N = 101), Cri-du-Chat (N = 58), Fragile X (N = 191), Prader-Willi (N = 189), Lowe (N = 56) and Smith-Magenis (N = 42) syndromes and individuals with intellectual disability of heterogeneous aetiology (N = 56). Repetitive behavior was variable across syndromes. Fragile X syndrome scored highly on all subscales. Angelman syndrome demonstrated a significantly lowered probability for most behaviors. Prader-Willi, Cri-du-Chat and Smith-Magenis syndrome evidenced unique profiles of repetitive behavior. There is extreme heterogeneity of repetitive behavior across genetic syndromes, highlighting syndrome specific profiles.

Emergence of stereotypies in juvenile monkeys (Macaca mulatta) with neonatal amygdala or hippocampus lesions

The emergence of stereotypies was examined in juvenile rhesus monkeys (Macaca mulatta) who, at 2 weeks of postnatal age, received selective bilateral ibotenic acid lesions of the amygdala (N = 8) or hippocampus (N = 8). The lesion groups were compared to age-matched control subjects that received a sham surgical procedure (N = 8). All subjects were maternally reared for the first 6 months and provided access to social groups throughout development. Pronounced stereotypies were not observed in any of the experimental groups during the first year of life. However, between 1 to 2 years of age, both amygdala- and hippocampus-lesioned subjects began to exhibit stereotypies. When observed as juveniles, both amygdala- and hippocampus-lesioned subjects consistently produced more stereotypies than the control subjects in a variety of contexts. More interesting, neonatal lesions of either the amygdala or hippocampus resulted in unique repertoires of repetitive behaviors. Amygdala-lesioned subjects exhibited more self-directed stereotypies and the hippocampus-lesioned subjects displayed more head-twisting. We discuss these results in relation to the neurobiological basis of repetitive stereotypies in neurodevelopmental disorders, such as autism.

Convergent validity of the aberrant behavior checklist and behavior problems inventory with people with complex needs

The current study aimed to replicate and extend Rojahn et al. [Rojahn, J., Aman, M. G., Matson, J. L., & Mayville, E. (2003). The aberrant behavior checklist and the behavior problems inventory: Convergent and divergent validity. Research in Developmental Disabilities, 24, 391-404] by examining the convergent validity of the behavior problems inventory (BPI) and the aberrant behavior checklist (ABC) for individuals presenting with multiple complex behavior problems. Data were collected from 69 children and adults with severe intellectual disabilities and challenging behavior living in residential establishments. MANCOVA analyses showed that individuals with elevated BPI stereotyped behavior subscale scores had higher scores on ABC lethargy and stereotypy subscales, while those with elevated BPI aggressive/destructive behavior subscale scores obtained higher scores on ABC irritability, stereotypy and hyperactivity subscales. Multiple regression analyses showed a corresponding pattern of results in the prediction of ABC subscale scores by BPI subscale scores. Exploratory factor analysis of the BPI data suggested a six-factor solution with an aggressive/destructive behavior factor, four factors relating to stereotypy, and one related to stereotypy and self-injury. These results, discussed with reference to Rojahn et al. [Rojahn, J., Aman, M. G., Matson, J. L., & Mayville, E. (2003). The aberrant behavior checklist and the behavior problems inventory: Convergent and divergent validity. Research in Developmental Disabilities, 24, 391-404], support the existence of relationships between specific subscales of the two instruments in addition to an overall association between total scores related to general severity of behavioral disturbance.

The Behavior Problems Inventory: an instrument for the assessment of self-injury, stereotyped behavior, and aggression/destruction in individuals with developmental disabilities

The Behavior Problems Inventory (BPI-01) is a 52-item respondent-based behavior rating instrument for self-injurious, stereotypic, and aggressive/destructive behavior in mental retardation and other developmental disabilities. Items are rated on a frequency scale and a severity scale. The BPI-01 was administered by interviewing direct care staff of 432 randomly selected residents from a developmental center between the ages of 14 to 91 years. For 73% of those selected, at least one problem was endorsed on the BPI-01. A total of 43% showed self-injury, 54% stereotyped behavior, and 38% aggressive/destructive behavior. Confirmatory factor analysis and item-total correlations supported the three a priori factors. Analyses of variance (ANOVA) showed that of the variables age, sex, and level of mental retardation, only the latter had a significant effect on the BPI-01 total score, the SIB subscale score, and the Stereotyped Behavior subscale score. Aggression/destruction was not significantly related to any of the three variables. Individuals with a diagnosis of pervasive developmental disorder had higher scores on all three subscales than those without, whereas residents with a diagnosis of stereotyped movement disorder had higher Stereotyped Behavior scale scores than those without. The BPI-01 was found to be a reliable (retest reliability, internal consistency, and between-interviewer-agreement) and valid (factor and criterion validity) behavior rating instrument for problem behaviors in mental retardation and developmental disabilities with a variety of potentially useful applications. Strengths and limitations of the instrument are discussed.

The stereotyped behavior scale: psychometric properties and norms

The Stereotyped Behavior Scale (SBS) is an empirically developed behavior rating scale for adolescents and adults with mental retardation (Rojahn, Tassé & Sturmey, 1997). Since the original publication, one item was deleted and two items were merged, leaving 24 items. In an additional change, severity scales were added to the frequency scales. In this paper, psychometric properties and (relative) norms for the new SBS are presented. In the psychometric study, 45 adults with mental retardation from a residential facility participated. Of these, 15 were selected for high-rates or very severe forms of stereotyped behaviors, 15 for mild to moderate rates or less severe stereotypies, and 15 for the low rates or absence of stereotyped behaviors. Direct care staff familiar with the participants completed the SBS and the "Stereotypy" subscale of the Aberrant Behavior Checklist-Residential (ABC-R) (Aman, Singh, Stewart & Field, 1985). For 15 participants, two raters independently completed the SBS. In addition, 45-min direct behavior observations were conducted on 16 participants. After approximately four weeks, the instruments were completed a second time by the same raters. As for reliability, the SBS frequency and severity scale total scores yielded test-retest intraclass coefficients (ICC) of 0.93 and 0.71, ICC interrater agreement of 0.76 and 0.75, and each had an internal consistency a of 0.91. For criterion validity, the SBS frequency and severity scores correlated with the ABC-R "Stereotypy" score at 0.80 and 0.84 (Pearson r), with systematic behavior observations at 0.50 and 0.65 (Pearson r), and with the a priori classification at 0.50 and 0.65 (Spearman p). From a previous data set of 550 individuals with stereotypic behavior, normative data (percentile ranks and T-scores) were derived. The data were presented in two tables, one showing a breakdown of gender by age groups, and the second one of age groups by level of functioning.

Autistic features in young children with significant cognitive impairment: autism or mental retardation?

This review addresses the issues and challenges related to the differential diagnosis of autism in preschool children with significant cognitive impairment. Issues affecting differential diagnosis include the use of traditional diagnostic guidelines for preschoolers with developmental delays, developmental changes in behavioral characteristics, the involvement of cognitive factors in symptom expression, and the overlap between autism and mental retardation in individuals with significant cognitive impairment. The usefulness of autistic features for differential diagnosis is explored in terms of the core deficits of autism.