The validity of the Supports Intensity Scale for adults with psychiatric disabilities

Although the Supports Intensity Scale (SIS) was developed for persons with intellectual and developmental disabilities, we argue for its applicability for people with psychiatric disabilities. Previous empirical evidence for the criterion-related validity of SIS for this population is limited, based on only two studies with participants from the same Mexican state. In a nationwide study we found that SIS explained between 48 and 51% of the variance in the dependent measure, indicating very good validity. The profile of individual support needs showed sensitivity to activities relatively specific to people with psychiatric disabilities, further indicating the validity of the scale. Overall, we find SIS to be valid and appropriate instrument for assessing the support needs of this population.     

Evaluating the supports intensity scale as a potential assessment instrument for resource allocation for persons with intellectual disability

This study evaluated the potential of using the Supports Intensity Scale (SIS) for resource allocation for people with intellectual disabilities (ID) in Taiwan. SIS scores were compared with those obtained from three tools that are currently used in Taiwan for homecare services: the medical diagnosis issued by local authorities and two scales measuring Activities of Daily Life (ADL) and Instrumental Activities of Daily Life (IADL). Data were collected on 139 persons with ID aged 16 or older. The correlation between SIS subscales and the other three tools were calculated and compared. Six subscales of the SIS demonstrated adequate reliability and validity and had higher correlations with the IADL than the ADL and medical diagnosis. The results of these analyses suggest that the SIS can be used as a reference tool for resources allocation in this population in Taiwan.     

Sexuality and people with intellectual disabilities: assessment of knowledge, attitudes, experiences, and needs

The topic of sexuality and romantic relationships of people with mild to moderate intellectual disabilities was examined. We developed a questionnaire to investigate the 76 respondents' sexual knowledge, attitudes, experience, and needs. During the interviews, observational data were gathered to check the validity of the instrument. Results show that sexuality and romantic relationships are important aspects in the lives of many persons with intellectual disabilities. Male respondents generally reported more sexual needs than did females. Correlations were found between sexual knowledge and attitudes and between attitudes and experience or needs, suggesting that general behavioral models may be fruitfully used to further explore the topic of sexuality among people with intellectual disabilities.     

Investigating the structure and invariance of the Wechsler Adult Intelligence Scales,Fourth Edition in a sample of adults with intellectual disabilities

Recent research has questioned whether the Wechsler Adult Intelligence Scales (WAIS) measure the same constructs for adults with intellectual disabilities as they do for the general population (MacLean et al., 2011). Using the special validity sample of the WAIS-IV (Wechsler, 2008b), the structure of the WAIS-IV was investigated using confirmatory factor analysis and tested for measurement invariance across a sample with intellectual disabilities and a control group matched in demographic characteristics. The instrument demonstrated strong factorial invariance when the standard subtests were used. When the standard and supplemental subtests were included in the model, the WAIS-IV four-factor structure provided a model of measurement for the Subtest Scores in the intellectual disability group, but the Perceptual Reasoning factor demonstrated differentiation into Fluid Reasoning and Visual-Spatial factors in the matched control group. In general, the research findings suggest that the four-factor structure of the WAIS-IV is invariant across the intellectual disability and matched control groups.     

Extra-individual sources of social support as described by adults with mild intellectual disabilities

The extra-individual social support responses provided by adults with intellectual disabilities on a social support survey were examined. Felton and Berry (1992) argued that extra-individual social support, support from larger than individual entities, is a valid source of social support for older adults. We hypothesized that extra-individual support would also be relevant to adults with intellectual disabilities. Results showed that 43% of participants with intellectual disabilities listed extra-individual support sources in their social networks or as providers of one of several support functions. The most popular forms of extra-individual support were those from "staff" and "work." Findings are discussed in terms of implications for social support measurement for persons with intellectual disabilities.     

Transition planning for students with intellectual disability, autism, or other disabilities: data from the National Longitudinal Transition Study-2

To compare the status of transition planning for students with intellectual disability, autism, or other disabilities, we used data from the National Longitudinal Transition Study-2, a federally funded, national study of the secondary and postschool experiences of students with disabilities. Results show that although transition planning had been conducted for the majority of students, few of them took a leadership role in their transition planning. Students with autism or intellectual disability were significantly less likely than students with other disabilities to take a leadership role. The majority of the active participants in transition planning were school-based personnel. We also found limited participation from other agencies/support persons (e.g., vocational rehabilitation). Students with autism or intellectual disability had more identified needs for support after school than did students with other disabilities.     

Rasch calibration of physical activity self-efficacy and social support scale for persons with intellectual disabilities

The purpose of this study was to investigate the construct validity of the Self-Efficacy/Social Support for Activity for persons with Intellectual Disability (SE/SS-AID) scales developed by Peterson, Peterson, Lowe, & Nothwehr (2009). A total of 146 participants with intellectual disabilities completed 6 self-efficacy (SE) items and 18 social support (SS) items. After applying the Rasch rating model, all SE items and 17 SS items fit the model and measured a single-construct. Thus, it was able to determine the item difficulty and person's level of SE and SS for physical activity by calculated logit scores. No items showed evidence for differential functioning by the level of intellectual disability. Model fit of SS subscales (e.g., staff, family, and peer) showed good-fit as well. In conclusion, SE and SS scales for physical activity can be measured more accurately for persons with intellectual disabilities by using the modified scales validated in this study.     

Factor structure of the Schalock and Keith Quality of Life Questionnaire (QOL-Q): validation on Mexican and Spanish samples

Background The Quality of Life Questionnaire (QOL-Q) is used widely to evaluate the quality of life of persons with intellectual disability (ID). Its validity for use with Spanish-speaking cultures has been demonstrated for individuals with visual disabilities, but not for those with physical or intellectual disabilities. Such was the purpose of the present study. Method Two samples were administered the QOL-Q under standardized procedures. The first sample was composed of 209 Mexican participants with physical disabilities; the second was composed of 424 Spanish participants with ID. The hypothesis tested was: the applicability (i.e. etic properties) of the measure across countries and respondents would be demonstrated if reliability data and if factor composition were similar to the original measure. Cronbach's alpha was used to test reliability and exploratory factor analyses were used to test validity (i.e. factor structure). Results Data indicated that the reliability and factor structure was similar to that reported in the questionnaire's standardization manual and consistent with that reported in a number of Anglo-Saxon countries. Conclusion The present study offers additional support for the valid use of the QOL-Q with Spanish-speaking populations.     

What makes them feel like they do? Investigating the subjective well-being in people with severe and profound disabilities

BackgroundBecause of the problems measuring subjective well-being in people with severe and profound intellectual disabilities, there are no studies to date which explore the factors contributing to the subjective well-being in these groups. We wanted to explore the client and service characteristics contributing to the subjective well-being of persons with severe and profound intellectual disabilities, as measured by the MIPQ (Ross & Oliver, 2003).Materials and methodsThe MIPQ was completed for 360 persons with severe or profound intellectual disabilities by a member of the direct support staff. They also provided us with information on client, service and informant characteristics.ResultsWe found that the subjective well-being of persons with profound intellectual disabilities was lower than the subjective well-being of people with mild, moderate or severe intellectual disabilities or people without disabilities. Client and informant characteristics but no service characteristics were found to have an influence on the subjective well-being of people with severe and profound intellectual disabilities.ConclusionAs it is important for policy making to identify residence service and staff factors related to subjective well-being of persons with severe and profound intellectual disabilities, further research should try to identify these factors, taking in account the client characteristics that are found to be related to subjective well-being in this study.     

Validity of a performance assessment of activities of daily living for people with developmental disabilities

Background Since clients with different types of developmental disabilities often experience difficulties in activities of daily living (ADL), it is critical that assessments of ADL are evaluated in order to ensure that one can make valid judgements based on the results of the appraisal. The purpose of the present study was to evaluate the validity of a specific performance assessment instrument, the Assessment of Motor and Process Skills (AMPS), when used by occupational therapists with clients with developmental disabilities. Unlike global ADL assessments, the AMPS is used not only to evaluate the level of ADL dependence, but also to estimate the quality of each specific action performed when a person is performing ADL tasks. Methods Data were gathered from 1724 participants with different developmental disabilities, including intellectual disability (ID), cerebral palsy and spina bifida. Many-Facet Rasch (MFR) analysis was used to examine person-response validity, and task and item scale validity. Results Goodness-of-fit statistics showed that the tasks and items had acceptable scale validity. The participants had acceptable person-response validity on the ADL motor scale, but had slightly lower than expected levels of person-response validity on the ADL process scale. The results indicate that clients with more severe forms of ID may have a higher proportion of different performance profiles in ADL than is expected by the MFR model of the AMPS. Since the proportion of participants who did not meet the criteria was only 3% lower than expected and in accordance with other studies, the difference may not be clinically meaningful. Otherwise, the results indicated that the AMPS is a valid tool when used with clients with developmental disabilities. Conclusions Further research is needed to evaluate the use of the AMPS in clinical assessment and intervention planning for this group of clients.     

The Utility and Psychometric Properties of the Abel-Blasingame Assessment System for Individuals With Intellectual Disabilities

This article describes the development and utility of the Abel-Blasingame Assessment System for individuals with intellectual disabilities (ABID) for assessment of sexual interest and problematic sexual behaviors. The study examined the preliminary psychometric properties and evaluated the clinical utility of the ABID based on a sample of 495 male adults with intellectual disabilities and/or developmental delays. The study examined (a) length of assessment time; (b) the ability of test takers to distinguish between gender and between 4 age groups; (c) whether the ABID has internal consistency within the cognitive distortions, social desirability scale, and fantasy vignettes items; (d) the criterion validity of the ABID to detect sustained sexual interest in children; and (e) whether the use of the ABID questionnaire as a structured clinical interview increases awareness of information about an individual's maladaptive behaviors important for treatment planning. The findings regarding these areas are discussed as well as the limitations of the tool in assessing individuals with intellectual disabilities.     

Community management of sex offenders with intellectual disabilities: characteristics, services, and outcome of a statewide program

The state of Vermont closed its only institution for persons with intellectual disabilities in 1993 and moved to a totally community-based model of services. Here we describe the characteristics of the near exhaustive statewide sample of adult male sex offenders with intellectual disabilities (N=103) who received these services between 1993 and 2004, discuss these services, and examine the sexual recidivism rates of the sample. Over an average follow-up period of 5.8 years, 10.7% of the sample was identified as having sexually reoffended. Most reoffenses were noncontact, and most victims were staff members, relatives, or housemates of the abuser. Results are discussed in terms of their clinical, policy, and research implications.     

A psychometric evaluation of a Swedish version of the psychopathology inventory for mentally retarded adults (PIMRA)

Given the difficulties with symptom identification and the assessment of mental health problems in persons with intellectual disabilities (ID) there has been a focus on the development of relevant assessment schedules for persons with ID. A Swedish version of the psychopathology inventory for mentally retarded adults (PIMRA, informant version), an instrument designed for identification of specific mental health problems in persons with ID, was evaluated in terms of inter-rater reliability, internal consistency, item grouping, criterion and concurrent validity based on a sample of 101 adults with different levels of ID. The Swedish version of the PIMRA had low inter-rater agreement on specific items but good agreement on low or high total score. In order to investigate internal validity, principal component analyses (PCA) were conducted in steps. Consequently, the majority of the 26 items, which remained after three PCA analyses, were grouped in a pattern approximating five of the original PIMRA subscales. The present analysis identified no item grouping matching the original Affective disorder subscale. Based on these results a revised Swedish version was developed. The concurrent validity analysis yielded a strong association between the total scores of the PIMRA and Reiss Screen for Maladaptive Behaviour (RSMB), between subscales on both instruments describing psychotic symptoms and between the RSMB subscale Aggressive behaviour and the PIMRA subscale Adjustment problems. The outcome of the criterion validity analysis indicated that individuals with a clinical diagnosis obtained higher total PIMRA scores than individuals without a clinical diagnosis and a comparison between the PIMRA subscale Psychosis and the clinical diagnosis indicating psychoses according to DSM-III-R or DSM-IV yielded a higher specificity than sensitivity measure. The results indicate that the PIMRA had a potential to identify individuals with mental health problems in persons with different levels (mild, moderate and severe) of ID and identify individuals with a specific mental disorder. Thus, professionals might use the PIMRA as a complement in the diagnostic process.     

Support needs and adaptive behaviors

We used a prepublication version of the Supports Intensity Scale (SIS), the Adaptive Behavior Scale-Residential and Community, and the Inventory for Client and Agency Planning to examine the relationship between support needs and adaptive behavior for 80 people with intellectual disabilities. Dimensionality of the SIS Support Needs Scale (Section 1) was examined in reference to the three areas of conceptual, social, and practical skills reported by the American Association on Mental Retardation as comprising the adaptive behavior construct. Factor analysis of the adaptive behavior subscales and SIS Support Need Scale offered support for measurement of a common underlying construct. When considered in terms of the three adaptive behavior skill areas, this construct related predominantly to conceptual skills.     

Psychometric evaluation of a Dutch version of the Mini PAS‐ADD for assessing psychiatric disorders in adults with different levels of intellectual disability

Background People with intellectual disabilities (ID) have an increased vulnerability to develop psychiatric problems. Moreover, the early recognition and the accurate diagnosis of psychiatric disorders in the population of persons with ID are challenging. Method A Dutch version of the Mini PAS‐ADD, which is a screening instrument for identification of mental health problems in people with ID, was evaluated in terms of internal consistency, interinformant reliability, item grouping and criterion validity based on a large‐scale random sample (n = 377) and a clinical sample (n = 99) of adults with ID. Results The Dutch version of the Mini PAS‐ADD showed moderate internal consistency, and moderate concordance among informants. Both aspects of the reliability were comparable for different levels of ID. A factor analysis largely confirmed the scale structure. Concurrent validity with the Reiss Screen for Maladaptive Behavior was high for the Depression, Psychosis and Autism scale. The outcome of the criterion‐validity analysis indicated high specificity. The sensitivity for specific psychiatric disorders by the corresponding scales was moderate, but the general sensitivity for the presence of psychopathology on the basis of any of the scales was satisfying. Conclusions The present research reconfirmed the use of the Mini PAS‐ADD as a primary screening device for the identification of mental health problems among people with ID.     

Suicide intent among parasuicide patients in Nicaragua: a surveillance and follow-up study.

This study examines suicide intent among parasuicide patients in a low-income country, Nicaragua, with special reference to gender patterns and future suicidal behavior. Using the Suicide Intent Scale (SIS), suicide intent was assessed in 204 persons presenting to hospital after parasuicide. Repetition was checked after a mean follow-up period of three years. The total SIS scores did not differ between women and men. However, a higher SIS score among women was significantly associated with older age, having children and use of pesticide as the parasuicide method. The overall method of suicide intent was low in Nicaragua compared to other countries, as was the nonfatal repetition rate (4.8% after three years). Subsequent suicides were found only in three men. Factor structures within the SIS disclosed supported the cross-cultural validity of the instrument. The level of suicide intent at the index attempt did not show any association with future suicidal behavior.     

A brief screening instrument for emotionally unstable and dissocial personality disorder in male offenders with intellectual disabilities

Personality disorder is prevalent among offenders with intellectual disabilities (ID), and it is associated with their risk for violence and recurrent offending behaviour. A new staff-rated instrument, the Personality Disorder Characteristics Checklist (PDCC), designed to screen for ICD-10 dissocial and emotionally unstable personality characteristics was evaluated for its reliability and validity, as applied to 129 male forensic patients with ID. Internal consistency and test–retest reliability were very good. Supportive evidence for concurrent and discriminant validity was obtained in conjunction with an established staff-rated instrument, but not for patient self-report measures. Construct validity support was found for the PDCC in association with violent offence and hospital assault history and in significantly accounting for the number of physical assaults in hospital, controlling for multiple covariates. Results for the new measure were favourable in comparison to established instruments. It clinical utility for treatment planning and for the management of risk is discussed.     

Adaptation and psychometric properties of the Spanish version of the Supports Intensity Scale (SIS)

The Supports Intensity Scale (SIS) is used to determine the profile and intensity of the supports needed by a person to participate successfully in major life activities. With its publication into 13 languages, a need has arisen to document its reliability and validity across language and cultural groups. Here we explain the adaptation and the validation process of the SIS on a Spanish sample of 885 people with intellectual disability. Results of the study are discussed in terms of the reliability and validity of the SIS on the Spanish sample and its efficacy for multiple uses in Spain.