PDD-NOS Symptoms in Adults with Intellectual Disability: Toward an Empirically Oriented Diagnostic Model

PDD-NOS has been an illusive diagnostic category in Autism Spectrum Disorders (ASD). It is a frequently occurring ASD, but it has typically been defined by what it is not—autism. This latter condition has received the bulk of the attention in the development of diagnostic methods, while PDD-NOS has largely been ignored from a diagnostic standpoint. The symptoms that characterize PDD-NOS in adults with intellectual disability (ID), beyond the extrapolation of a few child studies, are largely unknown. This study is an attempt to provide systematic empirical data to describe the condition of PDD-NOS in adults with ID. The implication of these data for diagnosis and future research are discussed.     

Psychopathology in Adults with Autism and Intellectual Disability

There have been few studies of psychopathology in adult with autism. This study examined psychiatric co-morbidity in 147 adults with intellectual disability (ID) and autism and 605 adults with ID but without autism. After controlling for the effects of gender, age, psychotropic medication and level of ID, people with autism and ID were no more likely to receive a psychiatric diagnosis than people with ID only. People with autism were less likely to receive a diagnosis of personality disorder. These findings cast doubts on the hypothesis that adults with ID and autism are more vulnerable to certain psychiatric disorders than non-autistic adults with ID.     

An initial assessment of the psychometric properties of the Complicated Grief Questionnaire for People with Intellectual Disabilities (CGQ-ID)

Given the research evidence that people with intellectual disability (ID) do grieve following bereavement, the present study aimed to describe and gather preliminary psychometric data for a version of the Inventory of Complicated Grief [Prigerson, H. G., Maciejewski, P. K., Reynolds, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., et al. (1995). Inventory of Complicated Grief: A scale to measure maladaptive symptoms of loss. Psychiatry Research, 59, 65–79] adapted for use with this population. Carers completed the Complicated Grief Questionnaire for People with ID (CGQ-ID) for 76 individuals with ID, half of whom had experienced a parental bereavement within the last 2 years. The final scale and subscales (Separation Distress and Traumatic Grief) showed very good internal and inter-rater reliability and distinguished between the two groups. While the findings suggest that the CGQ-ID is suitable for identifying complicated grief-type symptoms among adults with ID, further research must be conducted to ascertain whether the findings can be replicated.     

Screening for offenders with an intellectual disability: the validity of the Learning Disability Screening Questionnaire

The study assessed the validity of an intellectual disability screening tool, the Learning Disability Screening Questionnaire (LDSQ), in three forensic settings: a community intellectual disability forensic service; a forensic in-patient secure unit and a prison, using data for 94 individuals. A significant positive relationship was found between full scale IQ and LDSQ score, indicating convergent validity. Discriminative validity was indicated by, firstly, a significant difference in the LDSQ scores between those with and without an intellectual disability, with those with a diagnosis of intellectual disability, scoring significantly lower. Secondly, a ROC analysis indicated that the sensitivity and specificity of the LDSQ were both above 80%. The screening tool was found to have lower sensitivity in the forensic populations than was obtained in the original community standardisation sample, but had slightly higher specificity. Limitations and implications of the study are discussed.     

Life Experiences of Mothers of Children with an Intellectual Disability: A Qualitative Study

ABSTRACT

Introduction: Mothers of intellectually disabled children face several psychological problems. Qualitative studies use a process that can reveal truthful perceptions and help mothers express their emotions about their unique and personal experiences. Method: This study used a qualitative research method design with a hermeneutic approach to examine the life experiences of mothers of children with intellectual disabilities in light of their caregiving experiences. Results: A phenomenological, hermeneutical analysis with an inductive approach was used. The categories of interest were determined to be “impact,” “care management,” “stigma,” “uncertainty,” “relations,” and “search for meaning.” Conclusions: Not all mothers perceive having an intellectually disabled child negatively. Some mothers may not experience any problems providing care to their children. Almost all mothers, however, have concerns for the future and experience significant changes in their family and social relationships.     

Validity and reliability of the Spanish version of the diagnostic assessment for the severely handicapped (DASH-II)

Background and objectivesThe DASH-II scale is a specific instrument for measuring psychopathological symptoms in people with severe and profound intellectual disability (ID). The aim of the study is the validation of the Spanish version, evaluating its reliability and validity. At the same time we examine the prevalence of mental disorders in our sample.Material and methodsTwo reviewers independently passed the Spanish version of the DASH-II (DASH-II-S) to 83 users to establish inter-rater reliability. To assess inter-rater reliability or test–retest reliability, fifty participants were reassessed by the same rater within 7 days.ResultsDASH-II-S showed good internal consistency (Cronbach's α = 0.879) and good reliability, both intra and inter-rater reliability. The prevalence of psychopathology in the sample is 94%, and the use of psychotropic drugs is also high, with 61.4% receiving one or more antipsychotics.ConclusionsDASH-II-S is a valid and reliable instrument that can be used for the assessment of psychopathology in people with ID. The translated version retains the psychometric properties of the original English version. Moreover, the high prevalence of mental disorders in this population may explain the widespread use of psychotropic drugs, but it forces us to continuous reassessment and justification.     

Characterizing Mood States in Individuals Diagnosed with Bipolar Disorder and Intellectual Disability

Introduction: The purpose of this study was to gain additional insight on patterns of behavior of three individuals dually diagnosed with intellectual disability (ID) and bipolar disorder as they cycled between elevated and depressed mood states. Methods: Data were collected from weekly, one-hour observations across a period of several months. The total duration of time spent engaged in target responses (pacing, rocking, and talking), in addition to indirect measures of activity (Irritability and Hyperactivity subscale of the Aberrant Behavior Checklist–Community; ABC-C), were assessed to characterize and monitor changes in overall state. Results: While observable behavior seemed to be a good indicator of overall state, ABC-C Irritability and Hyperactivity subscales were not. Additional analyses included lag sequential analyses of environmental stimuli and conditions potentially correlated with observed behavior. Conclusions: Our findings suggest that observable behavior may be one way to monitor the progression of bipolar disorder in those with ID; however, further research needs to be conducted.     

Psychopathology in Children and Adolescents with Autism Compared to Young People with Intellectual Disability

Autism is a neurodevelopmental disorder with a specific pattern of behavioural, communication and social problems. Additional mental health problems are often poorly understood and undetected. This study investigates the level and pattern of emotional and behavioural problems in young people with autism compared with children with intellectual disability (ID). Subjects were 381 young people with autism and a representative group of 581 Australian young people with ID aged 4–18 years. Parents/carers provided details of the emotional and behavioural problems of their child using the Developmental Behaviour Checklist (DBC-P). Young people with autism were found to suffer from significantly higher levels of psychopathology than young people with ID. The implications of this finding are discussed.     

Contribution of Leisure Satisfaction,Acceptance Disability,and Social Relationship to Life Satisfaction among Korean Individuals with Intellectual Disability

ABSTRACT

There is a dearth of literature that explores the relationships among leisure satisfaction, acceptance of disability, social relationships, and life satisfaction among adults with intellectual disability from Eastern countries. The purpose of this study was to examine how leisure satisfaction, disability acceptance, and social relationships are associated with life satisfaction among Korean adults with mild intellectual disability. This study used the 2011 Panel Survey of Employment for the Disabled (PSED). Using hierarchical multiple regression analysis, the results showed that leisure satisfaction and disability acceptance were statistically significant predictors of life satisfaction. This study suggests that leisure satisfaction and positive disability acceptance can contribute to the psychological and physiological well-being of adults with intellectual disability.     

An analysis of differential item functioning by gender in the Learning Disability Screening Questionnaire (LDSQ)

The Learning Disability Screening Questionnaire (LDSQ; McKenzie & Paxton, 2006) was developed as a brief screen for intellectual disability. Although several previous studies have evaluated the LDSQ with respect to its utility as a clinical and research tool, no studies have considered the fairness of the test across males and females. In the current study we, therefore, used a multi-group item response theory approach to assess differential item functioning across gender in a sample of 211 males and 132 females assessed in clinical and forensic settings. Although the test did not show evidence of differential item functioning by gender, it was necessary to exclude one item due to estimation problems and to combine two very highly related items (concerning reading and writing ability) into a single literacy item Thus, in addition to being generally supportive of the utility of the LDSQ, our results also highlight possible areas of weakness in the tool and suggest possible amendments that could be made to test content to improve the test in future revisions.     

Psychometric properties of Psychopathology checklists for Adults with Intellectual Disability (P-AID) on a community sample of adults with intellectual disability

The DC-LD is a new classification system providing operationalized diagnostic criteria in recognition of lacking applicability of standard psychiatric criteria for adults with intellectual disability. This study attempts to evaluate internal consistency, inter-rater reliability and factor structure of the Psychopathology Checklists for Adults with Intellectual Disability (P-AID), a set of checklists developed from the DC-LD. The P-AID checklists comprising 10 psychiatric diagnoses and 8 types of problem behaviors were filled in by staff at community based homes for adults with intellectual disability in Western Norway. A total of 593 were returned (66%) of which 83 had two sets of checklists. Intellectual disability was administratively defined. Alpha (α) values for the total P-AID checklists indicating high internal consistency. The inter-rater reliability measured by ICC showed values between 0.63 and 0.88 in 8 of 10 psychopathology Checklists. Factor analysis indicated four orthogonal units measured by the P-AID. Issues regarding sensitivity and specificity are discussed. This study is the first attempt to develop and evaluate Psychopathology Checklists based on the DC-LD. The results from this study indicate the P-AID can be used in identifying mental health needs at a detailed diagnostic level.     

Prevalence and Correlates of Pica Among Adults with Intellectual Disability in Institutions

Increased knowledge of complex behaviors such as pica is needed to improve the support and services in the community for individuals with intellectual disability (ID). Though the prevalence of pica has been documented extensively in institutionalized settings, few studies have explored its etiology. The aim of this study is to explore the correlates of pica among institutionalized adults with ID. Secondary data analysis was performed on census-level data on 1,008 persons with ID residing in Ontario's remaining specialized institutions. All persons had been assessed using the interRAI Intellectual Disability (interRAI ID; Martin, Hirdes, Fries, & Smith, 2007 Martin, L., Hirdes, J. P., Fries, B. E and Smith, T. F. 2007. Development and psychometric properties of an assessment for persons with intellectual disability—The interRAI ID. Journal of Policy and Practice in Intellectual Disabilities, 4(1): 23–29.  [Google Scholar]) assessment instrument—a comprehensive and standardized instrument that supports service planning. Bivariate and multivariate analyses were used to explore the relation between pica and demographic, functional, and clinical characteristics. The overall prevalence of pica was 21.8%. Logistic regression analysis showed that being male, a diagnosis of autism, and use of nonverbal means of communication were associated with a higher likelihood of pica, whereas impairment in activities of daily living reduced that likelihood. A curvilinear relation was observed between cognitive functioning and pica. The prevalence of pica is quite high in Ontario's institutions, and nonverbal communication emerged as the strongest correlate of the behavior. The implications for education, training, and interventions are discussed.     

Development and validation of the Intellectual Disability Literacy Scale for assessment of knowledge, beliefs and attitudes to intellectual disability

Research into the general public's responses to individuals with intellectual disabilities has been dominated by attitudinal research. While this approach has unquestionably generated useful findings, it ignores important aspects, such as lay knowledge, explanatory models and beliefs about suitable interventions that can produce a multi-faceted understanding of public responses. This paper describes the development of a measure designed to assess respondents’ intellectual disability literacy. Following a pilot with 114 participants, the IDLS was revised and then completed by 1376 members of the public (aged 18-78 years) from diverse cultural backgrounds. The measure was able to distinguish respondents who showed good intellectual disability literacy. Confirmatory factor analyses revealed four causal beliefs factors (adversity, biomedical, fate, environment) that accounted for 55% of the variance and three intervention beliefs factors (lifestyle, expert help, religion/spiritual,) that explained 52% of the variance. Test-retest reliability for these factors was good for all ethnic groups. The four-item social distance scale had good internal consistency for all ethnic groups and acceptable concurrent validity. The IDLS is a useful new tool to evaluate knowledge, beliefs and social distance to intellectual disability in lay people, is suitable for cross-cultural research and allows comparison of intellectual disability and mental health literacy in any given population.     

Assessment of Physical Self-Concept in Adolescents with Intellectual Disability: Content and Factor Validity of the Very Short Form of the Physical Self-Inventory

The purpose of this study was to test the factor validity and reliability of the Very Short Form of the Physical Self-Inventory- (PSI-VSF) within a sample of adolescents with mild to moderate Intellectual Disability (ID). A total of 362 ID adolescents were involved in two studies. In Study 1, the content and format scale response of the PSI-VSF were adapted for adolescents with ID. This instrument was thus renamed PSI-VSF-ID and two versions with two alternative responses scales format, were developed: Likert and graphical. In Study 2, results provided support for: (1) the factorial validity and reliability; and (2) factorial invariance across gender, age, type of school placement and ID level of the PSI-VSF-ID associated with a graphical response scale format.     

People with an Intellectual Disability in the Australian Criminal Justice System

Intellectual disability (ID) is not accurately identified early enough in the criminal justice system. The extent to which each jurisdiction addresses the needs of persons with ID is inconsistent. Magistrate Court diversion programmes aiming to identify defendants with ID needs vary throughout Australia. This article argues the need for a national approach for the diversion of persons with ID from the criminal justice system. This will be important for persons with and without coexisting mental illness and will affirm international developments protecting the rights of persons with ID (including those in the criminal justice system) to improved and accessible health care.     

Spanish validation of the Brief Assessment in Cognition in Schizophrenia (BACS) in patients with schizophrenia and healthy controls

Neurocognitive impairment is a core feature of schizophrenia and is closely associated with functional outcome. The importance of cognitive assessment is broadly accepted today, and an easy-to-use, internationality validated cognitive assessment tool is needed by researchers and in daily clinical practice. The Brief Assessment of Cognition in Schizophrenia (BACS) has been validated in English, French, Japanese and Italian. It is as sensitive to cognitive dysfunction as a standard test battery, with the advantage of requiring less than 35 minutes to complete. In our study, we tested the psychometric characteristics of a Spanish version of the BACS in 117 patients with schizophrenia-spectrum disorders and 36 healthy controls. All BACS cognitive subtests discriminated between patients and controls (P < .001), and the concurrent validity between the BACS and a traditional neuropsychological test battery was similar to that reported in other languages. We conclude that the BACS can facilitate the comparison of the cognitive performance of patients with schizophrenia in many different countries.     

A Scoping Study of a Tertiary Intellectual Disability Mental Health Service: A Family Member and Support Person Perspective

ABSTRACT

Introduction: People with intellectual disability (ID) experience barriers in accessing mental health care. Recommendations have been made to implement specialist intellectual disability mental health (IDMH) services in Australia. However, there is limited evidence to inform service development.

Method: Family members and support persons of people with ID (n = 42) completed an on-line survey about support for, and operation of, a tertiary IDMH service in New South Wales, Australia.

Results: Participants agreed that a tertiary IDMH service would assist in meeting the needs of people with ID. Key service features included that it be delivered within the public health system, by psychiatrists and psychologists, provide face-to-face clinical contact and advice. Key service areas included behaviors of concern, self-harm, assessments, and interventions.

Conclusion: These findings suggest support for a tertiary IDMH service and how it could be delivered. Further research is required from the perspective of people with ID, mental health staff, and clinical experts.