Psychometric properties of a Dutch version of the Behavior Problems Inventory-01 (BPI-01)

There are only a limited number of Dutch validated measurement instruments for measuring behavioral problems in people with a moderate to profound intellectual disability. In this study, the psychometric properties of a Dutch version of the behavior Problems Inventory-01 (BPI-01; Rojahn et al., 2001) have been investigated among 195 people with a moderate to profound intellectual disability who live in a residential facility. The BPI-01 was completed by 42 informants (staff members) of 23 care units. The inter-rater reliability, intra-rater reliability and internal consistency turned out to be good. Factor analysis confirmed two of the three a priori factors and the third factor was a mix of self-injurious (SIB) behavior and stereotypic behavior. The BPI-01 was compared to the Aberrant Behavior Checklist (Aman et al., 1985a) and showed a good convergent validity. This study shows that a Dutch version of the BPI-01 has good psychometric properties for measuring behavior problems in individuals with moderate to profound intellectual disability.     

Stereotyped behaviors predicting self-injurious behavior in individuals with intellectual disabilities

We examined the relation between stereotyped behavior and self-injurious behavior (SIB) for 1871 individuals with intellectual disabilities who had a score of >0 on the Behavior Problem Inventory (BPI-01; Rojahn et al., 2001). We report three main findings: First, structural equation modeling techniques (SEM) revealed that the BPI-01stereotyped behavior subscale scores predicted BPI-01 SIB subscale scores. Second, when stereotyped behavior was modeled as a predictor of SIB, mixture-modeling techniques revealed two groups of individuals: one in which stereotyped behavior was a strong, statistically significant predictor of SIB (69% of the sample), and another one in which stereotyped behavior was not a predictor of SIB (31%). Finally, two specific stereotyped behavior topographies (i.e., body rocking and yelling) were identified that significantly predicted five different SIB topographies (i.e., self-biting, head hitting, body hitting, self-pinching, and hair pulling). Results are discussed in terms of future research needed to identify bio-behavioral variables correlated with cases of SIB that can, and cannot, be predicted by the presence of stereotyped behavior.     

Psychometric properties and factor structure of the Behavior Problems Inventory (BPI-01) in a Swedish community population of adults with intellectual disability

The aim of the present study was to evaluate the psychometric properties and factor structure of the Behavior Problems Inventory (BPI-01) in a community population. The Swedish version of the BPI-01 was administered by interviewing care staff of all adults (n = 915) with administratively defined intellectual disabilities (IDs) living in Örebro County, Sweden. Sixty-two percent of the participants had at least one behavior problem. Altogether, 30.9% showed self-injurious behavior, 41.3% stereotyped behavior, and 34.8% aggressive/destructive behavior. All but the self-injurious behavior scale reached acceptable levels of internal consistency. Confirmatory factor analysis supported the unidimensionality of the subscales as well as the proposed three factor structure of the original BPI-01. The present study demonstrates that the three subscales are highly similar constructs across different language and cultural settings, and that the BPI-01 is applicable in research on populations with varying mental functioning, diagnoses, ages, and living arrangements.     

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.     

Reliability and validity of the Japanese version of the Behavior Problem Inventory-Short Form

BackgroundThe Behavior Problems Inventory-Short Form (BPI-S), which assesses behavior problems in individuals with intellectual disabilities (ID), is a shorter version of the BPI-01. This study investigated the reliability and validity of the BPI-S Japanese version (BPI-S-J) for adolescents/adults with ID and behavior problems.MethodsThe test–retest reliability included participants with ID and behavioral problems who were enrolled in welfare services. For test–retest reliability, 42 caregivers independently responded to the BPI-S-J every two weeks. Inter-rater reliability was independently assessed using the BPI-S-J by two caregivers who were familiar with the 42 participants. The participants of the validity assessment were 227 students from special needs schools or patients with ID admitted to medical institutions. The total frequency total score was compared based on the degree of ID. To examine the criterion-related validity, we analyzed the total frequency score, the total score of the Criteria for Determining Severe Problem Behavior (CDSPB) and the total score of the Aberrant Behavior Checklist-Japanese version (ABC-J).ResultsThe BPI-S-J of test–retest reliability was satisfactory (intra-class correlation; ICC) = 0.954), and the total score significantly (ICC = 0.721) represented good inter-rater reliability. For the validity, the BPI-S-J score of participants who had severe and profound ID was significantly higher than those who had mild and moderate ID. Significant correlations were observed between the BPI-S-J score and CDSPB score (r = 0.499), and the ABC-J score (r = 0.699), indicating adequate criterion-related validity.ConclusionThis study showed the utility of the BPI-S-J to assess behavior problems in the Japanese ID population.     

An Independent Investigation Into the Psychometric Properties of the Adult Scale of Hostility and Aggression (A-SHARP)

Background: The Adult Scale of Hostility and Aggression (A-SHARP) rating scale assesses the frequency/severity (problem scale) and the reactive-proactive motivation (provocation scale) of aggressive behaviors in adults with intellectual disabilities (ID). Items are assigned to five subscales (Verbal Aggression, Physical Aggression, Hostile Affect, Covert Aggression, and Bullying). Although psychometric properties reported by the scale’s developers were very good, we wanted to corroborate them independently. We were also interested in whether the reactive-proactive distinction of aggressive behavior is related to a behavioral/functional classification. Method: Staff at a day-treatment program for adults with ID completed ratings for 155 clients using the A-SHARP, the Behavior Problems Inventory-01 (BPI-01), and the Questions about Behavioral Function (QABF). Results: Internal consistency was found to be excellent, and the A-SHARP Physical Aggression subscale had good congruent and clinical validity. Confirmatory factor analysis showed sufficient evidence toward the factorial validity of the A-SHARP’s problem scale. The reactive-proactive classification of aggressive behavior motivation by the A-SHARP’s provocation scale was independent of the functional classification. Conclusions: The A-SHARP is a useful addition to a small number of existing instruments for assessing aggressive behavior in adults with ID, especially its problem scale. We discuss how the A-SHARP provocation scales might provide therapy-relevant information. Empirical evidence for the clinical utility of the A-SHARP provocation scale will have to be established by future research.     

The Relationship of Steroid Hormones,Genes Related to Testosterone Metabolism and Behavior in Boys With Autism in Slovakia

ObjectivePurpose of the study was to identify the relationship among actual plasmatic levels of steroid hormones and behavioral manifestations in boys with autism and to assess the genetic contribution to these manifestations. Methods172 boys with autism under 10 years of age and 135 neurotypical boys attended the study. ADI-R and ADOS-2 were used to evaluate the core symptom severities. Problem behavior was assessed using BPI-01 questionnaire. Levels of testosterone, estradiol, dehydroepiandrosterone, dehydroepiandrosterone-sulfate and sex hormone binding globulin (SHBG) were measured in plasma of autistic boys. Three SNPs (in ESR1, SHBG, SRD5A2 genes) and one STR in AR gene (number of CAG repeats in first exon) were assessed. Hormonal levels and number of CAG repeats in AR gene were used for correlation analysis with behavioral measures. Genotype and allelic frequencies were compared among autistic and neurotypical boys. ResultsWe found negative relationship among SHBG levels and restricted, repetitive behaviors (measured by ADOS-2) and positive relationship among actual testosterone levels and frequency of stereotyped behavior (measured by BPI-01). ConclusionActual levels of SHBG and testosterone are related to severities of restricted and repetitive behaviors in boys with autism. Mechanisms of action of these hormones in brain require further investigation.     

Validity and reliability of the Behavior Problems Inventory,the Aberrant Behavior Checklist,and the Repetitive Behavior Scale – Revised among infants and toddlers at risk for intellectual or developmental disabilities: A multi-method assessment approach

Reliable and valid assessment of aberrant behaviors is essential in empirically verifying prevention and intervention for individuals with intellectual or developmental disabilities (IDD). Few instruments exist which assess behavior problems in infants. The current longitudinal study examined the performance of three behavior-rating scales for individuals with IDD that have been proven psychometrically sound in older populations: the Aberrant Behavior Checklist (ABC), the Behavior Problems Inventory (BPI-01), and the Repetitive Behavior Scale – Revised (RBS-R). Data were analyzed for 180 between six and 36 months old children at risk for IDD. Internal consistency (Cronbach's α) across the subscales of the three instruments was variable. Test–retest reliability of the three BPI-01 subscales ranged from .68 to .77 for frequency ratings and from .65 to .80 for severity ratings (intraclass correlation coefficients). Using a multitrait–multimethod matrix approach high levels of convergent and discriminant validity across the three instruments was found. As anticipated, there was considerable overlap in the information produced by the three instruments; however, each behavior-rating instrument also contributed unique information. Our findings support using all three scales in conjunction if possible.     

Psychiatric diagnoses in relation to severity of intellectual disability and challenging behaviors: a register study among older people

ABSTRACT

Objective: To investigate the possible association between severity of intellectual disability (ID) and presence of challenging behavior, respectively, on diagnoses of psychiatric disorders among older people with ID.

Methods: People with a diagnosis of ID in inpatient or specialist outpatient care in 2002–2012 were identified (n = 2147; 611 with mild ID, 285 with moderate ID, 255 with severe or profound ID, and 996 with other/unspecified ID). Moreover, using impairment of behavior as a proxy for challenging behavior, 627 people with, and 1514 without such behavior were identified.

Results: Severe/profound ID was associated with lower odds of diagnoses of psychotic, affective, and anxiety disorders than was mild/moderate ID. People with moderate ID had higher odds than those with mild ID of having diagnoses of affective disorders. Diagnoses of psychotic, affective, and anxiety disorders, and dementia were more common among people with challenging behavior than among those without.

Conclusions: People with severe/profound ID had lower odds of receiving psychiatric diagnoses than those with mild and moderate ID. Whether this is a result of differences in prevalence of disorders or diagnostic difficulties is unknown. Further, challenging behaviors were associated with diagnoses of psychiatric disorders. However, the nature of this association remains unclear.     

Validity and reliability of the Korean version of Autism spectrum disorders-comorbid for children (ASD-CC)

The purpose of the present study was to develop and evaluate the psychometric properties of the Autism Spectrum Disorder-Comorbid for Children (ASD-CC). Mothers of children with ASD (n = 330) and of typically developing children (n = 220) aged from 2 to 16 years were asked to complete the ASD-CC. The next four steps were conducted for data analysis. First, the confirmatory factor analysis (CFA) was used to figure out the factor structure of the Korean version of the ASD-CC. It revealed that the 7-factor structure of the ASD-CC is applicable to the Korean version, likewise. Second, the internal consistency and test-retest reliability were measured, which showed to be in either moderately good or within the acceptable range. Third, the inter-correlations between the ASD-CC and the Korean Child Behavior Checklist (K-CBCL) and the ASD-CC and Korean Behavior Problem Inventory (BPI-01) were computed to be revealed as significant. In addition, the discriminant validity between ASD and typically developing children was well established. And finally, cut-off scores for 7 subscales of the ASD-CC were calculated using the Mean and Standard Deviation. These findings suggest that the Korean version of ASD-CC is a psychometrically sound instrument. Clinical and research implications as well as limitations are measured.     

Attributions of People with Intellectual Disabilities of Their Own or Other Clients’ Challenging Behavior: A Systematic Review of Qualitative Studies

ABSTRACT

Introduction: As opposed to studies focusing on staffs’ attributions of challenging behavior (CB), relatively few studies have looked at how people with intellectual disabilities (ID) attribute such behaviors themselves, and a systematic overview is currently lacking. The aim of this review was to synthesize the evidence from qualitative studies on the attributions people with ID have concerning their own or other clients’ CB.

Methods: A systematic literature search was conducted in Embase, Medline Ovid, Web of science, Cochrane CENTRAL, PsychINFO Ovid, and Google Scholar. Studies were included if they focused on people with ID who report on attributions of their own or other clients’ actual CB. The methodological quality of the studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist.

Result: A total of 10 studies were included. Three main types of factors subdivided in 13 sub-types were reported by clients as potential causes of CB: interpersonal factors (1 support staff, 2 other clients, 3 general, 4 life history), environmental factors (1 ward, 2 social exclusion, 3 situational factors) and intrapersonal factors (1 syndrome or diagnosis, 2 medical or physical symptoms, 3 psychological reasons, 4 emotions and feelings, 5 coping, 6 other).

Conclusions: This thematic synthesis shows that clients with ID report a diverse range of attributions regarding their own or other clients’ CB. This spectrum can be used as a framework for interpreting CB and for the development of appropriate support systems for people with ID demonstrating CB.     

Mental health problems in children with intellectual disability: use of the Strengths and Difficulties Questionnaire

Background The assessment of mental health problems in children with intellectual disability (ID) mostly occurs by filling out long questionnaires that are not always validated for children without ID. The aim of this study is to assess the differences in mental health problems between children with ID and without ID, using a short questionnaire, the Strengths and Difficulties Questionnaire (SDQ). Methods We studied 260 children (6–12 years) selected from special education schools for trainable children (response: 57%). Parents completed the extended Dutch version of the SDQ, questions on background characteristics and on the care provided. A non‐ID control group of 707 children (response: 87%) was included to compare mental health problems. Results In total, 60.9% of children with ID had an elevated score on the SDQ, compared with 9.8% of children without ID. Only 45% of the children with ID and an elevated SDQ score had visited a healthcare professional for these problems in the last 6 months. Discussion The SDQ or an adapted version could contribute to the early identification of mental health problems in children with ID. Further research is needed to confirm the validity of the SDQ when used in a sample of children with ID.     

College students' conceptualizations of deficits involved in mild intellectual disability

Precedential rulings in recent capital murder trials may, in some cases, leave it up to a jury to determine whether or not an individual meets criteria for an intellectual disability (ID) and should be spared from the death penalty. Despite the potential for misconceptions about ID to bias decisions, few empirical studies have examined the public's conceptualizations of individuals with ID. This study sought to examine 890 college students’ conceptualizations of the deficits involved in mild ID. Students were asked to respond to two online surveys about the cognitive and adaptive behavior deficits that people with mild ID may experience. While most students were correct about basic facts, such as ID is not contagious and not curable, there was no clear consensus regarding beliefs about individuals with ID getting married, having children, or engaging in other mainstream activities of adult living. Students’ responses are examined in light of results of studies that identify and examine bona fide deficits and areas of successful mainstreaming among persons with ID. Implications of misconceptions are discussed.     

A systematic review on the effect of exercise interventions on challenging behavior for people with intellectual disabilities

BackgroundChallenging behavior, such as aggressive or self-injurious behavior, is a major concern for the health and well-being of people with intellectual disabilities (ID) and for their relatives, friends, and caregivers. The most common contemporary treatments have drawbacks, such as the adverse side effects of antipsychotics. Exercise interventions could be a good alternative, but little is known about its beneficial effects on challenging behavior in people with ID yet.MethodA systematic review of the literature was done and methodological quality of the selected studies has been judged on four points. With one-way Analysis of Variance (ANOVA), the effect of exercise interventions on challenging behavior was studied. The effect of low versus high intensity exercise interventions was studied with independent samples T-test using mean improvement scores.ResultsTwenty studies studying the effects of exercise interventions on challenging behavior in people with ID have been found. A quantitative evaluation of the results showed a significant decrease in challenging behavior after participating in an exercise intervention (M = 30.9%, 95% CI: 25.0, 36.8). Furthermore, no significant difference was found between high (M = 32.2%) and low (M = 22.9%) intensity exercise interventions.ConclusionsThe found decrease in challenging behavior shows that exercise seems to be recommendable as an effective treatment for people with challenging behavior and ID. However, most studies were of low methodological quality and more research is needed to optimize recommendations about the exact intensity, duration, frequency, and mode (group or individual) of exercise interventions for this group of people.     

The Behavior Problems Inventory (BPI-01) in community-based adults with intellectual disabilities: Reliability and concurrent validity vis-à-vis the Inventory for Client and Agency Planning (ICAP)

Reliability and concurrent validity of the Behavior Problems Inventory (BPI-01; Rojahn et al., 2001) was examined in a sample of 130 community residing adults with mild to profound intellectual disabilities with high rates of behavior problems and concurrent mental health problems. The BPI-01 and the Inventory for Client and Agency Planning (ICAP; Bruininks et al., 1986) were administered twice within a mean time interval of 7.8 weeks by 20 trained and experienced staff members. All three BPI-01 subscales had high inter-rater agreement (Self-Injurious Behavior [SIB]: mean ICC = .84; Stereotyped Behavior: mean ICC = .75; Aggressive/Destructive Behavior: mean ICC = .82), and stable test–retest reliability (SIB, mean ICC = .91; mean Stereotyped Behavior, mean ICC = .89, and Aggressive/Destructive Behavior, mean ICC = .88); internal consistency ranged from poor (SIB: α = .61) to excellent (Stereotyped Behavior, α = .90). Using the ICAP as criterion measure, the BPI-01 showed robust convergent validity. Solid relationships between BPI-01 subscales and corresponding ICAP subscales corroborated the concurrent validity of the BPI-01.     

Antecedent events as predictive variables for behavioral function

Challenging behavior is one of the largest barriers to ensuring that people with intellectual disabilities (ID) are able to participate in the community. These difficulties have become one of the main causes of social exclusion. The research into and treatment of challenging behavior has usually involved the identification of its function and the manipulation of the events or environmental conditions that influence its occurrence (antecedent variables). The present research explores the relationship between antecedents and behavioral function and the extent to which antecedent variables may act as predictors of behavioral function. This relationship is explored using two standardized instruments: Questions About Behavioral Function and Contextual Assessment Inventory. Data from the validation of these instruments for the Spanish population involved 300 participants with ID and 328 challenging behaviors. The results suggest that social/cultural variables are most related to challenging behavior, whereas biological variables seem to only be related to physically maintained behavior.     

Empirically supported psychological treatments: The challenges of comorbid psychiatric and behavioral disorders in people with intellectual disability

This paper reviews the current state of knowledge on psychological interventions with empirical evidence of efficacy in treating common psychiatric and behavioral disorders in people with intellectual disability (ID) at all stages of their life. We begin with a brief presentation of what is meant by psychiatric and behavioral disorders in this population, along with an explanation of some of the factors that contribute to the increased psychosocial vulnerability of this group to present with these problems. We then conduct a review of empirically supported psychological therapies used to treat psychiatric and behavioral disorders in people with ID. The review is structured around the three generations of therapies: Applied behavior analysis (e.g., positive behavior support), cognitive behavioral therapies (e.g., mindfulness-based cognitive therapy), and contextual therapies (e.g., dialectical behavior therapy). We conclude with some recommendations for professional practice in the fields of ID and psychiatry.     

歧视与病耻感量表(DISC)中文版在精神障碍患者中的信度和效度研究

目的:评估歧视与病耻感量表(DISC)在中国精神障碍患者中的信度和效度。方法:引进Thornicroft团队研发的DISC,按初译、回译等步骤形成DISC中文版,以242例精神障碍患者作为受访对象,验证量表的信度和效度。结果:DISC的Cronbach'α系数为0.70,分半信度为0.85,总分重测信度为0.83;DISC分量表1总分与精神疾病内在病耻感调查表(ISMI)歧视经历因子分呈正相关(r=0.417,P0.01),分量表2总分与ISMI社会退缩因子分呈正相关(r=0.332,P0.01);分量表2总分与自尊量表(SES)总分呈正相关(r=0.250,P0.01),分量表3总分与SES总分呈负相关(r=-0.187,P0.01);分量表4总分与社会支持评定量表(SSRS)客观支持分以及对支持的利用度分均呈正相关(r=0.177,0.170,P均0.01)。结论:DISC中文版具有较好的信度和效度,可作为评估精神障碍患者歧视与病耻感的临床工具。     

Behavior Problems Increase Costs of Care of Children With Intellectual Disabilities

It is well known that communities face high costs in the care of individuals with intellectual disability (ID). Factors that influence those costs are less well studied. This study examined the relationship between behavioral problems and the costs of caring for children with ID. Parents/family carers of 109 children with ID were surveyed using a modified version of the Client Service Receipt Inventory and the Developmental Behaviour Checklist. Behavioral and emotional disturbance was associated with increased cost of care for parents of children with ID. Such results demonstrate that effective early intervention services aimed at redressing behavioral problems have the potential to reduce costs of care. However, such programs will also need to be affordable if they are to have adequate reach and adoption.     

The Prevalence of Behavior Problems Among People with Intellectual Disability Living in Community Settings

With the desegregation processes of services for people with intellectual disability (ID) that is taking place in most Western countries there is a need for more knowledge related to the prevalence of behavior problems among people living in community settings. This study investigates the prevalence of behavior problems among 140 adolescents and adults with ID living in 5 municipalities in Norway using the Aberrant Behavior Checklist (Aman & Singh, 1986 Aman, M. G. and Singh, N. N. 1986. Aberrant Behavior Checklist: Manual, East Aurora, NY: Slosson Educational Publications.  [Google Scholar], 1994 Aman, M. G. and Singh, N. N. 1994. Aberrant Behavior Checklist-Community: Supplementary manual, East Aurora, NY: Slosson Educational Publications.  [Google Scholar]). Twenty percent of the sample were reported to show severe behavior disorder or “challenging behavior,” and this gives a prevalence for challenging behavior of 63.6 people per 100,000 base population. On the average, people showing challenging behavior had 7 behaviors rated as severe problems. A total of 60 participants were reported to have moderate or severe behavior problems, giving a prevalence for moderate and severe behavior problems of 136.3 per 100,000 base population. There were more people with profound ID and more people with autism in the group with challenging behavior and more people with Down syndrome in the group with mild or no problems. Those with severe behavior problems were perceived to be significantly less satisfied with their life situation than people without severe behavior problems. Challenging behavior seems to have a significant negative impact on the quality of life of people with ID. The results of this and other studies of challenging behavior among individuals with ID who live in areas with different service structures, using base population information, are important for analyzing the impact of reforms and different service systems on the life quality and well-being of people with ID.