The Behavior Problems Inventory: Reliability and Factor Validity in Institutionalized Adults with Intellectual Disabilities

Background The aim of this study was to reevaluate the reliability (internal consistency, inter‐rater and re‐test) and the factor structure of the Behavior Problems Inventory (BPI‐01) with adults with intellectual disabilities who resided in a state‐run developmental centre. Methods BPI‐01 was administered to informants who had known participants for a minimum of 6 months. For study 1, data were collected in two samples: 100 residents who were selected based on the challenging behaviour targeted in their behaviour treatment plan and 325 randomly selected residents. Results The internal consistencies of the BPI‐01 subscales were in the good to excellent range. Overall, the inter‐rater and test–re‐test reliability of the subscales and items were adequate with relatively lower reliability found for the Stereotypy subscale and items. For study 2, the data of the 425 participants from study 1 were used in a confirmatory factor analysis, which indicated that three a priori BPI‐01 subscales (Self‐Injurious Behavior, Stereotyped Behavior and Aggression/Destruction) were a reasonable fit. Conclusions The current study provides additional support to the reliability and factor structure of the BPI‐01 in adults with intellectual disabilities.     

Quality of Life for the Camberwell Cohort

Background Despite the acknowledged difficulties of measuring satisfaction for people with intellectual disabilities, the current study examined the quality of life (QoL) of the Camberwell Cohort, a total population sample of people with severe intellectual disability and/or autism [ Wing & Gould, Epidemiology and Classification, 9 , 1979, 11 ]. Methods The Lifestyle Satisfaction Scale (LSS) [ Harner & Heal, Research in Developmental Disabilities, 14 , 1993a, 221 ] was combined with selected questions from the Quality of Life Questionnaire Schalock & Keith 1993 , Quality of Life Questionnaire, IDS Publishing Corporation, Worthington and conducted with 12 people with intellectual disabilities and 72 proxy respondents. Results Inter‐rater reliability on overall score was available for 10 participants and was acceptable with a Spearman’s Rank order correlation co‐efficient over 0.8. There were no significant differences between the scores of proxies and service users on the domains of the LSS. The sample of service users who completed the interviews was too small to allow further detailed analysis of their responses. However, responses from the proxy interviews indicated that there were no differences in life satisfaction between those socially impaired and socially able. However those with autism were reported to be less satisfied on Community Satisfaction while those with challenging behaviour had lower scores overall and specifically on Community Satisfaction. Those with an IQ below 50 had lower scores overall, than those with an IQ above 50 and specifically on Recreation Satisfaction. Linear regression analysis on total QoL score indicated that only three variables seemed to be important in predicting proxy QoL scores: challenging behaviour at Time 3, IQ at Time 3 and independent living skills at Time 1. Conclusions Despite the difficulties encountered, this study provided some support for the widely help belief that QoL is lower for those with intellectual disability and for those with challenging behaviour.     

Improving healthcare access for older adults with intellectual disability: What are the needs?

This qualitative study was carried out in Spain with the aim of identifying the changes that the health system should make to improve healthcare access for older adults with intellectual disability. Three hundred and sixty‐nine family members and professionals expressed their opinion on how healthcare access could be improved. Participants responded to two open‐ended questions included in a general survey about the health status of older individuals with intellectual disability. Most informants were women and professionals who had known the person with intellectual disability for more than 12 months. A system of categories, which showed good inter‐rater agreement, was developed to analyse participants’ written responses. Both family members and professionals emphasized the need to improve disability training for healthcare practitioners and highlighted the urgent need for flexibility in the structure of a healthcare system that currently overlooks the specific needs of this vulnerable population.     

Predicting Change in Emotional and Behavioural Problems during Inpatient Treatment in Clients with Mild Intellectual Disability

Background Little is known about client characteristics that are related to outcome during inpatient treatment of adults with mild intellectual disability (ID) and severe behavioural problems. Method We explored variables that were related to a change in behavioural problems in 87 individuals with mild ID during inpatient treatment in facilities for adults with mild ID and severe behavioural problems. Emotional and behavioural problems were measured using the Adult Behaviour Checklist (ABCL) and relationships between a change in ABCL total scores and other variables (e.g. age, adaptive skills, and presence of personality disorder) were explored. Results For the sample as a whole, we found a decrease in emotional and behavioural problems within a 1‐year period of inpatient treatment (following a 3‐month observation and diagnostic period). Male clients, clients without a personality disorder classification, and/or clients who showed more improvement in adaptive and social functioning, showed a larger decrease in emotional and behavioural problems than other clients. Gender and personality disorder classification appeared to be the most important predictive factors. Conclusion Clients with mild ID and severe behavioural problems may benefit from inpatient treatment. Those with a personality disorder and/or female clients may benefit less from such a program. Results of such studies may have consequences for service provision and management. Limitations of this study were the lack of data on the quantity and quality of the treatment package and unknown reliability and validity of Axis‐I and personality disorder diagnoses.     

Psychometric Comparison of the Functional Assessment Instruments QABF,FACT and FAST for Self‐injurious,Stereotypic and Aggressive/Destructive Behaviour

Background Psychometric properties of three functional assessment rating scales were compared for three types of target behaviours [self‐injurious behaviour (SIB), stereotypic behaviour and aggressive/destructive behaviour]. Materials and method The Questions about Behavioural Function (QABF), the Functional Assessment for Multiple Causality (FACT) and the Functional Analysis Screening Tool (FAST) were administered twice by two raters to 130 adults with intellectual disability (total of 29 raters). Results and conclusions The reliability of the FACT and the QABF for estimates across all three behaviours was acceptable to good. Mean inter‐rater reliability intra‐class correlations across two administrations ranged from 0.63 to 0.68 for the QABF and from 0.65 to 0.78 for the FACT. Mean test‐retest reliability for the QABF ranged from 0.81 to 0.82 and for the FACT from 0.86 to 0.87. Internal consistency across the subscales ranged from 0.89 to 0.96 for the QABF and from 0.92 to 0.96 for the FACT. The FAST had generally poorer reliability scores. Convergent and discriminant validity (Spearman ρ) were better between FACT and the QABF than between the FAST and the other two instruments.     

The effect of technology assisted therapy for intellectually and visually impaired adults suffering from separation anxiety: Conquering the fear

Persons with an intellectual disability (ID) are at risk of developing separation anxiety (SA) and, if left untreated, this can be a risk factor for the development of psychopathology. The effects of an intervention, namely technology assisted therapy for SA (TTSA), were examined on the SA, challenging behavior, psychosocial functioning, and quality of life (QOL) experienced by moderate to mild intellectually and visually disabled adults. This study aimed to determine whether TTSA reduces SA and challenging behavior in persons with ID and visual impairment, and if this results in increased psychosocial functioning and QOL. A pre-experimental within-group design with randomized multiple baselines and staggered intervention start-points was used (n = 6). The variables were monitored with standardized instruments. The frequencies of each participant’s use of the technology and the frequency and intensity of their behavior were recorded over time. Results indicate that the SA and challenging behavior experienced by the participants decreased significantly and their psychosocial functioning and QOL increased significantly. The conclusions are that TTSA has the potential to be a valid intervention to address SA in adults with visual and moderate to mild IDs.     

The Reliability,Validity and Practical Utility of Measuring Supports using the I‐CAN Instrument: Part II

Background There is an urgent need for developing reliable, valid and practical instruments that assess and classify the support needed by persons with disability to function in their chosen living, working and social environments. I‐CAN is an instrument that addresses the frequency and level of support needed (not individual skills or deficits) for each individual with a disability. Method Studies were conducted to assess the test–retest reliability and inter‐rater reliability. Concurrent validity was investigated by exploring the relationship between the I‐CAN domain scales and the Inventory for Client and Agency Planning (ICAP) ( Bruininks et al. 1986 ) and the Quality of Life Questionnaire (QOL‐Q) ( Schalock & Keith 1993 ). Predictive validity studies were undertaken using day‐ and night‐time support hours. Regression analyses were run using these measures with I‐CAN domain scales. Two independent studies were also conducted to ascertain the practical utility of the instrument. Results The I‐CAN instrument demonstrated excellent inter‐rater and test–retest reliability in the Activities and Participation domains. Low‐to‐moderate test–retest results in Physical Health, Mental Emotional Health and Behaviour domains were tracked to actual change in support needs in these areas. Validity proved acceptable. The relationships between I‐CAN domain scales and adaptive behaviour were mixed but in the expected direction. Low‐to‐moderate correlation coefficients were evident between the I‐CAN scales and the QOL‐Q Total, but greater support needed in certain domains was associated with less empowerment and independence, and less community integration and social belonging. Attempts to explain current support hours against the I‐CAN scales were disappointing and suggest that a number of other factors apart from individual support need to play a significant role. There was general satisfaction with the assessment process from stakeholders and participant groups. Conclusions I‐CAN is a reliable, valid and user‐friendly instrument for assessing the support needs of people with disabilities. It uses a process that involves the persons with disability, their family and friends and staff as appropriate. It is also apparent that the current provision of paid support hours by agencies is a complex phenomenon that is not based solely on individual support needs. Further research is warranted on the influence of the environment and the perceptions of need for support based on negotiable and non‐negotiable support needs.     

Assessing the Severity of Challenging Behaviour: Psychometric Properties of the Challenging Behaviour Interview

Background The Challenging Behaviour Interview (CBI) was developed as an assessment of the severity of challenging behaviour. The CBI is divided into two parts. Part I of the interview identifies the occurrence of five clearly operationalized forms of challenging behaviour that have occurred in the last month. Part II of the interview assesses the severity of the behaviours identified on 14 scales measuring the frequency and duration of episodes, effects on the individual and others and the management strategies used by carers. In this paper we report upon its psychometric properties and discuss potential clinical and research uses of the new scale. Methods The CBI was administered to 40 adults and 47 children. Test–retest and inter‐rater agreement was assessed for 22 participants in the adult sample. Concurrent validity was assessed by correlating total scores for the child sample with the subscale and total scores of the Aberrant Behavior Checklist (ABC). Content validity was assessed by comparing scores for each behaviour on specific items relating to relevant aspects of severity of impact that would be expected to differ based upon the topographies of the behaviour. Results Mean inter‐rater and test–retest reliability kappa indices for the behaviours in Part I of the interview were 0.67 (range: 0.50–0.80) and 0.86 (range: 0.70–0.91), respectively. Mean inter‐rater and test–retest reliability Pearson‘s correlation indices for the behaviours in Part II of the interview were 0.48 (range: 0.02–0.77) and 0.76 (range: 0.66–0.85), respectively. Correlations with the ABC varied between 0.19 and 0.68. The majority of content validity comparisons were in line with prediction. Conclusions The potential of the interview for clinical assessment, as an outcome measure for services and individual interventions and research purposes, is discussed.     

Development of Parent‐ and Teacher‐Reported Emotional and Behavioural Problems in Young People with Intellectual Disabilities: Does Level of Intellectual Disability Matter?

Background This study described similarities and differences in the 5‐year stability and change of problem behaviour between youths attending schools for children with mild to borderline (MiID) versus moderate intellectual disabilities (MoID). Methods A two‐wave multiple‐birth‐cohort sample of 6 to 18‐year‐old was assessed twice across a 5‐year interval using the Developmental Behaviour Checklist Primary Carer version (n = 718) and Teacher version (n = 313). Results For most types of problem behaviour youths with MiID and MoID showed similar levels of stability of individual differences, persistence and onset of psychopathology. Whenever differences were found, youths with MoID showed the highest level of stability, persistence and onset across informants. Mean levels of parent‐reported, but not teacher‐reported, problem behaviour, regardless of level of intellectual disability, decreased during the 5‐year follow‐up period. Conclusions Youths with MoID and MiID are at risk for persistent psychopathology to a similar degree. Different informants showed to have a different evaluation of the level and the amount of change of problem behaviour, and should be considered complementary in the diagnostic process.     

Comparison of the WAIS‐III and WISC‐IV in 16‐Year‐Old Special Education Students

Background Previous research with earlier versions of the WISC and WAIS has demonstrated that when administered to people who have intellectual disabilities, the WAIS produced higher IQ scores than the WISC. The aim of this study was to examine whether these differences still exist. A comparison of the Wechsler Adult Intelligence Scale – Third Edition (WAIS‐III) with the Wechsler Intelligence Scale for Children – Fourth Edition (WISC‐IV) was conducted with individuals who were 16 years old and receiving special education. Materials and Methods All participants completed the WAIS‐III (UK) and WISC‐IV (UK). The order of administration was counterbalanced; the mean Full Scale IQ and Index scores on the WAIS‐III and WISC‐IV were compared. Results The WAIS‐III mean Full Scale IQ was 11.82 points higher than the mean Full Scale IQ score on the WISC‐IV. Significant differences were also found between the Verbal Comprehension Index, Perceptual Reasoning/Organization Index and Processing Speed Index on the WAIS‐III and WISC‐IV, all with the WAIS‐III scoring higher. Conclusions The findings suggest that the WAIS‐III produces higher scores than the WISC‐IV in people with intellectual disabilities. This has implications for definitions of intellectual disability and suggests that Psychologists should be cautious when interpreting and reporting IQ scores on the WAIS‐III and WISC‐IV.     

智残评定量表在司法精神鉴定案例中的应用研究

目的 :比较和分析司法鉴定中应用成人智残评定量表和成人智力测验对智力残疾进行等级评定的差异和一致性。案例和方法 :案例 6 0例 ,均来自 2 0 0 2～ 2 0 0 3年 3月在本鉴定中心鉴定的案例 ,分别应用成人智残评定量表和成人智力测验对智力水平进行评定 ,测定结果按照《中国实用残疾人评定标准 (试用 )》进行残疾等级分级 ,统计结果用spss11 0进行统计。结果 :分别应用成人智残评定量表和成人智力测验进行智残等级分级不存在统计学差异 (P >0 0 5 ) ,两者的相关系数为 0 75 1(P <0 0 0 1) ,说明智商分级结果与量表评定结果是一致的 ,但不是量表评定的每个等级与IQ等级都一致。两者符合率最高的为中度智力残疾等级 ,符合率为 76 9%。极重度符合率最低。讨论 :在司法鉴定中的智残等级评定 ,智力测验是很重要的指标 ,但影响智力测验结果的因素很多 ,测得的IQ值应作为参考 ,成人智残评定量表更接近实际。     

The Leicestershire Intellectual Disability Tool: A Simple Measure to Identify Moderate to Profound Intellectual Disability

Background It is often useful to ascertain whether adults have moderate to profound intellectual disability (approximate IQ < 50; developmental age <108 months) when deciding whether to refer to specialist or mainstream services. The aim of the present study was to develop a simple measure to estimate moderate to profound intellectual disability in adults with a potential need for specialist care. Materials and Methods Three hundred and twenty‐two individuals with information on home interviews from the Leicestershire Learning Disability Register were also assessed using the Vineland Adaptive Behaviour Scales. A variety of variables concerning intelligence, adaptive functioning and dependency were used to predict developmental age (as estimated from the Vineland) using backward stepwise regression. The derived equation formed the Leicestershire Intellectual Disability (LID) tool. A cut‐off point was chosen using a receiver operator characteristic (ROC) curve to achieve 95% sensitivity in identifying moderate to profound intellectual disability. Results Seven variables from the home interviews were found to predict estimated developmental age at the 10% level (P ≤ 0.1). When the tool was used to detect adults with moderate to profound intellectual disability, the area under the ROC curve was 0.93. The chosen cut‐off point was 95% sensitive and 65% specific. The positive predictive value was 95%, the negative predictive value was 65%, and the overall diagnostic accuracy was 91%. Conclusions These preliminary findings suggest that the LID tool may help to identify adults with moderate to profound intellectual disability among those with potential need for specialist care. Further evaluation is recommended.     

A new reliable tool (PVC assess) for assessment of peripheral venous catheters

Rationale and aims To evaluate the extensive use of peripheral venous catheters (PVCs), including catheter‐related complications, a reliable tool for PVC assessment is needed. The aim of this study was to develop such a tool to evaluate PVCs in relation to management, documentation and signs and symptoms of thrombophlebitis (TH), as well as to determine its inter‐rater and test‐retest reliability. Method The tool development included confirmation of content and face validity. Two groups of registered nurses used the new tool (PVC assess ) to assess PVC management and signs of TH independently. Group A (n = 3) assessed 26 items in 67 PVCs bedside (inter‐rater reliability). Group B (n = 3) assessed photographs (67 PVCs, 21 items) of the same PVCs as those in Group A with a 4‐week interval (test‐retest reliability). Proportion of agreement P(A) and Cohen's kappa were calculated to evaluate inter‐rater and test‐retest reliability. Results Among nurses assessing PVCs at bedside, the P(A) was good to excellent (0.80–1) in 96% of the items in PVC assess . In 80% of the items kappa was substantial to almost perfect (0.61–1). TH sign erythema fell into the fair range (kappa = 0.40). In test‐retest reliability analysis the P(A) was within the good and excellent range (0.80–1.0) and kappa varied from moderate to almost perfect (0.41–1.0) in 95% of the items. One item ‘outer dressing is clean’ was in fair range (0.21–0.40). Conclusions The PVC assess instrument shows satisfactory inter‐rater and test‐retest reliability. Reliability tests on reviewing documentation remain to be performed.     

Estimating IQ from Adaptive Behaviour Information in People with Moderate or Severe Intellectual Disability

It is often useful in studies of intellectual disability to be able to stratify the sample in terms of intellectual level. However, this information is sometimes difficult to obtain, and can involve a great deal of time if full IQ assessments are performed. This study explores the accuracy with which IQ scores can be projected by multiple regression from adaptive behaviour scores provided by informants. Fifty-one people with moderate, severe or profound intellectual disability received IQ assessments using the Kaufman Assessment Battery, and adaptive behaviour assessments using the Adaptive Behavior Scales (ABS). Ninety percent of projected estimates differed by less than 30% from that estimated by the K-ABC. Mean percentage divergence between actual and predicted estimates of IQ for the 51 cases for which all data were available was 15.0%. Limitations of the technique are discussed. The actual coefficients for calculating IQ are given in tabular form.     

‘Diagnostic Overshadowing’ Amongst Clinicians Working with People with Intellectual Disabilities in the UK

Background Mental health problems are known to be hard to recognize in people with intellectual disabilities. One factor that may contribute to this is the diagnostic overshadowing bias, which describes the tendency of the clinicians to overlook symptoms of mental health problems in this client group and attribute them to being part of ‘having an intellectual disability’. Although a small amount of research has investigated this in the USA, very little has taken place in the UK. Materials and methods Two clinical vignettes were produced. Both described identical clinical problems, except that one vignette described a man with an IQ of 58 and impaired social functioning (i.e. an intellectual disability) and one a man with an IQ of 108 and normal social functioning (i.e. non‐intellectually impaired). Psychiatrists (n = 274) and clinical psychologists (n = 412) throughout UK were randomly assigned to either the low IQ or normal IQ condition, and sent a corresponding clinical vignette. Results One hundred and thirty‐three psychologists and 90 psychiatrists responded. Diagnostic overshadowing did appear to be present. Clinicians were more likely to recognize a range of symptoms in those with IQs in the normal range than those with intellectual disabilities. Furthermore, psychiatrists appeared more likely to make this error under some circumstances than clinical psychologists. Conclusions Diagnostic overshadowing may contribute to the difficulties that mental health professionals commonly experience in identifying mental health problems in people with intellectual disabilities. However, the methodology commonly used in this type of research has a number of weaknesses, and would benefit from an alternative approach.     

Promoting Leisure Physical Activity Participation among Adults with Intellectual Disabilities: Validation of Self‐Efficacy and Social Support Scales

Background Many individuals with intellectual disabilities are not sufficiently active for availing health benefits. Little is known about correlates of physical activity among this population on which to build health promotion interventions. Materials and Methods We developed scales for measurement of self‐efficacy and social support for leisure physical activity among adults with intellectual disabilities. Study participants were 152 adults with mild to moderate intellectual disabilities. Results The scales demonstrated good internal consistency and fair to excellent test–re‐test reliability. Confirmatory factor analyses revealed good fit for each of the scales, supporting the hypothesized structure of each. Scales also correlated with self‐reported leisure physical activity, providing evidence of construct validity. Conclusions Studies of physical activity correlates are needed to formulate evidence‐based programmes to promote physical activity participation. This measure demonstrated good psychometric properties, and will be useful for examining social support and self‐efficacy for physical activity by adults with intellectual disabilities.     

Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research

Background The Cochrane Collaboration is strongly encouraging the use of a newly developed tool, the Cochrane Collaboration Risk of Bias Tool (CCRBT), for all review groups. However, the psychometric properties of this tool to date have yet to be described. Thus, the objective of this study was to add information about psychometric properties of the CCRBT including inter‐rater reliability and concurrent validity, in comparison with the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). Methods Both tools were used to assess the methodological quality of 20 randomized controlled trials included in our systematic review of the effectiveness of knowledge translation interventions to improve the management of cancer pain. Each study assessment was completed independently by two reviewers using each tool. We analysed the inter‐rater reliability of each tool's individual domains, as well as final grade assigned to each study. Results The EPHPP had fair inter‐rater agreement for individual domains and excellent agreement for the final grade. In contrast, the CCRBT had slight inter‐rater agreement for individual domains and fair inter‐rater agreement for final grade. Of interest, no agreement between the two tools was evident in their final grade assigned to each study. Although both tools were developed to assess ‘quality of the evidence’, they appear to measure different constructs. Conclusions Both tools performed quite differently when evaluating the risk of bias or methodological quality of studies in knowledge translation interventions for cancer pain. The newly introduced CCRBT assigned these studies a higher risk of bias. Its psychometric properties need to be more thoroughly validated, in a range of research fields, to understand fully how to interpret results from its application.     

The Prevalence of Psychiatric Disorders among People with Intellectual Disabilities: An Analysis of the Literature

Background It has often been stated that the prevalence of psychiatric disorders in people with intellectual disabilities is greater than it is in the population as a whole. Method The epidemiological studies on psychiatric disorders in people with intellectual disabilities were reviewed. Results There is evidence that the prevalence of psychiatric disorder is greater in children with intellectual disabilities, compared with children with normal IQs, that it is higher in both adults and children with severe intellectual disabilities compared with people with mild or no intellectual disability and that the rate of problematic behaviour is higher in both adults and children having intellectual disabilities, than in their non‐disabled peers. Conclusions There is no sound evidence that the prevalence of psychiatric disorders in adults with mild intellectual disability is greater than in the population as a whole.     

Reliability of the de Morton mobility index (DEMMI) in an older acute medical population

Background. The de Morton Mobility Index (DEMMI) is an instrument that accurately measures the mobility of older people across clinical settings. Purpose. To report the multiple reliability studies conducted during the development and validation of the DEMMI. Methods. Intra‐rater and inter‐rater reliability studies were conducted for the DEMMI in two independent samples (development and validation samples) of older acute medical patients (aged 65 years or older). Inter‐rater reliability studies were conducted between the test developer (a physiotherapist) and another experienced physiotherapist. Order of assessor administration was randomized by a coin toss. Patients who were fatigued after the first assessment were excluded from the inter‐rater reliability study. Intra‐rater reliability studies included participants with ‘unchanged’ mobility status between hospital admission and discharge. Scale reliability estimates were expressed as the minimal detectable change with 90% confidence (MDC₉₀). Item reliability was calculated using Kappa statistics and absolute percentage agreement. Results. The MDC₉₀ for the DEMMI development sample was 9.51 points (95% confidence interval [95% CI], 5.04–13.32; n = 21) and 7.84 (95% CI, 4.34–11.65; n = 16) on the 100‐point interval DEMMI scale for the inter‐rater and intra‐rater reliability studies, respectively. Similar estimates were obtained for the DEMMI validation samples of 8.90 (95% CI, 6.34–12.69; n = 35) and 13.28 points (95% CI, 8.08–20.87; n = 19). Items were not excluded from the DEMMI based on the results of item reliability. Conclusion. Reliability estimates for the DEMMI were consistent across independent samples of older acute medical patients using different reliability study methodology. Error represents approximately 9% of the DEMMI scale width. Copyright © 2010 John Wiley & Sons, Ltd.