The Prevalence and Characteristics of Intellectual and Borderline Intellectual Disabilities in a Sample of Inpatients with Substance Use Disorders: Preliminary Clinical Results

Introduction: There is reason to believe that many individuals with substance use disorders (SUD), who are in contact with services, have an undiagnosed intellectual disability. The aim of the present study was to investigate the prevalence of intellectual and borderline intellectual disabilities (ID/BID) among inpatients with SUD and to further explore their characteristics. Methods: Ninety-one SUD inpatients aged 19–64 participated in the study. SUD was diagnosed according to the ICD-10. ID/BID was diagnosed through the Wechsler Adult Intelligence Scale, the Vineland Adaptive Behavior Scale, and self-reported childhood learning difficulties. Results: ID/BID prevalence was up to 30%. There were significant differences between ID/BID and non-ID groups for several social variables. With the exception of substance-use relapse, there were no significant differences in substance-related factors. Conclusions: ID/BID prevalence in SUD might be high. These conditions often go undiagnosed in SUD treatment. The conditions and associated difficulties should be identified for better understanding and individually adapted treatment.     

Comparing Rates of Psychiatric and Behavior Disorders in Adolescents and Young Adults with Severe Intellectual Disability with and without Autism

Eight males and four females with an Autism Diagnostic Interview-Revised (ADI-R) diagnosis of autism (mean age of 16.3 years) and severe intellectual disability (IQ < 40) were individually matched to controls on the basis of chronological age, gender, and nonverbal IQ. The dependent measure was the Diagnostic Assessment for the Severely Handicapped-II, which is used to screen for psychiatric and behavior disorders in lower-functioning individuals. Participants with autism showed significantly greater disturbances as measured by the Diagnostic Assessment for the Severely Handicapped-II total score and seven of 13 subscales. They also averaged 5.25 clinically significant disturbances compared with 1.25 disturbances for participants without autism. Specific vulnerabilities to anxiety, mood, sleep, organic syndromes, and stereotypies/ tics were found in the participants with comorbid autism.     

Mental Disorders and Problem Behavior in a Community Sample of Adults with Intellectual Disability: Three-Month Prevalence and Comorbidity

The aim of this study was to investigate the prevalence of mental disorders in a Norwegian sample of adults with intellectual disability (ID) using the Psychopathology Checklists for Adults With Intellectual Disability (P-AID; Hove & Havik, 2008 Hove, O. and Havik, O. E. 2008. Psychometric properties of Psychopathology Checklists for Adults With Intellectual Disability (P-AID) on a community sample of adults with intellectual disability. Research in Developmental Disabilities, 29: 467–482.  [Google Scholar]), a screening instrument adopting diagnostic criteria from the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Intellectual Disability/Mental Retardation (DC-LD; Royal College of Psychiatrists, 2001 Royal College of Psychiatrists. 2001. DC-LD: Diagnostic criteria for psychiatric disorders for use with adults with learning disabilities/mental retardation, London: Gaskell.  [Google Scholar]). The P-AID checklists, comprising 10 psychiatric diagnoses and 8 types of problem behaviors, were completed by staff at community-based homes for adults with ID in Western Norway. One in three adults with ID showed indices of a mental disorder. Problem behavior was the most prevalent single diagnosis next to anxiety and affective disorder, and there was a high frequency of comorbidity among the disorders. The findings extend previous reports on mental disorders and comorbidity and support the use of DC-LD in epidemiological research.     

Psychometric Qualities of the Dutch Version of the Substance Use Risk Profile Scale Adapted for Individuals with Mild Intellectual Disabilities and Borderline Intellectual Functioning

ABSTRACT

Introduction

Personality traits may predict the use of substances in individuals with mild intellectual disabilities (MID) or borderline intellectual functioning (BIF). The Dutch version of the Substance Use Risk Profile Scale (SURPS), adapted for this population, was tested on its psychometric properties.     

Reliability and Validity of a German Version of the Questions About Behavioral Function (QABF) Scale for Self-Injurious Behavior in Individuals With Intellectual Disabilities

The psychometric properties of a German version of the Questions About Behavioral Function Scale (QABF) (Matson & Vollmer, 1995 Matson, J. L. and Vollmer, T. R., eds. 1995. User's guide: Questions About Behavioral Function (QABF), Baton Rouge, LA: Scientific Publishers.  [Google Scholar]) were examined in a sample of 522 individuals with intellectual disabilities residing in large facilities participated. The factor structure was first examined by exploratory factor analysis, yielding a five-factor-solution that was identical to the one described by the authors of the QABF and was statistically and clinically meaningful. Furthermore the factor structure was validated by confirmatory factor analysis. Fit indices indicated satisfactory model fit. Internal consistency was found to be good with Cronbach's alphas ranging from .84 to .62.

Interrater reliability was fair with intraclass correlations ranging from .66 to.58.     

Characteristics of Aggressive Behavior in People With Mild to Borderline Intellectual Disability and Co-Occurring Psychopathology

Introduction: People with intellectual disabilities and co-occurring psychopathology have a relatively high likelihood to engage in aggressive behavior. Nevertheless, structured clinical assessment of aggressive behavior, including when and where it occurs, is scarce in this population. Methods: On three wards specializing in the care for people with mild to borderline intellectual disability and co-occurring psychopathology, staff members completed the Staff Observation Aggression Scale–Revised adapted for people with intellectual disabilities (SOAS-R-ID) during a nine-month period, every time they witnessed aggressive behavior. Results: Based on 236 SOAS-R-ID forms, it was found that aggressive incidents were most common on Thursdays, and on two specific moments of the day (between 9–11 a.m. and 7–9 p.m.). The aggressive behavior was often exclusively of a verbal nature and was usually targeted against staff members (77.1% of the incidents). The Interclass (Pearson) Correlation Coefficient agreement between observers on the total score of the SOAS-R-ID was 0.72. Correlation between the judgment of the severity of aggressive behavior made by the staff members and the SOAS-R-ID severity scores was moderate (r = .40), but significant. Conclusions: Because aggressive behavior appeared to result often from interactions between the client and staff member or other clients, these interactions might be an important starting point for interventions. Structured clinical assessment of aggressive behavior can help to devise and test the effects of interventions. The SOAS-R-ID seems to be a clinically useful instrument and could therefore help to reduce the frequency of these incidents in the future.     

Beliefs About Aggression and Submissiveness: A Comparison of Aggressive and Nonaggressive Individuals with Mild Intellectual Disability

Recent research has examined the relevance of the social information processing model of aggression to individuals with intellectual disability (ID). This study investigated the “response access” and “response decision” steps of this model. Photo stories were used to compare aggressive and nonaggressive individuals' beliefs about the outcomes of responding aggressively and submissively in situations of interpersonal conflict. Coding of participants' open-ended answers indicated that aggressive individuals anticipated that aggressive responses would result in more favorable outcomes than their nonaggressive peers. The aggressive participants also made more negative evaluations of submissive responses. These findings have important implications for the assessment and treatment of aggression with people who have mild ID.     

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.     

Sleep Disturbances in Adults with Autism Spectrum Disorders and Severe Intellectual Impairments

Sleep disturbances are a significant problem for persons with developmental disabilities. These problems occur at a higher rate than what is observed in the typically developing population, and persons with Autism Spectrum Disorders (ASD) appear to be at a higher risk than individuals with other developmental disabilities. However, another major risk is intellectual disability (ID). These two groups of disorders overlap to a substantial degree. Thus, persons with ASD and ID appear to be particularly susceptible to sleep disturbances. These sleep problems can have serious consequences beyond sleep, particularly with respect to increased challenging behaviors and as an impediment to learning. Despite these concerns, adults with ASD and ID have been largely neglected with respect to the study of these nocturnal difficulties. In this report, 168 adults with ASD and ID were compared to 166 adults with ID alone in regard to sleep disturbance and related difficulties. Individuals in the ASD group presented with much higher rates of sleep disturbances, and greater severity of sleep disorder was related to the expression of more serious challenging behaviors. The implications of our results are discussed for future assessment and treatment of these disorders.     

Psychometric qualities of a tetrad WAIS-III short form for use in individuals with mild to borderline intellectual disability

Objective: To investigate the reliability and validity of a Wechsler Abbreviated Scale of Intelligence-based Wechsler Adult Intelligence Scale – third edition (WAIS-III) short form (SF) in a sample of individuals with mild to borderline intellectual disability (MBID) (N?=?117; M_IQ?=?71.34; SD_IQ?=?8.00, range: 52–85). Methods: A full WAIS-III was administered as a standard procedure in the diagnostic process. Results: The results indicate an excellent reliability (r?=?0.96) and a strong, positive correlation with the full WAIS-III (r?=?0.89). The SF correctly identified ID in general and the correct IQ category more specifically in the majority of cases (97.4% and 86.3% of cases, respectively). In addition, 82.1% of the full scale IQ (FSIQ) estimates fell within the 95% confidence interval of the original score. Conclusions: We conclude that the SF is a reliable and valid measure to estimate FSIQ. It can be used in clinical and research settings when global estimates of intelligence are sufficient.     

Psychopathology in Children with Intellectual Disability: Risk Markers and Correlates

The purpose of this literature review was to summarize studies examining risk factors, markers, and correlates of psychopathology in youngsters with intellectual disability. A total of 26 studies met inclusion criteria and were reviewed. Due to the limitations of research methods (i.e., not establishing precedence), no risk factors were identified. The majority of variables examined were risk markers (i.e., age, sex, level of functioning). The most consistent age finding was that hyperactivity and/or conduct disorder symptoms were negatively associated with age. Sex effects were equivocal but suggested that boys had more disruptive behavior problems than girls. Specific patterns emerged in regard to level of functioning. Those with milder delays were more likely to have disruptive and emotional disorders. Conversely, those with more severe delay had higher rates of stereotypy, self-injury, and social isolation and were less likely to show symptom improvement over time. This review also identified correlates of emotional and problem behavior such as parent psychopathology and stress and dysfunctional home environment. Parallels were drawn with the general child psychopathology field and further research directions were discussed.     

Looking for a Needle in the Haystack: Arsonists with Intellectual Disability in Australia

Arson attracts substantial penalties in Australia, reflecting the serious consequences of the crime. It is often asserted that people with intellectual disability are particularly likely to commit arson offences, and yet it is difficult to establish the prevalence in this population. This study sought to describe the characteristics of those people appearing in Australian Courts who have an intellectual disability and have been charged with arson. A search of the AustLII, LexisNexisAU and WestLawAU databases over the 10-year period from 2003 to 2013 identified 50 arson convictions reported in case law. Of these, six involved an offender with an identified intellectual disability. These offenders were likely to have committed other crimes at the time, or to have prior offences and were likely to receive longer sentences of imprisonment than their non-intellectually disabled counterparts. These findings are discussed in terms of the barriers that exist to understanding more about this under-researched population.     

Reliability and Validity of the SAINT: A Guided Self-Help Tool for People With Intellectual Disabilities

This study investigated the main psychometric properties of the Self Assessment and Intervention (SAINT), a unique and recently developed Guided Self-Help tool for people with intellectual disabilities (ID). Fifty-four adults with ID identified with symptoms of anxiety and/or depression completed the study. They were between 18 and 77 years old with a mean of 39.4 years of age (SD = 13.57). Participants were recruited from both community (n = 31, 57.4%) and inpatient settings (n = 23, 42.6%). The Glasgow Depression Scale-Learning Disabilities (GDS-LD) and Glasgow Anxiety Scale-Intellectual Disabilities (GAS-ID) were used as expert measures. Convergent validity, concurrent validity, test-retest, and internal consistency were all tested on the SAINT in comparison with the GDS-LD and GAS-ID as appropriate. There were no missing data from the questionnaires. Cronbach's alpha suggested high internal consistency for the SAINT questionnaire at 0.827 and interitem correlation for internal consistency of the SAINT for any item deleted ranged from 0.788 to 0.826. In terms of convergent validity using the Spearman's Rho correlation coefficient the SAINT showed significant correlation at the 0.01 level (2-tailed) with the GDS-LD (r = 0.707), GAS-ID worries subscale (r = 0.578). The correlation for test-retest (n = 20, 37%) between Time 1 and Time 2 was r = 0.897, p < .01. The SAINT has demonstrated potential as a measure for investigating mental distress for people with ID. One of the unique benefits of the SAINT is that it has a different utility from other measures used in this study that focus on psychopathology. The SAINT has not been designed as a diagnostic tool and aims to get the person to recognize and report a set of symptoms that indicates mental distress and to employ coping strategies once identified.     

How is Anxiety Identified and Diagnosed in Individuals with Autism Spectrum Disorder and Intellectual Disability? A Scoping Review

ABSTRACT

Introduction: Individuals with Autism Spectrum Disorder display a pattern of social communication deficits and restricted and repetitive behaviors that leave them particularly vulnerable to developing anxiety. The presence of a co-occurring Intellectual Disability further complicates the situation, compromising traditional diagnostic techniques and processes. The dual diagnosis of ASD and ID appears to result in specific behavioral patterns that affect the way anxiety is identified in this population.

Method: A scoping review was undertaken to explore what is currently known about the way anxiety is identified and diagnosed in individuals with ASD and ID.

Results: In the limited research available consistent themes of difficulties with the diagnostic process, inconsistencies among measurement tools and the need to consider behavioral symptomology were found.

Conclusion: Further research needs to be conducted to enhance our understanding of how anxiety is identified in those with ASD and ID. This research could more accurately inform reliable diagnostic processes and lead to better treatment and outcomes for this population.     

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.     

Assessing emotional and behavioral problems in children with intellectual disability: revisiting the factor structure of the developmental behavior checklist

The objective of the reported study was to reassess the factor structure of the Developmental Behaviour Checklist (DBC) in a large cross-cultural sample representing all levels of intellectual disability. Parent and teacher DBC ratings on a combined sample of 1536 Dutch and Australian children and adolescents (ages 3–22) with mild to profound intellectual disability were used. Principal components analyses produced five subscales: Disruptive/Antisocial, Self-Absorbed, Communication Disturbance, Anxiety, and Social Relating, explaining 43.7% of the total variance. Internal consistencies of these subscales ranged from .66 to .91. The revised factor structure of the DBC appears to be an improved and useful tool for assessing emotional and behavioral problems in children with intellectual disabilities.