Symptoms of psychopathology in adults with intellectual disability and seizures

Seizures are more common in individuals with intellectual disabilities than in the general population. As a result, differences in functioning for individuals with intellectual disability with and without seizures have been evaluated. Research on differences in psychopathology for individuals with intellectual disability with and without seizures has been mixed. The purpose of this study was to examine differences in subscale scores on the Diagnostic Assessment for the Severely Handicapped-II (DASH-II) between individuals with intellectual disability with and without seizures. In this study, 321 individuals from two large developmental centers in the southeastern United States were administered the DASH-II. Researchers found that the seizure group endorsed significantly more symptoms on the mood subscale than the group without seizures. No other group differences were found to be significant. Implications of these results are discussed.     

Psychiatric disorders and behavior problems in people with intellectual disability

The relationship between behavior problems and psychiatric disorders in individuals with intellectual disability is still unresolved. The present study compares the prevalence and pattern of psychiatric disorders in individuals with intellectual disability who were assessed on the ABC to have moderate and severe behavior problems and a matched group of individuals without such problems. Both groups were living in community settings and had their intellectual disability varied from mild to profound degrees. The participants were screened for psychiatric disorders using four different instruments; the Reiss Screen, the Mini PAS-ADD, the DASH-II and the ADD. The group with moderate and severe behavior problems showed significantly more symptoms of psychiatric disorders than the group without such problems when items related to behavior disorders were omitted, and the majority of the participants with behavior problems had symptoms of the main psychiatric disorders. The participants with mild and moderate intellectual disability showed more symptoms of psychosis and depression than the participants with severe and profound intellectual disability. There were no direct associations between individual behavior problems and psychiatric disorders, but the group with mild/moderate intellectual disability showed a somewhat different pattern of associations than the group with severe/profound intellectual disability. Depression was associated with screaming and aggression in the participants with severe and profound intellectual disability, and with self-injury in the participants with mild and moderate intellectual disability. The finding that the majority of the participants with behavior problems showed symptoms of psychiatric disorders suggests that many behavior problems may be (unconventional) symptoms of psychiatric disorders or reflect a difficult life situation caused by a psychiatric disorders, or that a difficult life situation may contribute to both psychiatric disorders and behavior problems in individuals with intellectual disability.     

Validity of the Autism/Pervasive Developmental Disorder Subscale of the Diagnostic Assessment for the Severely Handicapped-II

This study was designed to establish the empirical validity of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II) to screen for the presence of autism in severely and profoundly mentally retarded adults. Participants included 51 individuals residing in a large developmental center in Central Louisiana. The Autism/Pervasive Developmental Disorder subscale of the DASH-II was internally consistent. Additionally, the DASH-II was just as likely as the Childhood Autism Rating Scale (CARS) to classify autistic and control individuals. Specific items on the subscale were examined to identify those items most associated with a diagnosis of autism.     

Mania and behavioral equivalents: A preliminary study

Previous research has failed to address the possibility of behavioral equivalents in people with ID and mania. The relationship between a measure of mania and possible behavioral equivalents was assessed in 693 adults, most with severe or profound ID, living in a large residential setting. The mania subscale of the DASH-II proved to be a homogenous scale, suggesting that this may be a valid measure of mania in individuals with ID. Both item and factor analyses and correlations showed that many behavioral items acceptably correlated with the mania items. There may be some challenging behaviors that are related to mania in individuals with ID. A factor analysis noted a decreased need for sleep, restlessness, agitation, and irritability as items associated with mania.     

Investigating the relationship between challenging behavior, co-morbid psychopathology and social skills in adults with moderate to severe intellectual disabilities in Ireland

Researchers suggest that social skill deficits and psychiatric issues may be affected by the presence of maladaptive behaviors in people with intellectual disabilities. A sample of 39 participants with intellectual disability was surveyed for the presence of psychiatric symptoms and social skills deficits. Outcomes indicated that individuals with severe challenging behaviors scored significantly higher than those without problem behaviors in terms of presence of psychiatric symptoms in ten of the thirteen subscales of the DASH-II. Results also showed that individuals with severe problem behaviors scored significantly lower on social skills measures, using the MESSIER, than those without. A significant difference was observed between participants presenting with psychiatric symptoms and those who did not in terms of social skills, with the former scoring significantly lower than the latter. Results of the study provide weight to current research supporting the relationships between problem behaviors, co-morbid psychopathology and social skill deficits. This information could be used to further develop positive supports for adults with intellectual disability and challenging behaviors in order to improve their quality of life, community inclusion and social networks.     

Characteristics of schizophrenia among persons with severe or profound mental retardation

The symptoms of schizophrenia were examined in a residential sample of adults with severe or profound mental retardation. Three groups were compared: those with a significant elevation on the schizophrenia subscale of the Diagnostic Assessment for the Severely Handicapped (DASH-II) and a psychiatric diagnosis of schizophrenia; those with a significant elevation on the same subscale but no formal diagnosis of schizophrenia; and those with no elevation on any of the DASH-II subscales. A one-way analysis of variance showed statistically significant differences between the groups. Symptoms of schizophrenia among those in the first group were found to fall mainly into the categories of reality distortion and disorganization, with less evidence of negative symptoms.     

Screening individuals with intellectual disability for psychiatric disorders: comparison of four measures

Convergences and divergences between four of the most commonly used checklists for psychiatric disorders (the Reiss Screen, The Mini PAS-ADD, the DASH-II, and the ADD) were examined. We screened 181 individuals with intellectual disability for psychiatric disorders with the four checklists and compared the results on the checklists. The concordance of the overall scores on the four checklists was high; but the agreement on specific psychiatric disorders was limited. The results indicate that the checklists are useful as general indicators of psychiatric disorders, but are of less value for specifying the nature of the disorders in individuals with intellectual disability.     

The relationship between psychopathology symptom clusters and the presence of comorbid psychopathology in individuals with severe to profound intellectual disability

In the typically developing population, comorbid psychopathology refers to the co-occurrence of two different psychopathologies other than cognitive impairments. With respect to individuals with intellectual disability, comorbidity is often described as cognitive deficits and one additional psychopathology manifesting together. However, just as within the typically developing population, individuals with intellectual disability may also present with symptoms of two or more additional disorders. The presentation of these symptom clusters may similarly correlate. Therefore, the current study used the Diagnostic Assessment for the Severely Handicapped—II in order to examine relationships between psychopathological symptom clusters in adults with severe to profound intellectual disability. Additionally, we assessed comorbid presentation of disorders other than cognitive impairments in these same adults. Several symptom clusters were identified as being related with moderate to strong positive correlations. Furthermore, elevations on the Impulse subscale were noted to be the most prevalent in the current sample, with comorbid elevations most commonly occurring along the Mood, Mania, and Anxiety subscales. The significance of these findings is discussed.     

Patterns of emotional and behavioural disturbance associated with autistic traits in young people with severe intellectual disabilities and challenging behaviours

Emotional and behavioural disturbance was assessed in 82 individuals with severe intellectual disabilities and challenging behaviour using the Diagnostic Assessment for the Severely Handicapped-II (DASH-II). Levels of disturbance were compared firstly in individuals with and without features of autism as assessed by the DASH-II, and secondly in individuals with varying severities of autism. In both cases levels of ability and overall severity of behaviour disorder were comparable across groups. Individuals with autistic features were found to have significantly higher scores than nonautistic individuals on the DASH-II organic disorder, anxiety, mania, PDD/autism and stereotypies subscales. When participants with autistic features were separated into groups of severe and moderate autism and compared with nonautistic participants, significant effects of group were found for scores on the anxiety, mood, mania, PDD/autism, schizophrenia and stereotypies subscales. Scheffé tests were conducted to further evaluate between-group differences. Item analysis showed seven DASH-II items to have a 30% or more difference between levels of endorsement in autistic and nonautistic individuals, with six further items showing a 20% or greater difference in levels of endorsement. Findings are compared to those from previous research and implications for the conceptualisation of emotional and behavioural disorders in individuals with autism are discussed.     

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.     

Incidence and trends in psychopathology symptoms over time in adults with severe to profound intellectual disability

Individuals with intellectual disability (ID) have a high risk for developing comorbid psychopathology. While researchers have shown that symptoms of psychopathology remain relatively stable in children with ID over time, little research has been conducted to demonstrate symptom stability for adults with ID. Incidence of psychopathology symptoms was examined in 124 adults with severe to profound ID. Then, trends in symptoms of psychopathology over time were studied in 74 of those individuals who had data collected quarterly over the span of one year. Data from the Diagnostic Assessment for the Severely Handicapped - Second Edition (DASH-II) were evaluated for each of the 13 subscales, as well as the total DASH-II score. For all of the scales except PDD/Autism, symptoms did not fluctuate significantly over the one year period. The PDD/Autism scale revealed a significant change in symptoms from Time 1 to Time 3. The implications of these results are discussed.     

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.     

Correlates of restraint use in an institutional population: a replication

Background Reducing inappropriate restraint is an important mission of services for people with intellectual disabilities (IDs). Methods In this study, 52 clients who had been restrained were compared with 52 other clients, individually matched on age, gender and level of IDs. Participants were mostly adults with severe and profound IDs in an institutional setting. Results The two groups differed on six Diagnostic Assessment for the Severely Handicapped-II (DASH-II) and three Aberrant Behaviour Checklist (ABC) scales. However, discriminant functional analysis demonstrated that only DASH-II Impulse control disorder and ABC Irritability and Elimination disorder scores predicted group membership but only moderately. Conclusions Individual differences in maladaptive behaviours were only moderately predictive of restraint use.     

CBCL in the assessment of psychopathology in Finnish children with intellectual disability

Structured checklists have been used to supplement psychiatric assessment of children with normal intelligence, but for children with intellectual disability, only a few checklists exist. We evaluated the Child Behavior Checklist (CBCL) in the assessment of psychopathology in Finnish children with intellectual disability. The CBCL was completed by parents or other carers of 90 children aged 6-13 years. Of the 118 CBCL problem items, the lowest scores were for 'Suicidal talks' and 'Alcohol, drugs', and the highest score for 'Acts too young'. Total Problem, Internalizing, and Externalizing scores were highest among children with moderate intellectual disability and lowest among those with profound intellectual disability. Externalizing scores were significantly higher among children with mild or moderate intellectual disability than among those with severe or profound intellectual disability. Compared with the original normative samples, Total Problem scores were higher in the present study. With a T-score cut-off point of 60, the rated frequency of psychiatric disorders was 43%. We conclude that, despite certain limitations, the CBCL can be used in the assessment of psychopathology among children with mild intellectual disability but is less reliable for those with moderate, severe, or profound intellectual disability.     

Characteristics of depression as assessed by the Diagnostic Assessment for the Severely Handicapped-II (DASH-II).

Fifty-seven individuals with severe and profound mental retardation (18 with a DSM-IV diagnosis of depression, 19 with a Diagnostic Statistical Manual, 4th edition diagnosis of autism, and 20 who meet no criteria for an emotional disorder) were studied. The validity of the Diagnostic Assessment for the Severely Handicapped II depression subscale was evaluated to determine its value in categorizing individuals in these two groups. Suggestions were made for diagnosing depression in persons with severe and profound mental retardation. In a second study the above individuals were compared on symptomology to assess comorbidity with related symptoms. These "core," peripheral, or associated features of depression were identified. Implications of the findings for describing and defining depression in these persons are discussed.     

Initial validation of the Brief Assessment of Service Satisfaction in Persons with an Intellectual Disability (BASSPID)

Individuals with an intellectual disability often require intensive services to promote their social participation to the fullest extent. As such, measuring satisfaction with these services appears essential to enhance the quality of life of individuals with an intellectual disability and to improve service delivery within agencies. Thus, the purpose of the study was to conduct an initial validation of the Brief Assessment of Service Satisfaction in Persons with an Intellectual Disability (BASSPID), a 15-item questionnaire designed to assess service satisfaction. To examine the structure, reliability, and validity of the BASSPID, we interviewed 98 individuals with an intellectual disability and 23 parents. Overall, the BASSPID contained one scale, which had strong content and convergent validity as well as items easily understandable for individuals with an intellectual disability. Furthermore, the questionnaire had good internal consistency and adequate test-retest reliability. However, parents generally overestimated the perceived satisfaction of their child. The study suggests that the BASSPID may be useful to assess the satisfaction of individuals with an intellectual disability, but more research is needed to examine its potential impact on improving service quality.     

The relationship of self-injurious behavior and other maladaptive behaviors among individuals with severe and profound intellectual disability

Participants were 101 individuals with self-injurious behavior (SIB) and severe or profound intellectual disability who were matched by gender, age, and level of intellectual disability to controls. Persons with SIB were more likely to exhibit the challenging behaviors of physical aggression, property destruction, sexually inappropriate behaviors and stereotypies when compared to controls, suggestive of co-occurring behaviors. Moreover, the maladaptive behavior of irritability, as assessed by the aberrant behavior checklist (ABC) was able to correctly classify 72.8% of the sample into their respective group memberships. Implications of these findings are discussed.     

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.     

The impact of visual impairment on the ability to perform activities of daily living for persons with severe/profound intellectual disability

BackgroundThe ability to perform activities of daily living (ADL) as a component of participation is one of the factors that contribute to quality of life. The ability to perform ADL for persons experiencing severe/profound intellectual disability (ID) may be reduced due to their cognitive and physical capacities. However, until recently, the impact of the significantly prevalent visual impairments on the performance of activities of daily living has not yet been revealed within this group.AimThe purpose of this prospective cross-sectional study was to investigate the impact of visual impairment on the performance of activities of daily living for persons with a severe/profound intellectual disability.MethodThe Barthel Index (BI) and Comfortable Walking Speed (CWS) were used to measure the ability of performing activities of daily living (ADL) in 240 persons with severe/profound ID and having Gross Motor Functioning Classification System (GMFCS) levels I, II or III; this included 120 persons with visual impairment. The impact of visual impairment on ADL was analyzed with linear regression.ResultsThe results of the study demonstrated that visual impairment slightly affects the ability of performing activities of daily living (BI) for persons experiencing a severe/profound intellectual disability. GMFCS Levels II or III, profound ID level, and visual impairment each have the effect of lowering BI scores.GMFCS Levels II or III, and profound ID level each have the effect of increasing CWS scores, which indicates a lower walking speed. A main effect of visual impairment is present on CWS, but our results do show a substantive interaction effect between GMFCS level III and visual impairment on Comfortable Walking Speed in persons with a severe/profound intellectual disability.ConclusionsVisual impairment has a slight effect on ability to perform ADL in persons experiencing severe/profound ID.