The Center for Epidemiologic Studies Depression Scale: factor validity and reliability in a French sample of adolescents with Intellectual Disability

The purpose of this study was to test the factor validity and reliability of the Center for Epidemiologic Studies Depression Scale (CES-D) within a sample of adolescents with mild to moderate Intellectual Disability (ID). A total sample of 189 adolescents (121 boys and 68 girls), aged between 12 and 18 years old, with mild to moderate ID were involved in two studies. In study 1, the content, phrasing and answering format of the CES-D were adapted for adolescents with ID. This instrument was renamed CES-D for ID (CES-D-ID) and two different versions based on two alternative answer scales (Likert and Likert-graphical) were developed and their psychometric properties were verified in study 2. The results provided support for the factor validity, reliability and invariance across gender and age of a 14-item version of the CES-D-ID based on a Likert-graphical answer scale.     

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

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

Psychometric properties of the revised Developmental Behaviour Checklist scales in Dutch children with intellectual disability

The present study assessed the reliability and validity of the revised scales of the Developmental Behaviour Checklist (DBC) in a Dutch sample of children with intellectual disability (ID). The psychometric properties of the parent and teacher versions of the DBC were assessed in various subsamples derived from a sample of 1057 Dutch children (age range = 6–18 years) with ID or borderline intellectual functioning. Good test–retest reliability was shown both for the parent and teacher versions. Moderate inter‐parent agreement and high one‐year stability was found for the scale scores. Construct validity was satisfactory, although limited by high informant variance. The DBC scales showed good criterion‐related validity, as indicated by significant mean differences between referred and non‐referred children, and between children with and without a corresponding DSM‐IV diagnosis. The reliability and validity of the revised DBC scales are satisfactory, and the checklist is recommended for clinical and research purposes.     

Self-reports on mental health problems of youth with moderate to borderline intellectual disabilities

OBJECTIVE: To determine the extent to which the Youth Self-Report (YSR) can be used to assess emotional and behavioral problems in adolescents with intellectual disabilities (IDs). METHOD: In 2003, 281 11- to 18-year-olds with IDs (IQ > or =48) completed the YSR in an interview, and in 1993, 1,047 non-ID adolescents completed the YSR themselves. Parents completed the Child Behavior Checklist (CBCL). The ID sample was split into lower (IQ 48-69) and higher (IQ > or =70) IQ groups. Cronbach's alpha values of the YSR scales and (intraclass) correlation coefficients between and within YSR and CBCL scale scores were calculated to determine parent-adolescent agreement and YSR construct validity, which were compared between samples. Mean YSR scale scores were compared between adolescents with ID with and without psychiatric symptoms. RESULTS: Cronbach's alpha, parent-adolescent agreement, and indications of construct validity were about similar in all samples, although discriminant validity was somewhat weaker in the lower IQ group. Mean scale scores were 1.5 to 2.0 times higher for ID adolescents with psychiatric symptoms. CONCLUSIONS: The YSR seems applicable in youth with an IQ > or =48. Further research is needed to refine and confirm these findings and the factor structure of the YSR in adolescents with ID and to differentiate between adolescents with moderate and mild IDs.     

Psychometric evaluation of a Dutch version of the Mini PAS‐ADD for assessing psychiatric disorders in adults with different levels of intellectual disability

Background People with intellectual disabilities (ID) have an increased vulnerability to develop psychiatric problems. Moreover, the early recognition and the accurate diagnosis of psychiatric disorders in the population of persons with ID are challenging. Method A Dutch version of the Mini PAS‐ADD, which is a screening instrument for identification of mental health problems in people with ID, was evaluated in terms of internal consistency, interinformant reliability, item grouping and criterion validity based on a large‐scale random sample (n = 377) and a clinical sample (n = 99) of adults with ID. Results The Dutch version of the Mini PAS‐ADD showed moderate internal consistency, and moderate concordance among informants. Both aspects of the reliability were comparable for different levels of ID. A factor analysis largely confirmed the scale structure. Concurrent validity with the Reiss Screen for Maladaptive Behavior was high for the Depression, Psychosis and Autism scale. The outcome of the criterion‐validity analysis indicated high specificity. The sensitivity for specific psychiatric disorders by the corresponding scales was moderate, but the general sensitivity for the presence of psychopathology on the basis of any of the scales was satisfying. Conclusions The present research reconfirmed the use of the Mini PAS‐ADD as a primary screening device for the identification of mental health problems among people with ID.     

Working memory structure in 10- and 15-year old children with mild to borderline intellectual,disabilities

The validity of Baddeley's working memory model within the typically developing population, was tested. However, it is not clear if this model also holds in children and adolescents with mild to, borderline intellectual disabilities (ID; IQ score 55–85). The main purpose of this study was therefore, to explore the model's validity in this population. Several verbal and visuo-spatial STM and WM tasks, were administered to 115 children with mild to borderline ID (mean age 10 years) and to 98, adolescents with mild to borderline ID (mean age 15). Structural equation modeling (LISREL) shows, that Baddeley's working memory model does not fit the data of the 10-year and 15-year old, participants. Principal components analyses on the other hand show a hazy pattern with on the one, side an indication for a ‘general’ component with loadings of visuo-spatial short-term memory and, working memory tasks and a separate verbal short-term memory component. On the other hand there, is also an indication of a modality specific memory structure; a visuo-spatial- versus a verbal, component. A straight-forward dichotomy between STM and WM indicates apparently an, oversimplification, at least it is for children and adolescents with mild to borderline ID.     

The Adolescent and Adult Psychoeducational Profile: Assessment of adolescents and adults with severe developmental handicaps

The purpose of this study was to determine the reliability and validity of the Adolescent and Adult Psychoeducational Profile (AAPEP), an assessment instrument designed for adolescents and adults with severe developmental handicaps. Subjects were 60 adolescents and adults, 30 with autism and 30 with mental retardation but without autism. The groups were matched on age and IQ. Results suggested high interrater reliability on all function areas of the AAPEP (Vocational Skills, Independent Functioning, Leisure Skills, Vocational Behavior, Functional Communication, Interpersonal Behavior) and on all three scales (Direct Observation, Home, School/Work). Validity measures suggested that the recommendations generated from the AAPEP were viewed by blind experts as more helpful than those already generated for the individual clients and contained in their Individual Education Programs (IEPs) or Individual Habilitation Plans (IHPs). Informal measures indicated that parents and/or group home staff also found AAPEP recommendations helpful. Finally, reliability and validity measures were also encouraging for moderately and severely handicapped adolescents and adults without autism. The AAPEP appears to be an effective new instrument for those working with older handicapped clients.     

Psychometric evaluation of a scale to assess satisfaction with life among people with intellectual disabilities living in community residences

Background In the context of a health intervention among people with intellectual disabilities (ID), there was a need to assess satisfaction with some aspects of life, in order to monitor both potential positive and negative effects of the intervention. The aim of the present study was to develop and evaluate an easily administered scale for assessing satisfaction with home environment and leisure time among people with mild or moderate ID, living in community residences. Methods A number of questions were constructed to measure satisfaction with home environment and leisure time. The questions were answered by 132 adults with mild or moderate ID, living in community residences in Sweden. The dimensionality of the scale was evaluated by factor analysis, and the reliability was estimated using Cronbach's alpha coefficients. Results The analysis supported a four‐factor solution with 12 items. The four factors were: (I) Satisfaction with housing environment; (II) Satisfaction with life; (III) Satisfaction with meals; and (IV) Satisfaction with recreational activity. The four factors explained almost 70% of the variance in the data set. Cronbach alpha coefficients for all scales were above 0.70, indicating that the reliabilities of the scales were satisfactory. Correlations between the four sub‐scales ranged from 0.06 to 0.52, indicating low to moderate inter‐correlations between the four sub‐scales. Conclusion The scale has fairly good psychometric properties and is easy to administer. The scale, which can be further improved, can be an important resource in health intervention studies.     

Reliability and Validity of the HoNOS-LD and HoNOS in a Sample of Individuals with Mild to Borderline Intellectual Disability and Severe Emotional and Behavior Disorders

In this study, psychometric properties of the Health of the Nation Outcome scales (HoNOS) and Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) were investigated in a sample (n = 79) of (young) adults with mild to borderline intellectual disability (ID) and severe behavior and mental health problems who were admitted for treatment. Informant pairs were 14 direct care staff and 15 psychiatrists/psychologists who completed both the HoNOS and HoNOS-LD as well as other scales (i.e., Social Functioning Scale for the Mentally Retarded [SRZ-P], Adult Behavior Checklist [ABCL]). Generally, internal consistency was fair to good for both scales, and intraclass coefficients for (sub)scales ranged from fair to good. Low Intraclass Correlation Coefficients (ICCs) were found for several items from both scales. Outcomes pertaining to criterion validity were mixed. Finally, although we found a positive relationship between scores on the HoNOS and HoNOS-LD and those of the ABCL, the relationships between scores of both HoNOS and HoNOS and the SRZ-P were negative. It is concluded that both HoNOS and HoNOS-LD may be used in clients with mild to borderline ID and that outcomes may depend on the type of rater. The HoNOS-LD may be more suitable for assessing general functioning of clients with mild to borderline ID than the HoNOS.     

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.     

Validation of the Korean version of the Eppendorf Schizophrenia Inventory as a screening measure to detect adolescents at ultra‐high risk for psychosis

Aim: No validated self‐report scale is available for use as a screening tool to detect non‐help‐seeking adolescents at ultra‐high risk (UHR) for psychosis in a community setting. The study aims to examine the reliability and validity of the Korean version of the Eppendorf Schizophrenia Inventory (K‐ESI) for assessing adolescents at UHR for psychosis in a community setting. Methods: In the first study, to confirm the reliability and discriminant validity of the K‐ESI, community sample (782 adolescents, 281 young adults, 122 early and middle‐aged adults) and outpatients with schizophrenia (109) were recruited. A single cross‐sectional survey was performed using the K‐ESI for the community sample and the K‐ESI and Positive and Negative Syndrome Scale for patients. In the second study, the Korean version of Youth Self Report (K‐YSR) was administered initially to 1002 students. Of the 217 students whose scores were equal to or higher than the cut‐off point of the K‐YSR, 120 who agreed to an in‐depth evaluation were interviewed using the Comprehensive Assessment of At‐Risk Mental States to confirm the predictive validity of the K‐ESI. Results: The K‐ESI showed good internal consistency and excellent test–retest reliability and discriminant validity. However, the factor structure in adolescents was substantially different from that of the original ESI. The best cut‐off point for the K‐ESI to identify UHR adolescents was 29, with a sensitivity of 77% and a specificity of 70%. Conclusion: The results revealed that the K‐ESI can be used as a valid and reliable instrument to identify adolescents at UHR for psychosis in a community setting.     

Problematic alcohol use and mild intellectual disability: standardization of pictorial stimuli for an alcohol cue reactivity task

The present study focused on the first step in developing a cue reactivity task for studying cognitive biases in individuals with mild to borderline intellectual disability (ID) and alcohol use-related problems: the standardization of pictorial stimuli. Participants (N=40), both with and without a history of alcohol use-related problems and varying in IQ, were admitted to a forensic setting and were all abstinent. They were asked to rate familiarity, complexity, valence and attractiveness of pictures portraying both alcoholic and non-alcoholic beverages. There was a tendency to rate non-alcoholic beverages as more pleasant and attractive than alcoholic beverages. In participants with mild to borderline ID, this difference reached statistical significance, even when controlling for alcohol use-related problems in the past. The overall result of the study is a large database of 255 pictures portraying both alcoholic and non-alcoholic beverages that will be used to validate an implicit measure of cognitive biases for alcohol in individuals with mild to borderline ID.     

Construct validity of the Nutrition and Activity Knowledge Scale in a French sample of adolescents with mild to moderate intellectual disability

The purpose of this study was to test the reliability (i.e. internal consistency and test–retest reliability) and construct validity (i.e. content validity, factor validity, measurement invariance, and latent mean invariance) of the Nutrition and Activity Knowledge Scale (NAKS) in a sample of French adolescents with mild to moderate Intellectual Disability (ID). A total sample of 260 adolescents (144 boys and 116 girls), aged between 12 and 18 years old, with mild to moderate ID was involved in two studies. In the first study, analysis of items’ content reveals that many words from the original version were not understood or induced confusion. These items were reworded and simplified while retaining their original meaning. In the second study, results provided support for: (i) the factor validity and reliability of a 15-item French version of the NAKS; (ii) the measurement invariance of the resulting NAKS across genders and ID levels; (iii) the partial measurement invariance of the resulting NAKS across age groups and type of school placement. In addition, the latent means of the 15-item French version of the NAKS proved to be invariant across gender, age categories, and ID levels, but to vary across type of school placement (with adolescents schooled in self-contained classes from regular schools presenting higher levels of NAK than adolescents placed in specialized establishments). The present results thus provide preliminary evidence regarding the construct validity of a 15-item French version of the NAKS in a sample of adolescents with ID.     

Use of the Interact Short Form as a tool to evaluate emotion of people with profound intellectual disabilities

Background One of the essential purposes of intervention programmes for people with profound intellectual disabilities (ID) is to enhance the desirable mood and behaviour and decrease the undesirable ones through stabilizing their emotion. There is lack of validated instrument to offer a comprehensive measure that covers the mood and behaviour, both desirable and undesirable, appropriate for people with profound ID. Method This study aimed to examine the validity and reliability of the Interact Short Form for evaluating the mood and behaviour of people with profound ID, and at the same time, review their emotional profile using the Interact Short Form. Both content validity using expert panel review and construct validity by means of factor analysis were investigated. A total of 75 people with profound ID were recruited. Inter‐rater reliability was tested. The results of the Interact Short Form were described to reflect the emotional profile of this group of participants. Results Using the results of expert panel review and those from factor analysis, we found three subscales representing the mood and behaviour of people with profound ID. They were: ‘emotional expression’, ‘interests towards tasks’ and ‘behaviours to environment’. All three subscales were found to be internally consistent (α = 0.71–0.88). The Interact Short Form– People with profound ID version also showed good inter‐rater reliability (mean = 0.72). The results of the Interact Short Form showed that this group of participants had fairly stable emotion under the structured setting and activities in the residential institutions where data were collected. Conclusions The Interact Short Form– People with profound ID version serves as a helpful tool for both clinical and research use in assessing the mood and behaviour of people with profound ID in a simple, comprehensive and systematic way.     

Development and preliminary evaluation of a questionnaire on cognitions related to sex offending for use with individuals who have mild intellectual disabilities

Background A number of authors note that distorted cognitions may play a significant role in sex offending behaviour in both the people with intellectual disability (ID) and general populations. However, no scales have been specifically developed for use with individuals with ID. To date, there is no valid, reliable, self‐report questionnaire that assesses cognitive factors in these individuals. This paper aims to develop a valid, reliable self‐report questionnaire to assess antisocial attitudes consistent with sex offending behaviour in individuals who have mild ID. Methods Seventeen male individuals with ID who had sexually offended were compared with two non‐sex offender groups: 19 males with and 36 males without ID. The Questionnaire on Attitudes Consistent with Sex Offending (QACSO) measure was used to establish sexual attitudes in the three groups. The reliability and validity of the QACSO was examined. Results The groups were compared and results demonstrated that the QACSO is a promising tool in terms of providing an internally consistent, reliable and valid indicator of cognitive distortions/attitudes held by sex offenders with ID. Conclusions The limitations, suggestions for modification, potential uses of the questionnaire and directions for further research are proposed.     

Assessing the reading comprehension of adults with learning disabilities

Background This study’s aim was to begin the process of measuring the reading comprehension of adults with mild and borderline learning disabilities, in order to generate information to help clinicians and other professionals to make written material for adults with learning disabilities more comprehensible. Methods The Test for the Reception of Grammar (TROG), with items presented visually rather than orally, and the Reading Comprehension sub‐test of the Wechsler Objective Reading Dimensions (WORD) battery were given to 24 service‐users of a metropolitan community learning disability team who had an estimated IQ in the range 50–79. Results & conclusions These tests were demonstrated to have satisfactory spilt‐half reliability and convergent validity with this population, supporting both their use in this study and in clinical work. Data are presented concerning the distribution across the sample of reading‐ages and the comprehension of written grammatical constructions. These data should be useful to those who are preparing written material for adults with learning disabilities.     

Self-determination, social abilities and the quality of life of people with intellectual disability

Background The international literature has documented that self‐determination is impacted by environmental factors, including living or work settings; and by intraindividual factors, including intelligence level, age, gender, social skills and adaptive behaviour. In addition, self‐determination has been correlated with improved quality of life (QoL). This study sought to contribute to the growing literature base in this area by examining the relationship among and between personal characteristics, self‐determination, social abilities and the environmental living situations of people with intellectual disabilities (ID). Methods The study involved 141 people with ID residing in Italy. Healthcare professionals and social workers who had known participants for at least 1 year completed measures of self‐determination, QoL and social skills. Analysis of variance was conducted to verify whether different levels of intellectual impairment were associated with different degrees of the dependent variables. The Pearson product–moment correlation was used to examine any relationships among dependent variables and IQ scores. Finally, discriminant function analysis was used to examine the degree to which IQ score, age, self‐determination and social abilities predicted membership in groups that were formed based on living arrangement, and on QoL status (high vs. low). Results The anova determined, as expected, that participants with more severe ID showed the lowest levels of self‐determination, QoL and social abilities. Discriminant function analysis showed that (a) individuals attending day centres were distinguished from those living in institutions in that they were younger and showed greater autonomy of choice and self‐determination in their daily activities; (b) basic social skills and IQ score predicted membership in the high or low QoL groups; and (c) the IQ score predicted membership in the high or low self‐determination groups. A manova conducted to examine gender‐ and age‐level differences on self‐determination found gender differences; women had higher self‐determination scores than men. Conclusions These findings contribute to an emerging knowledge base pertaining to the role of intraindividual and environmental factors in self‐determination and QoL. In general, the study replicated findings pertaining to the relative contribution of intelligence to self‐determination and QoL, added information about the potential contribution of social abilities, and pointed to the potentially important role of opportunities to make choices as a particularly important aspect of becoming more self‐determined, at least in the context of residential settings.     

Quality of life of adults with intellectual disabilities who live with families in Taiwan

Background Little research has been conducted about the quality of life (QOL) of people with intellectual disabilities (ID) in Taiwan, particularly their subjective QOL. This study examined the personal perceptions of these individuals as measured on internationally recognized core QOL domains and indicators. Methods A census interview survey was conducted in Hsin‐Chu City in Taiwan; 233 adults aged over 16 years with mild ID and living with their families participated in the study. Data were collected using the Cross‐Cultural QOL Indicators (CCQOLI) together with socio‐demographic data that included ‘activities of daily living’ and ‘instrumental activities of daily living’ (IADL). The CCQOLI were based on the three most commonly reported indicators of each of the eight QOL domains: emotional well‐being, interpersonal relations, material well‐being, personal development, physical well‐being, self‐determination, social inclusion and rights. Each indicator has two sets of questions related to the indicator's ‘importance’ and ‘use’. These are answered by the respondent using a 4‐point Likert scale. Results The importance and use of the QOL indicators were evaluated positively by the respondents. The adults' individual characteristics, namely IADL and educational level, were significant predictors for the ‘importance’ while the adults' perceptions of ‘use’ for overall QOL were significantly affected by his/her socio‐economic data, that is, residence location and father's educational level. Conclusions The present study addressed the issue of self‐reported QOL in people with ID in Taiwanese society, becoming a possible benchmark for similar measurements carried out by disability movements there. These results contribute to current advocacy efforts towards creating a supportive environment for people with ID.     

Reliability and validity of the Junior Temperament and Character Inventory

The Junior Temperament and Character Inventory (JTCI) was developed to assess the temperament (‘novelty seeking’, ‘harm avoidance’, ‘reward dependence’, ‘persistence’) and character (‘self‐directedness’, ‘cooperativeness’, ‘self‐transcendence’) dimensions of Cloninger's biosocial model of personality in children and adolescents. The psychometric properties of the JTCI are presented. We used the German version of JTCI in a clinical sample of 188 adolescent psychiatric patients (aged 12 to 18 years) and in a non‐referred sample of 706 German adolescents of the same age range. Aspects of reliability and validity are discussed. We subjected the JTCI to confirmatory factor analysis and were able to replicate the temperament and character scales of the original TCI. The internal consistency of the scales was satisfactory with the exception of ‘reward dependence’ and ‘persistence’. Construct validity was supported by good correspondence of JTCI dimensions with related constructs. Psychometric properties of the German version of JTCI are very promising. Results yield strong support for Cloninger's psychobiological theory. Copyright © 2001 Whurr Publishers Ltd.     

Assessment and diagnosis of depression in people with intellectual disability

Background Despite widespread acceptance that depression can occur in adults with intellectual disability (ID), the difficulties encountered in its assessment and diagnosis have hampered the individual clinician, and meant that questions of prevalence, treatment choice and outcome remain problematic. Method The present paper reviews the progress in this field since three reviews, all published in the mid‐1990s, recommended further attention to three interlinked issues: diagnostic criteria, the symptoms of depression in this group and the lack of rating scales. Results Despite a further 11 published papers and other studies in progress, the method of diagnosis for people with severe and profound ID remains debatable, with some authors advocating adherence to standard criteria, others suggesting adding criteria to the standard ones and yet others believing that substitute criteria are called for. However, for those with mild to moderate ID, a consensus is emerging that standard diagnostic criteria are appropriate. There has been progress in examining some of the symptoms which might constitute depression in people with ID. New diagnostic criteria issued by the Royal College of Psychiatrists are to be welcomed. There is an assumption in much of the research that symptoms of behaviour commonly termed challenging or maladaptive must be atypical symptoms of depression, but none of the studies reviewed demonstrate this effectively. This is compounded by methodological flaws in the way that depressed samples are arrived at for further study. Although new rating scales have emerged, there is as yet no gold standard diagnostic tool for depression amongst people with ID. Conclusions It is suggested that, given these difficulties, the validity of the conceptual frameworks for depression is still in doubt. It remains the case that large‐scale, collaborative, prospective studies are called for.