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.     

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.     

Validation of a questionnaire on behaviour academic competence among Chinese preschool children

The aim of this study was to validate a questionnaire on academic competence behaviour for use with Chinese preschool children in Hong Kong. A parent version and a teacher version were developed and evaluated. The participants included 457 children (230 boys and 227 girls) aged four and five years old, their preschool teachers and their parents. Besides, 44 children (39 boys and 5 girls) with developmental disabilities were recruited. The children were assessed on the cognitive domain of the Preschool Development Assessment Scale (PDAS). Their parents completed a questionnaire on academic competence behaviour, as well as the Strength and Difficulty Scale (SDQ). Their teachers completed the questionnaire on academic competence behaviour. Rasch analysis results provided support for the unidimensionality of the parent and teacher versions of the scale, with one item deleted. The parent and teacher versions of the revised scale correlated positively with the cognitive domain of the PDAS and the prosocial scale of the SDQ and negatively with SDQ total problem behaviour score. Children with developmental delay were assigned lower scores by their parents and teachers, compared with preschool children, on the revised versions of the academic competence behaviour scale. Reliability estimates (Cronbach's alpha) of the parent and teacher versions of this revised scale were above .80. The results suggested that the two versions of academic competence behaviour scales were promising instruments for the assessment of academic competence behaviour among Chinese preschool children.     

Psychometric comparisons of three measures for assessing motor functions in preschoolers with intellectual disabilities

Background Deficit in motor performance is common in children with intellectual disabilities (ID). A motor function measure with sound psychometric properties is indispensable for clinical and research use. The purpose of this study was to compare the psychometric properties of three commonly used clinical measures for assessing motor function in preschoolers with ID: the Bruininks‐Oseretsky Test of Motor Proficiency‐Second Edition, the Movement Assessment Battery for Children‐Second Edition and the Peabody Developmental Motor Scale‐Second Edition (PDMS‐2). Method One hundred and ninety‐one children aged 3–6 years with ID were evaluated with the three measures at three time points: two baseline measurements with a 1‐week interval before the intervention, and a follow‐up measurement after 6 months of paediatric rehabilitation programme. One hundred and forty‐one participants completed all of the assessments. The distribution (ceiling and floor effects) and reliability (internal consistency and test–retest reliability) of each measure were examined. Concurrent validity, predictive validity, and responsiveness were examined as well. Results All measures, except for the PDMS‐2, had significant floor effects or ceiling effects at one or more time points. The three measures had good internal consistency (Cronbach α ≥ 0.86) and test–retest reliability (intraclass correlation coefficient ≥ 0.96). The Spearman ρ correlation coefficient for each pair of the three measures was ≥0.80, indicating high concurrent validity. The predictive validity of the three measures was satisfactory (Spearman ρ ≥ 0.52). The responsiveness of the three measures was moderate (0.47 ≤ effect size ≤ 0.74). The minimal detectable changes of the three measures were satisfactory. Conclusions All three measures showed sufficient reliability, validity and responsiveness in preschoolers with ID, but the PDMS‐2 is recommended for its superior psychometric properties.     

Reliability and Validity of Two Brief Screening Measures of Preschoolers’ Social–Emotional Competencies

The emotional competence screening and the social competence screening for parents and teachers were developed in Romania as brief, multiinformant, strength-focused assessment tools to identify children at risk of underdeveloped social–emotional competencies. The objective of the current study was to gather further reliability and validity evidence concerning the teacher and parent versions of the screeners. Findings provided evidence of high internal consistency, test–retest reliability (3-month interval), and moderate levels of cross-informant reliability. Principal axis factoring was employed for testing latent dimensions associated with the theoretical models underlying the scales’ development. Construct validity was also established using measures of children’s social–emotional competencies and internalizing/externalizing problems and yielded moderate-to-strong correlations across all forms of the screeners. Diagnostic accuracy was assessed relative to the clinical range scores from the internalizing/externalizing problem scales from Achenbach System of Empirically Based Assessment and yielded acceptable specificity and sensitivity indices. Receiver operating characteristic analyses and area under the curve values indicate that these measures have moderate-to-strong utility (AUCs ≥ .78) in detecting children at risk of internalizing and externalizing problems based on ratings of their social–emotional skills. These data support the notion that these instruments might prove potential candidates for school-wide screening practices.     

Behavioural and emotional problems in children with intellectual disability attending special schools in Cape Town, South Africa

A sample of 355 children with intellectual disability (ID) attending special schools in Cape Town, South Africa, were assessed on the Developmental Behavioural Checklist – Teacher Version (DBC‐T). A prevalence rate of 31% for psychopathology was found. Boys manifested more behaviour problems than girls, especially in relation to disruptive, self‐absorbed and antisocial behaviours. Children with severe and profound levels of ID showed more behavioural difficulties than those in the mild and moderate categories. Specific behaviour problems were self‐absorbed and autistic behaviours in children with profound ID, communication problems and anxiety in those with severe ID and antisocial behaviour in children with mild ID. Epilepsy, but not cerebral palsy was associated with higher total behaviour scores. Ambulant children were more disruptive and antisocial, while non‐ambulant children were more anxious. Non‐verbal children had higher scores on all of the subscales except for disruptive behaviour.     

A dimensional approach to measuring anxiety for DSM‐5

In preparation for DSM‐5's planned inclusion of dimensional assessments of psychopathology as a complement to traditional categorical diagnoses, we developed brief self‐rated scales for anxiety disorders that are consistent in content and structure. In the present paper, we discuss the creation of the scales and examine their psychometric properties and clinical sensitivity. Phase One assessed psychometric properties of the initial versions of the scales in a large non‐clinical sample (n = 702). Phase Two assessed the psychometric properties of revised versions of the scales, including test–retest reliability, in a non‐clinical sample (n = 57). Phase Three examined the scales' psychometric properties and relationship with clinician ratings of disorder severity in a clinical sample (n = 48). The scales demonstrated internal consistency (α = 0.85–0.92), convergent validity (r_s = 0.39–0.69), and test–retest reliability in the non‐clinical samples (ICC = 0.51–0.81). In the clinical sample, the scales demonstrated significantly higher total scores than in the non‐clinical sample (Cohen's d = 0.72–1.50) and moderate to high correlations with clinician ratings of disorder severity (r = 0.43–0.82) Although further evaluation and refinement of the scales (particularly the specific phobia and agoraphobia scales) is needed, the results provide preliminary support for the use of these scales in DSM‐5 and thus take an important step toward the integration of standardized dimensional measurement into the diagnosis of anxiety disorders. Copyright © 2012 American Psychiatric Association. All rights reserved.     

The transition to school: adaptation in young children with and without intellectual disability

Background Previous research has highlighted the importance of the transition to school for young children and their families. A child's successful adaptation to school is likely influenced by a number of factors, including academic, social, emotional, behavioural and cognitive competencies. Children with intellectual disability (ID) may be at heightened risk for early school difficulties, in part due to their deficits in cognitive and adaptive behaviours. Methods Factors associated with the adaptive transition to school in young children with (n = 24) and without (n = 43) ID were examined. Adaptive transitions were defined as having few teacher‐reported problem behaviours and positive student–teacher relationships. Child self‐regulatory skills and both parent‐ and teacher‐reported social skills were evaluated to determine if they predicted positive adaptation in school for 5‐ to 6‐year‐old children. Data were gathered from child assessments, parent reports on standardized measures, direct observations of delay of gratification tasks and teacher reports on standardized measures. Results Children with ID had significantly more teacher‐reported problem behaviour, poorer overall student–teacher relationships, fewer parent‐ and teacher‐reported social skills and fewer self‐regulation skills than typically developing children. Self‐regulation at child age 36 months (latency to touch a desired toy) was significantly related to adaptation to school, as were parent and teacher reports of social skills. Social skills significantly predicted adaptation to school, even after accounting for the effects of child IQ and adaptive behaviour. Conclusions Children with ID had less positive early school experiences, as indicated by multiple indices of adaptation to school. Fostering early social skills may be an important target for increasing the positive adaptation to school for young children, especially those with ID.     

Validation of a questionnaire to measure mastery motivation among Chinese preschool children

The aim of this study was to validate a questionnaire on mastery motivation (task and effort) for use with Chinese preschool children in Hong Kong. A parent version and a teacher version were developed and evaluated. Participants included 457 children (230 boys and 227 girls) aged four and five years old, their preschool teachers and their parents. Further, 44 children (39 boys and 5 girls) with developmental disabilities were recruited. The children were assessed on the cognitive sub-test of the Preschool Development Assessment Scale (PDAS). Their parents completed the task and effort motivation scales, as well as the Strengths and Difficulties Questionnaire (SDQ). Their teachers also completed the task and effort motivation scales. Rasch analysis results provided support for the unidimensionality of the parent and teacher versions of the two motivation scales. The parent and teacher versions of the two motivation scales correlated positively with the PDAS cognitive sub-test and the SDQ prosocial scale scores, and negatively with the SDQ total problem behavior scores. Children with developmental disabilities were assigned lower scores by their teachers and parents on the two motivation scales, compared with children with typical development. Reliability (Cronbach's Alpha) of the parent and teacher versions of the two motivation scales were above .70. The results suggested that the task and effort motivation scales were promising instruments for the assessment of motivation among Chinese preschool children.     

Validation of a questionnaire to measure mastery motivation among Chinese preschool children

The aim of this study was to validate a questionnaire on mastery motivation (task and effort) for use with Chinese preschool children in Hong Kong. A parent version and a teacher version were developed and evaluated. Participants included 457 children (230 boys and 227 girls) aged four and five years old, their preschool teachers and their parents. Further, 44 children (39 boys and 5 girls) with developmental disabilities were recruited. The children were assessed on the cognitive sub-test of the Preschool Development Assessment Scale (PDAS). Their parents completed the task and effort motivation scales, as well as the Strengths and Difficulties Questionnaire (SDQ). Their teachers also completed the task and effort motivation scales. Rasch analysis results provided support for the unidimensionality of the parent and teacher versions of the two motivation scales. The parent and teacher versions of the two motivation scales correlated positively with the PDAS cognitive sub-test and the SDQ prosocial scale scores, and negatively with the SDQ total problem behavior scores. Children with developmental disabilities were assigned lower scores by their teachers and parents on the two motivation scales, compared with children with typical development. Reliability (Cronbach's Alpha) of the parent and teacher versions of the two motivation scales were above .70. The results suggested that the task and effort motivation scales were promising instruments for the assessment of motivation among Chinese preschool children.     

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

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

The development of a new measure for the assessment of psychopathology in adults with intellectual disability

Background   People with intellectual disability (ID) and untreated psychiatric disorder lead unnecessarily difficult and unhappy lives. The prevalence of mental illness in children and adults with ID is greater than that found in the general population. A carer-completed checklist of psychopathology that could be used with both children and adults would help identify those individuals with ID most likely to have a mental health problem, help ensure that they receive the limited services that are usually available and also assist the process of clinical assessment, diagnosis and management.
Method   This research aimed to develop a reliable and valid carer-completed checklist of psychopathology for adults with ID by redeveloping an existing measure for children with ID, the Developmental Behaviour Checklist (DBC-P). The new checklist, The Developmental Behaviour Checklist for Adults (DBC-A) was devised by changing, deleting and adding to DBC-P items. Reliability studies were conducted with paid and family carers, and DBC-A scores were compared with the results from two other measures of psychopathology.
Results   One DBC-P item was deleted, seven items changed and 12 items added. The psychometric properties of this new checklist, the DBC for Adults with ID (DBC-A), were investigated and found to be satisfactory. Intraclass correlations for test-retest and inter-rater reliability ranged from 0.72 to 0.85, and concurrent validity with two measures of emotional and behavioural disturbance was satisfactory.
Conclusions   The carer-completed DBC-A provides a broad and comprehensive survey of the emotional and behavioural problems of adults with ID. It has satisfactory psychometric properties and therefore can be used with confidence in clinical, research and service settings, and its development allows continuous assessment of psychopathology across the lifespan for all people with ID.     

Psychometric Properties of the Parent Version of the Revised Child Anxiety and Depression Scale in a Clinical Sample of Turkish Children and Adolescents

The Revised Child Anxiety and Depression Scale-Parent version (RCADS-P) is a self-report questionnaire that assesses dimensions of DSM-based anxiety and depressive disorders in children and adolescents. The present study examined the psychometric properties of the Turkish version in a clinical sample of 483 children and adolescents. The child and parent versions of the RCADS, parent versions of the Screen for Child Anxiety Related Emotional Disorders, the Strengths and Difficulties Questionnaire and Adolescent Symptom Inventory-Depression Scale were administered. Current psychiatric diagnoses were assessed via the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present Version. The RCADS-P demonstrated high internal consistency and test–retest reliability, and good convergent, divergent, and discriminant validity. Confirmatory factor analysis supported the DSM-related six-factor structure. With its demonstrated favorable psychometric properties, the Turkish RCADS-P is currently the only validated parent-report instrument that assesses DSM-based anxiety and depressive disorders in children and adolescents in Turkey.     

Assessment of change with the Developmental Behaviour Checklist

Background The Developmental Behaviour Checklist (DBC) is a 96‐item instrument designed for assessing behavioural and emotional problems among young people with intellectual disability. Methods The present study investigated the validity of the DBC as a measure of change. Changes in individual's DBC scores were correlated with changes in expert clinicians’ ratings of the same subjects. Results A high correlation was found between expert clinician ratings of change in behaviour and change in the total behaviour problem score of the DBC. Conclusions The DBC is able to measure changes in behaviour and emotions which are recognized by an experienced clinician who is following the progress of a child with ID.     

The ComFor: an instrument for the indication of augmentative communication in people with autism and intellectual disability

Background The ComFor (Forerunners in Communication) is an instrument to explore underlying competence for augmentative communication. More specifically, it measures perception and sense‐making of non‐transient forms of communication at the levels of presentation and representation. The target group consists primarily of individuals with autism and intellectual disability (ID) without or with only limited verbal communication. The ComFor is suitable for children and adults with a developmental level between 12 and 60 months. This paper describes the theoretical framework and structure of the ComFor, the results of a study on its psychometric properties and its clinical uses. Method The ComFor was tested on a sample of 623 children and adults from the Netherlands and Flanders: a group with autism and ID (n = 310); a group with ID without autism (n = 174); and a control group of typically developing children (n = 139). Results The data generally support the reliability and validity of the ComFor. Internal consistency, inter‐rater and test–retest reliability were found to be good. Construct validity (internal structure, convergent and divergent patterns) was established in different ways. The criterion‐related validity has yet to be established, as predictive data are not available at the moment. Conclusion Taken together, the results indicate that the ComFor is a promising instrument to explore underlying competence for augmentative communication. Areas for future research are outlined and the clinical relevance is discussed.     

The psychometric properties of the Attention–Distraction,Inhibition–Excitation Classroom Assessment Scale (ADIECAS) in a sample of children with moderate and severe intellectual disabilities

The Attention–Distraction, Inhibition–Excitation Classroom Assessment Scale (ADIECAS) [Evans, P. L. C. (1975). Inhibition and stimulus generalization in the discrimination learning of ESN(S) and ESN(M) children. Unpublished Ph.D. thesis. Manchester, UK: University of Manchester] assesses attention-related difficulties in children with intellectual disabilities (ID). The present study explored the psychometric properties of the ADIECAS with a sample of 84 children with moderate and severe ID whose teachers completed the ADIECAS and the Conners’ Teachers Rating Scale [Goyette, C. H, Conners, C. K., & Ulrich, R. F. (1978). Normative data on revised Conners’ parent and teachers rating scales. Journal of Abnormal Child Psychology, 6, 221–236]. Following factor analysis the Evans and Hogg [Evans, P. L. C., & Hogg, J. (1984). A classroom rating scale for use with mentally retarded children. British Journal of Clinical Psychology, 23, 187–194] structure was the most appropriate for use with this sample. Moderate to strong positive relationships were found between the ADIECAS and the Conners’, and the ADIECAS factors were significant predictors of the Conners’ subscales. This study provides further support for the ADIECAS as a reliable and valid measure of ADHD-related symptoms among children with moderate and severe ID.     

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.     

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.