Reliability of the Behavior Problems Inventory

The Behavior Problems Inventory (BPI) is a 29-item checklist for self-injurious, stereotypic, and aggressive behavior in persons with mental retardation. The BPI was originally developed for screening and classification of self-injury and stereotyped behavior in epidemiological studies (Rojahn, 1984, 1986), and was later expanded to include acts of aggression against others. The instrument has been used in structured interviews with residential staff and in self-administered fashion for a mail survey with teachers and mental retardation workers. This paper presents a new data set on interrater and retest reliability and compares it with previously published data. The majority of items achieved acceptable reliability levels, particularly those on aggression against others. More difficult to agree upon were some obscure self-injuries, such as pica, air swallowing, and extreme drinking. Further psychometric studies are recommended.     

智力残疾的适应性行为评估

适应性行为评估是智力残疾诊断与干预的必要依据。适应性行为的概念至今仍未有统一的观点，AAMR（2002）认为，适应性行为指的是概念、社会和应用3方面的技能，它的限制会影响个体的日常生活运作，进而影响其生活适应。对适应性行为进行评估的方法主要有测验法、行为观察法、功能性评估、生活质量评估和社会技能测量。无论使用什么方法进行评估，都应当以改善智力残疾个体现有状况为目的，考虑到各种评估方法的局限性，对智力残疾个体宜进行全面评估。     

Behavioral and naltrexone treatment of self-injurious behavior

Severe self-injurious behavior in a boy with severe mental retardation and autistic disorder was successfully treated with a behavioral treatment package following a trial of naltrexone to reduce self-injurious behavior. The subject was a 7-year-old boy who was hospitalized for self-injurious behavior, aggression, and a reported increased irritability. During baseline assessment, the subject was physically and verbally interrupted and redirected whenever he engaged in self-injurious behavior. During the first treatment phase, pediatric “no-no” splints were applied and systematic splint fading began. In addition, differential reinforcement of other behaviors (DRO) and a brief hand restraint were implemented. In the second treatment phase, naltrexone was administered with the continued use of systematic point fading, DRO and brief hand restraint. The third treatment phase consisted of a placebo trial and the same behavioral treatment. In the final phase, restraint fading continued and reinforcement was faded to a variable interval (VI)-3 minute schedule, as well as the use of brief hand restraint. This treatment package was effective in reducing this boy’s severe self-injurious behavior to zero upon discharge from the hospital. Follow-up data from the school indicated continued success with the use of the brief contingent hand restraint as well as reinforcement delivered on a VI-3 min schedule.     

精神发育迟滞伴行为障碍患者的安全问题及管理对策

目的探讨精神发育迟滞伴行为障碍患者住院期间存在的安全问题,为护理干预提供可靠依据。方法选择2008年8月至2010年3月收治的精神发育迟滞伴行为障碍患者165例为研究对象,对患者出现的安伞问题进行分析、整理、总结。结果存在攻击他人的患者60例,占36．36％;出走33例,占20．00％;毁物28例,占16．97％;饮食障碍26例,占15．76％;自伤18例,占10．91％。结论针对精神发育迟滞伴行为障碍患者主要存在攻击他人、出走、毁物、饮食障碍、白伤的问题制订相关措施,建立评估系统及干预措施,制订安全、有效、可行的安全管理措施,进而确保护理安全。     

Opioid antagonists. I: Pharmacology and rationale for use in treating self-injury

Endogenous opioid peptides have been implicated in the genesis and maintenance of self-injurious behavior. This paper presents an overview of the basic pharmacology of opioid peptides and opioid antagonists and briefly outlines the rationale for using these agents to treat self-injury in individuals with mental retardation. The basic assumption is that self-injury is related to the endogenous opioid system, with two, nonexclusive mechanisms having been postulated that may account for this behavior.     

Effects of drug changes and physician prescribing practices on the behavior of persons with mental retardation

Psychoactive drugs are often prescribed to control challenging behaviors of individuals with mental retardation. We examined the effects of drug changes and physician’s prescribing behavior on the aggressive and collateral behaviors of three individuals with severe and profound mental retardation. Despite repeated drug changes over the course of 2 years, no decrease in aggression was observed for any of the three subjects. In fact, with one of the clients (X.W.) aggression was more problematic after two years of attempted pharmaceutical control. Observed confounds to assessing behavior control included: the lack of withdrawal phases; unsystematic dosage manipulations; potential history and maturational effects; polypharmacy; and unreliable qualitative measures. Future psychopharmacological research should include the prescribing behavior of physicians as an ecobehavioral variable that may impact treatment outcome.     

Effects of haloperidol,alone and combined with DRO,on the self-injurious behavior in a woman with profound mental retardation and atypical psychosis

The effects of haloperidol, alone and combined with differential reinforcement of other behavior (DRO) on self-injurious behavior (SIB) of a woman with profound mental retardation and atypical psychosis were evaluated. Haloperidol, alone and combined with DRO, produced large reductions in SIB and injuries resulting from SIB. Response to environmental stimuli improved, meal refusal decreased significantly, her weight increased to an acceptable range, and sleep stabilized. SIB, meal refusal, sleep difficulties, weight loss, and inconsistent response to environmental stimuli appeared to be components of atypical psychosis that was responsive to low-dose haloperidol in combination with DRO. Treatment effects were maintained at a 27-month follow-up.     

Behavior Problems in Individuals with Cornelia de Lange Syndrome: Population-Specific Validation of the Behavior Problem Inventory-01

The purpose of this study was to validate the Behavior Problem Inventory-01 (BPI-01; Rojahn J Autism Dev Disord 31:577–588, 2001) in a population of 179 individuals with Cornelia de Lange Syndrome (CdLS) and to extend the literature on the behavioral phenotype of individuals with CdLS. We also set out to determine the relationship between the frequency of self-injurious behavior (SIB), stereotyped behavior, and aggressive/destructive behavior topographies with the level of intellectual disability (ID). The BPI-01 among the individuals with CdLS showed a sufficient factor structure and internal consistency of each of the three assessed construct (SIB, stereotyped behavior, and aggressive/destructive behaviors). Similar to the findings in other populations with intellectual disabilities, those with severe/profound intellectual impairment exhibited significantly more frequent SIB and stereotypic behavior than those with moderate or mild intellectual impairment or average intellectual abilities while no statistically a differences were noted for aggressive behavior across levels of intellectual impairment. There is a need for uniformity of assessment tools across different study to improve our ability to compare results across different prevalence studies.     

Behavioral Assessment,Analysis, and Support in a Psychiatric Partial Hospitalization Program for Adults with Developmental Disabilities

This article describes the objectives and operations of a behavioral psychology service within a partial hospitalization program for adults with psychiatric disorders and developmental disabilities. Partial hospitalization programs are an effective model of psychiatric service delivery but are not common for patients with mental retardation/mental illness. Phases of intake behavioral assessment, treatment planning and implementation, and discharge are described with an emphasis on functional assessment, data-based accountability, outcome measurement, and positively oriented behavioral support. The article concludes with a discussion of challenges which confront the design and application of behavior analysis procedures within the context of a psychiatric partial hospitalization program.     

Evidence of altered epidermal nerve fiber morphology in adults with self-injurious behavior and neurodevelopmental disorders

The purpose of this preliminary study was to examine the morphology and neuropeptide density of epidermal nerve fibers quantified through skin biopsy samples from three adults with neurodevelopmental disorders and chronic self-injurious behavior (SIB) secondary to mental retardation compared with non-SIB normal IQ controls. A cross-sectional design was used with 3mm punch skin biopsies collected from each participant from non-self-injurious body sites and compared with site-matched existing normal control skin samples. The study was conducted at an outpatient clinic. The primary dependent measure for the morphology analyses was the coefficient of variation (CV) to quantify the mean gap length between epidermal nerve fibers for each subject. Visual microscopic examination and quantitative analysis of the microscopy images suggested there were morphological abnormalities (increased CV) in the epidermal nerve fibers among the chronic SIB cases. Substance P (SP) fiber density was increased with 2-3 times as many fibers in SIB subjects as control subjects. Additional empirical work is needed to clarify the relation between sensory innervation of the skin and self-injury to improve assessment and treatment outcomes.     

Sensory Reinforcement Strategies for the Treatment of Nonsocially Mediated Self-Injury

Although self-injurious behavior (SIB) is often reinforced by social-positive reinforcement or social-negative reinforcement, it sometimes occurs independent of social consequences. In this paper, literature on the assessment of nonsocially mediated SIB and its treatment through the use of substitute sensory stimulation is reviewed. A brief look at biological factors that may play a role in the maintenance of nonsocially mediated SIB as well as suggestions for future research are also included.     

Community Habilitation and Integration of Adults with Psychiatric Disorders and Mental Retardation: Development of a Clinically Responsive Environment

Ten individuals with mental retardation and psychiatric disorders who failed in their community placements due to aggression, property destruction, and suicidal ideation were provided an environment emphasizing a network of mental health and developmental disabilities services. The focus of programing was the application of psychiatric rehabilitation principles and environmental behavior support strategies. Components of the treatment model included goal-setting, comprehensive case management, social skills training, positive reinforcement, crisis intervention, competency-based skills teaching, medication monitoring, data-based outcome measurement, and community-living arrangements. Results indicated that in contrast to their preintervention status, all individuals demonstrated significant reductions in targeted behaviors, maintained extended placement within the community without emergency hospitalizations, developed effective and adaptive social skills, secured job placement, and reported satisfaction with their quality of life.     

Assessment and treatment of self-injury in a deaf-blind child

This study addressed the assessment and treatment of high-rate self-injurious behavior in a child who was blind and deaf. The frequency of self-injury was assessed within different environmental conditions to identify potential influences on the behavior. Effective treatment was demonstrated in the form of a simple response interruption procedure that entailed physically blocking self-injurious behaviors. Subsequently, treatment was generalized successfully throughout the child's waking hours. The study provides an example of nonaversive treatment of a serious behavior disorder and the use of a functional assessment methodology to determine treatment selection.     

History of the roles of nurses caring for persons with mental retardation

A historic examination of the major responsibilities of nurses in providing care to individuals with mental retardation indicates that the responsibilities have remained relatively constant, whereas the roles have shifted and expanded over time from nursing assistant activities to advanced practice roles. Regardless of the setting, nurses have been involved in primary and secondary prevention, case finding, health care management of the individual with mental retardation and their family across the life span, instruction about this care to other nurses, and referral. This specialty nursing practice has a long history. In recent years, the role of nurses in interdisciplinary care has waned with the continual trend of institutional closings and movement of the clients to small community group homes. As individuals with mental retardation achieve greater participation in their communities, the roles and responsibilities of nurses who specialize in the care of persons with mental retardation will also change, but much effort is needed today to enforce nursing's contribution in this field to the other disciplines involved in the care of these individuals and to society. The recent Surgeon General's report [57], Closing the Gap: A National Blueprint for Improving the Health of Individuals with Mental Retardation (2001), could serve as such a springboard for renewal of nursing action in this field.     

Evaluation of pharmacologic treatment of destructive behaviors: Aggregated results from single-case experimental studies

In this investigation, 20 clients with mental retardation and destructive behavior disorders were treated with psychotropic medication based on symptoms associated with a psychiatric disorder. For each patient, single-case design and direct observation procedures were utilized to evaluate outcome. Three clients (15%) showed at least a 50% reduction in destructive behavior; seven (35%) experienced a 50% or greater increase in destructive behavior; 10 (50%) experienced no change in their destructive behavior. The best response was to stimulant medications prescribed on the basis of pervasive hyperactivity and distractibility. The worst response was to lithium prescribed on the basis of manic-like symptoms (e.g., psychomotor agitation) or cyclical behavior disturbance. The low response rate was hypothesized to be a function of the unique underlying brain dysfunction in severely to profoundly retarded individuals with destructive behavior disorders, and the difficulties with applying psychiatric diagnoses in the population. Given the individual variability of response among clients and the prevalence of behavior dysfunction of the population, single-case methodology may have a useful role in the assessment of psychopharmacotherapy with individuals with severe to profound mental retardation and destructive behavior disorders.     

半开放式管理对精神分裂症患者发生攻击行为的影响

目的　探讨半开放式管理对精神分裂症患者发生攻击行为的影响。方法　将半开放式管理模式精神病院中44例有攻击行为的精神分裂症患者作为实验组,封闭式管理模式精神病院中44例有攻击行为的精神分裂症患者作为对照组,用自编的“住院精神患者攻击行为相关因子评估表”进行临床资料收集和分析。结果　实验组攻击行为主要及相关因素中,与患者吵架及要求得不到满足的例数明显少于对照组;攻击行为与住院时间的关系中,第16 d以上的例数明显少于对照组;发生2次以上攻击行为明显少于对照组。结论　半开放式管理模式更有利于疾病的恢复。     

Relationship between diet and self-injurious behavior: A survey

This study examined the relationship between self-injurious behavior and caloric intake. Behavioral, dietary, and weight/height indices obtained on 80 neurodevelopmentally disabled and autistic clients revealed that maintenance on high caloric diets significantly predicted the occurrence of self-injurious behavior in male clients. Male clients with self-injurious behavior were also outside their recommended weight to height index. Systematic studies are needed to assess the relationship among diet, the endogenous opioid system, and self-injurious behavior.     

Diagnosis and management of depression and suicidal behavior in persons with severe mental retardation

This paper analyzes the suicidal behavior of eight individuals with mental retardation identified out of a pool of 305 persons with an accepted concomitant diagnosis of mental illness. They had been referred to an inpatient psychiatric facility for diagnosis and treatment. Analysis of each of these complex individuals is presented in conjunction with treatment strategies. A 5-year follow-up was conducted to assess the progress of these persons. Diagnostic challenges and future programmatic implications are presented.