Risk-Taking and Delinquent Behaviors among Youth with and without Intellectual Disabilities

ABSTRACT

Introduction: Youth with intellectual disabilities (ID) demonstrate higher rates of disruptive behavior disorders (DBDs) than youth with typical development (TD). DBDs such as oppositional defiant disorder (ODD) predict higher rates of delinquency during adolescence. Yet, few studies have examined risk-taking and delinquency among youth with ID.

Methods: We used a self-report measure to determine whether 13-year-old youth with ID (n = 23) reported higher rates of risk-taking and delinquent behavior than their TD peers (n = 77). We also examined whether or not youth had a previous diagnosis of ODD.

Results: Our results suggest that youth with ID reported fewer rule-breaking and risk-taking behaviors than their TD peers. In contrast, youth with a previous diagnosis of ODD reported more of these behaviors.

Conclusion: Our results appear discrepant from previous studies, which find higher rates of risk-taking and delinquency among youth with ID. As such, we discuss the factors that may explain our discrepant results, including our definition and assessment of ID, and the age of our participants.     

Daily living skills in adolescents with autism spectrum disorder: Implications for intervention and independence

BackgroundChallenges in adaptive behaviors are present in individuals with autism spectrum disorder (ASD), while variation in IQ, social skills, and comorbidities are possible influences on adaptive behaviors. However, adaptive behaviors do not consistently map onto cognitive abilities in ASD, as high IQ is not protective against challenges in adaptive behaviors. Additionally, individuals with both ASD and elevated levels of externalizing problem behaviors experience even worse adaptive behaviors. Identifying factors that contribute to the variance in adaptive behaviors, particularly daily living skills (DLS), may inform strategies to improve adaptive behaviors necessary for independence in adulthood.MethodAdolescents with typical cognitive development (TD, n = 84), intellectual disability (ID, n = 30), or ASD (n = 45) were included in this study to examine group differences in adaptive behaviors, identify relations between IQ and DLS, and determine factors that contribute to variance in DLS at youth age 13. The Vineland Adaptive Behavior Scales, 2nd Edition (VABS-II) was used to measure adaptive behaviors.ResultsAll domains of adaptive behavior were significantly higher in TD groups compared to ASD and ID youth. Significant positive correlations were observed between IQ and DLS in the ASD and ID groups. In the ASD youth group, higher externalizing behavior problems explained the most variance in DLS.ConclusionsDLS are below age-expected levels in young adolescents with ASD, in part because of the higher externalizing behavior problems in this group. Incorporating adaptive skills training and behavior management strategies into current interventions may serve to prepare adolescents and families for the transition to adulthood.     

Masculine gender-role adherence indicates conflict resolution patterns in heterosexual adolescent couples: A dyadic,observational study

IntroductionConflict resolution in romantic relationships is a critical skillset that relates to individual and relational well-being. In adolescence, heterosexual romantic relationships are highly gendered, and norms for traditional masculinity (a bravado focused on interpersonal dominance) may be relevant in shaping how adolescents navigate disagreements. Therefore, we examined the associations between adolescents’ conformity to norms for traditional masculinity and their conflict resolution in their romantic relationships.MethodUsing a sample of 91 heterosexual adolescent couples from the Southwest United States (M_age = 16.50, SD = .90; 44% White, 42% Latinx), we examined how self-reported conformity to traditional masculinity predicted independent observer ratings of negotiation, coercion, and avoidance strategies during a lab-based conflict and jealousy discussion task.ResultsResults of actor-partner interdependence models (APIMs) indicated that more highly masculine adolescents generally displayed less conflict negotiation and more coercion during the discussion task. Dyadic and gendered patterns characterized masculinity's associations with negotiation and coercion. Masculinity was unassociated with conflict avoidance.ConclusionsAdolescents in heterosexual relationships that adhere more rigidly to gendered norms for traditional masculinity may be challenged in acquiring skills for constructive conflict resolution with a romantic partner. Adolescent romantic relationships are a socialization context in which many individuals develop the skills for future romantic relationships, including those into young adulthood. Addressing masculine gender roles in adolescence may help promote the development of positive conflict management and overall romantic functioning in youth.     

A Scoping Study of a Tertiary Intellectual Disability Mental Health Service: A Family Member and Support Person Perspective

ABSTRACT

Introduction: People with intellectual disability (ID) experience barriers in accessing mental health care. Recommendations have been made to implement specialist intellectual disability mental health (IDMH) services in Australia. However, there is limited evidence to inform service development.

Method: Family members and support persons of people with ID (n = 42) completed an on-line survey about support for, and operation of, a tertiary IDMH service in New South Wales, Australia.

Results: Participants agreed that a tertiary IDMH service would assist in meeting the needs of people with ID. Key service features included that it be delivered within the public health system, by psychiatrists and psychologists, provide face-to-face clinical contact and advice. Key service areas included behaviors of concern, self-harm, assessments, and interventions.

Conclusion: These findings suggest support for a tertiary IDMH service and how it could be delivered. Further research is required from the perspective of people with ID, mental health staff, and clinical experts.     

Self-harm: a transdiagnostic marker of psychopathology and suicide risk during the COVID-19 pandemic?

There is a growing number of young people, diagnosed with an autism-spectrum disorder (ASD), transitioning to adulthood. Among this number, individuals without an intellectual disability have significant adaptive deficits and need individualized care and support services to better target vocational, social, and educational prospects and outcomes. Group-based interventions, including patient education, social-skills training, and cognitive–behavioral therapy, are widely used in clinical settings to improve the daily life and prospects of ASD individuals facing the challenge of transitioning to adulthood. We performed a systematic review of studies concerning the efficiency of group-based educational interventions with a focus on the transition to adulthood for young, ASD individuals without intellectual disability (ID). As a result of this systematic search, 21 studies out of 163 were found to be eligible for inclusion. We observed considerable heterogeneity across the studies, in terms of effect sizes and intervention design, delivery, and the comparison of controls. Strong evidence was found in favor of social-skills training and cognitive–behavioral therapy interventions. Professionals should consider group-based psychoeducational intervention to be an appropriate and relevant service for young subjects with ASD without ID transitioning to adulthood. Further research is needed on larger samples using multicentric designs to validate efficacy before generalization.

     

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

ABSTRACT

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

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

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

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

A personal digital assistant for improving independent transitioning in adolescents with high-functioning autism spectrum disorder

Objective: This study evaluated the effectiveness of a personal digital assistant (PDA) on independent transitioning between activities in a day treatment centre for youth with high-functioning ASD.

Methods: Within a multiple baseline design across four participants, data were collected on participant's transitioning and staff's prompting behaviour. Intervention by staff consisted of one technical instruction session on use of the PDA and non-specific instruction following incorrect transitions while not using the PDA, in the natural setting.

Results: Analysis revealed a significant increase in percentage independent daily transitions, which resulted from the independent use of the PDA. The change in staff's prompt use during intervention was mainly the result of a significant decrease in the use of non-specific prompts in correcting participant's transition behaviour.

Conclusion: A brief intervention was effective in improving independent transitioning using a PDA. Findings are evaluated in light of their clinical implications and suggestions for future research are discussed.     

Far from a monolith: a typology of externalizing behavior among African American youth

Purpose

Previous studies have examined externalizing behaviors among African American youth using variable-centered approaches that study aggression and delinquency separately. However, aggression and delinquency often operate together in shaping adolescent behavior. For this reason, person-centered approaches are essential for identifying subgroups of African American youth using multiple indicators of aggression and delinquency to model the behavioral heterogeneity within this population. We examined the relationship between interpersonal, school, and parenting factors and externalizing behaviors among African American youth.

Method

Drawing from the National Survey on Drug Use and Health 2015–2018, we conducted latent class analysis based on 5 externalizing behavior indicator variables (i.e., serious fight, attack to harm, stealing, drug selling, handgun carrying) using a sample of 7,236 African American adolescents, aged 12–17.

Results

We identified a three class solution: Class #1—No Involvement (74.4%), characterized by very low levels of involvement in all of the externalizing behaviors examined; Class #2—Serious fight (23.3%), which is characterized by near-universal involvement in a serious fight, far lower levels of attack to harm, and negligible levels of stealing, drug selling, and handgun caring; and Class #3—Multidimensional externalizing (2.3%), characterized by very high levels of involvement in all of the externalizing variables examined.

Conclusion

Most African American youth are not involved in externalizing behaviors. It is vital to support both the large majority of African-American youth who are abstaining from externalizing behaviors and to develop/implement programs to address the contextual and interpersonal needs of youth at elevated risk for consequences related to externalizing.

     

Psychiatric diagnoses in relation to severity of intellectual disability and challenging behaviors: a register study among older people

ABSTRACT

Objective: To investigate the possible association between severity of intellectual disability (ID) and presence of challenging behavior, respectively, on diagnoses of psychiatric disorders among older people with ID.

Methods: People with a diagnosis of ID in inpatient or specialist outpatient care in 2002–2012 were identified (n = 2147; 611 with mild ID, 285 with moderate ID, 255 with severe or profound ID, and 996 with other/unspecified ID). Moreover, using impairment of behavior as a proxy for challenging behavior, 627 people with, and 1514 without such behavior were identified.

Results: Severe/profound ID was associated with lower odds of diagnoses of psychotic, affective, and anxiety disorders than was mild/moderate ID. People with moderate ID had higher odds than those with mild ID of having diagnoses of affective disorders. Diagnoses of psychotic, affective, and anxiety disorders, and dementia were more common among people with challenging behavior than among those without.

Conclusions: People with severe/profound ID had lower odds of receiving psychiatric diagnoses than those with mild and moderate ID. Whether this is a result of differences in prevalence of disorders or diagnostic difficulties is unknown. Further, challenging behaviors were associated with diagnoses of psychiatric disorders. However, the nature of this association remains unclear.     

Sociodemographic Characteristics,Risk Factors,and Prevalence of Comorbidity among Children and Adolescents with Intellectual Disability: A Cross-sectional Study

ABSTRACT

Introduction: Intellectual disability (ID) is characterized by limitations in cognitive and adaptive functioning. The aim of this study is to examine sociodemographic characteristics, perinatal and childhood risk factors, and prevalence of psychiatric and biomedical comorbidities in children with ID.

Methods: 260 patients with ID were included in the study (mean age: 8.42 ± 3.59, 61% male, 75% mild ID). The Ankara Developmental Screening Inventory, the Wechsler Intelligence Scale for Children–Revised, and the Porteus Maze Test were used to assess the intelligence of the participants. An additional questionnaire was used to investigate their sociodemographic characteristics and birth, developmental, and medical histories.

Results: Adverse perinatal/neonatal events (p < .001), biomedical comorbidities (p < .001) and seizure/convulsion history (p < .001) were strongly associated with the moderate-severe ID. The children with mild ID had more emotional-social deprivation (p = .022). Low socioeconomic situation, parental education, and teenage parenthood were risk factors for stimulus deficiency. While internalizing disorders were more common in those with mild ID and among girls, externalizing disorders were more common in those with moderate-severe ID and among boys.

Conclusion: Interventions to perinatal/neonatal events may reduce the rate of moderate-severe ID. Evaluation of psychiatric and medical comorbidities and elimination of emotional-social deprivation should be fundamental components of the services offered to children with ID.     

Alcohol and its relationship to offence variables in a cohort of offenders with intellectual disability

Abstract

Background Alcohol use and misuse may be lower in people with intellectual disability (ID) than in the general population but may be related to offending.

Method Alcohol-related crime and history of alcohol use was recorded in 477 participants with ID referred to forensic ID services and related to offending.

Results Level of alcohol-related crime and history of alcohol misuse was lower than in some previous studies at 5.9% and 20.8%, respectively. History of alcohol abuse was associated with alcohol-related offences and theft. Higher rates of alcohol problem history were associated with histories of a number of offences, psychiatric disturbance in adulthood, psychiatric disturbance in childhood, and experiences of childhood adversity. Most effect sizes were weak or moderate.

Conclusions The convergence of childhood adversity, psychiatric problems in childhood and adulthood, and alcohol abuse is consistent with studies that have found these as risk markers for offending.     

Predictors of Anxiety Symptom Trajectory in Children with or without ID from Early Childhood to Adolescence

ABSTRACT

Introduction: We examined the development of anxiety in youth with or without intellectual disabilities (ID). We also examined the effects of child delay status, temperament, ethnicity, and negative parenting on anxiety symptom trajectory.

Method: Participants were 177 families in (blinded). We employed latent growth curve modeling to examine the trajectory of anxiety symptoms (ages 3–13 years) and to examine the individual and interactive effects of variables in predicting age 3 anxiety and change in anxiety.

Results: Anxiety symptoms increased over time. Children with ID demonstrated higher levels of anxiety compared to typically developing (TD) children. Social fearfulness was positively associated with anxiety at age 3. Anxiety increased at a slower rate in Latino children. Negative parenting positively predicted rate of change in anxiety for children with ID but not TD children.Conclusions: These findings inform early intervention targets for culturally diverse families of children with or without ID.     

The relationship between short-term memory,conflict resolution,and sentence comprehension impairments in aphasia

Background: Sentence comprehension involves the integration of multiple linguistic representations. This integration can be especially challenging when different cues lead to conflicting interpretations. Short-term memory (STM) and conflict resolution are two processes that have been previously linked to sentence comprehension and could assist in integration. However, the relation of each process to comprehension independently of the other has not been fully clarified.

Aims: We tested two patients with contrasting STM and conflict resolution profiles in different sentence comprehension tasks to evaluate the relationship between the three abilities.

Methods & Procedures: Patients completed (a) six STM tasks that tested either span or updating; (b) two executive function tasks that tested conflict resolution; and (c) three tasks that evaluated sentence comprehension.

Outcomes & Results: The patient with poorer STM and better conflict resolution had variable success in sentence comprehension that was contingent on memory load and the extent to which interpretation was supported by semantic knowledge. In contrast, the patient with good STM but slow conflict resolution demonstrated accurate comprehension across all tasks and conditions, and delayed reaction times for sentences containing conflict between cues.

Conclusions: The results provide broad support for a link between STM and sentence comprehension. They suggest that inefficient conflict resolution might be associated with slowed down but not inaccurate comprehension of sentences when other abilities, including STM, are intact. We discuss the ways in which STM and conflict resolution may and may not assist sentence comprehension in individuals with aphasia.     

From adolescence to parenthood: a multi-decade study of preconception mental health problems and postpartum parent–infant bonds

Purpose

To examine associations between anxiety and depressive symptoms across adolescence and young adulthood with subsequent maternal- and paternal–infant bonding at 1 year postpartum.

Methods

The data were from a prospective, intergenerational cohort study. Participants (381 mothers of 648 infants; 277 fathers of 421 infants) self-reported depression and anxiety at three adolescent waves (ages 13, 15 and 17 years) and three young adult waves (ages 19, 23 and 27 years). Subsequent parent–infant bonds with infants were reported at 1 year postpartum (parent age 29–35 years). Generalised estimating equations (GEE) separately assessed associations for mothers and fathers.

Results

Mean postpartum bonding scores were approximately half a standard deviation lower in parents with a history of persistent adolescent and young adult depressive symptoms (maternal β_adj = − 0.45, 95% CI − 0.69, − 0.21; paternal β_adj = − 0.55, 95% CI − 0.90, 0.20) or anxiety (maternal β_adj = − 0.42, 95% CI − 0.66, − 0.18; paternal β_adj = − 0.49, 95% CI − 0.95, 0.03). Associations were still mostly evident, but attenuated after further adjustment for postpartum mental health concurrent with measurement of bonding.

Conclusions

Persistent symptoms of depression or anxiety spanning adolescence and young adulthood predict poorer emotional bonding with infants 1-year postbirth for both mothers and fathers.

     

Sex and substance use behaviors among children of teen mothers: A systematic review

IntroductionAdolescent birth is a known correlate of many challenging behavioral health consequences for offspring. This systematic review seeks to understanding the sex and substance use behaviors of children born to teen mothers extending the body of literature on the long-term outcomes of being born to a teen mother.MethodsA systematic approach, in accordance with PRISMA guidelines, was used to review and identify eligible studies in the following electronic databases: Web of Science, ProQuest, PubMed, and Ovid MEDLINE. Study inclusion: (a) maternal age (>20) was the key predictor or group variable and (b) children's risky sexual or substance use behaviors were outcome variables. All articles meeting inclusion criteria were next screened using the quality assessment tool created by the Effective Public Health Practice Project.ResultsSeventeen articles reporting on risky sexual behaviors and 12 articles on substance use behaviors met inclusion criteria. We found a consistent association between being born to a teen mother and risky sexual behaviors, including early sexual debut and transitioning into motherhood during adolescence/young adulthood. The link between being born to a teen mother and substance use behaviors was inconsistent and only found in large population-based studies.ConclusionTeen mothers and their children have unique individual, family, and structural needs. Evidence highlights that while there is no clear need to adapt substance use prevention interventions for these children, investing in targeted adaptations of abstinence and safer sex interventions to meet the unique experiences of children of teen mothers and their children is warranted.     

Attributions of People with Intellectual Disabilities of Their Own or Other Clients’ Challenging Behavior: A Systematic Review of Qualitative Studies

ABSTRACT

Introduction: As opposed to studies focusing on staffs’ attributions of challenging behavior (CB), relatively few studies have looked at how people with intellectual disabilities (ID) attribute such behaviors themselves, and a systematic overview is currently lacking. The aim of this review was to synthesize the evidence from qualitative studies on the attributions people with ID have concerning their own or other clients’ CB.

Methods: A systematic literature search was conducted in Embase, Medline Ovid, Web of science, Cochrane CENTRAL, PsychINFO Ovid, and Google Scholar. Studies were included if they focused on people with ID who report on attributions of their own or other clients’ actual CB. The methodological quality of the studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist.

Result: A total of 10 studies were included. Three main types of factors subdivided in 13 sub-types were reported by clients as potential causes of CB: interpersonal factors (1 support staff, 2 other clients, 3 general, 4 life history), environmental factors (1 ward, 2 social exclusion, 3 situational factors) and intrapersonal factors (1 syndrome or diagnosis, 2 medical or physical symptoms, 3 psychological reasons, 4 emotions and feelings, 5 coping, 6 other).

Conclusions: This thematic synthesis shows that clients with ID report a diverse range of attributions regarding their own or other clients’ CB. This spectrum can be used as a framework for interpreting CB and for the development of appropriate support systems for people with ID demonstrating CB.     

Everyday memory difficulties in children and adolescents with Fetal Alcohol Spectrum Disorder

ABSTRACT

Purpose: To investigate whether significant differences exist in everyday memory between youth with Fetal Alcohol Spectrum (FASD) compared with a nonexposed (NE) control group, while controlling for socioeconomic status and other comorbidities.

Methods: Caregiver ratings using the Everyday Memory Questionnaire were obtained for 105 youth (9–17 years of age). Scores were compared between youth with a FASD diagnosis (N = 41; 56% male) and the NE group (N = 64; 53% male) using multivariate analysis of variance.

Results: Significantly poorer scores were found across all domains of everyday memory in youth with FASD (p<0.01 for all comparisons). Findings maintained significance after controlling for group differences in socioeconomic status, presence of learning, and attention disorders, as well as exposure to other teratogens.

Conclusions: This study provides important insights regarding the memory issues that underlie daily functional challenges faced by youth with FASD and the need for future intervention research.     

Combining CBT and Behavior-Analytic Approaches to Target Severe Emotion Dysregulation in Verbal Youth With ASD and ID

ABSTRACT

This article presents an individual intervention combining cognitive-behavioral and behavior-analytic approaches to target severe emotion dysregulation in verbal youth with autism spectrum disorder (ASD) concurrent with intellectual disability (ID). The article focuses on two specific individuals who received the treatment within a therapeutic school setting. Single-subject methodology utilizing a nonconcurrent multiple-baseline design across behaviors and participants was used to evaluate the intervention. The two participants presented with severe behavioral challenges, including physical aggression and verbal threats to harm others. Results suggest positive outcomes, including a reduction in the frequency and intensity of severe aggressive behavior and an increase in the use of coping skills, self-advocacy, and social participation. The planning and implementation of specific skills-generalization strategies was one innovative element of the intervention that proved to be pivotal to its successful application. Assessment and treatment techniques for different intervention phases are detailed along with two case examples. Intervention challenges, treatment outcomes, and future directions for clinical research are discussed.     

The D allele of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism is associated with worse functional outcome of ischaemic stroke

Purpose: Insertion/deletion polymorphism in ACE gene (ACE I/D) is known to be associated with the occurrence of ischaemic stroke through its effect on pathogenesis of atherosclerosis and hypertension. This study was aimed to examine the association between this polymorphism with functional outcome of ischaemic stroke.

Method: This was a cross-sectional study. The subjects were patients with ischaemic stroke in a reference hospital in Yogyakarta, Indonesia. Data on demographic characteristics, stroke risk factors, comorbidities and stroke severity were assessed on admission. The functional outcome, Barthel index (BI), was assessed when the patients were discharged from the hospital. ACE I/D genotypes of the patients were identified by polymerase chain reaction (PCR).

Result: In total, 61 patients were included. Of these, 38 patients (62.3%) had II polymorphism, 22 patients (36.1%) had ID polymorphism and 1 patient (1.6%) had DD polymorphism in the ACE gene. There were significant differences in the functional outcomes between patients without D allele (II polymorphisms) and patients with D allele (ID and DD polymorphism) (mean BI on discharge: 75 ± 23.57 and 60.65 ± 27.15, respectively; p = 0.034). Multiple linear regression model showed that the availability of D allele is an independent variable negatively associated with functional outcome as assessed by BI (β = ?0.232, p = 0.024).

Conclusion: This study showed that the D allele in ACE I/D polymorphism is associated with worse functional outcomes. This highlights the possibility of further research to improve functional outcomes of ischaemic stroke by inhibiting the ACE system.