The psychometric properties of the Multi-Dimensional Observation Scale for Elderly Subjects (MOSES) in middle aged and older populations of people with mental retardation

OBJECTIVE: To assess the internal consistency, inter-scale correlations and factor structure of the MOSES with older adults with mental retardation. METHOD: A series of outpatients with mental retardation were assessed with the MOSES. 163 middle aged and older adults with mental retardation living in community settings participated. RESULTS: The subscales and total scale of the Multi-Dimension Observation Scale for Elderly Subjects (MOSES) were highly internally consistent. The pattern of correlations between the five scales was very similar to that reported by Dalton et al. (1999). The results of a factor analysis using varimax rotation indicated a three-factor structure corresponding to adaptive behavior, externalizing and internalizing maladaptive behaviors. CONCLUSIONS: The MOSES appears to be was a psychometrically adequate instrument to screen older adults with mental retardation.     

Weight,lipids, glucose,and behavioral measures with ziprasidone treatment in a population with mental retardation

BACKGROUND: Atypical antipsychotics effectively reduce maladaptive behavior in individuals with mental retardation, yet bring significant weight gain and metabolic anomalies. Ziprasidone, a weight-neutral antipsychotic in patients with schizophrenia or schizoaffective disorder, has not been studied in a population with mental retardation and maladaptive behaviors. METHOD: Forty patients with mental retardation and maladaptive behaviors who had gained excessive weight or were inadequately responsive to other agents were switched to ziprasidone. Weight, total cholesterol, HDL, LDL, triglycerides, and frequency of maladaptive behavior were recorded at baseline and after 6 months of ziprasidone treatment. RESULTS: Ziprasidone treatment was associated with a significant weight loss of 8.1 lb (3.6 kg) as well as a significant reduction in total cholesterol and triglycerides (p < or =.05). The monthly frequency of the maladaptive behavior remained unchanged or improved in 72% (18/25) of the patients in whom maladaptive behavior was assessed. CONCLUSION: Ziprasidone effectively reduces the frequency of maladaptive behavior in a patient group with mental retardation without causing weight gain or metabolic disturbances.     

Change in Autism Symptoms and Maladaptive Behaviors in Adolescents and Adults with an Autism Spectrum Disorder

This study examined change prospectively in autism symptoms and maladaptive behaviors during a 4.5 year period in 241 adolescents and adults with an autism spectrum disorder who were 10–52 years old (mean = 22.0) when the study began. Although many individuals’ symptoms remained stable, a greater proportion of the sample experienced declines than increases in their level of autism symptoms and maladaptive behaviors, and there were significant improvements in mean levels of symptoms. Individuals with mental retardation had more autism symptoms and maladaptive behaviors than those without mental retardation, and they improved less over time. Compared to adolescents, older sample members (31 and older) had fewer maladaptive behaviors and experienced more improvement in these behaviors over time.     

Incidence and temporal patterns of adaptive behavior change in adults with mental retardation

The age-associated incidence of significant decline in adaptive behavior and the temporal pattern of decline in specific functional skill domains were examined in 646 adults with mental retardation through 88 years of age. Cumulative incidence of significant decline for adults with Down syndrome increased from less than.04 at age 50 to.67 by age 72, whereas cumulative incidence of significant decline for adults with mental retardation without Down syndrome increased from less than.02 at age 50 to.52 at age 88. Among adults experiencing overall decline, four clusters of behaviors were identified based upon the sequence and magnitude of changes, suggesting a pattern of loss not unlike that noted in the population without mental retardation with dementia.     

The assessment of social functioning in individuals with mental retardation: a review

Social skills deficits and excesses are a defining aspect of mental retardation (MR). Research indicates that there is an established relationship between social skills and maladaptive behaviors. A number of studies demonstrate that the social competence of individuals with MR and comorbid psychopathology can be enhanced with social skills training. However, to design an effective training package, an accurate assessment of adaptive and social functioning must first be conducted. Unique problems arise when assessing social skills in individuals with severe and profound MR (i.e., individuals often have limited verbal repertoires). Thus, a clinician must often rely on observable behavior and caregiver report rather than self-report. The three most common methods for assessing social skills are behavioral observations, role-playing, and checklists. These assessment strategies will be discussed, as well as suggestions for future research.     

Adaptive and maladaptive functioning of institutionalized and noninstitutionalized fragile X males

The profile of adaptive strengths and weaknesses of 12 institutionalized and 15 noninstitutionalized fragile X males was examined using the Vineland Adaptive Behavior Scales. Fragile X males in both living settings demonstrated relative strengths in Daily Living Skills compared to functioning in the domains of Communication and Socialization. Within daily living skills, personal (e.g., grooming, toileting) and domestic (e.g., cooking, cleaning) skills were better developed than community skills (e.g., managing money, attending work). Both institutionalized and noninstitutionalized fragile X males showed high levels of maladaptive behavior characterized by attentional impairments; impulsivity; and defiant, oppositional "externalizing" behaviors. High levels of anxiety were also apparent. The institutional sample showed particular deficits in expressive and written communication but was more likely than the noninstitutional group to have individuals with levels of daily living skills above their mental ages. These findings have direct implications for intervention with fragile X males.     

The behavioral function of feeding problems as assessed by the questions about behavioral function (QABF)

Differences in subscale scores on the questions about behavioral function (QABF) were assessed for participants identified with pica, rumination, food stealing, food refusal, and mealtime behavior problems (e.g., aggression, self-injurious behavior). The QABF was administered to informants for 125 individuals identified with problematic feeding behaviors and mental retardation primarily in the severe to profound range. Results of the nonparametric analyses yielded significant differences across the escape, nonsocial, physical, and tangible subscales of the QABF. Behavior functions most commonly associated with problematic feeding behaviors were identified. The results extend upon previous literature describing behavioral function of feeding problems for those with mental retardation.     

Adaptive and maladaptive behavior in Prader-Willi syndrome.

The development and profiles of adaptive and maladaptive behavior of 21 adolescents and adults with Prader-Willi syndrome were cross-sectionally examined with the Vineland Adaptive Behavior Scales and Achenbach's Child Behavior Checklist (CBCL). Adaptive strengths emerged for the group as a whole in daily living skills, and this strength became more pronounced with increasing age. A relative weakness was found in socialization, most notably in coping skills. CBCL findings indicated that externalizing behaviors were particularly heightened in adolescence and that many behaviors previously described as either emerging or worsening in adolescence also persist into the adult years (e.g., temper tantrums, arguing, irritability, stubbornness, lying, skin picking, obsessions, defiance). Certain elevated CBCL behaviors were unique to young versus old age groups, and aging in this syndrome may be associated with heightened confusion, withdrawal, and fatigue. The need to study adaptive and maladaptive features in a wider age range of subjects with Prader-Willi syndrome was emphasized.     

A validity study on the Questions About Behavioral Function (QABF) Scale: predicting treatment success for self-injury, aggression, and stereotypies

We investigated the validity of the Questions About Behavioral Function (QABF), a checklist designed to assess antecedent behavior, using a sample of 398 persons with mental retardation and a targeted maladaptive behavior of self-injurious behavior, aggression, or stereotypies. The QABF was used successfully to derive clear behavioral functions for most individuals (84%) across all three target behaviors. Further, subjects with treatments developed from functional assessment (QABF results) improved significantly when compared to controls receiving standard treatments not based on functional analysis. Implications of the present findings for assessing and treating maladaptive behaviors are discussed.     

Factor structure of maladaptive behavior across the lifespan of persons with mental retardation

Data obtained on a sample of persons with mild to profound degrees of mental retardation (N = 8255) and ranging from birth to 98 years of age were factor analyzed to provide information on the structure of maladaptive behavior relative to age and degree of mental retardation. Using the Problem Behavior scales of the Inventory for Client and Agency Planning, two principal factors emerged for children with mild to profound degrees of retardation: Internalized Maladaptive and Externalized Maladaptive. For adolescents and young adults, a three-factor solution which varied by degree of retardation was most appropriate. For middle and older adults, three- and four-factor solutions were identified across all ages and degrees of retardation. Across all samples as many as six different types of dimensions were identified, indicating that the structure of maladaptive behavior may well be influenced by age and level of mental retardation.     

Coping strategies and the impact of challenging behaviors on special educators' burnout

Although challenging behaviors have been identified as a source of staff stress, few researchers have directly addressed this relationship. In the present study, 55 teachers and support staff in special schools for children with mental retardation completed questionnaires assessing burnout, coping strategies for challenging behavior, and their exposure to challenging behavior. Results showed that (a) use of maladaptive coping strategies for challenging behaviors constitutes a risk for staff burnout, (b) this risk is in addition to that associated with exposure to challenging behavior, and (c) use of maladaptive coping strategies moderated the impact of exposure to challenging behaviors on emotional exhaustion burnout. Implications for future research and for the support of staff working with individuals who have challenging behaviors are discussed.     

Stability and change in health, functional abilities, and behavior problems among adults with and without Down syndrome

Changes in health, functional abilities, and behavior problems among 150 adults with Down syndrome and 240 adults with mental retardation due to other causes were examined with seven assessments over a 9-year period. Adults were primarily younger than 40, the age at which declines begin to be evident in individuals with Down syndrome. Adults with Down syndrome were advantaged in their functional abilities and lack of behavior problems, comparable in health, and exhibited comparable rates of change on these measures as adults with mental retardation due to other causes. Placement out of the parental home and parental death were predictors of change in health, functional abilities, and behavior problems.     

Normal ageing in adults with Down's syndrome: a longitudinal study

The ubiquitous presence of the neuropathoiogy of Alzheimer disease (AD) in individuals with Down's syndrome (DS) over 40 years of age suggests that this group of people will exhibit a high prevalence of dementia of the Alzheimer type (DAT) as they age. The present study indicates that there is a clear discrepancy between the presumed presence of AD neuropathoiogy and the clinical expression of DAT among older people with DS. In the first 6 years of a longitudinal study, the present authors compared 91 adults (31–63 years of age) with DS and mild or moderate mental retardation to 64 adults (3 l –76 years of age) with other forms of mental retardation (MR) on yearly measures of mental status, short-and long-term memory, speeded psychomotor function, and visuospatial organization. The results indicated that, over repeated testing on the verbal long–term memory test, younger participants with DS showed small increases in their scores, while older participants with DS showed very slight decreases. Overall performance scores on this test and a speeded psychomotor task were poorer for both diagnostic groups in individuals aged SO years and older. The magnitude and type of these selective changes in performance were consistent with performance profiles observed in older healthy adults without mental retardation on tests measuring similar cognitive functions. Only four out of the 91 people with DS in the present sample showed changes in funaioning that have led to a diagnosis of possible DAT. and in these individuals, alternative causes of performance declines were concurrently present (e.g, thyroid dysfunction). These findings indicate that some age–associated changes in funaioning are related to ‘normal’ but probably precocious ageing among adults with DS. Furthermore, these findings suggest that adults with DS and mild or moderate mental retardation may be at lower risk for dementia during their fourth and fifth decades of life than previous studies have suggested.     

Hispanic caregivers of adults with mental retardation: importance of family functioning

Our aim in this study was to validate a stress-process model for Hispanic caregivers of adults with mental retardation that incorporates family functioning. The model postulates that maladaptive adult behaviors are related to poorer family relationships and higher levels of family burden, which in turn is related to caregiver psychological distress and self-reported health. The 153 Hispanic caregivers were interviewed in their homes with structured interviews and self-report measures. We analyzed cross-sectional data using structural equation modeling. The hypothesized model provided an excellent fit to the data. Also, family relationships mediated the relationship between maladaptive adult behaviors and family burden, and higher levels of family burden were related to greater caregiver distress. Acculturation was negatively related to caregiver distress.     

Vigorous,aerobic exercise versus general motor training activities: Effects on maladaptive and stereotypic behaviors of adults with both autism and mental retardation

Examined the effects of antecedent exercise conditions on maladaptive and stereotypic behaviors in 6 adults with both autism and moderate to profound mental retardation. The behaviors were observed in a controlled environment before and after 2 exercise and 1 nonexercise conditions. From the original group of 6 participants, 2 were selected subsequently to participate in aerobic exercise immediately before performing a community-integrated vocational task. Only antecedent aerobic exercise significantly reduced maladaptive and stereotypic behaviors in the controlled setting. Neither of the less vigorous antecedent conditions did. When aerobic exercise preceded the vocational task, similar reductions were observed. There were individual differences in response to antecedent exercise. Use of antecedent aerobic exercise to reduce maladaptive and stereotypic behaviors of adults with both autism and mental retardation is supported.The authors acknowledge the important assistance provided by the following people: The staff and management of the Behavior Development and Learning Center at Camarillo State Hospital and Developmental Center directed by Israel Perel, Ellie Kimbauer, Judy Baptista, Kristine Herman, and especially the participants.     

Maladaptive behaviors related to dementia status in adults with Down syndrome

Changes in maladaptive behaviors related to specific stages of dementia were investigated in 251 adults 45 years of age and older with Down syndrome. Findings indicate clear differences in maladaptive behaviors at various stages of dementia. Generally, individuals with no signs or symptoms of dementia displayed fewer and less severe maladaptive behaviors than individuals in the early and mid-stages of dementia. Individuals transitioning into the early stages of dementia from no dementia displayed increased aggression, fearfulness, sadness, sleep problems, social inadequacy, stealing, and general regressive behavior. Thus, new concerns regarding these types of behaviors could be particularly useful in clarifying the dementia status of adults with Down syndrome and developing individualized plans for support.     

The relationship of comorbid problem behaviors to social skills in persons with profound mental retardation

Research into behavior problems among individuals with mental retardation has been well developed. However, few studies have addressed the effect of multiple problem behaviors on social skills. In the present study, the authors examined the relationship between two problem behaviors, stereotypy and self-injury, and social skills among individuals with profound mental retardation. A total of 120 participants were divided into four groups based on the presence of stereotypic and self-injurious behavior. Persons with comorbid stereotypy and self-injury evinced more negative nonverbal social skills than did those with self-injury alone or no problem behaviors. In the past, researchers examined behavior problems as isolated phenomena. However, a recent shift in the conceptualization of problem behaviors has exposed the lack of research regarding the nature of social and adaptive skills in the face of multiple topographies of problem behaviors using broader conceptualizations.     

Behavioral phenotypes of genetic syndromes with intellectual disability: comparison of adaptive profiles

The study of distinctive and consistent behaviors in the most common genetic syndromes with intellectual disability is useful to explain abnormalities or associated psychiatric disorders. The behavioral phenotypes revealed outcomes totally or partially specific for each syndrome. The aim of our study was to compare similarities and differences in the adaptive profiles of the five most frequent genetic syndromes, i.e. Down syndrome, Williams syndrome, Angelman syndrome, Prader-Willi syndrome, and Fragile-X syndrome (fully mutated), taking into account the relation with chronological age and the overall IQ level. The research was carried out using the Vineland Adaptive Behavior Scale (beside the Wechsler Intelligence scales to obtain IQ) with a sample of 181 persons (107 males and 74 females) showing genetic syndromes and mental retardation. Syndrome-based groups were matched for chronological age and mental age (excluding the Angelman group, presenting with severe mental retardation). Similarities and differences in the adaptive profiles are described, relating them to IQs and maladaptive behaviors. The results might be useful in obtaining a global index of adjustment for the assessment of intellectual disability level as well as for educational guidance and rehabilitative plans.     

Rating problem behaviors in outpatients with mental retardation: use of the Aberrant Behavior Checklist.

Parent and teacher ratings of behavior problems of an outpatient sample of 110 children, adolescents, and young adults with IQs ranging from severe mental retardation to borderline were obtained using a modified version of the Aberrant Behavior Checklist (ABC). Using factor analytic techniques, the five-factor structure of the parent data corresponded extremely well with the five factors originally obtained from staff ratings of mentally retarded inpatients (i.e., Irritability, Withdrawal, Hyperactivity, Stereotypies, and Inappropriate Speech). Factor content was virtually identical between the parent and original ABC data with differences involving only one or two items per scale. The teacher data also revealed a factor structure that corresponded to the same five factors as the parent and original data. Although the teacher and parent factors showed a high degree of similarity, the teacher data suggested that the Stereotypies and Inappropriate Speech factors of the parent and original analyses were not the same constructs for teacher respondents. Age was related to the withdrawal factor for parent data; level of intellectual functioning was the only subject characteristic related to factor scale scores in both parent and teacher data. Test-retest reliabilities were adequate to excellent for all factors for both parent and teacher data. Parent-teacher cross-informant reliabilities were adequate for at least four of the factors. The results of the report indicate that the ABC is a useful, reliable instrument for assessing maladaptive behaviors in young, developmentally disabled outpatients.     

Costs and benefits of alternative rehabilitation models

Adaptive behavior skills of 2,144 adults with Down syndrome aged 20–69 years were compared to those of a matched group of 4,172 developmentally disabled people without Down syndrome. Adaptive competence in eight skill domains was examined as a function of etiology, age-group and level of mental retardation. In all behavioural domains, and at all levels of mental retardation, individuals with Down syndrome displayed significantly more age-related deficits than did age-matched controls. In individuals with Down syndrome, substantial age-related deficits in adaptive competence were observed after 49 years of age and were most pronounced after 59 years of age. Our findings support previous suggestions of increased risk for Alzheimer disease among adults with Down syndrome. However, Alzheimer neuropathology is found in people with Down syndrome by 40 years of age; signs of regression in adaptive behavior occur 10–15 years after the presumed onset of pathological processes. These results may suggest that the processes underlying dementia in individuals with Down syndrome can have an extremely prolonged course.