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"Practice and Intellectual Disabilities will be highly relevant to a wide audience, including professionals working in community services, clinicians working in special education schools, residential facilities, and psychiatric hospitals, and parents and organizations involved in the care of individuals with intellectual disabilities"--

AbstractNo research has been conducted on PTSD manifestation in children with severe or moderate intellectual disability (SID; IQ 20 – 49) and no PTSD measurement instrument was available. This pilot explores the psychometric properties of a new diagnostic instrument to investigate trauma and to classify PTSD in children with SID. The Diagnostic Interview Trauma and Stressors-Severe Intellectual Disabilities (DITS-SID), Aberrant Behavior Checklist and Child and Adolescent Trauma Screener 3-6 were administered to parents and residential caregivers of fifteen children with SID. The inter-rater reliability of the DITS-SID is good to excellent. There are indications of a good convergent validity. PTSD prevalence seems high at 27%-33%. Self-injurious behavior was one of the most commonly reported PTSD symptoms. There is evidence that the PTSD manifestation of children with SID does not differ from that of children without SID. PTSD is probably underdiagnosed in this target group. In understanding challenging behavior, it is important to consider an underlying PTSD in order to provide appropriate treatment. The DITS-SID is potentially suitable for diagnosing PTSD. Follow-up research in a larger sample is needed.

AbstractBackgroundThe present study examined the psychometric properties of the Dynamic Risk Outcome Scales (DROS), an instrument developed to measure dynamic risk factors in individuals with mild intellectual disabilities or borderline intellectual functioning (MID‐BIF) and externalizing (including offending‐like) behaviour problems.MethodThe sample consisted of 606 clients (86% male) from inpatient treatment wards at a facility for individuals with MID‐BIF and externalizing behaviour problems.ResultsThe DROS showed an acceptable factor structure, good internal consistency, significant test–retest reliability and fair to excellent inter‐rater reliabilities for most subscales and total score. Compared to the Adult Behavior Checklist (ABCL; Achenbach & Rescorla, 2003 Manual for the ASEBA adult forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families), the DROS showed convergent and divergent validity, concurrent and longitudinal validity.ConclusionsThe DROS is a reliable and valid instrument to measure dynamic risk factors in clients with MID‐BIF. Future research on the DROS will focus on the assessment of recidivism and the inclusion of internalizing problems.

AbstractTo observe changes in three clients with intellectual disabilities and severe behavioral problems and staff in a long-term care residential facility after redesigning the clients' rooms by making them more personal and homely, adjusting the amount of stimuli, changing the layout, connecting to the outdoor area, and using high-quality natural materials. Relatively many clients with intellectual disabilities exhibit severe problem behaviors, including self-harm, aggression toward others, and repeated destruction of their own rooms, which can eventually result in a barren, inhumane living environment. Research on these clients is limited. Data were collected in a mixed methods study in which quantitative and qualitative data were analyzed. After the redesigns, positive changes were observed in the well-being and behavior of all three clients, for example, with respect to quality of life, privacy, freedom of choice, problem behavior, mood, cognition, activities of daily living, leisure activities, social behavior, self-harm, and constraints. There were no changes in the use of psychotropic medication. Quality of life scores increased in two cases, but were significant in only one. Emotional and behavioral problem scores decreased significantly in two cases, but in only one case these results were maintained at follow-up. Staff experienced a more pleasant, safe, and functional work environment, with improved provision of indicated care and interaction. Absenteeism decreased significantly in two of the three cases. Redesigning clients' rooms could potentially be a promising intervention for clients with intellectual disabilities and severe chronic behavioral problems.

AbstractBackgroundIn the Netherlands, Flexible Assertive Community Treatment (FACT) teams have been established for people with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and mental health problems or challenging behaviour. Little is known yet about service users' experiences with FACT.MethodAn inductive grounded theory approach was used to explore how service users valued the treatment and their own functioning, and which factors were perceived as supportive. Semi‐structured interviews were held with 15 service users.ResultsMost service users highly appreciated the contact with the staff and the practical and emotional support. Persistent involvement, availability and humanity, and respect for autonomy were distinguished as core values in the relationship with the staff. Most service users experienced improvement in time and attributed this to intrapersonal changes and/or less stress in life.ConclusionsFrom the perspective of service users with MID/BIF, FACT appears to have an added value.

Background  Individuals with Prader‐Willi syndrome (PWS) are at increased risk for mental health and behaviour problems, such as skin‐picking and compulsive behaviours. Prevalence and functional assessment of skin‐picking, and its association with compulsive behaviour and self‐injury, were investigated in a large group of individuals with PWS (n = 119).Materials and Methods  Data on demographic characteristics, skin‐picking and compulsive and self‐injurious behaviours were collected by questionnaires. Behavioural function of skin‐picking was assessed by administering the Questions About Behavioral Function scale.Results  Skin‐picking was found in 86% of the sample, and correlated positively with compulsive behaviours. No associations were found between skin‐picking and other variables. Functional assessment suggest that in most cases (i.e. 70%) skin‐picking primarily had non‐social functions.Conclusions  Skin‐picking and compulsive behaviours are common in PWS. In most cases, skin‐picking may be maintained by contingent arousal reduction. Controlled studies on behavioural treatment are lacking. Implications for treatment selection are discussed.

BackgroundThis study explored the effectiveness of eye movement desensitisation and reprocessing (EMDR) therapy for post‐traumatic stress disorder (PTSD) in persons with mild to borderline intellectual disability (MBID) using a multiple baseline across subjects design.MethodsOne child and one adolescent with MBID, who met diagnostic criteria for PTSD according to a PTSD clinical interview (i.e., ADIS‐C PTSD section), adapted and validated for this target group, were offered four sessions of EMDR. PTSD symptoms were measured before, during and after EMDR, and at six weeks follow‐up.ResultsFor both participants, number of PTSD symptoms decreased in response to treatment and both no longer met PTSD criteria at post‐treatment. This result was maintained at 6‐week follow‐up.ConclusionsThe results of this study add further support to the notion that EMDR can be an effective treatment for PTSD in children and adolescents with MBID. Replication of this study in larger samples and using a randomized controlled design is warranted.

AbstractBackgroundAggressive behaviour (AB) and non‐suicidal self‐injury (NSSI) are common in people with mild intellectual disability or borderline intellectual functioning, leading to adverse consequences for themselves and those around them.MethodWe investigated the relationship between AB (both total and physical in particular) and NSSI and risk factors in 125 residents in a treatment clinic using incident reports and standard clinical measurements.ResultsThere was a weak correlation between AB and NSSI, as well as between impulsivity and total AB, and between coping and AB and NSSI. However, NSSI, impulsivity and coping skills did not predict AB.ConclusionResults do not corroborate those of other studies in this area. In future studies impulsivity, coping, aggression and NSSI may be measured using other instruments, and differences between people with and without intellectual disability regarding these variables may be explored.

AbstractBackgroundSince the DSM‐5, adaptive functioning has taken a prominent place in the classification of intellectual disability (ID). The ADAPT was developed to assess adaptive skills in individuals with ID.MethodA total of 2,081 ADAPTs from clients with suspected ID or borderline intellectual functioning and 129 ADAPTs from people from the general population (non‐ID) were collected, along with background characteristics.ResultsInternal consistency of the ADAPT was high (α = 0.98). ADAPT scores were positively associated with IQ, educational level and level of independent living. Furthermore, individuals without ID scored significantly higher than the clients onallof the 65 ADAPT items. Reference values were established for different IQ groups and living situations.ConclusionResults suggest that the ADAPT is a valid instrument for measuring adaptive skills in individuals with ID. The reference values may be used for the purpose of estimating the level of ID and the needed intensity of support.

AbstractBackgroundThis study examined the relationship between substance use motives (i.e., social, conformity, coping and enhancement) and substance use in individuals with mild intellectual disability or borderline intellectual functioning (MID‐BIF).MethodData were collected among 163 clients with MID‐BIF using interactive questionnaires with visual cues on a tablet with a web application.ResultsResults show that social motives were positively related to frequency of alcohol use, while conformity, coping and enhancement motives were positively related to severity of alcohol use. Results for drug use show that social motives were positively related to frequency of cannabis and hard drug use and that conformity motives were negatively related to frequency of cannabis use. Coping motives were positively related to severity of drug use.ConclusionsInsight in substance use motives should be used when adapting interventions, as it could contribute to the prevention and reduction of substance use disorders in individuals with MID‐BIF.

Introduction: In this study, we explored if low vision or blindness affects adaptive functioning in individuals with and without intellectual disabilities, using the adaptive ability performance test (ADAPT). Method: Two hundred and nine ADAPTs were collected from individuals with low vision and blindness who were in care or lived independently. ADAPT scores were compared with 2642 ADAPT scores from sighted individuals. Separate comparisons were made for intellectually disabled and nonintellectually disabled groups. Results: ADAPT scores of low vision and blind individuals in both intellectually disabled and nonintellectually disabled groups were significantly lower than those of sighted individuals. ADAPT scores did not differ significantly between low vision and blind individuals. Reference values were established for individuals with visual impairments with and without intellectual disabilities. Discussion: Despite some limitations of this study, we conclude that adaptive skills are lower in individuals with visual impairments than in sighted individuals. Cross-cultural studies are required. Information for Practitioners: The results of this study provide insight into adaptive skills in individuals with visual impairments. Reference data on the ADAPT can be used for the classification of (the severity of) intellectual disabilities and assessment of the need for support or training of adaptive skills, which makes the ADAPT a useful instrument for professionals who work with individuals with visual impairments with and without intellectual disabilities.

AbstractIndividuals with mild intellectual disabilities (MID) or borderline intellectual functioning (BIF) and mental health problems or challenging behavior are difficult to reach by mainstream healthcare facilities and support organizations and frequently avoid the care they need. To improve the care for this client group in the Netherlands, the (Flexible) Assertive Community Treatment (ACT) model—originally developed for people with severe mental illness—was adapted and implemented by five organizations specialized in the care for people with MID/BIF and mental health problems or challenging behavior. After an introduction of the original ACT model and a description of the international state of the art of ACT for people with (M)ID/BIF, this paper describes the (Flexible) ACT‐MID/BIF model as developed and implemented in the Netherlands. Professionals' and clients' experiences with this new type of care are reported as well. Implications for clinical practice, policy and research are discussed.

AbstractBackgroundThe adaptive ability performance test (ADAPT) was developed to assess adaptive skills in individuals with intellectual disabilities and borderline intellectual functioning, with or without mental disorders. As a follow‐up to earlier research on the ADAPT, a factor analytic study was conducted.MethodOne thousand and sixty six ADAPTs from clients with (suspected) intellectual disabilities or borderline intellectual functioning and 129 ADAPTs from participants from the general population were collected along with other characteristics (e.g., IQ, psychiatric classifications, living situation).ResultsAn exploratory factor analysis (EFA) was performed and resulted in good fit indices. Subsequent confirmatory factor analysis (CFA) and multigroup CFA showed acceptable to good fit indices. This resulted in an instrument with eight factors and 62 items.ConclusionFactor analytic results suggest that the ADAPT is a valid instrument that measures adaptive skills in individuals with intellectual disabilities or borderline intellectual functioning.