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المشکلات الانفعالیة والسلوکیة لدى الأطفال ذوی الإعاقة الفکریة واضطراب طیف التوحد ومتعددی الإعاقة کما یدرکها المعلمون
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The main object of this review is to understand how emotional disorders develop and how they may interact with the score of functioning or with the severity of symptoms in autism spectrum disorder. We hypothesize that emotional disorders may influence negatively in the functionality of these patients. This review was based on a systematic research of published articles available up to July 2014. The initial literature search resulted in 149 citations. Of those, 21 met the inclusion criteria. Many of the unselected studies from the initial pool involved samples outside the targeted age range (e.g., adults or preschool children) or with non-ASD developmental disabilities. This review concluded that comorbid with emotional disorders among patients with ASD may be more common than previously thought. It may have consequent impairment in their psychological profile, social adjustment, adaptive functionality, cognitive and global functioning and should alert clinicians the importance of assessing mood disorders in order to choose the appropriate treatment.
Адолесцентите со интелектуална попреченост поради дефицитот во своею интелектуално функционираіье се изложени на поголем ризик од псдава на разни облици на распхуства во од- несувааето. Цел: да се утврди ризикот од подава на рас- тро^тва во однесувавьето од адолесцентите со лесна интелектуална попреченост. Примерок: адолесценти (211) со лесна инте- лектуална попреченост, воспитно-образов- ниот кадар во посебните средни училишта (39) и членови на стручниот тим (5). Методи: дескриптивен метод, метод на ком- паративна анализа. Поставки: анкетиракье и п о лу с тру кту ир а но интерв^у со воспитно-образовниот кадар и| стручниот тим. Статистичка обработка на податоците: \ѴіпсІо\ѵ$-програмот К х С за анализа на та- бели на контингенту а и тестот Різііег ЕхасГ. а како сигнификантни беа земени разликите на ниво на знача^ност од р<0.05. Резултати: Со статистичка обработка на по- датоците констатиравме дека училишниот ус- пех влиіае на похвата на несакано однесуван>е (р<0.001). Вработените во училиштата во 56.8% од случайте сметаат дека адолеепен тнте со лесна интелектуална попреченост немаат доволно сознашда за негативннте последшш од ваквого однесуваае. Поголем бро] случаи на растро)ства во однесувааето се за-бележани ка) постарите ученшш (р<0.05) кон живеат подолг период во ученички домовн. Заклучок: Констатнравме дека од ученипите се )авуваат различии форми на растро]ства во однесувааето за чин последипи петите не се доволно информирани и многу ретко самоиницщ ативно започнуваат разго вор за проблемот. Растро]ствата во однесу вааето ка] оваа категоріда на ученипи е мултифакторски условено. и тоа од видот на зг рижуваае. временскиот престо) во ученичкиот дом. училншннте постигнув ааа. воз- раста и полот.
In the present study, we sought to extend instrument validation research for a strength-based emotional and behavior rating
scale, the Teacher Rating Scale of the Behavior and Emotional Rating Scale-Second Edition (BERS-2; Epstein, M. H. (2004). Behavioral and emotional rating scale (2nd ed.). Austin, TX: PRO-ED) through the use of convergent validation techniques. The associations between the strength-based
domains of the BERS-2 were examined in relation to problem syndrome subscales of the Teacher’s Report Form (TRF; Achenbach, T. M. (1991b). Manual for the teacher’s report form and 1991 profile. Burlington: University of Vermont, Department of Psychiatry). Both measures were conducted with 58 students with emotional
disturbance in grades 2 through 12. The overall convergent validity of the BERS-2 and the TRF was strong, particularly for
TRF externalizing problems and associated syndromes. However, less evidence emerged for the convergence of domain subscales
characterized by behaviors of an internalizing nature. These results provide further support for the use of the BERS-2 in
the assessment of the social and behavioral functioning of students with emotional disturbance.
Children with autism spectrum disorder or Williams syndrome are vulnerable to anxiety. The factors that contribute to this risk remain unclear. This study compared anxiety in autism spectrum disorder and Williams syndrome and examined the relationship between repetitive behaviours and anxiety. Thirty-four children with autism and twenty children with Williams syndrome were assessed with measures of anxiety and repetitive behaviours. Children with autism had higher levels of anxiety. Within the autism sample higher levels of repetitive behaviours were associated with more anxiety. This was not replicated in the Williams syndrome sample, indicating a differential role for restricted and repetitive behaviours in relation to anxiety. Understanding the links between repetitive behaviours and anxiety is essential for effective intervention.
Behavioural problems are frequently reported in residential care for people with an intellectual disability (ID) in particular when they are additionally diagnosed with autism spectrum disorder (ASD). There are indications that impairment in cognitive shifting may be associated with problem behaviour. The objectives of this study were (1) to examine the relationship of cognitive shifting and severity of ASD symptoms with externalising problem behaviour in individuals with ID, with and without ASD, and (2) to examine whether a diagnosis based on shifting impairment is more predictive of externalising problem behaviour than an ASD diagnosis.
Participants consisted of adolescents and young adults with mild ID, with and without ASD (n = 41). Pearson intercorrelations were computed to explore the relationship between shifting impairment and severity of ASD symptoms on the one hand and ratings of externalising problem behaviour on the other hand. t-Tests were performed to analyse differences in externalising problem behaviour.
Unlike ASD symptom severity, shifting scores were found to be associated with externalising problem behaviour, but only if shifting was measured using rating scales and not when using neuropsychological tasks. Externalising problem behaviour scores significantly differed when groups were classified according to shifting impairment (impaired vs. non-impaired) but not when they were classified according to ID and ASD diagnoses.
It is proposed to use a cognition-based approach when analysing problem behaviour, thus concentrating not so much on ID and ASD diagnosis and their corresponding symptoms, but rather placing the focus on cognitive symptoms.
© 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.
Debate is ongoing about whether typically developing siblings of children with autism spectrum disorder (ASD) are at greater risk of behavioral or emotional problems than siblings of children without ASD. Most data on behavior is provided by mothers, and we do not know whether fathers' reports differ. The strengths and difficulties questionnaire (Goodman in J Child Psychol Psychiatry 38(5):581-586, 1997) was completed by 168 mothers and 130 fathers. Parents were more likely to rate siblings as having 'abnormal' behavior when compared to a normative population. We found moderate correlations between mother-father ratings. More research may be needed to understand any clinical benefits of gathering data about sibling adjustment from more than one parent in the family. Implications for clinical practice and future research are discussed.
Both the classification of personality disorder in intellectual disability (ID) and its identification in practice are deemed to be difficult. A simpler approach to classification and its relationship to challenging behaviours were tested in an adult Jamaican population with ID.
The study was carried out in Kingston, Jamaica, as part of a programme of field trials to determine the utility of the proposed revision of personality disorders in the 11th Revision of the International Classification of Diseases (ICD-11), in a population of adults with ID living with their families or in supported care homes. Thirty-eight people with borderline (n = 5), mild (n = 16), moderate (n = 14) and severe (n = 3) ID were assessed at face-to-face interview and with relatives or staff using the provisional criteria for severity of personality disorder and its associated domain traits, and challenging behaviour was assessed using the Problem Behaviour Check List (PBCL) (a 5-point, 7-item scale).
Using the severity scale 18 patients (47%) had no personality disorder, 7 (18%) had personality difficulty, 9 (24%) had mild personality disorder, and 4 (11%) had moderate personality disorder. None of the sample had severe personality disorder in which there is high risk of harm to self or others. Of the four major trait domains, provisionally named anankastic, detached, emotional and dissocial, three were evenly distributed in those with personality disturbance with the antagonistic (antisocial) trait less commonly shown (6 only). Scores on the PBCL were higher in those with increasing severity of personality disorder (P = 0.03) and those in the antagonistic personality trait domain had the highest PCL scores.
Despite previous difficulties in assessing personality disorder in intellectual difficulties the ICD-11 classification was easy to administer in practice in this population, and the higher problem behaviour scores in those with greater severity of personality disturbance support its construct validity.
Recent reports suggest that individuals with autism spectrum disorders (ASD) may experience depression at a high frequency, yet few published studies address this issue, especially among adults. In the current investigation, we reviewed features of depression and comorbid traits among depressed inpatients with intellectual disabilities (ID) as a function of ASD. A retrospective chart review was performed for 53 inpatients meeting criteria for depression (13 individuals with ASD and ID and 40 matched individuals with ID but without ASD), all of whom had received a diagnosis of depression at the time of discharge from a specialty psychiatric unit for adults with ID. The depression diagnoses were based on a comprehensive clinical assessment; specific mood and anxiety symptoms were reported by informants at the time of intake using the Mood and Anxiety Semi-Structured (MASS) Interview for Patients with Intellectual Disabilities (Charlot, Deutsch, Hunt, Fletcher, & McIlvane, 2007). Overall, few qualitative differences were detected between the 2 groups. Both depressed inpatient groups had high rates of comorbid anxiety disorders as well as externalizing behaviors. Inpatients with ASD had a total of 2 more symptoms (out of 29 possible symptom items) than their depressed peers without an ASD diagnosis (mean scores of 12.23 and 9.85, respectively). Anxiety disorders were reported in 62% of individuals with ASD and 38% of those without ASD. Antipsychotic medication was prevalent among the patients with ASD and depression. Over 80% of the inpatients with ASD and depression, compared with 49% of the non-ASD group, were treated with these medications.
This paper is a partial report of an investigation into the integration program at two A.C.T. special schools catering for moderately and severely intellectually handicapped children. Teachers and parents of the children at the special schools completed questionnaires concerning the conduct and outcomes of the program. The opinions of teachers at the regular schools were obtained by personal interview. Overall there were positive attitudes expressed towards the program. Areas of concern include the level of support required for the regular class teacher, the level of preparation the handicapped children required before integration commenced, a worry of parents that handicapped children may be exposed to unnecessary pressures in the regular school system, and the fact that mere exposure of a handicapped child to a regular school environment may not lead to effective integration in the larger community.
Principals from N.S.W. government and non‐government schools were surveyed to elicit their attitudes towards the integration of individual disabled‐children and the support services currently provided. Attitudes forwards mildly intellectually handicapped students in particular were also examined. Analysis of principals’ ratings for each educational/behavioural disability specified indicates that they are positive only about integrating children who demand neither extra competencies nor extra curricular duties from the regular class teacher. Results also suggest that principals are dissatisfied with the quality and quantity of support services routinely provided and now seek resource personnel with the expertise to directly assist the regular teacher in the classroom. Sub‐group variations among principals on both issues are also reported. Data on mildly intellectually handicapped students indicate little attitudinal change since a study undertaken in 1978, although knowledge of the most effective support services for this population appears to have increased. Implications of these findings for policy and practice are discussed.
While research indicates elevated behavioural and emotional problems in children with autism spectrum disorders (ASD) and decreased well-being in their parents, studies do not typically separate out the contribution of ASD from that of associated intellectual disabilities (ID). We investigated child behavioural and emotional problems, and maternal mental health, among cases with and without ASD and ID in a large population-representative sample.
Cross-sectional comparison of child behavioural and emotional problems and maternal mental health measures among 18,415 children (5 to 16 years old), of whom 47 had an ASD, 51 combined ASD with ID, 590 had only ID, and the remainder were the comparison group with no ASD or ID.
The prevalence of likely clinical levels of behavioural and emotional problems was highest among children with ASD (with and without ID). After controlling for age, gender, adversity, and maternal mental health, the presence of ASD and ID significantly and independently increased the odds for hyperactivity symptoms, conduct, and emotional problems. Emotional disorder was more prevalent in mothers of children with ASD (with or without ID). The presence of ASD, but not ID, significantly increased the odds for maternal emotional disorder. As has been found in previous research, positive maternal mental health was not affected by the presence of ASD or ID.
ASD and ID are independent risk factors for behavioural and emotional problems. ASD (but not ID) is positively associated with maternal emotional disorder. Approaches to diagnosing hyperactivity and conduct problems in children with ASD may need to be reconsidered.
Behavior problems such as aggression, property destruction, stereotypy, self-injurious behavior, and other disruptive behavior are commonly observed among adults with intellectual disabilities (ID), autism spectrum disorders (ASD), and epilepsy residing at state-run facilities. However, it is unknown how these populations differ on behavior problem indicies. Assessment of behavior problems were made with the ASD-behavior problems-adult version battery. One hundred participants with ID were matched and compared across four equal groups comprising 25 participants with ID, 25 participants with epilepsy, 25 participants with ASD, and 25 participants with combined ASD and epilepsy. When controlling for age, gender, race, level of ID, and hearing and visual impairments, significant differences were found among the four groups, Wilks's Lambda=.79, F(12, 246)=1.93, p<.05. The multivariate eta2 based on Wilks's Lambda was .08. A one-way ANOVA was conducted for each of the four subscales of the ASD-BPA as follow-up tests to the MANOVA. Groups differed on the aggression/destruction subscale, F(3, 96)=.79, p>.05, eta2=.03, and stereotypy subscale, F(3, 96)=2.62, p>.05, eta2=.08. No significant differences were found on the self-injury subscale and disruptive behavior subscale. Trend analysis demonstrated that individuals with ID expressing combined co-morbid ASD and epilepsy were significantly more impaired than the control group (ID only) or groups containing only a single co-morbid factor with ID (ASD or epilepsy only) on these four subscales. Implications of these findings in the context of known issues in ID, epilepsy, and ASD, current assessment practices among these populations and associated challenges are discussed.
This study describes the different prevalences obtained when varying combinations of informants were used to identify emotional and behavioural disorders in a representative sample of 336 children living in two-parent families in the community of Adelaide, South Australia. When different informants were used to identify children with disorders, the estimated prevalences ranged from 3.3 +/- 1.6% to 17.9 +/- 4.1% for younger children, and 6.0 +/- 2.9% to 19.9 +/- 4.9% for older children. Results from the study highlight potential methodological problems which arise in epidemiological studies due to differences between reports from children, parents, and teachers describing childhood emotional and behavioural problems.
The original factor structure of the Aberrant Behavior Checklist was cross-validated with an American sample of 470 persons with moderate to profound mental retardation, including nonambulatory individuals. The results of the factor analysis with varimax rotation essentially replicated previous findings, suggesting that the original five factors (Irritability, Lethargy, Stereotypic Behavior, Hyperactivity, and Inappropriate Speech) could be cross-validated by factor loadings of individual items. The original five scales continue to show high internal consistency. These factors are easily interpretable and should continue to provide valuable research and clinical information.
The assessment and diagnosis of psychiatric disorders in individuals with mental retardation has been a neglected area of research. However, current research indicates that these individuals suffer from the same range of psychiatric disorders that is evident in those who are not mentally retarded. A model of assessment and diagnosis of mental illness in this population is presented that incorporates psychiatric as well as behavioral methods. The emphasis is on the comprehensive assessment of an individual's behavior, based on family history, self and informant clinical interviews, rating scales, direct observations, and an experimental analysis of the target behaviors. The model provides the basis for making differential diagnoses in terms of related psychiatric disorders and between psychiatric disorders and behavior problems. Depression and schizophrenia are used as illustrative disorders to describe the application of this model. Given the paucity of literature on the assessment and diagnosis of mental illness in individuals with mental retardation, a number of suggestions are made regarding future research and refinement of the model.
The DASH scale was used to assess 506 profoundly and severely mentally retarded persons (247 females and 259 males). The scale, covering 13 major psychiatric disorders, consists of 83 items derived from DSM-III-R as well as previously published studies of this population. Data were collected on symptom frequency, duration and severity in individual interviews with direct-care staff. Elimination and pervasive developmental disorders were most frequent, self-injurious behaviour disorders most severe. Most symptoms had been evident for at least a year. Inter-rater reliability was generally good.
While sharing a new emphasis upon identifying discrete psychiatric disorders in children and adolescents, epidemiological field studies conducted during the past decade have used diverse methods of case ascertainment and definition. Half used the multimethod-multistage approach to ascertain cases. Severity rating scales and measures of pervasiveness, parent-child concordance, and global functional impairment were employed to enhance the specificity of case definition. The majority of overall prevalence estimates of moderate to severe disorder range from 14 to 20%. Those investigations that use multiple methods to define caseness show greatest promise in identifying true cases in community samples.
The Beck Depression Inventory (BDI) was administered to 35 outpatients diagnosed according to the DSM-III as primary generalized anxiety disorders and 101 outpatients diagnosed as primary major-depression and dysthymic disorders. A backward stepwise-discriminant analysis revealed that Sadness and Loss of Libido were the only two symptoms that meaningfully distinguished between the two groups. The depressed patients were sadder and complained of more loss of libido than did the anxious patients. It was concluded that the BDI is a powerful tool for differentiating the depressive from generalized anxiety disorders.
One hundred and ten adults, from borderline to severe levels of mental retardation, were assessed through the outpatient clinic of a university-affiliated mental health center and a large state psychiatric hospital. These patients were included only after they had demonstrated the ability to respond to questions of similar difficulty to those presented in the Psychopathology Instrument for Mentally Retarded Adults. This measure was designed by the authors based on DSM III criteria, and covered seven types of psychopathology including schizophrenia, depression, psychosexual disorders, adjustment disorder, anxiety, somatoform disorders, and personality problems. In the present study the psychometric properties of the scale were reviewed and/or evaluated including internal consistency of items and test-retest reliability, and factor analysis.
Investigated the association between various depression assessment methods in 38 adults with mild or moderate mental retardation, half of whom had relatively high and the other half had relatively low depression screening scores. Measures included a standard psychiatric interview (Diagnostic Interview for Children and Adolescents), an informant rating scale (Reiss Screen for Maladaptive Behavior), and a self-report measure (Self-Report Depression Questionnaire). Association between measures was generally low, yielding discordant classification results. Potential reasons for these discrepancies were offered, and implications for clinical and research assessment of mood disorders in mental retardation were discussed.
A survey of affective symptoms in two groups of institutionalized adults with mental retardation was conducted. The groups were comprised of subjects with prior diagnoses of affective disorders or other psychiatric disorders. Informants reported retrospectively on the presence or absence of DSM-III-R criteria for major depression and mania. Thirteen percent of the affective disorders group did not meet these criteria for depression or mania, whereas 20% of the other psychiatric disorders group did. Aggression was a frequent concomitant of psychopathology in both groups. These findings support previous reports that affective disorders may be underdiagnosed in this population. However, unlike prior investigations, most of the subjects (74%) in the present survey had severe to profound mental retardation.
The frequency, intensity, and content of specific fears in 299 children with and without mental retardation (ages 6 to 13 years) were investigated. The children with mental retardation reported a greater fear intensity than did younger children without mental retardation but did not differ in the number of fears reported. However, children with mental retardation reported both a greater frequency and intensity of fears than did similar-age peers without mental retardation. Gender differences in frequency and intensity of fears were assessed, and the most common fears (with and without regard to intensity ratings) of the groups were compared and implications for future research and practice presented.
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.
Over the past decade, increased attention has been paid to identifying and responding to the emotional and behavioural needs of children and adolescents with intellectual disability (ID). The aims of the present study were to add to this body of knowledge by identifying factors associated with emotional and behavioural needs among a sample of children with ID drawn from a large urban conurbation.
Information was collected by postal questionnaire (or interview for family carers who did not have English as their first language) from teachers and from family carers of 615 children administratively identified as having ID (47% of all children with ID).
Results indicated that: (1) the administrative prevalence of moderate but not severe ID was associated with social deprivation whereas the prevalence of severe but not moderate ID appeared to be associated with ethnicity; (2) 54% of children scored above the threshold on the Developmental Behaviour Checklist (DBC)-primary family carer, and 37% of children scored above the threshold on the DBC-teacher; (3) social deprivation, male gender, less severe ID and having fewer physical or sensory impairments were associated with antisocial and disruptive behaviour; and (4) more severe ID and additional impairments were associated with anxiety, communication disturbance, social relating and self-absorbed behaviours.
These results identify a range of risk factors associated with behavioural and emotional problems experienced by children with ID.
Inpatient aggression in treatment facilities for persons with intellectual disability (ID) can have aversive consequences, for co-clients and staff, but also for the aggressors themselves. To manage and eventually prevent inpatient aggressive incidents, more knowledge about their types and characteristics is necessary.
In four facilities, totalling 150 beds, specialized in the treatment of adults with mild ID or severe challenging behaviour, aggressive incidents were registered during 20 weeks using the Staff Observation Aggression Scale-Revised. Characteristics of auto-aggressive and outwardly directed incidents and differences in their incidence in male and female clients in these facilities were compared.
During the observation period of 20 weeks, 639 aggressive incidents were documented. Most of these (71%) were outwardly directed, predominantly towards staff, while most of the remaining incidents were of an auto-aggressive nature. Of the 185 clients present during the observation period, 44% were involved in outwardly directed incidents (range per client 1-34), and 12% in auto-aggressive incidents (range per client 1-92). Auto-aggressive and outwardly directed incidents differed regarding source of provocation, means used during the incident, consequences of the incident and measures taken to stop the incident. The proportion of men and women involved in each type of incident was comparable, as well as the majority of the characteristics of outwardly directed incidents caused by men and women.
Although approximately half of all clients were involved in aggressive incidents, a small minority of clients were responsible for the majority of incidents. Therefore, better management and prevention of aggressive incidents for only a small group of clients could result in a considerable overall reduction of aggressive incidents in treatment facilities. Comparability of aggressive behaviour in these facilities shown by men and women and differences in characteristics of auto-aggressive and outwardly directed incidents are discussed.
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