Incidence, types and characteristics of aggressive behaviour in treatment facilities for adults with mild intellectual disability and severe challenging behaviour

Background: 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. Method: In four facilities, totalling 150 beds, specialized in the treatment of adults with mild ID or severe challenging behaviour, aggressive incidents were registered during 20weeks 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. Results: 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. Conclusions: 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. © 2007 The Authors. Journal Compilation © 2007 Blackwell Publishing Ltd

A preliminary investigation into the utility of the Adult Behavior Checklist in the assessment of psychopathology in people with low IQ

Background: Achenbach & Rescorla (2003) recently developed the Adult Behavior Checklist (ABCL) to assess psychopathology in the general population. The ABCL should be completed by a proxy informant. The use of proxy informants, instead of self-reporting, makes the ABCL potentially suitable for the assessment of psychopathology in adults with intellectual disability. The aim of the present study was to examine reliability and validity of the ABCL in 124 adults with mild intellectual disability or low IQ, and severe challenging behaviour referred for residential treatment. Methods: The ABCL was completed by two independent informants to assess inter-rater reliability. To examine the validity of the ABCL, its relationship with three measures of functioning was assessed. Furthermore, association between scales of the ABCL and DSM-IV axis I disorders was examined. Results: The ABCL was reliable in terms of internal consistency of its scales, and inter-rater reliability. Relationships between clusters of axis I DSM-IV disorders and scales of the ABCL were found as expected. Moreover, ABCL scales predicted different measures of functioning. Conclusions: The ABCL appears to be a reliable and valid measure to assess psychopathology in persons with mild intellectual disabilities or low IQ, admitted for treatment in facilities for adults with mild intellectual disability and severe challenging behaviour. © 2007 The Authors

Assessment of DSM-IV personality disorders in obsessive-compulsive disorder: Comparison of clinical diagnosis, self-report questionnaire and semi-structured interview. [IF 1.7]

In patients with obsessive-compulsive disorder, personality disorders are not many times assessed according to DSM-IV criteria. The purpose of the present study is to examine the prevalence of personality disorders diagnosed according to the DSM-IV in a severely disordered OCD population (n = 65) with three different methods of assessing personality disorders (structured interview, questionnaire, and clinical diagnoses). Furthermore, correspondence between these different methods was investigated and their construct validity was examined by relating the three methods to external variables. Each method resulted in a predominance of Cluster C personality disorders, and obsessive-compulsive personality disorder had the highest prevalence. However, there was generally low correspondence regarding which patient had which personality disorder. Results concernign the relation of external variables were the most promising for the structured clinical interview

Markers for aggression in inpatient treatment facilities for adults with mild to borderline intellectual disability

Item does not contain fulltextIn high care settings for persons with intellectual disability (ID) aggressive incidents often occur. Still little is known about factors that are associated with an increased risk for aggressive behavior in clients who are admitted to an inpatient treatment facility. In four inpatient facilities, 108 adults with mild and borderline ID and behavior problems were categorised into three aggressive incidents groups (no, mild, severe) according to their actual aggressive behavior observed for six months. The three groups were compared with regard to background and admission characteristics, psychiatric co-morbidity and emotional and behavioral problems. Results show that antisocial behaviors, behaviors indicative of a lack of impulse control, psychotic behaviors, mood related behaviors, and auto-aggressive behavior increased the likelihood of severe aggression. The three groups did not differ with regard to client and admission characteristics or psychiatric co-morbidity. Behaviors that are predictive of severe inpatient aggression in settings for adults with mild to borderline ID and behavior problems closely resemble those that are distinguished in risk assessment instruments for forensic non-disabled individuals

Reliability and validity of the HoNOS-LD and HoNOS in a sample of individuals with mild to borderline intellectual disabilities and severe emotional and behavior disorders

Item does not contain fulltextIn this study, psychometric properties of the Health of the Nation Outcome scales (HoNOS) and Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) were investigated in a sample (n = 79) of (young) adults with mild to borderline intellectual disability (ID) and severe behavior and mental health problems who were admitted for treatment. Informant pairs were 14 direct care staff and 15 psychiatrists/psychologists who completed both the HoNOS and HoNOS-LD as well as other scales (i.e., Social Functioning Scale for the Mentally Retarded [SRZ-P], Adult Behavior Checklist [ABCL]). Generally, internal consistency was fair to good for both scales, and intraclass coefficients for (sub)scales ranged from fair to good. Low Intraclass Correlation Coefficients (ICCs) were found for several items from both scales. Outcomes pertaining to criterion validity were mixed. Finally, although we found a positive relationship between scores on the HoNOS and HoNOS-LD and those of the ABCL, the relationships between scores of both HoNOS and HoNOS and the SRZ-P were negative. It is concluded that both HoNOS and HoNOS-LD may be used in clients with mild to borderline ID and that outcomes may depend on the type of rater. The HoNOS-LD may be more suitable for assessing general functioning of clients with mild to borderline ID than the HoNOS