Psychometric properties of the Beliefs About Adults with ID Scale in American physicians: Application of classical test and Rasch measurement theories.

BACKGROUND: Physicians' erroneous assumptions about individuals with intellectual disability (ID) negatively impact the quality of care provided to this population. This study aimed to investigate the psychometric properties of the Beliefs About Adults with ID (BAID), an instrument we developed for measuring physicians' erroneous assumptions about adults with ID. METHODS: Two hundred ninety-two American physicians participated. Classical test theory and Rasch measurement theory were used to refine the scale (through item analysis, exploratory factor analysis, infit and outfit mean-squares statistics, and differential item functioning) and investigate its psychometric properties (functioning of the response scale, reliability, and validity). RESULTS: The BAID provided a unidimensional, reliable, valid, and precise measure in assessing high levels of erroneous assumptions. It showed convergent and divergent validity with the different factors of a scale measuring attitudes towards ID. The BAID items were discriminant, non-redundant, unambiguous, and invariant across gender and previous ID training. The BAID response scale was found to be appropriate for measuring physicians' erroneous assumptions about adults with ID. CONCLUSIONS: BAID is a brief instrument with good psychometric properties to assess erroneous assumptions about adults with ID in physicians of different genders and who have/have not previously received ID training. Therefore, it might be helpful for research and medical education purposes.

A new measure of physicians' erroneous assumptions towards adults with intellectual disability: A first study.

BACKGROUND: Incomplete knowledge and unfamiliarity with intellectual disability (ID) contribute to erroneous assumptions of physicians towards ID, which negatively impact the health equity of people with ID. This study aimed to identify the erroneous assumptions that, based on the ID stakeholders' perceptions, were the most prevalent in physicians and damaging for the healthcare of adults with ID, verify their unidimensionality and that no personal characteristics of ID stakeholders were associated with their ratings of erroneous assumptions' prevalence and damage. METHODS: Seventy-four possible physician erroneous assumptions were developed concerning health, daily living skills and quality of life of individuals with ID. ID stakeholders rated each one for perceived prevalence in physicians and damage for the healthcare of adults with ID. Frequency analysis, exploratory factor analysis and correlations were run separately for participants' prevalence and damage ratings. RESULTS: Twenty-seven erroneous assumptions were identified as those perceived most prevalent and damaging. Their unidimensionality was ascertained and participants' characteristics were not associated with their prevalence and damage ratings. CONCLUSIONS: The identified assumptions are appropriate to represent the items of a new instrument that can be used in medical education to guide the development of curricula to change erroneous assumptions.

Effects of mindfulness, coping styles and resilience on job retention and burnout in caregivers supporting aggressive adults with developmental disabilities.

BACKGROUND: Considering the growing body of studies investigating the effects of mindfulness-based interventions on caregivers supporting people with developmental disabilities, the current study aimed to explore the role that the cognitive processes of mindfulness, coping style and resilience played in predicting caregiver retention and burnout among a sample of direct support professionals working with aggressive adults with developmental disabilities. METHODS: Ninety-seven direct support professionals were surveyed to determine level of mindfulness, coping styles, resilience and burnout and were interviewed 3 months later to determine if they were still working with the aggressive adult. RESULTS: Mindfulness skills of describing non-judgmentally and observing one's environment, as well as problem-focused coping, emerged as protective factors against burnout, while avoidance-focused and maladaptive coping emerged as risk factors. Mindful openness acted as the only predictor of job retention. CONCLUSIONS: These results support that paid caregivers should receive trainings in mindfulness and positive coping mechanisms as part of their job trainings, to promote positive outcomes for both themselves and the people they support.

Are caregivers' reports of motivation valid? Reliability and validity of the Reiss Profile MR/DD.

BACKGROUND: Sensitivity theory proposes that there are wide individual differences in what motivates people with intellectual disability. The Reiss Profile MR/DD is a rating scale that measures 15 fundamental motives. This study examined the internal consistency and interrater reliability of the 15 subscales as well as the validity of motivational profiles. METHOD: The study consisted of two distinct but related steps. First, the interrater reliability of the rating scale was established by having pairs of raters evaluate 48 individuals. Second, raters were presented with three different motivational profiles and asked to identify which one corresponded to the individual they had rated 4 weeks earlier. RESULTS: Results indicated good internal consistency (average alpha=0.84), significant variability in the interrater reliability (average intraclass correlation coefficient=0.52), and excellent validity (95% of the correct profiles were chosen). Average discrepancies between pairs of raters are presented. CONCLUSIONS: Interrater reliability is an important topic for professionals working in the field of intellectual disability and results are discussed in terms of the factors that affect it. This is the first published study to report on the interrater reliability of the Reiss Profile MR/DD.

Sensitivity, functional analysis, and behavior genetics: a response to Freeman et al.

Freeman et al. (1998) asserted that sensitivity theory is circular, unsupported by empirical evidence, and represents an "either/or" decision in regard to applied behavior analysis. We reply by showing that sensitivities are objectively measured and that our theory permits testable predictions. Further, we briefly summarize the results of recent studies that support our theory, including investigations that link sensitivities to genes and challenging behavior. Finally, we reject the idea that sensitivity theory and functional analysis represent an "either/or" viewpoint and call again for research to integrate these approaches.

Distinguishing low levels of social support and social strain: implications for dual diagnosis.

Low social support is known to be a risk factor for mental illness in the general population. Social strain, or stressful social interaction, has also been shown to correlate highly with psychopathology but has been largely ignored for individuals with mental retardation. Results based on staff ratings of 104 adults with mental retardation are presented, highlighting the relationship among support, social strain, and psychopathology. Data suggest that social strain is more strongly associated with psychopathology than are overall low levels of social support for individuals with mental retardation.

The Reiss Screen for Maladaptive Behavior: confirmatory factor analysis.

We tested the factorial stability of the Reiss Screen for Maladaptive Behavior (Reiss, 1988a, The Reiss Screen for Maladaptive Behavior test manual). Reasonable fit was demonstrated in a geographically diverse sample of 448 individuals with mild, moderate, severe and profound mental retardation according to four measures of overall fit: RMSEA, ECVI, NNFI, and NFI. The results confirm Reiss' (1988a) factor solution of this widely used dual diagnosis (mental retardation and mental illness) screening instrument.

Sensitivity theory and mental retardation: why functional analysis is not enough.

Sensitivity theory holds that aberrant behavior is a function of aberrant contingencies (direct reinforcement of maladaptive behavior), aberrant motivation (a desire for an excessive amount of reinforcement), and aberrant environments (situations in which most people cannot satiate their fundamental desires by behaving appropriately). Applied behavior analysts are almost exclusively concerned with aberrant contingencies and, to a lesser extent, aberrant environments. Because they do not treat people for aberrant motivation, behaviorists tend to treat the same people repeatedly. When a person craves an excessive amount of attention, this desire must be reduced for a durable and generalized treatment outcome, but behaviorists do not even try to do this. Implications for communication theory, assessment, and treatment strategies were discussed.

Composite versus multiple-rating scales in the assessment of psychopathology in people with mental retardation.

This study tested the hypothesis that separate ratings of frequency and duration add significant information to ratings of problem severity in the assessment of psychopathology in people with mental retardation. The Reiss Screen was modified to require ratings of problem severity, frequency and duration for each of 38 maladaptive behaviours. The 171 adolescents and adults were rated by caretakers and supervisory staff on the modified Reiss Screen. The three ratings were found to be very highly intercorrelated. Moreover, multiple linear regression analyses revealed that the ratings of frequency and duration did not add significant information to that provided by ratings of problem severity in the prediction of psychiatric diagnosis in the person's case file. The results support the use of composite scaling over multiple-ratings in the assessment of psychopathology in persons with mental retardation.