Relationship between the Vineland Adaptive Behaviour Scales and the Wechsler Adult Intelligence Scale IV in adults with intellectual disabilities.

BACKGROUND: Diagnoses of intellectual disability (ID) are based on three criteria: significant impairments in intellectual functioning, concurrent deficits in adaptive behaviour, and both being acquired in the developmental period. Adaptive behaviour was formally incorporated into the diagnosis in 1959; the rationale being that IQ and adaptive behaviour were different constructs that independently contribute to the diagnosis. However, there are limited data on the relationship between IQ and adaptive behaviour and especially so for adults who have ID. The aim of this study was to investigate this relationship on two widely used assessment tools: the Wechsler Adult Intelligence Scale - fourth edition (WAIS-IV) and the Vineland Adaptive Behaviour Scales (VABS). METHOD: Data were extracted from the case files of 147 adults who had a formal diagnosis of ID based on the WAIS-IV and VABS. Internal consistency was computed and compared to general population data. Correlations between the WAIS-IV and the VABS were computed. RESULTS: Internal consistencies for the tests when used with adults who have ID were generally good. The correlations between the WAIS-IV and VABS composite and subdomain scores were all low and similar to those reported for the general population. CONCLUSION: These results suggest that the WAIS-IV and VABS are measuring different constructs that contribute to the diagnosis of ID. Unfortunately, by the time such data have been collected, tests are being revised. The Vineland has now been revised and is in its third edition, but no data on the relationship between IQ and the VABS were collected during test development. The WAIS-V is now in development, and so it is recommended that such work be incorporated into this process or shortly thereafter to ensure that the tools continue to access independent constructs.

Development and psychometric properties of the Psychological Therapies Outcome Scale - Intellectual Disabilities (PTOS-ID).

BACKGROUND: There are few valid and reliable psychological therapy outcome measures available for use with people with intellectual disabilities (ID). The current study involved the development of a new scale; the Psychological Therapies Outcome Scale - Intellectual Disabilities (PTOS-ID), and the examination of its validity and internal consistency. METHOD: The PTOS-ID was administered to 175 people who have ID accessing specialist ID services. The construct validity of the scale was investigated through exploratory factor analysis, concurrent validity through comparison with the Brief Symptom Inventory and internal reliability through internal consistency analysis. RESULTS: Three factors emerged from the principal components analysis with high levels of internal consistency: (1) anger and mood (α = 0.82); (2) positive well-being (α = 0.81); and (3) anxiety (α = 0.76). Factors (1) and (2) were combined to measure psychological distress (α = 0.85), which correlated strongly with the Global Severity Index of the Brief Symptom Inventory (r = 0.85). CONCLUSIONS: This preliminary study suggests that the PTOS-ID is a psychometrically robust measure of psychological distress and psychological well-being that can be used with people with ID. Further research is required to assess its reliability and ability to detect change.

A preliminary controlled trial of a trans-diagnostic programme for cognitive behaviour therapy with adults with intellectual disability.

BACKGROUND: Several studies have found a heightened prevalence of mental health disorders in people with intellectual disabilities (ID). There have been a number of successful case series and two promising controlled treatment trials of cognitive behaviour therapy (CBT) for emotional disorders (excluding anger) for people with ID. Several authors have promoted the development of trans-diagnostic approaches to cognitive treatment. The present study extends this work with the development and evaluation of a trans-diagnostic treatment manual for CBT in people with ID. METHOD: A controlled treatment trial was conducted with 12 participants in treatment and waiting list control data. Each treatment participant was matched to a control on age, IQ, presenting problem, and Brief Symptom Inventory (BSI) global severity index (GSI) score. The treatment group was also evaluated on the Glasgow anxiety and depression scales and was followed up for 3 to 6 months after treatment. RESULTS: There were no significant differences between groups at baseline. Following treatment, the CBT group was significantly improved when compared with the control group on the GSI scale of the BSI. The ancovas for all other measures were not significant but there were significant improvements for the treatment group on all scaled except BSI depression from pre to post-CBT. Gains were maintained to follow up, and changes were associated with large effect sizes. CONCLUSIONS: It was possible to treat a range of symptoms and psychiatric diagnoses with a general trans-diagnostic CBT manual. The effects of therapy were promising, suggesting that the participants could respond to treatment in a meaningful and helpful manner and supporting the case for further evaluation of the trans-diagnostic approach in ID.

Concordance of the mini-Psychiatric Assessment Schedule for Adults who have Developmental Disabilities (PASADD) and the Brief Symptom Inventory.

BACKGROUND: When assessing the mental health needs of people who have intellectual disabilities (ID) it is important to use measures that have good validity and reliability to ensure accurate case recognition and reliable and valid outcome data. Measures developed for this purpose tend to be self-report or by informant report. Multi-trait screening tools developed to identify psychological and psychiatric disorders in people who have ID tend to be informant based. Research examining the concordance of different tools has found this to be high but not for specific diagnoses. Multi-trait self-report measures are fewer and have not been compared with informant approaches. This study aims to examine the concordance between two multi-trait measures of mental health used with people who have ID. One administered to informants [the Mini-Psychiatric Assessment Schedule for Adults who have Developmental Disabilities (PASADD)] and one self-report [Brief Symptom Inventory (BSI)] METHOD: The measures were completed with 109 adults who have ID and with someone who knows them well. RESULTS: Level of agreement across the four scales in common was good for three. The poorest convergence was for the obsessive compulsive disorder sub-scales. However, a high level of concordance was found between most sub-scales. CONCLUSION: The BSI and the PASSAD seem to be good indicators of psychiatric problems and psychological distress; however, similar to other multi-trait measures they did not demonstrate appropriate specificity for particular disorders.

Interventions with family caregivers for people with dementia: efficacy problems and potential solution.

Family members are increasingly caring for relatives with dementia at home. It is well recognized that this is a stressful experience for carers. Treatment approaches that aim to alleviate this stress were introduced in the 1970s and later research began to evaluate their efficacy. Early studies using subjective ratings of satisfaction and usefulness demonstrated encouraging results. However, later studies using standardized measures of distress and burden, have not been able to demonstrate efficacy in a convincing way. There have been some positive significant changes; however, most findings have been poor, inconsistent and equivocal. This may be accounted for by the poor methodological rigour diluting the positive potential benefits of interventions for carers. This paper suggests that in order for the efficacy research to evolve, there needs to be a change in direction. It is vital that instead of repeating 'more of the same' studies, researchers need to prioritize the use of theoretically driven interventions and research design. This factor alone could provide the framework to influence the methodological issues that potentially dilute the demonstration of treatment efficacy. Without clearer evidence from research, guidance for practitioners about treatment for carers is ambiguous.

From research and development to practice-based evidence: clinical governance initiatives in a service for adults with mild intellectual disability and mental health needs.

BACKGROUND: Practice-based evidence represents the contribution of practitioners who utilize research methodologies to examine the quality of their clinical practice and service provision. METHODS: The present paper describes the evolution of a routine practice-based evidence system (PBES) via four phases of research and development. The four phases are described, as is their relevance to assessment and intervention with regard to the mental health problems of people with mild intellectual disability. Phase four describes the development of a routine PBES. RESULTS: The PBES is capable of profiling the individual mental health needs of service users and examining service effectiveness and quality at an organizational level. CONCLUSIONS: The PBES is discussed according to its current utility and possible directions for future development. The system is presented as an example of clinical governance that could be utilized by multidisciplinary teams to develop and maintain an organizational culture of quality.

Psychoanalytic psychotherapy with men with intellectual disabilities: a preliminary outcome study.

Psychotherapy has been demonstrated to be an effective form of treatment for people with psychological problems. However, there is considerable resistance to attempts to generalize these findings to people with intellectual disabilities. Such therapeutic disdain has a long history without any empirical foundation. Recently it has been argued on philosophical grounds that people with intellectual disabilities should have access to the same services as everyone else. Furthermore, that people with intellectual disabilities should be actively targeted as they are more likely to have psychological difficulties than non-handicapped people. The therapeutic literature concerning people with intellectual disabilities is overwhelmingly behavioural. More recently various psychotherapeutic approaches have been explored as alternatives to behavioural interventions. Publication of several case studies in the late 1980s and early 1990s has provided some evidence for the benefit of various psychotherapeutic approaches with people with intellectual disabilities. However, there are no outcome studies. This paper reports an outcome study of individual psychoanalytic psychotherapy provided in normal clinical practice for 25 men with intellectual disabilities who were referred for behaviour problems. Of the 25 participants in the study, 20 completed treatment. In most cases the problem behaviour was eliminated and this was maintained at six months follow-up.

The treatment of chronic post-traumatic nightmares using psychodynamic-interpersonal psychotherapy: a single-case study.

This article presents a single-case experimental study of a woman suffering a traumatized reaction to a road traffic accident (RTA). In addition to meeting the DSM-IV (APA, 1994) criteria for the diagnosis of PTSD, the client suffered recurrent bizarre nightmares. The client reported at assessment, that each night her dreams were dominated by a terrifying hooded cloaked faceless figure. The central aim of the study therefore was to assess the efficacy of a psychodynamic-interpersonal (PI) style psychotherapy in the context of an unusual PTSD reaction. The methodology employed an A/B multiple baseline time series design, with six month follow-up. A and B represent a series of dream diary observations under two conditions: assessment/baseline (A) and treatment/intervention (B). Treatment consisted of a manualized psychodynamic-interpersonal (PI) psychotherapy to facilitate insight into the content and meaning of the nightmares. The intervention reduced the frequency and associated distress of the nightmares to zero. Follow-up at six months noted the long-term efficacy of the psychotherapy. The study is discussed with reference to the assimilation model of psychotherapeutic change.

Sexual abuse of adults with learning disabilities.

This paper reports a clinical study of reported or disclosed sexual abuse of adults with learning disabilities. The findings support the results of a recent survey [V. Turk & H. Brown (1993) Sexual abuse of adults with learning disabilities: results of a two-year incidence survey. Mental Handicap Research 6, 193-216] but some differences were found, particularly with regard to sex of the survivors. The study also illustrates more than previous studies a link between sexual abuse and sexualized and inappropriate sexual behaviour and other challenging behaviours in men with learning disabilities.

Dietary treatment of hyperlysinaemia.

We describe the lysine restricted, dietary management of three out of four siblings who were identified as having hyperlysinaemia. The diets, started in the neonatal period, were maintained for varying periods with unpredictable success. The propositus, who was not treated, was diagnosed at the age of 5 years, by which time he was already severely handicapped, presumably because of his metabolic disorder. Tentative recommendations are put forward for the management of this seemingly rare disorder. Mild chronic ammonia toxicity may be a factor in the pathogenesis of this condition.

Evaluation of a staffed ordinary house for children with severe learning difficulties.

The concept of living in an ordinary house in an ordinary street is becoming well accepted by those providing services to people with mental handicaps. Numerous examples have been described, but little in the way of service evaluation has been done. It is important to demonstrate that the quality of life is better in 'smaller units' and that institutional patterns of care are not being reproduced in the community. An observational study of small homely units for adults with mental handicaps has been carried out and has shown that the quality of life is better. This paper reports an observational study of the quality of care in a small staffed house for children with severe learning difficulties. The rate and content of naturally occurring interaction patterns were observed. The Child Management Practices Questionnaire was also administered. The results show that these children are enjoying a better standard of care than that found in hospital studies. However, some management practices were found to be institutionally orientated. For example, there was restricted access to some areas of the house, a lack of personal possessions and staff served and supervised meals rather than eating with the children. The implications of the findings are discussed in relation to recent policy trends and alternative forms of care in the community.

The nature of interactions between nursing staff and profoundly multiply handicapped children.

The rate and content of naturally-occurring interaction patterns between nursing staff and profoundly multiply handicapped children were observed within a long-stay ward in a large mental handicap hospital. Child behaviours were recorded as appropriate, inappropriate or neutral and responses to the target child's behaviour were coded as positive attention, negative attention and no attention. It was found that for more than half of the time (54%) that the children were observed, they were doing nothing. Staff interacted with them for 16.2% of the total observation period. Most of the attention given by staff was positive, regardless of the appropriateness of the child's behaviour. A social learning framework suggests that given the low rate of interaction, potential therapeutic opportunities are being missed and the style of those interactions which occur may be anti-therapeutic. The implications of these findings for nurse training and hospital management are discussed.

A comparative study of profoundly multiply handicapped children's scores on the Bayley and the Griffiths developmental scales.

Twenty-five profoundly multiply handicapped children were tested using both the Bayley and the Griffiths scales by the same psychologist, who did not have prior knowledge of their medical and social histories. Scores obtained from the Griffiths scales were consistently higher than those obtained from the Bayley scales. The intercorrelation between the two tests was high. These results suggest that although the two tests may be used interchangeably, their numerical scores are not equivalent when administered to this population.

Consensus grids: what about the variance?

This paper examines the extent to which a consensus grid represents the individual repertory grids which comprise it. The results of a repertory grid study are reported to demonstrate that generalizations about certain groups made on the basis of a consensus grid can misrepresent or miss important aspects of the data, because the method does not take into account variation in response.