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    Abstract

    People with intellectual disabilities (ID) are more often exposed to potentially traumatic events than people without ID. Due to impairments in their cognitive and adaptive skills, processing adverse life events is supposed to be more difficult. This chapter contains an overview of the literature on the (1) manifestations and assessment of posttraumatic stress disorder (PTSD) in people with ID and (2) treatment (i.e., trauma-focused cognitive behavioral therapy [TF-CBT] and eye movement desensitization and reprocessing [EMDR] therapy) of PTSD symptoms in people with ID. There is evidence to suggest that manifestations of PTSD in children with ID correspond with those in children without ID. To assess the effects of psychological trauma in children and to establish the diagnosis of PTSD, the Adapted ADIS-C PTSD Section appears to be a valid and reliable clinical interview. To determine the severity of PTSD symptoms in adults, two questionnaires with good psychometric properties are available (i.e., LANTS; IES-IDs). TF-CBT and EMDR therapy are the only psychotherapies recommended by the World Health Organization (WHO) for the treatment of PTSD. However, the literature on the treatment of manifestations of PTSD in people with ID is limited to case reports showing positive outcomes. For persons with ID suffering from PTSD, EMDR therapy seems most suited, particularly considering its nonverbal character and the lack of need to do homework and practice outside the sessions. Controlled studies are needed to establish empirical support for PTSD treatments in this population at risk for the development of PTSD.


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  • 01/01/16--00:00: Assistive Technology
  • Abstract

    This chapter provides an overview of technology-aided intervention programs directed at helping persons with intellectual and multiple disabilities: (a) develop some basic control of environmental stimulation, (b) improve their assisted ambulation, (c) exercise stimulus choice opportunities, (d) manage environmental stimulation and call for caregiver’s attention, (e) manage environmental stimulation and curb inappropriate behavior or posture, (f) exercise request opportunities, and (g) manage occupational engagement and vocationally relevant activities. For each of the aforementioned areas, the technology and intervention programs available are illustrated through detailed summaries of a few relevant studies published in scientific journals. The final part of the chapter provides general considerations about the studies (technological resources and intervention strategies) reviewed and their implications for daily programs and also suggests several issues for new research in the area.


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  • 01/01/16--00:00: Communication
  • Abstract

    Communication disorders are common among people with intellectual disabilities. Consequently, enhancing the communication skills of such individuals is a major intervention priority. This chapter reviews the nature and prevalence of the speech, language, and communication problems associated with intellectual disability, including consideration of (a) fluency/articulation problems, (b) receptive language deficits, and (c) expressive disorders. Assessment approaches include the use of (a) general measures of adaptive behavior functioning, (b) communication-specific measures, and (c) non-standardized assessments of prelinguistic communication. The strengths and limitations of each of these approaches are outlined. A range of treatment approaches have been studied to address the myriad of communication problems associated with intellectual disabilities. The treatment approaches reviewed in this chapter include (a) imitation training, (b) stimulus-stimulus pairing, (c) fluency training, (d) the cues-pause-point procedure, (e) milieu therapy, (f) functional communication training, and (g) augmentative and alternative communication. The indications for, and efficacy of, each of these approaches are reviewed. Based on this research review, a four-step process is described to facilitate the translation of research into effective clinical practice. The process consists of (a) constructing a clinical question, (b) locating relevant studies, (c) appraising the evidence, and (d) applying the evidence. Effective translation of research to clinical practice is an important part of communication assessment and intervention processes for persons with intellectual disabilities.


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  • 01/01/16--00:00: Aggressive Behavior
  • Abstract

    Aggressive behavior is common in individuals with intellectual and developmental disabilities (IDDs), and it is most often targeted for intervention. Psychological, contextual, and biological risk factors may contribute to the risk of aggressive behavior. Risk factors are gender (males), level of IDD (lower levels of IDD), autism spectrum disorder (ASD), communication deficits, emotion regulation problems, impulsivity, and mental health problems. Next to this, several genetic syndrome groups (e.g., Prader–Willi, fragile X) are associated with aggressive behavior. This chapter provides a selective review of the evidence based on four major treatment approaches: anger management treatment (AMT), behavioral interventions, psychotropic medications, and mindfulness-based procedures. Studies have shown that relaxation coupled with stress inoculation and a focus on adaptive responses are effective components of AMT. There is evidence that behavioral interventions—especially extinction, differential reinforcement, and functional communication training—are effective in reducing aggression. Prior to behavioral intervention, the function(s) of the aggressive behavior should be determined using functional assessment. On the basis of the scientific evidence, it is difficult either to recommend or to refute the use of psychotropic medications for the management of aggression in people with IDD. Good-quality evidence is available only for risperidone among children with IDD and/or ASD. Before initiating medication, a case formulation should be documented including assessment and rationale for the use of medication. Finally, mindfulness-based procedures have been shown to be effective in reducing aggressive behavior of individuals with IDD in studies by one research group. These results, however, need to be replicated before conclusions may be drawn on whether mindfulness is evidence-based practice for aggressive behavior in individuals with IDD.


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    Abstract

    People with intellectual disabilities (ID) are more often exposed to potentially traumatic events than people without ID. Due to impairments in their cognitive and adaptive skills, processing adverse life events is supposed to be more difficult. This chapter contains an overview of the literature on the (1) manifestations and assessment of post-traumatic stress disorder (PTSD) in people with ID and (2) treatment (i.e., trauma-focused cognitive behavioral therapy [TF-CBT] and eye movement desensitization and reprocessing [EMDR] therapy) of PTSD symptoms in people with ID. There is evidence to suggest that manifestations of PTSD in children with ID correspond with those in children without ID. To assess the effects of psychological trauma in children and to establish the diagnosis of PTSD, the Adapted ADIS-C PTSD Section appears to be a valid and reliable clinical interview. To determine the severity of PTSD symptoms in adults, two questionnaires with good psychometric properties are available (i.e., LANTS; IES-IDs). TF-CBT and EMDR therapy are the only psychotherapies recommended by the World Health Organization (WHO) for the treatment of PTSD. However, the literature on the treatment of manifestations of PTSD in people with ID is limited to case reports showing positive outcomes. For persons with ID suffering from PTSD, EMDR therapy seems most suited, particularly considering its nonverbal character and the lack of need to do homework and practice outside the sessions. Controlled studies are needed to establish empirical support for PTSD treatments in this population at risk for the development of PTSD.


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    Abstract

    Individuals with intellectual and developmental disabilities (IDD) have an increased risk for developing problems related to use and misuse of substances such as alcohol and drugs. The consequences for mental and somatic health are often detrimental. Substance use disorder is a chronic and multifaceted problem and it is the result of an interplay between biological, psychological and social risk factors. An increasing number of studies have explored effectiveness of different types of interventions. However, the body of evidence on their effectiveness is still small. Adequate treatment of substance use related problems and comorbid somatic and mental health problems calls for a close collaboration between addiction medicine, IDD service providers and general psychiatry.


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    Abstract

    While most typically developing children learn to communicate without formal teaching, children with developmental disabilities are often delayed in the use of first words and may need guidance to learn how to communicate. Because prelinguistic communication (e.g., facial expressions, natural gestures, and vocalizations.) is seen as a foundation for spoken word production, helping children to develop their prelinguistic communication may facilitate acquisition of spoken language. This chapter explores Prelinguistic Milieu Teaching (PMT), an intervention designed to teach children to initiate nonverbal communication during social routines in their natural environment as a foundation for later spoken word production. First, the theoretical background of PMT, which is typically viewed as a transactional model is discussed. Then, the implementation of PMT is described and the available research reviewed. Finally, suggestions for further research and implications for practitioners are provided.


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  • 01/01/16--00:00: Substance Use Disorders
  • Abstract

    There is a growing body of research on substance use and substance use disorders among individuals with intellectual and developmental disabilities who have been identified as a group at risk. Use of alcohol, tobacco and/or illicit drugs is prevalent, especially among those with mild to borderline intellectual and developmental disabilities. Epidemiological studies however have many shortcomings and valid measurement instruments are largely lacking. Though educational and intervention programs to educate clients about the adverse effects of tobacco and alcohol use, and to reduce the actual use of these substances have been evaluated, the evidence-base of these interventions remains small. In this chapter we propose a range of measures to improve policy and practice concerning case identification, and diagnosing and treating substance use disorders, such as the need for more cross-system collaboration and the use of integrated treatment approaches for the benefit of individuals with intellectual and developmental disabilities.


    0 0

    Abstract

    People with intellectual disabilities (ID) are more often exposed to potentially traumatic events than people without ID. Due to impairments in their cognitive and adaptive skills, processing adverse life events is supposed to be more difficult. This chapter contains an overview of the literature on the (1) manifestations and assessment of posttraumatic stress disorder (PTSD) in people with ID and (2) treatment (i.e., trauma-focused cognitive behavioral therapy [TF-CBT] and eye movement desensitization and reprocessing [EMDR] therapy) of PTSD symptoms in people with ID. There is evidence to suggest that manifestations of PTSD in children with ID correspond with those in children without ID. To assess the effects of psychological trauma in children and to establish the diagnosis of PTSD, the Adapted ADIS-C PTSD Section appears to be a valid and reliable clinical interview. To determine the severity of PTSD symptoms in adults, two questionnaires with good psychometric properties are available (i.e., LANTS; IES-IDs). TF-CBT and EMDR therapy are the only psychotherapies recommended by the World Health Organization (WHO) for the treatment of PTSD. However, the literature on the treatment of manifestations of PTSD in people with ID is limited to case reports showing positive outcomes. For persons with ID suffering from PTSD, EMDR therapy seems most suited, particularly considering its nonverbal character and the lack of need to do homework and practice outside the sessions. Controlled studies are needed to establish empirical support for PTSD treatments in this population at risk for the development of PTSD.


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    Samenvatting

    Verslavingsproblematiek gaat gepaard met allerlei neuropsychologische veranderingen in de hersenen. Dit artikel presenteert de conclusies van een onderzoeksproject gericht op deze veranderingen bij problematische drinkers met een lichte verstandelijke beperking (LVB). Gebaseerd op dit onderzoek wordt het gebruik van indirecte maten (zoals computertaken) voor klinische doeleinden afgeraden. Het verdient aanbeveling om vroeg in het behandeltraject een uitgebreid neuropsychologisch onderzoek te doen en het behandeltraject hierop aan te passen. De complexiteit van verslavingsproblematiek bij deze doelgroep vraagt om een gespecialiseerde aanpak, waarbij kennis van de LVB en van verslavingsproblematiek noodzakelijk is. Samenwerking tussen verstandelijk-gehandicaptenzorg en verslavingszorg is daarom essentieel.


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    Abstract

    Deficits in question-asking are common in children with autism spectrum disorder (ASD). Furthermore, their opportunities to self-initiate questions are often hindered by directive behavior of their conversation partners. This study assessed the effectiveness of staff training in pivotal response treatment (PRT) on staff member-created opportunities and self-initiated questions of school-aged children with ASD. Generalization and maintenance were also assessed. Participants were 14 staff members and children with ASD attending an inpatient treatment facility. Data showed that PRT resulted in significant increases in both staff member-created opportunities and child-initiated questions. Generalization to group situations and collateral changes in children’s language, pragmatic, and adaptive skills, and maladaptive behaviors did not occur. Implications for clinical practice and directions for future research are discussed.


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    Abstract

    Although the neuropsychological underpinnings of problematic alcohol use have been studied extensively, this research has not yet been generalised to individuals with mild to borderline intellectual disability (MBID). In this paper, we present the main findings of a research project aimed at studying the deficiencies in information processing associated with problematic alcohol use in problematic drinkers with and without MBID. The objectives were to develop and test indirect measures of cognitive biases and executive dysfunctioning of problematic drinkers with MBID and studying the extent and nature of the influence of IQ and executive control on these deficiencies. In addition to extending the fundamental knowledge about problematic alcohol use, the research findings provide practical implications that can be translated into the screening, assessment and treatment of problematic drinkers—both with and without MBID. Based on our results, we discourage the use of indirect, reaction time-based measures for cognitive biases for clinical purposes. The word association task, on the other hand, provides better opportunities, for example as a way to identify high-risk situations for alcohol use. With regard to cognitive and executive functioning, we advise practitioners to conduct a thorough assessment in an early phase of the treatment but withhold from incorporating neurocognitive treatment protocols in the treatment of problematic alcohol use.


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    Abstract

    Knowledge regarding substance-related problems and offending behavior in individuals with mild intellectual disability or borderline intellectual functioning (MBID; IQ 50-85) has increased over the last years, but is still limited. The present study examined differences in prevalence and clinical characteristics of individuals with and without MBID in a forensic addiction treatment center. Participants were 190 court mandated male clients of a low to high security forensic addiction treatment center in the Netherlands (aged between 21 and 59 years old, 82% of Dutch origin). Of the total sample 39% could be identified with MBID which is much higher than the estimated 12% to 15% of the general population. Results showed that clients with MBID reported significantly lower scores on desire for help, compared to clients without MBID (F (1, 73) = 5.12, p = .027). Against expectations, no significant group differences were found for aggression during treatment while controlling for impulsivity, treatment duration and type of substance use and offense. As results of the present study showed that clients with MBID are overrepresented in the forensic addiction treatment center, future research should further explore characteristics and responses to treatment of these clients. More knowledge about the characteristics of clients with MBID will not only help to better identify these clients, but will also to improve treatment for this group


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    Abstract

    Students with disabilities and/or autism spectrum disorders (ASD) are particularly vulnerable to be involved in bullying compared to their peers without ASD. Studies have found that students with ASD are at higher risk to be involved in bullying as a bully (i.e., perpetrator of bullying), a victim (i.e., victim of bullying), or bully-victim (i.e., both perpetrator and victim of bullying). However, due to the nature of their disability (e.g., difficulties in understanding others’ feelings and intentions, nonverbal behaviors, and nonliteral speech), it is unclear whether youth with ASD construe bullying and victimization in similar ways as typically developing youth. Researchers generally agree that bullying is characterized by three defining criteria – (1) negative actions, (2) carried out repeatedly and over time, (3) in an interpersonal relationship characterized by a power imbalance. Different forms of bullying exist: physical bullying (e.g., hitting, kicking, and damage to property), verbal bullying (e.g., name-calling, insulting, and making fun of another person), and relational bullying (e.g., exclusion, ignoring, and spreading rumors). More recent forms of bullying include cyberbullying (e.g., hurtful text messaging or emailing, and posting hurtful messages/objectionable content on websites and social networking sites).


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    Abstract

    Little is known about rates and risk factors of substance use (SU) in individuals with mild to borderline intellectual disabilities (MBID, IQ 50–85). This hinders targeted prevention and treatment. In this study we assessed SU rates and risk factors in individuals with MBID in 419 adults (63% male, average IQ = 66) in 16 Dutch disability services. Lifetime and current SU, SU picture recognition, knowledge, attitudes and modeling were assessed with the Substance use and misuse in Intellectual Disability - Questionnaire (SumID-Q). Lifetime licit SU (alcohol and tobacco) was 97%, lifetime illicit SU (predominantly cannabis) was 50%. Current users of tobacco (62%), alcohol (64%), and cannabis (15%) initiated SU at a younger age than those who desisted SU (ps < .001). Participants with mild ID and those with borderline ID did not differ in SU rates (ps .429–.812), or age at SU initiation (ps .221–.853). Current licit SU and lifetime illicit SU were related to male gender, younger age, and (for smoking and stimulant use) to lack of daytime activities. However, these factors did not contribute to multivariate models when recognition, knowledge, attitudes and modeling were added. The models correctly identified current SU in 84% (smoking) and 74% (drinking), and lifetime SU in 76% (cannabis) and 84% (stimulants) of the participants. As almost all participants reported lifetime use of licit, and about half reported lifetime illicit substance use, systematic screening for substance use, and development of preventative and treatment interventions targeted to this group are needed.


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    Samenvatting

    Dit artikel gaat over een onderzoek naar de samenhang van de persoonlijkheidsdimensies angstgevoeligheid, negatief denken, impulsiviteit en sensatiezoeken met stoornissen in het gebruik van middelen bij mensen met een licht verstandelijke beperking (LVB). De data zijn verzameld met de SURPS (persoonlijkheidsdimensies) en de SumID-Q (middelengebruik) bij 118 cliënten van een zorginstelling voor mensen met LVB en ernstige gedragsproblemen. Het gemiddelde IQ van de deelnemers was 71,1 en de gemiddelde leeftijd was 20,5 jaar. Bij mensen die minder angstgevoelig zijn, meer negatief denken, impulsiever zijn en meer sensatiezoeken, werd een hoger risico op stoornissen in het gebruik van alcohol gevonden. Mensen met een sterkere neiging tot negatief denken en sensatiezoeken hadden een hoger risico op stoornissen in het gebruik van drugs. De SURPS-persoonlijkheidsdimensies kunnen worden gebruikt om mensen met LVB met een groter risico op middelenmisbruik te identificeren en kunnen dienen als basis voor gepersonaliseerde interventies met betrekking tot middelenmisbruik bij deze groep.


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    Abstract

    This study investigates the understanding of intentions in 100 children with autism spectrum disorder (ASD) and intellectual disability (ID; mean IQ 36) between 2 and 10 years of age. A within-subject design with two conditions was used. In the target condition, the experimenter successfully performed the task; while in the unfulfilled attempt condition, the experimenter attempted but did not successfully completed the task. Children with ASD and ID completed the tasks significantly more frequent and showed less off-task behavior in the target condition than in the unsuccessful attempt condition, which might indicate that children with ASD and ID experience difficulty in understanding the intentions of others. Successful completion of the task after an unsuccessful attempt is predicted by the ability to imitate and behavioral inflexibility and is associated with better performance on receptive and expressive language tests. The latter results are in line with several other studies suggesting a relation between the understanding of intentions and early social communication and language.


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    Samenvatting

    Voor gezinnen waar uithuisplaatsing van kinderen dreigt, is het KINGS-model ontwikkeld. Ouders en kinderen doorlopen een intensieve klinische traumabehandeling, ingebed in een trauma-sensitief opvoedondersteuningsprogramma. Voor gezinnen waar een (of meer) van de gezinsleden een licht verstandelijke beperking heeft, is er de KINGS-LVB variant.


older | 1 | (Page 2)