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Substance Use Disorders

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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.


‘Het zit allemaal tussen mijn oren!’

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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.

Increasing Opportunities for Question-Asking in School-Aged Children with Autism Spectrum Disorder: Effectiveness of Staff Training in Pivotal Response Treatment

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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.

The Usefulness of Implicit Measures for the Screening, Assessment and Treatment of Problematic Alcohol Use in Individuals with Mild to Borderline Intellectual Disability

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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.

Individuals with Mild Intellectual Disability or Borderline Intellectual Functioning in a Forensic Addiction Treatment Center: Prevalence and Clinical Characteristics

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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

Bullying Among Youth with Autism Spectrum Disorders

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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).

Substance Use in Individuals with Mild to Borderline Intellectual Disability: an Exploration of Rates and Risks in the Netherlands

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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.

De relatie tussen persoonlijkheidsdimensies en middelengebruik bij mensen met een licht verstandelijke beperking

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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.


Understanding of Intentions in Children with Autism Spectrum Disorder and Intellectual Disability

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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.

Het KINGS-model bij licht verstandelijke beperking

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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.

Effectiveness of Parent Education in Pivotal Response Treatment on Pivotal and Collateral Responses

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Abstract

In two studies, we investigated the effectiveness of parent education in Pivotal Response Treatment (PRT) on parent-created opportunities and spontaneous child initiations in two community-based treatment facilities for children with autism spectrum disorder (ASD). Changes in parental stress and self-efficacy were explored. Participants were 26 parents and their children who participated in group (Study 1) or individual (Study 2) parent education in PRT. Results indicated that group-based parent education resulted in moderate increases in opportunities, functional initiations, and empathic social initiations. Furthermore, parental stress reduced and self-efficacy increased. Individual parent education resulted in large increases in opportunities and functional initiations, but parental stress and self-efficacy did not change. Implications for clinical practice and directions for future research are discussed.

Substance Use Disorders

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Abstract

People with intellectual disabilities are at risk for substance use disorders. There has been an increasing awareness for this problem in the past decades. This chapter presents the prevalence of substance-use disorders among individuals with intellectual disabilities, risk factors and means to assess and rehabilitate these persons in the context of the available research literature.

Treatment of Substance Abuse in Dual Diagnosis

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Abstract

Interventions for substance use–related problems are limited for individuals with intellectual disability (ID). This is problematic, as the lack of interventions can lead to substance use initiation, progression of substance use into substance use disorder, poorer outcomes of treatment, and stigmatization of individuals with dual diagnosis. Additionally, staff who work with individuals with ID and addiction treatment lack resources to effectively help substance use in individuals with ID. Nevertheless, there has been an increase in studies assessing the feasibility and outcomes of interventions for substance use and abuse in individuals with ID. This chapter reviews psychological and pharmacological interventions for individuals with dual diagnosis of substance abuse and ID.

Community Safety Skills of People with Intellectual and Developmental Disabilities

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Abstract

Community safety skills for people with intellectual disabilities to ensure personal safety and are valued by individuals with intellectual disability and their carers alike, although individuals with intellectual disability remain at greater risk of injuries than the general population. This chapter reports the results of a systematic review of the safety literature. Studies that addressed responding to lures from strangers, being lost in the community, road safety, bullying, first aid, and putting out a fire. Results on acquisition of these skills through procedures, such as modeling, behavioral skills training were quite positive. Data on generalization were mixed and there was insufficient data on long-term maintenance. The chapter concludes with practitioner recommendations and a case study illustrating the applications of these research findings.

Persoonlijkheidsdiagnostiek bij LVB


Persoonlijkheids- diagnostiek bij LVB

A Systematic Review of Dog-Assisted Therapy in Children with Behavioural and Developmental Disorders

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Abstract

Objectives

Animal-assisted therapy with dogs is regularly used in children with behavioural and developmental disorders. Aims of this systematic review were threefold: to analyse the methodological quality of studies on dog-assisted therapy (DAT) for children with behavioural and developmental disorders, to determine to which extent the studies on DAT adhere to the quality criteria developed by the International Association of Human Animal Interaction Organisation (IAHAIO) and to describe the characteristics of the participants, the intervention and the outcomes.

Method

Three databases (i.e. PsycInfo, MedLine and Eric) were searched, and 14 studies on DAT were included. The Joanna Briggs Institute checklist (JBIC) and the quality criteria developed by the IAHAIO were used during data extraction. Characteristics of the participants, the intervention, the therapy dogs and the outcomes of the studies were summarised.

Results

Six of the 14 included studies reported significant outcomes of DAT, whereof six in the social domain and two in the psychological domain. However, scores on the JBIC indicated low to moderate methodological quality and only three of the included studies adhered to the IAHAIO quality criteria.

Conclusions

DAT is a promising intervention for children with behavioural and developmental disorders, especially for children with autism spectrum disorder. A clear description of the therapy’s components, the role of the therapy dog and analysis of the treatment integrity and procedural fidelity would improve the methodological quality of the studies and the field of dog-assisted interventions.

Nonpharmacological Interventions

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Abstract

A range of nonpharmacological interventions have shown promising results in the treatment of behavioral and/or mental health problems in individuals with intellectual disabilities. This chapter presents a selective overview of interventions that are often applied in clinical practice and that have been documented in the scientific literature. Two main categories of interventions are distinguished: client-oriented and contextual approaches. In client-oriented approaches, the focus of the intervention is the client who is the main recipient of the intervention. We describe the assumptions, common components, and evidence-base of behavioral interventions, cognitive behavior therapy (CBT), and interventions such as mindfulness and relaxation. In contextual approaches, the intervention is primarily directed at persons in the environment of the client such as parents, staff members, and others. The assumption is that a client’s well-being will improve and behavioral/mental health problems will be reduced through a change in behavior and attitude of carers and other in the client’s environment. To be effective, interventions need to be adapted to the characteristics and learning style of individuals with intellectual disabilities for which this chapter provides guidelines.

Standard Urotherapy for Children with Neurodevelopmental Disabilities: A Systematic Review

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Abstract

Objectives

Standard urotherapy (SU) is regularly used as a first-line intervention for children with incontinence. It is suggested that SU is also effective for children with neurodevelopment disabilities (NDs) when altered to the specific needs of these children. The aim of the review was to answer the following research questions: (a) what was the effectiveness of SU interventions in children with ND?, (b) which procedures and protocols were utilized during SU?, (c) what was the role of parents during SU?, and (d) what was the current evidence base regarding SU and children with NDs?

Methods

Four electronic databases (i.e., Embase, PsychInfo, PubMed, Web of Science) were searched in accordance with the JBI methodology for mixed methods systematic reviews (MMRS) in the Joanna Briggs Institute (JBI) manual for Evidence Synthesis. The Mixed Method Appraisal Tool (MMAT) from JBI was utilized to determine the methodological quality of the studies.

Results

The search resulted in the inclusion of five articles related to SU in children with ND, indicating that research relating to SU and NDs is scarce. Results of the review indicate that SU resulted in a complete or partial positive response in 30% of the children with NDs (N = 114) based on the criteria listed by the International Children’s Continence Society (ICCS). When using criteria by the authors of the included articles, the results indicate that 59% of the children achieved full continence. Most importantly, the evidence suggests that most children showed improved symptoms (e.g., reduction in urinary/fecal accidents, schedule-dependent continence) even if full continence was not obtained.

Conclusions

The review indicated that SU could be beneficial as a first-line treatment for children with NDs. Individualizing treatment to the needs of the child, parental involvement, follow-up appointments, and adding adjuncts when SU alone is not effective seem to be beneficial for this specific population. However, research relating to this topic is scarce and therefore more research needs to be completed regarding the role of parents and effective guidelines specific to different NDs. Implications for future research are discussed.

Posttraumatic Stress Disorder in Children with Severe or Moderate Intellectual Disability: A Study Using the Diagnostic Interview Trauma, Stressors – Severe/Moderate ID

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Abstract

No research has been conducted on PTSD manifestation in children with severe or moderate intellectual disability (SID; IQ 20 – 49) and no PTSD measurement instrument was available. This pilot explores the psychometric properties of a new diagnostic instrument to investigate trauma and to classify PTSD in children with SID. The Diagnostic Interview Trauma and Stressors-Severe Intellectual Disabilities (DITS-SID), Aberrant Behavior Checklist and Child and Adolescent Trauma Screener 3-6 were administered to parents and residential caregivers of fifteen children with SID. The inter-rater reliability of the DITS-SID is good to excellent. There are indications of a good convergent validity. PTSD prevalence seems high at 27%-33%. Self-injurious behavior was one of the most commonly reported PTSD symptoms. There is evidence that the PTSD manifestation of children with SID does not differ from that of children without SID. PTSD is probably underdiagnosed in this target group. In understanding challenging behavior, it is important to consider an underlying PTSD in order to provide appropriate treatment. The DITS-SID is potentially suitable for diagnosing PTSD. Follow-up research in a larger sample is needed.





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