International validation of a behavioral scale in Parkinson's disease without dementia

The “Ardouin Scale of Behavior in Parkinson's Disease” is a new instrument specifically designed for assessing mood and behavior with a view to quantifying changes related to Parkinson's disease, to dopaminergic medication, and to non‐motor fluctuations. This study was aimed at analyzing the psychometric attributes of this scale in patients with Parkinson's disease without dementia. In addition to this scale, the following measures were applied: the Unified Parkinson's Disease Rating Scale, the Montgomery and Asberg Depression Rating Scale, the Lille Apathy Rating Scale, the Bech and Rafaelsen Mania Scale, the Positive and Negative Syndrome Scale, the MacElroy Criteria, the Patrick Carnes criteria, the Hospital Anxiety and Depression Scale, and the Mini‐International Neuropsychiatric Interview. Patients (n = 260) were recruited at 13 centers across four countries (France, Spain, United Kingdom, and United States). Cronbach's alpha coefficient for domains ranged from 0.69 to 0.78. Regarding test–retest reliability, the kappa coefficient for items was higher than 0.4. For inter‐rater reliability, the kappa values were 0.29 to 0.81. Furthermore, most of the items from the Ardouin Scale of Behavior in Parkinson's Disease correlated with the corresponding items of the other scales, depressed mood with the Montgomery and Asberg Depression Rating Scale (ρ = 0.82); anxiety with the Hospital Anxiety and Depression Scale—anxiety (ρ = 0.56); apathy with the Lille Apathy Rating Scale (ρ = 0.60). The Ardouin Scale of Behavior in Parkinson's disease is an acceptable, reproducible, valid, and precise assessment for evaluating changes in behavior in patients with Parkinson's disease without dementia. © 2015 International Parkinson and Movement Disorder Society     

The Parkinson Anxiety Scale (PAS): Development and validation of a new anxiety scale

Existing anxiety rating scales have limited construct validity in patients with Parkinson's disease (PD). This study was undertaken to develop and validate a new anxiety rating scale, the Parkinson Anxiety Scale (PAS), that would overcome the limitations of existing scales. The general structure of the PAS was based on the outcome of a Delphi procedure. Item selection was based on a canonical correlation analysis and a Rasch analysis of items of the Hamilton Anxiety Rating Scale (HARS) and the Beck Anxiety Inventory (BAI) from a previously published study. Validation was done in a cross‐sectional international multicenter study involving 362 patients with idiopathic PD. Patients underwent a single screening session in which the PAS was administered, along with the Hamilton Depression Rating Scale, the HARS, and the BAI. The Mini International Neuropsychiatric Interview was administered to establish Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses of anxiety and depressive disorders. The PAS is a 12‐item observer or patient‐rated scale with three subscales, for persistent, episodic anxiety and avoidance behavior. Properties for acceptability and reliability met predetermined criteria. The convergent and known groups validity was good. The scale has a satisfactory factorial structure. The area under the receiver operating characteristics curve and Youden index of the PAS are higher than that of existing anxiety rating scales. The PAS is a reliable and valid anxiety measure for use in PD patients. It is easy and brief to administer, and has better clinimetric properties than existing anxiety rating scales. The sensitivity to change of the PAS remains to be assessed. © 2014 International Parkinson and Movement Disorder Society     

Neural alterations associated with anxiety symptoms in obstructive sleep apnea syndrome

Background: Neuropsychological comorbidities, including anxiety symptoms, accompany obstructive sleep apnea (OSA); structural and functional brain alterations also occur in the syndrome. The objective was to determine whether OSA patients expressing anxiety symptoms show injury in specific brain sites. Methods: Magnetic resonance T2‐relaxometry was performed in 46 OSA and 66 control subjects. Anxiety symptoms were evaluated using the Beck Anxiety Inventory (BAI); subjects with BAI scores>9 were classified anxious. Whole brain T2‐relaxation maps were compared between anxious and nonanxious groups using analysis of covariance (covariates, age and gender). Results: Sixteen OSA and seven control subjects showed anxiety symptoms, and 30 OSA and 59 controls were nonanxious. Significantly higher T2‐relaxation values, indicating tissue injury, appeared in anxious OSA versus nonanxious OSA subjects in subgenu, anterior, and mid‐cingulate, ventral medial prefrontal and bilateral insular cortices, hippocampus extending to amygdala and temporal, and bilateral parietal cortices. Brain injury emerged in anxious OSA versus nonanxious controls in bilateral insular cortices, caudate nuclei, anterior fornix, anterior thalamus, internal capsule, mid‐hippocampus, dorsotemporal, dorsofrontal, ventral medial prefrontal, and parietal cortices. Conclusions: Anxious OSA subjects showed injury in brain areas regulating emotion, with several regions lying outside structures affected by OSA alone, suggesting additional injurious processes in anxious OSA subjects. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

A revised sexual knowledge assessment tool for people with intellectual disabilities: is sexual knowledge related to sexual offending behaviour?

Background The aim of the current study was to update an existing short measure of sexual knowledge and generate some initial reliability and normative data. Comparisons of sexual knowledge across several groups were made to examine whether or not a lack of sexual knowledge is related to sexual offending. Methods The Bender Sexual Knowledge Questionnaire (BSKQ) was revised, and a new questionnaire, the General Sexual Knowledge Questionnaire (GSKQ), was created and administered to four groups of participants: (1) sex offenders with an intellectual disability (ID) and a history of engagement in treatment (n = 12); (2) sex offenders with an ID and no history of treatment (n = 13); (3) non‐offenders with an ID (n = 28); and (4) non‐offenders without an ID (n = 10). Between‐group comparisons were made; internal consistency, split‐half reliability and correlations were examined. Results The internal consistency and the split‐half reliability of the entire questionnaire was good. Non‐offenders without an ID scored significantly higher than non‐offenders with an ID on all sections of the GSKQ. Sex offenders who had undergone treatment scored significantly higher than non‐offenders with an ID on several sections of this questionnaire. Conclusions The initial findings from this study suggest that the psychometric properties of the GSKQ are promising. The assumption that lower sexual knowledge may be related to the risk of committing a sexual offence by people with IDs is possibly erroneous, and further research is required to clarify this possibility.     

Severity of anxiety and work‐related outcomes of patients with anxiety disorders

Background: This study examined associations between anxiety and work‐related outcomes in an anxiety disorders clinic population, examining both pretreatment links and the impact of anxiety change over 12 weeks of treatment on work outcomes. Four validated instruments were used to also allow examination of their psychometric properties, with the goal of improving measurement of work‐related quality of life in this population. Methods: Newly enrolled adult patients seeking treatment in a university‐based anxiety clinic were administered four work performance measures: Work Limitations Questionnaire (WLQ), Work Productivity and Activity Impairment Questionnaire (WPAI), Endicott Work Productivity Scale (EWPS), and Functional Status Questionnaire Work Performance Scale (WPS). Anxiety severity was determined using the Beck Anxiety Inventory (BAI). The Clinical Global Impressions, Global Improvement Scale (CGI‐I) was completed by patients to evaluate symptom change at a 12‐week follow‐up. Two severity groups (minimal/mild vs. moderate/severe, based on baseline BAI score) were compared to each other on work measures. Results: Eighty‐one patients provided complete baseline data. Anxiety severity groups did not differ in job type, time on job, job satisfaction, or job choice. Patients with greater anxiety generally showed lower work performance on all instruments. Job advancement was impaired for the moderate/severe group. The multi‐item performance scales demonstrated better validity and internal consistency. The WLQ and the WPAI detected change with symptom improvement. Conclusion: Level of work performance was generally associated with severity of anxiety. Of the instruments tested, the WLQ and the WPAI questionnaire demonstrated acceptable validity and internal reliability. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Psychometric evaluation of a Dutch version of the Mini PAS‐ADD for assessing psychiatric disorders in adults with different levels of intellectual disability

Background People with intellectual disabilities (ID) have an increased vulnerability to develop psychiatric problems. Moreover, the early recognition and the accurate diagnosis of psychiatric disorders in the population of persons with ID are challenging. Method A Dutch version of the Mini PAS‐ADD, which is a screening instrument for identification of mental health problems in people with ID, was evaluated in terms of internal consistency, interinformant reliability, item grouping and criterion validity based on a large‐scale random sample (n = 377) and a clinical sample (n = 99) of adults with ID. Results The Dutch version of the Mini PAS‐ADD showed moderate internal consistency, and moderate concordance among informants. Both aspects of the reliability were comparable for different levels of ID. A factor analysis largely confirmed the scale structure. Concurrent validity with the Reiss Screen for Maladaptive Behavior was high for the Depression, Psychosis and Autism scale. The outcome of the criterion‐validity analysis indicated high specificity. The sensitivity for specific psychiatric disorders by the corresponding scales was moderate, but the general sensitivity for the presence of psychopathology on the basis of any of the scales was satisfying. Conclusions The present research reconfirmed the use of the Mini PAS‐ADD as a primary screening device for the identification of mental health problems among people with ID.     

Is the Parkinson anxiety scale comparable across raters?

The Parkinson Anxiety Scale is a new scale developed to measure anxiety severity in Parkinson's disease specifically. It consists of three dimensions: persistent anxiety, episodic anxiety, and avoidance behavior. This study aimed to assess the measurement properties of the scale while controlling for the rater (self‐ vs. clinician‐rated) effect. The Parkinson Anxiety Scale was administered to a cross‐sectional multicenter international sample of 362 Parkinson's disease patients. Both patients and clinicians rated the patient's anxiety independently. A many‐facet Rasch model design was applied to estimate and remove the rater effect. The following measurement properties were assessed: fit to the Rasch model, unidimensionality, reliability, differential item functioning, item local independency, interrater reliability (self or clinician), and scale targeting. In addition, test–retest stability, construct validity, precision, and diagnostic properties of the Parkinson Anxiety Scale were also analyzed. A good fit to the Rasch model was obtained for Parkinson Anxiety Scale dimensions A and B, after the removal of one item and rescoring of the response scale for certain items, whereas dimension C showed marginal fit. Self versus clinician rating differences were of small magnitude, with patients reporting higher anxiety levels than clinicians. The linear measure for Parkinson Anxiety Scale dimensions A and B showed good convergent construct with other anxiety measures and good diagnostic properties. Parkinson Anxiety Scale modified dimensions A and B provide valid and reliable measures of anxiety in Parkinson's disease that are comparable across raters. Further studies are needed with dimension C. © 2014 International Parkinson and Movement Disorder Society     

Impulsiveness as a factor in sexual offending by people with mild intellectual disability

Background It has been suggested that sexual offending by people with intellectual disability (ID) results from a pattern of impulsive behaviour that is consistent with psychosocial disadvantage, rather than sexual deviancy. This study aimed to explore this hypothesis by assessing levels of impulsiveness in sexual offenders, non‐sexual offenders and non‐offenders with mild ID. Method Impulsiveness was assessed using a modified version of the Barratt Impulsiveness Scale (11th edition). Total impulsivity scores were compared between sexual offenders, non‐sexual offenders and non‐offenders, all with mild ID. Results There was a significant difference in the levels of impulsiveness between sexual offenders and non‐sexual offenders with ID (t = 2.83, P < 0.01). The sexual offenders were less impulsive than non‐sexual offenders. Conclusions This study did not support the hypothesis that sexual offending by people with ID is better explained by impulsive behaviour rather than sexual deviancy. It supports recent findings that among the general population, sexual offenders are less impulsive than controls and violent offenders.     

患者健康问卷-15在卒中门诊的信度和效度研究

目的 研究卒中人群中患者健康问卷-15（Patient Health Questionnaire-15,PHQ-15）的信度和效度。 方法 对107例门诊复查的卒中患者分别进行PHQ-15、Beck焦虑自评量表（Beck Anxiety Inventory, BAI ）、患者健康问卷-9（Patient Health Questionnaire-9,PHQ-9）、汉密尔顿抑郁量表（Hamil ton Depression Rating Scale,HDMA）、汉密尔顿焦虑量表（Hamilton Anxiety Rating Scale,HAMA）和症状自 评量表-12（the Sel f-report Symptom Inventory,Symptom Checklist-12,SCL-12）,分析PHQ-15应用于卒中 患者的信度、效度。信度检验用克朗巴赫α系数;用条目和总分的相关系数评价内容效度,用SCL-12 与PHQ-15的相关性评价效标效度,用BAI 、HDMA、HAMA、PHQ-9与PHQ-15的相关性评价结构效度。 结果 （ 1）PHQ-15克朗巴赫α系数为0.811,提示该量表内部一致性较好;（2）15项条目与总分的相 关系数为0.275～0.763（均P <0.001）,提示该量表内部一致性较好;（3）PHQ-15的效标效度为0.768 （P <0.001）,提示该量表效标效度良好;（4）PHQ-15与BAI的相关系数为0.602（P <0.001）,与PHQ-9 的相关系数为0.654（P <0.001）,与HDMA的相关系数为0.769（P <0.001）,与HAMA的相关系数为0.793 （P <0.001）,提示该量表结构效度良好。 结论 P HQ-15具有良好的信度和效度,基本符合心理测量学标准,可作为门诊评价卒中患者躯体化 症状的良好工具。     

Feasibility, reliability and validity of the Spanish version of Psychiatric Assessment Schedule for Adults with Developmental Disability: a structured psychiatric interview for intellectual disability

Background Over 30% of people with intellectual disability (ID) have a comorbid psychiatric disorder. However, there are few assessment instruments available for international use and cross‐cultural validation studies of these instruments are rare. The aim of the present study was to standardize the Spanish version of the Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS‐ADD‐10), a semi‐structured interview for people with ID. Methods After a conceptual translation, feasibility (i.e. applicability, acceptability and practicality) and reliability analyses were carried out. The predictive validity of the PAS‐ADD‐10 CATEGO‐5 codings was also examined (i.e. positive and negative predictive values). Four independent raters with wide‐ranging experience in quantitative evaluation and psychiatric assessment of ID evaluated a sample of 80 subjects with ID and borderline intellectual functioning at the AFANAS occupational centre in Jerez, Southern Spain. The ICD‐10 codes were used for psychiatric diagnosis. Results The practicality of the PAS‐ADD‐10 is limited because of the need for previous standardization of SCAN interviews. Nevertheless, its overall feasibility was judged adequate by raters and the PAS‐ADD‐10 was considered extremely useful for training. Test–retest and inter‐rater reliability kappa values were moderate to high. The CATEGO coding showed limited validity because of overdiagnosis of anxiety disorders and underdiagnosis of mood and psychotic disorders (positive predictive value = 74%, negative predictive value = 76%). Conclusions The PAS‐ADD‐10 is a useful tool for standard psychiatric assessment of people with ID; however, CATEGO codings show low validity and a series of modifications should be considered before this instrument is used extensively in Spain. In this regard, a study on the clinical usefulness of the PAS‐ADD‐10 in patients with ID and severe mental disorders has been undertaken.     

Injury risk in young people with intellectual disability

Epidemiological studies have established injury as a major public health problem for young people in the general population, but minimal population‐based injury information exists on those with intellectual disability (ID). The present study investigated risk factors for injury to subjects in the Australian Child and Adolescent Development (ACAD) programme, which is examining emotional and behavioural problems in young people with ID. Extensive biopsychosocial data for the ACAD programme were collected at two time intervals (i.e. 1990–1991 and 1995–1996). Carer report of medically attended injury over one year was collected for the first time period (1995–1996) on a sample of 465 ACAD subjects (aged 5–29 years) representative of young people with ID (IQ < 70) to determine risk factors for injury using the ACAD biopsychosocial data. Psychopathology [odds ratio (OR) = 3.4] epilepsy (OR = 2.4) and an overly sociable temperament (OR = 2.2) are associated with injury in young people with ID. Social and family factors had minimal influence on injury risk in this population. Those who are highly disruptive, self‐absorbed, anxious, have problems relating socially, have communication disturbance or have attention deficit hyperactivity symptoms are particularly at increased risk for injury. The present study demonstrates a largely under‐recognized public health problem of a high unintentional injury risk for young people with ID, and identifies substantial and important risk factors for injury. Injury prevention programmes, with a particular focus on those with highly disturbed behaviours or epilepsy, are warranted in this population.     

Symptoms of anxiety in depression: assessment of item performance of the Hamilton Anxiety Rating Scale in patients with depression

Background: Although diagnostically dissociable, anxiety is strongly co‐morbid with depression. To examine further the clinical symptoms of anxiety in major depressive disorder (MDD), a non‐parametric item response analysis on “blinded” data from four pharmaceutical company clinical trials was performed on the Hamilton Anxiety Rating Scale (HAMA) across levels of depressive severity. Methods: The severity of depressive symptoms was assessed using the 17‐item Hamilton Depression Rating Scale (HAMD). HAMA and HAMD measures were supplied for each patient on each of two post‐screen visits (n=1,668 observations). Option characteristic curves were generated for all 14 HAMA items to determine the probability of scoring a particular option on the HAMA in relation to the total HAMD score. Additional analyses were conducted using Pearson's product–moment correlations. Results: Results showed that anxiety‐related symptomatology generally increased as a function of overall depressive severity, though there were clear differences between individual anxiety symptoms in their relationship with depressive severity. In particular, anxious mood, tension, insomnia, difficulties in concentration and memory, and depressed mood were found to discriminate over the full range of HAMD scores, increasing continuously with increases in depressive severity. By contrast, many somatic‐related symptoms, including muscular, sensory, cardiovascular, respiratory, gastro‐intestinal, and genito‐urinary were manifested primarily at higher levels of depression and did not discriminate well at lower HAMD scores. Conclusions: These results demonstrate anxiety as a core feature of depression, and the relationship between anxiety‐related symptoms and depression should be considered in the assessment of depression and evaluation of treatment strategies and outcome. Depression and Anxiety, 2008. © 2008 Wiley‐Liss, Inc.     

Transfer and interference of motor skills in people with intellectual disability

Atypical laterality (i.e. the lack of a clear pattern of lateralization) has been found to be a characteristic feature of individuals with intellectual disability (ID). The evidence for this has been based on ‘handedness’ studies which have contained little information about the ability of people with ID to carry out interhemispheric tasks reflecting bilateral transfer or interference. The present study examined this capacity in individuals with ID by utilizing bilateral transfer and interference paradigms. Right‐handed subjects with ID (IQ = 55–76) and controls matched for age and sex were tested for bilateral transfer of motor skill in contralateral hands with a mirror‐drawing task. The subjects were also tested for their ability to perform a finger‐tapping task while processing verbal and non‐verbal stimuli. The findings indicated that people with ID are significantly deficient relative to matched controls in bilateral transfer of motor skills from their non‐preferred (left) hand to their preferred (right) one. The effect of interference during performance of the dual task was significantly greater in individuals with ID. Subjects with ID were found to perform better with their non‐preferred than with their preferred hand. A within‐group comparison revealed that right‐handed performance was more affected by interference than left in these subjects.     

Psychometric properties of the dimensional anxiety scales for DSM‐5 in a Brazilian community sample

The DSM‐5 highlights the use of dimensional assessments of mental health as a supplement to categorical diagnoses. This study investigated the psychometric properties of the DSM‐5 Dimensional Anxiety Scales in a Brazilian community sample. Dimensional scales for generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, and specific phobia were administered to 930 adults aged 18 to 70, 64.2% female. Psychometric properties investigated were: unidimensionality; measurement invariance; internal consistency; composite reliability; test–retest reliability; convergent and divergent validity; category thresholds and item performance analyses. Analyses revealed unidimensionality for all scales except for specific phobia. Measurement invariance, high internal consistency and composite reliability, and convergent and divergent validity were demonstrated. Test–retest reliability was high for all scales but generalized anxiety disorder. Item‐based analyses evidenced that none of the items were very easy to endorse and that the scales offered more information about subjects with high severity estimates of anxiety. The DSM‐5 Dimensional Anxiety Scales are a valid and reliable alternative to assess anxiety symptomatology in community settings, although further evaluation is needed, especially for specific phobia. The scales seem to be more useful for characterizing dimensionality of symptoms for subclinical or clinical cases than for slight or mildly anxious subjects.     

Symptomatology and markers of anxiety disorders in Parkinson's disease: A cross‐sectional study

Anxiety is understudied in Parkinson's disease (PD), which is not justified by the prevalence and impact of anxiety disorders on quality of life in PD patients. In this cross‐sectional study, 342 patients suffering from idiopathic PD underwent a research‐based assessment including DSM IV criteria for anxiety disorders, the Hamilton anxiety rating scale (HARS) and the beck anxiety inventory (BAI). Thirty‐four percent (34%) of subjects met the DSM IV criteria for at least one anxiety disorder; 11.8% met criteria for multiple anxiety disorders; and 11.4% had clinically relevant anxiety symptoms without meeting the criteria for any specific anxiety disorder. Score profiles on the HARS and BAI differed significantly between the disorders, but these differences were associated with different scores on a limited number of items, and the respective symptom profiles were not readily interpretable. Female sex, the presence of motor fluctuations, as well as a previous history of an anxiety disorder were markers for anxiety disorders. The use of a mono‐amino oxidase (MAO)‐B inhibitor was associated with a reduced prevalence of anxiety disorders. Research into anxiety in PD is hampered by the questionable validity of DSM IV defined anxiety disorders in this population. A first focus for research should therefore be the identification of clinically useful anxiety presentations and their validation in PD. © 2011 Movement Disorder Society     

Convergent and divergent validity of the Beck Anxiety Inventory for patients with panic disorder and agoraphobia

Psychometric properties of the Beck Anxiety Inventory (BAI) (Beck and Steer, 1990) were investigated in a sample of 82 patients suffering from panic disorder with agoraphobia. Before and after brief treatment, patients completed a battery of questionnaires and, for 2-week periods, kept a daily panic diary in which they recorded panic attacks, fear of panic, and average anxiety. The BAI demonstrated excellent internal consistency and good test–retest reliability over a 5-week interval. A partial multitrait, multimethod correlation matrix provided evidence of convergent validity with other measures of anxiety and of divergent validity vis á vis measures of depression. Factor analyses of pretest scores and residual gain scores used to address criticism that the BAI is excessively panic-centric yielded mixed results. In one analysis, the BAI was loaded with multimethod measures of panic and anxiety and, in the other, with questionnaire methods of assessing anxiety and depression. However, the BAI was clearly distinguished from measures of fear of fear, a central construct in panic disorder, and agoraphobic avoidance. Finally, the BAI proved sensitive to change with treatment, yielding effect sizes for improvement comparable to those of other anxiety measures. Depression and Anxiety 6:140–146, 1997. © 1997 Wiley-Liss, Inc.     

Should we be anxious when assessing anxiety using the Beck Anxiety Inventory in clinical insomnia patients?

Assessing for clinical levels of anxiety is crucial, as comorbid insomnias far outnumber primary insomnias (PI). Such assessment is complex since those with Anxiety Disorders (AD) and those with PI have overlapping symptoms. Because of this overlap, we need studies that examine the assessment of anxiety in clinical insomnia groups. Participants (N = 207) were classified as having insomnia: 1) without an anxiety disorder (I-ND), or 2) with an anxiety disorder (I-AD). Mean Beck Anxiety Inventory (BAI) item responses were compared using multivariate analysis of variance (MANOVA) and follow-up ANOVAs. As a validity check, a receiver operating characteristic (ROC) curve analysis was conducted to determine if the BAI suggested clinical cutoff was valid for identifying clinical levels of anxiety in this comorbid patient group. The I-ND had lower mean BAI scores than I-AD. There were significant group differences on 12 BAI items. The ROC curve analysis revealed the suggested BAI cutoff (≥16) had 55% sensitivity and 78% specificity. Although anxiety scores were highest in those with insomnia and an anxiety disorder, those with insomnia only had scores in the mild range for anxiety. Nine items did not distinguish between those insomnia sufferers with and without an anxiety disorder. Additionally, published cutoffs for the BAI were not optimal for identifying anxiety disorders in those with insomnia. Such limitations must be considered before using this measure in insomnia patient groups. In addition, the poor specificity and high number of overlapping symptoms between insomnia and anxiety highlight the diagnostic challenges facing clinicians.     

The Controllability Beliefs Scale used with carers of people with intellectual disabilities: psychometric properties

Background Beliefs about the controllability of behaviour have been consistently shown to be important in understanding the responses of carers to the challenging behaviour of people with intellectual disabilities (IDs). This paper reports the reliability and validity of the Controllability Beliefs Scale (CBS), a 15‐item measure of beliefs regarding the controllability of challenging behaviour when used with carers of people with IDs. Methods Two hundred and sixty‐four carers of people with IDs completed the CBS, 74 people also completed the Modified Attributional Style Questionnaire and the Self‐Injury Behavioural Understanding Questionnaire scale to determine concurrent and convergent validity and 34 people completed the scale twice within a 2‐ to 4‐week period to determine test–retest reliability. Results The scale has a two‐factor structure and has adequate internal reliable. The scale is significantly correlated with the controllability, internality and stability items from the Modified Attributional Style Questionnaire, showed expected associations with behavioural and internal emotional understanding items from the Self‐Injury Behavioural Understanding Questionnaire. The scale has good test–retest reliability. Conclusions The data support use of the CBS in clinical practice and research to assess carers' beliefs regarding challenging behaviour of people with IDs.     

Development of a measure to assess the impact of epilepsy on people with an intellectual disability: the Glasgow Epilepsy Outcome Scale – Client version (GEOS-C)

Background Epilepsy is common in people with intellectual disability, yet clinicians and researchers seldom obtain information directly from the client. The development and preliminary validation of a novel measure for use with people with mild to moderate intellectual disabilities is described. Methods Focus group methods (6 groups; 24 participants) identified issues of concern, and qualitative analysis (NUD*IST) was applied to derive items and themes for a draft scale. Psychometric scale development techniques were then used in a pilot study and subsequent field‐testing to investigate validity and reliability (n = 46). Results A total of 148 issues of concern was reduced initially to 52 and then to 42 items using these methods. The derived scale comprised sub‐scales reflecting (1) concerns about having seizures; (2) about injury; (3) about issues during; and (4) after seizures; (5) about medication; (6) about what people think; and (7) about daily life. Cronbach α for the Glasgow Epilepsy Outcome Scale – Client version (GEOS‐C) was 0.92, and ranged from 0.64–0.81 for the sub‐scales. Relatively weak associations (r ≤ 0.40), between client and family carer, staff carer or clinician views, suggests that proxy reports are not good predictors of how people with epilepsy themselves are feeling. Preliminary validation suggests that the GEOS‐C can discriminate on variables of clinical importance. Conclusions The GEOS‐C complements existing GEOS measures, can be completed in 5–15 min depending upon the level of support required, and may provide a valuable clinical and research tool. Further validational work and appraisal of sensitivity are required.