Impulse control and aggressive response generation as predictors of aggressive behaviour in children with mild intellectual disabilities and borderline intelligence

Background   A growing interest exists in mechanisms involved in behaviour problems in children with mild intellectual disabilities and borderline intelligence (MID/BI). Social problem solving difficulties have been found to be an explanatory mechanism for aggressive behaviour in these children. However, recently a discrepancy was found between automatic and reflective responding in social situations. We hypothesise that low impulse control and aggressive social problem solving strategies together may explain mechanisms involved in aggressive behaviour by children with MID/BI.
Method   In a clinical sample of 130 children with MID/BI receiving intramural treatment, main, moderating and mediating effects of impulse control and aggressive response generation on aggressive behaviour were examined by conducting hierarchical linear multiple regression analyses.
Results   Independent main effects of both impulse control and aggressive response generation on aggressive behaviour were found. Results indicated that low impulse control and aggressive response generation each explain unique variance in aggressive behaviour.
Conclusions   As this study is the first that has shown both impulse control and aggressive response generation to be important predictors for aggressive behaviour in children with MID/BI, future research should further examine the nature of relations between low impulse control and social problem solving.     

Contextual variables affecting aggressive behaviour in individuals with mild to borderline intellectual disabilities who live in a residential facility

Background   Aggression is a common type of problem behaviour in clients with mild to borderline intellectual disability who live in a residential facility. We explored contextual events that elicit aggressive behaviour and variables that were associated with such events.
Method   Respondents were 87 direct-care staff members of 87 clients with aggressive behaviour who lived in a residential facility. Staff members completed the Contextual Assessment Inventory (CAI) and a questionnaire on demographic information and types, frequency and severity of aggressive behaviour. Internal consistency of the total CAI was excellent ( α  = 0.95), and Cronbach alpha's for the CAI sub-scales ranged from 0.75 to 0.93. Inter-rater agreement for the CAI could be considered good (mean intra-class correlation coefficient = 0.63).
Results   Both social and task-related events were reported to evoke aggressive behaviour of clients most often. Negative interactions, task characteristics and daily routines relatively often evoked aggressive behaviour while an uncomfortable environment, medication, illness and physiological states (i.e. physical and biological events) evoked aggressive behaviour least often. Mean CAI sub-scale scores were significantly related to gender, IQ and frequency of aggressive behaviour.
Conclusion   The present study extends our knowledge regarding events that are associated with an increased probability of aggressive behaviour. Knowledge of these contextual variables may be helpful in designing programmes (e.g. applied behaviour analysis, social skills training and cognitive behavioural therapies) for the management and prevention of aggressive behaviour in clients with mild to borderline intellectual disability who live in a residential facility.     

Prevalence and types of aggressive behaviour among adults with intellectual disabilities

Background Aggressive behaviours represent major obstacles to the integration into society of individuals with intellectual disability (ID) and pose significant management issues for carers. Methods The present study assessed the prevalence and severity of five types of aggressive behaviours in 3165 adult men and women with ID receiving services from three rehabilitation agencies in Québec by surveying their carers using the Modified Overt Aggressive Scale. Results The 12‐month prevalence of aggressive behaviour was 51.8%: 24% property damage, 37.6% verbal, 24.4% self‐oriented and 24.4% physical aggression, and 9.8% sexually aggressive behaviour, most of which being mild in severity. Only 4.9% of individuals displayed aggressive behaviour leading to injury of the victim. Few gender differences were observed. Conclusions The capacity to document and assess the types as well as the severity of aggressive behaviour is thus critical, not only to better understand the correlates of various types of behaviours but also to orient intervention programmes whether they be prevention, assessment, monitoring or management of aggressive behaviour.     

Do children do what they say? Responses to hypothetical and real-life social problems in children with mild intellectual disabilities and behaviour problems

Background Most research on children's social problem-solving skills is based on responses to hypothetical vignettes. Just how these responses relate to actual behaviour in real-life social situations is, however, unclear, particularly for children with mild intellectual disabilities (MID). Method In the present study, the spontaneous and selected responses of 56 children with MID to hypothetical situations from the Social Problem-Solving Test for children with MID (SPT-MID) were compared to their actual behaviour in comparable staged standardized real-life conflict situations. Correlations to externalizing behaviour problems were assessed using the Teacher's Report Form (TRF). Results The results show children with MID and accompanying externalizing behaviour problems to behave more aggressively in the staged real-life conflicts and provide more spontaneous aggressive responses to the hypothetical vignettes than children with MID and no accompanying externalizing behaviour problems; they did not, however, select more aggressive responses from the hypothetical options provided. A moderate correlation was found between the aggressiveness of the spontaneous responses in the hypothetical situations and actual behaviour in the staged real-life situations. In addition, both the spontaneous aggressive responses under hypothetical circumstances and the actual aggressive behaviour under staged real-life circumstances were related to teacher-rated aggressive behaviour in the classroom. Conclusions It is concluded that the hypothetical vignettes from the SPT-MID do provide information on both the actual behaviour and knowledge of social problem-solving skills of children with MID.     

Social information processing in boys with autistic spectrum disorder and mild to borderline intellectual disabilities

Background   Children with autistic spectrum disorders (ASD) and mild to borderline intellectual disability (ID) have less adaptive behaviour and more behaviour problems than children with mild to borderline ID. Social information processing appears to be an important mechanism in the explanation of the socially inadequate behaviour of children with mild to borderline ID; however, little is known about the social information processing skills of children with ASD and mild to borderline ID.
Method   In the present study, a total of 136 boys in the age of 10–14 years participated; 26 with ASD (specifically Pervasive Developmental Disorder – Not Otherwise Specified) and mild to borderline ID, 54 with mild to borderline ID without ASD and 56 typically developing boys. They completed the Social Problem Solving Test to measure their social information processing.
Results   The research results show boys with PDD-NOS and mild to borderline ID to differ from typically developing boys in their encoding of information; they focus on negative and emotional information in the social situation. They differ from boys with mild to borderline ID in response generation, evaluation of inadequate solutions (aggressive and submissive responses) and assertive response decision.
Conclusions   The present study extends our knowledge regarding social information processing of children with ASD (PDD-NOS) and mild to borderline ID. This knowledge may be helpful in designing and adapting programmes (e.g. social skills training, self-management training) for the management of behaviour problems and development of adaptive behaviour of children with ASD and mild to borderline ID.     

Profiles and correlates of aggressive behaviour among adults with intellectual disabilities

Background Despite the heterogeneity in aggressive behaviours observed among individuals with intellectual disabilities (ID), little attention has been paid to the identification of typologies of aggression among individuals with mild or moderate ID and their associated factors. Objective The goal of the present study was to identify profiles of aggressive behaviour and their psychosocial correlates. Method In this cross‐sectional study of 296 adults with mild or moderate ID, information was gathered through interviews with the ID participants, their case manager and a significant other. Client files were also reviewed. Results Multiple correspondence analysis followed by hierarchical cluster analysis generated six distinct profiles of aggressive behaviour in this sample. The ‘violent’ group clearly stood out as lacking social and vocational involvement, having more severe mental health problems, high levels of impulsivity and antisocial tendencies compared with all other groups. Discussion The identification of distinct profiles of aggressive behaviour offers new possibilities for studying risk factors and eventually targeting specific risk prevention strategies.     

Assessment of anger coping skills in individuals with intellectual disabilities

Recent controlled studies have supported the effectiveness of anger management training for people with intellectual disabilities (IDs). This report describes an evaluation instrument designed to assess their usage of specific anger coping skills. The Profile of Anger Coping Skills (PACS) is designed for completion by a staff member or carer. Three situations are first elicited in which a client frequently displays anger. The respondent then rates each situation for the extent to which the client deploys each of eight behavioural and cognitive coping skills. In a preliminary reliability study, 20 users of a day service for people with IDs were rated independently by two staff members, with one of them completing the assessment on two separate occasions: the PACS showed good test–retest reliability and lower, but still acceptable, interrater reliability. The PACS was subsequently used, in a different day service, as part of the assessment pack administered before and after a 12-week anger management group, with a parallel assessment of an untreated control group. The treated group showed substantial decreases in measures of anger, which were maintained at 6-month follow-up. Increases in PACS-rated anger coping skills were also seen in all participants in the anger management group, but not in the control group. There were differences in the extent to which different coping skills were acquired by the treated group, and there were also individual differences in the profile of specific skills acquired. It is concluded that the PACS is a reliable instrument for assessing anger coping skills, particularly when used repeatedly with the same informant. It provides information that is useful for both individual care planning and the design of future anger management programmes.     

Overcoming the barriers experienced in conducting a medication trial in adults with aggressive challenging behaviour and intellectual disabilities

Background   Aggressive challenging behaviour in people with intellectual disability (ID) is frequently treated with antipsychotic drugs, despite a limited evidence base.
Method   A multi-centre randomised controlled trial was undertaken to investigate the efficacy, adverse effects and costs of two commonly prescribed antipsychotic drugs (risperidone and haloperidol) and placebo.
Results   The trial faced significant problems in recruitment. The intent was to recruit 120 patients over 2 years in three centres and to use a validated aggression scale (Modified Overt Aggression Scale) score as the primary outcome. Despite doubling the period of recruitment, only 86 patients were ultimately recruited.
Conclusions   Variation in beliefs over the efficacy of drug treatment, difficulties within multidisciplinary teams and perceived ethical concerns over medication trials in this population all contributed to poor recruitment. Where appropriate to the research question cluster randomised trials represent an ethically and logistically feasible alternative to individually randomised trials.     

Measurement of perceived competence in Dutch children with mild intellectual disabilities

Background Little research has been conducted on the perceived competence of children with mild intellectual disabilities (MID). One of the reasons for the marked absence of research appears to be the lack of reliable and clearly valid measurement instruments for this particular group of children. In the present study, it was examined whether a pictorial scale originally designed to measure perceived competence in typically developing children could successfully be used with children with MID. Methods The pictorial scale was administered to a group of 106 children with MID. The construct validity, reliability and stability of the scale were investigated. Results The results of the exploratory factor analyses and the confirmatory factor analyses supported the conceptual framework proposed. The construct validity was also supported by the pattern of intercorrelations between the subscales. The scale had adequate internal consistency and the stability analyses showed sufficient stability across a 4-month period. Conclusions The findings show the psychometric properties of the pictorial scale to justify its use with children with MID.     

Do social information‐processing models explain aggressive behaviour by children with mild intellectual disabilities in residential care?

Background This study aimed to examine whether the social information‐processing model (SIP model) applies to aggressive behaviour by children with mild intellectual disabilities (MID). The response‐decision element of SIP was expected to be unnecessary to explain aggressive behaviour in these children, and SIP was expected to mediate the relation between social schemata and aggressive behaviour. Method SIP and aggressive behaviour of 130 10‐ to 14‐year‐old children with MID in residential care were assessed. The fit of various SIP models was tested with structural equation modelling. Results The response‐decision process was found not to be necessary to explain aggressive behaviour. Social schemata were indirectly related to aggressive behaviour with aggressive response generation as mediating variable. Conclusions Implications for SIP theory and intervention are discussed.     

The effectiveness of antidepressant medication in the management of behaviour problems in adults with intellectual disabilities: a systematic review

Background A comprehensive systematic review was performed to establish the current evidence base regarding the effectiveness of antidepressant medication for the management of behaviour problems in adults with intellectual disabilities. Method An electronic search of PsycInfo, Embase, Medline and Cinahl databases was conducted spanning the time period 1990 to October 2005 for primary trials. This was supplemented by hand searching and cross‐referencing of relevant reviews. Strict scientific methodology requirements were formulated that the studies had to meet in order to merit inclusion in this review. Results One crossover randomized controlled trial in a small cohort, seven prospective uncontrolled trials and two retrospective studies were yielded in the search. Of these, one explored the effectiveness of the tricyclic antidepressant – clomipramine, and nine considered various selective serotonin reuptake inhibitors (SSRIs). Conclusion Evidence based primarily on a small number of either prospective or retrospective case studies that included a small number of participants and often used non‐validated outcome measures for a short period of follow‐up, suggests that antidepressants, particularly SSRIs, show improvement of aggression and self‐injurious behaviour on average in less than 50% of cases and the rest show either no improvement or deterioration. The effect is most pronounced in the presence of an underlying anxiety or an associated diagnosis of obsessive‐compulsive disorder. Most studies have highlighted the concern regarding adverse effects.     

Motor performance of children with mild intellectual disability and borderline intellectual functioning

Background There is a relatively small body of research on the motor performance of children with mild intellectual disabilities (MID) and borderline intellectual functioning (BIF). Adequate levels of motor skills may contribute to lifelong enjoyment of physical activity, participation in sports and healthy lifestyles. The present study compares the motor skills of children with intellectual disability (ID) to the abilities observed in typically developing children. It also aimed to determine whether there is an association between degree of ID and motor performance. Methods A total of 170 children between 7 and 12 years old with MID or BIF, who attended schools for special education, were examined on the test component of the Movement Assessment Battery for Children (MABC) test. Both groups were compared with the norm scores of the total score, sub‐scale scores and individual items of the MABC test. Results Of the children, 81.8% with MID and 60.0% with BIF performed below the 16th percentile on the total score of the MABC. Both groups demonstrated a relative weakness in the area of manual dexterity. Comparisons between both groups showed small to moderate effect sizes on the total score of the MABC, as well as for all three sub‐scales, favouring the children with BIF. Conclusions Children with ID had significantly more borderline and definite motor problems than the normative sample and there was an association between degree of ID and performance of manual dexterity, ball skills and balance skills. This study highlights the importance of improving motor skill performance in both children with borderline and mild ID, and the results support the notion that the level of motor and cognitive functioning are related in children with ID.