Development and psychometric properties of the Attitudes Toward Intellectual Disability Questionnaire - Short Form.

BACKGROUND: Understanding public attitudes towards people with intellectual disability (ID) can help orient activities to promote the social inclusion of this group. The ATTitudes toward Intellectual Disability (ATTID) questionnaire is a validated 67-item tool used to assess attitudes towards people with ID from a multidimensional perspective. It is based on a five-factor model tapping into cognitive, emotional and behavioural components of attitudes. In order to facilitate international research, the goal of this study was to develop a short version that would retain the long form's psychometric properties. METHODS: Analyses were conducted on a sample of 1608 respondents who completed the full-length ATTID. A four-step test refinement procedure was used to reduce the number of items. The first two steps involved a Cronbach's alpha analysis. Items retained were then reviewed to assess face validity. Correlations between factors were calculated, and a factor analysis was performed to compare the original and short forms. RESULTS: The number of items in the ATTID was reduced from 67 to 35. The short form maintained good overall reliability. The correlational pattern between factors in both the long and short form is generally the same. The factor analysis of the short form showed a similar five-factor structure with some loss of variance. CONCLUSIONS: We recommend the short form be used when administration time is an issue, particularly in a research context. Replication studies with new samples are needed to further assess the psychometric properties of the ATTID-Short Form.

Attitudes of health care professionals toward people with intellectual disability: a comparison with the general population.

BACKGROUND: Few studies have examined attitudes that may promote the social inclusion of persons with an intellectual disability (ID) among health care providers (HCPs). Yet these attitudes could impact the accessibility and quality of services provided to this population, as well as the general attitudes of HCPs. The objectives of this study were to (1) examine HCPs' pro-inclusion attitudes toward people with ID, (2) compare these to the general population's attitudes and (3) examine how HCPs' attitudes vary as a function of their socio-demographic characteristics. METHOD: The Attitudes Toward Intellectual Disability Questionnaire was administered to 367 HCPs and a representative sample of the Québec population (N = 1605). RESULTS: Results indicated that at least half of HCPs displayed positive attitudes, that is, attitudes that are compatible with notions of social inclusion and equal rights, toward individuals with ID. Positive attitudes were less frequently observed for the Interaction and the Sensitivity or tenderness factors measured by the Attitudes Toward Intellectual Disability Questionnaire. In comparison with the general population, HCPs exhibited more positive attitudes on the Knowledge of causes and Sensitivity or tenderness factors and less positive attitudes on the Interaction factor. HCPs who regarded themselves as more knowledgeable about ID and those who reported higher quality contacts or interactions with persons with ID expressed attitudes that were more favourable toward social inclusion. CONCLUSIONS: In addition to providing general knowledge about ID and the specific health care needs of individuals with ID, training programmes should also promote interactions with this population. Further studies are needed to document HCPs' pro-inclusion attitudes toward people with ID and to assess the impact of interventions on these attitudes.

Norms of the Attitudes Toward Intellectual Disability Questionnaire.

BACKGROUND: The Attitudes Toward Intellectual Disability Questionnaire (ATTID) has demonstrated good psychometric qualities for measuring the attitudes of different groups of adults in the general population toward intellectual disability (ID). A significant advantage of the ATTID is that it addresses the concept of attitudes using a three-dimensional model (affective, cognitive and behavioural). To our knowledge, there are no normative data published regarding attitudes toward ID on general population-based samples. METHODS: The sample of 1605 men and women was stratified to be representative of the general adult population of Quebec. The ATTID was administered by phone interview through an independent survey firm. RESULTS: Normative data are presented as percentile scores associated with the raw score of the ATTID by gender and age categories. Analysis of the variance yielded significant differences in attitude by gender and age. The directions and the strength of these associations vary according to each of the five factors used to define attitudes. CONCLUSION: These norms will provide an essential tool to compare different groups and assess the effectiveness of various public campaigns to encourage more positive attitudes towards persons with ID. These norms would also allow international comparisons.

The role of personality in aggressive behaviour among individuals with intellectual disabilities.

BACKGROUND: Aggressive behaviour is associated with certain personality traits in both the general population and among individuals with mental health problems, but little attention has been paid to the relationship between aggressive behaviour and personality among individuals with intellectual disabilities (ID). The aim of this study was to circumscribe personality profiles associated with aggressive behaviour among individuals with ID. METHOD: In this cross-sectional study of 296 adults with mild or moderate ID, information on mental health, personality and aggressive behaviour was gathered through structured interviews with the ID participants and their case manager, and a review of client files. RESULTS: The results of the Reiss Profile were submitted to hierarchical cluster analysis method. Subsequently, the distribution of aggressive behaviour, sociodemographic characteristics and clinical characteristics across personality profiles was analysed. The analyses yielded seven distinct personality profiles in relation to patterns of aggressive behaviour: Pacifists, Socials, Confidents, Altruists, Conformists, Emotionals and Asocials. CONCLUSION: The identification of distinct personality profiles sheds light on the risk factors for aggressive behaviour, and suggests new approaches to improving diagnostic and intervention strategies.

Intellectual disability and co-occurring mental health and physical disorders in aggressive behaviour.

BACKGROUND: Mental and physical health problems are more prevalent among individuals with an intellectual disability (ID) than in the general population. Studies suggest that there may be significant associations between these co-occurring disorders and aggressive behaviour, but few studies have taken into account multiple mental and physical problems, as well as their level of severity. OBJECTIVES: The main goal of this study was to identify the associations between different types of aggressive behaviour and various types of physical and mental health problems. METHODS: These associations were explored through a cross-sectional study of 296 adult men and women with mild or moderate ID living in the community and receiving ID services. Information was gathered through interviews with ID participants, case managers and file review. RESULTS: The results show that individuals with ID who have more mental and physical health problems have higher odds of displaying aggressive behaviour than those with fewer and less severe physical health problems. DISCUSSION: These results can help guide future prevention and intervention strategies for persons with ID who display aggressive behaviour or who are at risk of become aggressive.

Public attitudes towards intellectual disability: a multidimensional perspective.

BACKGROUND: Public attitudes towards persons with intellectual disabilities (IDs) have a significant effect on potential community integration. A better understanding of these can help target service provision and public awareness programmes. OBJECTIVE: The objective of the present study is threefold: (1) describe public attitudes towards persons with ID along affective, cognitive and behavioural dimensions; (2) compare and contrast attitudes according to sex, age, education and income, as well as frequency and quality of contacts with persons with ID; and (3) ascertain whether the level of functioning has an effect on attitudes. METHODS: The Attitudes Toward Intellectual Disability Questionnaire (ATTID) was administered by phone to 1605 randomly selected adult men and women, stratified by region in the province of Québec, Canada. The ATTID uses a multidimensional perspective of attitudes that reflect affective, cognitive and behavioural dimensions. RESULTS: The results showed that public attitudes were generally positive regarding all three attitudinal dimensions. Public attitudes towards persons with ID are presented in terms of the five factors measured through the ATTID: (1) discomfort; (2) sensibility or tenderness; (3) knowledge of causes; (4) knowledge of capacity and rights; and (5) interaction. Attitude factor scores vary as a function of participant characteristics (sex, age, education and income) and the degree of knowledge about ID, the number of persons with ID known to the participants, as well as the frequency and quality of their contacts with these persons. Men had greater negative attitudes than women as regards the discomfort factor, while women had more negative attitudes regarding the knowledge of capacity and rights factor. More positive attitudes were revealed among younger and more educated participants. Attitudes were generally not associated with income. Public attitudes tended to be more negative towards people with lower functioning ID. CONCLUSION: These results yield useful information to target public awareness and education.

Validation of the attitudes toward intellectual disability: ATTID questionnaire.

BACKGROUND: Individuals with an intellectual disability (ID) continue to experience major obstacles towards social, educational and vocational integration. Negative attitudes toward persons with ID has remained relevant over time and has led to discrimination and stigma. OBJECTIVE: The present study describes the development of a new questionnaire for tapping into the general population's attitudes toward individuals with ID and addresses its psychometric properties. METHODS: Adopting a multidimensional perspective, the Attitudes Toward Intellectual Disability Questionnaire (ATTID) was developed from a series of previously validated instruments and principles from the Montreal Declaration on Intellectual Disability (2004). The ATTID was administered by phone to 1605 randomly selected adult men and women, stratified by region in the Province of Quebec, Canada. RESULTS: The ATTID yielded a five-factor structure overlapping the tri-partite model of attitudes. The cognitive component was represented by two factors: knowledge of capacity and rights and knowledge of causes of ID. The affective component tapped into two factors: discomfort and sensitivity/compassion. Finally, the behavioural component emerged as a single factor. The ATTID had good internal consistency with Cronbach's alpha coefficients ranging from 0.59 to 0.89 for the five factors and of 0.92 for the overall questionnaire. Test-retest reliability yielded correlations from 0.62 to 0.83 for the five factors. CONCLUSION: The ATTID can be used to measure attitudes among different populations and allows comparisons over time within the same population as a function of various intervention strategies for de-stigmatising ID.

Evolving systems of care: Individuals found not criminally responsible on account of mental disorder in custody of civil and forensic psychiatric services.

Following psychiatric deinstitutionalization and changes in involuntary civil commitment laws, many individuals with severe mental disorders have been receiving mental health services through the back door, that is, the criminal justice system. Significant changes to the section of Criminal Code of Canada dealing with individuals with mental disorders have led to significant annual increases in the number of individuals declared Not criminally responsible on account of mental disorder (NCRMD), many of whom are directed to civil psychiatric settings. The goal of the present study was to describe the psychosociocriminological and risk characteristics of individuals found NCRMD remanded to civil psychiatric hospitals (CPH) compared to a forensic psychiatric hospital (FPH). This study was conducted between October 2004 and August 2006 in the sole FPH of the province of Québec and two large CPH in the Montréal metropolitan area. The final sample for the current study consisted of 96 men: 60 from the FPH and 36 from the two CPH. Results indicate that individuals in both settings have similar psychosociocriminal profiles, including PCL-R scores, but that individuals in CPH have higher scores in the Risk subscale of the HCR-20 than do their counterparts in the FPH. This difference is due to a higher score on two items: exposure to destabilizing factors and noncompliance with remediation attempts. Results are discussed in terms of the need for civil psychiatric settings to implement risk assessment and management programs into their services, and the need for further research into forensic mental health services.

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.

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.

[Instruments to evaluate fitness to stand trial:a review of recent literature]. / Instruments d'évaluation de l'aptitude à subir son procès: une recension de la documentation scientifique.

OBJECTIVES: To present current methods used to assess fitness to stand trial (FST), draw a parallel between these methods and studies of factors associated with decisions regarding FST, and describe the limits inherent to the field of FST. METHOD: Survey of the relevant literature from Psychinfo and Medline databases from 1967 to 1996 inclusively. RESULTS: Ten instruments were identified for the systematic collection of information from persons assessed for FST. The description and analysis of their psychometric qualities, however, indicate that these instruments present some problems. CONCLUSION: Although some research has shown that diagnosis is the factor most associated with decisions regarding FST, no instrument includes a systematic assessment of psychopathology. If we take into account the possible consequences of these decisions for the accused as well as for society, these assessments and the recommendations that follow prove to be extremely important.