The Behavior Problems Inventory-Short Form for individuals with intellectual disabilities: part II: reliability and validity.

BACKGROUND: The Behavior Problems Inventory-01 (BPI-01) is an informant-based behaviour rating instrument for intellectual disabilities (ID) with 49 items and three sub-scales: Self-injurious Behavior, Stereotyped Behavior and Aggressive/Destructive Behavior. The Behavior Problems Inventory-Short Form (BPI-S) is a BPI-01 spin-off with 30 items. METHODS: The psychometric properties of these two versions of the scale were computed using aggregated archival data from nine different sites in the USA, Wales, England, the Netherlands and Romania with a total of 1122 cases with a BPI-01 total score >0. RESULTS: The internal consistency of the BPI-01 and the BPI-S ranged from fair to excellent with the BPI-01 showing slightly stronger reliability. Construct validity (confirmatory and discriminant) was computed by comparing BPI sub-scale scores with the scores of four other behaviour rating scales (the Aberrant Behavior Checklist, the Diagnostic Assessment for the Severely Handicapped-II, the Nisonger Child Behavior Rating Form and the Inventory for Client and Agency Planning). Strong evidence for confirmatory and discriminant validity was found for both the BPI-01 and the BPI-S. Confirmatory fit indices for the BPI and the BPI-S were comparable and suggesting that the factor structures fit the data well. CONCLUSION: In summary, both BPI versions were found to be equally sound psychometrically and can be endorsed for future use. However, independent future studies are needed to replicate the psychometrics of the BPI-S with new data.

The Behavior Problems Inventory-Short Form for individuals with intellectual disabilities: part I: development and provisional clinical reference data.

BACKGROUND: The Behavior Problems Inventory-01 (BPI-01) is an informant-based behaviour rating instrument that was designed to assess maladaptive behaviours in individuals with intellectual disabilities (ID). Its items fall into one of three sub-scales: Self-injurious Behavior (14 items), Stereotyped Behavior (24 items), and Aggressive/Destructive Behavior (11 items). Each item is rated on a frequency scale (0 = never to 4 = hourly), and a severity scale (0 = no problem to 3 = severe problem). The BPI-01 has been successfully used in several studies and has shown acceptable to very good psychometric properties. One concern raised by some investigators was the large number of items on the BPI-01, which has reduced its user friendliness for certain applications. Furthermore, researchers and clinicians were often uncertain how to interpret their BPI-01 data without norms or a frame of reference. METHODS: The Behavior Problems Inventory-Short Form (BPI-S) was empirically developed, based on an aggregated archival data set of BPI-01 data from individuals with ID from nine locations in the USA, Wales, England, the Netherlands, and Romania (n = 1122). The BPI-S uses the same rating system and the same three sub-scales as the BPI-01, but has fewer items: Self-injurious Behavior (8 items), Stereotyped Behavior (12 items), and Aggressive/Destructive Behavior (10 items). Rating anchors for the severity scales of the Self-injurious Behavior and the Aggressive/Destructive Behavior sub-scales were added in an effort to enhance the objectivity of the ratings. RESULTS: The sensitivity of the BPI-S compared with the BPI-01 was high (0.92 to 0.99), and so were the correlations between the analogous BPI-01 and the BPI-S sub-scales (0.96 to 0.99). Means and standard deviations were generated for both BPI versions in a Sex-by-age matrix, and in a Sex-by-ID Level matrix. Combined sex ranges are also provided by age and level of ID. CONCLUSION: In summary, the BPI-S is a very useful alternative to the BPI-01, especially for research and evaluation purposes involving groups of individuals.

Examining cross-cultural differences in autism spectrum disorder: A multinational comparison from Greece, Italy, Japan, Poland, and the United States.

Autism spectrum disorder (ASD) is characterized by social and communication impairments as well as restricted, repetitive behavior patterns. Despite the fact that ASD is reported worldwide, very little research exists examining ASD characteristics on a multinational scale. Cross-cultural comparisons are especially important for ASD, since cultural differences may impact the perception of symptoms. Identifying behaviors that are similarly reported as problematic across cultures as well as identifying behaviors in which there is cultural variation could aid in the development and refinement of more universally effective measures. The present study sought to examine similarities and differences in caregiver endorsement of symptom severity through scores on the Baby Infant Screen for Children with aUtIsm Traits (BISCUIT). The BISCUIT was utilized to examine ASD core symptomology in 250 toddlers diagnosed with ASD from Greece, Italy, Japan, Poland, and the United States. Significant differences in overall ASD symptom severity and endorsement were found between multinational groups. Implications of the results are discussed.

Assessment of depression in mentally retarded adults.

Depression and psychopathology were assessed in 110 adult patients (ages 18-71 years) classified as borderline, mildly, moderately, or severely mentally retarded. Patients completed modified versions of the Beck Depression Inventory, the Zung Self-Rating Depression Scale, the MMPI depression scale, the Thematic Apperception Test, and the Psychopathology Instrument for Mentally Retarded Adults. Clinicians and ward personnel rated the patients on the Hamilton Rating Scale for Depression and an informant version of the Psychopathology Instrument for Mentally Retarded Adults. The measures correlated significantly with each other and were consistently related to the diagnosis of depression.

Effects of thioridazine and withdrawal dyskinesias on workshop performance of mentally retarded young adults.

The authors conducted a two-part study of the effects of thioridazine and withdrawal dyskinesias on the workshop performance of mentally retarded young adults. In part 1, 80 mentally retarded subjects were divided into five groups of 16 according to administration, discontinuation, or nonadministration of thioridazine. The major finding was that thioridazine can impair the workshop performance of mentally retarded individuals. In part 2, 28 subjects were divided into four matched groups of 7 subjects each whose thioridazine dose was abruptly or gradually discontinued and who did or did not have withdrawal dyskinesias. Workshop performance declined with the onset of the dyskinesias and improved as the dyskinesias subsided.

Theories of dual diagnosis in mental retardation.

Dual diagnosis, defined in this instance as the co-occurrence of mental health disorders with mental retardation, has become a major area of clinical practice and research in the past 10 years. Whereas areas such as differential diagnosis, assessment, and prevalence have been major focuses of research, etiologies of dual diagnosis have received less attention. Current etiological theories have practical implications for the treatment and prevention of dual diagnoses and suggest important directions for future research. This article provides a historical review of theory development in the field of dual diagnosis. Current status of etiological theories and future directions are discussed with an aim toward encouraging further study.

Comparison of psychotic and autistic children using behavioral observation.

The purpose of this study was to assess the relationship between autism and childhood psychosis. Fifteen children with psychotic symptoms were compared to 15 children with autism, using two observational measures, the Ritvo-Freeman Real Life Rating Scale (RLRS) and the Childhood Autism Rating Scale (CARS), which rate subjects on behaviors pathognomic to autism. In comparison to autistic persons, psychotic individuals were judged to have better language and social skills. In addition, autistic persons were also rated as having more difficulty adapting to new situations and appeared more "autistic-like." Overall scores on the CARS and RLRS were significantly different between the two groups, indicating that these two assessment instruments may be useful in differential diagnosis. However, 20% of the psychotic subjects received pervasive developmental disorder diagnoses, indicating that there may be a relationship between those two disorders.

A comparison of social skills in adults with autistic disorder, pervasive developmental disorder not otherwise specified, and mental retardation.

We examined the social skills of adults with autism, PDDNOS, and mental retardation. All participants were diagnosed with profound mental retardation. Participants in the autism and PDDNOS groups had been previously diagnosed using the Childhood Autism Rating Scale (CARS) and record review. These diagnoses were confirmed by readministering the CARS by one author and an independent rater. Social skills were assessed by using the Vineland Adaptive Behavior Scales and the Matson Evaluation of Social Skills in the Severely Retarded. Significant differences between the autism and mental retardation groups were found on both measures. The PDDNOS group demonstrated better positive nonverbal social skills than the autism group but not the mental retardation group. Special treatment needs of institutionalized adults with autism appear warranted along with a need to clarify further the differences between PDDNOS and mental retardation.

Validity of the Autism/Pervasive Developmental Disorder subscale of the Diagnostic Assessment for the Severely Handicapped-II.

This study was designed to establish the empirical validity of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II) to screen for the presence of autism in severely and profoundly mentally retarded adults. Participants included 51 individuals residing in a large developmental center in Central Louisiana. The Autism/Pervasive Developmental Disorder subscale of the DASH-II was internally consistent. Additionally, the DASH-II was just as likely as the Childhood Autism Rating Scale (CARS) to classify autistic and control individuals. Specific items on the subscale were examined to identify those items most associated with a diagnosis of autism.

The Behavior Problems Inventory: an instrument for the assessment of self-injury, stereotyped behavior, and aggression/destruction in individuals with developmental disabilities.

The Behavior Problems Inventory (BPI-01) is a 52-item respondent-based behavior rating instrument for self-injurious, stereotypic, and aggressive/destructive behavior in mental retardation and other developmental disabilities. Items are rated on a frequency scale and a severity scale. The BPI-01 was administered by interviewing direct care staff of 432 randomly selected residents from a developmental center between the ages of 14 to 91 years. For 73% of those selected, at least one problem was endorsed on the BPI-01. A total of 43% showed self-injury, 54% stereotyped behavior, and 38% aggressive/destructive behavior. Confirmatory factor analysis and item-total correlations supported the three a priori factors. Analyses of variance (ANOVA) showed that of the variables age, sex, and level of mental retardation, only the latter had a significant effect on the BPI-01 total score, the SIB subscale score, and the Stereotyped Behavior subscale score. Aggression/destruction was not significantly related to any of the three variables. Individuals with a diagnosis of pervasive developmental disorder had higher scores on all three subscales than those without, whereas residents with a diagnosis of stereotyped movement disorder had higher Stereotyped Behavior scale scores than those without. The BPI-01 was found to be a reliable (retest reliability, internal consistency, and between-interviewer-agreement) and valid (factor and criterion validity) behavior rating instrument for problem behaviors in mental retardation and developmental disabilities with a variety of potentially useful applications. Strengths and limitations of the instrument are discussed.

A comparison and evaluation of three commonly used autism scales.

Reliability and validity of three commonly used autism scales, the Autism Behavior Checklist (Krug, Arick, & Almond, 1980), the Real Life Rating Scale (Freeman, Ritvo, Yokota, & Ritvo, 1986), and the Childhood Autism Rating Scale (Schopler, Reichler, & Renner, 1988), were investigated. Data analyses were based on completed protocols for 24 children or adolescents who met DSM-III-R criteria for pervasive developmental disorders. First, to replicate previous findings, interrater reliability of each of the two direct observational scales was assessed. Second, correlations between pairs of the three scales were calculated. Third, diagnostic classifications based on autism scale cutoff scores were compared to classifications based on DSM-III-R criteria. Fourth, relationships between autism scale scores and adaptive behavior scores were investigated. Results and implications for the use of these scales in the assessment of autistic behaviors are discussed.

Empirically derived subtypes of pervasive developmental disorders: a cluster analytic study.

A cluster analytic study was conducted to empirically derive behaviorally homogeneous subtypes of pervasive developmental disorders (PDD). Subjects were clustered based on a broad range of behavioral symptoms which characterize autism. Behavioral variables were measured using several of the standardized psychometric instruments most commonly employed in assessing autistic individuals. The cluster solution indicated the presence of four distinct groups. Validity checks generally confirmed significant between-group differences on independent measures of social, language, and stereotyped behaviors. In addition, the four-group cluster solution was compared to previously developed typological systems of PDD (i.e., subcategories based on IQ early onset, styles of social interaction, and DSM-III-R diagnosis). Results generally supported both the behavioral homogeneity of the four subgroups and also several important between-group differences. The potential utility of using cluster analyses to explore subtypes of PDD is discussed.

Behavior problems of children with Down syndrome and life events.

Behavior problems of 44 children with Down syndrome between the ages of 6 and 15 and 44 controls without mental retardation matched for age, sex, and socioeconomic status were compared on the basis of mother and teacher ratings. Ratings from both sources indicated that children with Down syndrome had more behavior problems, in particular attention deficit, noncompliance, thought disorder, and social withdrawal. Life events from the past year were significantly associated with mother but not teacher ratings of Down syndrome behavior problems.

Characteristics of schizophrenia among persons with severe or profound mental retardation.

The symptoms of schizophrenia were examined in a residential sample of adults with severe or profound mental retardation. Three groups were compared: those with a significant elevation on the schizophrenia subscale of the Diagnostic Assessment for the Severely Handicapped (DASH-II) and a psychiatric diagnosis of schizophrenia; those with a significant elevation on the same subscale but no formal diagnosis of schizophrenia; and those with no elevation on any of the DASH-II subscales. A one-way analysis of variance showed statistically significant differences between the groups. Symptoms of schizophrenia among those in the first group were found to fall mainly into the categories of reality distortion and disorganization, with less evidence of negative symptoms.

The differential validity of hyperactivity/attention deficits and conduct problems among mentally retarded children.

The independence of hyperactivity, attention deficits, and conduct problems among mentally retarded children was addressed using factors of the Conners' Teacher Rating Scale-39 (CTRS-39) and the more recently developed IOWA Conners' inattention/overactivity (IO) and aggression (A) subscales. CTRS-39 ratings were obtained for children of normal intelligence and for mentally retarded children. Differences between the groups were examined as were intercorrelations of the Conners' factors and IOWA subscales. Conduct problems proved to be less strongly associated with hyperactivity and attention deficits among mentally retarded children compared to children of normal intelligence. However, attention problems and conduct problems may be associated with mental retardation in general. Implications of these data and CTRS scoring system recommendations for mentally retarded children are discussed.

Factor structure of the Matson Evaluation of Social Skills for Individuals with Severe Retardation (MESSIER).

OBJECTIVE: A factor analysis of the Matson Evaluation of Social Skills for Individuals with Severe Retardation (MESSIER) was conducted to determine if there was an underlying factor structure which supported a distinction between positive and negative social skills. DESIGN: Principal Axis Factoring with oblimin rotation was used to determine if a two-factor solution was valid. This method was selected to account for shared variance between the items and for correlation between the factors. METHOD: The MESSIER was administered by trained staff to 805 individuals with severe and profound intellectual disability residing in a state residential facility. RESULTS: Results of the factor analysis yielded two categories (positive and negative behaviours) that corresponded to the general division of the clinically derived subscales. CONCLUSIONS: The psychometric research on the MESSIER was extended with an examination of the factor structure. The results of the factor analysis, corresponding with the general division of the clinically derived subscales, are promising. Future research should be conducted to determine if factor scores can be used to determine norms.

Psychopathology in older adults with severe and profound mental retardation.

The prevalence of psychopathology in younger and older adults with severe and profound mental retardation was examined. Participants were evaluated by direct-care staff using the Diagnostic Assessment for the Severely Handicapped (DASH), which measures the frequency, duration, and severity of symptoms associated with 13 major psychiatric disorders derived from the DSM-III-R. The frequency of disorders was comparable for younger and older adults. Age group differences favoring the older adults were revealed in the analyses of duration and severity on 4 of the DASH subscales. Implications of these findings for research and practice were discussed.

Exploration of phobic behavior in a small child.

Behavioral assessment is an area receiving ever increasing attention. In the present manuscript an attempt is made to expand the ways in which one problem area frequently addressed by behavior therapists, phobias, is assessed and evaluated. A number of overt behaviors and self reports of fear by a very young girl are described in a naturalistic setting and the implications of these data are presented.

Training social interpersonal skills in two autistic children.

Two children, a 10-year-old girl and a 9-year-old boy both of whom were autistic and mentally retarded and one of whom was also hyperactive, were treated for social skill deficits. Targets of treatment were refraining from perseveration, appropriate affect, appropriate content of speech, appropriate sitting, and eye contact. Training included modeling, instructions, performance feedback, role-playing, rehearsal, and tangible and social reinforcers. A multiple baseline within subjects and across behaviors design was employed. Marked improvements were noted soon after treatment was implemented. The significance of these effects and their implications for future research are discussed.

Treatment of elective mute behavior in two developmentally delayed children using modeling and contingency management.

Most classification schemes differentiate elective mutism from language problems seen in the developmentally delayed population. Two preschool developmentally delayed children were treated for speech reluctance using modeling and contingency management. Employing a multiple baseline across therapists, it was found that these treatment components were effective in increasing frequency of labeling behavior in both children. Results were maintained at follow-up. Generalization to new words and to spontaneous speech were also noted, and suggest that characteristics of elective mutism in this population may be similar to what is found in the general population.