The Behaviour Problems Inventory-Short Form: Reliability and Factorial Validity in Adults with Intellectual Disabilities.

BACKGROUND: The Behaviour Problems Inventory-Short Form (BPI-S) is a spin-off of the BPI-01 that was empirically developed from a large BPI-01 data set. In this study, the reliability and factorial validity of the BPI-S was investigated for the first time on newly collected data from adults with intellectual disabilities. METHODS: The sample consisted of 232 adults with intellectual disabilities who represented all levels of intellectual functioning. They were recruited at several day programs in the USA (n = 148) and the UK (n = 84). RESULTS: We found acceptable reliability in terms of internal consistency, inter-rater agreement and test-retest reliability. Confirmatory factor analysis validated the three BPI-S subscale structure. CONCLUSIONS: We corroborated the factor structure underly-ing the three subscales and found the BPI-S to have adequate to good psychometric properties in a newly collected sample of adults with intellectual disabilities.

Psychometric properties of the Chinese Behavior Problems Inventory-01 in children and adolescents with or at risk for intellectual disabilities.

As the world's most populous country, China is likely to have the highest number of people with intellectual disabilities (ID) in the world. As many people with ID are susceptible to serious and persistent behavior problems, research by Chinese scientists on this public health issue is needed. However, there are only very few reliable Chinese-language behavior assessment instruments for problem behaviors. To fill this gap we translated the Behavior Problems Inventory-01 (BPI-01; Rojahn, Matson, Lott, Esbensen, & Smalls, 2001) into Chinese. The BPI-01 is an informant-based behavior rating instrument that was designed to assess self-injurious behavior (SIB), stereotyped behavior, and aggressive/destructive behavior in individuals with ID. We then assessed the behavior of 222 children and young adults (age range 1.5-21.5 years) with or at risk for ID from three special needs service programs in mainland China. Teachers or staff members, respectively, served as respondents. The Chinese version of the BPI-01 showed good reliability (internal consistency) and good factor validity tested by confirmatory factorial analysis. We conclude that the Chinese version of the BPI-01 can be used for research and clinical evaluation of Chinese children and adolescents with ID.

Stereotyped behaviors predicting self-injurious behavior in individuals with intellectual disabilities.

We examined the relation between stereotyped behavior and self-injurious behavior (SIB) for 1871 individuals with intellectual disabilities who had a score of >0 on the Behavior Problem Inventory (BPI-01; Rojahn et al., 2001). We report three main findings: First, structural equation modeling techniques (SEM) revealed that the BPI-01stereotyped behavior subscale scores predicted BPI-01 SIB subscale scores. Second, when stereotyped behavior was modeled as a predictor of SIB, mixture-modeling techniques revealed two groups of individuals: one in which stereotyped behavior was a strong, statistically significant predictor of SIB (69% of the sample), and another one in which stereotyped behavior was not a predictor of SIB (31%). Finally, two specific stereotyped behavior topographies (i.e., body rocking and yelling) were identified that significantly predicted five different SIB topographies (i.e., self-biting, head hitting, body hitting, self-pinching, and hair pulling). Results are discussed in terms of future research needed to identify bio-behavioral variables correlated with cases of SIB that can, and cannot, be predicted by the presence of stereotyped behavior.

The Parental Concerns Questionnaire: A Brief Screening Instrument for Potentially Severe Behavior Problems in Infants and Toddlers At-Risk for Developmental Delays.

The Parental Concerns Questionnaire (PCQ) was designed as a parent-interview screening instrument for young children with developmental concerns at risk for potentially severe behavior problems (SBDs). Parents of 262 young children (4 to 48 months) answered to the 15 dichotomous PCQ items interviewed by trained staff. Cluster analysis for items revealed three item clusters, which we labeled Developmental/Social (8 items), Biomedical (3 items), and Behavior Problems (3 items). This paper discussed primarily the Behavior Problems cluster, with items referring to self-injurious, aggressive, and destructive behaviors. Parents' concerns about behavior problems were high, with item-endorsements of the Behavior Problems cluster ranging from 41.8 % to 68.8 %. The Behavior Problems cluster was significantly correlated with all three subscales of the Behavior Problems Inventory (BPI-01), with select subscales of the Aberrant Behavior Checklist (ABC), and with the Repetitive Behavior Scale-Revised (RBS-R) providing some evidence for concurrent validity. Sensitivity and specificity data were computed for the three PCQ items as well as for the cluster score in comparison with the BPI-01, ABC, and RBS-R showing strong sensitivity. The PCQ Behavior Problems cluster is a useful screening checklist with high sensitivity for potential SBDs in young children at-risk for developmental delays.

Psychometric properties of a Dutch version of the behavior problems inventory-01 (BPI-01).

There are only a limited number of Dutch validated measurement instruments for measuring behavioral problems in people with a moderate to profound intellectual disability. In this study, the psychometric properties of a Dutch version of the behavior Problems Inventory-01 (BPI-01; Rojahn et al., 2001) have been investigated among 195 people with a moderate to profound intellectual disability who live in a residential facility. The BPI-01 was completed by 42 informants (staff members) of 23 care units. The inter-rater reliability, intra-rater reliability and internal consistency turned out to be good. Factor analysis confirmed two of the three a priori factors and the third factor was a mix of self-injurious (SIB) behavior and stereotypic behavior. The BPI-01 was compared to the Aberrant Behavior Checklist (Aman et al., 1985a) and showed a good convergent validity. This study shows that a Dutch version of the BPI-01 has good psychometric properties for measuring behavior problems in individuals with moderate to profound intellectual disability.

The effect of shame-proneness, guilt-proneness, and internalizing tendencies on nonsuicidal self-injury.

Nonsuicidal self-injury is especially common in adolescents and young adults. Self-injury may be related to shame or guilt--two moral emotions--as these differentially predict other maladaptive behaviors. Using a college sample, we examined not only how shame-proneness, guilt-proneness, and internalizing emotional tendencies related to self-injury, but also whether these moral emotions moderate the relation between internalizing tendencies and self-injury. High shame-proneness was associated with higher frequencies of self-injury. High guilt-proneness was associated with less self-injury, although this effect was mitigated at higher levels of internalizing tendencies. These results suggest shame-proneness is a risk factor for self-injury, while guilt-proneness is protective.

The progression of severe behavior disorder in young children with intellectual and developmental disabilities.

Behavior disorders, such as self-injurious, stereotypic, and aggressive behavior are common among individuals with intellectual or developmental disabilities. While we have learned much about those behaviors over the past few decades, longitudinal research that looks at developmental trajectory has been rare. This study was designed to examine the trajectory of these three forms of severe behavior disorders over a one year time period. The behaviors were measured on two dimensions: frequency of occurrence and severity. Participants were 160 infants and toddlers at risk for developmental delays in Lima, Peru. Using structural equation modeling, we found that the frequency of self-injury and stereotypic behavior and the severity of aggressive behavior remained stable over the 12-month period. Uni-directional structural models fit the data best for self-injurious and aggressive behavior (with frequency being a leading indicator of future severity of self-injury and severity being a leading indicator of future frequency for aggression). For stereotypic behavior, a cross-lagged autoregressive model fit the data best, with both dimensions of frequency and severity involved as leading indicators of each other. These models did not vary significantly across diagnostic groups, suggesting that toddlers exhibiting behavior disorders may be assisted with interventions that target the specific frequencies or severities of behaviors, regardless of diagnostic category.

Validity and reliability of the Behavior Problems Inventory, the Aberrant Behavior Checklist, and the Repetitive Behavior Scale-Revised among infants and toddlers at risk for intellectual or developmental disabilities: a multi-method assessment approach.

Reliable and valid assessment of aberrant behaviors is essential in empirically verifying prevention and intervention for individuals with intellectual or developmental disabilities (IDD). Few instruments exist which assess behavior problems in infants. The current longitudinal study examined the performance of three behavior-rating scales for individuals with IDD that have been proven psychometrically sound in older populations: the Aberrant Behavior Checklist (ABC), the Behavior Problems Inventory (BPI-01), and the Repetitive Behavior Scale - Revised (RBS-R). Data were analyzed for 180 between six and 36 months old children at risk for IDD. Internal consistency (Cronbach's α) across the subscales of the three instruments was variable. Test-retest reliability of the three BPI-01 subscales ranged from .68 to .77 for frequency ratings and from .65 to .80 for severity ratings (intraclass correlation coefficients). Using a multitrait-multimethod matrix approach high levels of convergent and discriminant validity across the three instruments was found. As anticipated, there was considerable overlap in the information produced by the three instruments; however, each behavior-rating instrument also contributed unique information. Our findings support using all three scales in conjunction if possible.

Translation, adaptation, and preliminary validation of the Brazilian version of the Behavior Problems Inventory (BPI-01).

INTRODUCTION: Children with atypical development often present behavior problems that impair their psychosocial adaptation. OBJECTIVE: To describe the cultural adaptation to Brazilian Portuguese of the Behavior Problems Inventory (BPI-01), as well as preliminary indicators of instrument reliability and validity. METHODS: The process involved translation, back-translation, and cultural adaptation of the instrument. Psychometric properties (reliability and validity) were assessed comparing scores obtained with the BPI-01, the Wechsler Intelligence Scales for Children and Adults, the Child Behavior Checklist for Ages 6-18 (CBCL/6-18), and the Autism Screening Questionnaire (ASQ). The sample comprised 60 children (30 typically developing and 30 atypically developing). RESULTS: The cultural adaptation process was considered adequate. Internal consistency of the BPI-01 was satisfactory, with a Cronbach's alpha of 0.65 for the self-injurious behavior scale, 0.82 for stereotyped behaviors, and 0.91 for aggressive/destructive behaviors. Considering a mean frequency of 0.5, the receiver operating characteristic (ROC) curve revealed 80% sensitivity and 3% specificity in the stereotyped behavior scale, 50 and 10% in aggressive/destructive behaviors, and 76 and 6% in self-injurious behaviors, respectively. Low-to-moderate correlations were observed between BPI-01, ASQ, and CBCL/6-18 scores. CONCLUSION: BPI-01 showed good psychometric properties, with satisfactory preliminary indicators of reliability, convergent validity, and sensitivity for the diagnosis of atypical development.

Translation, adaptation, and preliminary validation of the Brazilian version of the Behavior Problems Inventory (BPI-01) / Tradução, adaptação e validação preliminar da versão brasileira do Behavior Problems Inventory (BPI-01)

Introduction: Children with atypical development often present behavior problems that impair their psychosocial adaptation. Objective: To describe the cultural adaptation to Brazilian Portuguese of the Behavior Problems Inventory (BPI-01), as well as preliminary indicators of instrument reliability and validity. Methods: The process involved translation, back-translation, and cultural adaptation of the instrument. Psychometric properties (reliability and validity) were assessed comparing scores obtained with the BPI-01, the Wechsler Intelligence Scales for Children and Adults, the Child Behavior Checklist for Ages 6-18 (CBCL/6-18), and the Autism Screening Questionnaire (ASQ). The sample comprised 60 children (30 typically developing and 30 atypically developing). Results: The cultural adaptation process was considered adequate. Internal consistency of the BPI-01 was satisfactory, with a Cronbach's alpha of 0.65 for the self-injurious behavior scale, 0.82 for stereotyped behaviors, and 0.91 for aggressive/destructive behaviors. Considering a mean frequency of 0.5, the receiver operating characteristic (ROC) curve revealed 80% sensitivity and 3% specificity in the stereotyped behavior scale, 50 and 10% in aggressive/destructive behaviors, and 76 and 6% in self-injurious behaviors, respectively. Low-to-moderate correlations were observed between BPI-01, ASQ, and CBCL/6-18 scores. Conclusion: BPI-01 showed good psychometric properties, with satisfactory preliminary indicators of reliability, convergent validity, and sensitivity for the diagnosis of atypical development.

Introdução: Crianças com desenvolvimento atípico frequentemente apresentam problemas de comportamento que prejudicam sua adaptação psicossocial. Objetivo: Descrever o processo de adaptação cultural para português do Brasil do Behavior Problems Inventory (BPI-01), bem como indicadores preliminares de sua fidedignidade e validade. Método: O processo envolveu as etapas de tradução, retrotradução e adaptação cultural do instrumento. Para a verificação das propriedades psicométricas (fidedignidade e validade), foram comparados os escores obtidos com o BPI-01, as Escalas de Inteligência Wechsler para Crianças e Adultos, o Inventário dos Comportamentos de Crianças e Adolescentes de 6 a 18 anos (CBCL/6-18) e o Questionário de Rastreamento de Autismo (Autism Screening Questionnaire, ASQ). A amostra foi composta por 60 crianças (30 com desenvolvimento típico e 30 com atípico). Resultados: O processo de adaptação cultural foi considerado adequado. A consistência interna do BPI-01 foi satisfatória, com alfa de Cronbach de 0,65 para a escala de comportamentos autoagressivos, 0,82 para comportamentos estereotipados e 0,91 para comportamentos agressivos/destrutivos. Considerando-se uma frequência média de 0.5, a curva receiver operating characteristic (ROC) verificou sensibilidade de 80% e especificidade 3% na escala de comportamentos estereotipados, 50 e 10% para comportamentos agressivos/destrutivos, e 76 e 6% para comportamentos autoagressivos, respectivamente. Foram verificadas correlações de baixas a moderadas entre os escores do BPI-01, do ASQ e do CBCL/6-18. Conclusões: O BPI-01 apresentou boas características psicométricas, com indicadores preliminares satisfatórios de fidedignidade, validade convergente e sensibilidade para o diagnóstico de desenvolvimento atípico.

Functions of maladaptive behavior in intellectual and developmental disabilities: behavior categories and topographies.

Research has shown that different maladaptive behavior categories may be maintained by different contingencies. We examined whether behavior categories or behavior topographies determine functional properties. The Questions about Behavioral Function with its five subscales (Attention, Escape, Nonsocial, Physical, and Tangible) was completed by direct care staff for one target behavior for each of 115 adults with varying degrees of intellectual disabilities. In the first step we examined the functional properties of three broad behavior categories (self-injurious behavior [SIB], stereotypic behavior, and aggressive/destructive behavior). Consistent with previous research stereotyped behaviors and SIB had significantly higher QABF Nonsocial (i.e., automatic positive reinforcement or self-stimulation) subscale scores than aggressive behavior, while none of the other subscales showed differences across the three behavior categories. Contrary to earlier studies, escape (or negative social reinforcement) was an important function not only for aggressive behavior, but also for SIB and stereotypies. A second analysis examined functional properties depending on two factors: the behavior topography (hitting vs. non-hitting behaviors) and their respective behavior category (SIB vs. aggression). SIB topographies had higher ratings than aggressive behavior on the QABF Nonsocial subscale. Of the five QABF subscales, only the subscale Nonsocial differed between categories of maladaptive behavior. Furthermore it was the behavior categories rather than the topographies that determined functional properties.

The effects of developmental quotient and diagnostic criteria on challenging behaviors in toddlers with developmental disabilities.

Previous research has found that individuals with intellectual disability and/or autism spectrum disorder (ASD), and those with greater symptom severity within these diagnoses, show higher rates of aggressive/destructive behavior, stereotypic behavior, and self-injurious behavior. In this exploratory cross-sectional study, toddlers at-risk for a developmental disorder (n=1509) ranging from 17 to 36 months fell into one of three diagnostic categories: Autistic Disorder, Pervasive Developmental Disorder-Not Otherwise Specified [PDD-NOS], and atypically developing - no ASD diagnosis. Mental health professionals from EarlySteps, Louisiana's Early Intervention System, interviewed parents and guardians using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) -Part 3 (Matson, Boisjoli, & Wilkins, 2007) to obtain measures of challenging behaviors and the Battelle Developmental Inventory, 2nd Edition (BDI-2) (Newborg, 2005) to obtain developmental quotients (DQ). Toddlers diagnosed with Autistic Disorder or PDD-NOS showed a positive relationship between total DQ and challenging behavior; whereas, atypically developing toddlers with no ASD diagnosis showed a more adaptive, negative relationship. The DQ domains that were most influential on challenging behaviors varied by diagnosis, with communication and motor domains playing greater roles for toddlers with Autistic Disorder or PDD-NOS, and personal-social and cognitive domains playing greater roles for atypically developing toddlers with no ASD diagnosis.

Psychometric properties of the Aberrant Behavior Checklist, the Anxiety, Depression and Mood Scale, the Assessment of Dual Diagnosis and the Social Performance Survey Schedule in adults with intellectual disabilities.

Progress in clinical research and in empirically supported interventions in the area of psychopathology in intellectual disabilities (ID) depends on high-quality assessment instruments. To this end, psychometric properties of four instruments were examined: the Aberrant Behavior Checklist (ABC), the Assessment of Dual Diagnosis (ADD), the Anxiety, Depression and Mood Scale (ADAMS), and the Social Performance Survey Schedule (SPSS). Data were collected in two community-based groups of adults with mild to profound ID (n = 263). Subscale reliability (internal consistency) ranged from fair to excellent for the ABC, the ADAMS, and the SPSS (mean coefficient α across ABC subscales was .87 (ranging from fair to excellent), the ADAMS subscales .83 (ranging from fair to good), and the SPSS subscales .91 (range from good to excellent). The ADD subscales had generally lower reliability scores with a mean of .59 (ranging from unacceptable to good). Convergent and discriminant validity was determined by bivariate Spearman ρ correlations between subscales of one instrument and the subscales of the other three instruments. For the most part, all four instruments showed solid convergent and discriminant validity. To examine the factorial validity, Confirmatory Factor Analyses (CFA) were attempted with the inter-item covariance matrix of each instrument. Generally, the data did not show good fits with the measurement models for the SPSS, ABC, or the ADAMS (CFA analyses with the ADD would not converge). However, most of the items on these three instruments had significant loadings on their respective factors.

Comparison of problem behaviours in atypically developing infants and toddlers as assessed with the baby and infant screen for children with aUtIsm traits (BISCUIT).

OBJECTIVE: Compares infants and toddlers with intellectual and developmental conditions in regard to the presence of challenging behaviour. METHODS: Parents and caregivers to 140 children ranging from 17-35 months with five different conditions (Down syndrome (n = 23), developmental delay (n = 18), prematurity (n = 56), Cerebral Palsy (n = 15) and Seizure disorder (n = 28)) were administered the BISCUIT-Part 3. An ANOVA on overall scores and a MANOVA on the sub-scale scores were conducted to determine if groups differed significantly. RESULTS: Results found no significant differences on total scores or differences on the sub-scales of the BISCUIT-Part 3: Aggressive/Destructive, Stereotypic and Self-Injurious. Some trends in individual item endorsement were found. CONCLUSIONS: It is possible that differences among individuals with these disorders are not apparent until later in life. These results emphasize the importance of monitoring challenging behaviours in all at-risk infants and toddlers to ensure that early interventions to treat these challenging behaviours are possible.

Cut-offs, norms and patterns of problem behaviours in children with developmental disabilities on the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT-Part 3).

PURPOSE: Challenging behaviours present major impediments to a young child's life. Being able to properly assess these behaviours can lead to early intervention and remediation. METHOD: In the present study, the problem behaviours of 644 children 17-37 months of age who were at risk for developmental disabilities were studied using the BISCUIT-Part 3. In study one, norms and cut-off scores were established for this new scale using this sample. In study 2, the frequency and patterns of various challenging behaviours were evaluated. RESULTS: The majority of developmentally delayed children who had severe challenging behaviours engaged in aggressive/destructive acts. However, severe problem behaviours were in the minority of occurrence. CONCLUSIONS: Outcomes suggest that these behaviours can be identified at an early age using a validated instrument tool. Implications are that pinpointing emerging problematic behaviours allows for a more accurate assessment of the delayed child's overall functioning. Being able to pinpoint behaviour problems allows for earlier and more effective treatment.

The Behavior Problems Inventory (BPI-01) in community-based adults with intellectual disabilities: reliability and concurrent validity vis-à-vis the Inventory for Client and Agency Planning (ICAP).

Reliability and concurrent validity of the Behavior Problems Inventory (BPI-01; Rojahn et al., 2001) was examined in a sample of 130 community residing adults with mild to profound intellectual disabilities with high rates of behavior problems and concurrent mental health problems. The BPI-01 and the Inventory for Client and Agency Planning (ICAP; Bruininks et al., 1986) were administered twice within a mean time interval of 7.8 weeks by 20 trained and experienced staff members. All three BPI-01 subscales had high inter-rater agreement (Self-Injurious Behavior [SIB]: mean ICC=.84; Stereotyped Behavior: mean ICC=.75; Aggressive/Destructive Behavior: mean ICC=.82), and stable test-retest reliability (SIB, mean ICC=.91; mean Stereotyped Behavior, mean ICC=.89, and Aggressive/Destructive Behavior, mean ICC=.88); internal consistency ranged from poor (SIB: alpha=.61) to excellent (Stereotyped Behavior, alpha=.90). Using the ICAP as criterion measure, the BPI-01 showed robust convergent validity. Solid relationships between BPI-01 subscales and corresponding ICAP subscales corroborated the concurrent validity of the BPI-01.

Behaviour problems in institutionalised people with intellectual disability and schizophrenia spectrum disorders.

BACKGROUND: Although our understanding of dual diagnosis has improved, a deficit still exists in our knowledge of how schizophrenia spectrum disorders (SSD) manifest themselves in individuals with intellectual disability (ID). In addition, little is known about the relationship between behaviour problems and psychopathology in this population. METHOD: Utilising the Behavior Problems Inventory (BPI), three areas of problem behaviour (self-injurious, stereotyped, and aggressive/destructive) were assessed in 58 individuals with ID divided into three groups (with SSD, with a diagnosis of psychopathology other than SSD, and with ID only) and a total BPI score was calculated for each. RESULTS: The SSD group was unique when compared to the Control group (ID only) for frequency of stereotyped behaviours. Further, severity of stereotyped behaviours in the SSD group was unique compared to the Psychopathology and Control groups. CONCLUSION: The SSD group was unique compared to the other two groups, particularly for severity of stereotyped behaviours. Many specific behavioural differences were also related to either SSD or general psychopathology.

Facial emotion recognition in intellectual disabilities.

PURPOSE OF REVIEW: Interpreting facial emotion is a requisite skill that enables us to navigate our social environment. Autism spectrum disorder is characterized by shortcomings in socio-cognitive abilities in general, and in emotion recognition in particular, and much has been written on this subject. Less research, however, has been conducted on individuals with intellectual disabilities. This review discusses recent emotion recognition research in this population. RECENT FINDINGS: Facial emotion recognition research in individuals with intellectual disabilities can be divided into two broad categories: studies on the causes of emotion recognition deficits (i.e. primary deficits or secondary phenomena) and studies on the effects of emotion recognition deficits (behavioral implications). Recent research on causes has not yet produced definitive conclusions and current research on specific effects has been limited to aggression and self-reported anger. SUMMARY: Some evidence exists that individuals with intellectual disability of heterogeneous etiology (excluding autism) have facial affect recognition deficits that cannot be fully accounted for by cognitive-intellectual abilities. In addition, cognitive processing strategies and genetic syndrome-specific differences in facial affect recognition have been discovered but further research is needed. We found no evidence that emotion recognition deficits contribute to the emergence of later antisocial behavior.

[Self-injurious-behavior in children and adolescents with intellectual disabilities]. / Selbstverletzendes Verhalten bei Kindern und Jugendlichen mit intellektueller Beeinträchtigung.

10% of the children and teenagers with intellectual disability develop self-injurious behavior during lifespan. The causes for this are investigated, often various and reach from learn-theoretical up to neurobiological conditions. The available work gives overview of the current state of research to the etiology, further factors of influence as well as the process of self-injurious behavior by intellectual disability. Beyond that current diagnostics procedures, standard of treatment of the last thirty years and their effectiveness are presented and discussed finally.

Relationships between facial discrimination and social adjustment in mental retardation.

Sixty-two adults with mental retardation of heterogeneous etiology performed four facial emotion discrimination tasks and two facial nonemotion tasks. Staff members familiar with the participants completed measures of social adjustment (the Socialization and Communication domains of the Vineland Adaptive Behavior Scales and the Social Performance Survey Schedule). All facial discrimination tasks had very good reliability (internal consistency), but only some of the tasks correlated with measures of social adjustment. Furthermore, no evidence was found that emotion tasks and nonemotion tasks assessed different social constructs. Emotion tasks in which participants were presented with visual emotion stimuli correlated significantly with prosocial behavior, whereas those with verbal emotion stimuli did not.