Feasibility and potential effectiveness of an intensive trauma-focused treatment programme for families with PTSD and mild intellectual disability.

BACKGROUND: Persons with mild intellectual disabilities or borderline intellectual functioning (MID-BIF; IQ 50-85) have a higher risk of being exposed to traumatic events and developing posttraumatic stress disorder (PTSD). EMDR therapy has shown to be applicable, safe and potentially effective for the treatment of PTSD in individuals with MID-BIF. However, in traumatized multi-problem families with MID-BIF and (impending) out of home placement of children, standard PTSD treatment in an outpatient setting may not be appropriate. OBJECTIVE: To evaluate the feasibility and potential effectiveness of KINGS-ID, a six-week clinical trauma-focused treatment programme consisting of intensive EMDR therapy with parents and children, and parental skills training followed by two weeks of parent support at home. METHOD: Six families (nine parents of whom six had MID-BIF) and 10 children (all having MID-BIF) participated in the KINGS-ID programme. Seven parents and seven children had PTSD. Data were collected within a single case study design. For each family member data were collected during baseline (three measurements), treatment (seven weekly measurements), posttreatment (three measurements) and at follow-up (three measurements). RESULTS: None of the family members dropped out. Within the first two treatment weeks all but one child and one parent no longer met PTSD symptom criteria. In both children and parents, trauma-related symptoms and daily life impairment significantly decreased following treatment and in parents a significant decrease in symptoms of general psychopathology and parental stress was found. Results were maintained at six-month follow-up. CONCLUSIONS: The findings of the current study are promising given that the treatment programme seems to offer new perspectives for traumatized multi-problem families with MID-BIF.

Antecedentes: Las personas con discapacidades intelectuales moderadas o funcionamiento intelectual límite (MID-BIF; IQ 50-85) tienen un mayor riesgo de estar expuestas a eventos traumáticos y desarrollar trastorno de estrés postraumático (TEPT). La terapia EMDR o DRMO ha demostrado ser aplicable, segura y potencialmente efectiva para el tratamiento de TEPT en individuos con MID-BIF. Sin embargo, en familias traumatizadas con múltiples problemas y MID-BIF e inminente relocalización de niños fuera del hogar, el tratamiento con EMDR estándar en modalidad ambulatoria puede ser inapropiado.Objetivo: Evaluar la factibilidad y potencial efectividad de KINGS-ID, un programa clínico de seis semanas de tratamiento centrado en el trauma, consistente en tratamiento EMDR intensivo con padres y niños, y un entrenamiento de habilidades parentales seguido por dos semanas de apoyo parental en el hogar.Método: Seis familias (nueve padres, de los cuales seis tenían MID-BIF) y 10 niños (todos con MID-BIF) participaron en el programa KINGS-ID. Siete padres y siete niños tenían TEPT. Los datos fueron recopilados en un diseño de estudio de caso único. Para cada miembro de la familia los datos fueron obtenidos durante el inicio (tres mediciones), el tratamiento (siete mediciones semanales), post-tratamiento (tres mediciones) y seguimiento (tres mediciones).Resultados: Ningún miembro de las familias desertó. Durante las dos primeras semanas de tratamiento, todos excepto un niño y un padre no cumplían criterios sintomáticos para TEPT. Tanto en niños como en los padres, los síntomas relacionados con el trauma y el deterioro en la vida diaria disminuyeron significativamente siguiendo el tratamiento y en los padres se encontró una disminución significativa en síntomas de psicopatología general y de estrés parental. Los resultados se mantuvieron a los seis meses de seguimiento.Conclusiones: Los hallazgos de este estudio son promisorios, dado que el programa de tratamiento parece ofrecer nuevas perspectivas para familias traumatizadas con múltiples problemas y MID-BIF.

Psychometric Properties of the Dutch Strengths and Difficulties Questionnaire (SDQ) in Adolescent Community and Clinical Populations.

This study assessed the factor structures of the Strengths and Difficulties Questionnaire (SDQ) adolescent and parent versions and their measurement invariance across settings in clinical (n = 4,053) and community (n = 962) samples of Dutch adolescents aged 12 to 17 years. Per SDQ version, confirmatory factor analyses were performed to assess its factor structure in clinical and community settings and to test for measurement invariance across these settings. The results suggest measurement invariance of the presumed five-factor structure for the parent version and a six-factor structure for the adolescent version. Furthermore, evaluation of the SDQ scale sum scores as used in practice, indicated that working with sum scores yields a fairly reasonable approximation of working with the favorable but less easily computed factor scores. These findings suggest that adolescent- and parent-reported SDQ scores can be interpreted using community-based norm scores, regardless of whether the adolescent has been referred for mental health problems.

An Internet version of the Diagnostic Interview Schedule for Children (DISC-IV): correspondence of the ADHD section with the paper-and-pencil version.

The authors recently developed an Internet version of the Diagnostic Interview Schedule for Children-Version 4 (DISC-IV), parent version (D. Shaffer, P. Fisher, C. P. Lucas, M. K. Dulcan, & M. E. Schwab-Stone, 2000), with the main purpose of using it at home without an interviewer. This offers many advantages (e.g., extended applicability, fast communication, reduction of costs) but requires thorough study of correspondence between diagnostic outcomes of the interview and self-administered Internet versions. This is the 1st study to report on Internet administration of the DISC-IV. Using the attention-deficit/hyperactivity disorder (ADHD) section, the authors investigated whether the 2 versions yielded the same diagnostic outcome. Parents (N = 120) of patients visiting a child and adolescent psychiatry outpatient clinic were randomly divided into 4 groups, each completing 1 test and about 2 weeks later another according to 1 of these patterns: Internet-interview, interview-Internet, interview-interview, and Internet-Internet. Correspondence between the Internet and interview versions at the level of symptom scores was excellent, and correspondence with respect to the presence/absence of ADHD was good. Although highly comparable diagnostic outcomes between self-administration through the Internet and interviewer administration were found, further study using other DISC-IV modules is required.

Refinement of the Children's Social Behavior Questionnaire (CSBQ): an instrument that describes the diverse problems seen in milder forms of PDD.

The objective of this study was to refine the Children's Social Behavior Questionnaire (CSBQ), to reduce its length, and to verify its psychometric properties. The CSBQ is a questionnaire for parents or caregivers of children with PDD. The items describe a broad range of features that are typical of PDD, particularly in its milder forms. Based on conceptual judgment and factor analyses, the number of items was reduced from 96 to 49. Six subscales were constructed to allow a differentiated description of PDD problems. Estimates for internal, test-retest, and inter-rater reliability, and for convergent and divergent validity were good. Different clinical and control groups showed the hypothesized patterns in nature and degree of their problems.