Internal consistency, factor structure, and concurrent validity of the treatment evaluation inventory.

The Treatment Evaluation Inventory (TEI) is a commonly used 19-item measure of treatment acceptability. It yields a total score and Patient Progress and Acceptability subscales. The internal consistency and factor structure of the TEI were assessed in two samples, 218 members of the general public and 131 dental students. The total and both subscales had very high internal consistency (alpha for total scale = .96 and .94 in the two samples; alphas for Patient Progress .95 and .92; alphas for Acceptability .90 and .86). Factor analysis yielded a two-factor solution that accounted for 64.4% and 54.0% of the variance, but which did not correspond to the two existing subscales. A second analysis examined the distribution of TEI scores and correlations with two other measures of treatment acceptability (a thermometer rating scale and a 5-point Likert-type scale) in a sample of 222 undergraduate students. All measures were negatively skewed. There were large, significant correlations between the full scale TEI and the other measures, so the full TEI has concurrent validity. However, the TEI did not meet Anastasi's (1976) criterion for independent and useful subscales, therefore only the full scale score should be used.

Psychiatric co-morbidity and gender differences in intellectual disability.

BACKGROUND: Although gender differences in psychopathology among the general psychiatric population appear to be well documented, such differences have been either ignored or inconsistently investigated among people with intellectual disability (ID). METHODS: The study examined psychiatric co- morbidity in 295 men and 295 women with ID and significant social impairments living in community settings. The sample was drawn from consecutive clinical referrals to a specialist mental heath service of South-East London. Psychiatric diagnoses were based on ICD-10 criteria. RESULTS: Personality disorder was more common among men, although dementia and adjustment reaction were more common among women. There were also gender differences in marital status, with a larger percentage of women being either married or in a stable relationship. Gender differences in the source of referral were also observed, with more women being referred through primary care and more men being referred through generic mental health services. CONCLUSIONS: Female patients seem to have at some extent different mental health needs from male patients. Such differences should be taken into account in the design and delivery of clinical service for people with ID.

The Assessment of Basic Learning Abilities (ABLA) test predicts the relative efficacy of task preferences for persons with developmental disabilities.

BACKGROUND: Prior studies have showed that presentation methods could affect the accuracy of a choice assessment. METHODS: In the current study, high- and low-preferred work tasks were identified in nine adults with developmental disabilities. Both tasks were then introduced in pairs within a choice assessment using the actual tasks, pictures of the tasks and spoken descriptions of the tasks. Participants were also given the Assessment of Basic Learning Abilities (ABLA) test that evaluated their discrimination skills. RESULTS: For five of the participants, their consistent choice of preferred task was predicted by their discrimination skills as assessed by the ABLA. CONCLUSIONS: These findings extend that of Conyers et al. whereby the systematic assessment of discrimination skills could predict the effectiveness of different presentation methods in this population.

Preferences in individuals with Angelman syndrome assessed by a modified Choice Assessment Scale.

BACKGROUND: Individuals with Angelman syndrome (AS) seem to have a strong preference for water-related items. Until present, preference assessment in AS has not been reported. METHODS: An adapted Dutch version of the Choice Assessment Scale (CAS) was administered by parents and other caregivers to 105 individuals with AS. The CAS was adapted by adding several items related to water and by adding a sub-scale describing activities and materials that individuals may avoid or escape. RESULTS: The five sub-scales and total scale of the modified CAS had good internal consistency. Water-related items were more often scored as preferred than non-water-related items. No associations were found between sub-scale and total scale scores and demographic characteristics (e.g. genetic subtype, age). CONCLUSIONS: This study shows that people with AS often have strong preferences for water-related items. The modified CAS is a reliable and sensitive instrument to assess client preferences.

Correlates of restraint use in an institutional population: a replication.

BACKGROUND: Reducing inappropriate restraint is an important mission of services for people with intellectual disabilities (IDs). METHODS: In this study, 52 clients who had been restrained were compared with 52 other clients, individually matched on age, gender and level of IDs. Participants were mostly adults with severe and profound IDs in an institutional setting. RESULTS: The two groups differed on six Diagnostic Assessment for the Severely Handicapped-II (DASH-II) and three Aberrant Behaviour Checklist (ABC) scales. However, discriminant functional analysis demonstrated that only DASH-II Impulse control disorder and ABC Irritability and Elimination disorder scores predicted group membership but only moderately. CONCLUSIONS: Individual differences in maladaptive behaviours were only moderately predictive of restraint use.

Development of a short form of the Treatment Evaluation Inventory for acceptability of psychological interventions.

The Treatment Evaluation Inventory of Kazdin, French, and Sherick is a 19-item measure of the perceived acceptability of behavioural treatments. Development of two brief forms was based on data from two sources. For Study 1, data from 218 completed questionnaires were used to develop internally consistent brief scales. In Study 2 internal consistency and the validity of the brief forms were estimated for a set of 131 questionnaires. Item reduction was achieved by analysis of item-total minus item correlations. Brief forms with 3, 6, 9, and 12 items were proposed. Their internal consistency (Cronbach alpha) and construct validity were based on correlations of scores on each short form with the full scale scores and on comparing means of different forms. Discriminant validity was based on the difference between two groups (estimated effect size 0.7). Scores for all forms showed high internal consistency and correlated highly with total scale scores. Only the 12-item brief scale yielded mean scores similar to the full scale. The 3-item form could be used as a quick screen, and the 12-item form for more intensive purposes as it is most similar to the full-scale.

Attitudes towards the use of hand over mouth (HOM) and physical restraint amongst paediatric specialist practitioners in the UK.

PURPOSE: To assess the views of paediatric specialist dental practitioners in the United Kingdom of the use of the hand over mouth technique and physical restraint. METHODS: Questionnaire survey of all specialist dental practitioners in paediatric dentistry in the United Kingdom (n = 216). Replies were received from 179 individuals (82.8%). RESULTS: The majority of the sample (over 80%) described HOM as having three components, broadly mirroring the description of the technique in clinical textbooks. Approximately 60% of the respondents reported that HOM should never be used (106 individuals, 59.2%). Those who endorsed the use of HOM suggested it should be used with cases of hysterical, tantrum behaviour (57 respondents, 32%). The use of physical restraint was endorsed for certain disabled patients by 110 individuals (62%); for very young patients by 69 respondents (39%); premedicated patients by 35 respondents (20%); physically resistive patients by 25 respondents (14%). Forty-three respondents (24%) felt there were no psychological consequences of the use of HOM or physical restraint; 91 (51%) felt that HOM would result in the child fearing dental treatment. CONCLUSIONS: Specialist paediatric dental practitioners in the UK are familiar with the technique of HOM although they also feel that this technique should never be used. A large proportion of practitioners felt that the use of physical restraint was appropriate with certain disabled patients. The most commonly anticipated psychological sequeala which may accompany the use of these techniques was subsequent fear of dental treatment.

Referral trends of people with intellectual disabilities and psychiatric disorders.

BACKGROUND: The Specialist Mental Health Service for people with an intellectual disability (ID) and psychiatric disorder (referred to throughout this paper as 'the Service') has been in operation in south-east London for the last 18 years, during which time two local, long-stay institutions have closed. AIMS: To measure the number of referrals to the Service from 1983 to 2001 and identify trends. METHODS: Data were recorded on 752 new referrals using the assessment and information rating profile. Diagnoses according to the International Classification of Diseases (10th edition) were made by two psychiatrists. Referrals for a one off consultation or assessment, or with an IQ>70 were excluded from analysis. RESULTS: Over time more non-white clients and more clients with mild ID were referred. More referrals were made in later years, and a greater proportion came from primary care. Later referrals were also more likely to have a psychiatric diagnosis than those in earlier years. CONCLUSION: Significant trends in referrals were identified, which may be explained by various external factors.

The acceptability of the use of sedation in the management of dental anxiety in children: views of dental students.

The aim of the present study was to determine the views of dental students concerning the acceptability of the use of sedation in the management of dentally anxious children. Dental students in Trinidad (n = 100) were asked to rate the acceptability of vignettes describing the management of a young teenager with dental anxiety. The vignettes varied systematically along two dimensions: nature of intervention for anxiety (sedation vs. the use of relaxation training and rewards) and outcome of the intervention (good vs. poor). Ratings of acceptability were made using a standardized questionnaire measure. The data were analysed using analysis of variance (ANOVA). There were significant main effects of nature of intervention (F = 5.54; P < 0.05) and outcome of intervention (F = 298.01; P < 0.001), though the students' year of study did not influence ratings. None of the interaction terms were significant. Sedation was viewed as a less acceptable intervention than relaxation and rewards. Interventions associated with good outcomes were seen as more acceptable than interventions associated with poor outcomes. It is concluded that dental students' perceptions of the acceptability of interventions for use with dentally anxious patients are related to the effectiveness of the intervention. Sedation, regardless of the outcome, is seen as less acceptable than the use of rewards and relaxation.

The psychometric properties of the Multi-Dimensional Observation Scale for Elderly Subjects (MOSES) in middle aged and older populations of people with mental retardation.

OBJECTIVE: To assess the internal consistency, inter-scale correlations and factor structure of the MOSES with older adults with mental retardation. METHOD: A series of outpatients with mental retardation were assessed with the MOSES. 163 middle aged and older adults with mental retardation living in community settings participated. RESULTS: The subscales and total scale of the Multi-Dimension Observation Scale for Elderly Subjects (MOSES) were highly internally consistent. The pattern of correlations between the five scales was very similar to that reported by Dalton et al. (1999). The results of a factor analysis using varimax rotation indicated a three-factor structure corresponding to adaptive behavior, externalizing and internalizing maladaptive behaviors. CONCLUSIONS: The MOSES appears to be was a psychometrically adequate instrument to screen older adults with mental retardation.

Challenging behaviours should not be considered as depressive equivalents in individuals with intellectual disability.

BACKGROUND: Depression is one of the most common forms of psychopathology in people with intellectual disability (ID). The present study evaluated the utility of an expanded assessment of psychiatric symptoms and challenging behaviours, as measured by the Clinical Behavior Checklist for Persons with Intellectual Disabilities (CBCPID). METHODS: The CBCPID was administered to 92 people with ID, 35 of whom were diagnosed with a depressive disorder. RESULTS: Item and factor analysis of the scale indicated that depression was best assessed using the core DSM-IV symptoms of depressive disorder. Challenging behaviours such as self-injury or aggression were not closely associated with depression. Short scales using the core DSM-IV symptoms of depression were highly internally consistent. There was also evidence of the validity of these scales. CONCLUSIONS: This study found no evidence that challenging behaviours were depressive equivalents in this population. The present authors conclude that the assessment of depression in people with ID should focus on the core DSM-IV symptoms of depression.

The social validation of three physical restraint procedures: a comparison of young people and professional groups.

The treatment acceptability of three forms of physical restraint was evaluated with three groups of raters. One restraint method involved personal restraint in a chair, two other methods involved personal restraint on the floor. The three groups of raters were special education staff, residential staff, and a group of young adults with no experience of residential services. Ratings, of videotaped role-play using the Treatment Evaluation Inventory (Kazdin, 1980) revealed that the chair method of restraint was rated as more acceptable than the other method to all three groups. The residential staff rated the chair method as more acceptable than the other methods. The results are discussed in terms of the importance of evaluating restrictive, emergency procedures, and future methodological refinements.

Correlates of restraint use in an institutional population.

Demographic and behavioral correlates of the use of restraint were analyzed in an institutional population of 300 persons with developmental disabilities. Examination of the frequency distributions of restraint frequency and duration indicated that there were 33 consumers who experiences relatively few, short-duration restraint and 11 consumers who had daily restraint for many hours. Separate analyses of these two kinds of restraint were performed. Short-duration restraint was predicted by behavioral variables indicating extra-personal maladaptive behaviors. Demographic variables did not predict short-term restraint. Multiple regression analysis indicated that only independent predictor of short-term restraint was the severity rating of Hurts Others. Similar results were found for predictors of the duration of short-term restraint. The only correlates of long-duration restraint was low weight, Hurts Self, and Withdrawn Behavior. Multiple regression analysis indicated that the only variable that independently predicted long-duration restraint was the severity rating of Hurts Self. The implications of these data for the management of restraint are discussed.

The Stereotyped Behavior Scale for adolescents and adults with mental retardation.

The development of the Stereotyped Behavior Scale for adolescents and adults with mental retardation was described. Service provider staff in three states selected 600 clients known for stereotypic behaviors and then used 66 items to rate the frequency of occurrence of these behaviors. Items with test-retest reliability less than .45 and/or interrater agreement less than .30 were deleted. The remaining 30 items were subjected to a principal component analysis with varimax rotation. A single-factor solution emerged, which explained 24.9% of the variance. After eliminating 4 items with low factor loadings, we found that the final 26-item Stereotyped Behavior Scale had an internal consistency alpha of .88, test-retest reliability was pI = .90, and interrater reliability was pI = .76.

The factor structure of the Reiss Screen for Maladaptive Behaviors in institutional and community populations.

The Reiss Screen for Maladaptive Behavior was factor analyzed in two institutional samples and one community sample of persons with mental retardation. In Sample I a general factor was found. In Samples 2 and 3 a three-factor structure was found. These three factors were named Intra-personal Maladaptive Behavior, Psychotic Behavior, and Extra-personal Maladaptive Behavior. None of the factor solutions bore any close resemblance to a factor structure implied by the seven scales on the Reiss Screen. The implications for the future development of assessments of dual diagnosis are discussed.

Maladaptive behaviour in Prader-Willi syndrome in adult life.

Thirty adults with Prader-Willi syndrome (PWS) were compared with 30 adults with non-specific learning disability matched for age, sex and severity of mental retardation. Maladaptive behaviour was assessed with the Aberrant Behavior Checklist (ABC), a 58-item structured interview which rates behaviours from 0 (not a problem) to 3 (severe problem) and which yields five factors (I) irritability, agitation; (II) lethargy, withdrawal; (III) stereotypic behavior; (IV) hyperactivity, non-compliance; and (V) inappropriate speech). The PWS sample had significantly higher factor I (P < 0.001) and factor V (P < 0.05) scores. The PWS sample had mean scores above 1 for 17 ABC items; the contrast subjects had no mean scores above 1. The factor I scores for the PWS sample were similar to those of inpatients in hospital facilities for adults with mental retardation and mental illness or severely challenging behaviour. The results support previous work, and extend it by suggesting that temper tantrums, self-injury, impulsiveness, lability of mood, inactivity and repetitive speech are characteristic behaviours in PWS in adult life. Studies of the reasons for heterogeneity in behaviour are now needed.

DSM-III-R and persons with dual diagnoses: conceptual issues and strategies for future research.

Diagnosis of mental health needs in people with mental retardation using the DSM-III-R manual was critically reviewed. Conceptual issues included the interaction of different diagnosis categories; the cognitive and linguistic competencies often required for diagnosis; the potential mismatch between psychopathology in people with mental retardation and the DSM-III-R nosology; and issues relating to multi-axial classification. Strategies identified to explore and resolve these issues include better documentation of the frequency and nature of these problems when using unmodified DSM-III-R criteria, better empirical piloting of modified diagnostic criteria with people with severe and profound mental retardation, and the use of social validity data to identify potential mismatches between psychopathology in people with mental retardation and DSM-III-R diagnoses.