Expectant parents with intellectual disabilities in child protection: Risk factors for child safety.

BACKGROUND: Newborns of parents with intellectual disabilities face higher risks in their environment for child unsafety, despite parents' good intentions. To help parents prevent unsafe circumstances, a good understanding of the risk factors faced by these parents is needed. METHODS: This casefile study examined (1) which risk factors were present for expectant parents with intellectual disabilities in child protection, (2) which domains of risk factors, and (3) whether a cumulation of risk factors was related to child safety. RESULTS: Expectant parents with intellectual disabilities in child protection before the child was born often experienced a cumulation of risk factors. Child, family, and care factors best predicted child safety. A cumulation of risk factors over multiple life domains increased the risks for child unsafety. CONCLUSIONS: To reduce the risks of unsafe parenting conditions for newborns, preventive interventions for expectant parents with intellectual disabilities should address their needs from an ecological perspective.

Explaining Risk Factors for Successful Family Supervision Orders: Families with Intellectual Disabilities in Child Protection in the Netherlands.

Families with mild to borderline intellectual disabilities (MBID) are overrepresented in child protection, and are at higher risk for long and unsuccessful family supervision orders (FSOs). This is worrisome, as many children apparently are exposed to unsafe parenting situations for longer periods of time. Therefore, the present study examined which child and parental factors and child maltreatment are related to the duration and success of an FSO in families with MBID in the Netherlands. Casefile data were analysed of 140 children with an ended FSO. Results from binary logistic regression analyses showed that in families with MBID, young children, children with psychiatric problems, and children with MBID were at higher risk for a longer duration of FSOs. Furthermore, young children, children with MBID and children who were sexually abused had a lower chance of a successful FSO. Unexpectedly, children who witnessed domestic violence or whose parents were divorced, had a higher chance of a successful FSO. The discussion focuses on implications of these results for treatment and care of families with MBID from the perspective of child protection.

The first 1001 days: A scoping review of parenting interventions strengthening good enough parenting in parents with intellectual disabilities.

There are concerns about parents' parenting skills with intellectual disabilities. However, it is reported that parents with intellectual disabilities show good enough parenting if they are supported effectively and in line with their needs. This scoping review identifies and critically evaluates preventive interventions for parents with intellectual disabilities and a cumulation of multiple and complex problems that aim to prepare them for good enough parenting. Six interventions were identified, with preliminary to strong indications of effectiveness. Although none of the interventions focused on all conditions of good enough parenting and only one intervention incorporated all seven key elements to effectively work with parents with intellectual disabilities, the limited evidence on the effectiveness of these interventions suggests that significant and societally relevant effects on parents' knowledge and skills can be attained. This suggests that more comprehensive early preventive interventions with rigorous evaluations can have a significant impact.

Social information processing, normative beliefs about aggression and parenting in children with mild intellectual disabilities and aggressive behavior.

BACKGROUND: High levels of aggressive behavior in children with mild intellectual disabilities to borderline intellectual functioning (MID-BIF) are associated with deviant social information processing (SIP) steps. The current study investigated deviant SIP as a mediating mechanism linking both children's normative beliefs about aggression and parenting to aggressive behavior in children with MID-BIF. Additionally, the mediating role of normative beliefs about aggression in linking parenting and deviant SIP was investigated. METHODS: 140 children with MID-BIF in community care in the Netherlands, their parent(s) or caretaker(s), and their teacher participated in this cross-sectional study. Structural equation modeling was performed to test mediations. Models were run separately for parent and teacher reports of aggression, and included three deviant SIP steps (interpretation, response generation, response selection). RESULTS: A total indirect effect through deviant SIP steps was found from normative beliefs about aggression to teacher-reported aggression, but not to parent-reported aggression. An indirect effect was found from positive parenting through normative beliefs about aggression to deviant SIP. CONCLUSION: The results of this study suggest that, next to deviant SIP and parenting, normative beliefs about aggression may be a relevant intervention target for children with MID-BIF and aggressive behavior.

Therapist alliance building behavior and treatment adherence for dutch children with mild intellectual disability or borderline intellectual functioning and externalizing problem behavior.

BACKGROUND: Psychological interventions targeting children with mild intellectual disability or borderline intellectual functioning (MID-BIF) are suggested to be effective in reducing their externalizing problem behavior, but less is known about the specific treatment processes that may be associated with these effects. AIMS: The current study investigated whether the treatment processes of observed treatment adherence (i.e., the degree to which a therapist sticks to the protocol of a treatment and provides the treatment as intended) and observed therapist alliance-building behavior (TA-BB; i.e., behavior contributing to the affective bond between the therapist and the client) predicted treatment outcomes in a group behavioral parent training combined with group child cognitive behavior therapy targeting externalizing problem behavior in children with MID-BIF. METHODS AND PROCEDURES: Seventy-two children (aged 9-18; Mage = 12.1) and their parents in The Netherlands received the intervention program. They reported on children's externalizing behavior, parenting practices and the parent-child relationship by questionnaires at pre-test and post-test, and the observed treatment processes were coded by audio tapes of therapeutic sessions. OUTCOMES AND RESULTS: The results showed high levels of both treatment adherence (M = 2.49; SD = 0.20; range 1 - 3) and TA-BB (M = 4.11; SD = 0.32; range 1 - 5). Additionally, repeated measures analyses revealed that levels of treatment adherence significantly predicted the improvement of the parent-child relationship (F(1, 66) = 5.37; p = .024) and that levels of TA-BB significantly predicted the decrease of parent reported externalizing problem behavior (F(1, 66) = 9.89; p = .002). CONCLUSIONS AND IMPLICATIONS: The current study suggested that optimal treatment processes are important for treatment outcomes in an intervention targeting children with MID-BIF.

Modification of hostile attribution bias reduces self-reported reactive aggressive behavior in adolescents.

Aggressive individuals more readily interpret others' motives and intentions in ambiguous situations as hostile. This hostile attribution bias has been argued to be causally involved in the development and maintenance of aggression, making it a target for interventions. In our current study, adolescents selected for high levels of aggression (N = 39) were assigned to either a test-retest control group or a five-session hostile attribution bias modification training, in which they were trained to make more benign interpretations of ambiguously provocative social situations. Before and after the training, we assessed hostile attribution bias and both reactive and proactive self-reported aggression in both groups. The training not only tended to produce the expected reduction in hostile attribution bias but also crucially led to decreased levels of reactive but not proactive aggression compared with the control group. Our results thus support the idea that hostile attribution bias can be targeted using training techniques and that such training-induced changes in bias may reduce aggression. However, future studies using an active control group and multiple outcome measures are needed to address the long-term effects of training.

Social information processing skills link executive functions to aggression in adolescents with mild to borderline intellectual disability.

Executive Functions (EFs) have been associated with aggression in children and adolescents. EFs as higher-order cognitive abilities are assumed to affect cognitive functions such as Social Information Processing (SIP). We explored SIP skills as a mediating mechanism linking EFs to aggression in adolescents with mild to borderline intellectual disability (MBID with IQ from 50-84), a high risk group for aggressive behaviors and EF impairments. A total of 153 adolescents (Mage = 15.24, SD = 1.35; 54% male) with MBID participated. Focused attention, behavioral inhibition, and working memory were tested with multiple neurocognitive tasks to define latent EF constructs. Participants responded to a video-based SIP task. A latent construct for aggression was defined by caretaker, teacher, and adolescent self-reports of aggression (Child Behavior Check List, Teacher Report Form, and Youth Self Report). Structural equation modeling was performed to test mediation. Results were consistent with mediation of the relation between focused attention and aggression by SIP, namely via hostile interpretations and self-efficacy for aggression. Behavioral inhibition was linked to aggression, but this relation was not mediated by SIP. The relation between working memory and aggression was mediated by SIP, namely via hostile interpretations, aggressive response generation and via self-efficacy for aggressive responses. Bearing the cross-sectional design in mind, support was found for SIP skills as a mechanism linking EFs, in particular focused attention and working memory, to aggression, providing a viable explanation for the high vulnerability of adolescents with MBID for aggression.

Effectiveness of an Intervention for Children with Externalizing Behavior and Mild to Borderline Intellectual Disabilities: A Randomized Trial.

This study evaluated the effectiveness of Standing Strong Together (SST), a combined group based parent and child intervention for externalizing behavior in 9-16 year-old children with mild to borderline intellectual disabilities (MBID). Children with externalizing behavior and MBID (IQ from 55 to 85) (N = 169) were cluster randomly assigned to SST combined with care as usual or to care as usual only. SST led to a significant benefit on teacher reported but not on parent reported externalizing behavior. SST had significant effects on parent rated positive parenting and the parent-child relationship. The present study shows that a multicomponent group based intervention for children with MBID is feasible and has the potential to reduce children's externalizing behavior and improve both parenting behavior and the parent-child relationship.

Executive functions and processing speed in children with mild to borderline intellectual disabilities and externalizing behavior problems.

Several studies suggest impaired executive functions (EFs) in children with externalizing behavior problems and average intelligence (e.g., IQ > 85). Even though children with mild to borderline intellectual disabilities (MBID) are at higher risk of developing externalizing behavior problems compared to children with average intelligence, it is not yet clear if impaired EFs are also associated with the occurrence of externalizing behavior problems in children with MBID. In the current study, we therefore assessed three EF components (inhibition, cognitive flexibility, and working memory) as well as processing speed in children with MBID and externalizing behavior problems (n = 71) versus children with MBID with no such problems (n = 70). This was accomplished using a well-established computerized test battery. Even after IQ was controlled for, the children with MBID and externalizing behavior problems showed more impaired working memory performance. Differences for inhibition performance and processing speed were also found but less consistent across the tasks used to measure these aspects of EF. Cognitive flexibility was not more impaired in children with both MBID and externalizing behavior problems relative to children with MBID only. Our findings highlight working memory as a potential target to enhance the treatment of children with MBID and externalizing behavior problems.

Cultural, social and intrapersonal factors associated with clusters of co-occurring health-related behaviours among adolescents.

BACKGROUND: Adverse health-related behaviours (HRBs) have been shown to co-occur in adolescents. Evidence lacks on factors associated with these co-occurring HRBs. The Theory of Triadic Influence (TTI) offers a route to categorize these determinants according to type (social, cultural and intrapersonal) and distance in the causal pathway (ultimate or distal). Our aims were to identify cultural, social and intrapersonal factors associated with co-occurring HRBs and to assess the relative importance of ultimate and distal factors for each cluster of co-occurring HRBs. METHODS: Respondents concerned a random sample of 898 adolescents aged 12-18 years, stratified by age, sex and educational level of head of household. Data were collected via face-to-face computer-assisted interviewing and internet questionnaires. Analyses were performed for young (12-15 years) and late (16-18 years) adolescents regarding two and three clusters of HRB, respectively. RESULTS: For each cluster of HRBs (e.g. smoking, delinquency), associated factors were found. These accounted for 27 to 57% of the total variance per cluster. Factors came in particular from the intrapersonal stream of the TTI at the ultimate level and the social stream at the distal level. Associations were strongest for parenting practices, risk behaviours of friends and parents and self-control. CONCLUSION: Results of this study confirm that it is possible to identify a selection of cultural, social and intrapersonal factors associated with co-occurring HRBs among adolescents.

Parenting and the parent-child relationship in families of children with mild to borderline intellectual disabilities and externalizing behavior.

This cross-sectional study examined the association between parenting behavior, the parent-child relationship, and externalizing child behavior in families of children with mild to borderline intellectual disabilities (MBID). The families of a child with MBID and accompanying externalizing behavior problems (n=113) reported more positive discipline and physical punishment but less involvement, less positive parenting, less monitoring, a lower sense of parenting competence, less acceptance of the child, and less closeness to the child than the families of a child with MBID and no accompanying externalizing behavior problems (n=71). The parent-child relationship was most strongly associated with externalizing child behavior, over and above parenting behaviors. In addition, the parent-child relationship was found to be associated with parenting behavior, over and above the child's externalizing behavior. Our results highlight the importance of both the parent-child relationship and parenting behavior in connection with the occurrence of externalizing behavior problems on the part of children with MBID. Parenting behavior and the parent-child relationship may thus be promising targets for interventions with this group of children.

Verbal interactional dominance and coordinative structure of speech rhythms of staff and clients with an intellectual disability.

Social interactions between staff and clients with an intellectual disability contain synchronized turn-taking patterns. Synchrony can increase rapport and cooperation between individuals. This study investigated whether verbal interactional dominance and balance, an indication of attunement between staff and clients with ID, are associated with synchrony of turn-taking patterns during staff-client interactions and whether the level of dominance and balance is related to the observed quality of the social interactions. Nineteen staff members video-recorded a social interaction with one of their clients in which the client asked for support. The recordings were analyzed using Cross Recurrence Quantification Analysis and Initiative Response Analysis. Fifteen staff observers as well as client observers completed a questionnaire on the quality of the video-recorded interactions. Staff and clients' patterns of verbal interactional dominance and balance were associated with the synchrony of their turn-taking behaviors. Staff's dominance was associated with a higher level of synchrony of turn taking, whereas client's dominance was associated with a lower level of synchrony. The patterns of verbal interactional dominance and balance were associated with staff observer reports about the quality of the interactions. The study suggested that staff and clients have a tendency to be sensitive to different aspects of interactions, which in turn may have different functions.

Developing a new assessment procedure of social information processing in adolescents within secure residential care.

The purpose of the present study was to develop a new assessment procedure of social information processing (SIP) for adolescents, to explore its validity and to examine whether it differentiated between IQ groups. Ninety-four adolescents within secure residential care were administered the SIP instrument, the Youth Self Report and two subtests of the WISC/WAIS. Results showed that the constructs underlying the items of the instrument were associated with profiles from the SIP theory, the subsequent SIP steps were correlated, and several SIP steps were correlated to self-reported behavior. No differences were found between IQ groups. These first results have implications for adjustment of the instrument. Further research should confirm construct validity and psychometric qualities of the scales.

Targets for primary prevention: cultural, social and intrapersonal factors associated with co-occurring health-related behaviours.

OBJECTIVE: Multiple studies have identified clusters of co-occurring health-related behaviours. Little is known, however, about factors associated with such clusters. This study aims to identify these factors and to assess whether their effects are in accordance with the Theory of Triadic Influence (TTI). DESIGN: A cross-sectional study using a representative sample (N = 3497) of the Dutch population aged 19-40. MAIN OUTCOME MEASURES: Our data concerned 18 health-related behaviours combined in three clusters (Health, Alcohol and Delinquency) and 30 non-behaviour-specific (i.e. ultimate or distal) cultural, social and intrapersonal factors. The three clusters were used as outcomes in regression analyses. RESULTS: Descriptive Norms of Friends and Gender were associated with all three behaviour clusters. Furthermore, Having Parents who Smoke or Consume Alcohol was associated with, respectively, the Health and Alcohol clusters. Self-Control and past Parental Monitoring were associated with the Health and Delinquency clusters. Effect sizes were moderate to large (r²: 0.05 to 0.22). CONCLUSION: Factors with a moderate to large association with several behaviour clusters were identified. These factors were located within the social and intrapersonal stream of the TTI, not within the cultural stream.

Clustering of health and risk behaviour in immigrant and indigenous Dutch residents aged 19-40 years.

OBJECTIVES: Studies on the co-occurrence, 'clustering' of health and other risk behaviours among immigrants from non-industrialised countries lack until now. The aim of this study was to compare this clustering in immigrant and indigenous adults. METHODS: A representative sample (N = 2,982; response 71%) of the Dutch population aged 19-40, with 247 respondents from non-industrialized countries (Turkey, Morocco, Surinam, Netherlands Antilles), was asked about health behaviours (alcohol, smoking, drugs, unsafe sex, exercise, nutrition, sleep behaviour, traffic behaviour), and about rule-breaking behaviour and aggression. Data were collected using internet questionnaires, which excluded respondents unable to read Dutch. RESULTS: Among indigenous adults, health and risk behaviours co-occur in three clusters (alcohol, health-enhancing behaviour, and rule-breaking behaviour), whereas among immigrant groups two clusters were found (alcohol and rule-breaking behaviour/smoking). Differences mostly concerned health-enhancing behaviours such as nutrition, which was not part of any cluster, and physical activity. CONCLUSIONS: This supports an integrated promotion of healthier lifestyles to immigrants who are able to read Dutch. Regarding potentially risky behaviours like alcohol use and rule-breaking behaviours, this could be similar to that for indigenous people.

Clustering of health-compromising behavior and delinquency in adolescents and adults in the Dutch population.

OBJECTIVE: This study investigates the clustering of a broad range of health-compromising and delinquent behaviors. We examine whether these behaviors belong to a single but broad cluster, 'risk-taking behavior', and whether the nature and degree of clustering in adolescents differs from that in adults. METHOD: A representative sample (N=4395) of the Dutch population aged 12 to 40 (overall response rate 67%), was asked about various health-compromising behaviors, such as alcohol consumption, smoking, illegal drug use, unsafe sexual behavior, physical inactivity, poor nutrition (such as skipping breakfast and not eating fruit and vegetables), poor sleep behavior, unlawful traffic behavior, and delinquent and aggressive behavior. Data were collected from fall 2005 to spring 2006 using internet questionnaires and face-to-face computer-assisted interviews. RESULTS: No single broad cluster was found. Instead, there were several separate but interrelated clusters. The contents of these clusters differed between age groups. For young adolescents (12-15) two clusters were identified: Alcohol and Delinquency. For older adolescents (16-18) and adults (19-40) three clusters were identified: Alcohol, Delinquency and Health. CONCLUSION: The findings of this study support a more integrated approach to promoting healthier lifestyles, and suggest that the behavior targets of integrated prevention programs should be different for adolescents and adults.

Social problem-solving and mild intellectual disabilities: relations with externalizing behavior and therapeutic context.

Relations among externalizing behavior, therapeutic context (community care vs. residential care), and social problem-solving by children with mild intellectual disabilities or borderline intelligence were examined. Participants were 186 children (12 to 14 years of age) who responded to a video-based social problem-solving task. Of these, 130 received residential care and the majority suffered from severe externalizing behavior problems. The results indicated that externalizing behavior was related to encoding, generation of aggressive responses, and negative evaluation of assertive responses. Therapeutic context was related to encoding, positive evaluation of assertive responses, and negative evaluation of aggressive responses. Results indicate a discrepancy between appropriate problem-solving skills and behavior in daily life. Implications for interventions are discussed.