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Background: Aggressive behaviour (AB) and non-suicidal self-injury (NSSI) are common in people with mild intellectual disability or borderline intellectual functioning, leading to adverse consequences for themselves and those around them., Method: We investigated the relationship between AB (both total and physical in particular) and NSSI and risk factors in 125 residents in a treatment clinic using incident reports and standard clinical measurements., Results: There was a weak correlation between AB and NSSI, as well as between impulsivity and total AB, and between coping and AB and NSSI. However, NSSI, impulsivity and coping skills did not predict AB., Conclusion: Results do not corroborate those of other studies in this area. In future studies impulsivity, coping, aggression and NSSI may be measured using other instruments, and differences between people with and without intellectual disability regarding these variables may be explored., (© 2024 The Author(s). Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Introduction: This study investigated the reliability and validity of the dynamic risk outcome scales-short version (DROS-SV). This instrument is developed to monitor treatment progress using dynamic risk factors in clients with mild intellectual disabilities or borderline intellectual functioning and behavioural and/or mental health problems., Method: Data were collected from 264 clients who received Flexible Assertive Community Treatment (FACT), a form of intensive outpatient treatment., Results: A principal component analysis showed that there were six components explaining 73.9% of the variance. Furthermore, the DROS-SV showed good internal consistency of its subscales and total score (α > 0.78). Correlating the DROS-SV with the Historical and Clinical subscales of the Historical, Clinical and Future-30 indicated convergent and divergent validity., Discussion: The DROS-SV has good psychometric properties for measuring dynamic risk factors in clients with mild intellectual disabilities or borderline intellectual functioning in FACT teams., (© 2024 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: The Group Climate Inventory (GCI) was tested for measurement invariance across 332 adults with and 225 adults without mild intellectual disabilities in Dutch forensic treatment, and for latent mean differences on its Support, Growth, Repression, and Atmosphere subscales., Method: Multigroup confirmatory factor analysis was used to evaluate the configural, threshold, and loading and threshold invariance of the GCI across both groups, and to compare group latent means on each subscale., Results: Measurement invariance was found across groups. Latent mean group comparisons showed small but significant differences reflected in lower scores on Support and Atmosphere in the group with mild intellectual disabilities., Conclusion: The GCI allows meaningful comparisons between clients with and without mild intellectual disabilities in secure facilities. Results from the between-group comparisons suggest that consideration should be given as to whether, and why, the support and atmosphere perceptions of clients with mild intellectual disabilities might be less good., (© 2023 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: In secure residential facilities, group climate perceptions of clients with mild intellectual disability or borderline intellectual functioning are systematically assessed for quality improvement. A valid and reliable measure may ensure that this process is consistent. The Group Climate Inventory-Revised (GCI-R) is a new measure to assess group climate perceptions., Method: Confirmatory factor analysis was conducted in 148 adult clients (79% male) with mild intellectual disability or borderline intellectual functioning in a secure facility to examine internal structure validity and internal consistency reliability of the GCI-R., Results: The results indicate support for the five-factor structure of the GCI-R ('Support', 'Growth', 'Repression', 'Peer interactions', and 'Physical environment'). The internal consistency reliability of its scales ranged from acceptable to good (α: .72-.87; ω: .76-.86)., Conclusion: The GCI-R demonstrates evidence of psychometric adequacy when applied to adult clients with mild intellectual disability or borderline intellectual functioning in secure residential facilities., (© 2023 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: The dynamic risk outcome scales (DROS) was developed to assess treatment progress of clients with mild intellectual disability or borderline intellectual functioning using dynamic risk factors. We studied the predictive value of the DROS on various classifications and severity levels of recidivism., Method: Data of 250 forensic clients with intellectual disabilities were linked to recidivism data from the Judicial Information Service in the Netherlands. Receiver operating characteristics (ROC) analyses were used to determine the predictive values., Results: The DROS total score could not significantly predict recidivism. A DROS recidivism subscale predicted general, violent and other recidivism. These predictive values were comparable to those of a Dutch tool validated for risk assessment in the general forensic population., Conclusions: The DROS recidivism subscale predicted various classifications of recidivism better than chance. At present, the DROS appears to have no added value beyond the HKT-30 for the purpose of risk assessment., (© 2023 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: Relationships between dynamic risk factors for externalising problem behaviour and group climate were investigated in 151 adult in-patients with mild intellectual disability or borderline intellectual functioning in a Dutch secure residential facility., Method: Regression analysis was used to predict total group climate score and Support, Growth, Repression, and Atmosphere subscales of the 'Group Climate Inventory'. Predictor variables were Coping Skills, Attitude towards current treatment, Hostility, and Criminogenic attitudes subscales of the 'Dynamic Risk Outcome Scales'., Results: Less hostility predicted a better overall group climate, better support and atmosphere, and less repression. A positive attitude towards current treatment predicted better growth., Conclusion: Results indicate relationships of hostility and attitude towards current treatment with group climate. A focus on both dynamic risk factors and group climate may provide a basis for improving treatment for this target group., (© 2023 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: Aggressive incidents are common in people with intellectual disabilities. Therefore, we aimed to assess whether supplementation of multivitamins, minerals, and omega-3 fatty acids (FA) reduces aggressive incidents., Methods: We conducted a randomised, triple blind, placebo controlled, single crossover intervention trial. People with intellectual disabilities or borderline intellectual functioning, between 12 and 40 years of age, and showing aggressive behaviour were included. Participants received either a daily dose of dietary supplements, or placebo. Primary outcome was the number of aggressive incidents, measured using the Modified Overt Aggression Scale (MOAS)., Results: there were 113 participants (placebo, n = 56), of whom 24 (placebo, n = 10) participated in the crossover phase of the trial. All 137 trajectories were included in the analyses. There was no significant difference in mean number of aggressive incidents per day between those assigned to supplements and those who received placebo (rate ratio = 0.93: 95% Confidence Interval [CI] = 0.59-1.45)., Conclusion: In this pragmatic trial, we did not find significant differences in the outcomes between the supplement and placebo arms. The COVID-19 pandemic started midway through our trial, this may have affected the results., (© 2022 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: The adaptive ability performance test (ADAPT) was developed to assess adaptive skills in individuals with intellectual disabilities and borderline intellectual functioning, with or without mental disorders. As a follow-up to earlier research on the ADAPT, a factor analytic study was conducted., Method: One thousand and sixty six ADAPTs from clients with (suspected) intellectual disabilities or borderline intellectual functioning and 129 ADAPTs from participants from the general population were collected along with other characteristics (e.g., IQ, psychiatric classifications, living situation)., Results: An exploratory factor analysis (EFA) was performed and resulted in good fit indices. Subsequent confirmatory factor analysis (CFA) and multigroup CFA showed acceptable to good fit indices. This resulted in an instrument with eight factors and 62 items., Conclusion: Factor analytic results suggest that the ADAPT is a valid instrument that measures adaptive skills in individuals with intellectual disabilities or borderline intellectual functioning., (© 2022 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: Studies about teams of staff supporting people with intellectual disability have focused on team performance of existing teams. This study aimed to examine important factors in the process of setting up a new team of support staff. Specifically, we considered the process for a team that supports service users with mild intellectual disability or borderline intellectual functioning who display severe challenging behaviour from the orthopedagogical perspective (i.e., with a focus on contextual factors)., Method: Three participant groups (service users, support staff, and professionals supporting a team) participated in a concept mapping procedure, including generating statements in interviews and focus groups, sorting, and rating. An expert group interpreted the results., Results: Important factors to one or more groups were: service users and support staff getting acquainted early, team safety, social support, a shared vision, and a positive reputation of the new home., Conclusions: Four core outcomes were addressed that may help service organisations to provide an environment matching the needs of service users who show severe challenging behaviour from the start., (© 2022 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: We sought to assess diet quality among people with intellectual disabilities or borderline intellectual functioning, living in residential facilities or receiving day care., Methods: We measured diet quality using the Dutch Healthy Diet Food Frequency Questionnaire (DHD) and compared this between participants with (n = 151) and controls without intellectual disabilities (n = 169). Potential correlates of diet quality were explored., Results: We found lower mean diet quality among people with intellectual disabilities (M = 80.9) compared to controls (M = 111.2; mean adjusted difference -28.4; 95% CI [-32.3, -24.5]; p < .001). Participants with borderline intellectual functioning and mild intellectual disabilities had lower diet quality and higher body mass index than individuals with severe to profound intellectual disabilities. Being female was a predictor of better diet quality., Conclusions: Overall, we found that diet quality was low in the sample of people with intellectual disabilities or borderline intellectual functioning., (© 2021 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: Since the DSM-5, adaptive functioning has taken a prominent place in the classification of intellectual disability (ID). The ADAPT was developed to assess adaptive skills in individuals with ID., Method: A total of 2,081 ADAPTs from clients with suspected ID or borderline intellectual functioning and 129 ADAPTs from people from the general population (non-ID) were collected, along with background characteristics., Results: Internal consistency of the ADAPT was high (α = 0.98). ADAPT scores were positively associated with IQ, educational level and level of independent living. Furthermore, individuals without ID scored significantly higher than the clients on all of the 65 ADAPT items. Reference values were established for different IQ groups and living situations., Conclusion: Results suggest that the ADAPT is a valid instrument for measuring adaptive skills in individuals with ID. The reference values may be used for the purpose of estimating the level of ID and the needed intensity of support., (© 2021 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: This study examines associations between group climate, aggressive incidents and coercive measures in adults with mild intellectual disability or borderline intellectual functioning (MID-BIF) of a secure forensic setting., Method: Participants (N = 248) were interviewed about their perception of group climate utilizing the Group Climate Instrument. Data on aggressive incidents and coercive measures were retrieved from the facilities' electronic database. A multilevel structural equation model was fitted in which variability in perception of group climate within and between living groups was examined., Results: An open and therapeutic group climate was associated with lower levels of aggression within and between groups. A higher number of aggressive incidents were significantly associated with a higher number of coercive measures., Conclusions: The findings have implications for the understanding of how group climate may play a role in reducing aggressive incidents at the living group in treatment of individuals with MID-BIF in secure forensic settings., (© 2020 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: In the Netherlands, Flexible Assertive Community Treatment (FACT) teams have been established for people with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and mental health problems or challenging behaviour. Little is known yet about service users' experiences with FACT., Method: An inductive grounded theory approach was used to explore how service users valued the treatment and their own functioning, and which factors were perceived as supportive. Semi-structured interviews were held with 15 service users., Results: Most service users highly appreciated the contact with the staff and the practical and emotional support. Persistent involvement, availability and humanity, and respect for autonomy were distinguished as core values in the relationship with the staff. Most service users experienced improvement in time and attributed this to intrapersonal changes and/or less stress in life., Conclusions: From the perspective of service users with MID/BIF, FACT appears to have an added value., (© 2020 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: The present study examined the psychometric properties of the Dynamic Risk Outcome Scales (DROS), an instrument developed to measure dynamic risk factors in individuals with mild intellectual disabilities or borderline intellectual functioning (MID-BIF) and externalizing (including offending-like) behaviour problems., Method: The sample consisted of 606 clients (86% male) from inpatient treatment wards at a facility for individuals with MID-BIF and externalizing behaviour problems., Results: The DROS showed an acceptable factor structure, good internal consistency, significant test-retest reliability and fair to excellent inter-rater reliabilities for most subscales and total score. Compared to the Adult Behavior Checklist (ABCL; Achenbach & Rescorla, 2003 Manual for the ASEBA adult forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families), the DROS showed convergent and divergent validity, concurrent and longitudinal validity., Conclusions: The DROS is a reliable and valid instrument to measure dynamic risk factors in clients with MID-BIF. Future research on the DROS will focus on the assessment of recidivism and the inclusion of internalizing problems., (© 2018 John Wiley & Sons Ltd.)

Research on follow-up outcomes of systemic interventions for family members with an intellectual disability is scarce. In this study, short-term and long-term follow-up outcomes of multisystemic therapy for adolescents with antisocial or delinquent behaviour and an intellectual disability (MST-ID) are reported. In addition, the role of parental intellectual disability was examined. Outcomes of 55 families who had received MST-ID were assessed at the end of treatment and at 6-month, 12-month and 18-month follow-up. Parental intellectual disability was used as a predictor of treatment outcomes. Missing data were handled using multiple imputation. Rule-breaking behaviour of adolescents declined during treatment and stabilized until 18 months post-treatment. The presence or absence of parental intellectual disability did not predict treatment outcomes. This study was the first to report long-term outcomes of MST-ID. The intervention achieved similar results in families with and without parents with an intellectual disability., (© 2019 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Background: This study examined the relationship between substance use motives (i.e., social, conformity, coping and enhancement) and substance use in individuals with mild intellectual disability or borderline intellectual functioning (MID-BIF)., Method: Data were collected among 163 clients with MID-BIF using interactive questionnaires with visual cues on a tablet with a web application., Results: Results show that social motives were positively related to frequency of alcohol use, while conformity, coping and enhancement motives were positively related to severity of alcohol use. Results for drug use show that social motives were positively related to frequency of cannabis and hard drug use and that conformity motives were negatively related to frequency of cannabis use. Coping motives were positively related to severity of drug use., Conclusions: Insight in substance use motives should be used when adapting interventions, as it could contribute to the prevention and reduction of substance use disorders in individuals with MID-BIF., (© 2019 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd.)

Background: An adaptation of multisystemic therapy (MST) was piloted to find out whether it would yield better outcomes than standard MST in families where the adolescent not only shows antisocial or delinquent behaviour, but also has an intellectual disability., Method: To establish the comparative effectiveness of MST-ID (n = 55) versus standard MST (n = 73), treatment outcomes were compared at the end of treatment and at 6-month follow-up. Pre-treatment differences were controlled for using the propensity score method., Results: Multisystemic therapy-ID resulted in reduced police contact and reduced rule breaking behaviour that lasted up to 6 months post-treatment. Compared to standard MST, MST-ID more frequently resulted in improvements in parenting skills, family relations, social support, involvement with pro-social peers and sustained positive behavioural changes. At follow-up, more adolescents who had received MST-ID were still living at home., Conclusions: These results support further development of and research into the MST-ID adaptation., (© 2019 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd.)

Background: This study explored the effectiveness of eye movement desensitisation and reprocessing (EMDR) therapy for post-traumatic stress disorder (PTSD) in persons with mild to borderline intellectual disability (MBID) using a multiple baseline across subjects design., Methods: One child and one adolescent with MBID, who met diagnostic criteria for PTSD according to a PTSD clinical interview (i.e., ADIS-C PTSD section), adapted and validated for this target group, were offered four sessions of EMDR. PTSD symptoms were measured before, during and after EMDR, and at six weeks follow-up., Results: For both participants, number of PTSD symptoms decreased in response to treatment and both no longer met PTSD criteria at post-treatment. This result was maintained at 6-week follow-up., Conclusions: The results of this study add further support to the notion that EMDR can be an effective treatment for PTSD in children and adolescents with MBID. Replication of this study in larger samples and using a randomized controlled design is warranted., (© 2017 John Wiley & Sons Ltd.)

Background: Problematic alcohol use is associated with neuropsychological consequences, including cognitive biases. The goal of the study was to explore the moderating role of executive control and readiness to change on the relationship between alcohol use and cognitive biases in light and problematic drinkers with and without mild to borderline intellectual disability (MBID)., Method: Participants (N = 112) performed the visual dot probe task to measure the strength of the cognitive biases. Executive control was measured using two computerised tasks for working memory capacity (Corsi block-tapping task) and inhibitory control (Go/No-go task). Readiness to change was measured using the Readiness to Change Questionnaire., Results: No cognitive biases or executive dysfunctions were found in problematic drinkers. Working memory capacity and inhibitory control were impaired among individuals with MBID, irrespective of severity of alcohol use-related problems. Executive control and readiness to change did not moderate the relationship between alcohol use and cognitive biases., Conclusion: The results fail to support the dual-process models of addiction, but results need to be treated with caution given the problematic psychometric qualities of the visual dot probe task. Implementing a neurocognitive assessment and protocols in the treatment of substance use disorders seems premature., (© 2016 John Wiley & Sons Ltd.)

Objective: To assess and identify the frequency and type of urinary incontinence (UI), as well as associated symptoms in persons with Prader-Willi syndrome (PWS). PWS is characterized by mental retardation, short stature, obesity and hypogonadism. The behavioural phenotype includes eating problems, temper outbursts, affective disorders, stereotypies and speech abnormalities. UI is common in children with mental retardation in general, but has not been reported systematically in children with PWS so far., Materials and Methods: The Dutch version of the 'Parental Questionnaire: Enuresis/Urinary Incontinence' was completed by 118 parents of children with PWS. This questionnaire includes items referring to day- and night-time wetting, toilet habits, observable voiding behaviours and reactions, urinary tract infections, stool habits and behavioural symptoms., Results: The rate of nocturnal enuresis in persons with PWS was 13.6% (16) at a mean age of 15.1 years. 3.8% (5) had additional daytime urinary incontinence, and 3.3% (4) had faecal incontinence. Lower urinary tract symptoms were commonly indicative of overactive bladder, dysfunctional voiding and postponement. Also, the rate of internalizing and externalizing behavioural problems was high., Conclusion: Urinary incontinence is more common in persons with PWS than in typically developing children, adolescents and adults. As lower urinary tract symptoms are common, detailed assessment and specific treatment of UI should be part of the care of all persons with PWS., (© 2010 THE AUTHORS. JOURNAL COMPILATION © 2010 BJU INTERNATIONAL.)