Behavior Problems In Adults Research Articles

Psychotropic medication for challenging behavior in people with learning disabilities in Qatar

IntroductionChallenging behavior is a common reason for referral to psychiatric service. Psychotropic medications widely used to modify behaviors, even when no evidence of diagnosable mental illness. However, literature show little evidence that benefits outweigh the risks in their prescription. Monitoring using International guidelines may help improving the outcomes. We audit current practice against known standards.Objectives- To assess adherence within the Qatar Mental Health Services to National guidelines on using medication to manage behavior problems in adults with a learning disability. - To identify strengths and weaknesses in current practice. - To Make recommendations to improve LD patient careMethodsPatients with LD attending psychiatric clinic screened using selection and exclusion criteria and data collected and analyzed using format from the International standards.Results102 patients screened, 85 selected and 17 cases excluded Age range 18 to 50 years. 27% mild, 29% moderate and 44% severe LD, Autism 40% Psychiatric Diagnosis 55% Challenging behavior 45% Antipsychotic prescribing: 79% Rationale documented in 74%, Capacity assessment in 81%, Review of side effects in 53% Safety of medication in 61%, Medication discontinuation in 66%, Reasons for discontinuation in 36%ConclusionsAntipsychotics use (79%) is high with several combinations of IM and oral or more than 2 drugs. There is need for improvement across all standards. Rationalising the prescribing for LD patients to improve the outcomes for the safety of these patients. The audit indicate need for specialist service to monitor prescribing and apply standards of care in clinical service.DisclosureNo significant relationships.

Prenatal cocaine exposure: Direct and indirect associations with 21-year-old offspring substance use and behavior problems

BackgroundPrenatal cocaine exposure (PCE) has been linked to child/adolescent behavior problems and substance use in several longitudinal cohort studies. It is unclear whether these effects extend into adulthood and influence young adult behavior problems and substance use and, if so, whether they are mediated by childhood and adolescent experiences. MethodsThese data are from an ongoing longitudinal study of individuals born to women who were recruited early in pregnancy. Trimester-specific data on prenatal drug exposure were obtained. Caregivers and offspring were assessed at delivery and at 1, 3, 7, 10, 15, and 21 years postpartum. This report is from age 21, when 225 offspring (52% females; 54% African American, 46% Caucasian) reported on behavior problems, emotion regulation, and substance use. ResultsThere were significant direct associations between PCE and early initiation of marijuana, 21-year emotion regulation problems, arrest history, and Conduct Disorder. The relation between PCE and young adult internalizing behavior was mediated by adolescent mood symptoms. The association between PCE and 21-year marijuana use was mediated by early initiation of marijuana use. ConclusionsPCE has both direct and indirect long-term associations with young adult development. Using statistical models that considered the complex interrelationships among PCE and adult outcomes, we demonstrated that the direct effects of PCE on young adult emotion regulation problems, arrest history, and Conduct Disorder are not completely explained by earlier adolescent behavior. Moreover, the analyses suggesting mediated pathways from PCE to young adult problems identify crucial variables to target interventions for exposed children and adolescents.

Long-term Impact of Parental Well-Being on Adult Outcomes and Dementia Status in Individuals With Down Syndrome

Parental characteristics were significant predictors of health, functional abilities, and behavior problems in adults with Down syndrome (n = 75) over a 22-year time span, controlling for initial levels and earlier changes in these outcomes. Lower levels of behavior problems were predicted by improvements in maternal depressive symptoms. Higher levels of functional abilities were predicted by prior measures of and improvements in maternal depressive symptoms. Better health was predicted by prior measures of maternal depressive symptoms, paternal positive psychological well-being, relationship quality between fathers and their adult children, and improvements in maternal positive psychological well-being. Dementia status was also predicted by parental characteristics. The study suggests the importance of the family context for healthy aging in adults with Down syndrome.

Prenatal cigarette smoking: Long-term effects on young adult behavior problems and smoking behavior

We examined the long-term effects of prenatal cigarette smoke exposure (PCSE) on the behavior problems and smoking behavior of 22-year-old offspring. The mothers of these offspring were interviewed about their tobacco and other drug use during pregnancy at the fourth and seventh gestational months, and at delivery. Data on the offspring are from interviews at age 22 (n=608). Behavior problems were measured by the Adult Self-Report (ASR) with the following outcome scales: total behavior problems, externalizing, internalizing, attention, anxiety/depression, withdrawn, thought, intrusive, aggression, somatic and rule breaking behavioral problems. Young adult smoking behavior was measured using self-reported average daily cigarettes, and was validated with urine cotinine. Nicotine dependence was measured with the Fagerström Tobacco and Nicotine Dependence (FTND) scale. Regression analyses tested the relations between trimester-specific PCSE and young adult's behavioral problems and smoking behavior, adjusting for demographic and maternal psychological characteristics, and other prenatal substance exposures. Exposed young adults had significantly higher scores on the externalizing, internalizing, aggression, and somatic scales of the ASR. These young adults were also more likely to have a history of arrests. Young adults with PCSE also had a higher rate of smoking and nicotine dependence. Our previous findings of the relations between PCSE and aggressive behavior in early childhood and PCSE and smoking behavior in early adolescence extend into young adulthood.

Social vs pharmacological stimulation of the stress system, mentalisation processes and behavior problems in adults born premature

Social vs pharmacological stimulation of the stress system, mentalisation processes and behavior problems in adults born premature

Role of psychological flexibility in parents of adolescents with chronic pain: Development of a measure and preliminary correlation analyses

Parent responses to the experiences of adolescents with chronic pain are deemed important. At the same time the best ways to conceptualize, measure, and intervene with these are unclear. The purpose of the present study was to develop a measure of parent responses based on the approach proposed in Acceptance and Commitment Therapy (ACT), an approach that focuses on psychological flexibility. A total of 183 adolescents attending a specialty treatment center for chronic pain, and adults attending with them, provided the data examined in this study. Standard measures of adolescent functioning and parent responses were obtained. In addition, the attending adults, who were mostly mothers, also completed a pool of items for an instrument called the Parent Psychological Flexibility Questionnaire (PPFQ). Preliminary analyses of these items showed an internal consistency of α=0.91. The total score for parent psychological flexibility was negatively correlated with protective and encouraging parent responses to pain, as predicted. It was also positively correlated with adolescent acceptance of pain and negatively correlated with measures of pain-related impact on their social, emotional, family, and developmental functioning. Additional analyses showed that the PPFQ yields significant unique information about adolescent functioning independent of age and gender and beyond that provided by another well-established measure of parent responses. There is increasing evidence for the effectiveness of ACT in the treatment of a range of behavior problems in adults and young people and in training for persons without identified “disorders.” It seems potentially applicable for parent training in the context of adolescent chronic pain.Parent responses effective in promoting psychologically flexible behavior in adolescents with chronic pain are addressed, including the design of an instrument to measure them.

ADHD Impulsivity, Discipline Referrals, Sexual Harassment, and Criminal Sexual Deviancy

© 2011 The Guilford Press The ADHD Report • 1 Children and adolescents with impulsive tendencies have a difficult time due to the fact that they usually receive negative attention or consequences for their inability to control their behavior. Behaviors such as grabbing for a toy, not waiting one’s turn, or being unable to follow directions are characteristics of impulsive children. These behaviors usually earn the child a stern look or a negative consequence by the supervising adult. As a child comes of age and moves into middle school years, impulsivity can lead to harsher consequences due to the different interpretations adults attach to impulsive behaviors. For instance, impulsive children’s not keeping their hands to themselves can be interpreted as bullying. A child’s inability to wait for his or her turn can elicit peer rejection. Failure or refusal to follow directions is labeled defiance, and inappropriate touching becomes sexual harassment. When children enter school and begin their formal education, the behavioral issues around impulsivity surface. Barkley (2006) describes impulsivity, or impaired impulse control, as the inability to stop and think before acting. The challenges start when children must interact in a group setting away from their families and must take directions from new adults in charge at each grade level. Each grade level transition presents new behavioral challenges. During the middle school years, peer influences are strongest, sexual identities begin to form, and for most children, puberty starts (Arnett, 2004). Puberty, with its hormonal and biological changes, is challenging for the preadolescent struggling with impulse control. Maughan, Rowe, Messer, Goodman, and Meltzer (2004) documented that behavior disorder risk rates peak around the middle school years, underscoring the importance of this particular transition time. The connection between childhood behavior problems and adult behavior problems has been well documented. For example, the risk of becoming an adult offender has been associated by some researchers with childhood conduct disorders—a persistent behavior pattern of violating basic rights of others and ignoring age-appropriate social standards (Satterfield & Schell, ADHD Impulsivity, Discipline Referrals, Sexual Harassment, and Criminal Sexual Deviancy

Reflections on the "Cognitive Behavior Modification"

This paper is meant to outline the origins of cognitive-behavior modification. At the same time, we describe the main cognitive techniques used in the treatment of infant and adult behavioral problems.

Use of Medication for the Management of Behavior Problems Among Adults With Intellectual Disabilities: A Clinicians' Consensus Survey

Current prescribing preferences among relevant experts regarding the use of psychotropic medication for the management of behavior problems in adults with intellectual disabilities in the absence of a diagnosed psychiatric illness was defined. We used a questionnaire design to synthesize the preferences of a large group, namely, clinical psychiatrists, thereby establishing a consensus. A total of 108 completed questionnaires were analyzed. A very strong preference for the use of nonmedication-based interventions was established. Of the medication options presented, atypical antipsychotics were most favored, with Risperidone the most preferred option from within this group. Citalopram was the most preferred antidepressant and Carbamazepine, the most preferred mood stabilizer/antiepileptic.

Behavior problems in adults with mental retardation and maternal well-being: examination of the direction of effects.

We examined the occurrence and stability of behavior problems over a 6-year period among 193 adults with mental retardation who lived with their mothers. At the beginning of the study period, almost 30% of the sample had clinically significant behavior problems and about 25% had no behavior problems. During the study period, group-level stability of behavior problems and individual-level change were observed. We tested the bidirectional relations between behavior problems and maternal well-being and found evidence of both directions of influence. Initial levels and changes over time in behavior problems predicted changes in maternal well-being, and initial levels and changes over time in maternal well-being predicted changes in behavior problems in the son or daughter.

Gender differences in the development of substance-related problems: the impact of family history of alcoholism, family history of violence and childhood conduct problems.

This study examined gender differences regarding the relative influence of family history of alcoholism (FHA) and family history of violence (FHV) on reported childhood conduct problems (CCP) and adult problems with alcohol, drugs and violence. The participants were 110 men and 103 women with alcohol-related problems recruited within 30 days of enrolling in treatment for substance abuse or dependence. Participants completed self-report measures of pretreatment violence, FHV, CCP, substance use and consequences, and demographics; a semi-structured interview was used to assess FHA. Structural equation modeling (SEM) analyses revealed gender differences with regard to the influence of FHA and FHV as important factors in the development of childhood and adult behavioral problems. For women, the influence of FHA on subsequent childhood conduct problems and adult problems with alcohol was accounted for by FHV. For men, FHA was not directly associated with CCP or adult problems with alcohol and violence, but was associated with adult drug problems. For both men and women, FHV was associated with CCP, and CCP were associated with adult problems with drugs and violence. Overall, the analyses illustrate the relative importance of FHV as a risk factor in the developmental course leading to problems with drugs and violence among individuals with alcohol-related problems enrolled in treatment for substance abuse or dependence. Further, there was evidence that women may be impacted more than men by family background variables (both FHA and FHV) in terms of the development of adult problems with alcohol, drugs and violence.

Prevalence, characteristics, and impact of childhood sexual abuse in a southwestern American Indian tribe

Objective: There were two objectives; first, to investigate the prevalence and characteristics of child sexual abuse in an American Indian community, and second, to determine whether persons with histories of child sexual abuse are at greater risk to develop psychiatric disorders and behavioral problems than persons who report no such history. Method: A sample of 582 Southwestern American Indian tribal members was collected for a genetic and linkage study on alcoholism and psychiatric disorders in three large and interrelated pedigrees. Subjects were recruited from the community without knowledge of their clinical histories or those of their relatives. Child sexual abuse and psychiatric disorders were assessed using a semi-structured psychiatric interview. Results: Females were more likely to be sexually abused as children (49%) than were males (14%). Intrafamilial members accounted for 78% of the reported child sexual abuse. Sexually abused males and females were more likely to report childhood and adult behavioral problems than were nonabused subjects. There was a strong relationship between multiple psychiatric disorders and child sexual abuse, with sexually abused males and females more likely to be diagnosed with ≥3 psychiatric disorders, both including and excluding alcohol dependence or abuse, than were nonabused subjects. Conclusion: Child sexual abuse in this population is both an index of family dysfunction and community disorganization as well as a predictor of later behavioral patterns and psychopathology.

The Influence of Antecedent Exercise on Problem Behaviors in Persons with Mental Retardation: A Failure to Replicate

The purpose of this study was to evaluate the effects of a jogging program on behavior problems in adults with mental retardation. Six adults with severe mental retardation were exposed to sequential conditions of baseline (routine physical education activities), leisure games (attention control), and 15 minutes of daily jogging. The results showed that neither the jogging nor the leisure games condition produced consistent changes in problem behaviors. Possible explanations for this failure to replicate results of previous studies are discussed.

A Comparative Analysis of Behavior Management in the Nursing Home

Behavior management has long been recognized as a productive therapeutic technique when working with children and adult behavioral problems; yet, literature concerning its use with the older population appears quite sparse. Given that the nursing home is a long-term care environment where opportunities exist to control and modify behavior, this present study surveys 89 midwestern nursing homes in an attempt to determine if and to what extent there is behavior management use. Results indicate moderate, but ambiguous usage. Conclusions are drawn in terms of the management approach and its opportunities.