Borderline Intellectual Functioning Research Articles

Dog-Assisted Therapy in Mental Health Care: A Qualitative Study on the Experiences of Patients with Intellectual Disabilities.

(1) Background: Dog-assisted therapy (DAT) is an experiential intervention to promote psychological, physical, and social functioning in children and adults. Only few studies have been conducted on DAT in adults with a mild intellectual disability or borderline intellectual functioning (MID-BIF). The purpose of this study was to explore the experiences of patients with MID-BIF undergoing DAT in a mental health care facility. (2) Method: Seven patients completed 13 to 15 sessions of DAT. Within two weeks of completing the program, they were interviewed using a semi-structured interview. The transcripts of the interviews were analysed using interpretational phenomenological analysis. In addition, the patients' relatives and the DAT therapist were interviewed, and a focus group discussion took place with each patient's treatment team. (3) Results: The patients' experiences were predominantly positive. Physical contact with the dog calmed them down. The dog offered them emotional support and helped them to make contact inside and outside the therapy and the setting where they lived. The patients also liked the fact that DAT focused on the dog rather than their problems, that the therapy was experiential and using a positive approach, and that, during the therapy, they did not feel like a patient but a human being. DAT is a promising therapy for patients with MID-BIF in mental health care facilities, but more research into its effectiveness and cost-effectiveness and ways to implement DAT in clinical practice is needed to make more definitive statements.

Reliability and validity of the dynamic risk outcome scales-short version for clients with mild intellectual disabilities or borderline intellectual functioning.

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. Data were collected from 264 clients who received Flexible Assertive Community Treatment (FACT), a form of intensive outpatient treatment. 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. 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.

Personality in individuals with mild intellectual disability to borderline intellectual functioning: a comparative study

PurposeThis study aims to investigate the distinctive personality traits and characteristics of individuals with borderline intellectual functioning (BIF) and mild intellectual disability (MID) within specialized centers for MID-BIF treatment and care compared with individuals without MID-BIF diagnosis gathered from general mental health care (GMH) settings.Design/methodology/approachPatients classified with MID-BIF (n = 58), most with comorbid psychopathology, were thoroughly interviewed by trained clinicians who afterward completed the Shedler–Westen Assessment Procedure (SWAP-200) about the patient. The authors compared SWAP-200 profiles of MID-BIF patients with profiles of GMH individuals. In addition, the authors have compared these profiles for the MID and BIF groups (differentiated based on previously known intelligence quotient scores).FindingsResults show significantly higher scores for the MID-BIF group than the GMH group on scales encompassing emotional instability, impulsivity and antagonism. On scales containing constraint and healthy traits, significantly lower scores were found for the MID-BIF group than for the GMH group. Importance of including SWAP-200 personality assessment for a more comprehensive understanding and treatment planning for individuals with MID-BIF is discussed.Originality/valueThis study offers insights into personality within individuals with an MID-BIF diagnosis, compared with individuals in a GMH setting.

Long-term medication for ADHD (LMA) trial: 2-year prospective observational study in children and adolescents. Core symptoms, daily functioning, and comorbidity outcomes.

More knowledge is needed about long-term ADHD medication and symptom, daily functioning, comorbidity, and tolerability outcomes. This "Long-term Medication for ADHD (LMA) trial" was a prospective observational 2-year trial in children and adolescents aged 6-18years (extension of 1-year trial). Participants met criteria for DSM-5 ADHD (inattentive or combined), with complex comorbidities; autism spectrum disorder (31%), autistic traits (24%), oppositional symptoms (59%), anxiety (32%), dyslexia/language disorder (16%), borderline intellectual functioning (17%). Medication was individually tailored and followed-up at clinical visits (1, 2, 3, 6, 12, 18, 24months). Primary outcome: Clinical Global Impression-Severity and Improvement scales (CGI-S, CGI-I). Secondary outcomes: Investigator-rated ADHD-Rating Scale, Weiss Functional Impairment Rating Scale-Parent report(WFIRS-P; Family, School Learning and Behavior, Life Skills, Self-Concept, Social Activities, and Risky Activities domains), comorbidity symptoms and adverse events (AEs). One hundred twenty-eight participants were enrolled (1-year trial only n = 27, LMA trial n = 101). Of these 29 (23%) discontinued, mainly due to AEs (n = 7), moving (n = 7), or no longer needing medication (n = 6). Main AEs were poor appetite, low mood, anxiety, irritability, fatigue. Improvements from baseline to 2years were large in CGI-S (effect size (ES) 2.28), ADHD-RS (ES 2.06), and moderate to large in WFIRS-P (ES total 0.73, learning 0.4, family 0.67). Overall, the trial showed robust and sustained improvements in ADHD symptom severity and daily functioning over a period of 2years of ADHD medication in children and adolescents with ADHD and complex comorbidities. Most AEs were mild. Comorbidity symptoms were improved after 1year, particularly oppositionalsymptoms, depression, and anxiety.

Cognitive Abilities in Schizoid Personality Disorder with and without Borderline Intellectual Functioning: The Burden in Psychopathology

Background: Borderline intellectual functioning (BIF) and schizoid personality disorder (Schizoid PD) are clinical conditions under-researched and poorly understood. The principal aim of this retrospective study was to investigate cognitive abilities in people with BIF and Schizoid PD. Clinical, demographic, and neuropsychological data of forty-seven Schizoid PD participants, with an average age of 35, were analyzed. The sample split into two groups: Schizoid PD with BIF (BIF+: n = 24; intelligence quotient – IQ range: 71-84) and Schizoid PD without BIF (BIF-: n = 23; IQ range: 89-121). A descriptive analysis of the clinical and demographic characteristics of the two groups was performed.
 Methods: Neuropsychological measures (Wechsler Adult Intelligence Scale-Revised – WAIS-R IQ, factor index, subtest scores) and cognitive performance deficits in the two groups were compared using parametric and non-parametric tests, as necessary. Correlation coefficients were calculated for relationships between variables. Regression analyses were conducted to identify predictors associated with negative outcomes, such as substance use behavior.
 Results: The results revealed that the cognitive profile of BIF+ deviated significantly from that observed in BIF-. Peculiar BIF+ dysfunctions were found in the domains of verbal and perceptual reasoning, attention, memory, processing speed, planning, and problem-solving. The verbal IQ had the highest discriminative value for the presence of BIF in patients with Schizoid PD.
 Conclusions: The BIF condition and the verbal comprehension index were the predictors most associated with substance use behavior. Early identification of BIF should be relevant to planning targeted intervention strategies to improve daily life skills and outcomes.

Interrogative Suggestibility and Ability to Give Resistant Responses in Children with Mild Intellectual Disabilities and Borderline Intellectual Functioning

Children with intellectual disabilities can be victims of crimes but are generally deemed less reliable in the forensic context than children without disabilities. Their deficits may cause inaccurate recall, greater memory errors, and greater suggestive vulnerability. The aim of the present study is to verify the effects of intellectual abilities on recall tasks, levels of suggestibility, vulnerability to negative social pressure, and Resistant Behavioural Responses (RBR). The study involved 120 children aged 7–16 years who were administered the GSS2 (1997) and Raven Matrices. Forty children had a diagnosis of mild intellectual disability (MID), 40 had borderline intellectual functioning (BIF), and 40 were typically developing peers. Children with MID and BIF showed more errors in distortions, inventions, and confabulations at the recall task and higher levels of suggestibility.Low IQs reduced the ability of source monitoring and led to less resistant responses to misleading questions. IQ affected resistant responses both at the first and second suggestive interview, reducing both source monitoring capabilities and the ability to manage social pressure. Age may impact the ability to provide resistant responses but only in the first suggestive interview (Yield 1), which depends more on the maturity of cognitive processes involved in interrogative suggestibility.

Hao-Fountain syndrome: 32 novel patients reveal new insights into the clinical spectrum.

Hao-Fountain syndrome (HAFOUS, OMIM: #616863) is a neurodevelopmental disorder caused by pathogenic variants in the gene USP7 coding for USP7, a protein involved in several crucial cellular homeostatic mechanisms and the recently described MUST complex. The phenotype of HAFOUS is insufficiently understood, yet there is a great need to better understand the spectrum of disease, genotype-phenotype correlations, and disease trajectories. We now present a larger cohort of 32 additional individuals and provide further clinical information about six previously reported individuals. A questionnaire-based study was performed to characterize the phenotype of Hao-Fountain syndrome more clearly, to highlight new traits, and to better distinguish the disease from related neurodevelopmental disorders. In addition to confirming previously described features, we report hyperphagia and increased body weight in a subset of individuals. HAFOUS patients present an increased rate of birth complications, congenital anomalies, and abnormal pain thresholds. Speech impairment emerges as a potential hallmark of Hao-Fountain syndrome. Cognitive testing reports reveal borderline intellectual functioning on average, although some individuals score in the range of intellectual disability. Finally, we created a syndrome-specific severity score. This score neither indicates a sex- nor age-specific difference of clinical severity, yet highlights a more severe outcome when amino acid changes colocalize to the catalytic domain of the USP7 protein.

Congenital Bilateral Aniridia with Ectopia Lentis: A Case Report

Aniridia is characterised by variable degrees of hypoplastic iris or complete absence of iris tissue and is a rare congenital disorder. Mutation in the PAX6 gene is mostly responsible for aniridia. It is associated with various ocular manifestations involving both anterior and posterior segments of the eye. A 14-year-old male patient, presented to the ophthalmology outpatient department with complaints of a gradual decrease in vision in his left eye. Upon examination, photophobia and bilateral aniridia associated with nystagmus were present in both eyes, along with a sclerally fixated intraocular lens in the right eye and a superiorly subluxated mature cataract in the left eye. Intraocular pressure was elevated in the left eye. Gonioscopy revealed rudimentary iris tissue in both eyes. Upon systemic examination, the patient was diagnosed with hydro-ureteronephrosis of the right-side, which was asymptomatic, and borderline intellectual functioning. This case highlights the unique features of WAGR syndrome (Wilm’s tumour, Aniridia, Genito-urinary anomalies, Range of developmental delay) presenting with aniridia and genito-urinary conditions, along with borderline intellectual functioning without the presentation of Wilm’s tumour. Cataract extraction by lens aspiration with scleral fixation of intraocular lens implantation was performed in the left eye. This study adds to the broader knowledge of the disease entity’s spectrum, exploring the diagnostic challenges associated with the case and potentially influencing diagnostic criteria. It may guide future studies exploring the diverse clinical presentations of WAGR syndrome.

경계선급 지적 기능 학습자의 교육지원 현황과 요구에 대한 학부모, 교사, 교육전문가의 인식: 경기도를 중심으로

This study investigated the perceptions of parents, teachers, and related education experts regarding the status and needs of educational support for learners with borderline intellectual functioning in Gyeonggi-do. A total of 545 people participated in the online survey, including 148 parents, 243 teachers, and 154 related educational experts. The research participants said that they are currently experiencing difficulties in adapting to school life due to the fact that there is a blind spot in the education law and related system for learners with borderline intellectual functioning, and that there is no individualized educational support system according to the life cycle. The research participants requested the development of a school life support plan that reflects curriculum and career progression guidance, and social skills guidance that takes into account the characteristics of learners with borderline intellectual functioning. Based on the research results, a screening and diagnosis system was established based on the characteristics and support needs of learners with borderline intellectual functioning, a cooperation plan to strengthen school education accountability, and support for lifelong education in adulthood were proposed.

경계선급 지적 기능 학습자의 생애주기별 특성과 교육지원 요구: 경기도를 중심으로

In this study, we examined the perceptions of parties, parents, teachers, and experts regarding
 characteristics and educational support needs by life cycle of learners with borderline intellectual
 functioning, focusing on Gyeonggi-do. A total of 52 people were selected as research participants,
 including 6 adolescents with borderline intellectual function, 6 young adults, 8 parents, 13 teachers,
 and 19 relationship experts, and in-depth interviews were conducted. As a result of analyzing the
 interview data through continuous comparative analysis, the interview results were divided into 16
 superordinate categories and 38 categories centered on two main themes such as characteristics
 and educational support needs of learners with borderline intellectual functioning. Regarding
 subcategories, 82 contents were derived. Learners with borderline intellectual functioning who
 participated in the study were experiencing difficulties in learning and social adaptation throughout
 their entire life cycle, from preschool to adulthood, and related experts said that life cycle-specific
 support at the national level was needed for these learners. Based on the research results,
 implications on the direction of support for each life cycle were presented.

Comparison Metaphor and Reasoning Comprehension Between Children with Borderline Intelligence and Typical Developing School-Aged children

Purpose: Metalinguistic skills play a critical role in school-aged children’s language development and academic achievement. This study investigates whether metaphorical reasoning in children with borderline intellectual functioning (BIF) (or slow learners) differs from that of typically developing children.Methods: A total of 52 children (29 boys and 23 girls), who voluntarily agreed to participate in the study, were included. Children were categorized into three groups (15 slow learner group, 18 chronological age-matched group, and 19 language age-matched group) based on their K-WISC and receptive vocabulary scores in the Receptive and Expressive Vocabulary Test (REVT). All children completed the Metaphorical and Reasoning Comprehension test (MARC) to estimate their metaphor and reasoning comprehension ability.Results: As a result of a one-way analysis of variance, there was a significant difference among the groups, and a significant difference was found between the slow learners and the chronological age-matched group (<i>p</i>=0.000), but no significant difference was presented between the slow learner group and the language age-matched group. Similarly, regarding the expressive vocabulary score, a one-way ANOVA revealed a significant difference only between the slow learner and the chronological age-matched group (<i>p</i>=0.000). When comparing the scores for metaphorical reasoning comprehension among the three groups, the metaphorical reasoning comprehension scores were significantly different among the groups, with the slow learners having the lowest scores: the slow learner group was substantially different from the language age-matched group (<i>p</i>=0.025), while there was also a significant difference between the slow learner group and the chronological age-matched group (<i>p</i>=0.000).Conclusions: This study suggests that the semantic component of language is not affected in BIF children, but rather, the meaning of words is affected by tasks that require higher-order metalinguistic skills, such as understanding metaphorical inferences embedded in the context of a sentence. Accordingly, the ability to understand metaphorical reasoning can identify slow learners.

Psychometric analysis of the Group Climate Inventory-Revised in adults with mild intellectual disability or borderline intellectual functioning in a secure residential facility.

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. 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. 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). 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.

Borderline Intellectual Functioning and Vulnerability in Education, Employment and Family

Borderline Intellectual Functioning and Vulnerability in Education, Employment and Family

Mental health and service use of parents with and without borderline intellectual functioning.

People with borderline intellectual functioning (BIF) encounter greater social adversities than the general population and have an increased prevalence of mental illness. However, little is known about the socio-demographic characteristics and mental health of parents with BIF. A secondary data analysis of the Adult Psychiatric Morbidity Survey 2014 was conducted. Logistic regression models were fitted to compare differences in socio-demographic, mental health and service-use characteristics between parents and non-parents with and without BIF, and to investigate if the relationship between parent status and mental health outcomes was modified by BIF status, sex, and employment. Data from 6872 participants was analyzed; 69.1% were parents. BIF parents had higher odds of common mental disorder, severe mental illness, post-traumatic stress disorder, self-harm/suicide and were more likely to see their General Practitioner (GP) and to receive mental health treatment than non-BIF parents. BIF parents did not have a higher prevalence of mental health problems than BIF non-parents. Being a parent, after adjusting for BIF status and other confounders, was associated with increased odds of having a common mental disorder, visits to see a GP and treatment for mental health. Female parents had higher odds of treatment for mental health problems. Being a parent is associated with elevated rates of common mental disorders. There is a higher burden of mental health problems and service use in people with BIF. A greater provision of specialist support services including ascertainment is indicated for this group.

An AAIDD-informed framework for cognitive behavioral case formulation and cognitive behavior therapy for young people with mild intellectual disabilities or borderline intellectual functioning.

An AAIDD-informed framework for cognitive behavioral case formulation and cognitive behavior therapy for young people with mild intellectual disabilities or borderline intellectual functioning.

An AAIDD-informed framework for cognitive behavioral case formulation and cognitive behavior therapy for young people with mild intellectual disabilities or borderline intellectual functioning.

An AAIDD-informed framework for cognitive behavioral case formulation and cognitive behavior therapy for young people with mild intellectual disabilities or borderline intellectual functioning.

Insights into cognitive and behavioral comorbidities of SLC6A1-related epilepsy: five new cases and literature review.

SLC6A1 pathogenic variants have been associated with epilepsy and neurodevelopmental disorders. The clinical phenotype includes different seizure types, intellectual disability, and psychiatric symptoms affecting mood and behavior. Few data regarding neuropsychological features have been described, and details on cognitive profiles are often missing due to the lack of standardized tests. We retrospectively reviewed the neuropsychological assessments of five subjects carrying heterozygous missense genetic variants in SLC6A1. We also collected data on epileptic features, EEGs, and brain MRIs. Additionally, we reviewed neuropsychological data from 204 previously reported patients with SLC6A1 pathogenic variants. In our series, at the last evaluation (median 12.6 years), three patients had borderline intellectual functioning, one patient had mild cognitive impairment, and one patient presented with a moderate cognitive disability. Three out of five patients underwent at least two neuropsychological evaluations, which revealed a worsening of cognitive functions over time. We detected attention deficits in all patients. In addition, we observed anxiety, disruptive behavior disorder, emotional instability, and hetero aggressiveness. We also performed a literature review that highlighted that most of the patients with SLC6A1 pathogenic variants have mild-to-moderate intellectual disability and that one-third of cases have autistic traits. Based on the literature review and the detailed description of our cases, we conclude that patients with SLC6A1-related epilepsy mostly present with mild-to-moderate intellectual disability, often associated with attention disorders. Such symptoms may worsen over time. Periodic standardized neuropsychological tests may be useful tools to follow development over time, and patient-specific rehabilitation programs could be tailored consistently.

Neuropsychiatric comorbidities and cognition in epilepsy with eyelid myoclonia: A retrospective pediatric case series.

Epilepsy with eyelid myoclonia (EEM) is a rare epileptic syndrome classified within the Genetic Generalized Epilepsies of childhood. It is characterized by a high drug resistance, and little is known about prognostic factors and neurodevelopmental comorbidities. The aim of this study was to describe the clinical features, cognitive profile, and prognostic factors in a series of children with EEM. This is a retrospective observational study of patients diagnosed with EEM from 2012 to 2022 in a tertiary pediatric hospital. Seventeen patients were analyzed (mean age at symptom onset 5.8 years). Neuropsychiatric comorbidities were present in 76.4% (attention deficit hyperactivity disorder 58.8%, behavioral disorder 11.8%, autism spectrum disorder 11.8%, and psychotic outbreaks 11.8%). Neurocognitive assessment was performed in 75%, revealing cognitive impairment in 66.6% (62.5% with borderline intellectual function and 37.5% with -IQ <70-), with predominant difficulties in executive functions, comprehensive language, and motor skills. Cognitive deterioration was observed in one patient in parallel onset with psychotic symptoms. High refractoriness to antiseizure medication (ASM) was observed, with only 23.5% of the patients being seizure-free after a mean follow-up of 7 years. The most effective ASM was valproic acid, and two of them received ketogenic diet with good response. Regarding prognostic factors, psychotic symptoms were associated with a greater number of antiseizure medication (p < .05) implying a more drug-resistant epilepsy. In our study, we found a high rate of cognitive and psychiatric comorbidities and high refractoriness. These data support the concept of EEM as an intermediate entity between idiopathic generalized epilepsy and epileptic and/or neurodevelopmental encephalopathy. Making a proper diagnosis and management of these comorbidities is necessary to improve prognosis and quality of life in EEM.

Evaluating the Effectiveness of Take it Personal!+ in People With Mild Intellectual Disability or Borderline Intellectual Functioning and Substance Use Disorder: A Multiple Baseline Single-Case Experimental Study

Individuals with mild intellectual disabilities or borderline intellectual functioning are at increased risk to develop a substance use disorder—however, effective treatment programs adapted to this target group are scarce. This study evaluated the effectiveness of Take it Personal!+ in individuals with mild intellectual disabilities or borderline intellectual functioning and substance use disorder. Take it Personal!+ is a personalized treatment based on motivational interviewing and cognitive-behavioral therapy supported by an mHealth application. Data were collected in a nonconcurrent multiple baseline single-case experimental design across individuals with four phases (i.e., baseline, treatment, posttreatment, and follow-up). Twelve participants were randomly allocated to baseline lengths varying between 7 and 11 days. Substance use quantity was assessed during baseline, treatment, and posttreatment with a daily survey using a mobile application. Visual analysis was supported with statistical analysis of the daily surveys by calculating three effect size measures in 10 participants (two participants were excluded from this analysis due to a compliance rate below 50%). Secondary, substance use severity was assessed with standardized questionnaires at baseline, posttreatment, and follow-up and analyzed by calculating the Reliable Change Index. Based on visual analysis of the daily surveys, 10 out of 12 participants showed a decrease in mean substance use quantity from baseline to treatment and, if posttreatment data were available, to posttreatment. Statistical analysis showed an effect of Take it Personal!+ in terms of a decrease in daily substance use in 8 of 10 participants from baseline to treatment and if posttreatment data were available, also to posttreatment. In addition, data of the standardized questionnaires showed a decrease in substance use severity in 8 of 12 participants. These results support the effectiveness of Take it Personal!+ in decreasing substance use in individuals with mild intellectual disabilities or borderline intellectual functioning.

Developing a recovery-oriented intervention for people with severe mental illness and an intellectual disability: design-oriented action research.

Mild intellectual disability or borderline intellectual functioning (MID/BIF) are common in people with severe mental health problems (SMHP). Despite this, there is a lack of treatments adapted for this group of clients. This qualitative study describes the development of a new intervention, guided by the principles of action research, for people with SMHP and MID/BIF and mental health professionals to help them talk about all aspects of the process of recovery. The intervention was developed in four cycles and in close cooperation with mental health professionals, experts by experience, other experts in the field of SMHP or MID/BIF, and clients. During all cycles there was a strong focus on the content of the intervention, exercises, understandable language, and drawings for visual support. This resulted in the intervention "Routes to Recovery," which covers both complaints and strengths, coping strategies, helpful (social) activities, and how to determine future steps in a recovery plan. Routes to Recovery is a first step in helping professionals and their clients with SMHP and MID/BIF to have a conversation about personal strengths and what the client needs to recover. Future research should investigate the effects of this intervention.