Developmental Behaviour Checklist Research Articles

A pilot randomised controlled trial of a telehealth-delivered brief ‘Sleeping Sound Autism’ intervention for autistic children

BackgroundAccess to behavioural sleep intervention is beneficial for autistic children, yet many families face barriers to access associated with location and time. Preliminary evidence supports telehealth-delivered sleep intervention. However, no studies have evaluated brief telehealth sleep intervention. To address this, we evaluated telehealth delivery of the brief behavioural Sleeping Sound Autism intervention, using a two-armed, parallel-group, non-blinded, pilot randomised controlled trial (RCT) design (trial registration: ANZCTR12620001276943). MethodSixty-one families of autistic children without intellectual disability (5–12 years, 46% female) with caregiver-reported moderate–severe behavioural sleep problems participated Australia-wide, randomised to an intervention (n = 30) or treatment as usual control group (n = 31). Intervention group participants were invited to attend two video-conference telehealth sessions and one follow-up phone call with a trained clinician. Survey data was collected from caregivers at baseline and three- and six-months post-randomisation, to evaluate feasibility, acceptability, and efficacy. Ten intervention group caregivers participated in end-of-study semi-structured interviews to explore their experiences. ResultsForty-nine caregivers completed surveys. At baseline, 87% felt positive and 84% felt confident about participating via telehealth, and 75% believed the program would improve child sleep. At three-months, intervention group caregivers (n = 24) reported the usefulness (100%) of and preference for (71%) telehealth, and 95.8% would recommend this sleep program to other families. A significant group by time difference was observed in child sleep (Children's Sleep Habits Questionnaire) with large effect sizes (d = 0.87–1.05), emotion and behaviour (Developmental Behavior Checklist 2) with moderate effect sizes (d = 0.40–0.57), and caregiver mental health (Kessler 10) with small to moderate effect sizes (d = 0.60–0.28), favouring the intervention group (n = 23). There were no significant group differences in child (Child Health Utility instrument) or caregiver (Assessment of Quality of Life) quality of life. However, there were individual differences in the clinical significance of improved child sleep. Qualitative data showed that whilst telehealth was convenient for caregivers, without attenuating the benefits of most key intervention features, not all children were able to engage effectively with the clinician via telehealth. ConclusionsThis first pilot RCT of a brief telehealth behavioural sleep intervention for primary-school-aged autistic children suggests that telehealth delivery is acceptable, feasible and likely efficacious in improving sleep in the short-term. Providing families with ongoing choice of mode of delivery (telehealth/in-person) and examining the person-environment fit of telehealth for autistic children is important.

Dyskinetic Cerebral Palsy in Children: Clinical Perspectives on Common Comorbidities and Health-Related Quality of Life.

The data on specific comorbidities in children with dyskinetic cerebral palsy (DCP) is limited. We evaluated the pattern of comorbidities and health related quality of life (HRQOL) in these children and compared them between etiological and motor impairment subgroups. This cross-sectional study was conducted over 18 months in children with DCP of both sex, and age between one and 14 years. Comorbidities were assessed using standardized scales such as gross motor functioning scale (GMFCS), developmental profile-3 (DP-3), developmental behaviour checklist, sleep behaviour questionnaire (SBQ), and caregiver questionnaire. Sixty-five children with DCP were evaluated (hyperbilirubinemia n = 43, 66% and perinatal asphyxia n = 19, 29%). The majority of children were severely affected in gross motor functioning (level IV 29.2% and level V 53.8%). Epilepsy was seen in 21.5% of cases (19% in hyperbilirubinemia and 32% in asphyxia, p = 0.4). The mean age of onset of seizures was 15.4 + 20.6 months (range 2-72). Visual problems were seen in 54% of cases and included upgaze palsy, squint, refractive error, optic atrophy and cortical blindness. A significant proportion of children with hyperbilirubinemia had upgaze palsy as compared to those with perinatal asphyxia (70% vs. 32%, p 0.01). Rest of the visual problems were not significantly different between the two etiological subgroups. Drooling (87.6%), protein-energy malnutrition (66.6%), and reflux (57%) were the most common gastrointestinal problems in children with DCP. Children with DCP showed problems in social relating (33.8%), anxiety (26.2%), and self-absorbed behaviour (7.7%). However, there were no statistically significant differences between the etiological, motor impairment and age-based subgroups. Children with DCP had high scores on SBQ, suggesting sleep problems. Sleep scores were similar in the hyperbilirubinemia and perinatal asphyxia subgroups. Greater sleep problems were noted in children aged < 4y (70.6 + 10.1 vs. 56.5 + 11.3, p < 0.05 as compared to children above 4y of age) and severe motor impairments (68.2 + 11.3 vs. 57.2 + 13.1, p 0.008 as compared to mild-moderate motor impairment). Poor overall developmental scores were seen in 61.5% children and were significantly associated with GMFCS (p 0.04). The majority of children showed impairments in physical (58.5%), adaptive behaviour (58.5%), social-emotional (50.8%), cognitive (60%) and communication (52%) subscales of DP-3. Cognitive impairment was similar in the etiological (hyperbilirubinemia vs. perinatal asphyxia, p = 0.3), and motor impairment (mild-moderate vs. severe, p = 0.9) subgroups. HRQOL was significantly affected by motor impairment in positioning-transfer (p value 0.0001), and interaction-communication domains (p value 0.0001), however, there was no difference based on the etiology of hyperbilirubinemia and asphyxia. Children with DCP demonstrate several comorbidities and impaired quality of life. These are similar in hyperbilirubinemia and perinatal asphyxia cohorts, expect for significant proportion of upgaze palsy in DCP secondary to hyperbilirubinemia. Younger children have more problematic behaviour and impaired sleep quality. Severe motor disability influences the developmental outcomes, cognition, sleep and HRQOL in children with DCP.

Applicability and Psychometric Properties of General Mental Health Assessment Tools in Autistic People: A Systematic Review.

In recent years, there has been a proliferation of instruments for assessing mental health (MH) among autistic people. This study aimed to review the psychometric properties of broadband instruments used to assess MH problems among autistic people. In accordance with the PRISMA guidelines (PROSPERO: CRD42022316571) we searched the APA PsycINFO via Ovid, Ovid MEDLINE, Ovid Embase and the Web of Science via Clarivate databases from 1980 to March 2022, with an updated search in January 2024, to identify very recent empirical studies. Independent reviewers evaluated the titles and abstracts of the retrieved records (n = 11,577) and full-text articles (n = 1000). Data were extracted from eligible studies, and the quality of the included papers was appraised. In all, 164empirical articles reporting on 35 instruments were included. The review showed variable evidence of reliability and validity of the various instruments. Among the instruments reported in more than one study, the Aberrant Behavior Checklist had consistently good or excellent psychometric evidence. The reliability and validity of other instruments, including: the Developmental Behavior Checklist, Emotion Dysregulation Inventory, Eyberg Child Behavior Inventory, Autism Spectrum Disorder-Comorbid for Children Scale, and Psychopathology in Autism Checklist, were less documented. There is a need for a greater evidence-base for MH assessment tools for autistic people.

Caregiver reported behavior, sleep and quality of life in children with Dravet syndrome: A population-based study

ObjectiveThe aim of this population-based study was to assess behavior, sleep, and quality of life, and explore factors associated with these in children with Dravet syndrome. MethodsThe Developmental Behavior Checklist, the Insomnia Severity Index, and a global question regarding quality of life from the Epilepsy and Learning Disabilities Quality of Life scale were completed by primary caregivers of 42/48 Swedish children with Dravet syndrome, born 2000–2018. Factors associated with problems with insomnia, behavior and quality of life were analyzed using multivariable linear regression. ResultsScores indicating significant behavioral problems were seen in 29/40 (72 %) children, scores indicating moderate or severe clinical insomnia in 18/42 (43 %) and scores indicating poor or very poor quality of life in 7/41 (17 %). On multivariable analysis, autistic symptoms were significantly associated with behavioral problems (p = 0.013), side-effects of anti-seizure medications (ASMs) were associated with insomnia (p = 0.038), whilst insomnia was significantly associated with poor quality of life (p = 0.016). SignificanceDravet syndrome in children is associated with significant problems with behavior, sleep and quality of life. There is a need to optimize treatment via ASMs and develop and evaluate interventions to treat behavioral and sleep difficulties to optimize outcomes.

Validering av den norske foreldreversjonen av Developmental Behavior Checklist (DBC-P)

This study examined the psychometric properties of the Norwegian version of the Developmental Behavior Checklist – Parent (DBC-P) in an intellectual and developmental disabilities (IDD) sample of children and adolescents (N = 168). Internal consistency was adequate to excellent for all scales (Cronbach’s alpha ranged between .70–.96). The DBC-P showed meaningful overlap with and differentiation from the Aberrant Behavior Checklist, clinical diagnoses, the Vineland Adaptive Behavior Scales, and the Full Scale IQ. The Norwegian scale scores for a mild IDD level were comparable with the American norms. Further research including severe IDD levels is needed on the Norwegian DBC-P. In summary, the study shows that the Norwegian DBC-P has both adequate reliability and validity. Keywords: Developmental Behavior Checklist, intellectual and developmental disabilities, mental health problems

Daytime sleepiness and emotional and behavioral disturbances in Prader-Willi syndrome

Individuals with Prader-Willi syndrome (PWS) often have excessive daytime sleepiness and emotional/behavioral disturbances. The objective of this study was to examine whether daytime sleepiness was associated with these emotional/behavioral problems, independent of nighttime sleep-disordered breathing, or the duration of sleep. Caregivers of individuals with PWS (aged 3 to 25 years) completed the Pediatric Sleep Questionnaire (PSQ), Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), and the parent version of the Developmental Behavior Checklist (DBC-P). Sleep adequacy was adjusted for age by computing sleep duration against age-specific recommendations. The associations between ESS-CHAD and the total DBC and its subscale scores were evaluated by linear regression, adjusted for sleep-related breathing difficulties, sleep adequacy, and body mass index (BMI). There were 54 responses for individuals with PWS (including 22 males) aged 4.4–24.0 (mean 12.5) years. Daytime sleepiness predicted a substantial proportion of the variance in total DBC-P scores in the unadjusted model (28%; β = 0.028; p < 0.001) and when adjusted for sleep adequacy, BMI, and sleep-related breathing difficulties (29%; β = 0.023; p = 0.007). This relationship was not moderated by BMI Z-scores, but the relationship was more prominent for children younger than 12 years than for children older than 12 years.Conclusions: These findings provide preliminary novel evidence that daytime sleepiness may drive the expression of emotional/behavioral disturbances, and should be explored as a potential modifiable risk factor for these disturbances in PWS, particularly pre-adolescent children.What is Known:• Individuals with Prader-Willi syndrome (PWS) commonly experience excessive daytime sleepiness and exhibit emotional/behavioral disturbances.• In the typically developing population, sleepiness is associated with emotional/behavioral disturbances, independently of sleep-disordered breathing..What is New:• This study found evidence for a direct link between daytime sleepiness and emotional/behavioral disturbances, independent of sleep-related breathing difficulties, sleep adequacy, and body mass index.• Excessive daytime sleepiness may be a modifiable risk factor for emotional/behavioral disturbances in PWS.

An evaluation of the German teacher version of the Developmental Behaviour Checklist in children and adolescents with intellectual disability

ABSTRACT Background The Developmental Behaviour Checklist (DBC) is an established, internationally used questionnaire for assessing behavioural and emotional problems among young people with developmental or intellectual disabilities (ID). The present study aims to evaluate the psychometric properties of its German teacher version (DBC-T). Method The German DBC-T was administered to 397 school staff members who reported twice on 1177 children and adolescents with ID over a period of 7–9 months. Data were analysed within an exploratory structural equation modelling framework. Results Our results supported the five-factor structure of the DBC-T and found good reliability for all scales. Analyses on the relationship of DBC-T scores with students’ age, gender, and adaptive behaviour provided further evidence for the validity of the DBC-T. Conclusions Our study endorses the notion that the German DBC-T is an important instrument both for research and practice. Limitations and further directions are discussed.

Strengths and challenging behaviors in children and adolescents with Prader-Willi syndrome: Two sides to the coin.

Prader-Willi Syndrome (PWS) is a rare genetic disorder associated with emotional/behavioral disturbances. These difficulties are well documented in the literature, but the positive attributes of these individuals are not described. Taking a strengths-based approach, the aim of this study was to describe the emotional/behavioral strengths and difficulties in children and young people with PWS from their parent caregivers' perspectives. Parent caregivers of 52 individuals with PWS aged 4-24 years (median=12.1 years; including 22 males) completed the parent form of the Developmental Behavior Checklist (DBC-P), including its original two open-ended questions regarding positive traits. Prevalences of emotional/behavioral disturbances were comparable to those reported in previous literature: common behaviors of concern across studies being skin-picking (75%), impulsivity (69%), poor sense of danger (67%), lying (67%), and tantrums (54%). Total DBC-P scores showed that just over half (n=28, 54%) had scores indicative of clinically significant behavior problems. However, thematic analysis of caregivers' written comments regarding their children's strengths resolved into three themes: warmth (94%), persistence (41%), and skills (41%). Warmth encompassed friendliness, happiness, and empathy. A strength-based approach to behavioral difficulties in PWS provides a more balanced view of the children and a more holistic foundation for interventions.

Anxiety in Angelman Syndrome.

Angelman Syndrome (AS) is a neurodevelopmental disorder most commonly caused by the impaired expression of the maternal UBE3A gene on chromosome 15. Though anxiety has been identified as a frequently present characteristic in AS, there are limited studies examining anxiety in this population. Studies of anxiety in other neurodevelopmental disorders have found disorder specific symptoms of anxiety and age specific displays of anxiety symptoms. However, there is a consistent challenge in identifying anxiety in people with neurodevelopmental disorders given the lack of measurement instruments specifically designed for this population. Given the limited information about AS and anxiety, the aims of the current project were to (a) examine symptoms of anxiety in children with AS and (b) determine the correlates of anxiety in children with AS. Participants included 42 adult caregivers of youth with AS in the AS Natural History study who completed the Developmental Behavior Checklist (DBC). The results found that 26% of the sample demonstrated elevated symptoms of anxiety and established a relationship between elevated anxiety in youth with AS and higher levels of irritability, hyperactivity, self-absorbed behaviors, and disruptive/antisocial behaviors. Findings from this research provide a foundation for tailoring evidence-based assessments and treatments for youth with AS and anxiety.

Antioxidant interventions in autism spectrum disorders: A meta-analysis

BackgroundAutism spectrum disorder (ASD) might be associated with oxidative stress, and antioxidants are commonly used in the treatment of young people with ASD. However, the evidence about the effectiveness of these interventions remains debatable. We performed a meta-analysis to evaluate the effect of antioxidants on the symptoms of patients with autism. MethodsData sources: PubMed and Web of Science databases. Study selection: We selected placebo-controlled, double-blind, randomized clinical trials published until February 2021 to evaluate the efficacy of antioxidant interventions on ASD. Data analysis: Aberrant Behavior Checklist (ABC), Repetitive Behavior Scale-Revised (RBS), Social Responsiveness Scale (SRS), Developmental Behavior Checklist (DBC) and Clinical Global Impressions Severity scale (CGIS) were used to evaluate the 22 different symptom outcomes. The Hedges-adjusted g value was used to estimate the effect of each dietary intervention relative to the placebo. ResultsIn this meta-analysis, we examined 13 double-blind randomized clinical trials, comprising a total of 570 patients with ASD: 293 in the intervention group and 277 in the placebo group. Antioxidants (N-acetylcysteine (NAC), other antioxidants) are more effective than placebos in improving the irritability among symptoms in the ABC and communication disturbance symptoms in the DBC. There was a good trend of improvement in the stereotypic behavior symptoms in the ABC. Treatment with NAC antioxidants showed a good trend of improvement in irritability in the ABC and symptoms of hyperactivity. The effect size was small, and there was a low risk of statistical heterogeneity and publication bias. Limitations: The number of studies in this meta-analysis was small and the sample size was small. ConclusionThis meta-analysis suggests that antioxidant intervention has a potential role in the management of some symptoms in patients with ASD, and indicates the feasibility of using antioxidants to treat autism in the future.

Effect of Behavior Modification Intervention Through Parents and Teachers Support among Adolescents with Special Needs

The study ‘Effect of Effect of Behavior Modification Intervention Through Parents and Teachers Support among Adolescents with Special Needs’- was conducted in Chennai, at the ‘National Institute for the Empowerment of Persons with Multiple Disabilities’ (NIEPMD) and the ‘Spastic Society of Tamil Nadu’ (SPASTN) by using Convenient Sampling Method. Initially, 50 adolescents were randomly selected. They were screened for categorization and final selection (n=30). The sample included 19 boys and 11 girls in the age range of 12-18 years. The tools used for assessment were the Case History Schedule (2015) developed by the researcher, Test of Non-Verbal Intelligence (Brown, Sherbenou & Johnsen, 2010), Swassing-Barbe Modality Test (Barbe & Swassing, 1979), and the Developmental Behavior Checklist (Parent and Teacher Versions) Einfeld & Tonge, 2002. The Behavior Modification Intervention was applied to the sample with the help of their parents and teachers as support system. After two months, the re-assessment was done using the DBC tool. The follow-up session was conducted to analyze the sustenance of the outcome. The aim was to manage the behavior turbulences in the adolescents with the help of their parents and teachers. Repeated measures- One-Way ANOVA was conducted to obtain the statistical results. The findings indicated a significant reduction in the behavior issues. This indicates that the effect of behavior modification intervention shows promising result among the sample.

Health Profile of Australian Adolescents with Intellectual Disability

Background: Data on the health of adolescents with intellectual disability are scarce. This study describes carer-reported symptoms, chronic illnesses, level of functioning, and behaviour among Australian adolescents with intellectual disability. We compare students attending mainstream and special schools. Methods: Cross-sectional questionnaire data were obtained from a cohort of 592 adolescents (10–21 years) with intellectual disability attending school and living in South-East Queensland, Australia, in May 2007. We analysed data from a subset (176) who completed a health check before visiting their general practitioners. Results: Adolescents had significant health needs, and those in special education schools had worse health than those from mainstream schools. There was a discrepancy between the prevalence of significant psychopathology detected via the short form Developmental Behaviour Checklist (DBC-P24) and psychiatric conditions reported by carers. Conclusions: Given the significant health needs of this population, carefully designed and targeted programs, potentially including medical visits to these schools, are needed.

Objective and Subjective Prevalence of Obstructive Sleep Apnoea/Hypopnoea Syndrome in UK Adults with Down Syndrome: A Strong Marker for Diurnal Behavioural Disturbances.

Prior to this study, the prevalence of obstructive sleep apnoea/hypopnoea syndrome (OSAHS) in adults with Down syndrome was unknown. We hypothesized that unrecognised OSAHS could have an additional deleterious impact on mood and behavioural disturbances in this group of people. Aims: To assess the prevalence of OSAHS in adults with Down syndrome in the United Kingdom, subjectively and objectively, and ascertain its association with diurnal behavioural disturbances. Method: Cross-sectional questionnaire study with home sleep apnoea testing (HSAT) during 2011–2015 across the four nations of the United Kingdom. Participants were adults aged ≥16 years with Down syndrome. Main outcome measures were: self- or caregiver-completed questionnaire data, including the Pictorial Epworth Sleepiness Scale (pESS), selected domains of the Developmental Behavioural Checklist for Adults (DBC-A), anthropometric measures, and symptoms of OSAHS. Objective prevalence was undertaken in a sample of responders using HSAT. Results: Responses were received from 1321/5270 participants (25%), with 1105 valid responses (21%). Eighty-one participants (7%) reported a prior diagnosis of OSA, of whom 38 were receiving therapy. Using validated algorithms, a diagnosis of OSAHS was probable in 366 participants (35%), who were younger, with higher BMI and higher mean total pESS (p < 0.0001). A total of 23% of participants had a pESS > 10. OSAHS was a strong marker for behavioural disturbances on the DBC-A depression, disruption and anti-social subscales (p < 0.001). Of 149 individuals who underwent HSAT, 42% were diagnosed with OSAHS. Conclusions: Untreated OSAHS in Down syndrome is common and associated with behavioural and mood disturbances. Improving awareness of OSAHS amongst adults with Down syndrome, their families and healthcare professionals is essential.

Clinical utility of the parent-reported Strengths and Difficulties Questionnaire as a screen for emotional and behavioural difficulties in children and adolescents with intellectual disability.

We assessed the clinical utility of the parent-reported Strengths and Difficulties Questionnaire (SDQ) as a screen for emotional and behavioural difficulties in 626 children and young people with intellectual disability. Using the Developmental Behavior Checklist (DBC2-P) to determine clinical caseness, the area under the curve for the SDQ total difficulties score was 0.876 (95% CI 0.841-0.911), indicating that it is a good measure for identifying significant emotional and behavioural difficulties requiring further investigation. Analyses supported the use of the same SDQ cut-off for those with and without intellectual disability, which may assist with consistent and comparable assessment in clinical practice.

Behavioural and emotional disturbances associated with sleep-disordered breathing symptomatology in children with Down's syndrome.

Down's syndrome (DS) predisposes to sleep-disordered breathing (SDB). In children with DS, behavioural and emotional disturbances secondary to SDB are often assumed to result from cognitive impairment alone. Our aim was to explore the relationship of behavioural and emotional disturbances with SDB in a population of children with DS. A modified sleep questionnaire, Epworth Sleepiness Scale (ESS), Paediatric ESS and the short form of the developmental behaviour checklist (DBC-P24) were sent to 261 carers of children aged 4 to 15years with DS in 2012. Of 120 participants, 25% had probable SDB. In children with probable SDB compared to those without nocturnal symptoms, the total behaviour problem score (TBPS) was significantly higher (20.3±8.6/48 vs. 12±7.5/48; P=0.002) as was the PaedESS (7.7±5.6/24 vs. 2.8±3.5/24; P=0.002). For every increase in frequency of choking attacks, snoring and night awakenings, the TBPS increased by 1.37, 1.28 and 1.75 points, respectively, indicating worsening behaviour. The TBPS was found to decrease by 1.31 points for every hour more of self-reported sleep duration (r=-0.25, P=0.017). SDB symptoms and shorter self-reported sleep duration are highly prevalent among children with DS and are independently associated with worsening behaviour using the TBPS.

Assessment of emotions and behaviour by the Developmental Behaviour Checklist in young people with neurodevelopmental CNVs.

A number of genomic conditions caused by copy number variants (CNVs) are associated with a high risk of neurodevelopmental and psychiatric disorders (ND-CNVs). Although these patients also tend to have cognitive impairments, few studies have investigated the range of emotion and behaviour problems in young people with ND-CNVs using measures that are suitable for those with learning difficulties. A total of 322 young people with 13 ND-CNVs across eight loci (mean age: 9.79 years, range: 6.02-17.91, 66.5% male) took part in the study. Primary carers completed the Developmental Behaviour Checklist (DBC). Of the total, 69% of individuals with an ND-CNV screened positive for clinically significant difficulties. Young people from families with higher incomes (OR = 0.71, CI = 0.55-0.91, p = .008) were less likely to screen positive. The rate of difficulties differed depending on ND-CNV genotype (χ2 = 39.99, p < 0.001), with the lowest rate in young people with 22q11.2 deletion (45.7%) and the highest in those with 1q21.1 deletion (93.8%). Specific patterns of strengths and weaknesses were found for different ND-CNV genotypes. However, ND-CNV genotype explained no more than 9-16% of the variance, depending on DBC subdomain. Emotion and behaviour problems are common in young people with ND-CNVs. The ND-CNV specific patterns we find can provide a basis for more tailored support. More research is needed to better understand the variation in emotion and behaviour problems not accounted for by genotype.

Incontinence in persons with tuberous sclerosis complex.

Tuberous sclerosis complex (TSC) is a multisystem genetic disorder caused by a mutation in the TSC1 or TSC2 gene with a broad spectrum of physical and psychological manifestations. The aim of the study was to examine incontinence, psychological problems, and adaptive behavior skills in patients with TSC. Through a worldwide TSC support group, 26 children (4-17 years) and 15 adults (18-50 years) with TSC were recruited (38.1% male, mean age 16.4 years). Parents or care-givers completed the Developmental Behavior Checklist (DBC), the Parental Questionnaire: Enuresis/urinary Incontinence, and the Vineland Adaptive Behavior Scales (3rd edition). A total of 60.0% of the participants had nocturnal enuresis (NE), 51.3% daytime urinary incontinence (DUI) and 52.4% fecal incontinence (FI). 65.4% of children and 50.0% of adults had a clinically relevant DBC score. Psychological symptoms were associated with at least one subtype of incontinence. The mean adaptive behavior composite (ABC) score of the patients was 57.2 (SD = 26.1), with 38.1% in the average or below-average range (IQ >70), 26.2% with a mild, 11.9% with a moderate and 23.8% with a severe/profound intellectual disability. The incontinence rate was significantly higher in the groups with a lower ABC score. A substantial proportion of patients with TSC are affected by incontinence and psychological symptoms. Incontinence was higher in persons with lower adaptive skills and those with at least one type of incontinence showed a significantly higher DBC score. As incontinence and psychological problems affect daily functioning and well-being, assessment, and treatment are recommended.

Prevalence estimates of mental health problems in children and adolescents with intellectual disability: A systematic review and meta-analysis

Children and adolescents with intellectual disability are at risk of developing psychiatric symptoms and disorders; yet, the estimates reported in the literature have been inconsistent, presenting a potential barrier for service planning and delivery. Sources of variability could arise from differences in measurement instruments as well as subgroup membership by severity of intellectual disability, gender and age. This systematic review aimed to address these gaps. MEDLINE and PsycINFO databases were searched from inception to 2018 and selected studies were reviewed. Studies were included if they reported point prevalence estimates of mental health symptomology or diagnoses in a general population of 6- to 21-year-old individuals with intellectual disability. The Joanna Briggs Institute Prevalence Critical Appraisal Checklist was applied to eligible papers to appraise their scientific strength. Pooled prevalence for mental health symptomology was determined using a random-effects meta-analysis. A total of 19 studies were included, including 6151 children and adolescents. The pooled prevalence estimate captured by the Developmental Behaviour Checklist was 38% (95% confidence interval = [31, 46]), contrasting with 49% (95% confidence interval = [46, 51]) captured by the Child Behaviour Checklist; both rates were higher than a non-intellectual disability population. Severity of intellectual disability did not significantly influence the Developmental Behaviour Checklist risks. Insufficient data were available to conduct statistical analyses on the effects of age, gender and socioeconomic status. Of diagnosed psychiatric disorders, attention deficit/hyperactivity disorder (30%), conduct disorder (3-21%) and anxiety disorders (7-34%) were the most prevalent conditions. This review consists of the largest sample hitherto evaluated. In the intellectual disability population, mental health comorbidities could be better detected by a symptom phenotype than a psychiatric diagnostic phenotype. Crucially, future research needs to address the effect of measurement validity in the intellectual disability population. Estimated prevalence rates were high compared to the general population, indicating the importance of systematic screening, case detection and appropriate management.

The Role of Impulsive Behavior in Predicting the Emotional/ Behavioral Problems of Adults with Intellectual Disability

The purpose of this research was to investigate the role of impulsive behavior in the prediction of the emotional/behavioral problems of adults with intellectual disability (ID). The statistical population included all adults with ID who were being trained in vocational rehabilitation centers, supported by the State Welfare Organization of Iran and the educational organization for children with special needs, in Shahrekord, Iran, in 2017-2018. The sample consisted of 134 adults with ID, selected through convenience sampling. The Barratt Impulsiveness Scale Version 11 (BIS-11) was used for measuring the impulsive behavior and The Developmental Behavior Checklist for Adults was used for measuring the emotional and behavioral problems. The collected data were analyzed using the Pearson correlation coefficient and simultaneous multiple regression. The results showed that impulsive behavior was a positive and significant predictor for emotional/behavioral problems and its subscales (P&lt;0.01). Impulsive behaviors could predict emotional/behavioral problems such as self-absorbed problems, disruptive problems, antisocial problems, depressive problems, communication and anxiety disturbance and social relating problems. Therefore, designing and implementing preventive and interventional programs to improve the impulsive behavior of adults with ID appears to be necessary to reduce their emotional/behavioral problems.

Age-related changes in behavioural and emotional problems in Smith-Magenis syndrome measured with the Developmental Behavior Checklist.

Smith–Magenis syndrome (SMS) is a genetic syndrome most often caused by a deletion on chromosome 17 or more rarely by a mutation in the retinoic acid-induced 1 gene. The aim of this study was to investigate the Developmental Behavior Checklist (DBC) profile of persons with SMS and the associations between behavioural and emotional problems, age, gender, adaptive behaviour and autism symptomatology. Twenty-eight persons with SMS were represented by their parents in this study. DBC Total scores are reduced with age, but they still show a mean that is clearly above the cut-off of 46. The differences between the age groups <9 years and 9–17 years (p = 0.024) and between the age groups <9 years and >18 years (p = 0.007) are significant. We found a significant decrease in behavioural and emotional problems with age in SMS. We did not find a relationship between adapted behaviour and communication and behavioural and emotional problems.