Evidence-Based Practice and Intellectual Disabilities E-Book

Peter Sturmey

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 661

Veröffentlichungsjahr: 2014

Beschreibung

Evidence-Based Practice and Intellectual Disabilities responds to the recent increased focus on, and need for, the use of evidence-based practice (EBP) in treating intellectual disabilities.

• The first book wholly dedicated to addressing EBP specifically in relation to intellectual disabilities
• Provides clinical guidelines based on the strength of evidence of treatments for a given problematic behavioral topography or disorder
• Highly relevant to a wide-ranging audience, including professionals working in community services, clinicians and parents and carers

Leseprobe

CONTENTS

Cover

Title Page

Copyright Page

Contributors

Preface

Aim of This Volume

Overview of the Volume

Future Directions

Reference

Acknowledgments

Part I: Foundational Issues and Overview

1 Evidence-Based Practice

Evidence-Based Practice

What Is Evidence-Based Practice?

Rationale

Methods Used in Evidence-Based Practice

Evidence-Based Practice and Developmental Disabilities

A Challenge Revisited

References

2 Adaptive Behavior

General Adaptive Behavior

Specific Adaptive Behaviors

References

3 Maladaptive Behavior

General Challenging Behavior

Specific Maladaptive Behavior

Specific Interventions

Summary

References

4 But Is It Worth It?

Intellectual Disabilities Services Are Often Expensive

Reluctance to Address Economic Evaluations

Methodologies to Evaluate Costs and Benefits

Applications

What Treatments Are Missing?

Summary

References

Part II: Specific Disorders and Challenging Behavious

5 Aggressive Behavior

Introduction

Definition

Prevalence and Risk Factors

Etiology

Impact

Search Strategies

Treatment Review

Conclusions

Guidelines and Recommendations

References

6 Self-Injurious Behavior

Introduction

The Nature of SIB among Individuals with ID

Methodology for Identifying Treatment Studies

Treatment Review

Clinical Guidelines

References

7 Stereotypic Behavior

Overview

Functions of Stereotypic Behavior

The Evidence Base for Treatment of Stereotypy

Promising Procedures

Insufficient or Inadequate Research

Conclusion

Future Directions

References

8 Feeding Problems

Food Refusal

Pica

Rumination

Other Feeding Issues

General Discussion

References

9 Sleep Problems

Introduction

Search Strategy and Treatment Classification

Melatonin

Behavioral Strategies

Extinction

Graduated Extinction

Bedtime Fading

Differential Reinforcement

Relaxation

Other Strategies

Alternative Therapies

Guidelines

References

10 Anxiety Disorders

Overview

Anxiety Disorders in People with Intellectual Disabilities

Fears and Phobias

Obsessive–Compulsive Disorders

Posttraumatic Stress Disorder

Summary and Conclusions

References

11 Mood Disorders

Introduction

Search Strategies

Review of the Evidence

Conclusions

Acknowledgment

References

12 Offenders with Developmental Disabilities

Introduction

Offenders with Intellectual and Developmental Disabilities

Treatment

Conclusions

References

List of Tables

Chapter 01

Table 1.1 Some Definitions of EBP

Table 1.2 A Summary of the Right to Effective Treatment Statement (Van Houten et al., 1988)

Table 1.3 A Summary of the Four Levels of Evidence from the National Standards Project

Chapter 02

Table 2.1 The Characteristics of These Meta-Analyses, Their Findings, and Main Conclusions Related to the Effectiveness of EI

Table 2.2 A Table Summarizing Five Meta-Analyses of VM

Table 2.3 A Summary of Three Meta-Analyses of Caregiver Training

Chapter 03

Table 3.1 A Summary of General Meta-analyses of Maladaptive Behavior

Table 3.2 Meta-analyses of Treatment of Challenging Behavior for Specific Populations

Table 3.3 A Summary of Two Meta-analyses of Specific Interventions Methods for General Challenging Behavior

Table 3.4 A Table of Meta-analyses of Psychosocial Treatments for Self-Injurious Behavior

Table 3.5 A Summary of Three Meta-analyses of Positive Behavioral Support

Chapter 05

Table 5.1 Summary of Evidence for the Treatment of Aggression

Chapter 06

Table 6.1 Common Forms of SIB among Individuals with ID

Table 6.2 Summary of Evidence Base for SIB Treatments

Chapter 07

Table 7.1 Evidence-Based Practice for Stereotypy

Chapter 08

Table 8.1 EBP for Specific Feeding Problems

Chapter 09

Table 9.1 Evidence Base for the Treatment of Sleep Problems

Chapter 10

Table 10.1 A Summary of Evidence-Based Practice for Behavioral Treatment of Fears and Phobias

Table 10.2 Participant Characteristics and Methodological Considerations

Table 10.3 A Summary of Evidence-Based Practice for Treatment of OCBs

Table 10.4 A Summary of Evidence-Based Practice for Behavioral Treatment of Posttraumatic stress disorder

Chapter 11

Table 11.1 A Summary of the Experimental Evidence for Psychosocial Treatment of Depression in People with ID

Table 11.2 Summary of Practitioner Recommendations

List of Illustrations

Chapter 07

Figure 7.1 Examples of stereotypic behavior during a functional analysis. The percentage of intervals is presented along the y-axis, and sessions are presented along the x-axis. Korey engaged in repetitive head hitting, head banging, and hand biting, and Rhonda engaged in repetitive hand mouthing. Although these responses produced tissue damage in the long run, they are functionally consistent with the topic insofar as the behavior persists in the absence of social reinforcement. Such behavior is maintained by automatic reinforcement. Adapted from Vollmer et al. (1994).

Figure 7.2 Showing that stereotypic hair pulling and hair manipulation occurred almost exclusively in the alone condition of the functional analysis for one subject. Such a functional analysis outcome is another means of ruling out social reinforcement. Adapted from Rapp et al. (1999).

Figure 7.3 Although the target response was SIB (repetitive ear flicking that caused a wound on the ear), it was automatically reinforced SIB (stereotypic SIB) so the example serves. For this subject (Ron) during EE+, a highly preferred stimulus was used. During EE–, a low-preferred stimulus was used. This effect demonstrates the role of and importance of considering stimulus preference in environmental enrichment.

Guide

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Table of Contents

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Evidence-Based Practice and Intellectual Disabilities

Edition by

Peter Sturmey and Robert Didden

This edition first published 2014© 2014 John Wiley & Sons, Ltd.

Registered OfficeJohn Wiley & Sons, Ltd., The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

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Library of Congress Cataloging-in-Publication Data

Sturmey, Peter.Evidence-based practice and intellectual disabilities / Peter Sturmey, Robert Didden.pages cmIncludes bibliographical references and index.ISBN 978-0-470-71068-5 (hardback) – ISBN 978-0-470-71069-2 (paper) 1. People with mental disabilities–Psychology. 2. Evidence-based social work. I. Didden, Robert. II. Title.HV3004.S858 2014362.3′53–dc23

2013042692

A catalogue record for this book is available from the British Library.

Cover image: © causeandeffectAU / iStockphoto

Cover design by Nicki Averill Design & Illustration

Contributors

Amanda B. Bosch is Assistant Professor and Coordinator, Low Incidence Disabilities and Autism (LIDA) Program, Sam Houston State University. She received her PhD in Behavior Analysis from the University of Florida. Her research interests include assessment and treatment of stereotypy and empirically validated versus scientifically untested treatments for autism.

Wiebe Braam is a physician for people with intellectual disability and affiliated with the ‘s Heeren Loo care center. He specializes in the treatment of sleep problems in individuals with intellectual disabilities. His clinical and research interest is in the role of melatonin in sleep disorders and autism.

Leopold Curfs is Director of the Governor Kremers Centre at the Academic Hospital Maastricht and Maastricht University. He was rewarded with the Governor Kremers professorship at the Faculty of Health, Medicine and Life Sciences of Maastricht University, a Research Chair in Intellectual Disability at the Maastricht University Medical Centre.

Robert Didden is Professor of Intellectual Disabilities, Learning, and Behavior at the Behavioural Science Institute of the Radboud University Nijmegen and a Psychologist affiliated with Trajectum, a center for the treatment of severe behavioral and/or mental health problems in individuals with mild intellectual disability.

Klaus Drieschner is Senior Researcher of Trajectum, a large treatment facility for individuals with mild intellectual disability and severe problem behavior, including offenders. His current research concerns treatment effectiveness, routine outcome monitoring, inpatient aggression, and test construction. Earlier, he published on treatment motivation, treatment engagement, and nonverbal therapy.

Douglas G. Field is Chief of Pediatric Gastroenterology and the Vice Chair of Pediatric Outreach at the Penn State Hershey Medical Center and Professor of ediatrics at the Penn State College of Medicine. His clinical and research interests involve working with children with feeding problems.

Olive Healy is Lecturer in Psychology at the National University of Ireland and Program Director of the structured PhD in Applied Behavior Analysis and lectures on the MSc program. She has over 15 years of experience in the treatment of developmental disorders.

Giulio E. Lancioni is Professor in the Department of Psychology, University of Bari, Italy. His research interests include development and assessment of assistive technologies, training of social and occupational skills, and evaluation of strategies for examining preference and choice with individuals with severe/profound intellectual and multiple disabilities.

Russell Lang is Assistant Professor of Special Education. She has published over 100 research papers and multiple book chapters concerning the education and treatment of children with autism and other developmental disabilities. His primary research interest is in the treatment of problematic and challenging behaviors in individuals with autism spectrum disorders.

William R. Lindsay is Professor of Psychology at the University of Abertay and Honorary Professor at Bangor University and Deakin University. He has published over 300 articles and chapters and given many presentations on cognitive therapy and offenders. He has published five books on offenders and Cognitive Behavior Therapy for people with intellectual disability (ID).

Sinéad Lydon is a PhD candidate in Applied Behavior Analysis at the National University of Ireland, Galway. Her doctoral research, funded by the Irish Research Council, investigates the contribution of psychophysiological measurement to the understanding, assessment, and treatment of challenging behavior in Autism Spectrum Disorder.

Anneke Maas is a Lecturer in the Bachelor’s and Master’s Program in Special Education at Radboud University Nijmegen, the Netherlands, and behavioral consultant at the outpatient sleep clinic of ‘s Heeren Loo Advisium in Wekerom. She will soon defend her PhD thesis entitled “Sleep problems in individuals with genetic disorders associated with intellectual disability” at Maastricht University, the Netherlands.

Clodagh Murray completed her PhD in Applied Behavior Analysis at the National University of Ireland, Galway, with research focusing on increasing variability in children with autism spectrum disorders (ASD). She has extensive experience in delivering behavioral interventions and is currently course coordinator of the PostGraduate Diploma in Behavior Analysis at Trinity College Dublin.

Nicole Neil is Adjunct Lecturer and Doctoral Student, Department of Psychology, Queens College, City University of New York. She earned her Master’s in Applied Disability Studies at Brock University, Canada. Her current research interests include applied behavior analysis and repetitive behavior and increasing communication in children with Down syndrome.

Mark F. O’Reilly is the Mollie Villeret Davis Professor in Learning Disabilities. His research focuses on functional assessment and treatment of severe challenging behavior, interventions to promote generalization and maintenance of skills, and examining how behavioral interventions must adapt to be respectful and supportive of diversity.

John T. Rapp is Associate Professor of Psychology, Auburn University. He received his doctoral degree in Behavior Analysis from the University of Florida in 2003. His current research interests include the assessment and treatment of automatically reinforced behavior such as stereotypy, research methods, and compliance.

Joel E. Ringdahl is Assistant Professor in the Behavior Analysis and Therapy Program in the Rehabilitation Institute, Southern Illinois University. He received his PhD in Psychology from Louisiana State University. His research interests include functional analysis and treatment of severe behavior problems exhibited by individuals with developmental disabilities.

Laura J. Seiverling is a Licensed Psychologist and Board Certified Behavior Analyst at the Cindy and Tod Johnson Center for Pediatric Feeding Disorders at St Mary’s Hospital for Children in Bayside, NY. She specializes in treating children with autism spectrum disorder who have food selectivity.

Jeff Sigafoos received his PhD in Educational Psychology from the University of Minnesota in 1990. He is currently a Professor in the School of Educational Psychology at Victoria University of Wellington in New Zealand. His research focuses on communication intervention for individuals with developmental disabilities.

Marcel Smits is a Neurologist and Head of the Center for Sleep–Wake Disturbances and Chronobiology of the Gelderse Vallei Hospital in Ede. He is also a member of the Governor Kremers Dutch Expertise Centre for sleep disturbances in individuals with intellectual disabilities. He supervises several PhD studies on biological clock sleep disturbances.

Peter Sturmey is Professor of Psychology at Queens College and the Graduate Center, City College of New York. He publishes widely on developmental disabilities. His interests include evidence-based practice, autism, clinical case formulation, staff and parent training, restrictive behavioral interventions, and behavior analytic approaches to psychopathology.

Tricia Vause obtained her PhD in Clinical Psychology. She is an Associate Professor in the Department of Child and Youth Studies and is cross-appointed to the Centre for Applied Disability Studies at Brock University, Ontario, Canada. She has over 17 years of experience in working with persons with developmental disabilities and is a board certified behavior analyst (BCBA-D).

Timothy R. Vollmer is Professor of Psychology, University of Florida. He received his PhD in psychology from the University of Florida and has held positions at Louisiana State University and the University of Pennsylvania before returning to the University of Florida in 1998. He specializes in the assessment and treatment of behavior disorders.

Keith E. Williams is the Director of the Feeding Program at the Penn State Hershey Medical Center and a Professor of Pediatrics at the Penn State College of Medicine. He is the coauthor of over 50 books, articles, and book chapters on feeding problems in children.

Preface

Aim of This Volume

It is now well-established that people with intellectual disabilities (IDs) have an increased risk for developing behavioral and/or mental health problems including aggressive and self-injurious behavior and anxiety and depression. Such problems usually have adverse consequences for them and their relatives, staff members, and others who are involved in their care and treatment. The body of knowledge on prevalence rates and risk factors for behavioral and/or mental health problems in individuals with IDs has grown, and the number of scientific studies on the effectiveness of treatment for such problems has increased during the last decades. This may be explained in part by the increased focus on evidence-based practice in the field of IDs from funding agents and governments as well as the expansion of evidence-based practice outside of medicine.

Despite the increasing body of scientific knowledge, many children and adults with IDs and/or autism receive ineffective treatment, no treatment at all, or are even subjected to harmful therapies. Individuals with IDs have the same rights to high standards of treatment as other people; however, professionals may be unaware of the literature concerning evidence-based practice, misinformed about treatment effectiveness, indifferent or hostile to scientific approaches to treatment or unable to use it in practice, or they may lack appropriate training in providing effective therapies to people with IDs.

The aim of this volume is to provide an overview of the evidence base of psychological therapies for specific disorders and challenging behaviors often encountered in this target group. For each of these disorders/behaviors, psychological treatments are evaluated using the Chambless and Hollon (1998) criteria for evidence-based practice. In addition, each chapter includes a selective review on studies on prevalence rates and risk factors. Each chapter finishes with clinical guidelines for professional caregivers and therapists.

We hope that this volume informs professional caregivers and therapists about the state of the art of effective treatments, which may help them provide more effective treatment to individuals with IDs. This volume may also be a useful resource for students who undergo training in the use of psychological treatments and for managers, agencies, and funding bodies when designing and funding services for individuals with intellectual and developmental disabilities.

Overview of the Volume

This book is divided into two parts. Part I, “Foundational Issues and Overview,” consists of four chapters by the first editor, which sets the stage for Part II, “Specific Disorders and Challenging Behaviors.” Chapter 1, “Evidence-Based Practice: An Overview,” defines evidence-based practice (EBP) and reviews the rationale and methods for using EBP. It also describes a few controversies related to EBP in passing. The next two chapters, “Adaptive Behavior” and “Maladaptive Behavior,” summarize the results of approximately 100 meta-analyses of treatment related to IDs and/or autism. The final chapter in Part I asks the contentious question “But Is It Worth It?” and reviews the economic data on treatment efficacy. It finds several plausible examples of treatments that may pay society back for the investment in treatment.

Both aggression and self-injury are some of the most challenging and often treatment-responsive problems for individuals with ID and/or autism. Thus, Part II, “Specific Disorders and Challenging Behaviors,” begins with a review of treatment of aggressive behavior from Olive Healy, Sinéad Lydon, and Clodagh Murray and of self-injurious behavior from Jeff Sigafoos, Mark F. O’Reilly, Giulio E. Lancioni, Russell Lang, and Robert Didden. Stereotypic behavior is stigmatizing and interferes with learning and adaptive behavior. Thus, Timothy R. Vollmer, Amanda B. Bosch, Joel E. Ringdahl, and John T. Rapp provide a review of this problem. Recently, greater attention has been given to feeding problems, such as overselectivity and food refusal. Keith E. Williams, Laura J. Seiverling, and Douglas G. Field review the treatment of feeding problems. Chapter 9, “Sleep Problems,” by Robert Didden, Wiebe Braam, Anneke Maas, Marcel Smits, Peter Sturmey, Jeff Sigafoos, and Leopold Curfs, reviews a variety of treatments including melatonin and behavioral interventions for sleep problems in people with IDs and/or autism.

Anxiety and depression are often referred to as the common colds of mental health. There is good evidence that teenagers and adults with ID and/or autism, like the rest of us, experience these problems frequently. Hence, Chapter 10 by Peter Sturmey, William R. Lindsay, Tricia Vause, and Nicole Neil and Chapter 11 by Peter Sturmey and Robert Didden review the evidence-based practice concerning the treatment of anxiety and depression, respectively. Offenders with ID represent a special challenge to society, and their treatment is especially important to prevent harm to future potential victims. Thus, the final chapter, “Offenders with Developmental Disabilities,” by Peter Sturmey and Klaus Drieschner reviews the limited data available on this difficult question.

Future Directions

From this volume, it is evident that various types of skills deficits and behavioral problems and disorders may be treated effectively primarily using behavioral treatments and some nonbehavioral ones, such as melatonin. The chapters propose guidelines implementing these evidence-based treatments in clinical practice.

Although implementing treatments that have been shown to be effective under controlled research circumstances may or may not always be easy to implement in regular settings, it is our contention that there is now sufficient evidence to begin dissemination of evidence-based practice to professionals working in diverse settings as generic and mainstream mental health settings, medium and high-security settings, organizations providing early intervention, and care centers. Dissemination requires selection of socially important targets that can be effectively and economically treated by local practitioners. Such an endeavor requires readily accessible and easy to use treatment manuals and related materials and protocols to train and support local practitioners in evidence-based practices. Thus, future research should evaluate how to disseminate these evidence-based practices to professionals working with clients with intellectual disabilities in typical settings.

Future research should also address five other issues. First, little attention continues to be given to treatment generalization in behavioral interventions, and this issue has been almost completely ignored by other approaches. Second, although therapies may be effective in short-term demonstrations, little is known about long-term effectiveness and benefits. Third, little is known about cost benefits of many commonly used treatments, and future research should address that important issue. The third step is to analyze for whom this treatment works best, how to increase treatment compliance and reduce dropout, and which elements contribute to its effectiveness. Future studies should be conducted exploring which variables predict treatment outcome. Behavioral treatments address this by using functional assessment and analysis to predict effective and contraindicated treatments and the effects of treatment integrity and staff and parent training on outcome and treatment integrity. In the treatment of offenders, this question is addressed by consideration of criminogenic needs in case formulation. Future research should also explore other methods, especially those that identify independent variables amenable to change. Fourth, the field of evidence-based practice in intellectual disabilities is rapidly evolving, and new approaches are being developed such as eye movement desensitization reprocessing for trauma and trauma-related problems, dialectical behavior therapy for challenging behaviors, intensive interaction, new psychopharmacological agents, new diets, and new technology, such as IPODs. Future research should continue to evaluate new therapies as they evolve. A final issue is the contribution to treatment outcome of the relationship between client and therapist to treatment outcome.

Reference

Chambless, D., & Hollon, S. (1998). Defining empirically supported therapies.

Journal of Consulting and Clinical Psychology

,

66

, 7–18.

Acknowledgments

We would like to thank all our authors for their patience in writing and often rewriting their chapters. We would also like to thank Bill Lindsay and John Taylor for significant input in developing the chapter on offenders with intellectual disabilities.

Part IFoundational Issues and Overview

1Evidence-Based Practice: An Introduction

Peter Sturmey

Evidence-Based Practice

Questions concerning evidence-based practice (EBP) permeate services for people with developmental disabilities. A parent must decide whether or not to participate in early intervention for their child with autism and stay at home instead of working. A teacher selects certain target behaviors and teaching strategies for a child and decides not to teach other skills and not to use other teaching strategies. An agency for adults with disabilities decides whether to operate traditional, center-based services or to implement a new job coaching service. A city, state, or government agency decides whether or not to fund early intervention or to place some individuals in specialized, expensive, out-of-district services.

EBP is reflected in many educational and clinical decisions by individual teams. Consider the following example. A team of professionals in special education attempt to treat food refusal in a child with autism for 6 months using sensory integration therapy. Not only did the child continue to refuse food, but the child continued to lose weight. When outside therapists proposed using escape extinction (see Chapter 8) as an EBP, the educators oppose such treatment on the grounds that it does not address the sensory needs of the child and will not work or they refuse to treat the problem by “conditioning” or “behavior modification” which they think is “inhuman” or “disrespectful.” After 2 weeks of escape extinction, the child now ate a wide range of foods and gained weight; resources are no longer wasted on ineffective therapy and useless discussion of ineffective treatment.