Prevalence of dual diagnosis in an institution for individuals who are developmentally handicapped

The prevalence of dual diagnosis (developmental handicap with accompanying mental illness) was examined in a population of 71 persons who are institutionalized and developmentally handicapped. The Reiss Screen for Maladaptive Behavior (Reiss, 1988) revealed that 69% of the popula- tion had a dual diagnosis. The incidence of dual diagnosis was not related to level of functioning, although the type of psychopathology varied considerably across levels of functioning. In contrast to findings from the Reiss Screen, previous psychiatric diagnosis indicated a much lower rate of dual diagnosis (26.8%), as did current psychiatric assessment. There was little agreement between the two psychiatric assessments, or between the Reiss Screen and the psychiatric assessments. The Reiss Screen appears to provide information of more practical value for community placement decisions than is provided by the psychiatric assessments. Limitations to the concept of ?dual diagnosis’? for characterizing the mental health needs of persons with a developmental handicap are discussed.     

Reviews and critiques of school psychology materials Douglas T. Brown, Associate Editor : Assessing psychopathology in persons with mental retardation: A review of the Reiss Scales

This review addresses two instruments, the Reiss Scales for Children's Dual Diagnosis and the Reiss Screen for Maladaptive Behavior, that are commonly used with persons who are mentally retarded. An analysis of the psychometric properties of each instrument is provided. The circumstances under which each instrument could be appropriately used are discussed. It is concluded that both scales are useful as screening devices, especially given the lack of instrumentation for evaluation of social and emotional status in the mentally retarded. Concern is expressed in regard to the need for a more comprehensive set of items in each test and to the author's rationale for cut scores.     

A comprehensive assessment of human strivings: test-retest reliability and validity of the Reiss Profile

Sensitivity theory provides an analysis of personality based on what people say motivates their behavior. After Reiss and Havercamp (1998) confirmed a 15-factor solution to self-reported human strivings, the Reiss Profile of Fundamental Goals and Motivation Sensitivities (Reiss & Havercamp, 1998) psychometric instrument was standardized. In 3 studies, the Reiss Profile was shown to possess good test-retest and internal reliability and concurrent and criterion validity. Ten independent samples of adults (n = 764) and a comparison group (n = 737) participated in these studies. Pearson product-moment correlations between the Marlowe-Crowne Social Desirability Scale (Crowne & Marlowe, 1960) and the Reiss Profile ranged in absolute value from .01 to.39 (M =.16). How people self-reported their trait motives correlated with how they behaved in the "real world." The Reiss Profile can be used to study motivational traits.     

AN INVESTIGATION OF THE EFFECTS OF TOKEN REINFORCEMENT ON DIVERGENT VERBAL RESPONDING1

The effect of token reinforcement on three classes of divergent verbal responding to verbal stimulus items from three measures of the Wallach-Kogan Creativity test was examined. The subjects consisted of two “gifted”, two “average”, and two “learning disabled” children from a public-school setting. The design utilized both an intra-subject and inter-subject multiple-baseline design with a reversal design added. Tokens were dispensed contingent upon the number of appropriate verbal responses to each stimulus item, i.e., a continuous schedule of reinforcement was used—one token per appropriate response. Interobserver agreement on “appropiateness” was 993%. The tokens could be used to “purchase” items listed in a “menu” format (e.g., ball and jacks—100 tokens). Consistently large effects of token reinforcement were observed, without generalization of effect across the three classes of behaviors, or conditions. These results support the works of Goetz and Baer (Journal of Applied Behavior Analysis, 1973, 6 , 209–217), Goetz and Salmonson (Behavior Analysis and Education, G. Semb, (Ed.), University of Kansas, 1972, 53–61), and Maloney and Hopkins (Journal of Applied Behavior Analysis, 1973, 6 , 425–434). Implications lie in continued experimental analysis of behavior approach to the concept called “creativity”. Additionally, implications are made in classroom application of assessing and intervening in the area of divergent responding for children with deficits in those areas.     

Anxiety sensitivity within the anxiety disorders: disorder-specific sensitivities and depression comorbidity

The tendency to perceive anxious states as aversive and harmful is hypothesized to confer vulnerability to the development of anxiety disorders. The most commonly used measure of anxiety sensitivity, the Anxiety Sensitivity Index [ASI; Reiss, S., Peterson, R.A., Gursky, D.M., & McNally R.J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behavior Research and Therapy, 24, 1-8], is composed of multiple lower-order factors, assessing fear of physical symptoms, fear of publicly observable anxious symptoms, and fear of cognitive dyscontrol. This study examined the convergent validity of the lower-order anxiety sensitivity dimensions in DSM-IV diagnosed anxiety disorders. Participants with primary diagnoses of panic disorder with agoraphobia, social phobia, and generalized anxiety disorder (GAD) completed the ASI and measures of anxiety and depression severity. Support was found for the convergent validity of all ASI dimensions in reference to thematically related anxiety disorders and in the identification of patients presenting with and without secondary major depressive disorder (MDD). The ASI-fear of cognitive dyscontrol dimension displayed strong and nonredundant associations with GAD, dimensional depression scores, and secondary diagnoses of MDD. The conceptual implications of the shared importance of fear of cognitive dyscontrol in GAD and MDD are discussed.     

Does Mastery of ABLA Level 6 Make it Easier for Individuals with Developmental Disabilities to Learn to Name Objects?

Level 6 of the Assessment of Basic Learning Abilities (ABLA) assesses the ease or difficulty with which persons with developmental disabilities are able to learn a two-choice auditory-visual discrimination. We investigated whether participants who passed ABLA Level 6 (Group 1) would more readily learn object naming (vocal tacts) than those who failed ABLA Level 6 (Group 2). The groups were matched on the Communication Subscale of the Vineland Adaptive Behavior Scale. Results indicated that Group 1 met mastery criterion for a significantly larger number of naming responses and in significantly fewer trials than Group 2. The implications for language training are discussed.     

The Relationship of Functional Variables and Psychopathology to Aggressive Behavior in Persons With Severe and Profound Mental Retardation

A number of hypotheses have emerged regarding the etiology of physical aggression in persons with mental retardation. Although a multicomponent model is appropriate, results of functional analysis-based studies have yielded promising results in identifying instigating and maintaining factors of aggression. However, the relationship between functional variables and conditions such as psychiatric diagnosis to aggressive behavior has yet to be investigated in persons with mental retardation. We conducted a study examining the prevalence of environmental or physical factors in aggressive behavior in mentally retarded persons with and without psychiatric disturbance. One hundred and thirty-five individuals with mental retardation who exhibited physical aggression were assessed with the Questions About Behavior Function Scale (QABF) to identify environmental or physical contribution to aggressive behavior. One or more behavioral functions were identified for 75% of the participants. Additionally, of 66 of the participants scoring above the clinical cutoff on an assessment for dual diagnosis, 75% met criteria for an environmental or physical function for aggression. No significant differences in number of participants with an identifiable function of aggression were found between the no dual diagnosis and dual diagnosis groups. Our findings underscore the importance of identifying functions underlying aggressive behavior in persons with mental retardation, and the need to consider functional variables regardless of psychiatric condition in treatment planning efforts for such individuals.     

Behavior Problems in Young Children With or At Risk for Developmental Delay

We examined the prevalence of behavior problems and their relationship to child, parent, and family factors in 76 children with or at risk for developmental delay. Parents reported that 42% of the children had behavior problems. Child Behavior Checklist (CBC) scores revealed that 25% of the sample scored above the borderline cutoff. Although the total, externalizing, and internalizing mean CBC scores did not differ from the normative group (same-aged peers without developmental delay), each of the syndrome subscales was significantly higher in the study group. The Reiss Scales for Children's Dual Diagnosis revealed that, as compared to older children (4 years) with developmental delay, the study sample scored significantly lower on the total score and 8 of the 10 subscales. Increased CBC total scores were significantly related to dependency and management of the child, birth weight, gestational length, paternal illness, maternal depression, perceived personal burden of care, maternal escape-avoidance coping strategy, family disharmony, and financial stress. CBC total scores were significantly negatively correlated with being of a multiple birth, paternal education, maternal employment, two-parent family, family social support, and family income. Multiple regression analyses revealed that an empirically-derived combination of child, parent, and family variables accounted for 31% of the variance in CBC total scores. Our findings suggest that 2-year old children with or at-risk for developmental delay may already be showing signs of increased risk of behavior problems relative to peers without developmental delay. We identified several child, parent, and family variables that may help to pinpoint children at increased riskxs for psychopathology.     

Effects of Gender, Age, and Education on Assertiveness in a Nigerian Sample

Two hundred fourteen (214) married persons, 101 men and 113 women aged 20–60, with at least high school education, participated in the study which investigated the effects of gender, age, and educational attainment on assertiveness among married persons in Nigeria. The Assertive Behavior Assessment scale (ABAS; Onyeizugbo, 1998 ) was used to measure assertiveness. It was hypothesized that persons with higher educational attainment will report more assertiveness than persons with lower educational attainment. Results supported the hypothesis. In addition, interactions between gender and age, and gender and educational attainment were found. Younger men reported more assertiveness than younger women whereas older women reported more assertiveness than older men. Also, women participants of lower educational attainment reported more assertiveness than their men counterparts whereas men of higher educational attainment reported more assertiveness than their women counterparts. Results of this study suggest that women in Nigeria may become more assertive with age.     

Predictive validation of an insurance agent support person selection battery

This study investigated the predictive validity of a selection battery for insurance agent support persons. The selection battery included cognitive tests, personality scales, and biodata scales. Predictor data were collected as part of the agent support person selection process. Behavior summary scale ratings made by immediate supervisors of agent support persons were used as criteria in this study. Uncorrected correlations for six matched predictor composite-criterion dimension combinations identified in a previous concurrent validation study (Ashworth, Barge, Dunnette, & Carter, 1987) ranged from .17 (p<. 01) to .28 (p< .01) (M=.21, N=357).     

The Influence of Self-Esteem on Cognitive Responses to Machine-Like versus Human-Like Computer Feedback

Abstract

Business school students (N = 49) who were preclassified as being either high or low in self-esteem (Texas Social Behavior Inventory) interacted with a computer that delivered either human-like, neutral, or machine-like feedback. In line with a compensatory, self-enhancement perspective (Baumeister, 1982), this experiment found that persons high in self-esteem generated more negative cognitive responses and made fewer errors when faced with human-like rather than machinelike feedback from a computer. Overall, however, persons low in self-esteem did not perform more poorly than did persons high in self-esteem.     

The adoption of physical activity and eating behaviors among persons with obesity and in the general population: the role of implicit attitudes within the Theory of Planned Behavior

Obesity can be prevented by the combined adoption of a regular physical activity (PA) and healthy eating behaviors (EB). Researchers mainly focused on socio-cognitive models, such as the Theory of Planned Behavior (TPB), to identify the psychological antecedents of these behaviors. However, few studies were interested in testing the potential contribution of automatic processes in the prediction of PA and EB. Thus, the main objective of this study was to explore the specific role of implicit attitudes in the pattern of prediction of self-reported PA and EB in the TPB framework, among persons with obesity and in adults from the general population. One hundred and fifty-three adults participated to this cross-sectional study among which 59 obese persons (74% women, age: 50.6 ± 12.3 years, BMI: 36.8 ± 4.03 kg m^–²) and 94 people from the general population (51% women; age: 34.7 ± 8.9 years). Implicit attitudes toward PA and EB were estimated through two Implicit Association Tests. TPB variables, PA and EB were assessed by questionnaire. Regarding to the prediction of PA, a significant contribution of implicit attitudes emerged in obese people, β = .25; 95%[CI: .01, .50]; P = .044, beyond the TPB variables, contrary to participants from the general population. The present study suggests that implicit attitudes play a specific role among persons with obesity regarding PA. Other studies are needed to examine which kind of psychological processes are specifically associated with PA and EB among obese people.     

THE BEHAVIOR OBSERVATION INSTRUMENT: A METHOD OF DIRECT OBSERVATION FOR PROGRAM EVALUATION1

The background and development of a multicategory direct observation system, the Behavior Observation Instrument (BOI), is described. This time-sampling procedure for recording the behavior of persons is demonstrated in several treatment settings and the results applied to issues of program evaluation. Elements that have prevented direct observation from being widely adopted, such as costs, manpower, and training requirements, are systematically analyzed. A basic psychometric analysis of the instrument is used to determine optimum frequency and duration of observation intervals as well as observer agreement. The results imply that direct observation methods, once assumed by some to belong to the special province of the single-subject design, can be used to assess the effects of programs on groups of psychiatric clients in an efficient and economic manner.     

The Mediating Role of Resiliency in the Relationship Between Temperament and Posttraumatic Growth

The purpose of the research is to investigate the mediating role of resiliency in the relation between temperamental traits and posttraumatic growth. Data of 74 persons who have experienced the death of someone close were analyzed. The range of age of the participants was 21–74 years (M = 38.4; SD = 15.5). The Posttraumatic Growth Inventory (PTGI), the Formal Characteristics of Behavior–Temperament Inventory (FCB-TI), and the Resiliency Assessment Scale were used in the study. Resiliency plays a mediating role among four traits of temperament (Briskness, Emotional Reactivity, Endurance, and Activity) and posttraumatic growth. Resiliency seems to modify the direct impact of temperamental traits on positive posttraumatic changes.     

Behavioral Research on the Severe and Persistent Mental Illnesses

We are honored to introduce the special series highlighting behavioral research on the severe and persistent mental illnesses (SPMIs) that appears in this issue of Behavior Therapy. We begin this series by providing a succinct overview of this category of disorders, noting briefly their impact, cost, etiology, and management. We then identify four recent advances in the care of persons living with a SPMI, and provide an overview of the six articles that appear in this series. The series recognizes and showcases outstanding behavioral research, and seeks to encourage new and continuing participation by behavior therapists in the care of persons living with a SPMI.     

Family connections: a program for relatives of persons with borderline personality disorder

This study assessed changes in family members who participated in Family Connections, a 12-week manualized education program for relatives of persons with borderline personality disorder (BPD). Family Connections, led by trained family members, is based on the strategies of standard Dialectical Behavior Therapy (DBT) and DBT for families. The program provides (a) current information and research on BPD, (b) coping skills, (c) family skills, and (d) opportunities to build a support network for family members. Forty-four participants representing 34 families completed the pre-, post-, and 6-month postbaseline self-report questionnaires. Analyses employing hierarchical linear modeling strategies showed significant reductions in grief and burden, and a significant increase in mastery from pre- to post-group assessment. Changes were maintained at 6 months post baseline.     

Neurology--psychiatry in Dresden from E. Kraepelin through S. Ganser to J. Suckow

The broad outline of the psychiatric-neurological care of hospitalised patients in Dresden from 1885 to 1963 is sketched, with special reference to the work and achievements of E. Kraepelin (1885), S. Ganser (1886-1913), E. Reiss (1925-1933), H. Krisch (1933-1945), and J. Suckow (1955-1963).     

Prophylactic psychiatry

The great contributions of Gantt to the problems of prophylactic psychiatry are pointed out. The author reviews his experiences with a 30-year follow-up of a population of 1800 persons. Over the 30 years, there appeared to be a 50% increase of neuroses, which raises great problems for mental health services. The Berlevåg population was offered optimal psychiatric services. Behavior therapy of neuroses and drug treatment of depression may possibly have lowered the prevalence of mental disorders. Psychophysiologic tests were used in the project. It is hoped that such tests may be utilized for early detection and treatment of mental disorders.     

Psychological predictors of HIV-preventive behavior among Zimbabwean students

This report is based on a study of 852 sexually active volunteer student teachers in Zimbabwe who were assessed on their AIDS risk reduction behavior and the Health Belief Model of Janz and Becker. The model posits that behavior modification occurs if there is knowledge of the disease and its severity, susceptibility, effective prevention, self- efficacy for prevention, accessible health care and advice, normative support for behavior change, and few barriers to action. Behavior change is measured by reduced numbers of sexual partners, increased condom use, and decreased prostitute contact. The 404 women showed no sex differences from the 448 men, except that men reported lower self- efficacy. The multiple linear regression analysis revealed that for men the Health Belief Model was significant and explained 15% of the variance (F=7.50, p.0001). Behavior risk reduction was predicted by self-efficacy (B=.10, p.0001), perceived barriers to action (B=-.19, p.01), and belief in the effectiveness of preventive practices (B-.10, p.001). The women's model was also significant and explained 12% of the variance (F=4.06, p.001). Preventive behavior was predicted by perceived susceptibility to infection (B=.19, p.01), access to health care and advice (B=.09, p.05), and belief in the efficacy of preventive measures (B=.06, p.05). Future research in planned to try to augment the Health Belief Model results by including the following variables: contact with AIDS-affected persons and specific barriers to action such as dependence on paid sex, the breakdown in traditional values, familial separation, and attitudes toward monogamy. Also, the role of alcohol and drugs in the context of sexual behavior will be considered. Other alternative models will also be examined, such as Bandura's social learning theory and Fishbein's theory of reasoned action. New theories which are uniquely applied to AIDS may need to be formulated.     

A test of the interactive effects of anxiety sensitivity and mindfulness in the prediction of anxious arousal, agoraphobic cognitions, and body vigilance

The present investigation sought to examine the interactive effects of anxiety sensitivity [AS; Reiss, S., & McNally, R. J. (1985). Expectancy model of fear. In S. Reiss, & R. R. Bootzin (Eds.), Theoretical issues in behavior therapy (pp. 107-121). San Diego: Academic Press] and mindfulness [Brown, K. W., & Ryan, R. M. (2003). The benefit of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822-848] in predicting panic-relevant processes. A community sample of 248 individuals participated in the study by completing a battery of self-report instruments. Consistent with prediction, the interaction between AS and mindfulness significantly predicted anxious arousal symptoms and agoraphobic cognitions, above and beyond the individual main effects, and did not significantly predict anhedonic depression symptoms. Contrary to prediction, the AS by mindfulness interaction did not significantly predict body vigilance. Theoretical implications are discussed and future directions are delineated.