Problem behaviours and symptom dimensions of psychiatric disorders in adults with intellectual disabilities: An exploratory and confirmatory factor analysis.
Problem behaviors in adults with ID cluster into a dysregulation factor, not a mood factor, so target coping skills before assuming depression.
01Research in Context
What this study did
The team ran factor analysis on behavior checklists filled out by staff.
All participants were adults with intellectual disability living in services.
They wanted to see if problem behaviors group into clear emotion or mood factors.
What they found
Two main dimensions popped out.
One was dysregulation: hitting, yelling, running off.
The other was mood: looking sad, eating less, sleeping poorly.
The dysregulation factor predicted later problems better than a depression label.
How this fits with other research
Christopher et al. (1991) did the same math on 8,000 people across the lifespan.
They also found separate factors, but the pattern shifted with age and ID level.
van Timmeren et al. (2016) systematic review warns that most factor studies use weak stats.
They say results like these look tidy but need bigger samples and better checks.
Smiley et al. (2003) push the DC-LD checklist for depression in ID.
The current paper says problem behavior is more about dysregulation than mood.
Both can be true: DC-LD is useful until finer tools arrive.
Why it matters
Stop writing "depression" every time an adult with ID yells or hits.
Note which behaviors load on the dysregulation factor and track that cluster.
Share the two-factor picture with staff so they see mood signs as separate.
This small shift can guide you toward self-regulation teaching instead of just psychiatry referral.
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02At a glance
03Original abstract
BACKGROUND: The limited evidence on the relationship between problem behaviours and symptoms of psychiatric disorders experienced by adults with intellectual disabilities leads to conflict about diagnostic criteria and confused treatment. This study examined the relationship between problem behaviours and other psychopathology, and compared the predictive validity of dimensional and categorical models experienced by adults with intellectual disabilities. METHODS: Exploratory and confirmatory factor analyses appropriate for non-continuous data were used to derive, and validate, symptom dimensions using two clinical datasets (n=457; n=274). Categorical diagnoses were derived using DC-LD. Severity and 5-year longitudinal outcome was measured using a battery of instruments. RESULTS: Five factors/dimensions were identified and confirmed. Problem behaviours were included in an emotion dysregulation-problem behaviour dimension that was distinct from the depressive, anxiety, organic and psychosis dimensions. The dimensional model had better predictive validity than categorical diagnosis. CONCLUSIONS: International classification systems should not include problem behaviours as behavioural equivalents in diagnostic criteria for depression or other psychiatric disorders. Investigating the relevance of emotional regulation to psychopathology may provide an important pathway for development of improved interventions. WHAT THIS PAPER ADDS: There is uncertainty whether new onset problem behaviours or a change in longstanding problem behaviours should be considered as symptoms of depression or other types of psychiatric disorders in adults with intellectual disabilities. The validity of previous studies was limited by the use of pre-defined, categorical diagnoses or unreliable statistical methods. This study used robust statistical modelling to examine problem behaviours within a dimensional model of symptoms. We found that problem behaviours were included in an emotional dysregulation dimension and not in the dimension that included symptoms that are typical of depression. The dimensional model of symptoms had greater predictive validity than categorical diagnoses of psychiatric disorders. Our findings suggest that problem behaviours are a final common pathway for emotional distress in adults with intellectual disabilities so clinicians should not use a change in problem behaviours as a diagnostic criterion for depression, or other psychiatric disorders.
Research in developmental disabilities, 2016 · doi:10.1016/j.ridd.2016.03.007