Borderline intellectual functioning: an increased risk of severe psychiatric problems and inability to work.

Students with intellectual disabilities (IDs) have various learning difficulties and are at risk for school failure. Large inter-individual differences are described for reading, but it is unclear how these vary as a function of grade. The aim of this study was to examine various reading fluency, accuracy and comprehension parameters in second-to-eighth-grade Italian children with either borderline intellectual functioning (BIF) or mild ID (MID). We examined 106 children with BIF (67 M and 39 F) and 168 children with MID (107 M and 61 F). The children were in the second to eighth grade and were comparable for chronological age (7 to 14years). They were administered a battery of tests that assessed fluency and accuracy of word, pseudo-word and text reading, as well as text comprehension. Standardised scores allowed us to compare the performance of the two groups with normative values. Children with ID obtained generally low scores compared with normative values. Those with MID had greater difficulty than those with BIF. Furthermore, difficulty was greater for speed than for accuracy measures and for words than for pseudo-words. Difficulty (particularly in the case of reading speed) tended to be pronounced at later grades. Marked individual differences were present independently of MID-BIF subgrouping, as well as stimulus category and reading parameter. As a group, children with ID showed difficulty in reading acquisition; the effect was greater for children with more severe ID, but large individual differences were observed in children with both BIF and MID. Relatively spared pseudo-word reading skills indicate efficient use of the grapheme-to-phoneme conversion routine. This processing mode may prove more ineffective at higher levels of schooling when even in regular orthographies such as Italian typically developing children rely on lexical activation.

In the Netherlands, patients with borderline intellectual functioning are eligible for specialized mental health care. This offers the unique possibility to examine the mix of psychiatric disorders in patients who, in other countries, are treated in regular outpatient mental health care clinics. Our study sought to examine the rates of all main Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Axis I psychiatric diagnoses in outpatients with borderline intellectual functioning of 2 specialized regional psychiatric outpatient departments and to compare these with rates of the same disorders in outpatients from regular mental health care (RMHC) and outpatients with mild intellectual disabilities (IDs). Our study was a cross-sectional, anonymized medical chart review. All participants were patients from the Dutch regional mental health care provider Rivierduinen. Diagnoses of patients with borderline intellectual functioning (borderline intellectual functioning group; n = 235) were compared with diagnoses of patients from RMHC (RMHC group; n = 1026) and patients with mild ID (mild ID group; n = 152). Compared with the RMHC group, psychotic and major depressive disorders were less common in the borderline intellectual functioning group, while posttraumatic stress disorder and V codes were more common. Compared with the mild ID group, psychotic disorders were significantly less common. Mental health problems in people with borderline intellectual functioning may not be well addressed in general psychiatry, or by standard psychiatry for patients with ID. Specific attention to this group in clinical practice and research may be warranted lest they fall between 2 stools.

BackgroundPersons with mild intellectual disability or borderline intellectual functioning are often studied as a single group with similar characteristics. However, there are indications that differences exist within this population. Therefore, the aim of this study was to identify classes of persons with mild intellectual disability or borderline intellectual functioning and to examine whether these classes are related to individual and/or environmental characteristics.MethodsLatent class analysis was performed using file data of 250 eligible participants with a mean age of 26.1 (SD 13.8, range 3–70) years.ResultsFive distinct classes of persons with mild intellectual disability or borderline intellectual functioning were found. These classes significantly differed in individual and environmental characteristics. For example, persons with a mild intellectual disability experienced fewer problems than those with borderline intellectual disability.ConclusionsThe identification of five classes implies that a differentiated approach is required towards persons with mild intellectual disability or borderline intellectual functioning.

Little is known about the associations between mild intellectual disability (MID), borderline intellectual functioning (BIF) and aggressive behaviour in general mental health care. The study aims to establish the association between aggressive behaviour and MID/BIF, analysing patient characteristics and diagnoses. 1174 out of 1565 consecutive in-and outpatients were screened for MID/BIF with the Screener for Intelligence and Learning Disabilities (SCIL) in general mental health care in The Netherlands. During treatment, aggressive behaviour was assessed with the Staff Observation Aggression Scale-Revised (SOAS-R). We calculated odds ratios and performed a logistic and poisson regression to calculate the associations of MID/ BIF, patient characteristics and diagnoses with the probability of aggression. Forty-one percent of participating patients were screened positive for MID/BIF. Patients with assumed MID/BIF showed significantly more aggression at the patient and sample level (odds ratio (OR) of 2.50 for aggression and 2.52 for engaging in outwardly directed physical aggression). The proportion of patients engaging in 2-5 repeated aggression incidents was higher in assumed MID (OR = 3.01, 95% CI 1.82-4.95) and MID/BIF (OR = 4.20, 95% CI 2.45-7.22). Logistic regression showed that patients who screened positive for BIF (OR 2,0 95% CL 1.26-3.17), MID (OR 2.89, 95% CI 1.87-4.46), had a bipolar disorder (OR 3.07, 95% CI 1.79-5.28), schizophrenia (OR 2.75, 95% CI 1.80-4.19), and younger age (OR 1.69, 95% CI 1.15-2.50), were more likely to have engaged in any aggression. Poisson regression underlined these findings, showing a SCIL of 15 and below (β = 0.61, p<0.001) was related to more incidents. We found an increased risk for aggression and physical aggression in patients with assumed MID/BIF. We recommend screening for intellectual functioning at the start of treatment and using measures to prevent and manage aggressive behaviour that fits patients with MID/BIF.

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.

AimsTo assess the effectiveness of Take it personal!, a prevention programme for individuals with mild intellectual disabilities and borderline intellectual functioning (MID‐BIF) and substance use (SU). The prevention programme aims to reduce SU (alcohol, cannabis and illicit drugs) among experimental to problematic substance users.DesignA quasi‐experimental design with two arms and a 3‐month follow‐up.SettingAdolescents were recruited from 14 treatment centres in the Netherlands specialized in offering intra‐ and extramural care for people with MID‐BIF and behavioural problems.ParticipantsData were collected from 66 individuals with MID‐BIF assigned either to the intervention condition (n = 34) or to the control condition (n = 32).InterventionsTake it personal! was designed to target four personality traits: sensation‐seeking, impulsive behaviour, anxiety sensitivity and negative thinking. For each of these profiles, interventions were developed that were structurally the same but contained different personality‐specific materials, games and exercises. The control group received care as usual.MeasurementsPrimary outcomes at 3‐month follow‐up were frequency of SU, severity of SU and binge drinking.ResultsResults showed intervention effects for SU frequency (F (1, 50.43) = 9.27, P = 0.004) and binge drinking (F (1, 48.02) = 8.63, P = 0.005), but not for severity of SU (F (1, 42.09) = 2.20, P = 0.145).ConclusionsA prevention programme to reduce substance use among experimental to problematic users with mild intellectual disabilities and borderline intellectual functioning helped participants to decrease substance use frequency and binge drinking.

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.

Psychogenic non-epileptic seizures in individuals with intellectual disability/borderline cognitive function: Characterization through a comparison study

Purpose– The purpose of this paper is to provide a synthesis of the literature on the topic of developmental framework and health comorbidities of children and adults with borderline intellectual functioning (BIF) and neurodevelopmental disorders.Design/methodology/approach– A rapid review of the literature and hand searching of relevant papers from 1999 to 2015 was carried out. Totally, 21 papers were identified covering a range of perspectives from neurodevelopmental trajectories to prevalence, treatment and service use.Findings– All papers were utilised and complemented a previous review which, however, had not covered the aspect of treatment approaches for this population. As a group they appear to have distinctly different profiles from people with mild intellectual disability and of peers with average intelligence.Practical implications– The evidence summary indicates an ongoing interest by the international scientific community in the topic of BIF. This group are often lost in the health system and may not receive appropriate care given their unique clinical profile. More should be done to increase clinicians’ awareness of their health needs.Originality/value– The paper adds substantially to a previous review of the topic. An international collaboration may help to increase the profile of this work and lead to further changes in the care these individuals receive across the diagnostic and treatment spectrum.

This study aimed to investigate the effect of mindfulness training on improving attention and executive function in children with mild to borderline intellectual functioning. Two groups of children participated in the study. The first group consisted of 30 children with borderline intellectual functioning, ages ranging from 7 years to 9 years. A group of 30 children, ages ranging from 7 years to 9 years, formed a comparison group. The effect of mindfulness training on improving attention and executive function in children with borderline intellectual functioning and mild intellectual disability were assessed using pre- and post test design. The mindfulness group received 24 sessions of mindfulness training, while the control group received no training at all. The results showed that the post-test scores of inhibitory control, working memory, cognitive flexibility and the total score of children in mindfulness group are significantly higher than those in control group.

Introduction Take it Personal!+ is a treatment program for individuals with Mild Intellectual Disability or Borderline Intellectual Functioning (MID-BIF) and Substance Use Disorder (SUD). It is supported by a mobile health application (mHealth), and researchers found it can reduce Substance Use (SU). Aims: This study aimed to explore the usability of the treatment program in as experienced by clients and their confidants. Methods We conducted post-treatment, semi-structured interviews with clients (n = 8) and their confidants (n = 8). We coded transcripts according to thematic analysis and using inductive and deductive methods. Subsequently, we analyzed connections between the codes and grouped them into themes using axial coding. Results Overall clients and confidants experienced the treatment program as usable, and most mentioned the program helped to reduce SU. The clients and confidants reported the presence of a confidant was helpful. Some clients and confidants reported the mHealth application was helpful. Components that were perceived as effective were self-control skills, daily registration exercise and discussing quantity of SU non-judgingly. Perceived impeding factors were video calling and a non-supportive network. Conclusion This study shows that Take it Personal!+ is an useable treatment program for individuals with MID-BIF and SUD, that helps to decrease their self-reported SU. Nevertheless, there is room for improvement for further adapting the treatment, which will be discussed.

BackgroundMeasuring eudaimonic well-being is important to gain a complete picture of the well-being of individuals with mild intellectual disabilities or borderline intellectual functioning (MID-BIF), but there is no measurement instrument available for this population coding for multiple dimensions of eudaimonic well-being. AimsThe current study developed and piloted a new instrument coding for eudaimonic well-being in individuals with MID-BIF. Methods and proceduresThe instrument (SPWB-ID) was adapted from Ryff’s scales of psychological well-being, including subscales addressing purpose in life, environmental mastery, positive relationships, self-acceptance, personal growth, and autonomy. Adaptations were based on the literature and interviews with people with MID-BIF and experts in the field. The SPWB-ID was piloted among 103 adults with MID-BIF. Outcomes and resultsThe trimmed version of the SPWB-ID showed sufficient to good internal consistency and test-retest reliability. Hypothesis testing for construct validity suggested the subscales of the SPWB-ID measured well-being, showing moderate to high correlations with quality of life, and differences in eudaimonic well-being between participants with and without clinically relevant depression scores. Conclusions and implicationsThe SPWB-ID reliably measures eudaimonic well-being in individuals with MID-BIF. This enables support providers to collect information on eudaimonic well-being, providing input for person-centred care and support for individuals with MID-BIF.

Background and aimsWe investigated whether improving the cognitive accessibility of a widely used self-report measure leads to better understanding and more accurate answers in a sample of adults with mild intellectual disability and borderline intellectual functioning. Methods and proceduresWe undertook a series of cognitive interviews before and after adaptation of the instructions and selected items of an existing self-report measure of adaptive functioning. Interview results and participant feedback were supplemented with quantitative comparisons between participant and carer scores. Outcomes and resultsAdaptation based on participant experiences and preferences combined with evidence-informed guidelines improved understanding and accuracy. Self-report and carer-report scores showed greater convergence after adaptation; this occurred because people with intellectual disabilities appeared to understand the self-report measure more effectively. Conclusions and implicationsThe results show that adaptation of the self-report instrument to suit the needs and preferences of people with mild intellectual disability or borderline intellectual functioning leads to a more accessible measure and more reliable and valid results. Results also highlight the importance of complementing proxy reports with a first-person perspective in assessment as clients and informants may differ in their assessment of behavior and skills.

Community participation has been defined as performing daytime activities by people while interacting with others. Previous studies on community participation among people with intellectual disability (ID) have mainly focused on the domestic life aspect. This study investigates the variation in community participation in the domains work, social contacts and leisure activities among people with ID in the Netherlands. A number of categories of people with ID were distinguished by: (1) gender; (2) age; (3) type of education; (4) severity of ID; and (5) accommodation type. Data were gathered on 653 people with mild or moderate ID, of whom 513 by oral interviews and 140 by structured questionnaires filled in by representatives of those who could not be interviewed. Pearson chi-square tests were used to test differences between categories of people with ID in the distributions of the participation variables. Additional logistic regression analyses were conducted to correct for differences between the categories in other variables. Most people with mild or moderate ID in the Netherlands have work or other daytime activities, have social contacts and have leisure activities. However, people aged 50 years and over and people with moderate ID participate less in these domains than those under 50 years and people with mild ID. Moreover, people with ID hardly participate in activities with people without ID. High participation among people with a mild or moderate ID within the domains of work, social contact and leisure activities does not necessarily indicate a high level of interaction with the community, because the majority hardly interact with people without ID. Furthermore, older people with ID and people with a more severe level of ID seem to be more at risk for social exclusion.

Purpose The purpose of this study is to provide an in-depth account of how individuelas with a mild intellectual disabilitiy or borderline intellectual functioning (MID-BIF; IQ 50–85) perceive their group climate in a secure forensic setting. Giving voice to these service users may provide relevant insights for secure forensic settings. Design/methodology/approach The interpretative phenomenological analysis was used to explore what individuals with MID-BIF experience with regard to their group climate. Findings In the interviews about the four domains of group climate (i.e. repression, support, growth and atmosphere), five overarching dimensions appeared, namely, autonomy, uniformity, recognition, competence and dignity. Depending on the person and the (treatment) context in which he/she resides, these five dimensions relate to all four factors of the group climate instrument. Originality/value From the perspective of individuals with MID-BIF, this study contributes by providing a framework to “fine-tune” group climate on five dimensions. Training socio-therapists to be sensitive to interpret ambiguous signals on these dimensions can contribute to optimizing group climate in secure forensic settings.