مشکلات رفتاری در کودکان با ناتوانی های ذهنی خفیف : گامی اولیه در جهت پیش‌گیری

To develop prevention activities, an analysis is conducted of child and parent characteristics that occur significantly more often among children with a mild intellectual disability and behavior problems than among children with a mild intellectual disability and no behavior problems and their families. The sample consisted of 45 children attenting schools for special education. Data were collected from the children, their parents, and their teachers. The instruments used are the Dutch version of the Parenting Stress Index, the Nijmegen Child-Rearing Situation Questionnaire and the Strenghts and Difficulties Questionnaire for parents, teachers and children. On the basis of the results of parents on the Strenghts and Difficulties Questionnaire, the research sample was divided into one group of children with behavior problems and one group without behavior problems. Parents of the children with behavior problems were found to feel less competent, more socially isolated, less satisfied about their relationship with their partner, and indicate more negative life occurrences than the parents of the children without behavior problems. Characteristics in the area of adaptability, mood, distractibility/hyperactivity, demandingness, reinforcement of parents, and acceptability were found to contribute to the total stress in the child–parent relationship for those children with behavior problems and their parents. On the basis of these results prevention activities will be developed and tested on their effectiveness.

Children with mild intellectual disabilities (MID) have a greater risk for developing psychopathology and behavior problems compared to children without MID (Dekker & Koot, 2003). According to this Dutch study of Dekker and Koot, executed by 474 children, 38.6% of the participants had a DSM-IV diagnose, compared to 21.5% of the normal population. Beside the higher levels of psychopathology, behavior problems are also more prevalent in children with MID. A study of Einfeld and Tonge (1996) showed that well over 40% of the children with MID have serious emotional and behavioral problems. Moreover, the majority of children and adolescents with MID referred for mental health care, suffer from disruptive behavior problems and/or aggressiveness, oppositionality, defiance and conduct disorders (Wallander, Dekker & Koot, 2003). The prognosis for these children and adolescents is unfavorable: behavior problems co-occur with internalizing and social problems, minimize opportunities in society and predict a host of unfavorable adult outcomes. The burden of the behavior problems on families and friends is such that they have been reported to consider these problems the most important issue for treatment. When children with MID and/or their parents need help, the Dutch government strives to see that support, guidance and treatment is provided within the immediate environment and family system of the child whenever is possible. One of the first steps in this process is offering prevention programs for the children with ID and/or their parents. Nevertheless, within the care for people with ID prevention programs are still in its infancy, as well as incorporating family processes in these programs, although several studies highlight the impact of behavior problems on families (e.g., Femmie, Bakermans-Kranenburg & IJzendoorn, 2005). Meta-analyses within mental health care conclusively show that prevention programs resulted in a reduction of 25% in symptoms of depression, fear, stress and behavioral problems. This effect is comparable to the decrease achieved by psychological, educational and behavioral treatment (Jané-Llopis, 2002 and Jané-Llopis et al., 2003). In addition, it appeared that effects were stable until at least 1-year follow-up and that interventions were twice as effective if performed by specialized professionals compared to exclusively offered by non-professionals (Jané-Llopis, 2002).