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2015-42: Adaptive functioning and risk management in (forensic) patients with mild intellectual disabilities (Call 2015 - 42)

In this report, the results are described of an empirical study in which, among others, the psychometric properties of a relatively new instrument to assess the level of adaptive functioning of patients with Mild or Borderline Intellectual disabilities (IQ in the range of 50-85) are investigated. This instrument, which is called the the 'Adaptieve Vragenlijst Verstandelijk Beperking' (AVVB) in Dutch, exists of 63 items which assess various commonly needed skills to function independently. Besides that, the associations were studied between the level of adaptive functioning (as assessed with the AVVB) and the level of emotional functioning (as assessed with the SEO-R) with (proxy) measures of recidivism risks. These proxy measures of recidivism risks were: 1) recent risk assessment scores of the included patients (i.e., HKT-R, HCR-20v3 and / or the DROS)  and 2) information about aggressive incidents and indicators of relapse during the last two years of treatment.

In total, data were collected concerning 157 patients (130 males and 27 females) residing in ten Dutch institutions. The average IQ of the included patients was 68.8. The interrater reliability of the AVVB total score was found to be fair-to-good (0.77) and the internal consistency of the instrument was high (0.97). In appendix 1 of this report, the Dutch version of the AVVB is presented. Furthermore, both the AVVB scores and the SEO-2 scores were found to correlate with risk assessment scores in the anticipated directions, which suggests that lower levels of adaptive and emotional functioning are associated with higher recidivism risks. The AVVB and SEO-R scores also turned out to be correlated with the likelihood that the patient had engaged in physically aggressive behaviour during the last two years of hospitalization.

Taking these findings together, the results suggest that deficits in adaptive skills and a low level of emotional functioning go hand in hand with more (externalizing) behavioural problems and higher risks. On the basis of these findings, it is advised to incorporate assessments of adaptive functioning and the level of emotional functioning in designing individualized risk management plans for forensic patients, particularly when they have limited intellectual capacities. In chapter 3 of this report, a number of tips, divided in a number of steps, are provided how this can be done. These steps are schematically presented in a form in appendix 2 of this report.

Executive party

Fivoor & Trajectum