title: Problem behaviours and symptom dimensions of psychiatric disorders in adults with intellectual disabilities: An exploratory and confirmatory factor analysis.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Glasgow, Institute of Health and Wellbeing, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, Scotland, UK. Electronic address: Craig.Melville@glasgow.ac.uk.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Melville
authors.affiliation: Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medicine Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK. Electronic address: Paul.Johnson@glasgow.ac.uk.
authors.forename: Paul C D
authors.initials: PC
authors.lastname: Johnson
authors.affiliation: Learning Disabilities Psychiatry, NHS Greater Glasgow and Clyde, Glasgow, G78 1AA, Scotland, UK. Electronic address: Elita.Smiley@ggc.scot.nhs.uk.
authors.forename: Elita
authors.initials: E
authors.lastname: Smiley
authors.affiliation: Learning Disabilities Psychiatry, NHS Greater Glasgow and Clyde, Glasgow, G78 1AA, Scotland, UK. Electronic address: Neill.Simpson1@nhs.net.
authors.forename: Neill
authors.initials: N
authors.lastname: Simpson
authors.affiliation: Department of Statistics, Strathclyde University, 16 Richmond St, Glasgow G1 1XQ, Scotland, UK. Electronic address: David.Purves@strath.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Purves
authors.affiliation: University of Glasgow, Institute of Health and Wellbeing, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, Scotland, UK. Electronic address: Alex.McConnachie@glasgow.ac.uk.
authors.forename: Alex
authors.initials: A
authors.lastname: McConnachie
authors.affiliation: University of Glasgow, Institute of Health and Wellbeing, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, Scotland, UK. Electronic address: Sally-Ann.Cooper@glasgow.ac.uk.
authors.forename: Sally-Ann
authors.initials: SA
authors.lastname: Cooper
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D004644:Emotions; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000523:psychology; D008875:Middle Aged; D000066553:Problem Behavior / Q000523:psychology*; D011618:Psychotic Disorders / Q000523:psychology*; D000068356:Self-Control / Q000523:psychology*