Graduate School of Childhood Development and Education
Implementing participatory peer research in the treatment of young adults
with mild intellectual disabilities and severe behavioural problems:
an application of Martin’s theory
Research Master Educational Sciences
Thesis 2
Name: Mijke J. Groeneweg
Student no.: 5953472
Supervisors: prof. dr. G.J.J.M. Stams, dr. X.M.H. Moonen, & dr. G.H.P. van der Helm Date: July 30, 2013
Abstract
This study is aimed at evaluating participatory peer research (PPR) in young adults with mild intellectual disabilities (MID) and severe behavioural problems. During the PPR intervention, control and feedback to individuals is restored by training them to become participant-researchers, who collaborate in a small group of people with MID. The field of their research is constituted by the problems they perceive and/or subjects of their interest. The study was designed as a multiple case study (experimental group: n = 5, comparison group: n = 5). Questionnaires and a semi-structured interview were administered before and after the participation project. Results showed no improvement in self-esteem or decrease in external locus of control after PPR. Meanwhile, a decrease in self-serving cognitive distortions was observed in the PPR group, but not in the comparison group. These results indicate that PPR may help to compensate for lack of adequate feedback and control, and in turn may decrease distorted thinking and possibly challenging behaviour.
Key-words: Mild intellectual disability; participatory peer research; I-D compensation theory; residential care institutions
Introduction
Cognitive distortions, in particular self-serving biases in social information processing, have been identified as antecedents of challenging behaviour among individuals with mild intellectual disabilities (MID) (Kerker, Owens, Zigler, & Horwitz, 2004; Langdon, Murphy, Clare,
Steverson, & Palmer, 2011). According to Martin’s I-D compensation theory, these cognitive distortions may stem from a lack of adequate feedback from the social environment (Martin, 1999). Martin claims that individuals function optimally and have feelings of being in control when they receive frequent feedback on progress towards their goals (Csikszentmihalyi, 1990; Wicklund, 1986), providing them with information on the degree to which their efforts will pay
off (Seta & Seta, 1992).The theory includes two components: immediate-return needs (the I in
I-D compensation), and delayed-return abilities (the I-D in I-I-D compensation). Individuals will function optimally if they are able to satisfy their immediate-return needs. If they fail in satisfying these needs, because rewards are delayed in time, they will, in the absence of real feedback, increase their reliance on imaginary mental processes, such as the simulation of feedback and problem solving through dissonance reduction. This can create thinking errors and distorted cognitions (Martin & Tesser, 1996; Roese & Olson, 1995; Taylor, Pham, Rivkin, & Armor, 1998).
Especially individuals with MID living in residential care institutions may experience lack of feedback from their (social) environment. The present study aims to evaluate the effects of participatory peer research (PPR) in young adults with MID and severe behavioural problems residing in a residential care facility. It is assumed that some feedback, and therewith control, is restored by training them to become researchers who collaborate in a small group of people with MID. The field of their research is constituted by the problems they perceive in the institution and/or subjects of their interest.
Individuals with MID and their urge for instant gratification
Individuals with MID encounter not only significant deficits in the area of intellectual functioning, but also in the area of adaptive behaviors, such as lack of effective communication, difficulties interacting with other people, and not being able to take care of oneself (definition AAIDD, Schalock et al., 2010). It is argued that an IQ-score in itself is too limited a predictor of problems in individuals with MID. It is not only the limitations in intellectual functioning, but also those in social adjustment that seem to cause behavioural problems that warrant treatment (Ras, Woittiez, Van Kempen, & Sadiraj, 2010). In clinical practice in the Netherlands, MID refers to individuals with an IQ score between 50 and 85, and significant problems in adaptive behaviour, more specifically in the area of social adjustment (Dutch Knowledge Centre on MID, 2012).
Compared to their typically developing peers, individuals with MID are generally more focused on immediate gratification instead of on delayed rewards (Parry & Lindsay, 2003; Weelden & Niessen, 1976). They often show impulsive behaviour and an inability to resist delay of immediate gratification (Leppers, 1981; Loeber, 1990; Parry & Lindsay, 2003; Weelden & Niessen, 1976). In general, individuals with MID tend to underestimate the value of negative consequences and have difficulties delaying personal gratification. Therefore, they more often opt for a smaller, immediate reinforcer over a larger, delayed reinforcer (Parry & Lindsay, 2003). Indeed, research shows that individuals with MID often show an inability to pursue long-term goals and to account for future consequences of their behaviour (e.g., Logue, 1988; Parry & Lindsay, 2003). They tend to live in the present and are generally not inclined to focus on the future, which makes that they can hardly postpone instant gratification (Parry & Lindsay, 2003; Weelden & Niessen, 1976).
The demand for instant gratification renders individuals with MID more vulnerable to ego-defensive tendencies and distorted cognitions. These tendencies and cognitions are inaccurate or biased causal inferences to social problem situations (Barriga, Gibbs, Potter, &
Liau, 2001; Nas, Brugman, & Koops, 2008) and can be divided in primary and secondary
self-serving cognitive distortions (Gibbs, 2003; Gibbs, Potter, & Goldstein, 1995). Primary
distortions are self-centered attitudes and beliefs: an individual thinks its own needs, immediate feelings, desires, etcetera are so important that the feelings and needs of others (or even one's own long-term best interests) are not taken (fully) into account (Barriga et al., 2001). To neutralize conscience, potential empathy, and guilt, and thereby prevent damage to the self-image, secondary cognitive distortions are used. Three secondary distortions are distinguished: blaming others, minimizing/mislabeling, and assuming the worst. Blaming others refers to misattributing blame to outside sources (e.g., another person or a momentary aberration). Minimizing/mislabeling means considering challenging behavior as acceptable and causing no real harm (e.g., belittling or dehumanizing labels). Assuming the worst refers to attributing hostile intentions to others, seeing worst-case scenarios as inevitable, or assuming that improvement is impossible (Barriga et al., 2001). These self-serving cognitive distortions are often considered important precursors of challenging behaviour (Brugman, 2007; Kerker, Owens, Zigler, & Horwitz, 2004; Langdon, Murphy, Clare, Steverson, & Palmer, 2011), which provides individuals with easy and immediate gratification (Pratt & Cullen, 2000).
Young adults with MID in residential care institutions
Because we nowadays live in a culture in which gratification and outcomes of efforts are often delayed and sometimes uncertain (Martin, 1999), especially individuals with MID (and behavioural problems) may be inclined to show social problems, problems in executive
residential care institutions often experience a lack of frequent feedback and control, because staff responsiveness to the needs of the individuals is often insufficient, and living group climate is often characterized by repressive control (Van der Helm, Klapwijk, Stams, & Van der Laan, 2009; Wehmeyer, 2001). Furthermore, individuals with MID generally have few opportunities for self-determination or control over their lives (Wehmeyer, 2001).
Besides, research shows that living in an impoverished environment, in which adequate feedback and opportunities for application of newly acquired competences are insufficient, fosters learned helplessness (Van der Helm et al., 2009). Learned helplessness is thought to be associated with an external locus of control in individuals living in residential facilities (Page & Scalora, 2002; Van der Helm, Beunk, Stams, & Van der Laan, 2013). Indeed, several studies reported that young adults in secure care tend to attribute success or failure primarily to factors outside personal control (Langdon, 2006; Van der Helm et al., 2009). Such an external locus of control is thought to increase the susceptibility to criminal cognitions and other kinds of distorted cognitions as well (Groeneweg et al., 2012; Martin, 1999; Thomaes, 2007). This lack of adequate feedback and control may be resolved by involving individuals with MID in decisions regarding their daily lives, for instance, by implementing opportunities for participation (Dedding, Jurrius, Moonen, & Rutjes, 2013; Lauwers & Vanderstede, 2009).
Participatory peer research (PPR)
One method to allow clients in residential care institutions to perceive reinforcement and regain self control is ‘participatory peer research (PPR). In ‘participatory peer research’ (PPR) clients function as participant-researchers of problems or developments that occur within the same group of people. An important characteristic of this peer research is that the clients are actively involved in various phases of the research process, such as composing a list of interview questions, interviewing, and brainstorming about the consequences of the results. The clients
actively and independently acquire information (De Winter & Noom, 2003; Dedding et al., 2013; Hart, 1997). Based on such an approach, clients have input in formulating topics, research questions, choice of methodology, data collection, presentation, and implementation and
monitoring of the consequences of the results (Dedding et al., 2013; De Winter & Noom, 2003). A democratic dialogue is developed, in which the imbalance in power between clients and supervisors can disappear (Hart, 1997; Sabo Flores, 2007). PPR was developed as a response to an increased focus on minors’ rights (UNICEF 1995). Minors were involved more and more in decision-making affecting their lives (in policy, research or practice).
Each PPR project is unique, because the design of the project depends on the input of the participants. A summary of the PPR project in this study is described in the method section. Although the content of the project cannot be established in advance, the working procedure is approximately equal for all PPR projects (Dedding et al., 2013). At first, a group of clients is selected to form a research group. Generally, clients within institutional care have questions, points of interests, problems with their direct environment or things they miss within the institution. These subjects are the starting points for the PPR project. With guidance of the PPR coach(es), the participant-researchers start with group wise brainstorming to attain to subjects they would like to change or create within the institution. Subsequently, the research method and instruments are chosen. It is important that this method is consistent with the environment and capacities of the clients. Then, the client researchers are involved in several aspects of the design of the research (e.g. composing questionnaires, communication with peers and professionals). At the same time, the client researchers are trained in (research) communication skills. Hereafter, respondents are selected. It is defined and justified how this selection is made, who play a role in the selection procedure and how the group of respondents is composed. During this process, the qualities and capacities of the participant-researchers are taken into account and it is verified whether the selection of respondents will generate sufficient data to answer the research
question(s). The next step is data collection, in which the client researchers gather the data themselves. In advance, it is assessed whether the client researchers know how to collect the data, how to handle the data recording, and how the coaches support the client researchers during data collection. Based on these data, the client researchers and coaches draw conclusions and formulate follow-up actions. The coaches help to draw correct and concrete conclusions and check the extent to which the client researchers subscribe to these conclusions. The next step in the research process is presenting and reporting results. Together, the participant-researchers and coaches decide which form of presentation is appropriate for this particular research. At last, it is discussed which follow-up actions are needed on the occasion of the research results. In this phase of the research, specific attention is paid to the role of the client researchers; what can they do themselves to implement the results? Moreover, it is recommended to test the chosen
approach/solution in practice before implementing it (Dedding et al., 2013).
Present study
The aim of this study was to evaluate the effects of participatory peer research in young adults with MID and severe behavioural problems living in a residential care institution. It was hypothesized that participatory peer research leads to (1) an improvement in self-esteem, (2) a decrease in external locus of control, and (3) a decrease in self-serving cognitive distortions.
Method Participants
The present study was conducted in a residential care institution for young adults with intellectual disabilities and severe behavioural problems (and additional psychiatric problems) in the Netherlands. The study was designed as a multiple case study, which included 10
participants; five respondents in the experimental group and five respondents in the comparison group. Three inclusion criteria were used to select participants; (1) respondents were between 18
and 35 years old, (2) had mild intellectual disabilities (IQ score between 50 and 85), and (3) showed severe behavioural problems. The mean age of the respondents was 21.4 years (SD = 5.06, age range: 18-35 years), and the mean length of stay in the institution was 31 months (range: 1-160 months).
Procedure
Data were collected by means of questionnaires and a semi-structured interview, which were administered twice to the participants in both the experimental group and the comparison group; before (T = 0) and after the PPR project (T = 1) of three months. All respondents participated voluntarily in the project and study, and were informed in advance about what it meant to participate in the study and what they could possibly encounter in the participation project. They were told that their answers to the research questions would be treated
confidentially and anonymously and would be accessed only by the researchers. Based on this information, participants decided whether they agreed to participate both in the project and study or not. To compose an experimental and a comparison group, participants were asked to indicate in which group they would like to participate. Participants in the experimental group joined PPR and were trained as participant-researchers, whereas participants in the comparison group did not receive any additional training or guidance. To conduct this study, permission was obtained from the management of the institution and the ethical committee of the Graduate School of Child Development and Education of the University of Amsterdam.
Intervention
In this particular PPR project, a group of five clients collaborated with two professionals (not being group workers) functioning as coaches. These coaches were supervised by an PPR expert and supported the client researchers in conducting research and encouraged them to show respect to each other and to interact assertively but friendly. Two hour meetings took place twice a week during a period of three months. After the brainstorm sessions, the clients wanted to
address four subjects: generating a music studio, setting up fire drills for clients, arranging more transportation options for clients, and to improve the mutual communication between group workers and between group workers and clients. Together with the coaches, the client researchers composed structured questionnaires to find out if other clients agreed with the importance of these subjects and to clarify the problems and requests. Subsequently, the client researchers recruited twenty three participants of several living groups. After an interview training of two sessions, the client researchers interviewed the respondents in pairs: one of the researchers interviewed the respondent and the other researcher wrote down the answers. Then, data were analysed by the coaches and results were discussed with the client researchers. Lastly, results of the project were presented to the management board by means of an oral presentation and a song.
Measures
Self-esteem. Self-esteem of the researchers was measured using the Rosenberg
self-esteem scale (RSES; Rosenberg, 1965; Cronbach’s α normative sample = .87; Schmitt & Allik,
2005). The RSES is a 10-item scale, designed to represent a continuum of self-worth statements. The scale contains five positively worded items (e.g., ‘I am satisfied with myself’) and five negatively worded items (e.g., ‘I think I am a loser’), which were answered on a 4-point Likert scale (1 = I strongly disagree to 4 = I strongly agree). For this study, the RSES was translated into Dutch and customized for use with individuals with mild intellectual disabilities by simplifying and shortening the statements of the questionnaire.
Locus of control. Locus of control was measured using a Dutch version of the Locus of
Control Scale by Rotter (Pugh, 1994; Cronbach’s α normative sample = .72). This scale was
customized for use with individuals with mild intellectual disabilities by simplifying and shortening the statements. The questionnaire uses 16 items (plus four filler items). Each item consists of two statements. Respondents were asked to select the statement they agreed with the
most. Scores range from zero to 16. A low score indicates a more internal locus of control while a high score indicates a more external locus of control.
Self-serving cognitive distortions. Self-serving cognitive distortions were measured
using the Dutch version of the How I Think Questionnaire (HIT; Brugman et al., 2011; Nas, Brugman & Koops, 2008). The HIT measures four categories of self-serving cognitive
distortions (thinking errors); self-centred (e.g., ‘Sometimes you have to lie to get what you want’;
Cronbach’s α normative sample = .76), blaming others (e.g., ‘I make mistakes because I hang out
with the wrong people’; Cronbach’s α normative sample = .77), minimizing/mislabeling (e.g., ‘Lying is ok, everyone does it’; Cronbach’s α normative sample = .78), and assuming the worst
(e.g., ‘You cannot trust anyone, because everyone is always lying to you’; Cronbach’s α
normative sample = .78). The questionnaire consists of 54 item, which are answered on a 6-point Likert scale (1 = I do not agree and 5 = I totally agree).
Level of participation. In addition to the questionnaires, all participants in both groups
were interviewed before and after the project to verify their perceived pre and post level of participation. By comparing these levels, it was assessed whether the participation level was successfully enlarged within the experimental group. To guide these interviews, a list of
questions was used. These questions were based on the levels of the participation ladder of Hart (1997). Furthermore, participants in the experimental group were asked whether they valued the project and they were inquired about the changes they experienced after finishing the project.
Statistical analysis
In order to investigate the individual changes over time, we used the Reliable Change Index (RCI; Jacobson & Truax, 1991). The RCI demonstrates how much, and in what direction an individual has changed, and whether change is reliable and clinically significant. Although the RCI may be used with any sample size, it particularly lends itself to small group research
calculating the difference between the pretest score and the posttest score on a questionnaire for each participant. Subsequently, this difference score is divided by the standard error of the instrument (from normative sample). Because improvement was expected for individuals within the experimental group, one-tailed significance tests with an alpha level of .05 were conducted. This meant that a RCI of ≥ 1.64 indicated a significant improvement in scores. In the comparison group, two-tailed significance tests with an alpha-level of .05 were conducted, because there was no expected (direction of) change. In this group, a RCI of ≥ 1.96 or ≤ –1.96 indicated a
significant change in scores (Jacobson & Truax, 1991; Hafkenscheid, Kuipers, & Marinkelle, 1998).
Results Reliable Change Indices (RCI)
To assess individual change in self-esteem, locus of control and thinking errors after the participation project of three months, the RCI was calculated for each participant. Table 1 and 2 present the pretest scores, the posttest scores and the RCI for self-esteem and locus of control of all participants. In contrast to our expectations, only one of the participants in the experimental group showed a significant positive change in self-esteem and none of them changed
significantly in their scores on locus of control. In the comparison group, one of the participants showed a significant deterioration in self-esteem, and another individual showed a significant deterioration in locus of control. This person showed more external locus of control at time of the posttest compared to its score at pretest.
As expected, Table 3 shows that a majority of the participants in the experimental group showed significantly less self-serving cognitive distortions at time of the posttest. Four of these participants showed significantly less self-centred thinking after three months of PPR, whereas one participant in the comparison group showed significantly more self-centred thinking at
posttest. Similarly, four of the participants in the experimental group were significantly less inclined to blame others after their participation in the project, whereas none of the participants in the comparison group showed a significant change in level of this cognitive distortion. Regarding minimizing/mislabeling, three of the participants in the experimental group were significantly less inclined to show this distortion. However, also two of the participants in the comparison group changed significantly in their level of minimizing/mislabeling; one of them showed significantly more minimizing/mislabeling, whereas the other showed significantly less minimizing/mislabeling. At last, three of five participants in the experimental group were significantly less inclined to assume the worst, whereas in the comparison group, one of the participants was more inclined to assume the worst.
As can be observed in Table 3, none of the participants in the experimental group showed a deterioration in any of the self-serving cognitive distortions. All participants who joined the participation project showed improvement in distorted thinking. However, this improvement was not significant in all cases. In contrast, many of the participants in the comparison group did show a deterioration in distorted thinking. In some of these cases, this deterioration was significant.
Level of participation
Since it was expected that the level of participation of the individuals in the experimental group would increase during the PPR project, the perception of the level of participation of all participants was assessed before and after the PPR project using an interview. To guide these interviews, a list of questions which were based on the levels of participation of Hart’s ladder (1997) was used. Only the most important findings are discussed below. An overview of the questions used and a more detailed resume of the interview results is displayed in Table 4.
At both pre- and posttest, all participants indicated that they were allowed to state their opinion at their living group and working place, but some of them declared that they were
generally not allowed to give their opinion on anything (e.g., not about other clients or negative topics). According to all participants in the experimental group, group workers did not or only scarcely inquired about their opinion in everyday life at time of both pre- and posttest.
Meanwhile, two participants in the experimental group indicated that group workers improved in listening to their opinion at time of posttest. At both pre- and posttest, all participants indicated that group workers were not or only sometimes interested in their opinion. Some of them thought group workers found it difficult if clients gave their opinion. When participants were asked whether something was done with it when they stated their opinion, the majority of participants indicated at both pre- and posttest that this happened only sometimes. In sum, no substantial changes in the interaction between group workers and clients and the possibilities to express opinions were reported after the PPR project.
In advance of the project, none of the participants was (fully) aware of developments and subjects that were worked on within the institution. After the project, all participants in the experimental group indicated that they were aware of some upcoming changes because of their participation in the PPR project. However, they did not know which developments were worked on within the institution apart from the issues that were discussed in the project. At posttest, all participants in the experimental group felt more able to say which aspects in the institution needed to change. Moreover, in contrast to the pretest they now believed it was useful to say what they would like to change and felt able to initiate and achieve changes themselves. No substantial changes in their involvement in developments within the institution were reported by the participants in the comparison group. In short, participants’ perceptions of their involvement in changes within the institution improved after participation in the PPR project. However, involvement was still limited to subjects concerning PPR.
Furthermore, the client researchers were interviewed about their experiences during participation in the project in order to evaluate the project. Some of them indicated that it was difficult to work on different subjects and tasks at the same time, and that some tasks were quite difficult for them. Besides, they mentioned that the collaboration with other clients with MID sometimes proved to be difficult and that they needed more awareness of the PPR project among professionals within the institution. In that way, it would be easier to collaborate with a variety of professionals within the institution and to mobilize and excite these professionals to contribute to the project.
On the other hand, all participants indicated that they appreciated the mutual
collaboration among clients and their coaches and the fact that they were able to represent the interests of other clients. They also thought the project was informative and challenged
participants in becoming active, aware and responsible for their own situation. One participant indicated that his perseverance was enlarged by the project. Besides, the participants appreciated the mutual trust and the way of communicating. According to the young adults, they learned several communication skills: conducting calm conversations, listening to others’ opinions, and allowing others to finish their sentence.
Discussion
In this study, participatory peer research (PPR) in young adults with MID and severe behavioural problems living in a residential care institution was evaluated. It was expected that participatory peer research would lead to more self-esteem and less external locus of control and self-serving cognitive distortions. In contrast to our expectations, none of the participants in the experimental group of the PPR project showed a significant improvement in self-esteem. A possible explanation is that it generally takes a long time to change one’s level of self-esteem. Self-esteem reflects people’s representations of how they typically feel about themselves across
time and context. Although these representations can change, the changes usually occur slowly and over an extended period of time (Rosenberg, 1986).
It was also expected that levels of external locus of control would decrease by means of participation in the PPR project. However, this was not the case. This may be due to the fact that the participants received frequent (and adequate) feedback within the context of the PPR project, but not yet in the other contexts they participated in, such as the living group and their working place. In these other contexts, the level of participation had not been changed. Nonetheless, most of the individuals who joined the PPR project did show a significant decrease in the four types of self-serving cognitive distortions. After three months of PPR, most of the individuals in the experimental group showed less self-centred thinking, were less inclined to blame others and to assume the worst, and tended no longer to minimize or mislabel their own or other’s behaviour. However, no change in self-esteem and external locus of control was found. It is possible that positive changes in cognitive distortions precede changes in self-esteem and locus of control, which would explain lack of changes in self-esteem and locus of control, because it simply takes more time before improved cognitive functioning affects self-esteem and locus of control.
In contrast to our expectations, results showed no substantial changes after PPR in the interaction between group workers and clients and possibilities for clients to express their opinion. This may be due to the fact that PPR was still a rather isolated project within the institution, and did not yet penetrate in other areas of the clients’ life within the institution. Nevertheless, participants’ perceptions of their involvement in changes within the institution improved after introduction of the PPR project. The participants who joined the project knew what was being changed, felt they could indicate what they wanted to change, and felt able to initiate changes within the institution themselves. Moreover, professionals indicated that the client researchers were far more capable of defining and performing research tasks than they
considered possible at start. No substantial changes in their involvement in developments within the institution were reported by the participants in the comparison group.
Also participants in the comparison group showed significant changes in some of the outcome measures. Most of these changes were in a negative direction. These results seem to indicate a buffer effect of PPR. In residential care institutions, individuals often experience a lack of frequent feedback and control, because staff responsiveness to the needs of the clients is often insufficient, and living group climate is often characterized by repressive control (Van der Helm, Klapwijk, Stams, & Van der Laan, 2009; Wehmeyer, 2001). Therefore, a decrease in self-esteem and an increase in external locus of control and cognitive distortions may be expected if nothing is changed.
There are some limitations of this study that need to be acknowledged. First, participants were not randomly assigned to the experimental and comparison group. Therefore, it cannot be ruled out that differences in results are caused by other unmeasured factors (i.e., pre-existing differences). Second, two questionnaires were customized for use with individuals with MID (Rosenberg’s RSES and Rotter’s Locus of Control Scale), which may have had consequences for the validity and reliability of these instruments. Third, the period between the pretest and posttest was only three months, which is a rather short period to implement PPR in more relevant aspects of living and working in an institution than just the aspects the project focused on. For future research, it is recommended to also pay attention, and perhaps influence too, the level of
participation in all aspects of a clients’ life in an institution, such as the living group, leisure time and working place. To achieve this, it is recommended to prolong the period of a PPR project, or to institutionalize PPR, and use research results of PPR projects as a source of constant
communication between clients, staff and management (Dedding et al., 2013). In that way, the probability of achieving significant positive changes in participants’ self-esteem, locus of control and self-serving cognitive distortions may be enlarged. Fourth, this project took place during a
troubled period in the institution. Many changes were entailed by the arrival of new clients and the redesigning of clients’ group homes. For individuals with MID, it is often difficult to deal with these changes (Dutch Knowledge Centre on MID, 2012). A lot of clients were confused and/or stressed, which led to agitation and dissatisfaction among the clients. These tensions made it difficult for some of the client researchers to continue the PPR project. Fifth, the groups were too small to produce generalizable results and sufficient statistical power to test differences between the experimental and comparison group. For future research, it is recommended to enlarge the sample sizes.
Despite these limitations, the results of this study provide preliminary evidence for positive changes in young adults with MID involved in PPR, compared to young adults who were not involved in PPR. There are some important implications for practice. First, this study indicates that frequent adequate feedback and restoring control could be important components of the daily care routines of individuals with MID. By providing clients with extended control and frequent social feedback by means of participatory peer research, self-serving cognitive distortions, and hereby possibly later challenging behaviour, may be mitigated. Second, the results fit with the recent ‘trend’ in thinking about individuals with MID that it is important to focus on capacities rather than on limitations of individuals with MID. Participants in the PPR project were capable to do research and that was far more than professionals in their institution thought they were capable of. Furthermore, although it did not lead to an increase in self-esteem (yet), the client researchers indicated they felt strengthened because they were taken seriously, were able to represent the interests of other clients, and could initiate change themselves.
The present study was the first to evaluate participatory peer research (PPR) in
individuals with MID. In Dutch society, there are more and more signals of increased problems with (young) individuals with MID. These problems, like committing crimes and expressing problem behavior, are often complex and have great social impact. To tackle these problems
adequately and to reverse this negative trend, new methods of treatment, care and guidance are
needed.Participatory peer research may compensate for a lack of adequate feedback and control
by implementing opportunities for participation, and in turn may diminish distorted thinking and problem behaviour in young individuals with MID. Future research should focus on the
effectiveness of PPR using a larger sample and random allocation to experimental and control groups to provide proof of the effects of PPR. However, the present study shows some first promising results.
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Table 1
Pretest scores, posttest scores and RCI for self-esteem in the experimental and comparison group
Subject Pretest Posttest RCI
exp er im en ta l 1 19 20 .44 2 33 37 1.75* 3 33 33 0 4 28 30 .88 5 29 30 .44 com par is on 6 21 22 .44 7 30 25 -2.19˟ 8 33 34 .44 9 34 30 -1.75 10 19 22 1.31
Note. * p < .05 (one-tailed significance);
˟ p < .05 (two-tailed significance)
Table 2
Pretest scores, posttest scores and RCI for locus of control in the experimental and comparison group
Subject Pretest Posttest RCI
exp er im en ta l 1 6 8 .80 2 13 13 0 3 12 12 0 4 10 9 -.40 5 5 9 1.60 com par is on 6 8 6 -.80 7 10 12 .80 8 10 10 0 9 13 8 -2.00˟ 10 9 8 -.40
Note. * p < .05 (one-tailed significance);
Table 3
Pretest scores, posttest scores and RCI for self-serving cognitive distortions in the experimental and comparison group
Subject Pretest Posttest RCI Pretest Posttest RCI
Self-centred Blaming others
exp er im en ta l 1 1.89 1.56 .71 2.80 1.70 2.22** 2 2.56 1.33 2.65** 2.60 1.30 2.63** 3 1.89 1.11 1.68* 1.90 1.40 1.01 4 3.33 2.33 2.15** 3.30 1.90 2.83** 5 2.22 1.44 1.68** 2.50 1.50 2.02** com par is on 6 2.22 2.44 -.47 2.40 2.30 .20 7 1.22 1.11 .24 2.60 2.30 .61 8 2.44 3 -1.21 2.50 3.30 -1.62 9 1.44 2.67 -2.65˟ 1.10 1.90 -1.62 10 1.78 1.78 0 1.50 1.60 -.20
Minimizing/mislabeling Assuming the worst
exp er im en ta l 1 3.44 1.67 3.98** 2.64 2.36 .64 2 2.00 1.44 1.26 2.91 1.64 2.90** 3 1.89 1.11 1.76* 1.45 1.27 .41 4 2.56 1.67 2.00** 3.36 2.18 2.70** 5 2.67 1.67 2.25** 2.64 1.73 2.08** com par is on 6 2.44 2.44 0 3.09 2.27 1.87 7 1.89 1.00 2.00˟ 2.00 1.36 1.46 8 1.56 2.56 -2.25˟ 2.09 3.09 -2.28˟ 9 1.56 2.33 -1.73 1.36 2.18 -1.87 10 1.44 1.89 -1.01 2.18 2.00 .41
Note. * p < .05, ** p < .025 (one-tailed significance);
Table 4
Level of participation: Resume of the interview questions and answers for the experimental and comparison group
Pretest Posttest Change
Group Times Answer Times Answer Subject Pretest > Posttest
1. Are you allowed to Ea 5 Yes 5 Yes - -
state your opinion at your Cb 5 Yes 5 Yes - -
living group and job?
2. Do group workers inquire E 2 No 2 No - -
about your opinion? 3 Sometimes 3 Sometimes
C 3 No 4 No 10 Sometimes > No
2 Sometimes 1 Yes
3. Do group workers listen E 2 Yes 2 Yes 1 Yes > No
to your opinion? 1 Sometimes 2 Sometimes 4 No > Yes
2 No 1 No 5 No > Sometimes
C 3 Sometimes 3 Sometimes - -
2 almost never 2 Scarcly
4. Are group workers E 3 Sometimes 3 Sometimes 1 Sometimes > No
interested in your 2 No 1 No 2 No > Don't know
opinion? 1 Don’t know 10 No > Sometimes
C 2 Sometimes 2 Sometimes 9 No > Don't know
3 No 2 No
1 Don’t know
5. Is something done with E 3 Sometimes 3 Sometimes - -
it when you stated your 2 No 2 No
opinion? C 4 Sometimes 4 Sometimes - -
1 No 1 No
6. Do you know which E 2 Sometimes 5 Yes, by PPRc All > Yes
subjects are being 3 No
changed within the C 3 Sometimes 5 No 8, 9, 10 Sometimes > No
institution? 2 No
7. Are you able to say you E 3
Yes, but no
sense 5 Yes, by PPR 3 Don't know > Yes
would want something to 2 Don't know 5 Don't know > Yes
change within the C 3
Yes, but no
sense 2 Yes, by PPR 6, 9 Yes > No
institution? 2 No 2 No 7 Yes > Don't know
1 Don't know 8, 10 No > Yes
8. Are you able to do E 1 Yes 4 Yes, by PPR 2, 3, 4 Don't think so > Yes something yourself to 4 Don't think so 1 No
changes subjects within C 2 Don't think so 2 Yes 8 Don't know > Yes
the institution? 3 Don't know 1 Don't know 9 Don't know > No
2 No 10 Don't think so > Yes
