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Social Information Processing in Adolescents with Mild to Borderline Intellectual

Disability

van Rest, M.M.

2018

document version

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Link to publication in VU Research Portal

citation for published version (APA)

van Rest, M. M. (2018). Social Information Processing in Adolescents with Mild to Borderline Intellectual

Disability: Executive Functions, Situational Factors, and Instrument Development.

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ŚĂƉƚĞƌ

ϭϯϬ ŽŶĚƵĐƚWƌŽďůĞŵƐWƌĞǀĞŶƟŽŶZĞƐĞĂƌĐŚ'ƌŽƵƉ͕ϮϬϭϯͿ͘/ƚƐŚŽƵůĚŚŽǁĞǀĞƌďĞŶŽƚĞĚƚŚĂƚŝƚ ŝƐƐƟůůƵŶĐůĞĂƌŚŽǁŵƵĐŚ&ƐĐĂŶďĞŝŵƉƌŽǀĞĚƚŚƌŽƵŐŚƚƌĂŝŶŝŶŐ;ŝĂŵŽŶĚΘ>ŝŶŐ͕ϮϬϭϲͿ͘ ZĞƐƵůƚƐŽĨƚŚŝƐĐƌŽƐƐͲƐĞĐƟŽŶĂůƐƚƵĚLJƐƵŐŐĞƐƚƚŚĂƚ^/WƐŬŝůůƐĨŽƌŵĂŵĞĚŝĂƟŶŐŵĞĐŚĂŶŝƐŵ ůŝŶŬŝŶŐƚŚĞ&ƐĨŽĐƵƐĞĚĂƩĞŶƟŽŶĂŶĚǁŽƌŬŝŶŐŵĞŵŽƌLJƚŽĂŐŐƌĞƐƐŝŽŶŝŶĂĚŽůĞƐĐĞŶƚƐǁŝƚŚ D/͘dŚĞƉŽƐƐŝďůĞŵĞĚŝĂƟŶŐƌŽůĞŽĨ^/W͕ŚŽǁĞǀĞƌ͕ŵƵƐƚďĞĨƵƌƚŚĞƌƚĞƐƚĞĚŝŶůŽŶŐŝƚƵĚŝŶĂů ƐƚƵĚŝĞƐ͘/ŶĂĚĚŝƟŽŶ͕ƚŚĞĐĂƵƐĂůƌŽůĞŽĨ&Ɛ͕ĨŽƌĞdžĂŵƉůĞtD͕ĐŽƵůĚďĞĞdžĂŵŝŶĞĚŝŶĂŶ ĞdžƉĞƌŝŵĞŶƚĂů ƐƚƵĚLJ ŝŶ ǁŚŝĐŚ &Ɛ ĂƌĞ ƚƌĂŝŶĞĚ͘ /ƚ ĐŽƵůĚ ƚŚĞŶ ďĞ ŝŶǀĞƐƟŐĂƚĞĚ ǁŚĞƚŚĞƌ ƚŚĞ ĞīĞĐƚ ŽĨ ĞdžƉĞƌŝŵĞŶƚĂůůLJ ĞŶŚĂŶĐĞĚ &Ɛ ŽŶ ůĞƐƐ ĂŐŐƌĞƐƐŝŽŶ ǁŽƵůĚ ďĞ ŵĞĚŝĂƚĞĚ ďLJ ĂŵĞůŝŽƌĂƚĞĚ^/WƐŬŝůůƐ͘dŚĞƐĞůŽŶŐŝƚƵĚŝŶĂůĂŶĚĞdžƉĞƌŝŵĞŶƚĂůƐƚƵĚŝĞƐĐŽƵůĚďĞŝŶĨŽƌŵĂƟǀĞ ŝŶƵŶĚĞƌƐƚĂŶĚŝŶŐĂŐŐƌĞƐƐŝŽŶŝŶLJŽƵƚŚǁŝƚŚD/ĂŶĚŝŶLJŽƵƚŚǁŝƚŚĂǀĞƌĂŐĞŝŶƚĞůůŝŐĞŶĐĞ levels. &ƵƚƵƌĞƌĞƐĞĂƌĐŚƐŚŽƵůĚĂůƐŽŝŶǀĞƐƟŐĂƚĞĚŝƐƟŶĐƟŽŶƐďĞƚǁĞĞŶĂĚŽůĞƐĐĞŶƚƐǁŝƚŚD/ ĂŶĚďŽƌĚĞƌůŝŶĞŝŶƚĞůůĞĐƚƵĂůĨƵŶĐƟŽŶŝŶŐ͕ďĞĐĂƵƐĞ/YƉůĂLJƐĂŶŝŵƉŽƌƚĂŶƚƌŽůĞŝŶƚŚĞŝƌůĞǀĞůƐ ŽĨ&ƐĂŶĚ^/W;Ğ͘Ő͕͘sĂŶĚĞƌDŽůĞŶĞƚĂů͕͘ϮϬϭϰ͖sĂŶEŝĞƵǁĞŶŚƵŝũnjĞŶĞƚĂů͕͘ϮϬϭϳͿ͕ĂŶĚ LJŽƵƚŚǁŝƚŚďŽƌĚĞƌůŝŶĞŝŶƚĞůůĞĐƚƵĂůĨƵŶĐƟŽŶŝŶŐĂƌĞƵŶĚĞƌƐƚƵĚŝĞĚŝŶŐĞŶĞƌĂů;WĞůƚŽƉƵƌŽ͕ ŚŽŶĞŶ͕<ĂĂƌƟŶĞŶ͕^ĞƉƉćůĂ͕ΘEćƌŚŝ͕ϮϬϭϰͿ͘ &ŝŶĂůůLJ͕ĨƌŽŵĐƵƌƌĞŶƚĮŶĚŝŶŐƐ͕ǁĞƉƌŽƉŽƐĞƚŽŝŶǀĞƐƟŐĂƚĞƐĞǀĞƌĂůƚLJƉĞƐŽĨŝŶŚŝďŝƟŽŶ ŵŽƌĞŝŶƚŽĚĞƚĂŝů͕ŝŶŽƌĚĞƌƚŽĞdžĂŵŝŶĞǁŚĞƚŚĞƌĐŽŐŶŝƟǀĞĂŶĚďĞŚĂǀŝŽƌĂůŝŶŚŝďŝƟŽŶ;EŝŐŐ͕ ϮϬϬϬͿƐŚŽǁĚŝīĞƌĞŶƚƌĞůĂƟŽŶƐǁŝƚŚ^/WĂƐĂŵĞĚŝĂƚŽƌŽĨƚŚĞƌĞůĂƟŽŶǁŝƚŚĂŐŐƌĞƐƐŝŽŶ͘ dŚĞƐĞ ĚŝīĞƌĞŶƚ ƚLJƉĞƐ ŽĨ ŝŶŚŝďŝƟŽŶ͕ ĂŶĚ ĂĚĚŝƟŽŶĂů &Ɛ ƐƵĐŚ ĂƐ ĐŽŐŶŝƟǀĞ ŇĞdžŝďŝůŝƚLJ͕ ĐŽŐŶŝƟǀĞ ĐŽŶƚƌŽů͕ ĂŶĚ ƉůĂŶŶŝŶŐ ;ŝĂŵŽŶĚ͕ ϮϬϭϯͿ͕ ƐŚŽƵůĚ ƚŚĞŶ ďĞŝŶĐŽƌƉŽƌĂƚĞĚ ŝŶƚŽ Ă more comprehensive model of EFs.

ϭϯϮ ϭϯϯ

CHAPTER 7

- SUMMAR

Y AND GENERAL DISCUSSION

dŚĞ ŵĂŝŶ Ăŝŵ ŽĨ ƚŚŝƐ ĚŝƐƐĞƌƚĂƟŽŶ ǁĂƐ ƚŽ ĐŽŶƚƌŝďƵƚĞ ƚŽ Ă ďĞƩĞƌ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ŽĨ ƚŚĞ ŚĞŝŐŚƚĞŶĞĚ ůĞǀĞů ŽĨ ĂŐŐƌĞƐƐŝǀĞ ďĞŚĂǀŝŽƌ ĂŵŽŶŐ ĂĚŽůĞƐĐĞŶƚƐ ǁŝƚŚ ŵŝůĚ ƚŽ ďŽƌĚĞƌůŝŶĞ ŝŶƚĞůůĞĐƚƵĂůĚŝƐĂďŝůŝƚLJ;D/ͿďLJƐƚƵĚLJŝŶŐƐŽĐŝĂůŝŶĨŽƌŵĂƟŽŶƉƌŽĐĞƐƐŝŶŐ;^/WͿ͕ĞdžĞĐƵƟǀĞ ĨƵŶĐƟŽŶƐ;&ƐͿ͕ĂŶĚƐŝƚƵĂƟŽŶĂůĨĂĐƚŽƌƐ͕ƵƐŝŶŐŶĞǁĂƐƐĞƐƐŵĞŶƚƉƌŽĐĞĚƵƌĞƐĨŽƌŵĞĂƐƵƌŝŶŐ ŝŶĚŝǀŝĚƵĂů^/WƐŬŝůůƐ͘/ŶĂĚĚŝƟŽŶƚŽŝŶĐƌĞĂƐŝŶŐƚŚŝƐƵŶĚĞƌƐƚĂŶĚŝŶŐ͕ƚŚĞŶĞǁĂƐƐĞƐƐŵĞŶƚ ƉƌŽĐĞĚƵƌĞƐ ĂĚŚĞƌĞ ƚŽ ƚŚĞ ŶĞĞĚƐ ŝŶ ƚŚĞ ĐůŝŶŝĐĂů ĮĞůĚ ƚŽ ŵŽƌĞ ĐŽŶĐƌĞƚĞůLJ ĚĞƐĐƌŝďĞ ƚŚĞ ƐŽĐŝĂůĂĚĂƉƟǀĞĨƵŶĐƟŽŶŝŶŐŽĨLJŽƵƚŚǁŝƚŚD/ĂŶĚǁŝƚŚĞdžƚĞƌŶĂůŝnjŝŶŐďĞŚĂǀŝŽƌƉƌŽďůĞŵƐ ;^ĐŚĂůŽĐŬĞƚĂů͕͘ϮϬϭϬ͖sĂŶEŝĞƵǁĞŶŚƵŝũnjĞŶ͕sƌŝĞŶƐ͕^ĐŚĞĞƉŵĂŬĞƌ͕^ŵŝƚ͕ΘWŽƌƚŽŶ͕ϮϬϭϭͿ͘ dŚĞ ĐƵƌƌĞŶƚ ƐƚƵĚLJ ĮŶĚŝŶŐƐ ƌĞǀĞĂůĞĚ ĂƐƐŽĐŝĂƟŽŶƐ ďĞƚǁĞĞŶ ƐĞǀĞƌĂů &Ɛ͕ ĨŽĐƵƐĞĚ ĂƩĞŶƟŽŶ͕ ďĞŚĂǀŝŽƌĂů ŝŶŚŝďŝƟŽŶ͕ ĂŶĚ ǁŽƌŬŝŶŐ ŵĞŵŽƌLJ͕ ĂŶĚ ^/W ƐŬŝůůƐ͕ ĞdžƉĂŶĚŝŶŐ ŽƵƌ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ŽĨ ĂŐŐƌĞƐƐŝǀĞ ďĞŚĂǀŝŽƌ ŝŶ ĂĚŽůĞƐĐĞŶƚƐ ǁŝƚŚ D/ ;ŚĂƉƚĞƌƐ ϯ ĂŶĚ ϲͿ͘ &ƵƌƚŚĞƌŵŽƌĞ͕ƚŚŝƐĚŝƐƐĞƌƚĂƟŽŶƉƌŽǀŝĚĞĚŝŶƐŝŐŚƚŝŶƚŽƚŚĞƐĞǀĞƌĂůƚLJƉĞƐŽĨƐŽĐŝĂůƐŝƚƵĂƟŽŶƐ ƚŚĂƚ͕ ĚĞƉĞŶĚŝŶŐ ŽŶ ƉĞƌƉĞƚƌĂƚŽƌ ŝŶƚĞŶƚ͕ ďƌŝŶŐ ƚŽ ůŝŐŚƚ ĚŝĸĐƵůƟĞƐ ĂŶĚ ďŝĂƐĞƐ ŝŶ ^/W ŝŶ ĂĚŽůĞƐĐĞŶƚƐǁŝƚŚD/ĂŶĚďŽƌĚĞƌůŝŶĞ/Y͕ĂŶĚĂĚŽůĞƐĐĞŶƚƐǁŝƚŚĞdžƚĞƌŶĂůŝnjŝŶŐďĞŚĂǀŝŽƌ ƉƌŽďůĞŵƐ͕ ĂƐ ĐŽŵƉĂƌĞĚ ƚŽ ƚŚĞŝƌ ƚLJƉŝĐĂůůLJ ĚĞǀĞůŽƉŝŶŐ ƉĞĞƌƐ ;ŚĂƉƚĞƌ ϱͿ͘ dŚĞƐĞ ^/W ŝŶǀĞƐƟŐĂƟŽŶƐ ŝŶ ĂĚŽůĞƐĐĞŶƚƐ ǁŝƚŚ D/ ǁĞƌĞ ŵĂĚĞ ƉŽƐƐŝďůĞ ďLJ ƚŚĞ ĚĞǀĞůŽƉŵĞŶƚ ŽĨ ĂŶĞǁĚŝŐŝƚĂůĚŝĂŐŶŽƐƟĐ^/WŝŶƐƚƌƵŵĞŶƚ͘dŚĞƐƚĞƉƐƚĂŬĞŶŝŶƚŚĞƉƌŽĐĞƐƐŽĨŝŶƐƚƌƵŵĞŶƚ ĚĞǀĞůŽƉŵĞŶƚǁĞƌĞƉƌĞƐĞŶƚĞĚŝŶƚŚĞŚĂƉƚĞƌƐϮĂŶĚϰŽĨƚŚŝƐĚŝƐƐĞƌƚĂƟŽŶ͘dŚĞƐƚƵĚŝĞƐŝŶ ƚŚĞƐĞĐŚĂƉƚĞƌƐĐŽŶƚƌŝďƵƚĞĚƚŽƚŚĞǀĂůŝĚĂƐƐĞƐƐŵĞŶƚŽĨŝŶĚŝǀŝĚƵĂů^/WƐŬŝůůƐƚŚĂƚŵĂLJďĞ associated with individual outcomes at the behavioral level.

ϭϯϰ ϭϯϱ

CHAPTER 7

- SUMMAR

Y AND GENERAL DISCUSSION

ϭϯϲ ϭϯϳ

CHAPTER 7

- SUMMAR

Y AND GENERAL DISCUSSION

;Ğ͘Ő͕͘DĂŐŶƵƐƐŽŶ͕ϭϵϳϲͿ͕ƚŚĞƐŝƚƵĂƟŽŶͲƐƉĞĐŝĮĐŝƚLJŽĨĐŽŐŶŝƟǀĞĂŶĚďĞŚĂǀŝŽƌĂůĨƵŶĐƟŽŶƐ ŝƐƵŶĚĞƌƐƚƵĚŝĞĚŝŶƚŚĞůŝƚĞƌĂƚƵƌĞŽŶ^/W͘^ŝƚƵĂƟŽŶͲƐƉĞĐŝĮĐŝƚLJŝƐĞƐƉĞĐŝĂůůLJŝŵƉŽƌƚĂŶƚĨŽƌ ƵŶĚĞƌƐƚĂŶĚŝŶŐƐŽĐŝĂůďĞŚĂǀŝŽƌŝŶƌĞůĂƟŽŶƚŽŽƚŚĞƌŝŶĚŝǀŝĚƵĂůƐ͘ŚĂƉƚĞƌϱƚŚĞƌĞĨŽƌĞĂŝŵĞĚ ƚŽŚĞůƉƵŶĚĞƌƐƚĂŶĚŝŶŐŚŽǁƐŝƚƵĂƟŽŶĂůĨĂĐƚŽƌƐĐŽƵůĚĂīĞĐƚ^/WƐŬŝůůƐ͘dŚĞŶĞǁůLJĚĞǀĞůŽƉĞĚ ^/sdǁĂƐƵƐĞĚƚŽŝŶǀĞƐƟŐĂƚĞƐĞǀĞƌĂůƐŝƚƵĂƟŽŶͲƐƉĞĐŝĮĐ^/WƐŬŝůůƐĨŽƌĂĚŽůĞƐĐĞŶƚƐǁŝƚŚD/ ĂŶĚĨŽƌĂĚŽůĞƐĐĞŶƚƐǁŝƚŚĞdžƚĞƌŶĂůŝnjŝŶŐďĞŚĂǀŝŽƌƉƌŽďůĞŵƐ͘&ŽůůŽǁŝŶŐƚŚĞƐĞŵŝŶĂůƐƚƵĚŝĞƐ ďLJ ŽĚŐĞ ;ϭϵϴϬ͖ ŽĚŐĞ͕ DƵƌƉŚLJ͕ Θ ƵĐŚƐďĂƵŵ͕ ϭϵϴϰͿ͕ ƉƌĞǀŝŽƵƐ ^/W ƐƚƵĚŝĞƐ ĨŽĐƵƐĞĚ ŵĞƌĞůLJŽŶ^/WŵĞĂƐƵƌĞĚŝŶƐŝƚƵĂƟŽŶƐǁŝƚŚĂŵďŝŐƵŽƵƐƉĞƌƉĞƚƌĂƚŽƌŝŶƚĞŶƚ͘/ŶLJŽƵƚŚǁŝƚŚ D/͕ŚŽǁĞǀĞƌ͕ŝƚǁĂƐĞdžƉĞĐƚĞĚƚŚĂƚŚŽƐƟůĞĂŶĚĞƐƉĞĐŝĂůůLJĂĐĐŝĚĞŶƚĂůƐŝƚƵĂƟŽŶƐĐŽƵůĚďĞ ĚŝĸĐƵůƚƚŽƵŶĚĞƌƐƚĂŶĚĂƐǁĞůů͘ĐĐŝĚĞŶƚĂůƐŝƚƵĂƟŽŶƐƌĞƋƵŝƌĞƚŚĞŝŶƚĞŐƌĂƟŽŶŽĨƉŽƐŝƟǀĞ ĂŶĚďĞŶŝŐŶĐƵĞƐŝŶĂƐŝƚƵĂƟŽŶǁŝƚŚĂŶĞŐĂƟǀĞŽƵƚĐŽŵĞ͕ƉƌŽĚƵĐŝŶŐĂůĂƌŐĞƌĐŽŐŶŝƟǀĞ ůŽĂĚ͘dŚĞƐĞƐŝƚƵĂƟŽŶƐǁĞƌĞƚŚĞƌĞĨŽƌĞĂůƐŽĞdžƉĞĐƚĞĚƚŽďĞƌĞůĞǀĂŶƚĨŽƌƚŚĞƵŶĚĞƌƐƚĂŶĚŝŶŐ ŽĨ^/WĚĞǀŝĂŶĐĞƐĂŶĚďĞŚĂǀŝŽƌĂůŵĂůĂĚũƵƐƚŵĞŶƚŽĨĂĚŽůĞƐĐĞŶƚƐǁŝƚŚD/͘ dŚĞ ĮŶĚŝŶŐƐ ŝŶ ŚĂƉƚĞƌ ϱ ƐŚŽǁĞĚ ƚŚĂƚ ƐƉĞĐŝĮĐĂůůLJ ŝŶ ĂĐĐŝĚĞŶƚĂů ƐŝƚƵĂƟŽŶƐ͕ ĂĚŽůĞƐĐĞŶƚƐǁŝƚŚŵŝůĚŝŶƚĞůůĞĐƚƵĂůĚŝƐĂďŝůŝƚLJ;D/ͿŝŶƚĞƌƉƌĞƚĞĚĂŚŝŐŚĞƌƉƵƌƉŽƐĞĨƵůŝŶƚĞŶƚ ŽĨƉĞƌƉĞƚƌĂƚŽƌƐĐŽŵƉĂƌĞĚƚŽƚŚĞŝƌƉĞĞƌƐǁŝƚŚďŽƌĚĞƌůŝŶĞŝŶƚĞůůĞĐƚƵĂůĨƵŶĐƟŽŶŝŶŐ;/&Ϳ ĂŶĚĂǀĞƌĂŐĞŝŶƚĞůůĞĐƚƵĂůĨƵŶĐƟŽŶŝŶŐ;&Ϳ͘/ŶƚŚĞƐĞĂĐĐŝĚĞŶƚĂůƐŝƚƵĂƟŽŶƐ͕ĂĚŽůĞƐĐĞŶƚƐǁŝƚŚ ĞdžƚĞƌŶĂůŝnjŝŶŐ ďĞŚĂǀŝŽƌ ƉƌŽďůĞŵƐ ŐĞŶĞƌĂƚĞĚ ĂŶĚ ƐĞůĞĐƚĞĚ ŵŽƌĞ ĂŐŐƌĞƐƐŝǀĞ ƌĞƐƉŽŶƐĞƐ ƚŚĂŶ ƚŚĞŝƌ ƉĞĞƌƐ ǁŝƚŚŽƵƚ ďĞŚĂǀŝŽƌ ƉƌŽďůĞŵƐ͘ ĚĚŝƟŽŶĂůůLJ͕ ŝŶ ĂŵďŝŐƵŽƵƐ ƐŝƚƵĂƟŽŶƐ͕ ĂĚŽůĞƐĐĞŶƚƐ ǁŝƚŚ D/ ĞǀĂůƵĂƚĞĚ ĂŶĚ ƐĞůĞĐƚĞĚ ŵŽƌĞ ĂŐŐƌĞƐƐŝǀĞ ƌĞƐƉŽŶƐĞƐ ƚŚĂŶ ƚŚĞŝƌ ƉĞĞƌƐ ǁŝƚŚ &͕ ďƵƚ ŝŶ ƚŚĞƐĞ ƌĞƐƉĞĐƚƐ ƚŚĞLJ ĚŝĚ ŶŽƚ ĚŝīĞƌ ĨƌŽŵ ƚŚĞŝƌ ƉĞĞƌƐ ǁŝƚŚ /&͘ /Ŷ ĂŵďŝŐƵŽƵƐ ƐŝƚƵĂƟŽŶƐ͕ ĂĚŽůĞƐĐĞŶƚƐ ǁŝƚŚ D/ ǁĞƌĞ ŵŽƌĞ ĂŶŐƌLJ ƚŚĂŶ ďŽƚŚ ƚŚĞŝƌ ƉĞĞƌƐ ǁŝƚŚ/&ĂŶĚ&͘/ŶĂĚĚŝƟŽŶ͕ĂĚŽůĞƐĐĞŶƚƐǁŝƚŚ/&ŝŶƚĞƌƉƌĞƚĞĚůĞƐƐƉƵƌƉŽƐĞĨƵůŝŶƚĞŶƚŝŶ ĂŵďŝŐƵŽƵƐƐŝƚƵĂƟŽŶƐƚŚĂŶƚŚĞŝƌƉĞĞƌƐǁŝƚŚ&͕ƌĞŐĂƌĚůĞƐƐŽĨďĞŚĂǀŝŽƌƉƌŽďůĞŵƐ͘&ŝŶĂůůLJ͕ ƐƉĞĐŝĮĐĂůůLJ ŝŶ ŚŽƐƟůĞ ƐŝƚƵĂƟŽŶƐ͕ ĂĚŽůĞƐĐĞŶƚƐ ǁŝƚŚ ĞdžƚĞƌŶĂůŝnjŝŶŐ ďĞŚĂǀŝŽƌ ƉƌŽďůĞŵƐ ƐĞůĞĐƚĞĚŵŽƌĞĂŐŐƌĞƐƐŝǀĞƌĞƐƉŽŶƐĞƐĐŽŵƉĂƌĞĚǁŝƚŚƚŚĞŝƌƚLJƉŝĐĂůůLJĚĞǀĞůŽƉŝŶŐƉĞĞƌƐ͘/Ŷ ŚŽƐƟůĞƐŝƚƵĂƟŽŶƐ͕ƚŚĞƌĞǁĞƌĞŶŽƐƉĞĐŝĮĐ^/WĚŝīĞƌĞŶĐĞƐĨŽƵŶĚĨŽƌLJŽƵƚŚǁŝƚŚD/Žƌ/& ĐŽŵƉĂƌĞĚƚŽ&LJŽƵƚŚ͘&ŽƌƚŚĞ^/WĐŽŐŶŝƟŽŶƐŽĨĞŶĐŽĚŝŶŐ͕ŚŽƐƟůĞŝŶƚĞŶƚĂƩƌŝďƵƟŽŶ͕ĂŶĚ ƐĞůĨͲĞĸĐĂĐLJĨŽƌĂŐŐƌĞƐƐŝŽŶ͕ŶŽƐŝƚƵĂƟŽŶͲƐƉĞĐŝĮĐĚŝīĞƌĞŶĐĞƐǁĞƌĞĨŽƵŶĚĨŽƌŐƌŽƵƉƐǁŝƚŚ D/ŽƌǁŝƚŚďĞŚĂǀŝŽƌƉƌŽďůĞŵƐ͘ĐƌŽƐƐĂůůƐŝƚƵĂƟŽŶƐĐŽŵďŝŶĞĚ͕ĂĚŽůĞƐĐĞŶƚƐǁŝƚŚD/ ǁĞƌĞƉĞƌǀĂƐŝǀĞůLJďŝĂƐĞĚŽŶƚŚĞƐĞ^/WŵĞĂƐƵƌĞƐ͕ǁŚŝůĞďŝĂƐĞƐĨŽƌĂĚŽůĞƐĐĞŶƚƐǁŝƚŚ/& were also notable, but less pervasive.

ϭϯϴ ϭϯϵ

CHAPTER 7

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Y AND GENERAL DISCUSSION

ϭϰϬ ϭϰϭ

CHAPTER 7

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Y AND GENERAL DISCUSSION

ϭϰϮ ϭϰϯ

CHAPTER 7

- SUMMAR

Y AND GENERAL DISCUSSION

ϭϰϳ REFERENCE S ϭϰϲ ĐŚĞŶďĂĐŚ d͘ D͘ ;ϭϵϵϭĂͿ͘ DĂŶƵĂů ĨŽƌ ƚŚĞ ŚŝůĚ ĞŚĂǀŝŽƌ ŚĞĐŬůŝƐƚ ͬ ϰͲϭϴ ĂŶĚ ϭϵϵϭ ƉƌŽĮůĞƐ͘ ƵƌůŝŶŐƚŽŶ͗hŶŝǀĞƌƐŝƚLJŽĨsĞƌŵŽŶƚ͕ĞƉĂƌƚŵĞŶƚŽĨWƐLJĐŚŝĂƚƌLJ͘ ĐŚĞŶďĂĐŚ͕ d͘ D͘ ;ϭϵϵϭďͿ͘ DĂŶƵĂů ĨŽƌ ƚŚĞ zŽƵƚŚ ^ĞůĨͲZĞƉŽƌƚ ĂŶĚ ϭϵϵϭ ƉƌŽĮůĞƐ͘ ƵƌůŝŶŐƚŽŶ͗ hŶŝǀĞƌƐŝƚLJŽĨsĞƌŵŽŶƚ͕ĞƉĂƌƚŵĞŶƚŽĨWƐLJĐŚŝĂƚƌLJ͘ ĐŚĞŶďĂĐŚ͕ d͘ D͕͘ Θ ĚĞůďƌŽĐŬ͕ ͘ ;ϭϵϵϭĂͿ͘ ŚŝůĚ ďĞŚĂǀŝŽƌ ĐŚĞĐŬůŝƐƚ͘ ƵƌůŝŶŐƚŽŶ͗ University of sĞƌŵŽŶƚ͕ĞƉĂƌƚŵĞŶƚŽĨWƐLJĐŚŝĂƚƌLJ͘ ĐŚĞŶďĂĐŚ͕d͘D͕͘ΘĚĞůďƌŽĐŬ͕͘;ϭϵϵϭďͿ͘zŽƵƚŚ^ĞůĨͲƌĞƉŽƌƚĂŶĚWƌŽĮůĞ͘ƵƌůŝŶŐƚŽŶ͗hŶŝǀĞƌƐŝƚLJŽĨ sĞƌŵŽŶƚ͕ĞƉĂƌƚŵĞŶƚŽĨWƐLJĐŚŝĂƚƌLJ͘ ůůŝƐŽŶ͕W͘͘;ϮϬϬϮͿ͘DŝƐƐŝŶŐĚĂƚĂ͗YƵĂŶƟƚĂƟǀĞĂƉƉůŝĐĂƟŽŶƐŝŶƚŚĞƐŽĐŝĂůƐĐŝĞŶĐĞƐ͘ƌŝƟƐŚ:ŽƵƌŶĂůŽĨ DĂƚŚĞŵĂƟĐĂůĂŶĚ^ƚĂƟƐƟĐĂůWƐLJĐŚŽůŽŐLJ, 55͕ϭϵϯͲϭϵϲ͘ĚŽŝ͗ϭϬ͘ϭϯϰϴͬϬϬϬϳϭϭϬϬϮϭϱϵϲϱϯ ůůŽǁĂLJ͕d͘;ϮϬϭϬͿ͘tŽƌŬŝŶŐŵĞŵŽƌLJĂŶĚĞdžĞĐƵƟǀĞĨƵŶĐƟŽŶƉƌŽĮůĞƐŽĨŝŶĚŝǀŝĚƵĂůƐǁŝƚŚďŽƌĚĞƌůŝŶĞ ŝŶƚĞůůĞĐƚƵĂůĨƵŶĐƟŽŶŝŶŐ͘:ŽƵƌŶĂůŽĨ/ŶƚĞůůĞĐƚƵĂůŝƐĂďŝůŝƚLJZĞƐĞĂƌĐŚ͕ϱϰ͕ϰϰϴͲϰϱϲ͘ ŵĞƌŝĐĂŶWƐLJĐŚŝĂƚƌŝĐƐƐŽĐŝĂƟŽŶ͘;ϮϬϭϯͿ͘ŝĂŐŶŽƐƟĐĂŶĚƐƚĂƟƐƟĐĂůŵĂŶƵĂůŽĨŵĞŶƚĂůĚŝƐŽƌĚĞƌƐ ;ϱƚŚĞĚ͘Ϳ͘ƌůŝŶŐƚŽŶ͕s͗ŵĞƌŝĐĂŶWƐLJĐŚŝĂƚƌŝĐWƵďůŝƐŚŝŶŐ͘ ƌŵĞůŝƵƐ͕ ͘ ͕͘ Θ ŶĚƌĞĂƐƐĞŶ d͘ ,͘ ;ϮϬϬϳͿ͘ ŽŐŶŝƟǀĞͲďĞŚĂǀŝŽƌĂů ƚƌĞĂƚŵĞŶƚ ĨŽƌ ĂŶƟƐŽĐŝĂů ďĞŚĂǀŝŽƌ ŝŶ LJŽƵƚŚ ŝŶ ƌĞƐŝĚĞŶƟĂů ƚƌĞĂƚŵĞŶƚ͘ ŽĐŚƌĂŶĞ ĂƚĂďĂƐĞ ^LJƐƚĞŵĂƟĐ ZĞǀŝĞǁ, ϰ. ĚŽŝ͗ϭϬ͘ϭϬϬϮͬϭϰϲϱϭϴϱϴ͘ϬϬϱϲϱϬ͘ƉƵďϮ ŶŐŽůĚ͕ ͘ ;ϮϬϬϮͿ͘ ŝĂŐŶŽƐƟĐ ŝŶƚĞƌǀŝĞǁƐ ǁŝƚŚ ƉĂƌĞŶƚƐ ĂŶĚ ĐŚŝůĚƌĞŶ͘ /Ŷ D͘ ZƵƩĞƌ ĂŶĚ ͘ dĂLJůŽƌ ;ĚƐ͘Ϳ͕ŚŝůĚĂŶĚĚŽůĞƐĐĞŶƚWƐLJĐŚŝĂƚƌLJ;ƉƉ͘ϯϮͲϱϭͿ͘KdžĨŽƌĚ͗ůĂĐŬǁĞůů͘ ƌLJ͕ ͘ s͕͘ ƵŶĐĂŶ͕ d͘ ͕͘ ƵŶĐĂŶ͕ ^͘ ͕͘ Θ ,ŽƉƐ͕ ,͘ ;ϭϵϵϵͿ͘ ĚŽůĞƐĐĞŶƚ ƉƌŽďůĞŵ ďĞŚĂǀŝŽƌ͗ dŚĞ ŝŶŇƵĞŶĐĞŽĨƉĂƌĞŶƚƐĂŶĚƉĞĞƌƐ͘ĞŚĂǀŝŽƵƌZĞƐĞĂƌĐŚĂŶĚdŚĞƌĂƉLJ, 37͕ϮϭϳͲϮϯϬ͘ĚŽŝ͗ϭϬ͘ϭϬϭϲͬ ^ϬϬϬϱͲϳϵϲϳ;ϵϴͿϬϬϭϯϯͲϴ ĂĚĚĞůĞLJ͕͘͘;ϭϵϴϲͿ͘tŽƌŬŝŶŐŵĞŵŽƌLJ͘KdžĨŽƌĚ͕h<͗KdžĨŽƌĚhŶŝǀĞƌƐŝƚLJWƌĞƐƐ͘ ĂĚĚĞůĞLJ͕ ͘ ;ϮϬϬϯͿ͘ tŽƌŬŝŶŐ ŵĞŵŽƌLJ͗ ůŽŽŬŝŶŐ ďĂĐŬ ĂŶĚ ůŽŽŬŝŶŐ ĨŽƌǁĂƌĚ͘ EĂƚƵƌĞ ZĞǀŝĞǁƐ͘ EĞƵƌŽƐĐŝĞŶĐĞ͕ϰ͕ϴϮϵ͘ ĞdžŬĞŶƐ͕͕͘sĂŶĚĞƌDŽůĞŶ͕D͘t͕͘ŽůůŽƚĚ͛ƐĐƵƌLJͲ<ŽĞŶŝŐƐ͕͕͘D>͕Θ,ƵŝnjĞŶŐĂ͕,͘D͘;ϮϬϭϰͿ͘ /ŶƚĞƌĨĞƌĞŶĐĞ ĐŽŶƚƌŽů ŝŶ ĂĚŽůĞƐĐĞŶƚƐ ǁŝƚŚ ŵŝůĚͲƚŽͲďŽƌĚĞƌůŝŶĞ ŝŶƚĞůůĞĐƚƵĂů ĚŝƐĂďŝůŝƟĞƐ ĂŶĚͬŽƌ behavior disorders. ŚŝůĚŶĞƵƌŽƉƐLJĐŚŽůŽŐLJ͕ϮϬ͕ϯϵϴͲϰϭϰ͘ ŝƌĚ͕,͘Z͕͘'ŽƵůĚ͕D͘^͕͘Θ^ƚĂŐŚĞnjnjĂ͕͘;ϭϵϵϮͿ͘ŐŐƌĞŐĂƟŶŐĚĂƚĂĨƌŽŵŵƵůƟƉůĞŝŶĨŽƌŵĂŶƚƐŝŶĐŚŝůĚ ƉƐLJĐŚŝĂƚƌLJĞƉŝĚĞŵŝŽůŽŐŝĐĂůƌĞƐĞĂƌĐŚ͘:ŽƵƌŶĂůŽĨƚŚĞŵĞƌŝĐĂŶĐĂĚĞŵLJŽĨŚŝůĚΘĚŽůĞƐĐĞŶƚ WƐLJĐŚŝĂƚƌLJ, ϯϭ͕ϳϴͲϴϱ͘ĚŽŝ͗ϭϬ͘ϭϬϵϳͬϬϬϬϬϰϱϴϯͲϭϵϵϮϬϭϬϬϬͲϬϬϬϭϮ ƵƌŬĞ͕:͕͘͘>ŽĞďĞƌ͕Z͕͘ΘŝƌŵĂŚĞƌ͕͘;ϮϬϬϮͿ͘KƉƉŽƐŝƟŽŶĂůĚĞĮĂŶƚĚŝƐŽƌĚĞƌĂŶĚĐŽŶĚƵĐƚĚŝƐŽƌĚĞƌ͗ ĂƌĞǀŝĞǁŽĨƚŚĞƉĂƐƚϭϬLJĞĂƌƐ͕WĂƌƚ//͘:ŽƵƌŶĂůŽĨƚŚĞŵĞƌŝĐĂŶĐĂĚĞŵLJŽĨŚŝůĚWƐLJĐŚŝĂƚƌLJ͕ϰ, ϭϮϳϱʹϭϮϵϯ͘ ĂůǀĞƚĞ͕͘ΘKƌƵĞ͕/͘;ϮϬϭϭͿ͘dŚĞŝŵƉĂĐƚŽĨǀŝŽůĞŶĐĞĞdžƉŽƐƵƌĞŽŶĂŐŐƌĞƐƐŝǀĞďĞŚĂǀŝŽƌƚŚƌŽƵŐŚ ƐŽĐŝĂůŝŶĨŽƌŵĂƟŽŶƉƌŽĐĞƐƐŝŶŐŝŶĂĚŽůĞƐĐĞŶƚƐ͘ŵĞƌŝĐĂŶ:ŽƵƌŶĂůŽĨKƌƚŚŽƉƐLJĐŚŝĂƚƌLJ͕ϴϭ͕ϯϴͲϱϬ͘ ĚŽŝ͗ϭϬ͘ϭϭϭϭͬũ͘ϭϵϯϵͲϬϬϮϱ͘ϮϬϭϬ͘ϬϭϬϳϬ͘dž ĂůǀĞƚĞ͕ ͕͘ Θ KƌƵĞ͕ /͘ ;ϮϬϭϮͿ͘ ^ŽĐŝĂů ŝŶĨŽƌŵĂƟŽŶ ƉƌŽĐĞƐƐŝŶŐ ĂƐ Ă ŵĞĚŝĂƚŽƌ ďĞƚǁĞĞŶ ĐŽŐŶŝƟǀĞ ƐĐŚĞŵĂƐĂŶĚĂŐŐƌĞƐƐŝǀĞďĞŚĂǀŝŽƌŝŶĂĚŽůĞƐĐĞŶƚƐ͘:ŽƵƌŶĂůŽĨďŶŽƌŵĂůŚŝůĚWƐLJĐŚŽůŽŐLJ͕ϰϬ͕ ϭϬϱͲϭϭϳ͘ ĂůǀĞƚĞ͕͕͘'ĂŵĞnjͲ'ƵĂĚŝdž͕D͕͘Θ'ĂƌĐŝĂͲ^ĂůǀĂĚŽƌ͕^͘;ϮϬϭϱͿ͘^ŽĐŝĂůŝŶĨŽƌŵĂƟŽŶƉƌŽĐĞƐƐŝŶŐŝŶĐŚŝůĚͲ ƚŽͲƉĂƌĞŶƚĂŐŐƌĞƐƐŝŽŶ͗ŝĚŝƌĞĐƟŽŶĂůĂƐƐŽĐŝĂƟŽŶƐŝŶĂϭͲLJĞĂƌƉƌŽƐƉĞĐƟǀĞƐƚƵĚLJ͘:ŽƵƌŶĂůŽĨŚŝůĚ ĂŶĚ&ĂŵŝůLJ^ƚƵĚŝĞƐ͕Ϯϰ͕ϮϮϬϰͲϮϮϭϲ͘ ^͕ĞŶƚƌĂůƵƌĞĂƵĨŽƌ^ƚĂƟƐƟĐƐŝŶƚŚĞEĞƚŚĞƌůĂŶĚƐ;ϮϬϭϳ͕ƉƌŝůϭϬͿ͘ZĞƚƌŝĞǀĞĚĨƌŽŵŚƩƉƐ͗ͬͬǁǁǁ͘ ĐďƐ͘ŶůͬŶůͲŶůͬĂĐŚƚĞƌŐƌŽŶĚͬϮϬϭϲͬϰϳͬďĞǀŽůŬŝŶŐͲŶĂĂƌͲŵŝŐƌĂƟĞĂĐŚƚĞƌŐƌŽŶĚ ŚŵĞůŬĂ͕D͕͘͘dƌŽƵƚ͕͘>͕͘DĂƐŽŶ͕t͕͘͘ΘtƌŝŐŚƚ͕d͘;ϮϬϭϭͿ͘ŚŝůĚƌĞŶǁŝƚŚĂŶĚǁŝƚŚŽƵƚĚŝƐĂďŝůŝƟĞƐ ŝŶƌĞƐŝĚĞŶƟĂůĐĂƌĞ͗ZŝƐŬĂƚƉƌŽŐƌĂŵĞŶƚƌLJ͕ĚĞƉĂƌƚƵƌĞĂŶĚƐŝdžͲŵŽŶƚŚĨŽůůŽǁͲƵƉ͘ŵŽƟŽŶĂůĂŶĚ ĞŚĂǀŝŽƵƌĂůŝĸĐƵůƟĞƐ, ϭϲ͕ϯϴϯͲϯϵϵ͘ĚŽŝ͗ϭϬ͘ϭϬϴϬͬϭϯϲϯϮϳϱϮ͘ϮϬϭϭ͘ϲϭϲϯϰϲ ŝĐĐŚĞƫ͕ ͕͘ Θ ZŽŐŽƐĐŚ͕ &͘ ͘ ;ϮϬϬϮͿ͘  ĚĞǀĞůŽƉŵĞŶƚĂů ƉƐLJĐŚŽƉĂƚŚŽůŽŐLJ ƉĞƌƐƉĞĐƟǀĞ ŽŶ adolescence. :ŽƵƌŶĂů ŽĨ ŽŶƐƵůƟŶŐ ĂŶĚ ůŝŶŝĐĂů WƐLJĐŚŽůŽŐLJ͕ ϳϬ͕ ϲͲϮϬ͘ ĚŽŝ͗ϭϬ͘ϭϬϯϳͬϬϬϮϮͲ 006X.70.1.6 ŽĐĐĂƌŽ͕͘&͕͘&ĂŶŶŝŶŐ͕:͘Z͕͘&ŝƐŚĞƌ͕͕͘ŽƵƚƵƌĞ͕>͕͘Θ>ĞĞ͕Z͘:͘;ϮϬϭϳͿ͘^ŽĐŝĂůĞŵŽƟŽŶĂůŝŶĨŽƌŵĂƟŽŶ ƉƌŽĐĞƐƐŝŶŐŝŶĂĚƵůƚƐ͗ĞǀĞůŽƉŵĞŶƚĂŶĚƉƐLJĐŚŽŵĞƚƌŝĐƐŽĨĂĐŽŵƉƵƚĞƌŝnjĞĚǀŝĚĞŽĂƐƐĞƐƐŵĞŶƚŝŶ ŚĞĂůƚŚLJĐŽŶƚƌŽůƐĂŶĚĂŐŐƌĞƐƐŝǀĞŝŶĚŝǀŝĚƵĂůƐ͘WƐLJĐŚŝĂƚƌLJZĞƐĞĂƌĐŚ͕Ϯϰϴ͕ϰϬͲϰϳ͘ĚŽŝ͗ϭϬ͘ϭϬϭϲͬũ͘ ƉƐLJĐŚƌĞƐ͘ϮϬϭϲ͘ϭϭ͘ϬϬϰ ƌŝĐŬ͕E͘Z͕͘ΘŽĚŐĞ͕<͘͘;ϭϵϵϰͿ͘ƌĞǀŝĞǁĂŶĚƌĞĨŽƌŵƵůĂƟŽŶŽĨƐŽĐŝĂůŝŶĨŽƌŵĂƟŽŶƉƌŽĐĞƐƐŝŶŐ ŵĞĐŚĂŶŝƐŵƐ ŝŶ ĐŚŝůĚƌĞŶ͛Ɛ ƐŽĐŝĂů ĂĚũƵƐƚŵĞŶƚ͘ WƐLJĐŚŽůŽŐŝĐĂů ƵůůĞƟŶ͕ ϭϭϱ͕ ϳϰͲϭϬϭ͘ ĚŽŝ͗ϭϬ͘ϭϬϯϳͬϬϬϯϯͲϮϵϬϵ͘ϭϭϱ͘ϭ͘ϳϰ ƌŽŶĞ͕ ͘ ͕͘ Θ ĂŚů͕ Z͘ ͘ ;ϮϬϭϮͿ͘ hŶĚĞƌƐƚĂŶĚŝŶŐ ĂĚŽůĞƐĐĞŶĐĞ ĂƐ Ă ƉĞƌŝŽĚ ŽĨ ƐŽĐŝĂůͲĂīĞĐƟǀĞ ĞŶŐĂŐĞŵĞŶƚĂŶĚŐŽĂůŇĞdžŝďŝůŝƚLJ͘EĂƚƵƌĞƌĞǀŝĞǁƐ͘EĞƵƌŽƐĐŝĞŶĐĞ, ϭϯ͕ϲϯϲ͘ ƵƉĞƌƵƐ͕ :͘ D͘ ;ϭϵϵϳͿ͘ ^ŽĐŝĂůĞ ƉƌŽďůĞĞŵŽƉůŽƐƐŝŶŐ ďŝũ ŬŝŶĚĞƌĞŶ ŵĞƚ ŐĞĚƌĂŐƐƐƚŽŽƌŶŝƐƐĞŶ ΀ƐŽĐŝĂů ƉƌŽďůĞŵ ƐŽůǀŝŶŐ ŝŶ ĐŚŝůĚƌĞŶ ǁŝƚŚ ďĞŚĂǀŝŽƌ ĚŝƐŽƌĚĞƌƐ΁ WŚ ƚŚĞƐŝƐ͕ hŶŝǀĞƌƐŝƚLJ hƚƌĞĐŚƚ͕ dŚĞ EĞƚŚĞƌůĂŶĚƐ͘ ĂŶŝĞůƐƐŽŶ͕,͕͘,ĞŶƌLJ͕>͕͘DĞƐƐĞƌ͕͕͘ΘZƂŶŶďĞƌŐ͕:͘;ϮϬϭϮͿ͘^ƚƌĞŶŐƚŚƐĂŶĚǁĞĂŬŶĞƐƐĞƐŝŶĞdžĞĐƵƟǀĞ ĨƵŶĐƟŽŶŝŶŐŝŶĐŚŝůĚƌĞŶǁŝƚŚŝŶƚĞůůĞĐƚƵĂůĚŝƐĂďŝůŝƚLJ͘ZĞƐĞĂƌĐŚŝŶĞǀĞůŽƉŵĞŶƚĂůŝƐĂďŝůŝƟĞƐ͕ϯϯ, ϲϬϬͲϲϬϳ͘ ĞŬŬĞƌ͕D͕͘͘Θ<ŽŽƚ͕,͘D͘;ϮϬϬϯͿ͘^DͲ/sĚŝƐŽƌĚĞƌƐŝŶĐŚŝůĚƌĞŶǁŝƚŚďŽƌĚĞƌůŝŶĞƚŽŵŽĚĞƌĂƚĞ ŝŶƚĞůůĞĐƚƵĂůĚŝƐĂďŝůŝƚLJ͘//͗ŚŝůĚĂŶĚĨĂŵŝůLJƉƌĞĚŝĐƚŽƌƐ͘:ŽƵƌŶĂůŽĨƚŚĞŵĞƌŝĐĂŶĐĂĚĞŵLJŽĨŚŝůĚ ĂŶĚĚŽůĞƐĐĞŶƚWƐLJĐŚŝĂƚƌLJ͕ϰϵ͕ϵϮϯͲϵϯϭ͘ ĞŬŬĞƌ͕D͕͘͘<ŽŽƚ͕,͘D͕͘sĂŶĚĞƌŶĚĞ͕:͕͘ΘsĞƌŚƵůƐƚ͕&͘͘;ϮϬϬϮͿ͘ŵŽƟŽŶĂůĂŶĚďĞŚĂǀŝŽƌĂů problems in children and adolescents with and without intellectual disability. :ŽƵƌŶĂůŽĨŚŝůĚ