Acquiescence in adolescents with and without
Mild Intellectual Disabilities or Borderline Intellectual Functioning
Internal Structure and Reliability of the Adapted Amsterdam Acquiescence Scale (AAAS)
Master’s thesis Forensic Child and Youth Care Sciences Graduate School of Child Development and Education
University of Amsterdam
Esther Beekman - 11285125
Supervisors: Prof. Dr. X. M. H. Moonen & Prof. Dr. G. J. J. M. Stams
Contents
Abstract P. 3
Introduction P. 4
Mild Intellectual Disabilities and Borderline Intelligence Functioning P. 6
When does acquiescence occur? P. 7
Submissiveness and acquiescence P. 8
Suggestibility and acquiescence P. 8
The context of the interview and acquiescence P. 8 Acquiescence and average cognitive abilities P. 9
Communication with people with MID or BF P. 10
Techniques to detect acquiescence P. 12
Present Study P. 13
Method P. 14
Participants P. 14
Procedure P. 15
Measurements P. 16
Acquiescence: The Adapted Amsterdam Acquiescence Scale P. 16
Data analysis P. 20
Results P. 22
The factor structure and reliability of the AAAS P. 22
Internal structure P. 22
Item Response Theory Analysis P. 24
Reliability P. 25
Difference in level of acquiescence between participants with and - P. 25 without MIDBIF
Cut-off points P. 26
Observations P. 27
Comments on the procedure used based on dairy notes P. 27
Experience of the participants P. 28
Other mistakes P. 29
Discussion P. 29
Limitations and recommendations for further research P. 33
References P. 36
Acknowledgements P. 42
Abstract
The passive agreement with a question that can be answered with a yes or no response,
irrespective of content, is called acquiescence. Many researchers have found a relationship
between acquiescence and intelligence. Acquiescence is affected by cognitive abilities,
psychological dispositions and the context of an interview. Interviewing someone who shows
acquiescence can be problematic, since it can lead to wrong conclusions. The Adapted
Amsterdam Acquiescence Scale (AAAS) is (re)developed to assess if people are prone to
acquiescence. For the construction of the AAAS, acquiescence was assessed in seven
categories, such as long and complex questions and pairs of contradicted questions. The
questions of the AAAS were answered by n = 67 participants with a known Total IQ score
between 50-85 (Mild Intellectual Disability or borderline intellectual functioning: MIDBIF)
and n = 68 participants with (above) average intelligence. A confirmatory Factor Analysis
(CFA) was used to confirm a one-dimensional structure of the AAAS, which proved to be
reliable. Item Response Theory was used to examine item discrimination and difficulty of the
AAAS items. Results show that participants with MIDBIF were significantly more acquiescent
than participants without MIDBIF. It can be concluded that acquiescence is more common in
participants with MIDBIF, but scores indicate that acquiescence may also be present in
participants without MIDBIF. So it is always important to be aware of acquiescence and of the
potential consequences. For this reason, it is advised in case of acquiescence to adapt
communication, for example, by avoiding long and complex questions. The study has several
limitations, and recommendations for further research are made.
Introduction
It may happen that someone asks you a question and you have no idea what he is talking
about. You decide to silently agree, nod your head and say: ‘hmm yeah’. In some situations we have no idea what the other is talking about, and we assume the other to know this, and for good
reasons we show him that we agree1. If you continuously agree with people and pretend to understand them, whilst this is not true, people will however assume you understood what they
said, and they will refrain from asking questions for further clarification. This behavior can
cause problems when it recurs on a daily basis.
Agreeing with a statement without objection, is designated as acquiescence. According
to Finlay and Lyons (2002), acquiescence is the tendency to agree with or say yes to statements
or questions, regardless of the content of the items. Acquiescence in clients in health and care situations can lead to several problems in clinical practice as well as in research. In mental
health care, in a consult with a psychologist who carries out diagnostics, the psychologist can
draw faulty conclusions, which prevents him or her from providing a proper treatment. For
clinicians, an assessment confounded by acquiescence may affect the interpretation of client
outcomes. It has been shown that acquiescence can bias the outcomes of personality inventories
(Rammstedt & Farmer, 2013; Rammstedt, Goldberg, & Borg, 2010), may cause measurement
invariance (Aichholzer, 2015), and is problematic for researchers, because they are prone to use
data confounded by acquiescence and are at risk of drawing inaccurate conclusions (Costello
& Roodenburg, 2015).
Many researchers have found a relationship between acquiescence and intelligence
(Gudjonsson & Young, 2011; Lechner & Rammstedt, 2015; Meisenberg & Williams, 2008;
Rammstedt, Kemper, & Borg, 2013; Waiyavutti, Johnson, & Deary, 2012). An important theme
in this research is that acquiescence could especially be problematic when it comes to
communication with people with Mild Intellectual Disabilities (MID) of borderline intellectual
functioning (BIF), causing misinterpretation of information given by them (Moonen, 2006).
Moreover, it can be a potential difficulty when interviewing or interrogating people with
MIDBIF (Costello & Roodenburg, 2015). In order to prevent, or to be aware of biased outcomes
caused by acquiescence, this has to be detected in an early stage.
To assess if people are prone to acquiescence, Moonen and Foppen (2010) developed
an experimental Amsterdam Acquiescence Scale (AAS). The scale indicated to what extent
persons agree with questions asked by an interviewer, whatever their own opinion or
preferences were. Given the fact that acquiescence is supposed to be most common in people
with MIDBIF, the aim of the AAS was to detect acquiescence in persons with MID or BIF.
However, the scale could also be used in persons without MIDBIF.
The AAS provides the opportunity for people working in practice to quickly estimate
whether acquiescence is present. When it turns out that someone is acquiescent, this should be
taken into account in further communication, for example by adjusting the use of language and
repeating the information. An appropriate response to the presence of acquiescence should also
be integrated in current trends that aim to improve police interrogation procedures. The fact that
adolescents with MIDBIF more often are confronted with police officers than adolescents
without MIDBIF (Moonen, de Wit, & Hoogeveen, 2011) highlights the importance to assess
whether the response style of a person being interrogated could be an acquiescent one.
Marijt and Kaal (2012) conducted a study in which a majority of a small sample of
Dutch police officers indicated that they had the impression that people with MIDBIF were
likely to agree, were willing to please, and were sensitive to suggestive questioning. Boon,
Odinot, Horselenberg and Geijsen (2016) advocated changing Dutch standard procedures
during interrogation. They encouraged to change from interrogating to forensic interviewing as
transparent, that the position of police officers should be a neutral one, and that the interviewee
should have the opportunity to speak for his own. An effective forensic interview should also
include an appropriate approach, which fits the cognitive abilities of the suspect, victim or
witness.
This is in line with the risk-need-responsivity (RNR) model, which has been widely
regarded as an effective model for guiding assessment and treatment of offenders. In this model
it is assumed that it is important to identify the presence of risk and protective factors, in order
to investigate which risks cause the problem. Moreover, the responsivity principle of this model refers to the importance of matching the style of the intervention to the client’s abilities (Andrews, Bonta, & Workmith, 2011). Especially this last principle should be considered in the
treatment of adolescents with MIDBIF and problem behavior. Both the choice for treatment
and the style of communication of the therapist, police officer, teacher or medical doctor should
match with the responsivity needed by the client. Offering a responsive style of communication
includes the identification of an acquiescent response style. This is in line with efforts towards
an inclusive society, which stands for equivalence, participatory citizenship, and is related to a
policy that allows people with any disabilities to fully participate in all social systems (Moonen,
2015).
In this introduction five issues will be discussed. First, the concepts Mild Intellectual
Disabilities and Borderline Intelligence Functioning will be discussed. Second, an analysis of
when acquiescence easily occurs will be provided. Third, likely adaptations in communication
with people with intellectual disabilities will be discussed. Fourth, techniques for detecting
acquiescence will be discussed. Finally, the present study will be explicated.
Mild Intellectual Disabilities and Borderline Intelligence Functioning
As mentioned before, acquiescence is often referred to as a problem for people with
& Young, 2011; Lechner & Rammstedt, 2015; Meisenberg & Williams, 2008). The American Psychiatric Association’s (APA) classification criteria for (Mild) Intellectual Disabilities (MID) can be found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, APA 2013).
MID includes deficits in intellectual functioning. Intellectual functioning includes mental
abilities, such as reasoning, problem solving, planning, abstract thinking, judgement, academic
learning, and experimental learning. These mental abilities can be measured by standardized
and culturally appropriate intelligence (IQ) tests. An IQ score between 50 and 70, which is
approximately two standard deviations below average, represents a significant cognitive deficit.
But to identify MID deficits in adaptive functioning should also be present, which involves
daily life skills, including conceptual, communication, practical and social skills. Impairments
in adaptive functioning lead to difficulties in developing age appropriate behaviour. These
deficits should also be measured by standardized and culturally appropriate tests. The third
criterion is that these deficits emerge during the developmental period in childhood or
adolescence (Greenspan, 2017; Moonen & Wissink, 2015).
In Dutch professional practice a broader definition of MID is advocated. This approach
focuses on the need for support of people with an IQ between 50 and 85. People with an IQ
score between 70 and 85 are addressed in DSM-IV as people with borderline intelligence
functioning (BIF). In Dutch practice people with an IQ score between 70 and 85 can be
classified as persons with MID when they also experience problems in adaptive functioning,
and this view gains international support (de Beer, 2011; Greenspan, 2017; Moonen & Wissink,
2015). In this manuscript these two categories are addressed as one category, namely, people
with mild intellectual disabilities or borderline intellectual functioning (MIDBIF).
When does acquiescence occur?
Finlay and Lyons (2002) consider acquiescence likely to occur for two prime reasons.
suggestibility). Second, it may result from the context of the interview. Both reasons seem to
be related to MID or BIF (Perlman, Ericson, Esses, & Isaacs, 1994; Everington & Fulero, 1999).
Submissiveness and acquiescence
Submissiveness can be described as a personality trait or as a learned response that can be adaptive in a range of situations. People are more likely to agree due to a greater desire to
please or to be submissive, which can result in a higher level of acquiescence (Finlay & Lyons,
2002; Perlman et al., 1994; Sigelman, Budd, Spanhel, & Schoenrock, 1981). The tendency to
be submissive can be related to the experience of failure in daily life of for instance people with
MIDBIF. Furthermore, many people with MID are familiar with institutionalized living
environments, where they get used to obeying authority figures and tend to agree with them
(Perlman et al., 1994).
Suggestibility and acquiescence
Suggestibility can be defined as: the extent to which people come to accept messages
communicated during formal questioning, as a result of which their subsequent behavioral response is affected (Gudjonsson, 1990, p.227). Several researchers have identified a relationship between intelligence and suggestibility. People with ID seem to be more
suggestible than people without ID (Clare & Gudjonsson, 1995; Everington & Fulero, 1999).
An explanation of this relation can be found in the fact that people with ID have poorer
executive functioning skills. Since information processing tasks include different tasks, they
show more suggestibility (Karpinski & Scullin, 2009). Suggestibility differs conceptually from
compliance. Suggestibility implies the personal acceptance of a statement as true. Compliance
refers to a situation in which the person does not accept the statement, but agrees with it due to
a desire to please the interviewer (Gudjonsson & Clark, 1986).
The context of the interview and acquiescence
acquiescence can also be explained from the context of the interview. This refers to whether
someone understands the questions or not. It is possible that someone does not know the answer
to a question, or that he understands the question in a different way than the interviewer
intended. From this perspective, acquiescence can be seen as a methodological artifact (Finlay
& Lyons, 2002). Furthermore, the use of reverse wordings and long and complex questions
appeals to linguistic skills, comprehension capacity, and knowledge. Because the linguistic
development of children with MIDBIF is delayed, this may result in acquiescence (van
Nieuwenhuijzen, 2010). Shaw and Budd (1982) conducted a study in which they asked people
with ID about the permissibility of a range of behaviors. It turned out that participants were more
likely to agree with questions about socially desirable behavior, not influenced by the fact that
the question was asked in a positive way (is it allowed to…?) or in a negative way (is it against the rules to…?). These results indicate that people with ID may not fully understand the structure of the questions (is it about a prohibition or a permission?), although they still responded to the
topic (is it about social desirable or undesirable behavior?). Besides, a certain amount of
(time)pressure in an interview may have an effect on the presence of acquiescence.
(Time)pressure makes a large appeal on information capacity processes, which seem to make
children with low executive functioning skills vulnerable to suggestibility. This can be related to
acquiescence (Clare & Gudjonsson, 1995; Everington & Fulero, 1999; Finlay & Lyons, 2002;
Karpinski & Scullin, 2009).
Acquiescence and average cognitive abilities
In conclusion, there is evidence for a relationship between impaired cognitive abilities
and a tendency for submissiveness, suggestibility, and acquiescence (Everington & Fulero,
1999; Perlman et al., 1994). Comprehension of questions demands cognitive skills, and can be
problematic for people with ID due to their delayed linguistic development (van
for people with ID. However, submissiveness, suggestibility, and comprehension can also occur
in people without MID or BIF, especially when acquiescence is mainly the result of the context
of an interview. Acquiescence can also be seen as an artifact of the organization of interviewing
and testing. Rapley and Antaki (1996) found that there probably are not particular
circumstances which can cause acquiescence. They also concluded that the cognitive ability is
not always the explanation for being acquiescent and that people without disabilities are also
acquiescent. Furthermore, Aichholzer (2015) mentions the possibility that respondents may
respond with acquiescence due to careless responding (Krosnick, 1991), or due to inconsistent
self-descriptive attributes (Bentler, Jackson, & Messick, 1971). These responding styles are not
particular to behavioral tendencies of people with MID or BIF. Finally, as mentioned,
time-pressure may effect suggestibility, which is related to acquiescence. Knowles and Condon (1999) found that people who often said ‘yes’ seem to give less effort to reconsideration. People who were likely to say ‘no’ give extensive time and effort to reconsider their answers. Offering limited time limits the time for using decision making and information processing strategies
(Maule, Hockey, & Bdzola, 2000).
Communication with people with MID or BF
Adolescents with MIDBIF often face communication problems due to several causes.
At first, this is a result of a limited working memory (e.g., Henry & Maclean, 2002; Karpinsky
& Scullin, 2009). Furthermore, the linguistic development of children with MIDBIF is delayed
(van Nieuwenhuijzen, 2010). Based on the RNR-principle discussed earlier, the communication
with offenders with MIDBIF should be responsive to their needs (Andrews et al., 2011). This
principle should also be applied to other fields than the judicial field. Adaptations in
communication enables inclusion of people with MIDBIF in all activities desired by them, but
also reduce the risk for an acquiescent response style, since the use of language is related to the
with MIDBIF several solutions have been established (e.g. Zoon, 2012). For example, the
limited capacity for abstract reasoning of people with MID can be addressed by using concrete
cases and examples that are based on characteristics of the living environment of the person.
Also the limited vocabulary has to be considered in a way that verbal information has to be
simplified and can be supported by visuals, such as pictograms or photos. Furthermore, it should
be checked regularly whether the person with MIDBIF understands the information given (de
Wit, Moonen, & Douma, 2011). These findings are translated into concrete advices for
caregivers working with people with MIDBIF. For example: use short sentences, formulate
concrete sentences, use simplified, but not childish, language, repeat information, do not offer
to many options, offer silence for information processing and speak slowly (e.g. Instruction
Youth and Safety, 2016).
Because of the above mentioned insights about communication with people with
MIDBIF there are several projects started in Dutch care. For example, the project ‘Taal voor Allemaal’ (‘Language for Everyone’) (TvA) by Zuyd Hogeschool (Zuyd University for applied sciences) (Moonen, 2016). The project has drafted language rules for good communication with
people with MIDBIF (See appendix 1). TvA is based on ‘easy to read’ principles which are used in Great Britain and ‘leichte Sprache’, which is used in German speaking countries. These principles are set in order to overcome communication barriers and offer equal asses to
information for everyone. For example clear information provision is required for making
informed decisions about treatment (Hurtado, Jones, & Burniston, 2014). The aim of TvA is to
improve communication between people with and without MIDBIF, by applying an universal
set of language rules which fits the level of comprehension of people targeted by this
communication. The rules consist of guidelines for words, guidelines for the use of signs and
numbers, guidelines for sentences, guidelines for texts, guidelines for design, guidelines for use
2016).
However, the application of special needs for people with MIDBIF in judicial authorities
is unsatisfactory realized (Hayes, 2007). In the Netherlands, all persons under 18 years old, with
or without ID, have the right to seek legal aid from a counselor because they are seen as
vulnerable witnesses or suspects (Bruning, Liefaard, & Vlaardingerbroek, 2016). However, it
could be argued that persons with MIDBIF over 18 years old should also be treated as
vulnerable persons. Until 2009 the interrogation of vulnerable persons in the Netherlands, such
as persons with MIDBIF, was often conducted by behavioral scientists. It turned out that
behavioral scientists acted too much as caregivers and did not possess sufficient legal
knowledge about collecting evidence (Department of Justice, 2009). For this reason, the
behavioral scientists now just advice the police officers who carry out the interrogation with
vulnerable persons (Department of Justice, 2015). This implies that nowadays all interrogation
officers should have substantial knowledge of the specific artefacts of communication with
people with MIDBIF. Unfortunately, this is currently not the case in the Netherlands.
Techniques to detect acquiescence
Researchers have used various techniques to detect acquiescence in interviews (Finlay
& Lyons, 2002). The AAS was based on these techniques (Moonen & Foppen, 2010). Because
of the results in a pilot research project a modified version of the AAS was constructed, the
Adapted Amsterdam Acquiescence Scale (AAAS) At first, the theories underlying the
techniques researchers use to screen for acquiescence will be explained. After that, the
techniques used in the AAAS and its items will be introduced in the method section.
First, researchers use nonsense questions to detect acquiescence (Sigelman et al., 1981;
Flynn, Reeves, Whelan, & Speak, 1985). These are questions to which the answer should be
no, regardless of the persons opinion or experience. Rapley and Antaki (1996) criticized the use
answers given to normal questions is not equivalent. However, Sigelman et al. (1981) found
that people who were acquiescent to nonsense questions, were also more acquiescent on reverse
wording questions (see later).
Secondly, researchers have tried to identify the presence of acquiescence by using pairs
of questions that are opposite in meaning (Flynn et al., 1985; Matikka & Vesala, 1997).
Applying this technique assumes that persons have a single position on a question, but this may
not always be the case (Potter & Wetherell, 1987).
A third technique to investigate the presence of acquiescence is using equivalent pairs
of questions asked in different formats, for example, in a yes-no format or in an either-or format
(e.g., Conroy & Bradley, 1985).
Acquiescence can also be identified by comparing answers of the respondent with
answers of informants (e.g. Sigelman, Budd, Winer, & Schoenrock, 1982). It has to be noted
that when differences between the respondent and the informant are found, it may be caused by
differences in interpretation (Barlow & Kirby, 1991). For this reason, it is important to avoid
using overly ambiguous concepts in questions.
Present Study
The purpose of this master thesis is to develop a new version of the experimental AAS
(Moonen & Foppen, 2010), the Adapted Amsterdam Acquiescence Scale (AAAS). In the
project the internal structure and reliability of the AAAS are examined. The main research
question was: what is the factor structure and reliability of the AAAS? A second point of
research was whether scores assessed with the proposed version of the AAAS differ between
adolescents with and without MIDBIF. For this reason, the levels of acquiescent adolescents
with MIDBIF (adolescents with an IQ score between 50 and 85) were compared to those of
adolescents without MIDBIF (adolescents with an IQ score > 85). The adjunct hypothesis was:
Method Participants
In this study the tendency to be acquiescent was assessed in a sample of N = 135
participants using the AAAS. 80 were male and 55 were female. Participants were between
ages 13 and 19. The average age of participants was 15,03 with a SD of 1,30. The entire sample
was divided in two equal groups.
The first group n = 67 consisted of adolescents with MIDBIF. Participants in this group
were between ages 13 and 19. The average age of these participants was 15,1 years with a SD
of 1,53. In the first group 14 women (Mage=15,14, SDage=1,17) and 53 men (Mage=15,09,
SDage=1,62) were included, all of whom attended secondary special education for pupils with
an intellectual disability (Dutch: Cluster 3 onderwijs) in Amsterdam. Participants had Total IQ
scores between 50 and 85. It turned out that participants in this group had an average Total IQ
score of 60,83 and SD was 9,07. Women in this group had an average Total IQ score of 61,63
and SD was 8,40 and men had an average Total IQ score of 60,68 and the SD was 9,22. Most
(n=46) IQ scores were assessed with the Wechsler Intelligence Scale for Children III. Other
tests used were SON-R, RAKIT, NIO, and WAIS-IV. The intelligence scores were provided
by the school.
The second group n = 68 consisted of adolescents without MIDBIF (adolescents with
an IQ score > 85). Participants in this group were between ages 14 and 18. The average age of
these participants was 14,96 and SD was 1,03. In this group were 41 women (Mage=14,88,
SD=.98) and 27 men (Mage=15,07, SDage=1,11) included. Of the participants, 31 attended higher
secondary education (Dutch: HAVO) and 37 attended pre-university education (Dutch: VWO)
in two Dutch cities. The Total IQ scores of the individual participants in this group were
unknown. However, norm scores of the Dutch intelligence test for the level of education (Dutch:
determining intelligence in pupils in secondary education, indicated that pupils in higher
secondary education (HAVO) often have intelligence scores between TIQ 105-115 and pupils
who attend pre-university education, have intelligence scores between TIQ 110-125 or higher
(van Dijk & Tellegen, 2004). For this reason, it was assumed that participants of the second
group all had significantly higher Total IQ scores than the participants of the first research
group.
Procedure
Prior to the study, assessing acquiescence in participants with and without MIDBIF
using the AAAS, the research proposal was submitted to the ethical review committee of the
University of Amsterdam. The committee accepted the research proposal, providing that all
participants signed an informed consent paper in advance, in which they declared that they were
fully informed about the procedures, that they were aware that participation was voluntary, and
that they had the right to stop answering questions at any time without giving a reason.
Differences in cognitive abilities in understanding words and procedures between the first and
second research group were considered, so two versions of the informed consent paper were
made. The first version was worded in Dutch at a B1-level (Common European Framework of
Reference for Languages: Learning, Teaching, Assessment: Council of Europe, 2001). A
similar worded version was constructed at a A2 level using an easy to read text with extra visual
support (pictograms) for the use with the adolescents with MIDBIF (See Appendix 2 and 3).
Participants took part in the study voluntary without receiving a reward. Given the fact that
almost all participants were minors, their caregivers or parents were informed too, and had the
opportunity to deny their child participating in the study (passive consent) (See Appendix 4).
After the approval of the ethical review committee was obtained, several schools were
approached in order to engage their students in this study using the network of the researchers,
letter was sent by email to the school contacted with the request to participate in the study (See
Appendix 5 and 6). Four schools for special education were approached by email to gather
participants for the first group (adolescents with MIDBIF). Two schools did not want to
participate and one school did not respond to the request. To gather participants for the second
group (adolescents with an IQ score >85), 34 schools for higher secondary education and
pre-university education were approached by email. Ten schools did not want to participate and 22
did not respond to the request. One school for special education was included in the study as
were two school for higher secondary education respectively pre-university education.
After these schools agreed to take part in the study, individual appointments were made
for planning the interviews and sending the passive consent letters to the parents or caregivers.
With 70, respectively 68 respondents an interview appointment was made. The interviews took
place in a quiet room.
All interviews started with a brief (standardized) explanation of the AAAS and informed
consent. N = 3 participants (all within the first research group) did not want to sign the informed
consent and did not want to continue participating.
The interviewer took diary notes of every interview. These notes involved potential
particularities (e.g. disruption of the interview), the overall ambiance, the time of the interview,
and other remarks the participant made (See Appendix 7). The interviewer also used a checklist
to make sure that every individual assessment was done in accordance to the manual, so
guaranteeing procedural reliability (See Appendix 8).
Measurements
Acquiescence: The Adapted Amsterdam Acquiescence Scale
The aim of the AAAS was to detect occurrence of acquiescence in persons with and
without MIDBIF. A certain score on the AAAS used as an indicator to what extent a participant
were. The AAAS was a new and adapted version of the Amsterdam Acquiescence Scale (AAS)
developed by Moonen and Foppen (2010). Foppen (2010) did a research project with the AAS in
a group of N=118 participants with MIDBIF. The results were not published in a peer-reviewed
magazine. The recommendations she made were used to further develop the scale.
The assessment took place individually and the questions of the AAAS were asked one
by one by the interviewer. The introduction to the assessment was standardized (See Appendix
9.1). During the introduction, the participants were explicitly told that they had to answer as
quick as possible. A stopwatch was openly showed and the time used was written down. This
procedure was chosen after the recommendations made by the researcher who conducted the
study to the experimental AAS (Foppen, 2010). As mentioned in the introduction, (time)pressure
makes a large appeal on information capacity processes, which seem to make children with low
executive functioning skills vulnerable to suggestibility. This can be related to acquiescence
(Clare & Gudjonsson, 1995; Everington & Fulero, 1999; Finlay & Lyons, 2002; Karpinski &
Scullin, 2009).
The AAAS consisted of 6 introductory questions and 60 acquiescence assessment
questions all to be answered by the participant, and 5 acquiescence assessment questions to be
verified by the interviewer (See Appendix 9.2). 34 items were expected to be associated with
the presence of acquiescence. Acquiescence was assumed to be present when participants answered these questions with ‘yes’. In these cases, the participants scored 1 acquiescence point, which resulted in a total acquiescence score after summing the scores on all items. The
remaining 26 items were not used for assessing acquiescence. These are questions that had to be answered with ‘yes’ because the statements were true. It was considered important to also contain these questions in the AAAS in order to achieve a balance in the distributions of answers
(yes and no).
AAAS, seven techniques to detect acquiescence were used. These techniques were based on
studies on acquiescence as described in the theoretical introduction of this thesis.
1. Category A: General questions
These questions were supposed easy to be answered and were meant to make the
participant feel at ease before the rest of the interview started. An example of a general question
was: Do you have brothers or sisters? The answers to these questions were not used for
assessing the level of acquiescence.
2. Category B: Questions to be verified by the interviewer
An example of a question that could be verified by the interviewer was: Do you have
brown eyes? After the AAAS, the interviewer wrote down the answers to these verification questions, for example: Do you have brown eyes? Acquiescence was presumed to be present when the participant said ‘yes’ to that question and the interviewer verified that the answer should be ‘no’.
3. Category C: Questions with a Contradiction
Contradictions were assessed using pairs of opposite questions. In the AAAS, two types
of contradictions were used. The first type consisted of pairs of questions which had to be answered with ‘yes’ or ‘no’. For example the question pair: Are you smart? and: Are you stupid? Acquiescence was supposed to be present when the participant said ‘yes’ to both questions. The second type of contradictions used consisted of pairs of questions in which the participant had
to choose between two opposites (in an either… or presentation). Later, the choice for both
opposite pairs was assessed again in a ‘yes/no format’ resulting each pair of questions formulated in three questions. For example: Is your life either difficult or easy?, Is your life
easy? And: Is your life difficult? Acquiescence was presumed to be present when the participant said ‘yes’ to a question and the answer did not correspondent with the answer given to the question in the ‘either … or format’.
4. Category D: Sense- and nonsense questions
This type of questions existed of questions that made sense and questions that did not
make sense. For example: Can you cut with a knife? And: Do you have to wear sunglasses when
it rains? Acquiescence was presumed to be present when the participant said ‘yes’ to nonsense questions. The answers to the questions that made sense were not used for assessing
acquiescence.
5. Category E: Sense- and nonsense propositions
The propositions in these questions were sometimes in a nonsense form and were
sometimes true. For example: A fish lives in the sand and: You breathe the whole day.
Acquiescence was presumed to be present when a participant answered a nonsense proposition
with ‘yes’. The answers to the questions with propositions that were true were not used for assessing acquiescence.
6. Category F: Long and complex questions
These questions consisted of more than 32 words and the answers could be true or false.
For example: Does it make sense to send a postcard without a stamp when you are on vacation
and you have a lot of fun and you suddenly have to think about your home and you want to send a postcard to your parents to let them know the weather is nice? and: Will I be in Rome in a few weeks when I start cycling today on my new bike and cycle every day over hills and mountains and sleep in a tent every night? Acquiescence was presumed to be present when participants answered a question which was false with ‘yes’. The answers to the questions with a true proposition were not used for assessing acquiescence.
7. Category G: Desirable and undesirable behavior
This category was constructed using questions about socially desirable and undesirable
behavior, that were asked in two formats, both in a positive and a negative wording. In the first
second format it was asked whether the socially (un)desirable behavior was prohibited. For
example: Is it against the rules to steal? And: Are you allowed to steal? Acquiescence was
presumed to be present when participants answered a question with ‘yes’ when it should be ‘no’. The answers to the questions which were supposed to be true were not used for assessing acquiescence.
8. Category H: Judgements of persons with a presumed high stature:
The last technique focused on the relation between suggestibility and acquiescence (Clare
& Gudjonsson, 1995; Everington & Fulero, 1999). Because of this, it was assumed that
participants were more likely to endorse a proposition which was based on the judgement of
someone of high stature. By applying this technique alleged propositions from persons with
high stature were worded. For example: The director of the biggest Dutch bank states that Dutch
people do have more money on average than African people. Is this true? Some propositions were true and some were not. Acquiescence was presumed to be present when participants
stated that a false proposition to be true. The answers to the questions with a true proposition
were not used for assessing acquiescence.
One point was given every time that acquiescence was presumed to be present. This
resulted in an acquiescence score per category and a total acquiescence score after summing the
scores on all items.
Data analysis
Research question 1: What is the factor structure of the AAAS?
As mentioned before, 34 items were expected to assess the presence of acquiescence. It
was decided to only include the items with the highest frequencies to acquiescence in the
analysis (n ≥ 7 participants scored 1 acquiescence point).
An explorative principal components analysis was used to assess whether there was an
acquiescence in the set of items chosen.
The Component Factor Analysis (CFA) tested adequate fit of a one factor model,
treating the items as dichotomous. Therefore the WLSMV estimator was used, which does not
assume normality and is the best option for fitting CFA models with dichotomous/nominal or
ordinal data (Brown, 2006; Li, 2016). The goodness of fit was evaluated using the χ2 p value,
which should be smaller than .05 for a test of exact model fit, the comparative fit index (CFI),
and Tucker-Lewis Fit Index (TLT) greater than .95, and RMSEA lower than .05 as close model
fit indices. As Brown (2006) and Kline (2005) recommended, multiple indices were selected in
order to provide different information for evaluating model fit. Mplus-software was used to
perform the CFA analyses.
The items that loaded on this component with a certain value could be used in an Item
Response Theory (IRT) analysis in Mplus. IRT is a method to assess the validity of
measurement scales (Yang & Kao, 2014). It is a model-based method of estimating parameters for each item included in the scale that separates the person’s responses to the items from the person’s underlying level of the construction that is being measured with the scale (Samejima,
1997 as referred to in Yang & Kao, 2014). First, it is tested whether the assumptions to conduct
IRT analyses, Root Mean Squared Error of Approximation < 0.05 and Comparative Fit Index
≥ .095, were met (Hu & Benter, 1998 and Browne & Cudeck, 1993 as referred to in Yang & Kao, 2014). Thereafter, values for Item discrimination and item difficulties could be estimated
using Mplus.
As for the reliability, Cronbach’s alpha was computed as a measure for internal consistency of the proposed scale. Furthermore, Cohen’s Kappa was calculated as a measure for interrater reliability. A second researcher was present scoring the answers provided by the
participants on the questions of the AAAS and observing the behaviour of the participant, and
procedural reliability, the interviewer used a checklist to make sure that every individual
assessment was done in accordance to the manual. Furthermore, The interviewer took diary
notes of every interview.
Research question 2: Participants with MIDBIF have a higher level of acquiescence assessed with the proposed version of the AAAS than participants without MIDBIF.
An independent samples t test was used to examine the difference between the level of
acquiescence assessed with the version of the AAAS as assessed in research question 1, between
the two groups of participants. The groups were the independent variables and the total
acquiescence scores assessed with the proposed scale were the dependent variables.
Results The factor structure and reliability of the AAAS Internal structure
34 questions of the AAAS were supposed to assess acquiescence. It was decided to
include those items in the factor analysis that were answered acquiescent by at least 5% of all
participants (n ≥ 7). On this basis 18 items were included in the model used to investigate the factor structure of the AAAS (See appendix 10).
To examine the underlying structure of the AAAS, the data of the 18 items that supposed
to assess acquiescence were analyzed by means of an explorative principal components
analysis, which resulted in a one-dimensional solution with eigenvalue exceeding 1. After
examining the frequencies of answers that supposed to asses acquiescence, a set of 18 items
was retained for factor analysis. Results showed that 11 items loaded on the extracted
component, with only one eigenvalue exceeding 1 (eigenvalue 3,082, accounting for 28,020%
of the variance), and all factor loadings ranging between .39 and .759. Subsequently, the 11
.448 and .968 (See Table 1). By using the weighted least squares means and variance estimator
for categorical data, the fit statistics for the unidimensional model of the 11-item AAAS were
good: Root Mean Squared Error of Approximation (RMSEA) = .035, Comparative Fit Index
(CFI) =.984. This indicated that the proposed 11-item AAAS scale showed a sufficient
unidimensional structure and local independence to move forward estimating IRT parameters
for the 11-item AAAS.
Table 1
Component loadings in the 11 items
Question Category Standardized factor
loadings
33 C Are you commonly happy?
(vs. are you commonly sad?)
.711
31 C Do you prefer to be inside?
(vs. Do you prefer to be outside?)
.785
50 C Do you prefer summer over winter?
(vs. do you prefer winter or summer?)
.639
55 C Are you commonly busy?
(vs. are you commonly calm?)
.570
42 C Do you prefer to be at home?
(vs. do you prefer to be at school?)
.619
11 D Do you know how to fly a real airplane? .609
16 E You are 2m50cm .520
12 F Does it make sense to send a postcard without a stamp when you are on holidays and you have a lot of fun and you suddenly have to think about home and you want to send a postcard to your parents to let them know the weather is nice?
.448
43 F Will you still be able to watch a movie when someone walks towards the TV and pulls the plug when you are watching your favorite movie on TV and you find the movie to be very exciting and you are eating chips?
.514
23 G Is it against the rules to give someone a present? .945 27 G is it against the rules to help someone when he does
not understand something?
Item Response Theory Analysis
Table 2 shows the IRT parameters and item difficulties that were estimated in Mplus.
The item with the highest level of discrimination was question 27 (is it against the rules to help
someone when he does not understand something?). This indicated that this item identified best for the score of the latent trait (level of acquiescence based on the 11-item AAAS). The highest
level of item difficulty (location) was found in question 16 (You are 2m50cm). This indicated
that this item described best how difficult it is to achieve a 0.5 probability for a correct response
for a specific item given the respondent’s level of the latent trait (level of acquiescence based on the 11-item AAAS).
Table 2
Item discrimination and Item difficulties
Question Category Item
discrimination
Item difficulties
33 C Are you commonly happy?
(vs. are you commonly sad?)
1,011 1,774
31 C Do you prefer to be inside?
(vs. Do you prefer to be outside?) 1,266 2,074
50 C Do you prefer summer over winter? (vs. do you prefer winter or summer?)
.831 2,546
55 C Are you commonly busy?
(vs. are you commonly calm?) .695 2,210
42 C Do you prefer to be at home? (vs. do you prefer to be at school?)
.789 2,525
11 D Do you know how to fly a real airplane? .768 1,941
16 E You are 2m50cm .610 2,778
12 F Does it make sense to send a postcard without a stamp when you are on holidays and you have a lot of fun and you suddenly have to think about home and you want to send a postcard to your parents to let them know the weather is nice?
.501 1,545
43 F Will you still be able to watch a movie when someone walks towards the TV and pulls the plug when you are watching your favorite movie on TV and you find the movie to be very exciting and you are eating chips?
.559 2,095
23 G Is it against the rules to give someone a
present? 2,881 1,213
27 G is it against the rules to help someone when he does not understand something?
Reliability
Cronbach’s Alpha for the proposed 11-item AAAS was .725. As a measure for interrater reliability in scoring the answers provided by the participants on the questions of the AAAS a
second researcher was present in 23 interviews in the first research group, Cohen’s Kappa was
calculated and was .975.
Difference in level of acquiescence between participants with and without MIDBIF
The 11-item AAAS results in a total acquiescence score of a maximum of 11 points.
Participants with MIDBIF score between 0 and 8 points. Participants without MIDBIF score
between 0 and 4 points (See Table 3). Participants with MIDBIF had a higher mean score on
the 11-item AAAS (M = 2,28, SD = 2,09) than participants without MIDBIF (M = .34, SD =
.61). Using an independent samples t test showed that the level of acquiescence (assessed with
the 11-item AAAS) of participants with MIDBIF was significantly higher than the level of
acquiescence of participants without MIDBIF, t(77,162) = 7,323, p < .001, one-tailed). There
was no equality of variance (Levene’s p ≤ .05), for this reason the values for unequal variances
were used. The magnitude of the differences in the means (mean difference = 1,945, 95% CI:
Table 3
Distribution of the total acquiescence score assessed with the 11-item AAAS Total Acquiescence
Score
Group 1 (IQ < 85) Group 2 (IQ >85) Total
0 16 49 65 1 14 16 30 2 11 2 13 3 7 1 8 4 10 0 10 5 2 0 2 6 4 0 4 7 2 0 2 8 1 0 1 9 0 0 0 10 0 0 0 11 0 0 0 Cut-off points
As hypothesized, the results showed that participants with MIDBIF had a significantly
higher total acquiescence score assessed with the 11-item AAAS than participants without
MIDBIF. However, a certain score does not indicate whether acquiescence is or is not present
in participants with and without MIDBIF. For this reason it was decided to determine cut-off
scores. A total acquiescence score of 0 points assessed with the 11-item AAAS indicates that
acquiescence is not present. A total acquiescence score of 1 or 2 points indicates that
acquiescence may be present. A total acquiescence score of 3 points or higher, indicates that
acquiescence is present. Using these cut-off scores show that in 76,1% of the participants with
MIDBIF acquiescence was present or could be present. It turns out that 26,5% of the
participants maybe showed acquiescence. Only 1 participant without MIDBIF was acquiescent
Table 4
The presence of acquiescence in the sample
Presence Group 1 (IQ < 85) Group 2 (IQ >85) Total No acquiescence (0 points) 23,9% 72,1% 48,1%
Acquiescence may be present (1 – 2 points) 37,3% 26,5% 31,9% Acquiescence is present (≥ 3 points) 38,8% 1,5% 20% Observations
Comments on the procedure used based on dairy notes
Almost all participants participated in the study in a serious fashion. This was observed
after the short and standardized instruction provided by the interviewer. One participant for
example said: “Oh, first I have to wake up!” Others asked questions, for example one participant asked: “Do I only have to answer with yes or no?”. Another observation showing the participants to be committed to the study, was their reaction to the time element in the
procedure. One participant asked whether he really had to answer immediately or if he could
take some time to think. They were interested in the time assessed using the stopwatch and
asked the researcher whether they were fast or not. One participant stated: “It feels like an
exam!”. This indicates that the setting in which the interview took place and the task (answer as quick as possible) led to feelings of achievement or to the desire to achieve. The researcher
did not provide feedback on the appropriateness of the achievement and emphasized in this
cases that every answer was OK and that she was happy with the participant participating in the
study.
A few participants were visibly irritated by some of the questions they had to answer.
a day is good for you by saying: “I don’t care”. Multiple participants asked during the interview how many questions were yet to be answered, which could have been an indication for the
perceived length of the AAAS.
Also important to note was that some participants explained their answer. Some added
a personal anecdote. In this case the interviewer had to interrupt them and told them to continue
answering the questions and invited the participant to illustrate the answer after the task was
completed. Other participants added irrelevant information. One participant for example asked
whether the interviewer watched a particular television series, and another participant asked the
interviewer what kind of phone she used. In these cases the interviewer insisted on them to
continue and stated that she would answer these questions after the task was completed.
Average assessment time was 5,57 minutes (SD = 1,21 minutes). Average assessment
time of the respondents with MIDBIF was higher (M = 5,99, SD = 1,42) than the average
assessment time of the respondents without MIDBIF (M = 5,13, SD = .74). Using an
independent samples t test showed that this difference was significant, t(96) = 3,783, p < .001.
Experiences of the participants
At the end of the assessment procedure, participants were asked their experiences during the interview. Participants answered mainly in a positive way about the interview (“fine”. “OK”, “nice”). Many participants stated that they found questions funny, but also confusing. Approximately 1/3 of them mentioned that the some questions repeatedly asked (“You asked
the same questions, but they were always reversed).
Besides asking about the overall experience of the participant, participants were also
questioned about the easiness or difficulty of the items. The majority of the participants stated
that they found it easy to answer the questions. Some of them (approximately 15%) stated that
they experienced it sometimes easy, but sometimes difficult to answer certain questions. No
Other mistakes
Besides the items that assess acquiescence, the AAAS also consisted of filler-items that
did not assess the level of acquiescence. These questions contained true information and had to
be answered with “yes”. However this is not acquiescence, it was notable that the researcher observed that some participants made mistakes in answering these questions (See Table in
appendix 11). In most categories, participants with MIDBIF tended to make more mistakes than
participants without MIDBIF. However, independent t tests showed that there was no
significant difference between participants with and without MIDBIF in the amount of mistakes
made when answering questions with statements that made sense (category E) and questions
with judgements of persons with high stature (category H).
Discussion
This study focused on the presence of acquiescence, the tendency to agree with or say
yes to statements or questions, regardless of the content of the items, in 135 participants with
and without MIDBIF. In conclusion, literature states that acquiescence can be seen as a result
of cognitive disabilities, psychological tendencies, and the context of an interview. Several
researchers refer to techniques to detect acquiescence in persons, e.g. using pairs of questions
that are opposite in meaning. With these insights, the AAS was further developed, which
resulted in the AAAS. Results gave insight into the internal structure of the AAAS and showed
that using a combination of different techniques to detect acquiescence adequately lead to a
score that gave insight into the level of acquiescence of a person. Furthermore, it can be
concluded that the score assessed with the AAAS discriminates between participants with and
without MIDBIF.
Analyzing the internal structure of the instrument resulted in a shorter 11-item version,
presence of acquiescence in adolescents with and without MIDBIF (See appendix 12). The core
items of the BAAS have an acceptable internal consistency and the measure for interrater
reliability is high (Bijleveld, 2006). This indicates that different interviewers agree about the
level of acquiescence using these BAAS items.
In the AAAS seven different techniques to detect acquiescence were used. Almost all
categories that were expected to detect acquiescence are represented in the BAAS with at least
one item items after conducting a explorative principal components analysis revealing 11 items
with the highest factor loadings. This was however not the case for the categories in which the
answers to the questions could be verified by the interviewer (category B) and for the questions
with judgement of persons with a presumed high stature (category H). These categories were
added in the AAAS to the experimental version of the AAS based on the expectation that these
categories also could be used assessing acquiescence although there was less evidence for using
these categories in advance.
For the BAAS is was decided to add 7 items that do not assess the level of acquiescence
to the set of 11 core items that assess acquiescence (See Appendix 13). First, 3 general questions
were added, because it was considered important to offer an introduction in order to make the
participant feel at ease. Furthermore, 4 filler-items were added to the scale. These were
questions in 3 different categories of questions: questions that could be verified by the
interviewer, and sense and nonsense questions and propositions. These are the items that were
expected to identify acquiescence but were not included in factor analysis, because results
showed no variance and low differentiation in the answers to these questions (See appendix
10). The reason for adding these filler-items was that there had to be created ‘distance’ between
both questions of one pair with opposite questions. The original AAAS had a larger number of
items, which provided us to ask a larger number of other questions between the first and last
questions between the first and last question of each pair. Adding the general and filler-items
resulted in a scale of 23 items, of which 11 assess acquiescence, 3 are general items, 4 are
filler-items, and 5 are part of a pair with opposite questions. For each item of the 11 questions that
assess acquiescence, 1 acquiescence point can be scored, which can result in a maximum
acquiescence score of 11 points. The total acquiescence score indicates the level of
acquiescence (See appendix 12).
Based on determined cut-off points, it can be stated that half of the sample researched
is or may be acquiescent. Although the mean total acquiescence score was significantly higher
for participants with MIDBIF, it turned out that 26,5% of the participants without MIDBIF
might show acquiescence. This implies that acquiescence is, or might not only be a risk in
communication with people with MIDBIF. Acquiescence also poses a risk in communication
with some people without MIDBIF.
This insight highlights the importance to be aware of the potential risk of the influence
of acquiescence in communication with people with and without MIDBIF. For this reason,
some practical recommendations are given in the manual of the BAAS (See Appendix 12).
These recommendations are in line with techniques to adapt communications described in the
theoretical introduction (Hurtado et al., 2014; Moonen, 2016; Zoon, 2016). When an
interviewee scores 0 acquiescence points, it can be assumed that acquiescence will not be a
potential risk in further communication. However, it is recommended to be always aware of the
typical communication style of the interviewee, because acquiescence can be induced by
particular circumstances. When acquiescence may be present in an interviewee, it is advised to
have a more detailed look at the questions to which the interviewee responded in an acquiescent
way. When the interviewee, for example, is prone to be acquiescence when long and complex
question are asked, it is advised to avoid long sentences with loads of information in further
targeting one topic. In order to make sure that the interviewee understands the information, it
is recommended to check understanding regularly. A higher score reflects the need to be aware
of acquiescence. Recommendations for appropriate communication are for example: addressing
one topic at a time, repeating information or questions, using visualizations, and encouraging
the interviewee to ask questions when information or questions are not clear.
Because the results found in this study indicate that acquiescence can be present in both
adolescents with and without MIDBIF, it is important to screen for it more regularly. The
presence of acquiescence in adolescents affects communication and can have negative
consequences for the them. The BAAS provides professionals just such a tool in different
situations as school, (mental) health care and the justice system. A high score on the BAAS can
function as a warning signal, requiring professionals to take limited communication capacities
of an specific adolescent into account and adaptations in the level of language use emerge.
Adaptations like in the Dutch ‘Taal voor Allemaal’, easy to read English or leichte Sprache (in
german speaking countries) may contribute in decreasing acquiescence in people with and
without MIDBIF.
Given the results of the observations some interesting aspects possibly affecting the
score of acquiescence were observed. First, the researcher observed that some of the
participants said that they did not know the answer. Participants with MIDBIF did this more
often than participants without MIDBIF. This was particularly the case for questions in
categories F and H (long and complex questions and statements of persons of high stature).
Second, it was observed that some participants had to be endorsed by the researcher to make a
choice between answer options. This was especially true when contradictions were introduced
(category C). For example, participants said that their favored answer was in between two
categories or that it depended on the situation. Participants with MIDBIF seemed to find it more
to make an addition to some of their answers. This was especially true when they were not sure
what to answer, or when they only agreed with the answer in particular circumstances.
Additions to the answer to question 9 (are you smart) were for example: “I think so” or “yes because I attend pre-university education”. Fourth, it was observed that some participants took
more time to think about their answers. In those cases, participants were silent for more than
approximately three seconds, or they explicitly showed that they were thinking (“hmm”, “eh”). This was the case in both groups researched . Fifth, some participants laughed when particular
items were introduced. The highest frequency of laughing was found when question 32 was
introduced: a fish lives in the sand. Sixth, it was observed that some participants corrected their
choice almost immediately after they answered (“Yes. Oh, I mean no!”). In correcting answers no difference between both groups were noted. Seventh, some participants interrupted the
interviewer when she was reading the question aloud by already answering it. This was more
often observed by participants with MIDBIF compared to participants without MIDBIF.
Interrupting the interviewer was mainly observed in answering questions belonging to category
F (long and complex questions).
Limitations and recommendations for further research
This study has several limitations. First, the theoretical introduction is based on studies
that all have different visions on assessing ID. In Dutch professional practice a broader
definition of ID is advocated than in international research. In this study MID and BIF were
addressed as belonging to one category. This implies that most international research on
acquiescence is done in people with (M)ID, and there is ample knowledge about acquiescence
in people with BIF.
Second, the study was conducted in a relatively small sample. Since the BAAS is a new
instrument, additional assessment of reliability and validity is recommended in a larger sample.
composition of the questions and length of the scale, which differ between the AAAS and the
BAAS, will have an effect on the total acquiescence score. For this reason it should be tested
whether the composition of the items of the BAAS will result in the same distribution of scores.
And testing using a larger sample gives the opportunity to further analyze the relationship
between the Total IQ scores and the level of acquiescence. In this study, participants with
MIDBIF (intelligence score between 50 – 85) were considered to belong to one group.
However, it is plausible that results differ between participants with MID and with BIF.
Third, because of the outline of this research project no complete assessment of
intelligence was done. Total IQ scores of the participants without MIDBIF were assumed and
of participants with MIDBIF were assessed in the context of school with different instruments.
This should be taken into account when reading about the (computed mean) Total IQ scores.
However, all Total IQ scores should be considered to be a good indicator of whether or not
belonging to the group adolescents with or without MIDBIF. A recommendation for further
research to research with the BAAS is to assessed levels of intellectual and adaptive functioning
using uniform instruments.
Also, the instrument is only tested in the context of school and with participants age 13
and 19 years. It is possible that adolescents react in a different way in other contexts, for
example when a police officer or a psychologist asses acquiescence using the BAAS. For this
reason, it is recommended to test the instrument in other contexts. Also, the BAAS should also
be tested in a sample of adults with and without MIDBIF.
For further research it could be interesting to standardize observation criteria used in
the present study. Using this additional data, relationships between acquiescence scores and
participants’ behavior could be compared also involving a second observer to determine interrater reliability.
not supposed to assess the presence of acquiescence (i.e., questions that had to be answered with ‘yes’). It is notable that some participants also made ‘mistakes’ when answering these questions. It could be interesting to analyze this phenomenon in relation to their acquiescence
score.
In conclusion, it can be stated that it is important not only refer to acquiescence as a
characteristic of people with MIDBIF. It was shown that participants with average cognitive
abilities may also be acquiescent. In spite of the limitations of this study, the BAAS is as a
promising and time-efficient instrument, which can be helpful to detect acquiescence and can
help professionals to adjust their judgement whether adolescents with and without MIDBIF
understand the communication used and if necessary adjust their level of communication when
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