The validity and effectivity of the new checklist ‘Attune & Stimulate’ for parents and caregivers of persons with severe intellectual disabilities (SID).

Rationale: Persons with severe intellectual disabilities (SID) often experience social and behavioural problems, resulting in difficulties in the attunement with other people or in stress when they have new social experiences. Also parents and caregivers find it hard to attune to the wishes of their child/client. This can lead to social and behavioral problems for persons with SID. It is therefore important that caregivers and parents can identify and prevent behavioural problems, in order to enable persons with SID to build relationships.

Objective: The goal of the current study is to examine whether the checklist Attune & Stimulate’ (A&S) developed at the Vrije Univesiteit Amsterdam (Doodeman, Blom-Yoo & Sterkenburg, 2018) is a valid tool that can support caregivers and parents in their daily contact with their child or client with SID (effectiveness).

Study design: A Randomised Controlled Trial which has one measurement and contains a group of caregivers using the Attune & Stimulate checklist and a control group with caregivers who do not use the checklist; they provide the care as usual. The measurement consists of a video of an interaction between the client and the caregiver, in which the client wears the skin conductance sensor sock (measuring level of arousal).

Study population: This study involves 140 adults with an IQ lower than 35 who live in group homes for this target group.

Intervention: The intervention is the checklist ‘Attune & Stimulate’ (Doodeman, Blom-Yoo & Sterkenburg, 2018).

Main study parameters: The attunement of the caregivers with the person with SID and the level of arousal of the person with SID.

1) The checklist 'Attune & Stimulate' is a valid instrument to assess the arousal level of clients with SID.

2) Caregivers who are randomized to the intervention group that is instructed to use the A&S-checklist attune better (sensitive responsiveness) to the behavior of their client than the control group with caregivers not given the A&S-checklist.

3) Clients whose caregiver is randomized to the intervention group that is instructed to use the A&S-checklist show more behaviour in an optimum arousal level during the interaction- and relaxation-moment than clients whose caregiver is randomized to the control group not given the A&S-checklist.

T0: Questionnaire – Minimum Data Set for Relatives and Professionals; The researchers in this project use the modules “Basis MDS fixed”, “Basis MDS relatives” and “Basis MDS professional” of the Minimum Data Set (MDS) for people with intellectual disabilities, variant adults fixed-Other (Kunseler, Schuengel, Embregts, & Mergler, 2016). The measured constructs are adaptive functioning, emotional development, communication and influence (as part of quality of life) and subjective well-being.

T1: Video recording and measurement of physiological arousal in session; The session consists of an observation-moment (15 minutes), an interaction-moment between caregiver and client (15 minutes) and a moment of relaxation (10 minutes). All three moments will be video recorded and the client wears a skin conductance sensor sock. Because of the Randomized Controlled Trial, there is a small difference between the instructions the caregivers of the control group and the caregivers of the intervention group are given;
- In the observation-moment, the caregivers of the control group are instructed to observe without the A&S-checklist and the caregivers of the intervention group are instructed to observe with the A&S-checklist, and;
- In the interaction-moment, the caregivers of the intervention group are instructed to take the recommended behavioural responses out of the second part of the checklist in their mind during the interaction, and the caregivers of the control group are instructed to interact with the client like they always do.

Afterwards, the recorded videos will be coded with;
1) the A&S-checklist to gain information about a) the arousal level of the client, and b) the applied recomended behaviours of the caregiver
2) the Maternal Behavior Rating Scale (Mahoney, 2008) to gain information about the ‘responsive/child oriented behaviour’ of the caregiver

The ‘Attune & Stimulate’ checklist (Doodeman, Blom & Sterkenburg, 2018); developed for parents and professional caregivers of persons with SID, to support them in noticing signs of psychosocial stress and responding adequately.

The checklist consists of two parts. The first part requires users to observe behaviour of the person with SID (92 behavioural item-options) and rate the level(s) of arousal of each observed behaviour. In the second part of the A&S-checklist, the parent or caregiver is presented a selection of recommended behavioural responses to attune to the level of arousal of the child or client. These recommendations are based on analysis of the behaviour of therapists providing the Integrative Therapy for Attachment and Behaviour (ITAB; Doodeman, Schuengel, & Sterkenburg, 2020; Sterkenburg, Janssen, & Schuengel, 2008). In a digital learning environment related to the A&S-checklist, parents and caregivers are trained to observe with the A&S-checklist and can get familiar with the recommended behavioural responses, by practicing with videos (1.5 hour training).