Robert Didden

Individuals with visual impairment (VI) are at increased risk of developing mental health problems. However, the role of emotional dysregulation remains unclear. This study examined the association between VI and emotional dysregulation, including the moderating effects of age at onset and severity of VI. We compared four groups defined by the presence or absence of VI and mental health problems. Results showed that participants with VI and mental health problems had higher levels of emotional dysregulation than those with VI alone and controls, but lower levels than those with comorbid mental health problems. VI alone was not associated with emotional dysregulation. Age at onset, but not severity of VI, was related to emotional dysregulation. Early onset of VI (0–20 years) strengthened the association between mental health problems and emotional dysregulation. These findings highlight the importance of early identification and intervention targeting emotion regulation, particularly among individuals with early onset of VI.

Background: Individuals with severe intellectual disabilities (SID; IQ 20–35) are believed to be at heightened risk of developing posttraumatic stress disorder (PTSD). However, research targeting trauma treatment in individuals with SID remains limited, and controlled intervention studies are scarce.

Introduction: Until recently, no diagnostic instrument was available to classify posttraumatic stress disorder (PTSD) in individuals with severe or moderate intellectual disability (SID). This study investigates the Diagnostic Interview Trauma and Stressors–Severe Intellectual Disability (DITS‐SID), a caregiver‐administered interview corresponding with DSM‐5(TR) PTSD criteria for children ≤ 6 years. Interrater reliability and convergent and content validity were examined. Methods: The DITS‐SID, Aberrant Behavior Checklist (ABC) and Child and Adolescent Trauma Screener 3–6 (KJTS 3–6) were administered to relatives and professional caregivers of 97 adults with SID. Results: Interrater reliability was good to excellent. Convergent validity was supported by correlations with ABC and KJTS 3–6 scores. Content validity appeared good as adults who met PTSD symptom criteria had, on average, higher interference scores, higher DITS‐SID atypical symptom scores and a greater number of experienced traumas and stressors. No association was found between meeting PTSD symptom criteria and PTSD criterion A. Conclusion: The DITS‐SID appears feasible for classifying PTSD in adults with SID. Future research should evaluate its validity in children with SID.

Rule-based digital learning environments operate through explicit “if–then” logic, production rules, or expert-system architectures that provide structured and predictable learning conditions for autistic learners. Despite growing interest in these systems, no systematic review has specifically synthesized their core characteristics or reported educational, social, and behavioral outcomes. This systematic review aimed to identify, characterize, and synthesize rule-based digital learning environments for autistic learners, with particular attention to generalization, long-term maintenance, and cultural adaptation in Arab contexts. Following PRISMA 2020 guidelines, a systematic search was conducted across PubMed, Scopus, Web of Science, IEEE Xplore, and ACM Digital Library from January 2014 through May 2026. Eligible studies included empirical research evaluating rule-based digital interventions for autistic learners across preschool, school-age, and transition-to-adulthood stages and reporting educational, social, or behavioral outcomes. Methodological quality was appraised using the Mixed Methods Appraisal Tool, and findings were synthesized narratively following the framework proposed by Popay et al. (2006). This review was prospectively registered on PROSPERO (CRD420261399393). Twenty-three studies involving 987 participants including autistic learners and, where applicable, comparison groups, parents, teachers, and educational professionals, met the inclusion criteria. Four categories of rule-based environments were identified: intelligent tutoring systems, rule-based serious games, digitally mediated social stories, and robot-, augmented reality-, and virtual reality-based platforms. Six recurring design characteristics emerged across interventions: explicit visual rule presentation, immediate feedback, adaptive progression, adult scaffolding, personalization, and performance analytics. Positive short-term outcomes were reported across academic, social communication, and behavioral domains. However, generalization was assessed in only 35% of studies, maintenance in 26%, and no study reported external validation. Methodological quality was generally moderate to high. Seven studies conducted in Arab contexts reported high learner engagement but highlighted challenges related to dialectal diversity and culturally specific social rules. Rule-based digital learning environments may support structured skill acquisition in autistic learners, particularly when transparent instructional rules are combined with adaptive flexibility and adult scaffolding. However, substantial gaps remain regarding generalization, long-term maintenance, external validation, and culturally responsive implementation. In Arab contexts, dialect-aware and culturally grounded approaches appear particularly important. Future research should prioritize rigorous multi-site evaluations with systematic assessment of generalization, maintenance, and external validation to establish real-world effectiveness across culturally diverse settings.

Background: Assessment of adaptive behaviour of people with moderate to profound intellectual disability is hampered by limited variation in scores within this range. We evaluated measurement properties of the Diagnostic Instrument on Adaptive Behaviour (DIAB), which was developed for this population. Method: The DIAB was completed by two care staff members for 73 adults (age 19–84) grouped by level of intellectual disability (i.e., moderate, severe or profound intellectual disability) along with Dutch normed measures of adaptive and motor functioning and a global rating. Results: Inter‐rater (ICC = 0.94) and test–retest (ICC = 0.96) reliability met standards. DIAB scores correlated highly with those of the two Dutch instruments ( r = 0.90; r = 0.77). Associations between measures were consistent with convergent and discriminant validity. DIAB scores differed between three severity levels of ID ( p < 0.001). Conclusion: The DIAB exhibited promising reliability, convergent, discriminant, concurrent, and known group validity.

Adults with severe or moderate intellectual disabilities frequently experience traumatic events, placing them at higher risk for trauma-related disorders. Although these events also affect their relatives, their experiences have not been studied. Thematic analysis was conducted on interviews with eight first-degree relatives of adults with severe or moderate intellectual disabilities who had experienced traumatic events, as identified through a trauma interview. Four themes emerged: (1) the impact varied, with some relatives developing trauma-related symptoms; (2) characteristics of events in terms of severity and frequency, accompanied by feelings of helplessness, guilt, and inadequacy; (3) coping strategies, including social support, persevering and avoidance; and (4) the link between impact and long-term care for the client, potentially increasing relatives' susceptibility to complaints. Professionals must be aware of the effects of trauma on relatives of individuals with severe or moderate intellectual disabilities. Further research needs to explore differences among relatives.

Background: Individuals with mild intellectual disability (MID; IQ 50-70) or borderline intellectual functioning (BIF; IQ 70-85) are at an elevated risk of post-traumatic stress disorder (PTSD), with PTSD symptoms possibly associated with behavioural problems. It is important to test the effectiveness of trauma-focused treatments, such as eye movement desensitisation and reprocessing (EMDR) therapy, for adults with MID-BIF, PTSD, and severe behavioural problems.Objective: To determine the safety and effectiveness of brief intensive EMDR therapy carried out by a team of rotating therapists in adults with MID-BIF, PTSD, and severe behavioural problems.Methods: Using a randomised non-concurrent multiple baseline between-subjects design, 11 adults with MID-BIF, PTSD, and severe behavioural problems received a maximum of 16 intensive EMDR sessions twice daily for a maximum of two weeks from six different EMDR therapists. Primary outcome measurements included severity of PTSD symptoms, PTSD diagnostic status, and adverse events. Secondary outcome measurements included the frequency and severity of behavioural problems, presence of adaptive behaviour, and the use of involuntary care. Outcome measurements were assessed at baseline, during the intervention and post-intervention phases, and at the follow-up phases, and subject to randomisation tests for statistical significance.Results: Intensive EMDR therapy carried out by a team of rotating therapists resulted in significant decreases in PTSD symptoms (M_difference = 15.84, p < .001) with nine of 11 participants no longer meeting the PTSD diagnostic criteria immediately following treatment and at the 9-week follow-up. Randomisation tests revealed no significant changes in adaptive behaviour, frequency, and severity of behavioural problems. Additionally, no decrease in the use of involuntary care measures was observed. One participant dropped out; no adverse events were observed.Conclusions: Brief intensive EMDR therapy for individuals with MID-BIF and severe behavioural problems, conducted by a team of rotating therapists, can be done safely and effectively to reduce PTSD symptoms.