SELF-REGULATION IN CHILDREN WITH INTELLECTUAL DISABILITY

Abstract

Self-regulation is an important executive function responsible for the control of emotions, behaviors and inner processes. It is related to the academic success of the children as well as to their cognitive and social development. Children with intellectual disability are reported to have significant deficits in self-regulation skills. The goal of this study was to examine self-regulation skills in children with mild intellectual disability. The additional goals were to examine self-regulation in relation to the child's gender and to examine the relationship between age and self-regulation. The sample for this study comprised 42 children with mild intellectual disability, aged 7 to 15. There were 22 boys and 20 girls. Self- regulation was assessed with the Behavior Rating Inventory of Executive Function (BRIEF). The results indicated that 10 children or 23.8% had clinically significant deficit in self-regulation skills. Self-regulation skills in this sample were significantly lower as compared to the normative sample. Boys had better self-regulation skills than the girls in this sample. Self-regulation skills were improving with age for this sample of participants. Given the fact that these skills can be improved, it is suggested that educational institutions should give more attention to the development of executive functions at school age. Educational institutions should consider incorporating the training of executive functions into their curriculums.

Headnote

Abstract

Background. Self-regulation is an important executive function responsible for the control of emotions, behaviors and inner processes. It is related to the academic success of the children as well as to their cognitive and social development. Children with intellectual disability are reported to have significant deficits in self-regulation skills.

Objective. The goal of this study was to examine self-regulation skills in children with mild intellectual disability. The additional goals were to examine self-regulation in relation to the child's gender and to examine the relationship between age and self-regulation.

Method. The sample for this study comprised 42 children with mild intellectual disability, aged 7 to 15. There were 22 boys and 20 girls. Self- regulation was assessed with the Behavior Rating Inventory of Executive Function (BRIEF).

Results. The results indicated that 10 children or 23.8% had clinically significant deficit in self-regulation skills. Self-regulation skills in this sample were significantly lower as compared to the normative sample. Boys had better self-regulation skills than the girls in this sample. Self-regulation skills were improving with age for this sample of participants.

Conclusion. Given the fact that these skills can be improved, it is suggested that educational institutions should give more attention to the development of executive functions at school age. Educational institutions should consider incorporating the training of executive functions into their curriculums.

Keywords: self-regulation, executive function, mild intellectual disability

Introduction

Self-regulation is one of the main aspects of adaptive human behavior (1). Among its many roles, self-regulation is also responsible for the goal-oriented behavior and the inhibition of maladaptive forms of behavior. Self-regulation can be variously defined and different definitions of self regulation can be found in Kopp (2). One of its many definetions states that self-regulation is the management of attention, emotion, and stress response physiology for the purposes of goal-directed action, primarily through executive function abilities (3).The ability to control one's behavior is of crucial impor - tance in personality development and social skills development, particularly in the area of emotionality, compliance, social competence and empathy (4,5). Some authors believe that understanding self-regulation processes will lead us to the fuller understanding of child development and psychopathology through improvements in diagnosis, prevention and treatment of developmental problems such as attention deficits and learning disabilities (6). Self-regulation skills also help children to gain access to their cognitive processes that facilitate learning (7). Children start to develop some early forms of self-regulation in the first three months of life and continue to develop it throughout the preschool years (2). Children gain mastery in some of the selfregulation skills at preschool age and that mastery is characterized by significant improvement in social, cognitive and academic competencies (8). Self-regulation skills are initially regulated externally (e.c. through parents' rules) and over the course of child's development they become more and more internalized, through the use of self-directed speech (9). This short introduction indicates the importance that self-regulation skills play in everyday life. Although, there are couple of theoretical frameworks from which self-regulation can be conceptualized (8), this study was based on the work of Gioia et al. (10) and their model of executive function. The model postulates that behavior regulation represents the children's ability to shift the cognitive set and to regulate emotions and behaviors through inhibitory control. In line with this, there are three components of self-regulation: Inhibition, attention shifting and emotional control. Inhibition or inhibitory control refers to the child's ability to stop one's own behavior at the appropriate time. Shifting refers to the ability to move from one activity to another in accordance with the circumstances. Lastly, emotional control refers to the child's ability to modulate emotional responses.

There is a relative paucity on the studies regarding prevalence of self-regulation skills in children with intellectual disability. There are, however, some studies that compared typically developing children with children with intellectual disability and the results of these studies indicated that children with intellectual disability have certain deficits in the area of self-regulation (8, 11).

The goal of the current study was to assess the frequency of self-regulation deficits in children with intellectual disability through the use of the Behavior Rating Inventory of Executive Function, an ecologically valid instrument. The additional goals were to compare the self-regulation skills in relation to the child's gender, to examine the relationship between age and self regulation. Finally, I wanted to assess the correlation between self-regulation and global executive function scores as conceptualized by Gioia et al (12) in order to examine the role that self-regulation plays in the concept of executive function.

Method

Participants

The sample for this study consisted of 42 children with mild intellectual disability (as defined by the IQ scores between 50 and 70), aged 7 to 15 (mean age- 10.8 years, standard deviation- 2.9 years), 22 boys and 20 girls. The mean age of boys was 11.1 years, and age of girls was 10.6 years (t(40)= 0.55; p>0.1). The etiology of intellectual disability in the sample was heterogeneous, 20 children had an unknown cause of intellectual disability, 12 children had Down syndrome, 10 children had brain injury or other genetic cause of intellectual disability. The information on the level of intellectual disability and etiology of intellectual disability was contained in the children's educational records. The children in this sample attended two special education schools in Canton Sarajevo.

Instrument

For the purposes of this study I used Behavior Rating Inventory of Executive Function (BRIEF) (12). The BRIEF is a valid and reliable test with 86 items on which teachers or parents provide answers (0-never, 1-sometimes, 2-often) and is one of the few instruments of executive functions with ecological validity, i.e., related to the real life behavior (13). The BRIEF has been used successfully in differentiating diagnostic categories such as ADHD, Pervasive Developmental disorders, Tourette syndrome, traumatic brain injury and intellectual disability (12). The Inventory is composed of 8 clinical scales: 1. Inhibition, 2. Shifting attention, 3. Emo- tional control, 4. Initiation, 5. Working memory, 6. Planning/ Organizational abilities, 7. Organization of material and 8. Monitoring. These clinical scales further form two indexes: 1. Behavior regulation index (consisting of scales 1 to 3) and 2. Meta-cognition index (consisting of scales 4 to 8). Finally, all 8 scales and two index scores are used for the calculation of the BRIEF Global Executive Score. In this study, we measured self-regulation (Behavior regulation in the BRIEF) as an index score consisting of Inhibition scale, Shifting attention scale and Emotional control. The BRIEF, teacher form, was standardized on a sample of 720 typically developing children with a standardized T score of 50 and standard deviation of 10 points. The T scores were created as a linear transformation of the raw scores. Lower scores on the BRIEF indicate better performance. Children in the normative sample were aged 5-18 years, with no history of special education or psychotropic medication usage. The teacher form sample consisted of 403 girls (56%) and 317 boys (44%). As there was a signifycant effect of gender and age on BRIEF scores, the separate normative scales were created by age and gender.

Procedure and statistical analysis

The BRIEF scale was completed by special education teachers who worked with children and have known the children for at least 3 months. After the raw scores were obtained they were converted into T scores. According to the BRIEF manual, any result above 65 (1.5 SD above the mean) is regarded as clinically significant. The first task in this study was to determine the percentage of children who had clinically significant results on the Self-regulation index. The second task in the study was to assess differences in the mean scores between the normative sample and this study's sample. For this task, a one sample t-test was used and as a measure of effect size, Cohen'd was calculated. The third task in the study was to assess differences in self-regulation skills in relation to the child's gender. Here, an independent t- test was used along with Cohen'd as a measure of an effect size. The correlation between the age of the child and self-regulation scores was assessed with Pearson correlation coefficient. Two correlations were performed. The first one was the correlation between the age and standardized self-regulation scores and the second one was between the age and raw self-regulation scores. The correlation was also measured between BRIEF self-regulation scores and BRIEF global executive function score. An alpha level of 0.05 was set for all statistical tests.

Results

The first task in this study was to assess the Prevalence of clinically significant deficits in self-regulation skills in children with mild intellectual disability. According to the BRIEF results, clinically significant deficits in self-regulation (scores above 65) were present in 10 children or 23.8%.

The second task was to compare differences in mean scores of the normative sample with the mean score of this study's sample. According to the results of one sample ttest, there were significant differences in the mean scores of normative sample of children and children with intellectual disability in this sample (t(41)=6.8, p<.001). The size of effect was also large (Cohen'd=1.0). These results are shown in table 1.

In relation to the gender differences, there were statistically significant differences between boys and girls in self regulation skills, with boys having better standardized self regulation scores (t(41)= 2.3, p=0.026). The size of the effect was also large (Cohen's d=0.71). These results are shown in table 2.

To further understand the nature of these results, an independent t-test was performed to assess the differences in raw self-regulation scores in relation to gender. This time, t-test was not significant (Table 3).

In addition to this, I assessed whether there were any differences in proportion of boys and girls who have clinically significant deficit in self-regulation skills. The results indicated that although more girls had clinically significant deficits in selfregulation skills, that difference was not statistically significant (X2 (1, N=42) = 0.81, p=0.37). Descriptive data are shown in table 4.

The correlation between age and standardized self-regulation scores was measured. According to the Pearson correlation coefficient, there was no significant correlation between age and standardized self-regulation scores (r=0.09, p=0.58, N=42). On the other hand, the correlation between age and raw self-regulation scores was statistically significant (r=-0.41, p<0.01, N=42).

Lastly, the correlation between BRIEF selfregulation scores and BRIEF global executive function scores was measured. The correlation was highly significant r=0.83, p<0.001, N=42.

Discussion

The goal of this study was to assess the selfregulation skills in children with intellectual disability. The results showed that about one fourth of children with mild intellectual disability have a clinically significant deficits in self-regulation skills. Children from the normative sample have the results that are about 1SD lower than in children with intellectual disability. This is in line with existing studies, pointing to the lower selfregulation skills in children with intellectual disability in comparison to typically developing children (14). It is important to note that children from the normative sample had IQ scores that are 2SD higher (typical population) than in this sample of children with intellectual disability. This further demonstrates that self regulation skills and IQ scores do not share much of the common variance, a finding which is also in line with existing studies (15). Another finding of this study was better result of boys in standardized self-regulation scores as compared to the girls, although the raw scores were practically the same. This was an unexpected finding which is not in line with existing studies. Thus, for example, in a large metaanalysis study, Else-Quest et al. (16) have consistently, across the studies reviewed, found that the girls showed greater ability to regulate attention and impulses than the boys. Weinberg et al. (17) have found that baby boys, 6 months old, have more limited capacity for self-regulation than 6 months old baby girls. This trend of girls outperformming boys in self-regulation skills was also evident in preschoolers (18). The participants of these two studies (17, 18) were typically developing children so these findings might not generalize to children with intellectual disability. Unfortunately there are no studies, to the best of author's knowledge, examining self-regulation skills in children with intellectual disability in relation to the child's gender. There are a couple of possible explanations for the better results of boys in this study. The first one might be that boys with intellectual disability have really better self-regulation skills than the girls. The second one might be that the found differences were due to chance (type 1 error). As the sample was not random, there might have been some initial differences in gender abilities on some other variables that may be connected with self-regulation skills. For example, the sample of boys and girls was not adjusted for IQ scores, academic achievement, social status etc. In interpreting the findings of this study one needs to be aware of the small sample used and the fact that self-regulation was assessed through the proxies (teachers). However, the most probable explanation for these differences in the self-regulation scores in relation to gender has to do with the standardization issues. It is important to note that the same raw scores on self- regulation scale produce different standard scores for boys and girls. Thus, for example, the raw score of 50 (for age group of 6 and 7 years) will produce the standard score of 55 for boys and 65 for girls. Of caution here is the fact that BRIEF was not standardized for population of children with intellectual disability and there might be different trends in scores in relation to gender. Additional studies should try to validate BRIEF norms for boys and girls with intellectual disability. In line with this, future studies are needed to examine whether the development of self-regulation skills in people with intellectual disability follows the same trends as in typically developing people and whether the developmental trend is the same across the gender. A partial answer to this question, regarding the children, is provided below in the discussion about the relationship between age and self-regulation. There was a strong correlation between age and raw self-regulation scores so that with an increase in age there was an improvement in self-regulation scores. Standard scores were more or less the same across the age groups. If we know that BRIEF was standardized in typically developing children this can indicate that the developmental trend of self-regulation skills in children with intellectual disability is parallel to the trend in typically developing children although somewhat delayed (around 1SD). The potential questions arise as to whether this trend is life long- are people with intellecttual disability at the age, say, 50 years still 1SD below the typical population in selfregulation skills? Is the pattern valid for children (people) with more severe levels of intellectual disability? Is there a decline in self-regulation skills at certain age for people with intellectual disability? All these questions merit a thorough scientific investigation and will help us in better understanding this important executive function. Also, future studies should definitely examine the validity of converting the BRIEF raw scores in the standardized scored in population of children with intellectual disability. Lastly I examined the correlation between the BRIEF construct of self-regulation and BRIEF executive function composite score. The results of this study indicate a strong relationship between self-regulation and executive function. This result further validated the role of self-regulation and its' importance in the theoretical conceptuallization of executive function.

Some of the limitations of this study are the small sample size, which reduces the power of generalization of these findings. Also, it would be of great benefit to this study if there were other variables to correlate with self-regulation such as IQ scores and adaptive behavior scores and especially other executive function constructs. Lastly, another limitation, which follows almost all studies using checklists filled by proxies, is the subjective nature of the BRIEF.

At the end I would like to point out some potential interventions for improving executive functions in general and selfregulation skills in particular. It is a wellknown fact that executive functions can be significantly improved through the training (19, 20). The most important period for that training is the early years. Specially designned early programs aiming at self-regulation skills have already shown a great potential in preventing self-regulation problems as well as in treating them (21). Educational institutions such as regular schools, specialized schools and preschools need to be aware of these programs and need to incurporate them into their curriculums.

Conclusion

Children with intellectual disability lag behind typically developing children in selfregulation skills. The development of selfregulation skills in children with intellectual disability seems to follow the same trajectory line as in typically developing children. In this study, the boys were perceived as having better self-regulation skills than the girls. It is of utmost importance, for educational institutions to incorporate executive functions training into their curriculums, given the fact that these functions can be improved. As is the case with many other cognitive processes, the earlier this training starts the better are the outcomes for the child.

Conflict of interests

Author declares no conflict of interests.

References

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