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Impact of Coercive Tactics on the Decision-Making of Adolescents with Intellectual Disabilities

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Title: Impact of Coercive Tactics on the Decision-Making of Adolescents with Intellectual Disabilities
Language: English
Authors: Khemka, I., Hickson, L., Casella, M.
Source: Journal of Intellectual Disability Research. Apr 2009 53(4):353-362.
Availability: Blackwell Publishing. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8599; Fax: 781-388-8232; e-mail: customerservices@blackwellpublishing.com; Web site: http://www.blackwellpublishing.com/jnl_default.asp
Peer Reviewed: Y
Physical Description: PDF
Page Count: 10
Publication Date: 2009
Document Type: Journal Articles
Reports - Research
Descriptors: Comprehension, Mental Retardation, Prevention, Adolescents, Program Effectiveness, Inferences, Decision Making, Vignettes, Performance, Victims of Crime
DOI: 10.1111/j.1365-2788.2009.01152.x
ISSN: 0964-2633
Abstract: Background: High rates of victimisation have raised concerns about the ability of adolescents with intellectual disabilities (ID) to avoid and escape from harmful situations and to make decisions in their own best interest. The present study was designed to assess the impact of specific coercive tactics on the decision-making of adolescents with ID. Method: Forty-eight adolescents with ID participated in the study. They were asked to respond to a series of brief vignettes depicting equal numbers of situations involving coercion with a lure, coercion with a threat, and no specific coercive tactic. Performance was assessed in terms of independent, prevention-focused decisions, reporting decisions and responses to fact and inference comprehension questions. Results: Overall, participants suggested independent, prevention-focused decisions only about half the time. They were more likely to suggest independent, prevention-focused decisions in situations with no specific coercive tactic or coercion with a lure than in situations involving a threat. However, reporting decisions were more likely in situations involving coercion with a threat than in the other two conditions and both fact and inference comprehension were best in situations involving coercion with a threat. Conclusions: Results indicated that adolescents with ID are not well-prepared to handle situations on their own that involve coercion, especially coercion with a threat. Because comprehension did not appear to be a key source of the decision-making difficulty in this study, further research is needed to examine all aspects of the decision-making process as a basis for the design of effective interventions.
Abstractor: As Provided
Number of References: 44
Entry Date: 2009
Accession Number: EJ832594
Database: ERIC
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  Value: <anid>AN0036922729;eul01apr.09;2019Jun04.10:45;v2.2.500</anid> <title id="AN0036922729-1">Impact of coercive tactics on the decision-making of adolescents with intellectual disabilities. </title> <p>Background  High rates of victimisation have raised concerns about the ability of adolescents with intellectual disabilities (ID) to avoid and escape from harmful situations and to make decisions in their own best interest. The present study was designed to assess the impact of specific coercive tactics on the decision‐making of adolescents with ID. Method  Forty‐eight adolescents with ID participated in the study. They were asked to respond to a series of brief vignettes depicting equal numbers of situations involving coercion with a lure, coercion with a threat, and no specific coercive tactic. Performance was assessed in terms of independent, prevention‐focused decisions, reporting decisions and responses to fact and inference comprehension questions. Results  Overall, participants suggested independent, prevention‐focused decisions only about half the time. They were more likely to suggest independent, prevention‐focused decisions in situations with no specific coercive tactic or coercion with a lure than in situations involving a threat. However, reporting decisions were more likely in situations involving coercion with a threat than in the other two conditions and both fact and inference comprehension were best in situations involving coercion with a threat. Conclusions  Results indicated that adolescents with ID are not well‐prepared to handle situations on their own that involve coercion, especially coercion with a threat. Because comprehension did not appear to be a key source of the decision‐making difficulty in this study, further research is needed to examine all aspects of the decision‐making process as a basis for the design of effective interventions.</p> <p>Keywords: coercion; decision‐making; intellectual disabilities; victimisation; adolescence</p> <p>With the increasing inclusion and community participation of individuals with intellectual disabilities (ID), it is essential for them to be able to successfully navigate a wide range of interpersonal situations. However, high rates of victimisation have raised concerns about their ability to avoid and escape from harmful situations and to make decisions in their own best interest ([<reflink idref="bib38" id="ref1">38</reflink>]; [<reflink idref="bib39" id="ref2">39</reflink>]; [<reflink idref="bib31" id="ref3">31</reflink>]; [<reflink idref="bib35" id="ref4">35</reflink>]). This vulnerability was exemplified in the widely publicised Glen Ridge, New Jersey case in which a young woman with ID was sexually assaulted by a group of young men from her community who took advantage of her disability to lure her to a basement where the assault took place ([<reflink idref="bib27" id="ref5">27</reflink>]). As in the Glen Ridge case, many incidents involving victimisation are associated with one or more decision‐making opportunities in which the potential victim may be able to take action to avoid or escape from a harmful situation. Situations where another person uses coercive tactics to pressure the decision‐maker to engage in an activity with potentially harmful consequences can pose formidable challenges for many individuals with ID ([<reflink idref="bib17" id="ref6">17</reflink>]).</p> <p>Much has been written about the risk‐taking and problem behaviours of adolescence that can make it a perilous stage of development ([<reflink idref="bib36" id="ref7">36</reflink>]; [<reflink idref="bib6" id="ref8">6</reflink>]; [<reflink idref="bib33" id="ref9">33</reflink>]). Although it is widely acknowledged that adolescents with ID are the frequent victims of peer harassment and abuse, very little systematic research has been conducted on this topic ([<reflink idref="bib32" id="ref10">32</reflink>]). In his extensive review of problematic behaviours during adolescence, [<reflink idref="bib11" id="ref11">11</reflink>]) concluded that 'with few exceptions, most of the problematic behaviors . . . result from a series of decisions made by adolescents' (p. 7). Furthermore, in their work on the competence of adolescents to stand trial, Grisso <emph>et al.</emph> ([<reflink idref="bib10" id="ref12">10</reflink>]; [<reflink idref="bib9" id="ref13">9</reflink>]) have examined legal decision‐making in relation to age and intellectual ability. They reported that decision‐making competence on a range of measures relevant to ability to stand trial increased with both age and intellectual ability. Because of the pivotal nature of decision‐making during adolescence, it is essential to gain a better understanding of how adolescents with ID process decisions pertaining to problem behaviours and risks in interpersonal situations.</p> <p>There is evidence indicating that individuals with ID exhibit serious limitations in important decision‐making skills, often jeopardising their health and safety in situations that pose a risk of danger ([<reflink idref="bib40" id="ref14">40</reflink>]; [<reflink idref="bib19" id="ref15">19</reflink>]; [<reflink idref="bib20" id="ref16">20</reflink>]; [<reflink idref="bib44" id="ref17">44</reflink>]). Reviews of research on this topic ([<reflink idref="bib14" id="ref18">14</reflink>], [<reflink idref="bib15" id="ref19">15</reflink>]; [<reflink idref="bib25" id="ref20">25</reflink>]) have indicated that individuals with ID typically fail to apply a systematic decision‐making process, but rather rely on a limited number of solutions drawn from their past experience that they may apply to new situations in an inflexible manner. In addition, when individuals with ID do attempt to apply a multi‐step process, they tend to experience limited success at each stage of the process, showing incomplete comprehension of decision situations, generating few alternative solutions, failing to anticipate the possible negative consequences of a course of action and not selecting an appropriate course of action ([<reflink idref="bib4" id="ref21">4</reflink>]; [<reflink idref="bib37" id="ref22">37</reflink>]; [<reflink idref="bib40" id="ref23">40</reflink>]; [<reflink idref="bib13" id="ref24">13</reflink>]; [<reflink idref="bib19" id="ref25">19</reflink>]; [<reflink idref="bib41" id="ref26">41</reflink>]).</p> <p>The decision‐making skills of individuals with ID have been examined across a wide range of interpersonal situations ([<reflink idref="bib17" id="ref27">17</reflink>]; [<reflink idref="bib14" id="ref28">14</reflink>], [<reflink idref="bib15" id="ref29">15</reflink>], [<reflink idref="bib16" id="ref30">16</reflink>], 2001, in press; [<reflink idref="bib22" id="ref31">22</reflink>]; [<reflink idref="bib23" id="ref32">23</reflink>], [<reflink idref="bib25" id="ref33">25</reflink>]; [<reflink idref="bib26" id="ref34">26</reflink>]). In the [<reflink idref="bib17" id="ref35">17</reflink>]) study, adults with and without ID were asked to respond to a series of brief decision‐making vignettes, one of which was based on the initiating event in the Glen Ridge incident. In that vignette, Jeff approached Emily who was playing basketball by herself in the park and asked her to come with him to his friend's house. When she initially refused, 'Jeff, who had often made fun of Emily in the past, put his arm around Emily and promised her a date with his handsome older brother' if she would come with him. When asked what Emily should do, all but one of the respondents without ID said that Emily should <emph>not</emph> go with Jeff, thus resisting the coercive lure of the promised date with Jeff's brother. However, only one‐third of the adults with ID recommended that Emily <emph>not</emph> go with Jeff. Decision‐making performance on the 'Emily' vignette was reflective of the overall findings of the study, which indicated that adults with ID made effective decisions across a range of situations that involved interpersonal conflict or danger only 50% of the time compared with 91% of the time for adults without ID.</p> <p>In coercive situations, defined as those in which another person (the antagonist) urges or pressures a decision‐maker (the protagonist) to take an action that may not be in his or her best interest, the ability to successfully predict and evaluate the coercive intentions and the potentially harmful consequences is critical to effective, self‐protective decision‐making. Greenspan has pointed to the centrality of social intelligence as a defining factor in ID and to risk awareness as a determining factor in successful community adaptation ([<reflink idref="bib7" id="ref36">7</reflink>], [<reflink idref="bib8" id="ref37">8</reflink>]) and several investigators have associated ID with significant delays in the development of interpersonal competence ([<reflink idref="bib2" id="ref38">2</reflink>]; [<reflink idref="bib43" id="ref39">43</reflink>]; [<reflink idref="bib21" id="ref40">21</reflink>]; [<reflink idref="bib35" id="ref41">35</reflink>]). Previous research has indicated that individuals with ID tend to have difficulty shifting perspectives to understand the possible motivations and intentions of the protagonist relative to the antagonist in the vignette situations and that they tend to acquiesce to the requests of others in a wide variety of situations (e.g. [<reflink idref="bib29" id="ref42">29</reflink>]; [<reflink idref="bib1" id="ref43">1</reflink>]; [<reflink idref="bib34" id="ref44">34</reflink>]; [<reflink idref="bib12" id="ref45">12</reflink>]).</p> <p>In this study, we have focused our attention on adolescents with ID as we believe that adolescence is a critical period for the acquisition of self‐protection and peer resistance skills (see [<reflink idref="bib25" id="ref46">25</reflink>]). We examined the decision‐making skills of adolescents with ID in response to hypothetical interpersonal situations that involved specific types of coercion (coercion with a lure, coercion with a threat, or coercion involving social pressure without a specific lure or threat tactic). The main objective of the study was to assess the impact of these coercive tactics on the decision‐making responses of adolescents with ID to a series of vignette situations. An additional objective of the study was to examine the relationship between the decision‐making ability of the participants and their ability to provide accurate responses to fact and inference comprehension questions based on the interpersonal situations of coercion.</p> <hd id="AN0036922729-2">Method</hd> <p></p> <hd id="AN0036922729-3">Participants</hd> <p>Forty‐seven (<reflink idref="bib47" id="ref47">47</reflink>) volunteer participants (32 male and 15 female) were recruited from life skills‐based programmes for adolescents with mild ID. The participants were recruited from two regional vocational secondary schools in the New York City area. Participants with ages ranging from ages 14–21 years (mean age = 18.49, SD = 1.68) were identified as having mild ID by their schools, but individual IQs were not available. In accordance with the policies of the Institutional Review Board at Teachers College, Columbia University, eligible participants were identified by the individual schools, and parent/guardian consent forms were mailed to their homes to request their participation in the study. Although some of the participants may have been legally competent to provide their own informed consent, school policy required that parent/guardian consent be obtained before students could be approached to join the study. After parent/guardian consent was received, students were individually invited to participate in the study; the purpose and procedures of the study were described to them; and they were asked to give individual informed consent with the understanding that they could withdraw from the study at any time. One of three trained examiners administered the decision‐making instrument to individual participants in 30‐ to 40‐min sessions.</p> <hd id="AN0036922729-4">Materials</hd> <p>Participants were interviewed using a decision‐making instrument designed to assess participants' decision‐making and comprehension skills. The Decision‐Making in Coercive Situations Scale ([<reflink idref="bib24" id="ref48">24</reflink>]) included 12 verbally presented vignettes depicting hypothetical situations of interpersonal coercion from the perspective of a key protagonist. Each vignette consisted of three sentences. The first provided background information to set up the situation. The second and third sentences presented the problem in the situation, thereby setting up the dilemma from the perspective of the protagonist. The vignettes, containing an equal number of female and male protagonists, were balanced for different types of coercive tactics: (<reflink idref="bib1" id="ref49">1</reflink>) <emph>coercion with a lure</emph>– the protagonist is tempted with a possibly desirable social or tangible gain as an incentive to engage in a potentially harmful activity at the urging of another; (<reflink idref="bib2" id="ref50">2</reflink>) <emph>coercion with a threat</emph>– the protagonist is threatened with a possibly undesirable social or material loss if he or she refuses to engage in a potentially harmful activity at the urging of another; and (<reflink idref="bib3" id="ref51">3</reflink>) <emph>no specific coercive tactic</emph>– the protagonist is urged by another to engage in a potentially harmful activity, but no overt lure or threat tactic is involved.</p> <p>Each of the three coercive tactic conditions was represented in four situational contexts in which the protagonist was urged to participate in a potentially harmful situation, including going with a group of guys who had made fun of the protagonist in the past, going for a ride with a stranger, going to a party with a troublemaker and giving a kiss to the janitor at work. Details of the situations were altered so that variations of the dilemma could be presented under all three coercive tactic conditions in counterbalanced order. The 12 vignettes described above were interspersed with 12 additional vignettes that depicted noncoercive interpersonal situations involving conflicting goals as filler items. The 24 vignettes, including 12 each of the target and filler vignettes, were divided into two counterbalanced sets of 12 vignettes (forms A and B) for purposes of administration. Sample coercion vignettes by type of coercion condition are presented in Table 1.</p> <p>1 Sample vignettes and questions from Decision‐Making in Coercive Situations Scale</p> <p> <ephtml> <table><tbody valign="top"><tr><td>Situation involving coercion with a threat</td></tr><tr><td><italic>Lisa goes for job training in a hospital where she is learning to do laundry. One day while Lisa is working in the laundry room, Mr Drake the janitor comes in. Suddenly, Mr Drake tells Lisa that he will hurt her if she does not kiss him.</italic></td></tr><tr><td>Decision‐making question: <italic>What should Lisa do?</italic></td></tr><tr><td>Fact comprehension question: <italic>Did Mr Drake tell Lisa that he would hurt her if she did not kiss him?</italic></td></tr><tr><td>Inference comprehension question: <italic>Does Lisa like Mr Drake a lot?</italic></td></tr><tr><td>Situation involving coercion with a lure</td></tr><tr><td><italic>Carol goes for job training in a shoe store where she is learning to shelve boxes. One day, while Carol is working in the storage room, Mr Jones the janitor comes in. Suddenly, Mr Jones offers to give Carol some money if she will kiss him.</italic></td></tr><tr><td>Decision‐making question: <italic>What should Carol do?</italic></td></tr><tr><td>Fact comprehension question: <italic>Does Carol go to the shoe store to hang out with her friends?</italic></td></tr><tr><td>Inference comprehension question: <italic>Does Carol know Mr Jones very well?</italic></td></tr><tr><td>Situation involving coercion with no specific tactic</td></tr><tr><td><italic>Julia goes for job training in a cafeteria where she is learning to wash dishes. One day while Julia is working in the kitchen, Mr Smith the janitor comes in. Suddenly, Mr Smith urges Julia to kiss him.</italic></td></tr><tr><td>Decision‐making question: <italic>What should Julia do?</italic></td></tr><tr><td>Fact comprehension question: <italic>Does Julia go for job training in a cafeteria?</italic></td></tr><tr><td>Inference comprehension question: <italic>Do Mr Smith and Julia do different jobs?</italic></td></tr></tbody></table> </ephtml> </p> <p>Each vignette was read to the participant and immediately afterwards the participant was asked, 'What should (name of the protagonist) do?' Participants were then asked to respond to a yes/no fact question and a yes/no inference question to assess their comprehension of each vignette. Participant responses were recorded manually and later transcribed onto a master data sheet for coding. Interviews followed a scripted protocol. Participants were prompted to attend to what the interviewer was saying ['Listen carefully while I tell you about (name of the protagonist)']. A single request for repetition of the vignette was honoured.</p> <p>Responses to the 'What should (the protagonist) do?' decision‐making question were categorised according to the type of decision response recommended by the participant for handling the situation of coercion presented in each vignette using a modified version of the coding criteria described by [<reflink idref="bib23" id="ref52">23</reflink>]). Decision responses were classified into one of three categories: (<reflink idref="bib1" id="ref53">1</reflink>) recommendations that the protagonist attempt independent, assertive action (e.g. either verbal or physical) to resist the coercion were classified as independent, prevention‐focused responses; (<reflink idref="bib2" id="ref54">2</reflink>) responses recommending that the protagonist seek help were classified as reporting responses; and (<reflink idref="bib3" id="ref55">3</reflink>) all other responses, including postponing decision‐making, reacting hastily or impulsively, giving in to the coercion, don't know, or no response, were treated as error responses. Cronbach alpha reliability for the Decision‐Making in Coercive Situations Scale based on the sample in this study is 0.71. Twenty per cent of the protocols were coded by two independent coders who were blind to the purpose of the study, and inter‐rater reliability was calculated and adjusted for chance using Cohen's kappa ([<reflink idref="bib5" id="ref56">5</reflink>]). An inter‐coder reliability of 90% was obtained.</p> <p>Comprehension fact and inference scores were derived by totalling across yes/no fact or inference questions answered correctly. The maximum score for each type of comprehension was 12.</p> <hd id="AN0036922729-5">Results</hd> <p>Means and SDs for decision‐making and fact and inference comprehension scores are presented separately for each coercive tactic condition in Table 2.</p> <p>2 Means and SDs for decision‐making and comprehension responses by coercion condition (n = 47)</p> <p> <ephtml> <table><thead valign="bottom"><tr><th><bold>Variable</bold></th><th><bold>Mean</bold></th><th><bold>SD</bold></th></tr></thead><tbody valign="top"><tr><td>Independent, prevention‐focused decisions</td><td /><td /></tr><tr><td> Coercion with threat</td><td>1.81</td><td>1.12</td></tr><tr><td> Coercion with lure</td><td>2.28</td><td>1.19</td></tr><tr><td> No specific coercive tactic</td><td>2.38</td><td>1.23</td></tr><tr><td>Reporting decisions</td><td /><td /></tr><tr><td> Coercion with threat</td><td>0.74</td><td>0.87</td></tr><tr><td> Coercion with lure</td><td>0.15</td><td>0.36</td></tr><tr><td> No specific coercive tactic</td><td>0.21</td><td>0.46</td></tr><tr><td>Correct fact comprehension</td><td /><td /></tr><tr><td> Coercion with threat</td><td>3.49</td><td>0.78</td></tr><tr><td> Coercion with lure</td><td>3.21</td><td>0.86</td></tr><tr><td> No specific coercive tactic</td><td>2.74</td><td>0.94</td></tr><tr><td>Correct inference comprehension</td><td /><td /></tr><tr><td> Coercion with threat</td><td>2.91</td><td>0.90</td></tr><tr><td> Coercion with lure</td><td>2.96</td><td>0.83</td></tr><tr><td> No specific coercive tactic</td><td>2.55</td><td>0.80</td></tr></tbody></table> </ephtml> </p> <hd id="AN0036922729-6">Decision‐making performance</hd> <p>Overall, participants made independent, prevention‐focused decisions in response to the <emph>What should ______ do?</emph> question on the Decision‐Making in Coercive Situations Scale 53.9% of the time and reporting decisions 9.2% of the time.</p> <hd id="AN0036922729-7">Independent, prevention‐focused decisions</hd> <p>To assess the impact of specific coercive tactics on the independent, prevention‐focused decision‐making responses of the adolescents with ID, an analysis of variance with repeated measures was performed (spss 14.0 for Windows) to compare performance in situations involving the three types of coercion. This analysis yielded a significant effect for coercive tactic condition, <emph>F</emph><subs>2,92</subs> = 5.47, <emph>P</emph> < 0.01. Follow‐up multiple comparisons indicated that the participants were more likely to suggest independent, prevention‐focused decisions in situations with no specific coercive tactic (mean = 2.38, SD = 1.23) or coercion with a lure (mean = 2.28, SD = 1.19) than in situations involving coercion with a threat (mean = 1.81, SD = 1.12). Decision‐making in situations with no specific coercive tactic and those involving coercion with a lure did not differ significantly.</p> <hd id="AN0036922729-8">Reporting decisions</hd> <p>A repeated measures analysis of variance on reporting responses also yielded a significant difference between the three coercive tactic conditions (<emph>F</emph><subs>2,92</subs> = 19.87, <emph>P</emph> < 0.001). Participants were more likely to suggest reporting decisions for situations involving coercion with a threat (mean = 0.74, SD = 0.87) relative to those involving coercion with a lure (mean = 0.15, SD = 0.36) or no specific coercive tactic (mean = 0.21, SD = 0.46), which did not differ from each other. This pattern suggested a possible trade‐off between independent, prevention‐focused decisions and reporting decisions.</p> <hd id="AN0036922729-9">Comprehension performance</hd> <p>Overall, participants correctly answered fact comprehension questions 78.7% of the time and correctly answered inference comprehension questions 70.2% of the time. Analyses were conducted to compare participants' comprehension performance for the three coercive tactic conditions. Separate repeated measures analyses of variance for fact and inference comprehension scores, with type of coercive tactic as the within‐subjects factor, indicated that participants' comprehension performance differed significantly across the types of coercive situation for both fact [<emph>F</emph><subs>2,92</subs> = 13.71, <emph>P</emph> < 0.001] and inference [<emph>F</emph><subs>2,92</subs> = 2.31, <emph>P</emph> < 0.05] comprehension questions. Fact comprehension scores were highest in situations involving coercion with a threat (mean = 3.49, SD = 0.78) and lowest in situations with no coercive tactic (mean = 2.74, SD = 0.94), but scores did not differ significantly between the threat and lure (mean = 3.21, SD = 0.86) situations. Inference comprehension scores for situations involving coercion with a threat (mean = 2.91, SD = 0.90) and coercion with a lure (mean = 2.96, SD = 0.83) were both significantly higher than scores for situations involving no coercive tactic (mean = 2.55, SD = 0.80). The means for the threat and the lure conditions did not differ significantly from each other.</p> <hd id="AN0036922729-10">Relationship between decision‐making and comprehension</hd> <p>Pearson product–moment correlations between fact and inference comprehension scores and independent, prevention‐focused decision‐making scores varied across the three coercive tactic conditions. The correlations between overall fact comprehension and independent, prevention‐focused decision‐making were low, but in a positive direction for the lure condition (<emph>r</emph> = 0.25, <emph>P</emph> > 0.05) and for the no coercive tactic condition (<emph>r</emph> = 0.26, <emph>P</emph> > 0.05), but in a negative direction for the threat condition (<emph>r</emph> = −0.11, <emph>P</emph> > 0.05). The correlations between overall inference comprehension and independent, prevention‐focused decision‐making were moderate and positive for the lure condition (<emph>r</emph> = 0.37, <emph>P</emph> < 0.05) and for the no coercive tactic condition (<emph>r</emph> = 0.35, <emph>P</emph> < 0.05), but in a negative direction and negligible for the threat condition (<emph>r</emph> = −0.004, <emph>P</emph> > 0.05).</p> <p>The absence of a positive relationship between comprehension scores and level of independent, prevention‐focused decision‐making in the threat condition warrants further scrutiny. It is possible that, regardless of comprehension accuracy, participants were simply unable to formulate an effective decision response in the face of a threat. However, it is of interest that reporting decisions were more prevalent in the threat condition than in the lure or no tactic conditions, suggesting that there may have been a tendency to prefer reporting responses over independent, prevention‐focused decision responses in the presence of a threat. If such were the case, one would predict that the elevated level of reporting responses would be more apparent when comprehension was accurate than when comprehension was inaccurate.</p> <p>To explore this possibility, descriptive analyses were conducted to compare decision‐making responses under the three coercive tactic conditions for items on which participants had demonstrated fully accurate comprehension (correct responses to both fact and inference comprehension questions) and items on which they had not demonstrated fully accurate comprehension (inaccurate responses to one or both of these measures). As shown in Table 3, it does appear that, in the threat condition, on items with fully accurate comprehension, there may have been a trade off between independent, prevention‐focused (48%) and reporting (24.8%) responses. In the lure condition, there was no indication of such a trade‐off, with participants making independent, prevention‐focused decisions 63.5% of the time and making reporting decisions only rarely (2.8%). A similar pattern was observed in the no coercive tactic condition, with participants making independent, prevention‐focused decisions 66% of the time and making reporting decisions only rarely (5%). Interestingly, this trade off was apparent only when comprehension was fully accurate. Taken together, the above findings suggest that, although the presence of an overt threat appeared to suppress independent, prevention‐focused decision‐making, the apparent suppression largely reflected a tendency towards increased caution on the part of the participants. This increased caution was manifested in an elevated level of reporting responses involving recommendations that the protagonist seek help in the face of a threatening situation rather than attempting to handle it themselves.</p> <p>3 Per cent of decision‐making responses in independent, prevention‐focused, reporting and other categories for items on which both fact and inference comprehension were accurate</p> <p> <ephtml> <table><thead valign="bottom"><tr><th><bold>Decision category</bold></th><th><bold>Threat</bold></th><th><bold>Lure</bold></th><th><bold>No specific tactic</bold></th></tr><tr><th><bold>Number</bold></th><th><bold>%</bold></th><th><bold>Number</bold></th><th><bold>%</bold></th><th><bold>Number</bold></th><th><bold>%</bold></th></tr></thead><tbody valign="top"><tr><td>Independent prevention</td><td>60</td><td>48.0</td><td>68</td><td>63.5</td><td>66</td><td>66.0</td></tr><tr><td>Reporting</td><td>31</td><td>24.8</td><td>3</td><td>02.8</td><td>5</td><td>5.0</td></tr><tr><td>Other</td><td>34</td><td>27.2</td><td>36</td><td>33.6</td><td>29</td><td>29.0</td></tr><tr><td>Total</td><td>125</td><td>100.0</td><td>107</td><td>100.0</td><td>100</td><td>100.0</td></tr></tbody></table> </ephtml> </p> <hd id="AN0036922729-11">Discussion</hd> <p>This research study was designed to examine the decision‐making processes of adolescents with ID and to provide information relevant to the development of instructional programmes to increase effective decision‐making. The study assessed the impact of different types of coercive tactics on decision‐making responses in hypothetical situations in which a protagonist was urged by another person to do something with potentially harmful consequences. The intent was to identify which types of situation pose the greatest challenges for adolescents with ID.</p> <p>Results of the study indicated that the participants suggested independent, prevention‐focused decisions in response to the interpersonal dilemmas involving coercion only about half of the time, suggesting that adolescents with ID are not well prepared to handle situations on their own that require them to resist coercion. The level of effective, independent decision‐making found in this study (54%) is similar to that reported for individuals with ID in earlier studies. [<reflink idref="bib17" id="ref57">17</reflink>]) found that adults with ID made effective, self‐protective decisions 50% of the time with situations involving the possibility of conflict, physical danger or sexual assault. Similarly, [<reflink idref="bib23" id="ref58">23</reflink>]) reported that adults with ID suggested direct, prevention‐focused decisions aimed at resisting or stopping abuse 45% of the time. It cannot be assumed, however, that people with ID are uniformly vulnerable. In a study that compared individuals with and without ID on a measure of vulnerability to sexual abuse, [<reflink idref="bib30" id="ref59">30</reflink>]) reported considerable variability and overlap between the two groups.</p> <p>The adolescents who participated in the present study were less likely to suggest independent, prevention‐focused decisions in the threat condition than in either the lure condition or the no specific coercive tactic condition. Adolescents with ID, therefore, may be most at risk of victimisation by others in coercive situations involving the use of threat tactics. Differences in performance as a function of the type of coercive tactic imply that the nature of a decision dilemma (type of coercive tactic) may place unique demands on decision‐making. It did not appear that the depressed level of independent, prevention‐focused decision‐making under the threat condition was due to a failure to comprehend or recognise the risks associated with the threat in the vignettes. In fact, comprehension scores were generally higher for the threat vignettes than for the lure or no‐specific‐coercive‐tactic vignettes. Although no clear explanation for the enhanced comprehension of the threat vignettes is apparent, it appears that an understanding of the potential danger in the threat situations may have led to a shift in participants' recommended decisions away from independent action and towards reporting the situation in order to seek help.</p> <p>These findings raise the question of whether reporting constitutes an adequately self‐protective response to a situation involving a threat or whether such a response fails to address the immediate risk inherent in the situation. Although seeking assistance is indeed desirable in many situations, the vignette situations in the present study implied potentially harmful consequences unless immediate preventive action was taken. Although the vignettes gave no indication that anyone was nearby, they did not preclude that possibility. To be coded as independent, prevention‐focused responses, it was necessary for the responses to indicate that the protagonist take independent action to avoid or escape from the potentially harmful situation with or without seeking help as a follow‐up. Responses coded as reporting responses were those that gave no clear acknowledgment of the need to avoid or escape from the immediate situation prior to seeking help. Although some responses coded as reporting may have been based on the assumption that someone in a position to provide immediate help was nearby, others seemed to imply that the protagonist would yield to the coercive demand prior to telling someone what had happened.</p> <p>For example the sample vignettes presented in Table 1 show the three variations of the situational context involving an incident at a job training site where a female protagonist is at work when a male janitor comes in and requests a kiss. In each of the vignette variations of this situational context, one of the three coercive tactics is employed to pressure the protagonist into kissing the janitor. In the threat condition, he tells her that 'he will hurt her if she does not kiss him'. In the lure condition, he offers to give her 'some money if she will kiss him'. In the no‐specific‐coercive‐tactic condition, he simply 'urges her to kiss him'.</p> <p>For this particular situational context, as in the main analyses, participants were least likely to suggest independent, prevention‐focused decisions in the threat condition. When comprehension was fully accurate for this situational context, participants suggested independent, prevention‐focused actions 61% of the time in the lure condition, 53% of the time in the no specific tactic condition and only 41% of the time in the threat condition. The proportions of reporting responses for the three variations of this situation paralleled the pattern reflected in the main analyses, with 13% in the lure condition, 9% in the no specific tactic condition and 38% in the threat condition. Under all three conditions, reporting responses included decisions to tell someone about the incident, such as 'tell the manager', 'tell her mother' or 'call the police'. None of these responses included an explicit statement of immediate action for escaping or getting away from the potentially harmful situation. Although it is possible that the 'manager' may have been in a position to provide immediate help, it is unlikely that the 'mother' or the 'police' would have been in a position to provide immediate assistance. In contrast, independent, prevention‐focused responses always included either verbal resistance (e.g. say 'no') or physical action to resist the coercive demand (e.g. walk away from him and then tell the supervisor), with or without follow‐up reporting of the incident. So, although reporting responses do reflect an understanding of the potential seriousness of the situation, they do not reflect an understanding of the need to take immediate, independent action to avoid or escape from the harmful situation.</p> <p>The failure to implicate comprehension as a key source of the decision‐making difficulties manifested in this study suggests that the search for explanations of the decision‐making limitations of adolescents with ID must continue to examine all aspects of the decision‐making process. According to a framework proposed to guide decision‐making research with people with ID ([<reflink idref="bib14" id="ref60">14</reflink>], [<reflink idref="bib15" id="ref61">15</reflink>]; [<reflink idref="bib25" id="ref62">25</reflink>]), difficulties may arise at one or more of the following phases of the decision‐making process: (<reflink idref="bib1" id="ref63">1</reflink>) framing of the situation; (<reflink idref="bib2" id="ref64">2</reflink>) generating possible alternative solutions; (<reflink idref="bib3" id="ref65">3</reflink>) evaluating potential consequences associated with each alternative; and (<reflink idref="bib4" id="ref66">4</reflink>) selecting a decision response. The framework further specifies that it is important to consider the role of motivational and emotional processes, as well as cognitive processes, in the decision‐making of individuals with ID. Research has supported the important role of each of these processes in decision‐making ([<reflink idref="bib20" id="ref67">20</reflink>]; [<reflink idref="bib22" id="ref68">22</reflink>]; [<reflink idref="bib15" id="ref69">15</reflink>]; [<reflink idref="bib18" id="ref70">18</reflink>]). In the present study, it is possible that emotional factors played a key role in how the participants responded to the threat situations. Participants may have had different emotional reactions to the situations representing the three coercive tactic conditions. For example, the shift towards reporting responses in the presence of a threat may have been associated with feelings of fear or anxiety in response to the threat, which could have interfered with the ability to generate independent, prevention‐focused decision responses. It is essential that future research examine the impact of emotions upon the decision‐making of individuals with ID.</p> <p>Limitations inherent in the instruments and procedures used in the present study preclude definitive interpretations of the findings. In particular, it should be noted that the vignette situations were presented in a very brief, three‐sentence verbal format, leaving many of the details of the situations open to interpretation. Future studies using expanded pictorial or video‐based situations (see [<reflink idref="bib22" id="ref71">22</reflink>]) could clarify the conditions under which reporting responses represent adequate, self‐protective decision responses. Furthermore, the absence of a comparison group of adults with ID or a comparison group of adolescents without ID in the present study limits our ability to unequivocally attribute the observed patterns of performance to either adolescence or ID.</p> <p>Nevertheless, the findings of the present study do highlight the limited ability of adolescents with ID to make effective decisions in a variety of situations, reinforcing the need for effective interventions to increase decision‐making effectiveness. The finding that the participants made independent, prevention‐focused decisions only about half the time supports the need for interventions that emphasise both the self‐protective decision‐making strategies needed to resist victimisation and abuse and to avoid the risky problem behaviours of adolescence (e.g. substance use and sexual risk taking) as well as the gain‐oriented strategies needed to accomplish the important life tasks of adolescence (e.g. establishing peer friendships). Inclusion in mainstream community settings provides adolescents with ID with unprecedented opportunities for making personal and social gains. However, a tendency to rely on others in coercive situations involving threats may increase their susceptibility to peer pressure. The inability to fully handle the social demands of mainstream settings may also result in placement in more restrictive settings ([<reflink idref="bib23" id="ref72">23</reflink>]; [<reflink idref="bib28" id="ref73">28</reflink>]).</p> <p>Thus, adolescents with ID need to develop effective decision‐making skills to enhance their ability to navigate a wide range of interpersonal situations on their own. The life stage of adolescence may be particularly sensitive to intervention effects and training and support provided during this critical stage of development may result in marked and lasting benefits into adulthood ([<reflink idref="bib3" id="ref74">3</reflink>]; [<reflink idref="bib42" id="ref75">42</reflink>]; [<reflink idref="bib25" id="ref76">25</reflink>]). It is clear that community participation will continue to place individuals with ID in a variety of situations in which they must make decisions with potentially important consequences. To maximise their full inclusion and integration into society, it is important to provide adolescents with ID with the tools necessary to make the effective decisions required for employment, independent living, and economic and social self‐sufficiency.</p> <ref id="AN0036922729-12"> <title> References </title> <blist> <bibl id="bib1" idref="ref43" type="bt">1</bibl> <bibtext> Bender N. N. & Carlson J. S. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Impact of Coercive Tactics on the Decision-Making of Adolescents with Intellectual Disabilities
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  Data: English
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  Data: <searchLink fieldCode="AR" term="%22Khemka%2C+I%2E%22">Khemka, I.</searchLink><br /><searchLink fieldCode="AR" term="%22Hickson%2C+L%2E%22">Hickson, L.</searchLink><br /><searchLink fieldCode="AR" term="%22Casella%2C+M%2E%22">Casella, M.</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Intellectual+Disability+Research%22"><i>Journal of Intellectual Disability Research</i></searchLink>. Apr 2009 53(4):353-362.
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  Data: Blackwell Publishing. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8599; Fax: 781-388-8232; e-mail: customerservices@blackwellpublishing.com; Web site: http://www.blackwellpublishing.com/jnl_default.asp
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  Data: PDF
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  Data: 10
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  Data: 2009
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  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
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  Data: <searchLink fieldCode="DE" term="%22Comprehension%22">Comprehension</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Retardation%22">Mental Retardation</searchLink><br /><searchLink fieldCode="DE" term="%22Prevention%22">Prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Inferences%22">Inferences</searchLink><br /><searchLink fieldCode="DE" term="%22Decision+Making%22">Decision Making</searchLink><br /><searchLink fieldCode="DE" term="%22Vignettes%22">Vignettes</searchLink><br /><searchLink fieldCode="DE" term="%22Performance%22">Performance</searchLink><br /><searchLink fieldCode="DE" term="%22Victims+of+Crime%22">Victims of Crime</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/j.1365-2788.2009.01152.x
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0964-2633
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: High rates of victimisation have raised concerns about the ability of adolescents with intellectual disabilities (ID) to avoid and escape from harmful situations and to make decisions in their own best interest. The present study was designed to assess the impact of specific coercive tactics on the decision-making of adolescents with ID. Method: Forty-eight adolescents with ID participated in the study. They were asked to respond to a series of brief vignettes depicting equal numbers of situations involving coercion with a lure, coercion with a threat, and no specific coercive tactic. Performance was assessed in terms of independent, prevention-focused decisions, reporting decisions and responses to fact and inference comprehension questions. Results: Overall, participants suggested independent, prevention-focused decisions only about half the time. They were more likely to suggest independent, prevention-focused decisions in situations with no specific coercive tactic or coercion with a lure than in situations involving a threat. However, reporting decisions were more likely in situations involving coercion with a threat than in the other two conditions and both fact and inference comprehension were best in situations involving coercion with a threat. Conclusions: Results indicated that adolescents with ID are not well-prepared to handle situations on their own that involve coercion, especially coercion with a threat. Because comprehension did not appear to be a key source of the decision-making difficulty in this study, further research is needed to examine all aspects of the decision-making process as a basis for the design of effective interventions.
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  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 44
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2009
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ832594
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ832594
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/j.1365-2788.2009.01152.x
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 10
        StartPage: 353
    Subjects:
      – SubjectFull: Comprehension
        Type: general
      – SubjectFull: Mental Retardation
        Type: general
      – SubjectFull: Prevention
        Type: general
      – SubjectFull: Adolescents
        Type: general
      – SubjectFull: Program Effectiveness
        Type: general
      – SubjectFull: Inferences
        Type: general
      – SubjectFull: Decision Making
        Type: general
      – SubjectFull: Vignettes
        Type: general
      – SubjectFull: Performance
        Type: general
      – SubjectFull: Victims of Crime
        Type: general
    Titles:
      – TitleFull: Impact of Coercive Tactics on the Decision-Making of Adolescents with Intellectual Disabilities
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Khemka, I.
      – PersonEntity:
          Name:
            NameFull: Hickson, L.
      – PersonEntity:
          Name:
            NameFull: Casella, M.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 04
              Type: published
              Y: 2009
          Identifiers:
            – Type: issn-print
              Value: 0964-2633
          Numbering:
            – Type: volume
              Value: 53
            – Type: issue
              Value: 4
          Titles:
            – TitleFull: Journal of Intellectual Disability Research
              Type: main
ResultId 1