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Mental Functions in People with Mild Intellectual Disability to Borderline Intellectual Functioning

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Title: Mental Functions in People with Mild Intellectual Disability to Borderline Intellectual Functioning
Language: English
Authors: E. C. M. Haacke, K. P. Lie Sam Foek-Rambelje, P. T. van der Heijden, H. P. L. M. Korzilius, R. Didden
Source: Journal of Mental Health Research in Intellectual Disabilities. 2025 18(1):102-118.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 17
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Education Level: Adult Education
Higher Education
Postsecondary Education
Descriptors: Metacognition, Intellectual Disability, Mild Intellectual Disability, Mental Health, Educational Background, Adults, Foreign Countries, Continuing Education, Vocational Education, Higher Education, Adult Learning
Geographic Terms: Netherlands
DOI: 10.1080/19315864.2024.2397361
ISSN: 1931-5864
1931-5872
Abstract: Introduction: The first aim of this study was to explore the mental functions of patients with mild intellectual disabilities or borderline intellectual functioning (MID-BIF) in mental health care. The second aim was to examine the differences in mental functions between people with MID-BIF and those with higher educational levels (i.e. further education [FE] and higher education [HE]). Materials and methods: Eleven mental functions were assessed using the Shedler-Westen Assessment Procedure (SWAP-200-NL). In total, 245 patients were included, divided into three groups (MID-BIF: N = 52; FE: N = 86; HE: N = 107). Results: Results showed that the MID-BIF group scored relatively high on three mental functions (i.e. the capacity for impulse control and regulation, capacity for defensive functioning, and capacity to construct and use internal standards and ideals). One mental function scored relatively low (the capacity for adaptation, resiliency, and strength). Regarding group comparisons, similar patterns in average scores emerged, and the HE group scored higher than the MID-BIF and the FE groups on most mental functions. Discussion: The mental functions of the HE group were most adaptive, whereas the mental functions of the FE and MID-BIF groups were less adaptive and on a similar level in each of these groups.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1456321
Database: ERIC
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  Value: <anid>AN0181985316;[5ew6]01jan.25;2025Jan03.04:15;v2.2.500</anid> <title id="AN0181985316-1">Mental Functions in People with Mild Intellectual Disability to Borderline Intellectual Functioning </title> <p>Introduction: The first aim of this study was to explore the mental functions of patients with mild intellectual disabilities or borderline intellectual functioning (MID-BIF) in mental health care. The second aim was to examine the differences in mental functions between people with MID-BIF and those with higher educational levels (i.e. further education [FE] and higher education [HE]). Materials and methods: Eleven mental functions were assessed using the Shedler-Westen Assessment Procedure (SWAP-200-NL). In total, 245 patients were included, divided into three groups (MID-BIF: N = 52; FE: N = 86; HE: N = 107). Results: Results showed that the MID-BIF group scored relatively high on three mental functions (i.e. the capacity for impulse control and regulation, capacity for defensive functioning, and capacity to construct and use internal standards and ideals). One mental function scored relatively low (the capacity for adaptation, resiliency, and strength). Regarding group comparisons, similar patterns in average scores emerged, and the HE group scored higher than the MID-BIF and the FE groups on most mental functions. Discussion: The mental functions of the HE group were most adaptive, whereas the mental functions of the FE and MID-BIF groups were less adaptive and on a similar level in each of these groups.</p> <p>Keywords: Mild intellectual disabilities; borderline intellectual functioning; mental functions; SWAP-200</p> <hd id="AN0181985316-2">INTRODUCTION</hd> <p>Mild intellectual disability (MID) or borderline intellectual functioning (BIF) often co-occur with mental disorders (e.g., Cooper & Van der Speck, [<reflink idref="bib7" id="ref1">7</reflink>]; Fletcher et al., [<reflink idref="bib13" id="ref2">13</reflink>]; Zarotti et al., [<reflink idref="bib43" id="ref3">43</reflink>]). It has been estimated that 6.4% of the general Dutch population falls into the MID-BIF category (Woittiez et al., [<reflink idref="bib42" id="ref4">42</reflink>]). People with MID-BIF are overrepresented in mental health care facilities, with prevalence rates of up to 67% in long-stay wards (Nieuwenhuis et al., [<reflink idref="bib22" id="ref5">22</reflink>]).</p> <p>Whether people with MID-BIF are at higher risk of developing personality pathology is a subject of discussion (Pridding & Procter, [<reflink idref="bib23" id="ref6">23</reflink>]). Nevertheless, it is assumed that due to different contextual factors, such as low socioeconomic status, social rejection by parents and peers, experiences of abuse and failure, or social deprivation, people with MID-BIF are likely to experience mental functioning problems (Gacek et al., [<reflink idref="bib14" id="ref7">14</reflink>]; Roy et al., [<reflink idref="bib24" id="ref8">24</reflink>]). Knowledge about mental functioning is important, since it is related to well-being, mental health, and adaptive functioning (Lingiardi & McWilliams, [<reflink idref="bib19" id="ref9">19</reflink>]). If vulnerabilities in mental functioning are overlooked, behavioral and emotional challenges might be misunderstood, and treatment may be less effective (e.g., Alexander et al., [<reflink idref="bib1" id="ref10">1</reflink>]; Pridding & Procter, [<reflink idref="bib23" id="ref11">23</reflink>]). However, it is challenging to integrate someone's mental functioning with their cognitive, social, and emotional levels of development and determine what fits these levels (Došen, [<reflink idref="bib9" id="ref12">9</reflink>]; Van den Hazel & Didden, [<reflink idref="bib29" id="ref13">29</reflink>]).</p> <p>The second edition of the Psychodynamic Diagnostic Manual (PDM-2; Lingiardi & McWilliams, [<reflink idref="bib19" id="ref14">19</reflink>]) gives a full description of mental functions from a developmental perspective. Mental functions can be operationalized by the capacity for regulation, attention and learning, personality functions (e.g., emotion regulation, mentalization, one's relationship with self and others, self-awareness, and self-direction), and defensive functioning and coping (see Table 1). This model is well suited for people with an intellectual disability (ID) or BIF. The PDM-2 formulates 12 mental functions, then divided into four categories: (a) cognitive and affective processes, (b) identity and relationships, (c) defense and coping, and (d) self-awareness and self-direction (see Table 1). Both maladaptive and adaptive functioning are taken into account, which is important to plan effective interventions, set goals, anticipate challenges, and evaluate treatment progress (Lingiardi & Bornstein, [<reflink idref="bib18" id="ref15">18</reflink>]).</p> <p>Table 1. Mental functions as based on the PDM-2.</p> <p> <ephtml> <table><thead><tr><td>Mental function</td><td>Description</td><td>Items SWAP-200-NL</td></tr></thead><tbody><tr><td>Cognitive and affective processes</td><td /></tr><tr><td><list list-type="Bullet"><list-item><p>(1) Capacity for affective range,communication and understanding</p></list-item></list></td><td>A person's ability to experience, express and comprehend the full range of pre-representational and representational patterns of affects in ways that are appropriate for a particular situation and consistent with the expectations and norms of the person's cultural milieu.</td><td>12, 57, 74, 106, 126,131, 144, 157, 191</td></tr><tr><td><list list-type="Bullet"><list-item><p>(2) Capacity for mentalization andreflective functioning</p></list-item></list></td><td>The individual's ability to infer and reflect on his own mental states as well as those of others, and to use this capacity in personal and social interactions.</td><td>29, 41, 87, 105, 148, 183</td></tr><tr><td>Identity and relationships</td><td /></tr><tr><td><list list-type="Bullet"><list-item><p>(3) Capacity for differentiationand integration (identity)</p></list-item></list></td><td>The ability to distinguish self from other, fantasy from reality, internal representations from external objects and circumstances, and present from past and future, and to make connections between these elements without confounding them.</td><td>10, 15, 38, 47, 89, 92</td></tr><tr><td><list list-type="Bullet"><list-item><p>(4) Capacity for relationships and intimacy</p></list-item></list></td><td>The depth, range, and consistency of the person's relationships and ability to adjust interpersonal distance-closeness as needed for different relationships, in line with cultural expectations.</td><td>5, 11, 17, 18, 23, 26, 32, 58, 65,77, 94, 98, 153, 158</td></tr><tr><td><list list-type="Bullet"><list-item><p>(5) Capacity for self-esteem regulation andquality of internal experience</p></list-item></list></td><td>The level of confidence and self-regard that characterizes an individual's relationship to self, others, and the larger world.</td><td>4, 36, 54, 63, 199</td></tr><tr><td>Defense and coping</td><td /></tr><tr><td><list list-type="Bullet"><list-item><p>(6) Capacity for impulse control and regulation</p></list-item></list></td><td>The individual's ability to modulate impulses and express them in adaptive, culture-appropriate ways.</td><td>109, 119, 134, 142, 166, 192</td></tr><tr><td><list list-type="Bullet"><list-item><p>(7) Capacity for defensive functioning</p></list-item></list></td><td>The way an individual attempts to cope with and express wishes, affect, and other inner experience, along with the ability to modulate anxiety resulting from internal conflict, external challenge, or threat to self without excessive distortion in self-perception and reality testing, and without making excessive use of acting out.</td><td>45, 76, 78, 79, 100,116, 152, 154, 165</td></tr><tr><td><list list-type="Bullet"><list-item><p>(8) Capacity for adaptation, resiliency and strength</p></list-item></list></td><td>The person's ability to adjust to unexpected events and changing circumstances, and the ability to cope effectively and creatively when confronted with uncertainty, loss, stress, and challenge.</td><td>2, 19, 32, 37, 59, 63, 82, 89,101,111, 179, 183, 196, 200</td></tr><tr><td>Self-awareness and self-direction</td><td /></tr><tr><td><list list-type="Bullet"><list-item><p>(9) Self-observingcapacities (psychological mindedness)</p></list-item></list></td><td>The individual's ability to observe his own internal life mindfully and realistically and use this information adaptively.</td><td>25, 82, 100, 119, 148, 183</td></tr><tr><td><list list-type="Bullet"><list-item><p>(10) Capacity to construct and useinternal standards and ideals</p></list-item></list></td><td>A person's capacity to formulate internal values and ideals that reflects a consideration of one's self in context of one's culture and the ability to make mindful decisions based on a set of coherent, flexible, and internally consistent underlying moral principles.</td><td>3, 15, 20, 31, 39, 57, 91,113, 114, 120, 163, 164</td></tr><tr><td><list list-type="Bullet"><list-item><p>(11) Capacity for meaning and purpose</p></list-item></list></td><td>The individual's ability to construct a personal narrative that gives coherence and meaning to personal choices, a sense of directedness an purpose, a concern for succeeding generations, and a spirituality that imbues one's life with meaning.</td><td>37, 50, 121, 149, 151</td></tr></tbody></table> </ephtml> </p> <p>Limited verbal or cognitive abilities in people with MID-BIF make assessment of mental functions challenging in this group (Moreland et al., [<reflink idref="bib21" id="ref16">21</reflink>]; Pridding & Procter, [<reflink idref="bib23" id="ref17">23</reflink>]). Most instruments regarding personality functioning are not adapted to people with MID-BIF (Williams & Rose, [<reflink idref="bib40" id="ref18">40</reflink>]). One possible way to circumvent the difficulties regarding self-report is to rely on a professional's clinical judgment. However, this approach also has disadvantages because professionals tend to assess patients using heuristics and biases, which influences the reliability of clinical judgment (Witteman et al., [<reflink idref="bib41" id="ref19">41</reflink>]). The use of systematic and statistical methods regarding diagnostics may increase reliability considerably, and are therefore advised (Westen & Weinberger, [<reflink idref="bib39" id="ref20">39</reflink>]). One such instrument is the Shedler-Westen Assessment Procedure (SWAP-200; Westen & Shedler, [<reflink idref="bib33" id="ref21">33</reflink>], [<reflink idref="bib34" id="ref22">34</reflink>]), a clinician-completed instrument that captures personality syndromes, trait dimensions, and mental functioning (Lingiardi & Bornstein, [<reflink idref="bib18" id="ref23">18</reflink>]). The SWAP-200 systematizes clinical judgment (Shedler & Westen, [<reflink idref="bib27" id="ref24">27</reflink>]). A Q-sort method is used (i.e., ratings according to a fixed distribution; Block, [<reflink idref="bib4" id="ref25">4</reflink>]) to minimize rater biases (Lingiardi & McWilliams, [<reflink idref="bib19" id="ref26">19</reflink>]). Although reliability and validity of the SWAP-200 have not yet been examined in individuals with MID-BIF, the advantages and options to assess mental functions make it a potentially valuable instrument to better understand personality functioning.</p> <p>The first aim of the present study was to explore mental functions in a sample of patients with MID-BIF in mental health care using the Dutch language version of the SWAP-200, the SWAP-200-NL. The second aim was to examine differences in mental functions between people with MID-BIF and those with higher educational levels. We hypothesized that the scores on the mental functions as assessed by the SWAP-200-NL for the MID-BIF group would be lower than the scores of further education (FE) and higher education (HE) groups, assuming that the MID-BIF group is more vulnerable to developing mental health problems (Gacek et al., [<reflink idref="bib14" id="ref27">14</reflink>]; Roy et al., [<reflink idref="bib24" id="ref28">24</reflink>]). The MID-BIF group consisted of 52 patients (mean age = 36.1 years (<emph>SD</emph> = 11.5; range = 19–66), 43 females), the FE group of 86 patients (mean age = 38.6 years (<emph>SD</emph> = 12.6; range = 19–68), 53 females) and the HE group op 107 patients (mean age = 39.4 (<emph>SD</emph> = 13.4, range 21–88), 69 females).</p> <hd id="AN0181985316-3">MATERIALS AND METHODS</hd> <p></p> <hd id="AN0181985316-4">Ethical Considerations</hd> <p>No active contribution was needed from the patient for the data collection since the required information was obtained based on routine clinical practice and the clinicians completed the questionnaire. No informed consent was required either because the clinicians used the data anonymously and uploaded this to the dataset used for the study. The study was approved by the institutional review board of GGZ Oost-Brabant (06.809/1484-mvds/pl). Based on a screening by the medical ethics committee, this study was not subject to the Dutch law of medical-scientific research (WMO). In addition, the Guidelines for Good Clinical Practice established by the International Conference on Harmonisation (CPMP/ICH/135/95) were followed, and the study was carried out according to the Declaration of Helsinki.</p> <hd id="AN0181985316-5">Participants</hd> <p>The data from people with MID-BIF (<emph>N</emph> = 52) were collected at the Center for Mild Intellectual Disabilities and Psychiatry at GGZ Oost-Brabant in the Netherlands. This center, offering supra-regional outpatient, part-time, and inpatient treatment for patients with MID-BIF who have mental health problems provides care and treatment to approximately 300 patients in total. The mean age of the participants was 36.1 years (<emph>SD</emph> = 11.5; range = 19–66), and 43 self-identified as female (83%). All were diagnosed with an MID or BIF according to the DSM-5. The mean total IQ (TIQ) score based on an intelligence test (e.g., WAIS-IV or WAIS-III) was 70 (<emph>SD</emph> = 7.25, range 55–87).</p> <p>The data of participants with MID-BIF were compared with data from two other groups of which the data were obtained from a dataset of patients in general mental health care (GMHC; Lie Sam Foek-Rambelje et al., [<reflink idref="bib17" id="ref29">17</reflink>]). The data were collected at three large mental health care facilities in the Netherlands, including the Vincent van Gogh Institute, Reinier van Arkel, and Virenze, which together offer care and treatment to patients across large swathes of the Netherlands. The patients were selected based on the highest education they received. They were divided into two groups: patients who completed FE (further education), which prepares one for a certain profession (sometimes also called secondary vocational education), and patients who completed HE (higher education), which focuses more on a theoretical/scientific basis (also called tertiary education).</p> <p>The FE group consisted of 86 patients of whom 53 self-identified as females (62%). The mean age of the total sample was 38.6 years (<emph>SD</emph> = 12.6; range = 19–68). The HE group (<emph>N</emph> = 107) had a mean age of 39.4 (<emph>SD</emph> = 13.4, range 21–88), and 69 of the participants were female (65%). Sociodemographic information regarding the participants is depicted in Table 2. DSM-5 classifications and number of years in treatment were compared for the three groups. Mood disorder, anxiety, and substance use disorder were most common in the groups. In the MID-BIF group, bipolar and psychotic disorders were more often diagnosed than in the other two groups. Concerning personality disorders, the personality disorder not otherwise specified and the avoidant personality disorder were most often diagnosed in the FE and HE groups, whereas this was the case for the borderline personality disorder in the MID-BIF group. Regarding the number of years in treatment, most participants in the FE and HE groups were 0–5 years in treatment, while most of the MID-BIF group were 5+ years in treatment.</p> <p>Table 2. Social demographic information regarding the three groups of patients.</p> <p> <ephtml> <table><thead><tr><td /><td>MID-BIF (%)</td><td>FE (%)</td><td>HE (%)</td></tr></thead><tbody><tr><td><italic>Native Country</italic></td><td /><td /><td /></tr><tr><td>The Netherlands</td><td>98</td><td>95</td><td>92</td></tr><tr><td>Dominican Republic</td><td>2</td><td>–</td><td>–</td></tr><tr><td>Turkey</td><td>–</td><td>2</td><td>–</td></tr><tr><td>Poland</td><td>–</td><td>2</td><td>–</td></tr><tr><td>Indonesia</td><td>–</td><td>1</td><td>–</td></tr><tr><td>Morocco</td><td>–</td><td>–</td><td>1</td></tr><tr><td>Other</td><td>–</td><td>–</td><td>7</td></tr><tr><td><italic>Status</italic></td><td /><td /><td /></tr><tr><td>Single with children</td><td>8</td><td>9</td><td>7</td></tr><tr><td>Single without children</td><td>44</td><td>34</td><td>37</td></tr><tr><td>Married with children</td><td>14</td><td>20</td><td>20</td></tr><tr><td>Married without children</td><td>5</td><td>4</td><td>20</td></tr><tr><td>Living together with children</td><td>14</td><td>6</td><td>6</td></tr><tr><td>Living together without children</td><td>5</td><td>18</td><td>16</td></tr><tr><td>Live apart together</td><td>2</td><td>2</td><td>8</td></tr><tr><td>Other</td><td>8</td><td>7</td><td>4</td></tr><tr><td><italic>Living situation</italic></td><td /><td /><td /></tr><tr><td>Alone</td><td>23</td><td>27</td><td>38</td></tr><tr><td>Together with children</td><td>17</td><td>17</td><td>24</td></tr><tr><td>Together without children</td><td>17</td><td>25</td><td>20</td></tr><tr><td>With both parents</td><td>6</td><td>9</td><td>7</td></tr><tr><td>With one parent (divorce)</td><td>4</td><td>4</td><td>4</td></tr><tr><td>With one parent (decease)</td><td>-</td><td>2</td><td>–</td></tr><tr><td>With a composite family</td><td>2</td><td>2</td><td>1</td></tr><tr><td>In a mental health care facility</td><td>17</td><td>6</td><td>–</td></tr><tr><td>In a facility (other)</td><td>–</td><td>4</td><td>1</td></tr><tr><td>Other</td><td>14</td><td>4</td><td>4</td></tr><tr><td><italic>Classification</italic></td><td /><td /><td /></tr><tr><td>Depressive disorder</td><td>37</td><td>36</td><td>25</td></tr><tr><td>Anxiety disorder</td><td>33</td><td>26</td><td>22</td></tr><tr><td>Substance use disorder</td><td>12</td><td>7</td><td>6</td></tr><tr><td>Bipolar disorder</td><td>8</td><td>2</td><td>3</td></tr><tr><td>Psychotic disorder</td><td>10</td><td>4</td><td>2</td></tr><tr><td>Anorexia</td><td>0</td><td>1</td><td>1</td></tr><tr><td>Bulimia</td><td>0</td><td>2</td><td>0</td></tr><tr><td>Eating disorder NOS</td><td>2</td><td>2</td><td>1</td></tr><tr><td>PD NOS</td><td>6</td><td>15</td><td>14</td></tr><tr><td>Avoidant PD</td><td>6</td><td>11</td><td>8</td></tr><tr><td>Borderline PD</td><td>17</td><td>9</td><td>5</td></tr><tr><td>Obsessive-compulsive PD</td><td>0</td><td>8</td><td>5</td></tr><tr><td>Narcistic PD</td><td>0</td><td>2</td><td>2</td></tr><tr><td>Anti-social PD</td><td>0</td><td>1</td><td>0</td></tr><tr><td>Dependent PD</td><td>6</td><td>6</td><td>1</td></tr><tr><td>Paranoid PD</td><td>0</td><td>0</td><td>1</td></tr><tr><td>Schizoid PD</td><td>0</td><td>0</td><td>1</td></tr><tr><td>Passive-aggressive PD</td><td>0</td><td>0</td><td>1</td></tr><tr><td><italic>Number of years in treatment</italic></td><td /><td /><td /></tr><tr><td>0–5 years</td><td>37</td><td>77</td><td>87</td></tr><tr><td>5+ years</td><td>63</td><td>23</td><td>13</td></tr></tbody></table> </ephtml> </p> <p>1 ID = intellectual disability, FE = further education, HE = higher education.</p> <p>2 NOS = not otherwise specified, PD = personality disorder.</p> <hd id="AN0181985316-6">Instruments</hd> <p></p> <hd id="AN0181985316-7">Shedler-Westen Assessment Procedure (SWAP-200-NL)</hd> <p>The SWAP-200-NL (Westen & Shedler, [<reflink idref="bib33" id="ref30">33</reflink>]; Dutch language adaptation by; Egger et al., [<reflink idref="bib10" id="ref31">10</reflink>], according to the forward–backward translation as described by; Brislin, [<reflink idref="bib5" id="ref32">5</reflink>]) consists of 200 statements regarding personality functioning, which are completed by a clinician. Statements (e.g., "tends to act impulsively, without regard for consequences;" "tends to idealize certain others in unrealistic ways") cover a broad spectrum of personality functioning, ranging from healthy to maladaptive or pathological (Westen & Shedler, [<reflink idref="bib33" id="ref33">33</reflink>], [<reflink idref="bib34" id="ref34">34</reflink>], [<reflink idref="bib35" id="ref35">35</reflink>]; Westen et al., [<reflink idref="bib37" id="ref36">37</reflink>], [<reflink idref="bib36" id="ref37">36</reflink>]). The clinicians rated the statements regarding a patient on an 8-point scale, ranging from 0 (<emph>not descriptive or irrelevant for the patient</emph>) to 7 (<emph>highly descriptive for the patient</emph>). A Q-sort procedure was used, which means that a fixed distribution is predetermined (of the 200 items, eight items are scored a 7, 10 items a 6, 12 items a 5, 14 items a 4, 16 items a 3, 18 items a 2, 22 items a 1, and 100 items a 0). The shape of the fixed distribution mirrored the naturally occurring distribution in the population (Shedler, [<reflink idref="bib26" id="ref38">26</reflink>]). The fixed distribution reduced the risk of rater bias, since the interpretation of the items was the same for everyone (i.e., "How well does this item describe my patient?") and it avoided individual response styles (e.g., a tendency to score average or extreme) (Block, [<reflink idref="bib4" id="ref39">4</reflink>]; Shedler, [<reflink idref="bib26" id="ref40">26</reflink>]). The SWAP-200-NL was completed based on the information a clinician gathered using a clinical diagnostic interview (CDI; a systematic clinical interview developed by Westen [revised version of 2007]) or on information collected from at least six treatment sessions.</p> <p>The psychometric qualities of the American version of the SWAP-200 were reported by Blagov et al. ([<reflink idref="bib3" id="ref41">3</reflink>]). The interrater reliability was above.80, the test–retest reliability had a mean of.85 over a 4–6-month period (Shedler, [<reflink idref="bib26" id="ref42">26</reflink>]; Waldron et al., [<reflink idref="bib31" id="ref43">31</reflink>]; Westen & Muderrisoglu, [<reflink idref="bib32" id="ref44">32</reflink>]). The SWAP scales also demonstrated strong relations with related constructs, with a convergent validity of <emph>r</emph> =.70 or higher (Westen et al., [<reflink idref="bib38" id="ref45">38</reflink>]). Some research with the SWAP-200-NL has shown acceptable good internal consistency of the trait dimensions (Lie Sam Foek-Rambelje et al., [<reflink idref="bib17" id="ref46">17</reflink>]).</p> <p>Furthermore, the SWAP-200 assesses personality in four different ways: personality syndromes or prototypes, trait dimensions, DSM-5 personality disorder categories, and an indication of mental functions. In this study, we used the SWAP-200 scores to assess mental functions. Results regarding other aspects of functioning measured by SWAP-200 were presented in another article (Lie Sam Foek-Rambelje et al., [<reflink idref="bib16" id="ref47">16</reflink>]). We excluded the mental function "capacity for regulation, attention and learning" from the analyses, since the PDM-2 stated that this function captured neuropsychological functioning and was not a part of someone's personality functioning. The 11 mental functions included were: "capacity for affective range, communication and understanding," "capacity for mentalization and reflective functioning," "capacity for differentiation and integration (identity)," "capacity for relationships and intimacy," "capacity for self-esteem regulation and quality of internal experience," "capacity for impulse control and regulation," "capacity for defensive functioning," "capacity for adaptation, resiliency and strength," "self-observing capacities (psychological mindedness)," "capacity to construct and use internal standards and ideals," and "capacity for meaning and purpose." Descriptions of the mental functions are depicted in Table 1, as well as the specific items used to measure them. To word all items in the same direction, a few were reversed. Next, we calculated an average score for each mental function. The higher the mean score, the more descriptive or salient that mental function was for that group. A high score suggested that that mental function was relatively well-developed.</p> <hd id="AN0181985316-8">Procedure</hd> <p>Eight clinicians working at the Center for Mild Intellectual Disabilities and Psychiatry at GGZ Oost-Brabant participated in the data collection. Seven of them were psychologists who had their degrees for 5–10 years, and four had a post-master's degree (Psy.D.). One clinician was a psychiatrist (MD) with over 30 years of experience. All clinicians received a 3-h training, during which the background of the SWAP-200-NL was explained, and instructions were given about the item content and the Q-sort method. In addition, a joint session was held in which clinicians scored a SWAP-200-NL for the first time and questions could be asked.</p> <p>The data were anonymously uploaded via a website, to which clinicians gained access after training. First, they completed a questionnaire regarding patients' sociodemographic information (e.g., gender, age, relationship status, education, occupation, native country, and DSM-IV-TR/DSM-5 classifications). For the people with MID-BIF, IQ scores were gathered as well. Next, the clinicians completed the SWAP-200-NL, after which they received the results via e-mail.</p> <hd id="AN0181985316-9">Statistical Analyses</hd> <p>Before conducting the study, a power analysis was performed. Given a power of.80, with an expected medium effect and an alpha of.05, 52 participants per group were required based on three groups (Cohen, [<reflink idref="bib6" id="ref48">6</reflink>]). Before conducting the main analyses, several data checks were done. An ANOVA and chi-squared tests were conducted to determine comparability of the groups regarding age, gender, and number of years in treatment. Next, a Levene's test was performed to check if the assumption of homogeneity of variance was violated. A Bonferroni correction was applied due to the large number of tests.</p> <p>Regarding the first aim of this study, the average scores of the mental functions within the MID-BIF group were determined and compared. Second, ANOVAs were performed to explore if average scores of the mental functions differed significantly between the MID-BIF, FE, and HE groups. Partial eta-squared was used to determine effect sizes, with the following effect size criteria:.01 small effect,.06 medium effect, and.14 large effect (Field, [<reflink idref="bib12" id="ref49">12</reflink>]; Kirk, [<reflink idref="bib15" id="ref50">15</reflink>]). Post-hoc tests were used in the main analyses to specify which group(s) differed from each other. For equal variances, Hochberg's GT2 was used; for unequal variances, the Games–Howell test was used (see Table 3).</p> <p>Table 3. Results from ANOVA comparing mental functions between a MID-BIF (<emph>N</emph> = 52), FE (<emph>N</emph> = 86) and HE (<emph>N</emph> = 107) group.</p> <p> <ephtml> <table><thead><tr><td>Mental function</td><td>MID-BIF</td><td>FE</td><td>HE</td><td><italic>F</italic> (2,242)</td><td><italic>p</italic></td><td><italic>η</italic><sub><italic>p</italic></sub><italic><sup>2</sup></italic></td><td><italic>Post Hoc</italic><sup><italic>abc</italic></sup></td></tr><tr><td>Mean</td><td>SD</td><td>Mean</td><td>SD</td><td>Mean</td><td>SD</td><td /><td /><td /><td /></tr></thead><tbody><tr><td>Cognitive and affective processes</td><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td><list list-type="Bullet"><list-item><p>(1) Capacity for affective range, communication and understanding</p></list-item></list></td><td>4.28</td><td>0.67</td><td>4.23</td><td>0.74</td><td>4.64</td><td>0.92</td><td>7.14</td><td>.001**</td><td>.056</td><td>MID-BIF, FE < HE<sup><italic>bc</italic></sup></td></tr><tr><td><list list-type="Bullet"><list-item><p>(2) Capacity for mentalization and reflective functioning</p></list-item></list></td><td>3.69</td><td>1.14</td><td>4.23</td><td>1.37</td><td>5.05</td><td>1.25</td><td>22.43</td><td><.001***</td><td>.156</td><td>MID-BIF < FE < HE<sup><italic>ac</italic></sup></td></tr><tr><td>Identity and relationships</td><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td><list list-type="Bullet"><list-item><p>(3) Capacity for differentiation and integration (identity)</p></list-item></list></td><td>4.42</td><td>0.80</td><td>4.73</td><td>0.85</td><td>5.21</td><td>0.81</td><td>18.05</td><td><.001***</td><td>.130</td><td>MID-BIF, FE < HE<sup><italic>ac</italic></sup></td></tr><tr><td><list list-type="Bullet"><list-item><p>(4) Capacity for relationships and intimacy</p></list-item></list></td><td>4.88</td><td>0.68</td><td>5.01</td><td>0.73</td><td>5.24</td><td>0.75</td><td>5.00</td><td>.007**</td><td>.040</td><td>FE, MID-BIF < HE<sup><italic>ac</italic></sup></td></tr><tr><td><list list-type="Bullet"><list-item><p>(5) Capacity for self-esteem regulation and quality of internal experience</p></list-item></list></td><td>3.77</td><td>1.00</td><td>4.09</td><td>1.13</td><td>4.54</td><td>1.05</td><td>10.20</td><td><.001***</td><td>.078</td><td>MID-BIF, FE < HE<sup><italic>ac</italic></sup></td></tr><tr><td>Defense and coping</td><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td><list list-type="Bullet"><list-item><p>(6) Capacity for impulse control and regulation</p></list-item></list></td><td>5.20</td><td>0.96</td><td>5.36</td><td>0.80</td><td>5.43</td><td>0.75</td><td>1.43</td><td>.243</td><td>.012</td><td>MID-BIF, FE, HE<sup><italic>bc</italic></sup></td></tr><tr><td><list list-type="Bullet"><list-item><p>(7) Capacity for defensive functioning</p></list-item></list></td><td>5.44</td><td>0.78</td><td>5.30</td><td>0.92</td><td>5.64</td><td>0.67</td><td>4.44</td><td>.013*<sup>d</sup></td><td>.035</td><td>FE < HE, MID-BIF<sup><italic>bc</italic></sup></td></tr><tr><td><list list-type="Bullet"><list-item><p>(8) Capacity for adaptation, resiliency and strength</p></list-item></list></td><td>1.86</td><td>1.04</td><td>2.14</td><td>1.18</td><td>3.23</td><td>1.45</td><td>27.07</td><td><.001***</td><td>.183</td><td>MID-BIF, FE < HE<sup><italic>bc</italic></sup></td></tr><tr><td>Self-awareness and self-direction</td><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td><list list-type="Bullet"><list-item><p>(9) Self-observing capacities (psychological mindedness)</p></list-item></list></td><td>3.74</td><td>0.87</td><td>3.71</td><td>1.13</td><td>4.00</td><td>1.11</td><td>1.92</td><td>.149</td><td>.016</td><td>MID-BIF, FE, HE<sup><italic>ac</italic></sup></td></tr><tr><td><list list-type="Bullet"><list-item><p>(10) Capacity to construct and use internal standards and ideals</p></list-item></list></td><td>5.30</td><td>0.51</td><td>5.01</td><td>0.57</td><td>5.23</td><td>0.50</td><td>3.21</td><td>.042*</td><td>.026</td><td>MID-BIF, FE, HE<sup><italic>ac</italic></sup></td></tr><tr><td><list list-type="Bullet"><list-item><p>(11) Capacity for meaning and purpose</p></list-item></list></td><td>3.45</td><td>0.98</td><td>3.47</td><td>1.08</td><td>4.06</td><td>1.19</td><td>8.76</td><td><.001***</td><td>.068</td><td>MID-BIF, FE < HE<sup><italic>ac</italic></sup></td></tr></tbody></table> </ephtml> </p> <ulist> <item>3 *<emph>p</emph> <.05. **<emph>p</emph> <.01. ***<emph>p</emph> <.001.</item> <item>4 Effect size <emph>partial eta<sups>2</sups></emph>.01 = small effect,.06 = medium effect,.14 = large effect (Field, [<reflink idref="bib12" id="ref51">12</reflink>]; Kirk, [<reflink idref="bib15" id="ref52">15</reflink>]).</item> <item>5 <sups>a</sups>Hochberg's GT2. <sups>b</sups>Games-Howell. <sups>c</sups>Bonferroni.</item> <item>6 Post hoc: < significant difference.</item> <item>7 <sups>d</sups>ANCOVA is used, since a significant interaction-effect appeared for covariate "number of years in treatment" (F(<reflink idref="bib2" id="ref53">2</reflink>,<reflink idref="bib242" id="ref54">242</reflink>) = 4.50, <emph>p</emph> =.012, ηp2 =.036</item> </ulist> <hd id="AN0181985316-10">RESULTS</hd> <p></p> <hd id="AN0181985316-11">Preliminary Analyses</hd> <p>The ANOVA showed that the MID-BIF, FE, and HE groups did not differ in age, <emph>F</emph>(<reflink idref="bib2" id="ref55">2</reflink>, 242) = 1.20, <emph>p</emph> =.309. The chi-squared tests showed that the groups did differ in gender, χ<sups>2</sups>(<reflink idref="bib2" id="ref56">2</reflink>) = 7.25, <emph>p</emph> <.05, and number of years in treatment, χ<sups>2</sups>(<reflink idref="bib2" id="ref57">2</reflink>) = 45.8, <emph>p</emph> <.001. Therefore, these two variables were controlled for in the main analyses by including them separately as covariates in the ANOVAs to establish if significant interaction effects appeared. Levene's test showed that the assumption of homogeneity of variance was violated for four of the 11 mental functions: "capacity for affective range, communication and understanding," <emph>F</emph>(<reflink idref="bib2" id="ref58">2</reflink>, 242) = 3.40, <emph>p</emph> <.05, "capacity for impulse control and regulation," <emph>F</emph>(<reflink idref="bib2" id="ref59">2</reflink>, 242) = 3.36, <emph>p</emph> <.05, "capacity for defensive functioning," <emph>F</emph>(<reflink idref="bib2" id="ref60">2</reflink>, 242) = 3.42, <emph>p</emph> <.05, and "capacity for adaptation, resiliency and strength," <emph>F</emph>(<reflink idref="bib2" id="ref61">2</reflink>, 242) = 1.38, <emph>p</emph> <.01.</p> <hd id="AN0181985316-12">Mental Functions in MID-BIF Patients</hd> <p>Mean scores of mental functions in patients with MID-BIF are shown in Table 3. A high score suggested that that mental function was relatively well developed. Three functions scored the highest ("capacity for impulse control and regulation," "capacity for defensive functioning," and "capacity to construct and use internal standards and ideals") and were most descriptive and best developed of the MID-BIF group. The "capacity for adaptation, resilience and strength" scored the lowest and was thus evaluated as least descriptive and less developed.</p> <hd id="AN0181985316-13">Differences in Mental Functions Between the MID-BIF, FE, and HE Groups</hd> <p>First, results regarding the mean scores of the three groups were graphically visualized (Figure 1). The pattern was quite similar for all the groups. For example, the mental function "capacity for adaption, resilience and strength" appeared to be the lowest score for all the groups, not only for the people with MID-BIF. As expected, the HE scores were the highest, whereas the FE and MID-BIF group scores were more alike on most mental functions.</p> <p>Graph: Figure 1. The mean scores on mental functions for all groups and confidence intervals.</p> <p>Next, a series of ANOVAs were performed to explore whether there were differences in mental functions between the three groups. Several significant results between the three groups were found with varying effect sizes (Table 3). Due to the large number of tests, we only interpreted medium and large effects. Large effects were found for "capacity for adaptation, resiliency and strength" and "capacity for mentalization and reflective functioning." In particular, in the first mentioned mental function, the HE group scored significantly higher than the other two groups, and for the latter mental function, all group differences were statistically significant.</p> <p>Medium effects were found for the "capacity for differentiation and integration (identity)," "capacity for self-esteem regulation and quality of internal experience," and "capacity for meaning and purpose." For all the effects, only the HE group scored significantly higher than the FE and MID-BIF groups.</p> <p>Small effect sizes were found for "capacity for affective range, communication and understanding," "capacity for relationships and intimacy," "capacity for defensive functioning," and "capacity to construct and use internal standards and ideals." For the first three mental functions, only the HE group scored significantly higher than the other two.</p> <hd id="AN0181985316-14">DISCUSSION</hd> <p>In the present study, we studied the mental functions of patients with MID-BIF in mental health care using the SWAP-200-NL. First, differences between 11 mental functions were explored in the MID-BIF group. Second, the mental functions of the MID-BIF group were compared to those of patients with higher levels of education (i.e., the FE and HE groups).</p> <p>Regarding the first aim of the study, three mental functions had the highest scores in comparison with the other functions in the MID-BIF group: (a) capacity for impulse control and regulation, (b) capacity for defensive functioning, and (c) capacity to construct and use internal standards and ideals. These three mental functions were thus most descriptive of the MID-BIF group. In contrast, the lowest mental function within the MID-BIF group was the capacity for adaptation, resiliency, and strength. This mental function was least descriptive of the MID-BIF patients. The relatively high score on the capacity for impulse control and regulation might be surprising at first glance, since it is often assumed that people with MID-BIF have problems in this area because of their overall lower developmental level (e.g., Došen, [<reflink idref="bib9" id="ref62">9</reflink>]). However, studies in this area have yielded inconclusive results. For example, Russo et al. ([<reflink idref="bib25" id="ref63">25</reflink>]) found negative and positive relationships between intelligence and impulsivity, depending on how impulsivity was defined and measured. Other studies have shown that poor impulse control in children was associated with an additional disorder (i.e., conduct disorder) and not with the level of IQ (Van der Meer & Van der Meere, [<reflink idref="bib30" id="ref64">30</reflink>]). In addition, some research on emotion regulation skills has suggested that people with MID-BIF used similar emotion regulation strategies and had similar outcomes compared to people without MID-BIF (Littlewood et al., [<reflink idref="bib20" id="ref65">20</reflink>]) and reported fewer problems with emotion regulation and maladaptive regulation strategies than people of average IQ (Te Brinke et al., [<reflink idref="bib28" id="ref66">28</reflink>]). The relatively low score on the capacity for adaptation, resiliency, and strength is easier to understand because the classification of (the severity of) an ID is primarily based on deficits in adaptive behavior (American Psychiatric Association, [<reflink idref="bib2" id="ref67">2</reflink>]). It should be noted that due to the absence of norm scores of both people with MID-BIF or those without MID-BIF regarding the assessed mental functions, conclusions regarding relative strengths and weaknesses within the MID-BIF group should be interpreted with caution. For future research, it would be interesting to collect SWAP data from a group of people with MID-BIF without mental health problems. This would allow us to make more solid statements about strengths and weaknesses regarding mental functions in patients with MID-BIF. Moreover, it could then be explored if and how strengths and weaknesses in mental functions may relate to (types of) mental disorders or mental health problems in people with MID-BIF.</p> <p>Regarding the second aim of the study, two findings are noteworthy. First, a similar pattern for all levels of education (MID-BIF, FE, HE) was found regarding the average scores of mental functions. This means that the three groups score relatively high and low on the same mental functions. To clarify how mental health problems might be related to mental functions, future research might compare current results with matched groups of individuals without mental health problems to explore whether different patterns emerge. Also, it would be interesting to see if these relations change over time. Second, despite the similar pattern, nine of the 11 mental functions differed significantly between the MID-BIF, FE, and HE groups, with small to large effects. The HE group scored the highest on seven of 11 functions, thus representing more adaptive mental functioning. Interestingly, there was no significant difference in average scores of six of the seven mental functions between the MID-BIF and FE groups, whereas on only one mental function the MID-BIF group scored significantly lower. This casts further doubt regarding the use of an IQ-criterium in clinical practice for the exclusion of certain treatments or admission into mental health services. In line with this finding, a recent Dutch guideline regarding personality disorders (PDs) stated that MID-BIF patients require adaptation of treatment, and a PD should not be a contraindication in advance (Federatie Medisch Specialisten, [<reflink idref="bib11" id="ref68">11</reflink>]).</p> <p>Contrary to what was expected, for one mental function (i.e., the capacity for impulse control and regulation), no significant differences between the groups were found. For another mental function (i.e., defensive functioning), the MID-BIF and HE groups scored similarly, and only the FE group scored significantly lower. An explanation might be that more patients were diagnosed with a PD in the FE group (52%) than in the MID-BIF (35%) and HE (38%) groups. Some research has suggested that more pathological personality styles are associated with more maladaptive defensive mechanisms (DiGiuseppe et al., [<reflink idref="bib8" id="ref69">8</reflink>]).</p> <p>This study had several limitations. First, it was impossible to determine the internal consistency of the mental functions since the items in the scale were parabolically associated with each other instead of positively linear. So, the reliability of the scales by which mental functions were measured remained uncertain. Second, which items of the SWAP-200-NL were assigned to a certain mental function was based on a theoretical framework and not on a statistical basis (e.g., factor analysis). In addition, the lack of norm scores made it difficult to draw firm conclusions regarding the interpretation of scores on mental functions, which would be an interesting focus for future research. Furthermore, all the clinicians scored their patients in light of their own frames of reference. Although the jargon-free statements used in the SWAP-200-NL should minimize this risk, it cannot be ruled out. Additionally, although some studies from independent research groups have shown that the reliability and validity of the SWAP-200 are acceptable (Blagov et al., [<reflink idref="bib3" id="ref70">3</reflink>]), it has not yet been determined for the MID-BIF group. Nevertheless, the participant groups did include patients with severe problems (e.g., inpatients at a maximum-security forensic hospital, highly psychopathic male inmates), and reliability and validity were still high. In addition, all the clinicians involved in this study (i.e., those working with patients with MID-BIF as well as those working in general mental health care) received the same 3-h training from the same trainers, in which the background of the SWAP-200-NL was explained, and instructions about the item content and the Q-sort method were given and practiced. Using this procedure, we aimed for standardization across facilities, patients, and clinicians per the assessment. Furthermore, we assumed that, based on the Wechsler norm scores, there were no people with MID or BIF in the HE and FE group. However, we could not rule this out. Last, it would have been interesting to explore if differences existed within the MID-BIF group between the MID and BIF participants. Unfortunately, the groups were too small to explore them separately.</p> <p>Overall, this study emphasizes that a differentiated description of mental functions for patients with MID-BIF is possible, just as with patients with higher levels of education. Mental functions offer a different lens through which to view the strengths and vulnerabilities of patients with ID and prevent challenges from being attributed solely to the MID or BIF. The SWAP-200-NL provides a more reliable and valid way to assess these functions than clinical judgment alone. Subsequently, information regarding these mental functions can help caregivers know how to best approach a patient to meet their needs and focus the care on support or treatment. For example, if vulnerabilities lie in the capacity for impulse control and regulation, emotion regulation training might be a focus of treatment. However, if there is limited resiliency, it is better to focus on a good support system. Finally, this study showed that the three groups had a similar pattern regarding mental functions, which raises questions regarding the importance that is given to someone's level of education/intelligence concerning clinical decision-making in mental health care.</p> <hd id="AN0181985316-15">Acknowledgments</hd> <p>We thank all the clinicians for their assistance in data collection.</p> <hd id="AN0181985316-16">Disclosure statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <hd id="AN0181985316-17">Data availability statement</hd> <p>The data that support the findings of this study are available from the corresponding author upon reasonable request.</p> <ref id="AN0181985316-18"> <title> References </title> <blist> <bibl id="bib1" idref="ref10" type="bt">1</bibl> <bibtext> Alexander, R. T., Chester, V., Gray, N. S., & Snowden, R. (2012). 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  Group: Ti
  Data: Mental Functions in People with Mild Intellectual Disability to Borderline Intellectual Functioning
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  Data: English
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  Data: <searchLink fieldCode="AR" term="%22E%2E+C%2E+M%2E+Haacke%22">E. C. M. Haacke</searchLink><br /><searchLink fieldCode="AR" term="%22K%2E+P%2E+Lie+Sam+Foek-Rambelje%22">K. P. Lie Sam Foek-Rambelje</searchLink><br /><searchLink fieldCode="AR" term="%22P%2E+T%2E+van+der+Heijden%22">P. T. van der Heijden</searchLink><br /><searchLink fieldCode="AR" term="%22H%2E+P%2E+L%2E+M%2E+Korzilius%22">H. P. L. M. Korzilius</searchLink><br /><searchLink fieldCode="AR" term="%22R%2E+Didden%22">R. Didden</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Mental+Health+Research+in+Intellectual+Disabilities%22"><i>Journal of Mental Health Research in Intellectual Disabilities</i></searchLink>. 2025 18(1):102-118.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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  Data: Y
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  Data: 17
– Name: DatePubCY
  Label: Publication Date
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  Data: 2025
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="EL" term="%22Adult+Education%22">Adult Education</searchLink><br /><searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Metacognition%22">Metacognition</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Mild+Intellectual+Disability%22">Mild Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Background%22">Educational Background</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Continuing+Education%22">Continuing Education</searchLink><br /><searchLink fieldCode="DE" term="%22Vocational+Education%22">Vocational Education</searchLink><br /><searchLink fieldCode="DE" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="DE" term="%22Adult+Learning%22">Adult Learning</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Netherlands%22">Netherlands</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/19315864.2024.2397361
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  Label: ISSN
  Group: ISSN
  Data: 1931-5864<br />1931-5872
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Introduction: The first aim of this study was to explore the mental functions of patients with mild intellectual disabilities or borderline intellectual functioning (MID-BIF) in mental health care. The second aim was to examine the differences in mental functions between people with MID-BIF and those with higher educational levels (i.e. further education [FE] and higher education [HE]). Materials and methods: Eleven mental functions were assessed using the Shedler-Westen Assessment Procedure (SWAP-200-NL). In total, 245 patients were included, divided into three groups (MID-BIF: N = 52; FE: N = 86; HE: N = 107). Results: Results showed that the MID-BIF group scored relatively high on three mental functions (i.e. the capacity for impulse control and regulation, capacity for defensive functioning, and capacity to construct and use internal standards and ideals). One mental function scored relatively low (the capacity for adaptation, resiliency, and strength). Regarding group comparisons, similar patterns in average scores emerged, and the HE group scored higher than the MID-BIF and the FE groups on most mental functions. Discussion: The mental functions of the HE group were most adaptive, whereas the mental functions of the FE and MID-BIF groups were less adaptive and on a similar level in each of these groups.
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  Data: 2025
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  Label: Accession Number
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  Data: EJ1456321
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        Value: 10.1080/19315864.2024.2397361
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 17
        StartPage: 102
    Subjects:
      – SubjectFull: Metacognition
        Type: general
      – SubjectFull: Intellectual Disability
        Type: general
      – SubjectFull: Mild Intellectual Disability
        Type: general
      – SubjectFull: Mental Health
        Type: general
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      – SubjectFull: Adult Learning
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      – SubjectFull: Netherlands
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    Titles:
      – TitleFull: Mental Functions in People with Mild Intellectual Disability to Borderline Intellectual Functioning
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            NameFull: H. P. L. M. Korzilius
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