154 Chapter 7 Summary of main findings Chapter 2 evaluated the effectiveness of an indicated prevention program called 'Take it Personal!' in reducing alcohol and/or drug use patterns of young people with a mild intellectual disability. The program targeted – for each individual – one of four high-risk personality profiles for substance use: negative thinking, anxiety sensitivity, impulsivity or sensation seeking. A two-arm quasi-experimental research design was used. Results showed that, on average, those in the intervention group decreased their substance use frequency and binge drinking more than those in the control group. No evidence was found for average effects on the overall severity of substance use. The intervention Take it Personal! thus elicits behavior change at the group level, thereby holding promise for addressing other individuals with a mild intellectual disability with similar substance use patterns in the future. Substance use, however, was not the sole focus of Take it Personal! Chapter 3 therefore assessed the program’s effectiveness on four problem domains: anxiety, withdrawal, rule-breaking, and aggression. Additionally, the potentially moderating role of these problems on the program’s effectiveness with substance use was explored. Take it Personal! seemed to reduce rule-breaking problems, albeit with a small effect size. None of the problem domains moderated the program’s effectiveness in reducing substance use frequency, indicating that participants with varying levels of emotional and behavioral problems benefit equally in terms of reduced substance use. Emotional and behavioral problems did not correlate with substance use at the group level, which suggests that interrelations in the heterogeneous mild intellectual disability group may be best explored idiographically. In Chapter 4 we explored the feasibility of a method to enable idiographic studies of change: diary monitoring using a mobile phone application. Participants could self-rate standardized and personalized questions once per day for 60 consecutive days. Diary entries were used as feedback in treatment. The content of personalized items varied widely between participants. On average, participants completed 70.4% of their diaries. Compliance was especially good in ambulatory and residential care, but not in juvenile detention. Participants who could use their own phones for diary entries, as opposed to a group-owned device, had higher compliance rates. The vast majority of participants – including the ones who dropped out prematurely – reported gains from participation such as increased self-awareness, improved communication with caregivers, and that it helped with reducing problem behaviors. Most deemed the once-per-day frequency and 60-day duration appropriate. We concluded daily monitoring to be feasible for young people with a mild intellectual disability, opening doors for idiographic studies of change.
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