Page 83 - Reduction of coercive measures
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                                Gooyen, & Van der Ploeg, 1995) was used to assess two domains, Communication and Socialization, of adaptive functioning. Communication refers to receptive, expressive and written language skills (133 items), and Socialization refers to skills needed to get along with others (134 items). The VABS was found moderately associated with IQ measures in young adults and is regularly used in studies with people with ID (Dacey, Nelson, & Stroeckel, 1999). The Dutch version of the VABS has been proven valid and reliable (De Bildt, Kraijer, Sytema, & Minderaa, 2005). The items of the questionnaire assess performance of discrete skills. Items were rated from 2 (yes, usually), 1 (sometimes, partially), and 0 (no, never). One is also scored whenever an answer is unknown or performance of the skill was not possible. A higher score refers to a higher developmental age. A strong Pearson correlation of .90 was found between both scales. Therefore these were combined into the scale ‘Social adaptive behavior’ by calculating the mean score of both scales. Cronbach’s alpha for this scale was .95.
Challenging behavior
Challenging behavior was assessed by the Dutch translation of the Behavior Problem Inventory BPI-01 (Lambrechts, Kuppens, & Maes, 2009; Rojahn, Matson, Lott, Esbensen, & Yemonja Smalls, 2001). The BPI-01 measures three domains of problem behavior, using 24 items for Stereotyped Behavior (SB), 14 items for Self-Injurious behavior (SIB), and 11 items for Aggressive/destructive behavior (AB). The BPI-01 defines SB as ‘repeated uniform body movements or postures that are obviously not part of some goal-directed act and includes rocking; twirling or twisting objects, smelling objects and screaming and yelling. SIB is defined as ‘behavior that can cause damage to the person’s own body and that occurs repeatedly and in an essentially unvarying manner’. SIB includes for example: hitting the head with the hand or other body parts, biting oneself, hair-pulling, regurgitating, and hitting the head with or against objects. AB is defined as ‘an offensive action or a deliberate overt attack directed towards people or objects’ and includes grabbing, pulling or hitting others (Rojahn et al., 2001). After the corresponding definition was mentioned in the list, descriptions of specific behaviors were provided. Then, respondents
Associate factors of coercive measures

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