Expressions of stress of people with severe intellectual disabilities and sensitive caregiving to regulate stress: A qualitative study

Tanja W.M. Doodeman*, Carlo Schuengel, Paula S. Sterkenburg

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


People with severe to profound intellectual disabilities have particular needs for others to help them regulate stress. Such support may be hampered by difficulties in detecting and interpreting expressions of stress. This study aimed to describe and identify stress-related behaviours and sensitive, stress-regulating responses to these behaviours.

Video recordings of psychotherapeutic interactions between four clients with severe intellectual disabilities and behavioural problems and two attachment therapists were analysed using a stepwise spiral of analysis approach. Stress-related behaviours were identified with a behaviour rating scale for arousal and valence.

Distinct stress-related behaviours were subdivided into stress-specific, non-stress-specific, and client-specific behaviours. Additionally, examples of responsive behaviours to clients’ expressions of varying arousal and valence were found.

A wide variety of expressions indicative of different levels of arousal were found, with few expressions specific for stress. The descriptions of responsive behaviours might support parents and caregivers in external stress regulation.
Original languageEnglish
Pages (from-to)308-317
Number of pages10
JournalJournal of Intellectual & Developmental Disability
Issue number4
Early online date24 Jan 2022
Publication statusPublished - 2022

Bibliographical note

Funding Information:
This work was supported by ZonMw (The Netherlands Organisation for Health Research and Development) located in the Hague (the Netherlands), under Grant [845004004] (the program of “Gewoon Bijzonder”). We are in particular grateful to Hanna Blom-Yoo, mother of a child with a severe intellectual disability, for starting and leading the coding process of the ITAB-videos as junior researcher and using her experience as a parent in this process. We also thank the participants of the ITAB-study and their representatives for their agreement to use the ITAB-videos for the current study. We acknowledge the contribution of the students to the coding process.

Publisher Copyright:
© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.


  • expressions of stress
  • parents and professional caregivers
  • sensitive and responsive behaviour
  • Severe and profound intellectual disabilities
  • stress-regulating relationship


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