Psychopathology in Children with Intellectual Disability: Risk Markers and Correlates

The purpose of this literature review was to summarize studies examining risk factors, markers, and correlates of psychopathology in youngsters with intellectual disability. A total of 26 studies met inclusion criteria and were reviewed. Due to the limitations of research methods (i.e., not establishing precedence), no risk factors were identified. The majority of variables examined were risk markers (i.e., age, sex, level of functioning). The most consistent age finding was that hyperactivity and/or conduct disorder symptoms were negatively associated with age. Sex effects were equivocal but suggested that boys had more disruptive behavior problems than girls. Specific patterns emerged in regard to level of functioning. Those with milder delays were more likely to have disruptive and emotional disorders. Conversely, those with more severe delay had higher rates of stereotypy, self-injury, and social isolation and were less likely to show symptom improvement over time. This review also identified correlates of emotional and problem behavior such as parent psychopathology and stress and dysfunctional home environment. Parallels were drawn with the general child psychopathology field and further research directions were discussed.     

Psychopathology in Children and Adolescents with Autism Compared to Young People with Intellectual Disability

Autism is a neurodevelopmental disorder with a specific pattern of behavioural, communication and social problems. Additional mental health problems are often poorly understood and undetected. This study investigates the level and pattern of emotional and behavioural problems in young people with autism compared with children with intellectual disability (ID). Subjects were 381 young people with autism and a representative group of 581 Australian young people with ID aged 4–18 years. Parents/carers provided details of the emotional and behavioural problems of their child using the Developmental Behaviour Checklist (DBC-P). Young people with autism were found to suffer from significantly higher levels of psychopathology than young people with ID. The implications of this finding are discussed.     

Life Experiences of Mothers of Children with an Intellectual Disability: A Qualitative Study

ABSTRACT

Introduction: Mothers of intellectually disabled children face several psychological problems. Qualitative studies use a process that can reveal truthful perceptions and help mothers express their emotions about their unique and personal experiences. Method: This study used a qualitative research method design with a hermeneutic approach to examine the life experiences of mothers of children with intellectual disabilities in light of their caregiving experiences. Results: A phenomenological, hermeneutical analysis with an inductive approach was used. The categories of interest were determined to be “impact,” “care management,” “stigma,” “uncertainty,” “relations,” and “search for meaning.” Conclusions: Not all mothers perceive having an intellectually disabled child negatively. Some mothers may not experience any problems providing care to their children. Almost all mothers, however, have concerns for the future and experience significant changes in their family and social relationships.     

Risk factors for psychopathology in children with intellectual disability: a prospective longitudinal population-based study

Background This study examined risk factors for the development of psychopathology in children with intellectual disability (ID) in the developmental, biological, family and social‐ecological domains. Methods A population sample of 968 children, aged 6–18, enrolled in special schools in the Netherlands for educable and trainable ID were assessed at Time 1. A random 58% were re‐contacted about 1 year later, resulting in a sample of 474 at Time 2. Results Psychopathology was highly consistent over 1 year. Risk factors jointly accounted for significant, but small, portions of the variance in development of psychopathology. Child physical symptoms, family dysfunction and previous parental mental health treatment reported at Time 1 were uniquely associated with new psychopathology at Time 2. Conclusions Prevention and early intervention research to find ways to reduce the incidence of psychopathology, possibly targeting family functioning, appear important.     

Prevalence and Correlates of Pica Among Adults with Intellectual Disability in Institutions

Increased knowledge of complex behaviors such as pica is needed to improve the support and services in the community for individuals with intellectual disability (ID). Though the prevalence of pica has been documented extensively in institutionalized settings, few studies have explored its etiology. The aim of this study is to explore the correlates of pica among institutionalized adults with ID. Secondary data analysis was performed on census-level data on 1,008 persons with ID residing in Ontario's remaining specialized institutions. All persons had been assessed using the interRAI Intellectual Disability (interRAI ID; Martin, Hirdes, Fries, & Smith, 2007 Martin, L., Hirdes, J. P., Fries, B. E and Smith, T. F. 2007. Development and psychometric properties of an assessment for persons with intellectual disability—The interRAI ID. Journal of Policy and Practice in Intellectual Disabilities, 4(1): 23–29.  [Google Scholar]) assessment instrument—a comprehensive and standardized instrument that supports service planning. Bivariate and multivariate analyses were used to explore the relation between pica and demographic, functional, and clinical characteristics. The overall prevalence of pica was 21.8%. Logistic regression analysis showed that being male, a diagnosis of autism, and use of nonverbal means of communication were associated with a higher likelihood of pica, whereas impairment in activities of daily living reduced that likelihood. A curvilinear relation was observed between cognitive functioning and pica. The prevalence of pica is quite high in Ontario's institutions, and nonverbal communication emerged as the strongest correlate of the behavior. The implications for education, training, and interventions are discussed.     

The Prevalence and Characteristics of Intellectual and Borderline Intellectual Disabilities in a Sample of Inpatients with Substance Use Disorders: Preliminary Clinical Results

Introduction: There is reason to believe that many individuals with substance use disorders (SUD), who are in contact with services, have an undiagnosed intellectual disability. The aim of the present study was to investigate the prevalence of intellectual and borderline intellectual disabilities (ID/BID) among inpatients with SUD and to further explore their characteristics. Methods: Ninety-one SUD inpatients aged 19–64 participated in the study. SUD was diagnosed according to the ICD-10. ID/BID was diagnosed through the Wechsler Adult Intelligence Scale, the Vineland Adaptive Behavior Scale, and self-reported childhood learning difficulties. Results: ID/BID prevalence was up to 30%. There were significant differences between ID/BID and non-ID groups for several social variables. With the exception of substance-use relapse, there were no significant differences in substance-related factors. Conclusions: ID/BID prevalence in SUD might be high. These conditions often go undiagnosed in SUD treatment. The conditions and associated difficulties should be identified for better understanding and individually adapted treatment.     

Mental Disorders and Problem Behavior in a Community Sample of Adults with Intellectual Disability: Three-Month Prevalence and Comorbidity

The aim of this study was to investigate the prevalence of mental disorders in a Norwegian sample of adults with intellectual disability (ID) using the Psychopathology Checklists for Adults With Intellectual Disability (P-AID; Hove & Havik, 2008 Hove, O. and Havik, O. E. 2008. Psychometric properties of Psychopathology Checklists for Adults With Intellectual Disability (P-AID) on a community sample of adults with intellectual disability. Research in Developmental Disabilities, 29: 467–482.  [Google Scholar]), a screening instrument adopting diagnostic criteria from the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Intellectual Disability/Mental Retardation (DC-LD; Royal College of Psychiatrists, 2001 Royal College of Psychiatrists. 2001. DC-LD: Diagnostic criteria for psychiatric disorders for use with adults with learning disabilities/mental retardation, London: Gaskell.  [Google Scholar]). The P-AID checklists, comprising 10 psychiatric diagnoses and 8 types of problem behaviors, were completed by staff at community-based homes for adults with ID in Western Norway. One in three adults with ID showed indices of a mental disorder. Problem behavior was the most prevalent single diagnosis next to anxiety and affective disorder, and there was a high frequency of comorbidity among the disorders. The findings extend previous reports on mental disorders and comorbidity and support the use of DC-LD in epidemiological research.     

One-Year Incidence of Suicide Attempts and Associated Risk and Protective Factors Among Adolescents

The goal of this study was to estimate incidence of adolescent suicide attempts and predictors of attempts. Data were collected using diagnostic interviews and questionnaires with a sample of 4,175 youths 11–17 and 3,134 followed-up a year later. Total incidence was 0.95% and first incidence 0.84% for attempts. We found few significant independent predictors of attempts. Multivariate analyses identified only 2 independent predictors of first incidence (marijuana use and caregiver attempts). We did find evidence for cumulative effects of risk factors, with increased odds of attempts with increasing number of risk factors. The difficulty in identifying a common set of modifiable risk factors continues to make development of effective interventions difficult. However, based on our results and those of other researchers, the impact of the cumulative risk conferred by multiple factors would seem to offer a viable strategy for reducing risk of suicide attempts as well as other mental health outcomes among adolescents.     

Relationship between Assessed Emotion,Personality, Personality Disorder and Risk in Offenders with Intellectual Disability

In mainstream studies on offenders and on individuals with psychopathology, relationships have been found between personality characteristics, emotional problems and personality disorders. This study reviewed the relationships between the Emotional Problems Scale, two circumplex measures of personality, personality disorder assessments and risk assessments in 212 offenders with intellectual disability. Previous studies had established the reliability and validity of these measures with the client group. Strong relationships emerged between externalizing emotional problems and dominant and hostile personality dimensions with weaker but significant relationships between internalizing problems and submissive and hostile dimensions. Externalizing problems were strongly associated with risk for violence, while internalizing problems had a weaker but significant relationship with some historical and clinical risk scales. Dominant personality dimensions were associated with narcissistic personality disorder and nurturant personality dimensions negatively associated with anti-social personality disorder. It would seem that there are orderly, significant relationships among measures of personality, personality disorders, emotional problems and risk. We discuss the implications of emotional assessment for the evaluation of risk and prediction of treatment progress.     

Aggression in Children and Adolescents with ASD: Prevalence and Risk Factors

The prevalence of and risk factors for aggression were examined in 1,380 children and adolescents with autism spectrum disorders (ASD). Prevalence was high, with parents reporting that 68% had demonstrated aggression to a caregiver and 49% to non-caregivers. Overall, aggression was not associated with clinician observed severity of ASD symptoms, intellectual functioning, gender, marital status, parental educational level, or aspects of communication. Individuals who are younger, come from a higher income family, have more parent reported social/communication problems, or engage in repetitive behaviors were more likely to demonstrate aggression. Given the significant impact of aggression on individual and family outcomes, it is hoped that this knowledge will inform more targeted intervention efforts.     

Sociodemographic and Psychopathological Risk Factors for Repetition of Attempted Suicide: A 5-Year Follow-Up Study

The present study examines the association between repetition of suicide attempts and sociodemographic and psychopathological characteristics of patients during a 5-year follow-up period. Participants were 874 suicide attempters referred to the University Hospital of Ghent, among whom 361 (41.3%) patients were available for follow-up analysis. Within 5 years, 29.2% of those admitted for an index suicide attempt repeated non-fatal suicidal behavior. Repetition of suicidal behavior was associated with high scores on measures of psychopathology. In addition, the risk of repetition was increased if the patient was female, aged between 20 and 49, and had a lower education. Multivariate analysis showed significant results for age, the Buglass & Horton Risk of Repetition Scale and for anxiety. Repetition of suicidal behavior is associated with high anxiety, severe depression, more psychiatric symptoms and is increased in young patients.     

A Scoping Study of a Tertiary Intellectual Disability Mental Health Service: A Family Member and Support Person Perspective

ABSTRACT

Introduction: People with intellectual disability (ID) experience barriers in accessing mental health care. Recommendations have been made to implement specialist intellectual disability mental health (IDMH) services in Australia. However, there is limited evidence to inform service development.

Method: Family members and support persons of people with ID (n = 42) completed an on-line survey about support for, and operation of, a tertiary IDMH service in New South Wales, Australia.

Results: Participants agreed that a tertiary IDMH service would assist in meeting the needs of people with ID. Key service features included that it be delivered within the public health system, by psychiatrists and psychologists, provide face-to-face clinical contact and advice. Key service areas included behaviors of concern, self-harm, assessments, and interventions.

Conclusion: These findings suggest support for a tertiary IDMH service and how it could be delivered. Further research is required from the perspective of people with ID, mental health staff, and clinical experts.     

Contribution of Leisure Satisfaction,Acceptance Disability,and Social Relationship to Life Satisfaction among Korean Individuals with Intellectual Disability

ABSTRACT

There is a dearth of literature that explores the relationships among leisure satisfaction, acceptance of disability, social relationships, and life satisfaction among adults with intellectual disability from Eastern countries. The purpose of this study was to examine how leisure satisfaction, disability acceptance, and social relationships are associated with life satisfaction among Korean adults with mild intellectual disability. This study used the 2011 Panel Survey of Employment for the Disabled (PSED). Using hierarchical multiple regression analysis, the results showed that leisure satisfaction and disability acceptance were statistically significant predictors of life satisfaction. This study suggests that leisure satisfaction and positive disability acceptance can contribute to the psychological and physiological well-being of adults with intellectual disability.     

Assessment of Physical Self-Concept in Adolescents with Intellectual Disability: Content and Factor Validity of the Very Short Form of the Physical Self-Inventory

The purpose of this study was to test the factor validity and reliability of the Very Short Form of the Physical Self-Inventory- (PSI-VSF) within a sample of adolescents with mild to moderate Intellectual Disability (ID). A total of 362 ID adolescents were involved in two studies. In Study 1, the content and format scale response of the PSI-VSF were adapted for adolescents with ID. This instrument was thus renamed PSI-VSF-ID and two versions with two alternative responses scales format, were developed: Likert and graphical. In Study 2, results provided support for: (1) the factorial validity and reliability; and (2) factorial invariance across gender, age, type of school placement and ID level of the PSI-VSF-ID associated with a graphical response scale format.     

Role of Impulsivity and Other Personality Dimensions in Attempted Suicide with Self-Poisoning among Children and Adolescents

The objective of this study was to clarify the role of impulsivity and personality dimensions in attempted suicide among youth. The study included 120 youths who attempted suicide and 100 matched controls. Attempters of suicide had higher total scores and subscales of impulsivity than controls. They had higher novelty seeking, harm avoidance, and reward dependence scores, lower scores on persistence, self-directedness, and cooperativeness. A total of 77.5% of suicide attempters had psychiatric disorders compared to 2% of controls. Main factors predicting the occurrence of suicidal attempts were the presence of psychiatric disorder, impulsivity, stressful life events, and high reward dependence of suicide attempters. The study supports that impulsivity and personality traits play an important role in youth suicide independently or as a part of other interacting factors.     

Comparing Observations and Perceptions of Mother-adolescent Conflict: Youth with Typical Development,Intellectual Disability,or Autism Spectrum Disorders

ABSTRACT

Introduction: While transitioning to adulthood presents challenges for youth with developmental disabilities (DD), opportunities to develop adult social roles and communication skills may foster more optimal outcomes. One such opportunity is developing conflict resolution skills within parent-adolescent relationships.

Methods: We examined how reported conflict and observed conflict resolution behaviors differed between adolescents with typical development or DD, specifically intellectual disability (ID) and/or autism spectrum disorder, and their mothers. Participants (n = 167) were mid-adolescents (age 15) from a longitudinal study of how psychopathology develops in youth with or without DD.

Results: While mothers’ Reported Conflict was similar across groups, Mother Problem Solving was highest, and Youth Problem Solving lowest, in families of youth with ID. Higher Reported Conflict related to more negative observed conflict resolution behaviors across all groups.

Conclusions: Results are considered in the context of transitioning to adulthood.     

A Focus Group Study of Police Officers' Recognition of Individuals with Intellectual Disability

Many societies require that individuals with an intellectual disability are provided with some protections when interacting with their justice systems. Police officers are often the first members of the justice system to make contact with offenders, victims, and witnesses, so their capacity to recognize that an individual requires additional supports is of paramount importance. This study used focus group methodology to determine how police in Queensland, Australia, recognized an individual as having an intellectual disability. Appearance was the most commonly nominated characteristic, followed by language difficulties, problems with comprehension, inappropriate behaviour for age, and problem behaviour. Invariable use of an appropriate screening tool is recommended as the only reliable method of ensuring that police officers identify individuals with an intellectual disability.     

Retrospective Study of Quetiapine in Children and Adolescents with Pervasive Developmental Disorders

A retrospective study was conducted in a clinic specialized in treating individuals with developmental disabilities to examine the effectiveness and tolerability of quetiapine in children and adolescents with pervasive developmental disorders. Ten consecutive outpatients (age = 12.0 ± 5.1 years) treated with quetiapine (dose = 477 ± 212 mg, duration = 22.0 ± 10.1 weeks) were identified and six were judged to be responders based on impressions from chart review and Conners Parent Scale (CPS). Improvements were observed in the conduct, inattention, and hyperactivity subscales of the CPS. Adverse events were mild with sedation being the most common, and no patient required treatment termination. Quetiapine may be beneficial in children and adolescents with pervasive developmental disorders, however open-label and double-blind, placebo-controlled studies are warranted.