51
|
|
52
|
Saemundsen E, Juliusson H, Hjaltested S, Gunnarsdottir T, Halldorsdottir T, Hreidarsson S, Magnusson P. Prevalence of autism in an urban population of adults with severe intellectual disabilities--a preliminary study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2010; 54:727-735. [PMID: 20633201 DOI: 10.1111/j.1365-2788.2010.01300.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Research on the prevalence of autism in Iceland has indicated that one possible explanation of fewer autism cases in older age groups was due to an underestimation of autism in individuals with intellectual disabilities (IDs). The present study systematically searched for autism cases in the adult population of individuals with severe ID living in the city of Reykjavik, Iceland. METHODS Potential participants (n = 256) were recruited through the Regional Office for the Affairs of the Handicapped in Reykjavik. First, a screening tool for autism was applied, followed by the Childhood Autism Rating Scale and finally the Autism Diagnostic Interview-Revised (ADI-R). RESULTS The point prevalence of severe ID was 3.7/1000 (95% CI 3.2-4.1) with a male-female ratio of 1.2:1. Participation rate in the study was 46.5%. Participants were younger than non-participants and more often residents of group homes. The prevalence of autism was 21% (25/119) (95% CI 14.7-29.2) with a male-female ratio of 1.8:1. Of the individuals with autism, 10/25 (40%) were verbal according to the ADI-R definition, and 18/25 (72%) had active epilepsy and/or other neurological conditions and handicaps. CONCLUSION The study identified twice the number of autism cases than those previously recognised within the service system. Autism is a prevalent additional handicap in individuals with severe ID, which should always be considered in this population. There are indications that the estimated prevalence of autism found should be considered minimal.
Collapse
Affiliation(s)
- E Saemundsen
- State Diagnostic and Counselling Centre, Division of Autism, Kopavogur, Iceland.
| | | | | | | | | | | | | |
Collapse
|
53
|
Kaufman L, Ayub M, Vincent JB. The genetic basis of non-syndromic intellectual disability: a review. J Neurodev Disord 2010; 2:182-209. [PMID: 21124998 PMCID: PMC2974911 DOI: 10.1007/s11689-010-9055-2] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 06/25/2010] [Indexed: 11/06/2022] Open
Abstract
Intellectual disability (ID), also referred to as mental retardation (MR), is frequently the result of genetic mutation. Where ID is present together with additional clinical symptoms or physical anomalies, there is often sufficient information available for the diagnosing physician to identify a known syndrome, which may then educe the identification of the causative defect. However, where co-morbid features are absent, narrowing down a specific gene can only be done by ‘brute force’ using the latest molecular genetic techniques. Here we attempt to provide a systematic review of genetic causes of cases of ID where no other symptoms or co-morbid features are present, or non-syndromic ID. We attempt to summarize commonalities between the genes and the molecular pathways of their encoded proteins. Since ID is a common feature of autism, and conversely autistic features are frequently present in individuals with ID, we also look at possible overlaps in genetic etiology with non-syndromic ID.
Collapse
|
54
|
Wriedt E, Wiberg A, Sakar V, Noterdaeme M. [Psychiatric disorders and neurological comorbidity in children with intellectual disability]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2010; 38:201-7; quiz 208-9. [PMID: 20464661 DOI: 10.1024/1422-4917/a000033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This article gives an overview of the consultant child and adolescent psychiatric services in the region of Upper Bavaria (Germany). METHOD The data of 257 children and adolescents with intellectual disability and psychiatric disorders were evaluated. RESULTS About 14% of the children with ID in special schools or day care centers, and 40% of the children with ID in residential care showed a definite psychiatric disorder. The most frequently diagnosed disorders were adjustment disorders, hyperkinetic disorders and conduct disorders, as well as emotional problems and pervasive developmental disorders. Children with severe intellectual disability had more additional somatic disorders and were more impaired in their psychosocial functions. CONCLUSIONS The results show the need for psychiatric services for children and adolescents with intellectual disability and psychiatric disorders. The development and implementation of integrative and interdisciplinary models is necessary to allow for adequate medical care for these patients.
Collapse
Affiliation(s)
- Elke Wriedt
- Heckscher Klinikum für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, München.
| | | | | | | |
Collapse
|
55
|
Hatton C, Emerson E. Poverty and the mental health of families with a child with intellectual disabilities. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.mppsy.2009.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
56
|
Matson JL, Shoemaker M. Intellectual disability and its relationship to autism spectrum disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2009; 30:1107-1114. [PMID: 19604668 DOI: 10.1016/j.ridd.2009.06.003] [Citation(s) in RCA: 357] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Intellectual disability (ID) and autism spectrum disorders (ASDs) covary at very high rates. Similarly, greater severity of one of these two disorders appears to have effects on the other disorder on a host of factors. A good deal of research has appeared on the topic with respect to nosology, prevalence, adaptive functioning, challenging behaviors, and comorbid psychopathology. The purpose of this paper was to provide a critical review and status report on the research published on these topics. Current status and future directions for better understanding these two covarying disorders was reviewed along with a discussion of relevant strengths and weaknesses of the current body of research.
Collapse
|
57
|
Harries J, Guscia R, Nettelbeck T, Kirby N. Impact of additional disabilities on adaptive behavior and support profiles for people with intellectual disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2009; 114:237-253. [PMID: 19642707 DOI: 10.1352/1944-7558-114.4.237-253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 12/13/2008] [Indexed: 05/28/2023]
Abstract
Numerous researchers have reported a high incidence of additional disabilities coexisting with intellectual disabilities. Although an intuitive link can be made between the existence of multiple disabilities and greater need for support, little has been reported about this relationship. Using measures of adaptive functioning and support needs, we examined the extent to which adaptive and challenging behaviors and consequent support needs (including medical) were impacted by the presence and severity of additional disabilities for individuals with intellectual disabilities. Results show that adaptive behaviors and support needs were meaningfully related to the number and severity of additional disabilities present, whereas this was not so for challenging behaviors. Findings are discussed in terms of contemporary models of disability and functioning.
Collapse
Affiliation(s)
- Julia Harries
- University of Adelaide, school of Psychology, Adelaide, SA 5005, Australia.
| | | | | | | |
Collapse
|
58
|
Thomson A, Maltezos S, Paliokosta E, Xenitidis K. Risperidone for attention-deficit hyperactivity disorder in people with intellectual disabilities. Cochrane Database Syst Rev 2009; 2009:CD007011. [PMID: 19370667 PMCID: PMC7387848 DOI: 10.1002/14651858.cd007011.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is increasingly recognised as occurring in people with intellectual disability (ID), although treatment of ADHD in this population has not ben tested widely. Risperidone has been used to treat ADHD in people with ID, although the evidence for its effectiveness is unclear. OBJECTIVES To examine the effectiveness of risperidone for the treatment of attention deficit hyperactivity disorder in people with intellectual disabilities. SEARCH STRATEGY In February 2009, MEDLINE, PsycINFO, EMBASE, AMED, ISI Web of Science and WorldCat Dissertations were searched using an extensive list of synonyms for ADHD and ID. CENTRAL, CCDPLP, Current Controlled Trials meta-register (mRCT), CenterWatch, NHS National Research Register, clinicaltrials.gov were searched, pharmaceutical companies and experts in the field were contacted. Reference lists of review articles were examined and citation searches were performed in ISI Web of Knowledge. SELECTION CRITERIA All randomised controlled trials (RCTs), both published and unpublished, in any language, in which children or adults with ADHD and ID were treated with risperidone. DATA COLLECTION AND ANALYSIS Data collection and analyses were planned but not performed due to a lack of suitable studies. MAIN RESULTS Eleven studies were considered but none were suitable for inclusion. AUTHORS' CONCLUSIONS There is no evidence from RCTs that risperidone is effective for the treatment of ADHD in people with ID. Prescribing in this population can only be based on open-label studies or extrapolation from research in people with autism and disruptive behaviour disorders; however these studies have not investigated people with ID separately so there are reservations regarding the applicability of these findings. Research into effectiveness and tolerability is urgently needed.
Collapse
Affiliation(s)
- Alex Thomson
- Section of Brain Maturation (P050), Kings College London, Institute of Psychiatry, De Crespigny Park, London, UK, SE5 8AF.
| | | | | | | |
Collapse
|
59
|
Thomson A, Maltezos S, Paliokosta E, Xenitidis K. Amfetamine for attention deficit hyperactivity disorder in people with intellectual disabilities. Cochrane Database Syst Rev 2009; 2009:CD007009. [PMID: 19160313 PMCID: PMC7388934 DOI: 10.1002/14651858.cd007009.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is increasingly recognised as occurring in people with intellectual disability (ID), although treatment of ADHD in this population has not been tested widely. Amfetamine has been used to treat ADHD in people with and without ID, although the evidence for its efficacy in people with ID is unclear. OBJECTIVES To examine the effectiveness of amfetamine for the treatment of attention deficit hyperactivity disorder in people with intellectual disabilities. SEARCH STRATEGY MEDLINE, PsycINFO, EMBASE, AMED, ISI Web of Science and WorldCat Dissertations were searched using an extensive list of synonyms for ADHD and ID. CENTRAL, Current Controlled Trials meta-register (mRCT), CenterWatch, NHS National Research Register, clinicaltrials.gov were searched in August 2007. Pharmaceutical companies and experts in the field were contacted. Reference lists of review articles were examined and citation searches were performed in ISI Web of Knowledge. SELECTION CRITERIA All randomised controlled studies, both published and unpublished, in any language, in which children or adults with ADHD and ID were treated with amfetamine. DATA COLLECTION AND ANALYSIS Data were extracted independently by two reviewers using a standardised extraction sheet. Risk of bias was assessed by two authors using a standardised framework. Meta-analyses were planned but were not performed due to a lack of suitable studies. MAIN RESULTS Only one study was suitable for inclusion. This was a cross-over study in 15 children with ADHD, ID and Fragile X syndrome. Duration of treatment was only one week. No significant difference was reported between amfetamine and placebo for any of the ADHD measures, but significantly more side effects were reported while taking amfetamine, mainly mood lability and irritability. AUTHORS' CONCLUSIONS There is very little evidence for the effectiveness of amfetamine for ADHD in people with ID . Prescribing in this population is based on extrapolation of research in people without ID. More research into effectiveness and tolerability is urgently needed.
Collapse
Affiliation(s)
- Alex Thomson
- Section of Brain Maturation (P050), Institute of Psychiatry, Kings College London, De Crespigny Park, London, UK, SE5 8AF.
| | | | | | | |
Collapse
|
60
|
Genetic correlation between autistic traits and IQ in a population-based sample of twins with autism spectrum disorders (ASDs). J Hum Genet 2009; 54:56-61. [DOI: 10.1038/jhg.2008.3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
61
|
Briegel W, Schneider M, Schwab KO. 22q11.2 deletion syndrome: behaviour problems of children and adolescents and parental stress. Child Care Health Dev 2008; 34:795-800. [PMID: 18785970 DOI: 10.1111/j.1365-2214.2008.00850.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND 22q11.2 deletion syndrome can be associated with a variety of somatic symptoms, developmental delays and psychiatric disorders. At present, there is little information on behaviour problems, parental stress and possible relations between these factors. Therefore, this study investigates behaviour problems of children and adolescents with 22q11.2DS, and their primary caregivers' stress. METHODS Parents of 4-17 year old subjects known to the German 22q11.2 deletion syndrome foundation were anonymously asked to fill out several questionnaires, e.g. the Child Behavior Checklist 4-18 (CBCL/4-18). RESULTS The primary caregivers of 77/126 children [43 males, 34 females, mean age: 8;0 (4;0-16;11) years] sent back filled-out questionnaires. Forty-six of 76 subjects were rated as clinical on at least one of the CBCL-scales. Males had significantly higher scores on the total problems scale and the internalizing problems scale than females. The patients' age correlated with several CBCL-scales. Eleven of 49 subjects were suspicious of an autism spectrum disorder. Compared with the general population, but not with other parents of mentally and/or physically handicapped children, the primary caregivers experienced higher levels of stress, but showed normal life satisfaction. CONCLUSIONS In spite of high rates of clinical behaviour problems among children and adolescents with 22q11.2DS and despite increased parental stress, most primary caregivers seem to have effective coping strategies, e.g. partnership support, to sustain normal levels of life satisfaction.
Collapse
Affiliation(s)
- W Briegel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Leopoldina Hospital, Schweinfurt, Germany.
| | | | | |
Collapse
|
62
|
Sheerin FK. Diagnoses and Interventions Pertinent to Intellectual Disability Nursing*. ACTA ACUST UNITED AC 2008; 19:140-9. [DOI: 10.1111/j.1744-618x.2008.00102.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
63
|
Bryson SE, Bradley EA, Thompson A, Wainwright A. Prevalence of autism among adolescents with intellectual disabilities. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:449-59. [PMID: 18674403 DOI: 10.1177/070674370805300710] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To estimate the prevalence of autism in an epidemiologically-derived population of adolescents with intellectual disabilities (ID). METHOD The prevalence of autism was examined using the Autism Diagnostic Interview-Revised, with appropriate care taken in assessing lower functioning individuals and those with additional physical and sensory impairments. Individual assessment during psychological evaluation, and consensus classification of complex cases, involving clinicians experienced in the assessment of autism, contributed to the identification of autism. RESULTS Overall, 28% of individuals, or 2.0 of the 7.1/1000 with ID in the target population (as we have previously identified in another study), were identified with autism. Autism rates did not differ significantly across severe ID (32.0%) and mild ID (24.1%); males predominated (2.3 males to 1 female), but less so for severe ID (2 males to 1 female, compared with 2.8 males to 1 female for mild ID). Socioeconomic status did not distinguish the groups with and without autism. Less than one-half of the adolescents who met diagnostic criteria for autism were previously diagnosed as such. CONCLUSIONS Our overall prevalence estimate for autism is in the higher range of estimates reported in previous studies of ID (more so for mild ID). This likely reflects the changes in diagnostic criteria for autism that have subsequently occurred. Discussion focuses on the identification of autism in the population with ID, and on the implications for service delivery and clinical training.
Collapse
Affiliation(s)
- Susan E Bryson
- Department of Pediatrics, Dalhousie University-IWK Health Centre, Halifax, Nova Scotia.
| | | | | | | |
Collapse
|
64
|
Gothelf D, Goraly O, Avni S, Stawski M, Hartmann I, Basel-Vanagaite L, Apter A. Psychiatric morbidity with focus on obsessive-compulsive disorder in an Israeli cohort of adolescents with mild to moderate mental retardation. J Neural Transm (Vienna) 2008; 115:929-36. [PMID: 18351287 DOI: 10.1007/s00702-008-0037-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 02/26/2008] [Indexed: 10/22/2022]
Abstract
The study evaluated the prevalence of DSM-IV-TR-defined psychiatric disorders in adolescents with mental retardation, with a focus on obsessive-compulsive disorder (OCD), for which data at present are sparse. Eighty-seven adolescents with mild to moderate mental retardation attending the Israeli special-education system were screened for psychiatric disorders in general and obsessive-compulsive symptoms in particular. Sixty-one percent had at least one psychiatric disorder. Of the 13 participants receiving antipsychotic medication, none had an underlying psychotic disorder and most had anxiety or depressive disorders. OCD was detected in 11% of participants and was characterized by high rates of psychiatric comorbidities. The severity of autistic symptoms predicted 39% of the variance in the severity of OCD symptoms. Adolescents with mild to moderate mental retardation have high rates of psychiatric morbidities that are often inappropriately treated. OCD is prevalent in this population and is strongly associated with autistic symptoms. Further studies are required in adolescents with mental retardation to better delineate psychiatric morbidities and their appropriate treatment in this at-risk population.
Collapse
Affiliation(s)
- Doron Gothelf
- The Behavioral Neurogenetics Center, Feinberg Department of Child Psychiatry, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
| | | | | | | | | | | | | |
Collapse
|
65
|
Emerson E, Hatton C. Mental health of children and adolescents with intellectual disabilities in Britain. Br J Psychiatry 2007; 191:493-9. [PMID: 18055952 DOI: 10.1192/bjp.bp.107.038729] [Citation(s) in RCA: 383] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few studies have employed formal diagnostic criteria to determine the prevalence of psychiatric disorders in contemporaneous samples of children with and without intellectual disabilities. AIMS To establish the prevalence of psychiatric disorders against ICD-10 criteria among children with and without intellectual disabilities, the association with social/environmental risk factors, and risk attributable to intellectual disability. METHOD Secondary analysis of the 1999 and 2004 Office for National Statistics surveys of the mental health of British children and adolescents with (n=641) and without (n=17 774) intellectual disability. RESULTS Prevalence of psychiatric disorders was 36% among children with intellectual disability and 8% among children without (OR=6.5). Children with intellectual disabilities accounted for 14% of all British children with a diagnosable psychiatric disorder. Increased prevalence was particularly marked for autistic-spectrum disorder (OR=33.4), hyperkinesis (OR=8.4) and conduct disorders (OR=5.7). Cumulative risk of exposure to social disadvantage was associated with increased prevalence. CONCLUSIONS A significant proportion of the elevated risk for psychopathology among children with intellectual disability may be due to their increased rate of exposure to psychosocial disadvantage.
Collapse
Affiliation(s)
- Eric Emerson
- Institute for Health Research, Lancaster University, Lancaster, UK.
| | | |
Collapse
|
66
|
Kanavin OJ, Woldseth B, Jellum E, Tvedt B, Andresen BS, Stromme P. 2-methylbutyryl-CoA dehydrogenase deficiency associated with autism and mental retardation: a case report. J Med Case Rep 2007; 1:98. [PMID: 17883863 PMCID: PMC2045671 DOI: 10.1186/1752-1947-1-98] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Accepted: 09/20/2007] [Indexed: 11/18/2022] Open
Abstract
Background 2-methylbutyryl-CoA dehydrogenase deficiency or short/branched chain acyl-CoA dehydrogenase deficiency (SBCADD) is caused by a defect in the degradation pathway of the amino acid L-isoleucine. Methods We report a four-year-old mentally retarded Somali boy with autism and a history of seizures, who was found to excrete increased amounts of 2-methylbutyryl glycine in the urine. The SBCAD gene was examined with sequence analysis. His development was assessed with psychometric testing before and after a trial with low protein diet. Results We found homozygosity for A > G changing the +3 position of intron 3 (c.303+3A > G) in the SBCAD gene. Psychometric testing showed moderate mental retardation and behavioral scores within the autistic spectrum. No beneficial effect was detected after 5 months with a low protein diet. Conclusion This mutation was also found in two previously reported cases with SBCADD, both originating from Somalia and Eritrea, indicating that it is relatively prevalent in this population. Autism has not previously been described with mutations in this gene, thus expanding the clinical spectrum of SBCADD.
Collapse
Affiliation(s)
- Oivind J Kanavin
- Department of Pediatrics, Ullevål University Hospital, Oslo, Norway
| | - Berit Woldseth
- Department of Clinical Chemistry, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway
| | - Egil Jellum
- Department of Clinical Chemistry, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway
| | - Bjorn Tvedt
- Department of Pediatrics, Ullevål University Hospital, Oslo, Norway
| | - Brage S Andresen
- Research Unit for Molecular Medicine, Skejby Sygehus, DK 8200, Århus N, Denmark
- Institute of Human Genetics, Aarhus University, Aarhus, Denmark
| | - Petter Stromme
- Department of Pediatrics, Ullevål University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| |
Collapse
|
67
|
Taggart L, McMullan P. An exploratory study of teachers' knowledge about the symptoms of depression in young people with and without intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2007; 11:183-95. [PMID: 17613593 DOI: 10.1177/1744629507076931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Research has shown that children and young people with intellectual disabilities are at a greater risk of developing a psychiatric disorder than their non-disabled peers. However, no information exists regarding teachers' knowledge of the signs and symptoms of these conditions. Using a postal questionnaire, 36 teachers working within schools for children and young people with severe intellectual disabilities in one part of the UK were asked about their knowledge of depression. Results indicated that the teachers reported few signs and symptoms. Furthermore, the teachers also highlighted a lack of confidence in working with this doubly disadvantaged population. This study shows that teachers have a vital role to play in the early recognition of psychiatric signs and symptoms in young people with intellectual disabilities. Teachers must also receive the appropriate education and training in an attempt to prompt early referral to specialists for a detailed and comprehensive psychiatric assessment rather than continuing to manage such young people's challenging behaviours.
Collapse
|
68
|
Simonoff E, Pickles A, Wood N, Gringras P, Chadwick O. ADHD symptoms in children with mild intellectual disability. J Am Acad Child Adolesc Psychiatry 2007; 46:591-600. [PMID: 17450050 DOI: 10.1097/chi.0b013e3180323330] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether the nature and correlates of attention-deficit/hyperactivity disorder (ADHD) symptoms are different in subjects with mild intellectual disability (ID) compared to subjects with average ability. METHOD From a general population sample of 2,726 12- to 15-year-olds, a stratified subsample was selected to enrich for mild ID. A total of 192 subjects were included in the analyses. ADHD symptoms and other emotional/behavioral problems were measured with the parent and teacher Strengths and Difficulties Questionnaire and IQ with the WISC-III-UK), and social communication difficulties were assessed by a short version of the Social Communication Questionnaire and academic attainments by the Wechsler Quicktest. RESULTS There was a negative linear relationship between ADHD symptoms and IQ (beta = -.087, p <.001). The relationship could not be explained by inappropriate rater expectations. Neither the profiles of ADHD symptoms nor the comorbidity with emotional/behavioral problems differed according to the presence of ID. When IQ was accounted for, the group difference in attainments was nonsignificant. CONCLUSIONS ADHD symptoms are increased in people with ID. We found no evidence that this increase can by explained by inappropriate expectations or by confounding associations with other emotional/behavioral or cognitive problems.
Collapse
Affiliation(s)
- Emily Simonoff
- Dr. Simonoff and Ms. Wood are with the Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, London; Dr. Pickles is with the Biostatistics Group, Division of Epidemiology and Health Science, University of Manchester, Manchester, UK; Dr. Gringras is with Guy's and St. Thomas' Hospitals NHS Trust, London; and Dr. Chadwick is with the Department of Psychology, King's College London, Institute of Psychiatry, London.
| | - Andrew Pickles
- Dr. Simonoff and Ms. Wood are with the Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, London; Dr. Pickles is with the Biostatistics Group, Division of Epidemiology and Health Science, University of Manchester, Manchester, UK; Dr. Gringras is with Guy's and St. Thomas' Hospitals NHS Trust, London; and Dr. Chadwick is with the Department of Psychology, King's College London, Institute of Psychiatry, London
| | - Nicky Wood
- Dr. Simonoff and Ms. Wood are with the Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, London; Dr. Pickles is with the Biostatistics Group, Division of Epidemiology and Health Science, University of Manchester, Manchester, UK; Dr. Gringras is with Guy's and St. Thomas' Hospitals NHS Trust, London; and Dr. Chadwick is with the Department of Psychology, King's College London, Institute of Psychiatry, London
| | - Paul Gringras
- Dr. Simonoff and Ms. Wood are with the Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, London; Dr. Pickles is with the Biostatistics Group, Division of Epidemiology and Health Science, University of Manchester, Manchester, UK; Dr. Gringras is with Guy's and St. Thomas' Hospitals NHS Trust, London; and Dr. Chadwick is with the Department of Psychology, King's College London, Institute of Psychiatry, London
| | - Oliver Chadwick
- Dr. Simonoff and Ms. Wood are with the Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, London; Dr. Pickles is with the Biostatistics Group, Division of Epidemiology and Health Science, University of Manchester, Manchester, UK; Dr. Gringras is with Guy's and St. Thomas' Hospitals NHS Trust, London; and Dr. Chadwick is with the Department of Psychology, King's College London, Institute of Psychiatry, London
| |
Collapse
|
69
|
Briegel W, Schneider M, Schwab KO. 22q11.2 deletion syndrome: behaviour problems of infants and parental stress. Child Care Health Dev 2007; 33:319-24. [PMID: 17439446 DOI: 10.1111/j.1365-2214.2006.00654.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND 22q11.2 deletion syndrome (22q11.2 DS) can be associated with a variety of somatic symptoms, developmental delays and psychiatric disorders. At present, there is little information on early behaviour problems, and nothing is known about parental stress and possible relations between these factors. Therefore, the aim of this study was to investigate behaviour problems of infants with 22q11.2 DS, and their primary caregivers' stress. METHODS Parents of infants with 22q11.2 DS known to the German 22q11.2 deletion syndrome foundation were anonymously asked to fill out several questionnaires, e.g. the Child Behavior Checklist (CBCL) 1.5-5. RESULTS The primary caregivers of 22/30 children [12 boys and 10 girls aged 1 year 8 months to 3 years 11 months (mean age: 2 years 9 months)] sent back filled-out questionnaires. Seventeen out of 21 children showed motor, and 15/21 language delay. Five out of 21 children were rated as clinical on at least one CBCL 1.5-5 scale. The patients' age was correlated with anxiety problems, and girls had significantly more sleep problems than boys. Compared with the general population, the primary caregivers did not experience higher levels of strain, and compared with parents of mentally and/or physically handicapped children, their parental stress was significantly lower. Parental stress and strain were correlated to a variety of child behaviour problems, e.g. externalizing and anxious/depressed behaviour. CONCLUSIONS Longitudinal studies are required to show whether behaviour problems and parental stress worsen when 22q11.2 DS patients grow older.
Collapse
Affiliation(s)
- W Briegel
- Department of Child and Adolescent Psychiatry, Leopoldina Hospital, Gustav-Adolf-Strasse 4, 97422 Schweinfurt, Germany.
| | | | | |
Collapse
|
70
|
Koskentausta T, Iivanainen M, Almqvist F. Risk factors for psychiatric disturbance in children with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2007; 51:43-53. [PMID: 17181602 DOI: 10.1111/j.1365-2788.2006.00871.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Children with intellectual disability (ID) have a higher risk for psychiatric disturbance than their peers with normal intelligence, but research data on risk factors are insufficient and partially conflicting. METHOD The subjects comprised 75 children with ID aged 6-13 years. Data were obtained from case files and the following four questionnaires completed by their parents or other carers: Developmental Behaviour Checklist, American Association of Mental Deficiency (AAMD) Adaptive Behavior Scale, a questionnaire on additional disabilities, and a questionnaire on family characteristics and child development. RESULTS The risk of psychopathology was most significantly increased by moderate ID, limitations in adaptive behaviour, impaired language development, poor socialization, living with one biological parent, and low socio-economic status of the family. CONCLUSIONS The risk of psychopathology in children with ID is increased by factors related to family characteristics and child development. Identifying these factors will help diagnose and possibly prevent psychiatric disorders in these children.
Collapse
|
71
|
Sarimski K. Psychische Störungen bei behinderten Kindern und Jugendlichen - Übersicht und Schlussfolgerungen für die Psychodiagnostik. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2007; 35:19-29; quiz 30-1. [PMID: 17230426 DOI: 10.1024/1422-4917.35.1.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Es wird eine Übersicht über die Studien zur Prävalenz psychischer Störungen bei Hörschädigung, Blindheit, körperlicher oder intellektueller Behinderung gegeben. Neben Entwicklungseinschränkungen in Folge von organischen oder genetischen Bedingungen tragen Belastungen der Eltern-Kind-Beziehung und der Entwicklung sozialer Kompetenzen sowie der sozialen Partizipation zu einem deutlich erhöhten Risiko für die Ausbildung emotionaler oder sozialer Störungen bei. Probleme der psychopathologischen Beurteilung sowie der Differenzierung zwischen Auswirkungen der Behinderung und psychischer Störung werden diskutiert und Schlussfolgerungen für die Praxis gezogen.
Collapse
|
72
|
Whitaker S, Read S. The Prevalence of Psychiatric Disorders among People with Intellectual Disabilities: An Analysis of the Literature. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2006. [DOI: 10.1111/j.1468-3148.2006.00293.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
73
|
Hastings RP. Longitudinal Relationships Between Sibling Behavioral Adjustment and Behavior Problems of Children with Developmental Disabilities. J Autism Dev Disord 2006; 37:1485-92. [PMID: 17006776 DOI: 10.1007/s10803-006-0230-y] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Accepted: 08/15/2006] [Indexed: 01/22/2023]
Abstract
Siblings of children with developmental disabilities were assessed twice, 2 years apart (N = 75 at Time 1, N = 56 at Time 2). Behavioral adjustment of the siblings and their brother or sister with developmental disability was assessed. Comparisons of adjustment for siblings of children with autism, Down syndrome, and mixed etiology mental retardation failed to identify group differences. Regression analysis showed that the behavior problems of the child with developmental disability at Time 1, but not the change in their behavior over time, predicted sibling adjustment over 2 years. There was no evidence that this putative temporal relationship operated bidirectionally: sibling adjustment did not appear to be related to the behavior problems of the children with developmental disabilities over time.
Collapse
Affiliation(s)
- Richard P Hastings
- School of Psychology, University of Wales Bangor, Bangor, Gwynedd LL57 2AS, UK.
| |
Collapse
|
74
|
Handen BL, Gilchrist R. Practitioner review: Psychopharmacology in children and adolescents with mental retardation. J Child Psychol Psychiatry 2006; 47:871-82. [PMID: 16930381 DOI: 10.1111/j.1469-7610.2006.01588.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of psychotropic medication to treat children and adults with mental retardation (MR) has a long and extensive history. There are no identified medications to address specific cognitive deficits among persons with MR. Instead, psychotropic medications are used to treat specific behavioral symptoms and/or psychiatric syndromes. The purpose of this review is to provide an overview of the recent literature regarding the use of psychotropic medications in this population, focusing primarily on children and adolescents. METHODS The paper is divided into five general drug categories: psychostimulants, antipsychotics, antidepressants, mood stabilizers, and other drugs. Each section offers an overview of the research supporting the use of that class of medications in children and adolescents with MR as well as cautions regarding potential side effects. Finally, specific clinical recommendations are offered. RESULTS The majority of studies in MR tend to be open trials, case reports, or controlled studies with small samples. The available data suggests that persons with MR respond to various psychotropic medications in ways similar to the typically developing population. However, rates of response tend to be poorer and the occurrence of side effects tends to be more frequent. CONCLUSIONS The use of psychotropic medications in children and adolescents with MR requires even greater monitoring and the use of lower doses and slower dosage increases than in the general population.
Collapse
Affiliation(s)
- Benjamin L Handen
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | | |
Collapse
|
75
|
Wallander JL, Dekker MC, Koot HM. Risk factors for psychopathology in children with intellectual disability: a prospective longitudinal population-based study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2006; 50:259-68. [PMID: 16507030 DOI: 10.1111/j.1365-2788.2005.00792.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
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.
Collapse
Affiliation(s)
- J L Wallander
- Sociometrics Corporation, Los Altos, CA 94022-2812, USA.
| | | | | |
Collapse
|
76
|
Guralnick MJ. Peer Relationships and the Mental Health of Young Children with Intellectual Delays. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2006. [DOI: 10.1111/j.1741-1130.2006.00052.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
77
|
Whitaker S, Read S. The Prevalence of Psychiatric Disorders among People with Intellectual Disabilities: An Analysis of the Literature. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2006. [DOI: 10.1111/j.1468-3148.2005.00293.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
78
|
Emerson E, Graham H, Hatton C. The Measurement of Poverty and Socioeconomic Position in Research Involving People with Intellectual Disability. INTERNATIONAL REVIEW OF RESEARCH IN MENTAL RETARDATION VOLUME 32 2006. [DOI: 10.1016/s0074-7750(06)32003-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
79
|
Niccols A, Feldman M. Maternal sensitivity and behaviour problems in young children with developmental delay. INFANT AND CHILD DEVELOPMENT 2006. [DOI: 10.1002/icd.468] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
80
|
Nachshen JS, Minnes P. Empowerment in parents of school-aged children with and without developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2005; 49:889-904. [PMID: 16287478 DOI: 10.1111/j.1365-2788.2005.00721.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Despite the widespread use of the term 'empowerment' in clinical literature to describe both a desirable process and the outcome of service delivery, the term remains more of a theoretical than practical construct. This study examined the factors that contribute to empowerment in parents of school-aged children with and without developmental disabilities (DD) using the Double ABCX model of family adaptation contrasted with the linear ACBX model. METHODS Parents of children with (n = 100, 97% mothers) and without (n = 100, 98% mothers) DD completed questionnaires relating to child behaviour problems, parent stress and well-being, and formal and informal support. Structural equation modelling was used RESULTS Parents of children with DD reported more child behaviour problems, more stress, less well-being and more social support than parents of children without DD. Structural equation modelling supported the ACBX model for both groups. A linear relationship was found in which parent well-being and resources mediated the relationship between the stressor (child behaviour problems) and the outcome (empowerment). CONCLUSIONS The results of the current study support Hastings and Taunt's assertion in 2002, in that empowerment was adequately explained using a traditional model of family functioning. The significant prediction offered by the parent's resources points to the need to deliver services in a manner that is more family-centred. In the education system, this means providing parents with clear messages regarding the schools goals, clarifying the parent's rights and responsibilities, including the parent in planning and decision making, respecting their knowledge as caregivers and supporting their hopes for their child.
Collapse
Affiliation(s)
- J S Nachshen
- Queen's University, Department of Psychology, Kingston, Ontario, Canada.
| | | |
Collapse
|
81
|
Hastings RP, Beck A, Daley D, Hill C. Symptoms of ADHD and their correlates in children with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2005; 26:456-68. [PMID: 16168883 DOI: 10.1016/j.ridd.2004.10.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2004] [Revised: 09/28/2004] [Accepted: 10/15/2004] [Indexed: 05/04/2023]
Abstract
Existing research suggests that children with intellectual disabilities are at increased risk for ADHD, and that the symptoms of the disorder might successfully be treated with stimulant drugs. However, there has been little exploration of ADHD symptoms and their correlates in children with intellectual disabilities. Analyses of three samples of children with intellectual disabilities are presented (total N=338). Correlational analyses showed that younger children, and those with a diagnosis of Autism were rated as having more ADHD/hyperactivity symptoms. There was little evidence of a sex difference, and no strong associations with domains of adaptive behavior (socialization, communication, and daily living skills). However, there was a small but significant negative association between mental age and ratings of symptoms. Finally, an increased prevalence of ADHD/hyperactivity symptoms was confirmed in the children with intellectual disabilities compared to their siblings. This effect remained after controlling for chronological and mental age differences between the siblings. These findings support those from previous research and suggest that ADHD/Hyperkinesis may be a valid psychiatric diagnosis for children with intellectual disabilities. However, a great deal more research is needed to explore the phenomenology of ADHD in intellectual disability and to develop an evidence base for psychosocial intervention.
Collapse
Affiliation(s)
- Richard P Hastings
- School of Psychology, University of Wales Bangor, Bangor, Gwynedd, Wales LL57 2AS, UK.
| | | | | | | |
Collapse
|
82
|
Eisenhower AS, Baker BL, Blacher J. Preschool children with intellectual disability: syndrome specificity, behaviour problems, and maternal well-being. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2005; 49:657-71. [PMID: 16108983 PMCID: PMC3072759 DOI: 10.1111/j.1365-2788.2005.00699.x] [Citation(s) in RCA: 279] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Children with intellectual disability (ID) are at heightened risk for behaviour problems and diagnosed mental disorder. Likewise, mothers of children with ID are more stressed than mothers of typically developing children. Research on behavioural phenotypes suggests that different syndromes of ID may be associated with distinct child behavioural risks and maternal well-being risks. In the present study, maternal reports of child behaviour problems and maternal well-being were examined for syndrome-specific differences. METHODS The present authors studied the early manifestation and continuity of syndrome-specific behaviour problems in 215 preschool children belonging to 5 groups (typically developing, undifferentiated developmental delays, Down syndrome, autism, cerebral palsy) as well as the relation of syndrome group to maternal well-being. RESULTS At age 3, children with autism and cerebral palsy showed the highest levels of behaviour problems, and children with Down syndrome and typically developing children showed the lowest levels. Mothers of children with autism reported more parenting stress than all other groups. These syndrome-specific patterns of behaviour and maternal stress were stable across ages 3, 4 and 5 years, except for relative increases in behaviour problems and maternal stress in the Down syndrome and cerebral palsy groups. Child syndrome contributed to maternal stress even after accounting for differences in behaviour problems and cognitive level. CONCLUSIONS These results, although based on small syndrome groups, suggest that phenotypic expressions of behaviour problems are manifested as early as age 3. These behavioural differences were paralleled by differences in maternal stress, such that mothers of children with autism are at elevated risk for high stress. In addition, there appear to be other unexamined characteristics of these syndromes, beyond behaviour problems, which also contribute to maternal stress.
Collapse
Affiliation(s)
- A S Eisenhower
- Department of Psychology, University of California, Los Angeles, CA 90095, USA.
| | | | | |
Collapse
|
83
|
Baker BL, Blacher J, Olsson MB. Preschool children with and without developmental delay: behaviour problems, parents' optimism and well-being. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2005; 49:575-90. [PMID: 16011551 DOI: 10.1111/j.1365-2788.2005.00691.x] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Children with intellectual disability are at heightened risk for behaviour problems, and these are known to increase parenting stress. This study explored the relation of behaviour problems to less child-related domains of parent well-being (depression and marital adjustment), as well as the moderating effect of a personality trait, dispositional optimism. METHOD Participating children (N = 214) were classified as developmentally delayed, borderline, or nondelayed. Mothers' and fathers' well-being and child behaviour problems were assessed at child ages 3 and 4 years. RESULTS Parents of delayed and nondelayed preschoolers generally did not differ on depression or marital adjustment, but child behaviour problems were strongly related to scores on both measures. Optimism moderated this relationship, primarily for mothers. When child behaviour problems were high, mothers who were less optimistic reported lower scores on measures of well-being than did mothers who were more optimistic. CONCLUSIONS Interventions for parents that aim to enhance both parenting skills and psychological well-being should be available in preschool. It may be beneficial for such programmes to focus not only on behaviour management strategies aimed at child behaviour change, but also on parents' belief systems, with the aim of increasing dispositional optimism.
Collapse
Affiliation(s)
- B L Baker
- Department of Psychology, University of California, Los Angeles, CA 90095, USA.
| | | | | |
Collapse
|
84
|
Emerson E, Robertson J, Wood J. Emotional and behavioural needs of children and adolescents with intellectual disabilities in an urban conurbation. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2005; 49:16-24. [PMID: 15634308 DOI: 10.1111/j.1365-2788.2005.00658.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Over the past decade, increased attention has been paid to identifying and responding to the emotional and behavioural needs of children and adolescents with intellectual disability (ID). The aims of the present study were to add to this body of knowledge by identifying factors associated with emotional and behavioural needs among a sample of children with ID drawn from a large urban conurbation. METHOD Information was collected by postal questionnaire (or interview for family carers who did not have English as their first language) from teachers and from family carers of 615 children administratively identified as having ID (47% of all children with ID). RESULTS Results indicated that: (1) the administrative prevalence of moderate but not severe ID was associated with social deprivation whereas the prevalence of severe but not moderate ID appeared to be associated with ethnicity; (2) 54% of children scored above the threshold on the Developmental Behaviour Checklist (DBC)-primary family carer, and 37% of children scored above the threshold on the DBC-teacher; (3) social deprivation, male gender, less severe ID and having fewer physical or sensory impairments were associated with antisocial and disruptive behaviour; and (4) more severe ID and additional impairments were associated with anxiety, communication disturbance, social relating and self-absorbed behaviours. CONCLUSIONS These results identify a range of risk factors associated with behavioural and emotional problems experienced by children with ID.
Collapse
Affiliation(s)
- E Emerson
- Institute for Health Research, Lancaster University, UK.
| | | | | |
Collapse
|
85
|
Verri AP, Maraschio P, Uggetti C, Pucci E, Ronchi G, Nespoli L, Destefani V, Ramponi A, Federico A. Late diagnosis in severe and mild intellectual disability in adulthood. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2004; 48:679-686. [PMID: 15357688 DOI: 10.1111/j.1365-2788.2003.00593.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND The diagnosis of intellectual disability (ID) is highly dependent on a comprehensive personal and family medical history, a complete physical examination and a careful developmental assessment of the patient. Our study intended to: (1) classify the aetiology of mild and severe ID in an adult population of 140 Italian subjects; (2) evaluate the frequency of associated medical conditions; (3) evaluate the age of diagnosis in both groups; and (4) underline the importance of aetiological diagnosis for adult ID patients also. METHODS The study involved 140 consecutive adult Italian ID inpatients and outpatients neurologically investigated at the Neurological Institute C. Mondino of Pavia Service for Mental Retardation. A total of 80 patients had mild ID (MID group) (39 females, 41 males), mean age 34 years (range 19-61 years), mean IQ = 64 (range 51-75), and 60 had severe ID (SID group) (32 females, 28 males), mean age 30 years (range 19-69 years). They underwent a complete diagnostic work-up that comprised prenatal, perinatal and postnatal history, physical examinations, laboratory investigations, genetic survey and neuroradiological investigations to determine the aetiology of ID and to evaluate the presence of associated medical conditions. RESULTS ID aetiology was classified as prenatal in 34% of the MID and 28% of the SID group. Perinatal and postnatal events were found in 6% of the MID and in 5% of the SID group. Associated medical conditions were found in 97 patients (47% MID and 26% SID). A genetic diagnosis was possible in 6% of patients above 20 years of age and in 5% of patients above 40 years. A diagnosis of cerebral dysgenesis was possible in 5% of patients above 20 years and 4% of patients above 40 years. CONCLUSIONS A long interval between the diagnosis of ID and the aetiological definition can be observed in a significant percentage (24%) of our population, leading to unfortunate consequences of late diagnosis: late onset of a specific therapeutic program, genetic counselling that is frequently no more useful, and ineffective prenatal diagnosis, leading to the birth of other affected subjects (for familiar ID).
Collapse
Affiliation(s)
- A P Verri
- Neurological Institute C. Mondino, via Palestro, Pavia, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
86
|
Blomqvist M, Holmberg K, Fernell E, Dahllöf G. A retrospective study of dental behavior management problems in children with attention and learning problems. Eur J Oral Sci 2004; 112:406-11. [PMID: 15458498 DOI: 10.1111/j.1600-0722.2004.00150.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Attention and learning problems in children are common. The aim of this study was to investigate whether children with attention and learning problems had more dental behavior management problems (BMP), more cancelled and missed appointments, and more traumatic dental injuries compared with a control group. All children born in 1991 attending mainstream schools (n = 555) in one Swedish municipality were screened for behavioral and learning problems. Conners' 10-item questionnaire and a questionnaire focused on executive and learning problems were used. A total of 128 screen-positive patients were index cases and 131 screen-negative patients control cases. The dental records of these children were studied from 1 yr of age until the child reached 10 yr. Behavior management problems on at least one occasion were more common in the index group (54% vs. 37%). The percentage of appointments at which the children exhibited BMP was higher in the index group (13% vs. 7%). No differences were found for cancelled or missed appointments or dental traumatic injuries between the two groups. In conclusion, the results of this study show that children with attention and learning problems had significantly more dental behavior management problems compared with a control group.
Collapse
Affiliation(s)
- My Blomqvist
- Department of Pediatric Dentistry, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | |
Collapse
|
87
|
Scior K, Grierson K. Service Provision for Young People with Intellectual Disabilities and Additional Mental Health Needs: Service-providers' Perspectives. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2004. [DOI: 10.1111/j.1468-3148.2004.00193.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
88
|
Koskentausta T, Iivanainen M, Almqvist F. CBCL in the assessment of psychopathology in Finnish children with intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2004; 25:341-354. [PMID: 15193669 DOI: 10.1016/j.ridd.2003.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2003] [Revised: 11/07/2003] [Accepted: 12/16/2003] [Indexed: 05/24/2023]
Abstract
Structured checklists have been used to supplement psychiatric assessment of children with normal intelligence, but for children with intellectual disability, only a few checklists exist. We evaluated the Child Behavior Checklist (CBCL) in the assessment of psychopathology in Finnish children with intellectual disability. The CBCL was completed by parents or other carers of 90 children aged 6-13 years. Of the 118 CBCL problem items, the lowest scores were for 'Suicidal talks' and 'Alcohol, drugs', and the highest score for 'Acts too young'. Total Problem, Internalizing, and Externalizing scores were highest among children with moderate intellectual disability and lowest among those with profound intellectual disability. Externalizing scores were significantly higher among children with mild or moderate intellectual disability than among those with severe or profound intellectual disability. Compared with the original normative samples, Total Problem scores were higher in the present study. With a T-score cut-off point of 60, the rated frequency of psychiatric disorders was 43%. We conclude that, despite certain limitations, the CBCL can be used in the assessment of psychopathology among children with mild intellectual disability but is less reliable for those with moderate, severe, or profound intellectual disability.
Collapse
Affiliation(s)
- Terhi Koskentausta
- Department of Psychiatry, Central Hospital of Päijät-Häme, Keskussairaalankatu 7, 15850 Lahti, Finland.
| | | | | |
Collapse
|
89
|
Kishore MT, Nizamie A, Nizamie SH, Jahan M. Psychiatric diagnosis in persons with intellectual disability in India. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2004; 48:19-24. [PMID: 14675227 DOI: 10.1111/j.1365-2788.2004.00579.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND This study examines the rate of psychiatric diagnosis as per ICD-10 and Reiss Screen for Maladaptive Behaviours (RSMB), and distribution of psychiatric diagnosis with regard to the severity of intellectual disability (ID). It also explores the degree of agreement between Reiss screen and clinical diagnosis (ICD-10) in relation to dual diagnosis. METHODS In this study Intelligence (IQ) and Social Quotient (SQ) were estimated on Indian adaptation of Binet's scale and Vineland Social Maturity Scales, respectively, in 60 consecutive persons with ID. Both ICD-10 and RSMB were used independently to determine the presence of psychiatric diagnosis. RESULTS Clinically, according to ICD-10, about 60% of the sample was found to have dual diagnosis as compared to 48% on RSMB. Agreement between ICD-10 and RSMB about psychiatric comorbidity was 82%. Commonest psychiatric diagnosis was unspecified psychosis followed by bipolar affective disorders. CONCLUSION Persons with ID do suffer from various psychiatric disorders. RSMB is a useful tool for differentiating between psychiatric problems and maladaptive behaviours. Hence RSMB can be used in the Indian context.
Collapse
Affiliation(s)
- M T Kishore
- Central Institute of Psychiatry, Ranchi, India
| | | | | | | |
Collapse
|
90
|
Baker BL, McIntyre LL, Blacher J, Crnic K, Edelbrock C, Low C. Pre-school children with and without developmental delay: behaviour problems and parenting stress over time. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2003; 47:217-30. [PMID: 12787154 DOI: 10.1046/j.1365-2788.2003.00484.x] [Citation(s) in RCA: 409] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Children with intellectual disability are at heightened risk for behaviour problems and diagnosed mental disorder. METHODS The present authors studied the early manifestation and continuity of problem behaviours in 205 pre-school children with and without developmental delays. RESULTS Behaviour problems were quite stable over the year from age 36-48 months. Children with developmental delays were rated higher on behaviour problems than their non-delayed peers, and were three times as likely to score in the clinical range. Mothers and fathers showed high agreement in their rating of child problems, especially in the delayed group. Parenting stress was also higher in the delayed group, but was related to the extent of behaviour problems rather than to the child's developmental delay. CONCLUSIONS Over time, a transactional model fit the relationship between parenting stress and behaviour problems: high parenting stress contributed to a worsening in child behaviour problems over time, and high child behaviour problems contributed to a worsening in parenting stress. Findings for mothers and fathers were quite similar.
Collapse
Affiliation(s)
- B L Baker
- Department of Psychology, University of California, Los Angeles, CA 90095, USA.
| | | | | | | | | | | |
Collapse
|
91
|
Emerson E. Mothers of children and adolescents with intellectual disability: social and economic situation, mental health status, and the self-assessed social and psychological impact of the child's difficulties. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2003; 47:385-399. [PMID: 12787168 DOI: 10.1046/j.1365-2788.2003.00498.x] [Citation(s) in RCA: 216] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Few large-scale studies with well-constructed samples have compared the socio-economic circumstances and social impact of raising a child with intellectual disability (ID). The aims of the present paper were to: (1) compare the socio-economic situation of mothers raising a child with ID to that of mothers of non-ID children; (2) assess the contribution of raising a child with ID to negative psychological outcomes for mothers; and (3) identify variables associated with negative psychological outcomes among mothers of children with ID. METHODS The 1999 Office for National Statistics survey, Mental Health of Children and Adolescents in Great Britain, 1999, collected information on a multistage stratified random sample of 10 438 children between 5 and 15 years of age across 475 postal code sectors in England, Scotland and Wales. Secondary analysis was undertaken of the social and economic circumstances, and stress reported by 245 mothers of sampled children with ID and a comparison group of 9 481 mothers of sampled children who did not have ID. RESULTS The results indicate that: (1) families supporting a child with ID were significantly economically disadvantaged when compared with families supporting a child who did not have ID; (2) when compared with mothers of sampled children who did not have ID, mothers of sampled children with ID reported that their child's difficulties resulted in greater social and psychological impact; (3) having a child with ID marginally reduced the odds of mothers screening positive for having mental health problems (once all other variables were taken into account); and (4) among mothers of children with ID, mental health problems were associated with the child's difficulties having a greater social impact, having a boy, the child experiencing more than one potentially stressful life event, poverty, receipt of means-tested welfare benefits and 'unhealthy' family functioning. CONCLUSIONS These results highlight the importance of combating poverty among children with ID and their families, and the need to develop more complex models of understanding and intervention.
Collapse
Affiliation(s)
- E Emerson
- Institute for Health Research, Lancaster University, Lancaster, UK.
| |
Collapse
|
92
|
Emerson E. Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2003; 47:51-58. [PMID: 12558695 DOI: 10.1046/j.1365-2788.2003.00464.x] [Citation(s) in RCA: 326] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND There have been very few population-based studies of the prevalence of psychiatric disorders among children and adolescents with and without intellectual disability (ID). METHODS Secondary analysis of the 1999 Office for National Statistics survey of the Mental Health of Children and Adolescents in Great Britain was performed. This survey collected information on a multistage, stratified, random sample of 10 438 children between 5 and 15 years of age across 475 postcode sectors in England, Scotland and Wales. RESULTS The prevalence of any diagnosed ICD-10 disorder, conduct disorder, anxiety disorder, hyperkinesis and pervasive developmental disorders were significantly greater among children with ID than among their non-ID peers. There were no statistically significant differences between children with and without ID with regard to the prevalence of depressive disorders, eating disorders or psychosis. Factors associated with an increased risk of psychopathology among children and adolescents with ID included age, gender, social deprivation, family composition, number of potentially stressful life events, the mental health of the child's primary carer, family functioning and child management practices. CONCLUSIONS Children and adolescents with ID are at significantly increased risk of certain forms of psychiatric disorder. Careful consideration of the social and economic adversity facing such families will be necessary to ensure that support services are responsive to both the needs of child as well as the needs of the family in which they are living.
Collapse
Affiliation(s)
- E Emerson
- Institute for Health Research, Lancaster University, Lancaster, UK.
| |
Collapse
|
93
|
Leonard H, Wen X. The epidemiology of mental retardation: challenges and opportunities in the new millennium. MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS 2002; 8:117-34. [PMID: 12216056 DOI: 10.1002/mrdd.10031] [Citation(s) in RCA: 379] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
There are a number of problems and challenges in relating the science of epidemiology to mental retardation (MR). These relate to how MR is defined and classified and how these definitions may change over time. These as well as other differences in ascertainment sources and methods need to be considered when comparing MR prevalence over time and place. On the other hand, advances in technology also provide new and efficient methods of data collection both by data linkage and by use of web-based methods to study rare diseases. While prevalence studies have not been individually reviewed, we have examined the range of data including recent studies relating to how prevalence differs according to age, gender, social class and ethnicity. Some problems with available etiological classification systems have been identified. Recent etiological studies, most of which use different classification systems, have been reviewed and explanations have been postulated to account for differences in results. Individual risk factors for MR are considered whilst the option of considering a population as opposed to a high risk strategy to MR prevention is raised. This might well involve improving the social milieu surrounding the occurrence of individual risk factors. The impact of biotechnological advances such as antenatal and neonatal screening and assisted reproduction on MR are discussed. The issue of how inequalities in access to technology may impact on case identification and even have the potential to further widen inequalities is raised. The importance of extending the use of epidemiological tools to study the social, health and economic burden of MR is also emphasized. However, in order to apply to MR the "prevention-intervention-research" cycle, which surely underpins all epidemiology, it is vital to ensure that the methodological challenges we raise are adequately addressed.
Collapse
Affiliation(s)
- Helen Leonard
- Centre for Child Health Research, The University of Western Australia, Telethon Institute for Child Health Research, West Perth, Australia.
| | | |
Collapse
|
94
|
Hastings RP, Mount RH. Early Correlates of Behavioural and Emotional Problems in Children and Adolescents with Severe Intellectual Disabilities: a Preliminary Study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2002. [DOI: 10.1046/j.13602322.2001.00079.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
95
|
Hastings RP, Brown T, Mount RH, Cormack KF. Exploration of psychometric properties of the developmental behavior checklist. J Autism Dev Disord 2001; 31:423-31. [PMID: 11569588 DOI: 10.1023/a:1010668703948] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The Developmental Behavior Checklist (DBC; Einfeld & Tonge, 1995) is one of a very small number of psychopathology assessment instruments designed specifically for use with children and adolescents with mental retardation. In the present study, a factor analysis of the DBC was performed using a sample of 531 children and adolescents. This analysis revealed a factor structure sharing a good deal of overlap with the factor analyses of the DBC's developers. Furthermore, the high levels of internal consistency of the DBC subscales were replicated. Further research and development is needed on the DBC and other instruments for children and adolescents with mental retardation.
Collapse
Affiliation(s)
- R P Hastings
- Centre for Behavioural Research, Analysis, and Intervention in Developmental Disabilities, Department of Psychology, University of Southampton, United Kingdom.
| | | | | | | |
Collapse
|