Clinical predictors of severe behavioural problems in people with intellectual disabilities referred to a specialist mental health service

[Immunological parameters in assessing the risk of decompensation in children with mental retardation]

AIM

To analyze the correlation between clinical and immunological parameters in children with mental retardation (MR) in order to explore the possibilities of using immunological data in assessing the severity of patient's condition and predicting a risk of decompensation, exacerbation of mental disorders comorbid to MR.

MATERIAL AND METHODS

Seventy-three school children, aged 8-17 years, mean age 12,6±2,4 years, with MR of different genesis and 64 physically and mentally healthy children (control group) of the same age and sex were studied clinically and immunologically. The degree of clinical severity of MR was evaluated by CGI-S scale (the Clinical global impression-severity), the level of intellectual disabilities was evaluated by the Wechsler Intelligence Scale. Enzymatic activity of leukocyte elastase; functional activity of α1-proteinase inhibitor; levels of autoantibodies to neurospecific antigens - S-100b and myelin basic protein were analyzed in the serum of patients and healthy children.

RESULTS AND CONCLUSION

The activation of the immune system was associated with comorbid to MR current psychopathological disturbances that were more severe, persistent and required long-term maintenance treatment. Analysis of immunological parameters can be used in children with MR treated in outpatient network as an additional test for the detection of mental state decompensation.

Behaviour Problems in Children with Intellectual Disabilities in a Resource-Poor Setting in India - Part 1: Association with Age, Sex, Severity of Intellectual Disabilities and IQ

BACKGROUND

Behaviour problems are most common in people with intellectual disabilities. Nature of behaviour problems can vary depending upon the age, sex and intellectual level (IQ).

OBJECTIVES

This study examined the distribution of behaviour problems across intellectual disability categories and their association with IQ age and sex in children with intellectual disabilities.

METHODS

This is a cross-sectional study design. A total of 104 participants (57 males and 47 females), aged 3-18 years, with intellectual disabilities were administered The Behavioural Assessment Scale for Indian Children with Mental Retardation (BASIC-MR).

RESULTS

It was found that violent and destructive, temper tantrum and self-injurious behaviours were differently distributed with reference to intellectual disability levels (P > 0.05) but cumulative scores per se problem behaviours did not vary with the level of intellectual disabilities. IQ showed a significant positive correlation with destructive and violent and misbehaves with other; and a significant negative correlation with temper tantrums and self-injurious behaviours. Age was significantly, positively associated with violent and destructive, odd, and hyperactive behaviours and inversely with self-injurious problem behaviours. There was no significant relationship between the sex of the child and problem behaviours. There was no significant interactive effect of sex and level of intellectual disabilities of the child on problem behaviours.

CONCLUSION

Behaviour problems, in general, are not equally distributed in all categories of intellectual disabilities. Relationship between behaviour problems and age, sex and IQ may not be uniform. But specific behaviours are more associated with specific age group and intellectual disability levels.

Family burden related to clinical and functional variables of people with intellectual disability with and without a mental disorder

Few studies have been found that to assess the factors that explain higher levels of family burden in adults with intellectual disability (ID) and intellectual disability and mental disorders (ID-MD). The aims of this study were to assess family burden in people with ID and ID-MD and to determine which sociodemographic, clinical and functional disability variables account for family burden. The sample is composed of pairs of 203 participants with disability and their caregivers, of which 33.5% are caregivers of people with ID and 66.5% of ID-MD. Assessments were performed using scales of clinical and functional disability as the following instruments: Weschler Adult Intelligence Scale-III (WAIS-III), Inventory for Client and Agency Planning (ICAP), Psychiatric Assessment Schedule for Adults with Development Disability (PAS-ADD checklist), Disability Assessment Schedule of the World Health Organization (WHO-DAS-II) and family burden (Subjective and Objective Family Burden Inventory - SOFBI/ECFOS-II). People with ID-MD presented higher levels of functional disability than those with ID only. Higher levels of family burden were related to higher functional disability in all the areas (p<0.006-0.001), lower intelligence quotient (p<0.001), diagnosis of ID-MD (p<0.001) and presence of organic, affective, psychotic and behavioral disorders (p<0.001). Stepwise multiple regression showed that behavioral problems, affective and psychotic disorder, disability in participation in society, disability in personal care and presence of ID-MD explained more than 61% of the variance in family burden. An integrated approach using effective multidimensional interventions is essential for both people with ID and ID-MD and their caregivers in order to reduce family burden.

Psychometric properties of the Disability Assessment Schedule (DAS) for behavior problems: an independent investigation

The present study employed the Disability Assessment Schedule (DAS) to assess problem behaviors in a large sample of adults with ID (N=568) and evaluate the psychometric properties of this instrument. Although the DAS problem behaviors were found to be internally consistent (Cronbach's α=.87), item analysis revealed one weak item ('Objectional habits') with item-total biserial correlation of only .20. An exploratory factor analysis revealed two main factors. The first factor consisted of items relating to disruptive/distractive problems. The second factor consisted of items relating to antisocial/delinquent problems. Disruptive/distractive problems were specifically associated with low ID level. Antisocial/delinquent behaviors were specifically associated with male gender, schizophrenia, hospital admission and troubles with police. For patients who had both disruptive/distractive problems and antisocial/delinquent behaviors, personality disorders and autism were more frequent, where as anxiety and depression were less frequent. On the basis of the obtained results, two new DAS subscales for assessing challenging behavior were proposed. Both subscales had good levels of internal consistency, as well as face and criterion validity. Overall, the new DAS subscales were shown to have acceptable psychometric properties and have therefore potential for use in both research and clinical practice.

Epidemiology of mental ill health in adults with intellectual disabilities

PURPOSE OF REVIEW

Adults with intellectual disabilities experience higher rates of mental ill health than the general population. Despite this, the epidemiological knowledge base remains limited. The purpose of this article is to review mental health epidemiological studies relevant to adults with intellectual disabilities, published since January 2008.

RECENT FINDINGS

Several studies have aimed to build the epidemiological evidence base, particularly with regards to problem behaviours, which appear to be remitting-relapsing conditions rather than necessarily being chronic. Most of such work confirms prevalence and incidence rates, and conducts exploratory analyses to determine factors independently related to mental ill health. Down syndrome protects against problem behaviours and mental ill health (except dementia that occurs at a higher rate), whereas epilepsy does not appear to affect risk for mental ill health. Dementia is four times more common in older persons with intellectual disabilities without Down syndrome than in the general population. Persons with borderline intellectual disabilities also experience higher rates of mental ill health than the general population, but receive fewer treatments.

SUMMARY

This work builds usefully upon previous studies. Further hypothesis-based analyses are needed.