Discovery of previously undetected intellectual disability by psychological assessment: a study of consecutively referred child and adolescent psychiatric inpatients

A Scoping Review of the Intersectionality of Autism and Intellectual and Developmental Disability with Social Inequity on Diagnosis and Treatment of Youth

Objective: To describe how the intersectionality of race, ethnicity, and language with autism and intellectual and developmental disability (IDD) impacts mental health inequities in psychopharmacological management of youth. Method: This was a scoping review in which a series of searches were conducted in PubMed, Web of Science, Google Scholar, and manual review of the articles collected. Results: Although autism and/or IDD increases the risk for poor physical and mental health, social determinants of health such as race, ethnicity, and language account for approximately a third of poor outcomes. Minoritized children with autism/IDD experience significantly greater delays to diagnosis and misdiagnosis and are less likely to receive appropriate services. Access to psychological testing and psychosocial services is often limited by availability, skilled practitioners, a shortage of non-English-language providers or interpreters, and poor reimbursement. Conclusion: The intersectionality of autism and/or IDD with race, ethnicity, and language compounds the health inequities associated with either of these challenges independently.

Adolescent inpatient mental health services in the UK

Inpatient mental health services are an indispensable part of the mental healthcare for adolescents. They provide comprehensive assessment and treatment for young people severely affected by mental health difficulties whose presentation is associated with high level of risk or where diagnostic clarity and effective intervention cannot be achieved with less intensive community input. In the UK, a range of different mental health units have been developed with the aim to meet the needs of young people requiring admission with the appropriate expertise and in the least restrictive way possible. Although an inpatient admission is necessary and helpful for a number of adolescents, it may also be linked to some adverse effects that need to be carefully assessed and managed when such an option is considered or pursued. Collaborative working between inpatient units, community teams and young people and their families is paramount in ensuring that inpatient interventions form part of a wider treatment plan, are as efficient and effective as possible and are used in a way that fosters engagement, independence and optimal outcomes.

Psychiatric comorbidities of mild intellectual disability in children and adolescents in a clinical setting

The aim of this study was to investigate the psychiatric disorders that accompany mild intellectual disability (ID) in school-aged children in a clinical setting. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version interview was conducted with the children with mild ID and their parents to diagnose any comorbid disorders. The mean age of the 111 children that fulfilled the study criteria was 12.09 ± 3.28 years, 59 of them (53.2%) were males, and 80.2% had at least one lifetime comorbid psychiatric diagnosis. Attention deficit hyperactivity disorder (64.9%), oppositional defiant disorder (21.6%), anxiety disorders (18.0%), were the most common comorbidities. The correlates of exhibiting comorbid psychiatric disorder were being male and irritability symptoms in the clinical history. Being aware of the comorbid psychiatric disorders and planning treatment strategies toward all of the diagnoses may help in the adaptation and rehabilitation of children with mild IDs.

A Blind Spot? Screening for Mild Intellectual Disability and Borderline Intellectual Functioning in Admitted Psychiatric Patients: Prevalence and Associations with Coercive Measures

Background

Failure to detect psychiatric patients’ intellectual disabilities may lead to inappropriate treatment and greater use of coercive measures.

Aims

In this prospective dynamic cohort study we screened for intellectual disabilities in patients admitted to psychiatric wards, and investigated the use of coercive measures with these patients.

Methods

We used the Screener for Intelligence and Learning disabilities (SCIL) to screen patients admitted to two acute psychiatric wards, and assessed patient characteristics and coercive measures during their stay and over the last 5 years.

Results

Results on the SCIL suggested that 43.8% of the sample had Mild Intellectual Disability or Borderline Intellectual Functioning (MID/BIF). During their current stay and earlier stays in the previous 5 years, these patients had an increased risk of involuntary admission (OR 2.71; SD 1.28–5.70) and coercive measures (OR 3.95, SD 1.47–10.54).

Conclusions

This study suggests that functioning on the level of MID/BIF is very prevalent in admitted psychiatric patients and requires specific attention from mental health care staff.

The diagnostic adaptive behavior scale: evaluating its diagnostic sensitivity and specificity

The Diagnostic Adaptive Behavior Scale (DABS) was constructed with items across three domains--conceptual, social, and practical adaptive skills--and normed on a representative sample of American individuals from 4 to 21 years of age. The DABS was developed to focus its assessment around the decision point for determining the presence or absence of significant limitations of adaptive behavior for the diagnosis of Intellectual Disability (ID). The purpose of this study, which was composed of 125 individuals with and 933 without an ID-related diagnosis, was to determine the ability of the DABS to correctly identify the individuals with and without ID (i.e., sensitivity and specificity). The results indicate that the DABS sensitivity coefficients ranged from 81% to 98%, specificity coefficients ranged from 89% to 91%, and that the Area Under the Receiver Operating Characteristic Curve were excellent or good. These results indicate that the DABS has very good levels of diagnostic efficiency.