1
|
Anacker L, Edwards M, Nonnemacher S, Pinals DA. Attending to Persons with Intellectual and/or Other Developmental Disorders in Crisis Settings. Psychiatr Clin North Am 2024; 47:563-576. [PMID: 39122346 DOI: 10.1016/j.psc.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
Crisis response is growing across the United States with increasingly broad phone, text, and chat response systems that lead to triaging callers who may be in need of further outreach. This might include deploying a mobile crisis response team and/or referring a caller to a crisis stabilization unit. The information set forth earlier aims to help advance the field and individual practices to ensure that persons with intellectual and/or other developmental disorders receive equivalent care and treatment with information that helps focus on this population's unique features and needs.
Collapse
Affiliation(s)
- Lisa Anacker
- Center for Forensic Psychiatry, 8303 Platt Road, Saline, MI 48176, USA
| | - Matthew Edwards
- Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Suite 2204, MC 5723, Stanford, CA 94305, USA
| | - Stacy Nonnemacher
- NASDDDS (National Association of State Directors of Developmental Disabilities Services), P.O. Box 26128, Alexandria, VA 22313, USA
| | - Debra A Pinals
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| |
Collapse
|
2
|
Mirzaian CB, Deavenport-Saman A, Hudson SM, Betz CL. Barriers to Mental Health Care Transition for Youth and Young Adults with Intellectual and Developmental Disabilities and Co-occurring Mental Health Conditions: Stakeholders' Perspectives. Community Ment Health J 2024; 60:1104-1116. [PMID: 38619698 PMCID: PMC11199219 DOI: 10.1007/s10597-024-01262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/25/2024] [Indexed: 04/16/2024]
Abstract
Youth and young adults (YYA) with intellectual and developmental disabilities (IDD) have high rates of co-occurring mental health (MH) conditions. The time during transition from pediatric to adult health and mental health care can be a very challenging, with risk of loss of services leading to poor outcomes. This study aimed to explore barriers to transition from pediatric to adult health and mental health care and services for individuals with IDD and co-occurring MH conditions, by eliciting the view of stakeholders, including disability advocates. Qualitative analysis was conducted using grounded theory, and themes were coded based upon the social-ecological model (SEM). We generated themes into multiple levels: the individual level, the family level, the provider level, the systems of care level, and the societal level. Stakeholders expressed a critical need to improve coordination between systems, and to increase provider availability to care for YYA with IDD and co-occurring MH conditions.
Collapse
Affiliation(s)
- Christine B Mirzaian
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA.
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Alexis Deavenport-Saman
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Sharon M Hudson
- AltaMed Institute for Health Equity, AltaMed Health Services, Los Angeles, CA, USA
| | - Cecily L Betz
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
3
|
Silva IMW, Gil-da-Silva-Lopes VL. Comprehensive insights into health services accessibility and quality of life of families with individuals with 22q11.2 deletion syndrome in Brazil. Orphanet J Rare Dis 2024; 19:255. [PMID: 38971792 PMCID: PMC11227184 DOI: 10.1186/s13023-024-03273-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 07/01/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND The 22q11.2 Deletion Syndrome (22q11.2 DS) presents unique healthcare challenges for affected individuals, families, and healthcare systems. Despite its rarity, 22q11.2 DS is the most common microdeletion syndrome in humans, emphasizing the need to understand and address the distinctive healthcare requirements of those affected. This paper examines the multifaceted issue of health service access and caregivers' quality of life in the context of 22q11.2 DS in Brazil, a condition with diverse signs and symptoms requiring multidisciplinary care. This study employs a comprehensive approach to evaluate health service accessibility and the quality of life of caregivers of individuals with 22q11.2 DS. It utilizes a structured Survey and the WHOQOL-bref questionnaire for data collection. RESULTS Individuals with 22q11.2 DS continue to receive incomplete clinical management after obtaining the diagnosis, even in the face of socioeconomic status that enabled an average age of diagnosis that precedes that found in sample groups that are more representative of the Brazilian population (mean of 3.2 years versus 10 years, respectively). In turn, caring for individuals with 22q11.2 DS who face difficulty accessing health services impacts the quality of life associated with the caregivers' environment of residence. CONCLUSIONS Results obtained help bridge the research gap in understanding how caring for individuals with multisystem clinical conditions such as 22q11.2 DS and difficulties in accessing health are intertwined with aspects of quality of life in Brazil. This research paves the way for more inclusive healthcare policies and interventions to enhance the quality of life for families affected by this syndrome.
Collapse
Affiliation(s)
- Isabela Mayá Wayhs Silva
- Department of Translational Medicine, Medical Genetics and Genomic Medicine Area, Universidade Estadual de Campinas (Unicamp), Tessália Vieira de Camargo Street, 126, Campinas, Sao Paulo, SP, 13083-887, Brazil
| | - Vera Lúcia Gil-da-Silva-Lopes
- Department of Translational Medicine, Medical Genetics and Genomic Medicine Area, Universidade Estadual de Campinas (Unicamp), Tessália Vieira de Camargo Street, 126, Campinas, Sao Paulo, SP, 13083-887, Brazil.
| |
Collapse
|
4
|
Maliszewski-Makowka D, Wieczorek D. Implementation of human genetic counseling in the MZEB (Medical Center for Adults with disabilities) at the psychiatric LVR Clinic Bedburg-Hau. MED GENET-BERLIN 2024; 36:103-109. [PMID: 38854638 PMCID: PMC11154173 DOI: 10.1515/medgen-2024-2026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Outpatient diagnostics for adult patients with intellectual disabilities and developmental disorders were significantly improved when 'Medical Centers for Adults with Disabilities' (MZEB) were established in 2015 in accordance with a new law (§ 119c SGB V). Due to the multi-professional nature of these MZEBs, cooperation with various specialized centers can be initiated. Accordingly, in 2023, a cooperation between the MZEB in the LVR-Clinic Bedburg-Hau and the Institute of Human Genetics, Heinrich-Heine University (HHU) Düsseldorf was initiated. Interdisciplinary consultation hours for adult patients have been established in Bedburg-Hau offering genetic counselling and testing to identify the underlying genetic entity. We will introduce this new structure and report preliminary results.
Collapse
Affiliation(s)
| | - Dagmar Wieczorek
- Institute of Human GeneticsMedical Faculty and University, Hospital DusseldorfMoorenstr. 540225DusseldorfGermany
| |
Collapse
|
5
|
Zemp C, Vallières F, Jama MA, Ali AH, Young K, Jagoe C. The unmet need for mental health support among persons with disabilities in Somalia: Principal correlates and barriers to access. Glob Ment Health (Camb) 2024; 11:e73. [PMID: 39257679 PMCID: PMC11383976 DOI: 10.1017/gmh.2024.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/23/2024] [Accepted: 04/29/2024] [Indexed: 09/12/2024] Open
Abstract
Disability and mental ill-health may be especially prevalent in Somalia, largely due to a protracted armed conflict and its consequent humanitarian crises. Little, if any, research to date, however, has simultaneously explored disability- and mental health-related factors in the Somali context. Using both descriptive and regression analytical techniques, we aimed to determine how increasing levels of functional impairment reported across different disability domains (i.e., visual, hearing and cognition), number of concomitant disabilities, and other empirically supported variables (such as employment and sex) are associated with the likelihood of self-identifying the need for mental health support among a sample (N = 1,355) of Somalis with disabilities, as well as identify the common barriers to such support. Despite most participants self-identifying a need for mental health support, only 15% were able to access it, with the most common barriers being the cost of services and the unavailability of local services. Being female, married, and having increasing levels of functional difficulty in the cognitive, mobility and self-care domains of disability were each significantly associated with an increased likelihood of the self-identified need for mental health support. This study's findings highlight potential points of prioritisation for mental health policy and programming in Somalia. A Somali version of this abstract can be found in the Supplementary Material.
Collapse
Affiliation(s)
- Charles Zemp
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin 2, Ireland
| | - Frédérique Vallières
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin 2, Ireland
| | | | | | - Kirsten Young
- United Nations Human Rights and Protection Group, Mogadishu, Somalia
| | - Caroline Jagoe
- Department of Clinical Speech & Language Studies, Trinity College Dublin, Dublin 2, Ireland
- School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
6
|
Bilder DA, Mthembu M, Worsham W, Aguayo P, Knight JR, Deng SW, Singh TP, Davis J. Developing and Implementing a Web-Based Branching Logic Survey to Support Psychiatric Crisis Evaluations of Individuals With Developmental Disabilities: Qualitative Study and Evaluation of Validity. JMIR Ment Health 2024; 11:e50907. [PMID: 38551644 PMCID: PMC11015367 DOI: 10.2196/50907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Individuals with developmental disabilities (DD) experience increased rates of emotional and behavioral crises that necessitate assessment and intervention. Psychiatric disorders can contribute to crises; however, screening measures developed for the general population are inadequate for those with DD. Medical conditions can exacerbate crises and merit evaluation. Screening tools using checklist formats, even when designed for DD, are too limited in depth and scope for crisis assessments. The Sources of Distress survey implements a web-based branching logic format to screen for common psychiatric and medical conditions experienced by individuals with DD by querying caregiver knowledge and observations. OBJECTIVE This paper aims to (1) describe the initial survey development, (2) report on focus group and expert review processes and findings, and (3) present results from the survey's clinical implementation and evaluation of validity. METHODS Sources of Distress was reviewed by focus groups and clinical experts; this feedback informed survey revisions. The survey was subsequently implemented in clinical settings to augment providers' psychiatric and medical history taking. Informal and formal consults followed the completion of Sources of Distress for a subset of individuals. A records review was performed to identify working diagnoses established during these consults. RESULTS Focus group members (n=17) expressed positive feedback overall about the survey's content and provided specific recommendations to add categories and items. The survey was completed for 231 individuals with DD in the clinical setting (n=161, 69.7% men and boys; mean age 17.7, SD 10.3; range 2-65 years). Consults were performed for 149 individuals (n=102, 68.5% men and boys; mean age 18.9, SD 10.9 years), generating working diagnoses to compare survey screening results. Sources of Distress accuracy rates were 91% (95% CI 85%-95%) for posttraumatic stress disorder, 87% (95% CI 81%-92%) for anxiety, 87% (95% CI 81%-92%) for episodic expansive mood and bipolar disorder, 82% (95% CI 75%-87%) for psychotic disorder, 79% (95% CI 71%-85%) for unipolar depression, and 76% (95% CI 69%-82%) for attention-deficit/hyperactivity disorder. While no specific survey items or screening algorithm existed for unspecified mood disorder and disruptive mood dysregulation disorder, these conditions were caregiver-reported and working diagnoses for 11.7% (27/231) and 16.8% (25/149) of individuals, respectively. CONCLUSIONS Caregivers described Sources of Distress as an acceptable tool for sharing their knowledge and insights about individuals with DD who present in crisis. As a screening tool, this survey demonstrates good accuracy. However, better differentiation among mood disorders is needed, including the addition of items and screening algorithm for unspecified mood disorder and disruptive mood dysregulation disorder. Additional validation efforts are necessary to include a more geographically diverse population and reevaluate mood disorder differentiation. Future study is merited to investigate the survey's impact on the psychiatric and medical management of distress in individuals with DD.
Collapse
Affiliation(s)
- Deborah A Bilder
- University of Utah Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Mariah Mthembu
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Whitney Worsham
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Patricia Aguayo
- University of Utah Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Jacob R Knight
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Steven W Deng
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Tejinder P Singh
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - John Davis
- University of Utah, Salt Lake City, UT, United States
| |
Collapse
|
7
|
Pucci V, La Face A, Gasteiger-Klicpera B, Mondini S. Cognitive reserve proxies for individuals with intellectual developmental disability: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13204. [PMID: 38361365 DOI: 10.1111/jar.13204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/18/2023] [Accepted: 01/09/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Cognitive reserve (CR) has not been studied in people with Intellectual Developmental Disability, a population with a high incidence of dementia. Commonly adopted CR proxies should be adapted to reflect more specifically the experiences of people with Intellectual Developmental Disability. METHOD This scoping review intended to identify CR proxies relevant to people with this condition. RESULTS Some of these were the same already detected in a population without intellectual disabilities (education, occupation, physical activity, leisure, community and social activities); others were found to be specifically relevant for this population: type of schooling, parental educational level, environmental stimulation and living place. CONCLUSIONS These proxies need to be considered in studies on CR and Intellectual Developmental Disability and in clinical practice. Research on the protective effect of CR aims to encourage policies promoting lifestyle-based educational and preventive interventions and overcome participation barriers for people with Intellectual Developmental Disability.
Collapse
Affiliation(s)
- Veronica Pucci
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padova, Italy
- Human Inspired Technology Centre (HIT), University of Padua, Padova, Italy
| | - Annalisa La Face
- Inclusive Education Unit, Institute of Education Research and Teacher Education, University of Graz, Graz, Austria
| | - Barbara Gasteiger-Klicpera
- Inclusive Education Unit, Institute of Education Research and Teacher Education, University of Graz, Graz, Austria
| | - Sara Mondini
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padova, Italy
- Human Inspired Technology Centre (HIT), University of Padua, Padova, Italy
| |
Collapse
|
8
|
Schipper-Eindhoven SM, de Knegt NC, Mevissen L, van Loon J, de Vries R, Zhuniq M, Bekker MHJ. EMDR treatment for people with intellectual disabilities: a systematic review about difficulties and adaptations. Front Psychiatry 2024; 14:1328310. [PMID: 38274435 PMCID: PMC10808451 DOI: 10.3389/fpsyt.2023.1328310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction People with intellectual disabilities (ID) are at increased risk for developing Post Traumatic Stress Disorder (PTSD). Emerging evidence indicates that Eye Movement Desensitization and Reprocessing (EMDR) therapy is feasible and potentially effective for this group. However, communication, cognition, stress regulation, and attachment difficulties may interfere with the EMDR process. Adaptation of the EMDR protocol seems therefore required for this population. Aim This review aims to systematically identify and categorize the difficulties in applying EMDR to people with ID and the adaptations made by therapists to overcome these challenges. Methods A literature search was performed in May 2023. Article selection was based on inclusion and exclusion criteria and quality appraisal. Results After screening, 13 articles remained for further review. The identified difficulties and adaptations were categorized into the three domains of adaptive functioning (i.e., conceptual, social, and practical functioning). Considerable difficulties in applying the EMDR protocol for this group were reported. The adaptations made by therapists to overcome these difficulties were highly variable. They could be divided into three main categories: adaptions in EMDR delivery (e.g., tuning to the developmental level of the client, simplifying language, decreasing pace), involvement of others (e.g., involving family or support staff during or in between sessions), and the therapeutic relationship (e.g., taking more time, supportive attitude). Discussion The variability of the number of mentioned difficulties and adaptations per study seems to be partly related to the specific EMDR protocol that was used. In particular, when the Shapiro adult protocol was administered, relatively more detailed difficulties and adaptations were described than in publications based on derived existing versions of an EMDR protocol for children and adolescents. A probable explanation is that already embedded modifications in these protocols facilitate the needed attunement to the client's level of functioning. Practical implications The authors of this review suggest that EMDR protocols for children and adolescents could be adapted for people with an intellectual disability. Further research should focus on the involvement of trusted others in EMDR therapy for people with ID and the therapeutic relationship from an attachment and relational-based perspective.
Collapse
Affiliation(s)
- Simone M. Schipper-Eindhoven
- Zodiak, Prinsenstichting, Purmerend, Netherlands
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | | | | | - Jos van Loon
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - Ralph de Vries
- Vrije Universiteit, Medical Library, Amsterdam, Netherlands
| | - Majlinda Zhuniq
- Department of Clinical Psychology, Biological Psychology, and Psychotherapy, University of Mannheim, Mannheim, Germany
| | - Marrie H. J. Bekker
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, Netherlands
| |
Collapse
|
9
|
Berg KL, Mihaila I, Feinstein RT, Shiu CS, Gussin H, Acharya K, Gladstone TRG, Bernard L, Best M, Renz E, Abdallah G, Weldy S, Herrman D, Lynch E, Gerges M, Perez P, Buchholz KR, Msall M, Aaron S, Mutti M, Arnold C, Danguilan C, Argueta I, Hunter M, Pela E, Diviak K, Kuhn J, Berbaum ML, Van Voorhees BW. BEhavioral Health Stratified Treatment (B.E.S.T.) to optimize transition to adulthood for youth with intellectual and/or developmental disabilities. Contemp Clin Trials 2024; 136:107374. [PMID: 37898308 DOI: 10.1016/j.cct.2023.107374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/03/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023]
Abstract
Youth with intellectual and/or developmental disabilities (IDD) often struggle with depression and anxiety, which adversely impacts transition to adulthood. Integrated behavioral health care coordination, wherein care coordinators and behavioral health specialists collaborate to provide systematic, cost-effective, patient-centered care, is a promising strategy to improve access to behavioral health services and address factors that impact transition to adulthood, including depression/anxiety symptoms. Current care coordination models (e.g., Title V Maternal and Child Health Bureau [MCHB]) do not include behavioral health services. The CHECK (Coordinated HealthCarE for Complex Kids) mental health model, hereby refined and renamed BEhavioral Health Stratified Treatment (B.E.S.T.), is a behavioral health intervention delivery program designed for integration into care coordination programs. This study aims to determine whether an integrated behavioral health care coordination strategy (i.e., MCHB care coordination plus B.E.S.T.) would be more acceptable and lead to better youth health and transition outcomes, relative to standard care coordination (i.e., MCHB care coordination alone). Results would guide future investment in improving outcomes for youth with IDD. This study is a two-arm randomized clinical trial of 780 transition-aged youth with IDD (13-20 years) to evaluate the comparable efficacy of MCHB Care Coordination alone vs. MCHB Care Coordination plus B.E.S.T. on the following outcomes: 1) decreased symptoms and episodes of depression and anxiety over time; 2) improved health behaviors, adaptive functioning and health related quality of life; 3) increased health care transition (HCT) readiness; and 4) improved engagement and satisfaction with care coordination among stakeholders.
Collapse
Affiliation(s)
- Kristin L Berg
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA; Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | - Iulia Mihaila
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Rebecca T Feinstein
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Cheng-Shi Shiu
- University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Helene Gussin
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Kruti Acharya
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA; Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Tracy R G Gladstone
- Wellesley Centers for Women, Wellesley College, Wellesley, MA 02481, USA; Brown University, Providence, RI, 02912, USA
| | - Leah Bernard
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Megan Best
- University of Illinois, Urbana-Champaign, Champaign, IL 61820, United States of America
| | - Ellie Renz
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Ghada Abdallah
- University of Illinois, Urbana-Champaign, Champaign, IL 61820, United States of America
| | - Sarah Weldy
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Deana Herrman
- Northern Illinois University College of Allied Health and Communicative Disorders, USA
| | - Emma Lynch
- The University of Chicago, Chicago, IL 60637, USA
| | - Michael Gerges
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Patricia Perez
- The University of Illinois Division of Specialized Care for Children, Chicago, IL 60607, USA
| | | | | | | | | | - Catherine Arnold
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Chris Danguilan
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Isai Argueta
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Madeline Hunter
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Emily Pela
- Institute of Health Research and Policy, University of Illinois, Chicago, IL 60608, USA
| | - Kathleen Diviak
- Institute of Health Research and Policy, University of Illinois, Chicago, IL 60608, USA
| | - Jocelyn Kuhn
- Emory University School of Medicine, Department of Pediatrics, USA
| | - Michael L Berbaum
- Institute of Health Research and Policy, University of Illinois, Chicago, IL 60608, USA
| | - Benjamin W Van Voorhees
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| |
Collapse
|
10
|
Jenner LA, Farran EK, Welham A, Jones C, Moss J. The use of eye-tracking technology as a tool to evaluate social cognition in people with an intellectual disability: a systematic review and meta-analysis. J Neurodev Disord 2023; 15:42. [PMID: 38044457 PMCID: PMC10694880 DOI: 10.1186/s11689-023-09506-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/25/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Relatively little is known about social cognition in people with intellectual disability (ID), and how this may support understanding of co-occurring autism. A limitation of previous research is that traditional social-cognitive tasks place a demand on domain-general cognition and language abilities. These tasks are not suitable for people with ID and lack the sensitivity to detect subtle social-cognitive processes. In autism research, eye-tracking technology has offered an effective method of evaluating social cognition-indicating associations between visual social attention and autism characteristics. The present systematic review synthesised research which has used eye-tracking technology to study social cognition in ID. A meta-analysis was used to explore whether visual attention on socially salient regions (SSRs) of stimuli during these tasks correlated with degree of autism characteristics presented on clinical assessment tools. METHOD Searches were conducted using four databases, research mailing lists, and citation tracking. Following in-depth screening and exclusion of studies with low methodological quality, 49 articles were included in the review. A correlational meta-analysis was run on Pearson's r values obtained from twelve studies, reporting the relationship between visual attention on SSRs and autism characteristics. RESULTS AND CONCLUSIONS Eye-tracking technology was used to measure different social-cognitive abilities across a range of syndromic and non-syndromic ID groups. Restricted scan paths and eye-region avoidance appeared to impact people's ability to make explicit inferences about mental states and social cues. Readiness to attend to social stimuli also varied depending on social content and degree of familiarity. A meta-analysis using a random effects model revealed a significant negative correlation (r = -.28, [95% CI -.47, -.08]) between visual attention on SSRs and autism characteristics across ID groups. Together, these findings highlight how eye-tracking can be used as an accessible tool to measure more subtle social-cognitive processes, which appear to reflect variability in observable behaviour. Further research is needed to be able to explore additional covariates (e.g. ID severity, ADHD, anxiety) which may be related to visual attention on SSRs, to different degrees within syndromic and non-syndromic ID groups, in order to determine the specificity of the association with autism characteristics.
Collapse
Affiliation(s)
- L A Jenner
- School of Psychology, University of Surrey, Surrey, UK.
| | - E K Farran
- School of Psychology, University of Surrey, Surrey, UK
| | - A Welham
- School of Psychology, University of Birmingham, Birmingham, UK
| | - C Jones
- School of Psychology, University of Birmingham, Birmingham, UK
| | - J Moss
- School of Psychology, University of Surrey, Surrey, UK
| |
Collapse
|
11
|
Baumer NT, Hojlo MA, Pawlowski KG, Milliken AL, Lombardo AM, Sargado S, Soccorso C, Davidson EJ, Barbaresi WJ. Co-occurring conditions in Down syndrome: Findings from a clinical database. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2023; 193:e32072. [PMID: 37873945 DOI: 10.1002/ajmg.c.32072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023]
Abstract
Individuals with Down syndrome (DS) experience a range of medical and neurodevelopmental conditions, necessitating systematic study of their occurrence and impact on neurodevelopmental outcomes. We describe the prevalence and relationships of medical, neurodevelopmental (ND), and mental health (MH) conditions in children with DS. We created a prospective clinical database of individuals with DS, integrated into the workflow of a specialty Down Syndrome Program at a specialty pediatric referral hospital. Conditions were collected through caregiver- and clinician report at clinical visits (N = 599). We calculated frequencies of medical, ND, and MH conditions and then assessed the relationship between medical, ND, and MH conditions using frequencies and comparative statistics. The most frequent co-occurring conditions were vision (72.5%), ear/hearing (71.0%), gastrointestinal (61.3%), respiratory (45.6%), and feeding (33.6%) problems, with variation in frequency by age. ND and MH conditions were reported in one quarter, most commonly autism spectrum disorder and attention-deficit/hyperactivity disorder. Those with ND and MH conditions had greater frequency of medical conditions, with highest rates of vision, ear/hearing, and gastrointestinal issues, and CHD. Systematically collected clinical data in a large cohort of children with DS reveals high prevalence of several co-occurring medical, ND, and MH conditions. Clinical care requires an understanding of the complex relationship between medical conditions and neurodevelopment.
Collapse
Affiliation(s)
- Nicole T Baumer
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret A Hojlo
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Katherine G Pawlowski
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Anna L Milliken
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Angela M Lombardo
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sabrina Sargado
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Cara Soccorso
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Emily J Davidson
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - William J Barbaresi
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Yang W, Li MH, Yu JJ, Wong SHS, Sum RKW, Sit CHP. The Associations Between Accelerometer-Measured Physical Activity Levels and Mental Health in Children and Adolescents with Intellectual Disabilities During the COVID-19 Pandemic. J Autism Dev Disord 2023; 53:4809-4821. [PMID: 36181649 PMCID: PMC9526382 DOI: 10.1007/s10803-022-05777-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 12/05/2022]
Abstract
To examine the associations between physical activity (PA) levels and mental health in children and adolescents with intellectual disabilities (IDs) during the COVID-19 pandemic, 117 participants aged between 6 and 17 years with IDs from 10 Hong Kong special schools were included. There were positive dose-response associations between PA (i.e., light PA, moderate PA, and vigorous PA) and mental health, and participants with higher levels of moderate-to-vigorous PA (MVPA) and self-concept (SC) had better social quality of life (QoL) than those with lower levels of MVPA and SC. Moreover, personal and environmental factors such as age, body mass index, school, sex, ID level, and parental education level influenced the PA levels and QoL in children and adolescents with IDs.
Collapse
Affiliation(s)
- Wen Yang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ming Hui Li
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jane Jie Yu
- Department of Sport and Exercise Science, Zhejiang University, Hangzhou, China
| | - Stephen Heung-Sang Wong
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Raymond Kim-Wai Sum
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Cindy Hui-Ping Sit
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
13
|
Bertelli MO, Forte L, Bianco A. Updates in the care of youths with intellectual disability and autism spectrum disorder. Curr Opin Psychiatry 2023; 36:455-460. [PMID: 37781976 DOI: 10.1097/yco.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW Since the turn of the new millennium, care for people with intellectual disability/intellectual developmental disorders (IDD) and/or autism spectrum disorder (ASD) has drawn increasing attention because of the continuous prevalence increase of these two conditions, the high health vulnerability, especially mental vulnerability, and the crucial role of care provision in the setting of continued deinstitutionalization and the shift to community care. The present review addresses the main issues related to mental healthcare in youth with IDD and/or ASD with a specific focus on adolescence and transition to adulthood. RECENT FINDINGS Despite the existence of specific recommendations, persons with IDD/ASD lack access to quality mental healthcare within communities, receive inadequate diagnosis and intervention, including medication overuse as well as ineffective residential, educational, employment, financial, and social support services. The lack of a unified care system that provides services across all domains and life ages may be the cause of users' perceptions and experiences of inefficiencies. SUMMARY The scientific community seems to converge on that care should be provided in accordance with principles of interdisciplinarity, life-span view, precision, personalization, and participation. Quality of life appears to be an ideal conceptual reference for care planning and outcome evaluation.
Collapse
Affiliation(s)
- Marco O Bertelli
- CREA (Research and Clinical Centre), Fondazione San Sebastiano, Misericordia di Firenze
| | - Luciana Forte
- CREA (Research and Clinical Centre), Fondazione San Sebastiano, Misericordia di Firenze
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Annamaria Bianco
- CREA (Research and Clinical Centre), Fondazione San Sebastiano, Misericordia di Firenze
| |
Collapse
|
14
|
Sheldrick RC, Marakovitz S, Garfinkel D, Perrin EC, Carter AS. Prevalence and Co-Occurrence of Developmental and Emotional-Behavioral Problems in Young Children. Acad Pediatr 2023; 23:623-630. [PMID: 36417968 PMCID: PMC10149553 DOI: 10.1016/j.acap.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE A limited number of studies have estimated the prevalence of emotional-behavioral disorders among young children. None have assessed their co-occurrence with developmental delays using standardized assessment tools. Our objective was to estimate the prevalence of emotional-behavioral disorders and their co-occurrence with developmental delays among young children (2-5.5 years). METHODS Parents of young children (N = 987) enrolled from pediatric waiting rooms completed developmental-behavioral screening questionnaires. Based on results, 585 families were invited to and 439 completed evaluations that included structured diagnostic interviews with parents to assess child psychopathology (Preschool Age Psychiatric Assessment (PAPA)), developmental testing with children (including the Bayley Scales of Infant and Toddler Development, third Edition for children ≤ 42 months; Differential Ability Scales, second Edition for older children), and videotaped observation to establish whether autism risk was sufficient to warrant further evaluation. RESULTS According to PAPA algorithms, 23.0% of children met criteria for a DSM-IV disorder, while 9% qualified for a developmental delay. Presence of delay doubled the odds of having a DSM-IV disorder (OR = 2.1; CI: 1.02-4.3), and presence of disorder doubled the odds of having a moderate-to-severe developmental delay (OR=2.0; CI: 1.10-3.50). Prevalence of DSM-IV disorders (48.8% (95% CI: 33.5-64.5%)) and developmental delays (57.5% (95% CI: 41.7-71.9%)) were both higher among children at risk for autism. While developmental delay did not vary by race/ethnicity, prevalence of DSM-IV disorders was lower among African-American/Black (10.6%; CI: 2.9-18.3) and Hispanic/Latino children (11.1%; CI: 4.3-17.9). CONCLUSIONS Developmental delays and emotional-behavioral disorders among young children seen in pediatric settings are characterized by high prevalence and substantial co-occurrence.
Collapse
Affiliation(s)
| | - Susan Marakovitz
- Division of Developmental-Behavioral Pediatrics (S Marakovitz, D Garfinkel, and EC Perrin), Tufts Medical Center, Boston, Mass
| | - Daryl Garfinkel
- Division of Developmental-Behavioral Pediatrics (S Marakovitz, D Garfinkel, and EC Perrin), Tufts Medical Center, Boston, Mass
| | - Ellen C Perrin
- Division of Developmental-Behavioral Pediatrics (S Marakovitz, D Garfinkel, and EC Perrin), Tufts Medical Center, Boston, Mass
| | - Alice S Carter
- Department of Psychology (AS Carter), University of Massachusetts Boston
| |
Collapse
|
15
|
Noble N, Fidler T, Bueno N, Lei X, Zatopek A, Lourenco M. The Impact of COVID-19 on College Students with Autism: Implications for College Counselors. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2023. [DOI: 10.1080/87568225.2023.2181254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Nicole Noble
- College of Education, Texas Tech University, Lubbock, Texas, USA
| | - Taylor Fidler
- College of Education, Texas Tech University, Lubbock, Texas, USA
| | - Nicholas Bueno
- College of Education, Texas Tech University, Lubbock, Texas, USA
| | - Xinyue Lei
- College of Education, Texas Tech University, Lubbock, Texas, USA
| | - Audrey Zatopek
- College of Education, Texas Tech University, Lubbock, Texas, USA
| | - Miles Lourenco
- College of Education, Texas Tech University, Lubbock, Texas, USA
| |
Collapse
|
16
|
General Measurement Tools for Assessing Mental Health Problems Among Children and Adolescents with an Intellectual Disability: A Systematic Review. J Autism Dev Disord 2023; 53:132-204. [PMID: 35022944 PMCID: PMC9889433 DOI: 10.1007/s10803-021-05419-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 02/04/2023]
Abstract
There is a need for more knowledge of valid and standardized measures of mental health problems among children and adolescents with intellectual disability (ID). In this study, we systematically reviewed and evaluated the psychometric properties of instruments used to assess general mental health problems in this population. Following PRISMA guidelines, we reviewed empirical research published from 1980 through February 2020 with an updated search in March 2021 in Medline, Embase, PsycINFO, Health and Psychological Instruments, CINAHL, ERIC, and Web of Science databases. Forty-nine empirical articles were included in this review. Overall, the review indicated consistently better documentation of the reliability and validity of instruments designed for the ID population compared to instruments developed for the general child population.
Collapse
|
17
|
Pattnaik JI, Panda UK, Chandran S, Padhy S, Ravan JR. Treatment resistant psychosis in children and adolescents and clozapine: Nuances. Front Psychiatry 2023; 14:1014540. [PMID: 36911129 PMCID: PMC9998521 DOI: 10.3389/fpsyt.2023.1014540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/25/2023] [Indexed: 03/14/2023] Open
Abstract
With proliferation in research on high-risk psychosis spectrum diseases, it is crucial to distinguish a prodrome or psychosis-like episode in children and adolescents from true psychosis. The limited role of psychopharmacology in such circumstances is well-documented, underlining the difficulties in diagnosing treatment resistance. To add to the confusion is emerging data on the head-to-head comparison trials for treatment-resistant and treatment-refractory schizophrenia. Clozapine, the gold-standard drug for resistant schizophrenia and other psychotic psychopathology, lacks FDA or manufacturer guidelines for use in the pediatric population. Possibly due to developmental pharmacokinetic (PK) considerations, clozapine-related side effects are more commonly seen in children than adults. Despite evidence of an increased risk for seizures and hematological problems in children, clozapine is widely used off-label. Clozapine reduces the severity of resistant childhood schizophrenia, aggression, suicidality, and severe non-psychotic illness. There is inconsistent prescribing, administration, and monitoring of clozapine, and limited database evidence-backed guidelines. Despite the overwhelming efficacy, problems remain regarding unambiguous indications of use and risk-benefits assessments. This article reviews the nuances in the diagnosis of treatment resistance psychosis in childhood and adolescents and its management, in particular highlighting the evidence base for clozapine in this population group.
Collapse
Affiliation(s)
| | - Udit Kumar Panda
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suhas Chandran
- Child and Adolescent Psychiatry, St. Johns Medical College and Hospital, Bengaluru, India
| | - Susanta Padhy
- Department of Psychiatry, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
| | | |
Collapse
|
18
|
Presnell J, Keesler JM, Thomas-Giyer J. Assessing Alignment Between Intellectual and Developmental Disability Service Providers and Trauma-Informed Care: An Exploratory Study. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:351-368. [PMID: 36162048 DOI: 10.1352/1934-9556-60.5.351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/24/2022] [Indexed: 06/16/2023]
Abstract
People with intellectual and developmental disabilities (IDD) are disproportionately impacted by potentially traumatic experiences; however, organizations serving this population have lagged in their integration of trauma-informed care (TIC). Trauma-informed care is a systemwide response to the pervasiveness of trauma that frequently requires an organizational shift rooted in staff training. Using an online statewide survey, the present study examined beliefs and training among IDD service providers. Responses from 288 service providers suggested some alignment among beliefs and staff training content with TIC principles. Although the findings indicate a foundation for TIC, intentional efforts are needed for IDD agencies to fully embrace TIC.
Collapse
Affiliation(s)
- Jade Presnell
- Jade Presnell, John M. Keesler, and Jen Thomas-Giyer, Indiana University
| | - John M Keesler
- Jade Presnell, John M. Keesler, and Jen Thomas-Giyer, Indiana University
| | - Jen Thomas-Giyer
- Jade Presnell, John M. Keesler, and Jen Thomas-Giyer, Indiana University
| |
Collapse
|
19
|
Yang W, Liang X, Sit CHP. Physical activity and mental health in children and adolescents with intellectual disabilities: a meta-analysis using the RE-AIM framework. Int J Behav Nutr Phys Act 2022; 19:80. [PMID: 35799257 PMCID: PMC9261031 DOI: 10.1186/s12966-022-01312-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children and adolescents with intellectual disabilities (IDs) tend to have lower levels of physical activity and poorer mental health than their typically developing peers. Studies on the effects of physical activity on the mental health of children with IDs using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework are scarce. METHODS A systematic literature review using six databases (CINAHL, Eric, PsycINFO, PubMed, SPORTDiscus, and Web of Science) was conducted from January 2000 to September 2021. Studies reporting at least one physical activity intervention and mental health outcome in children and adolescents with IDs aged between 5 and 17 years were included in the meta-analysis. Preferred Reporting Items for Systematic Review and Meta-Analysis guideline, Comprehensive Meta-Analysis, and the RE-AIM framework were utilized. RESULTS A total of 15 studies that met the inclusion criteria were included in the meta-analysis. The effects of physical activity on mental health in children and adolescents with IDs were significant and large (Hedges' g = 0.897, p < 0.01), with medium effects on psychological health (Hedges' g = 0.542, p < 0.01) and large effects on cognitive function (Hedges' g = 1.236, p < 0.01). Randomized controlled trial (RCT) design and intervention components (> 120 minutes per week, therapeutic, and aerobic exercise) demonstrated the strongest effects. Moreover, study background (publication year, study location, and sample size), participant characteristics (age and sex), and Maintenance (RE-AIM framework) moderated the effects of physical activity on mental health. Based on the RE-AIM framework, there were higher proportions in the dimensions of Reach and Effectiveness than Adoption, Implementation, and Maintenance. CONCLUSIONS Physical activity appears to have positive effects on mental health, including psychological health and cognitive function, in children and adolescents with IDs. Physical activity interventions using the RE-AIM framework are recommended to assess short- and long-term impacts and translate scientific evidence into practice. TRIAL REGISTRATION The protocol for this meta-analysis was registered with PROSPERO ( CRD42021256543 ).
Collapse
Affiliation(s)
- Wen Yang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Xiao Liang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Cindy Hui-Ping Sit
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| |
Collapse
|
20
|
Edwards G, Jones C, Pearson E, Royston R, Oliver C, Tarver J, Crawford H, Shelley L, Waite J. Prevalence of anxiety symptomatology and diagnosis in syndromic intellectual disability: A systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 138:104719. [PMID: 35661754 DOI: 10.1016/j.neubiorev.2022.104719] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/24/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
Individuals with syndromic intellectual disability are at increased risk of experiencing anxiety. Comparing prevalence estimates of anxiety will allow the identification of at-risk groups and inform causal pathways of anxiety. No known study has explored estimates of anxiety symptomatology and diagnosis, including specific anxiety profiles, across groups whilst accounting for methodological quality of studies. This systematic review and meta-analysis aimed to fill this gap. Prior to review completion, methodology and analysis plans were registered and documented in a protocol (CRD42019123561). Data from 83 papers, involving a pooled sample of 13,708 across eight syndromes were synthesised using a random effects model. Anxiety prevalence ranged from 9 % (95 % CI: 4-14) in Down syndrome to 73% in Rett syndrome (95 % CI: 70-77). Anxiety prevalence across syndromic intellectual disability was higher than for intellectual disability of mixed aetiology and general population estimates. Substantial variability between syndromes identified groups at higher risk than others. The identification of high-risk groups is crucial for early intervention, allowing us to refine models of risk and identify divergent profiles.
Collapse
Affiliation(s)
- Georgina Edwards
- The School of Psychology, College of Health and Life Sciences, Aston University, UK.
| | - Chris Jones
- School of Psychology, University of Birmingham, Edgbaston, UK.
| | - Effie Pearson
- The School of Psychology, College of Health and Life Sciences, Aston University, UK.
| | - Rachel Royston
- School of Psychology, University of Birmingham, Edgbaston, UK.
| | - Chris Oliver
- School of Psychology, University of Birmingham, Edgbaston, UK.
| | - Joanne Tarver
- The School of Psychology, College of Health and Life Sciences, Aston University, UK.
| | - Hayley Crawford
- Mental Health and Wellbeing Unit, Warwick Medical School, University of Warwick, UK.
| | - Lauren Shelley
- The School of Psychology, College of Health and Life Sciences, Aston University, UK.
| | - Jane Waite
- The School of Psychology, College of Health and Life Sciences, Aston University, UK.
| |
Collapse
|
21
|
Munir KM, Roy A, Javed A. The WPA Working Group on Intellectual Developmental Disorders: the need for a second paradigm shift. World Psychiatry 2022; 21:327-328. [PMID: 35524611 PMCID: PMC9077623 DOI: 10.1002/wps.20979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Kerim M. Munir
- WPA Working Group on Intellectual Disabilities/Intellectual Developmental Disorders,Boston Children's Hospital, Harvard Medical SchoolBostonMAUSA
| | - Ashok Roy
- WPA Working Group on Intellectual Disabilities/Intellectual Developmental Disorders,Coventry and Warwickshire Partnership NHS Trust, Brooklands HospitalBirminghamUK
| | - Afzal Javed
- WPA President,Pakistan Psychiatric Research Centre, Fountain HouseLahorePakistan
| |
Collapse
|
22
|
Rostami M, Paik Kim J, Turner-Essel L, Roberts LW. Maternal Perceptions of Safeguards for Research Involving Children. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:1220-1231. [PMID: 35875400 PMCID: PMC9307055 DOI: 10.1007/s10826-021-02037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 05/03/2023]
Abstract
The vitality of clinical research and the health of the public relies on continued efforts to engage children in clinical research in a fully protected and ethically robust manner. Parents serve as proxy decision-makers assessing the risks and benefits of any given study in order to do what is in the best interest of their child. This study investigated maternal perceptions of research safeguards and mothers' willingness to enroll their children in clinical research studies. We hypothesized that mothers' perceptions of the protectiveness of safeguard procedures utilized in clinical research would be associated with mothers' willingness to enroll their children in research studies with such safeguards. Through a survey conducted via Amazon Mechanical Turk, mothers were asked to rate the perceived protectiveness of four safeguard procedures (confidential data coding, data and safety monitoring boards (DSMBs), institutional review boards (IRBs), and informed consent) and the degree to which they were willing to have their child participate in research studies in the presence of each of the four safeguard procedures. Respondents generally perceived safeguard procedures to be protective. Mothers' trust in researchers' honesty positively impacted perceptions of the protectiveness of research safeguard procedures and willingness to enroll children in research. Mothers of only healthy children perceived research safeguards to be more protective than mothers with at least one child with at least one health issue. This study provides insight into whether maternal perceptions of the protectiveness of different safeguard procedures are associated with mothers' willingness to enroll their children in research.
Collapse
Affiliation(s)
- Maryam Rostami
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Jane Paik Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Laura Turner-Essel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Laura Weiss Roberts
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| |
Collapse
|
23
|
Alremawi S, Arabiyat AA. The Effectiveness of a Behavioral Program in Reducing the Aggressive Behavior of Children with Mild Mental Disabilities at the Mu’tah Center for Special Education. Health Psychol Res 2022; 10:32317. [DOI: 10.52965/001c.32317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sameer Alremawi
- Department of Psychology and special education, Al-Balqa Applied University
| | - Ahmed A. Arabiyat
- Department of Psychology and special education, Al-Balqa Applied University
| |
Collapse
|
24
|
Silva IMW, Gil-da-Silva-Lopes VL. An overview of the trajectory of Brazilian individuals with 22q11.2 deletion syndrome until diagnosis. Orphanet J Rare Dis 2022; 17:67. [PMID: 35189940 PMCID: PMC8862281 DOI: 10.1186/s13023-022-02225-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 02/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background 22q11.2 deletion syndrome (22q11.2DS) is a rare disease with an important characteristic—clinical heterogeneity. The diversity of organs, regions, and systems of the body that can be affected requires periodic updating of health professionals so that they can recognize these clinical signs as belonging to 22q11.2DS. Updated professionals are equally important for the appropriate and timely clinical management of individuals with a positive diagnosis. In this context, this article aimed to map and analyze the access to healthcare for individuals with 22q11.2DS until the moment of diagnosis. Results We analyzed the clinical data of 111 individuals with 22q11.2DS registered in the Brazilian Database on Craniofacial Anomalies (BDCA) from 2008 to 2020. In this study, individuals were diagnosed at a median age of 9 years (mean = 9.7 years). Before the genetic investigation, they accessed 68.75% of the internationally recommended evaluations available at BDCA. Recurrent 22q11.2DS clinical manifestations such as delayed neuropsychomotor development, lip and/or palate defects, cardiac malformation and/or hematological/immunological alteration co-occurred in at least 72.06% of individuals. Cardiac malformation was the only clinical alteration that lowered the median diagnostic age, corresponding to 6.5 years of age with a cardiac malformation versus 11 years of age without one (p = 0.0006). Conclusions In Brazil, 22q11.2 DS is under-recognized, and early diagnosis and management of affected individuals are still a distant reality. In this sense, 22q11.2 DS suspicion followed by the elimination of obstacles for its diagnosis confirmation is essential to increase life expectancy and improve the quality of life of these individuals in Brazil.
Collapse
|
25
|
Mutluer T, Aslan Genç H, Özcan Morey A, Yapici Eser H, Ertinmaz B, Can M, Munir K. Population-Based Psychiatric Comorbidity in Children and Adolescents With Autism Spectrum Disorder: A Meta-Analysis. Front Psychiatry 2022; 13:856208. [PMID: 35693977 PMCID: PMC9186340 DOI: 10.3389/fpsyt.2022.856208] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/29/2022] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED Psychiatric comorbidity in autism spectrum disorder (ASD) is a subject of critical scientific importance, affecting the quality of life, prognosis, and functional outcomes. The prevalence of psychiatric disorders vary considerably according to variables such as index subject characteristics, study setting, sampling frame, diagnostic methods used, as well as country of geographic origin. To date, most studies comprise clinical or treatment referral samples in tertiary care or subjects enrolled in clinical trials and genetic cohort collections. Such samples carry the potential for overestimation of both the frequency and severity of psychiatric comorbidity. A systematic literature search was performed using PubMed and Web of Science databases restricted to population-based study publications in the English between May 1, 2015, and May 31, 2020. A comprehensive keyword list was generated to investigate co-occurrence of psychiatric disorders in children and adolescents with ASD. A wide range of DSM-5 based disorders such as anxiety, mood, ADHD, intellectual disability/intellectual developmental disorder, eating/feeding, gender dysphoria and sleep-wake disorders were assessed. Initial search revealed a total of 1674 articles after removal of duplicates. Two independent researchers conducted a parallel-blinded screening process to identify the eligible studies based on titles and abstracts; 39 studies were analyzed in the current review. The main findings show prevalence estimates of 22.9% (95% CI: 17.7- 29.2) for intellectual disability; 26.2% (22-31) for attention-deficit hyperactivity disorder; 11.1% (8.6-14.1) for anxiety disorders; 19.7% (11.9-30.7) for sleep disorders; 7% (5.2- 9.3) for disruptive disorders; 2% (1.3- 3.1) for bipolar disorders; 2.7% (1.8- 4.2) for depression; 1.8% (0.4-8.7) for obsessive-compulsive disorder; and 0.6% (0.3-1.1) for psychosis. Psychiatric comorbidity in population-based studies is lower than in clinical and referred samples. However, our results also indicate that the frequency of psychiatric comorbidity in children and adolescents with ASD in the population context is considerable, without the influence of referral bias implicit in clinical and treatment samples. There is a need for better targeted diagnostic tools to detect psychiatric comorbidity in children and youth in future population-based studies, as an essential component in providing care as well as new insights into the nature and mechanisms of its underlying associations. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021234464].
Collapse
Affiliation(s)
- Tuba Mutluer
- Department of Psychiatry, School of Medicine, Koç University, Istanbul, Turkey.,Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey
| | - Herdem Aslan Genç
- Division of Child and Adolescent Psychiatry, Koç University Hospital, Istanbul, Turkey
| | - Aslihan Özcan Morey
- Division of Child and Adolescent Psychiatry, Koç University Hospital, Istanbul, Turkey
| | - Hale Yapici Eser
- Department of Psychiatry, School of Medicine, Koç University, Istanbul, Turkey.,Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey
| | | | - Merve Can
- Department of Child and Adolescent Psychiatry, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Mental Health and Nervous Disorders, Istanbul, Turkey
| | - Kerim Munir
- Developmental Medicine Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
26
|
Jain S, Narne VK. Auditory Profile of Children With Some Rare Neurodevelopmental Disorders. RESEARCH ANTHOLOGY ON PEDIATRIC AND ADOLESCENT MEDICINE 2022. [DOI: 10.4018/978-1-6684-5360-5.ch014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Neurodevelopmental disorder is an umbrella term comprising many muscular, skeletal, metabolic, endocrinal, systemic, and immune-related diseases, which are caused due to the improper/inaccurate development of the central nervous system. Most of these disorders are highly prevalent, but some express rarely in human beings. Such disorders with least prevalence rates are known as rare neurodevelopmental disorders. The sensory system is affected in all individuals with these rare neurodevelopmental disorders, although to a varying extent. Sensory processing in terms of hearing loss is reported by many researchers in many rare neurodevelopmental disorders, but the pathophysiology of audiological findings are seldom investigated. In this chapter, the authors highlight the possible relationship between underlying cause and the resultant audiological symptoms in some of the rare neurodevelopmental disorders. Further, the research studies on the audiological profiling in such disorders are discussed.
Collapse
|
27
|
Ying J, Tan GMY, Zhang MW. Intellectual disability and COVID-19: A bibliometric review. Front Psychiatry 2022; 13:1052929. [PMID: 36440400 PMCID: PMC9681827 DOI: 10.3389/fpsyt.2022.1052929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the vulnerabilities of certain groups of people have been highlighted, such as people with intellectual disability (ID). Although related research on ID has developed rapidly during the COVID-19 pandemic, the quantitative analysis of those research results has not been systematically performed through bibliometric analysis. Bibliometric analysis is a useful and rigorous method to explore large volumes of research data, and it allows researchers to extract quantitative information on distribution by author, time, country, and journal. AIM The aim of the present study is to comprehensively analyze the current status and developing trends in publications on ID research related to and conducted during the COVID-19 pandemic. METHODS A bibliometric analysis was performed using the Web of Science database. Biblioshiny software was used to analyze and visualize the following information: main information of dataset, annual scientific production, journals which published the most relevant sources, most-cited authors, most-cited countries, most-cited global documents, word-cloud of keywords authors have used, and both the co-occurrence and co-citation networks. RESULTS A total of 450 publications were included. The average number of citations per document was 5.104. Among the top three journals, Journal of Applied Research in Intellectual Disabilities published 32 articles, Journal of Intellectual Disability Research published 29 articles, and British Journal of Learning Disabilities published 17 articles. The article with the title COVID-19 and People with Intellectual Disability: Impact of a Pandemic was the most cited with total 144 citations The United Kingdom had the most publications and had strong cooperative relationships with the United States, Canada, and Australia. The most popular keywords included mental health, autism, developmental disability, and lockdown. Thematic map analysis identified several possible clusters, including telemedicine, physical activities, and mental health. CONCLUSION The present study provides a better understanding in this research field and may help clinicians, researchers and stakeholders to obtain more comprehensive view of ID and COVID-19. The insights gained from this analysis could inform future research.
Collapse
Affiliation(s)
- Jiangbo Ying
- East Region, Institute of Mental Health, Singapore, Singapore
| | | | | |
Collapse
|
28
|
Liverpool S, Pereira B, Pollard M, Prescod J, Trotman C. Children and young people's mental health in the English-speaking Caribbean: a scoping review and evidence map. Child Adolesc Psychiatry Ment Health 2021; 15:82. [PMID: 34969383 PMCID: PMC8719385 DOI: 10.1186/s13034-021-00435-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Internationally, there is a wealth of research suggesting that many children and young people experience mental health problems. However, the evidence from low- and middle-income countries and developing nations is generally limited. This scoping review aimed to add to the body of evidence by providing an overview of the available research literature on children and young people's (CYP's) mental health in the English-speaking Caribbean region. Seven key online academic databases and grey literature sources were searched until January 2021. Records were screened against predefined criteria and suitable articles retrieved. Relevant information was then charted and summarized. All stages of the review were informed by expert consultations. Ninety-six articles from 7901 records met the inclusion criteria. Most of the studies were conducted in Jamaica, Trinidad and Tobago and Barbados while fewer studies reported findings from St Lucia, The Bahamas and St Kitts and Nevis. Research funding was not frequently reported, and participants were predominantly recruited in education settings. There was a substantial focus on depressive symptoms and behaviour problems. Little or no research was available for younger children (< 12), complex clinical cases or commonly under-represented groups. Four unique interventions were identified of which one intervention showed no significant impact on CYP. Among the commonly used outcome measures only the Jamaican Youth Checklist (teacher-reported), Beck Depression Inventory-II, Brief Screen for Depression, Trinidad and Tobago Youth Survey and Minnesota Multiphasic Personality Inventory had evidence for psychometric validity within this population. We discuss future directions, implications and recommendations for research, practice, policy and training.
Collapse
Affiliation(s)
- Shaun Liverpool
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK. .,Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, University College London, London, UK.
| | - Brent Pereira
- grid.430499.30000 0004 5312 949XDepartment of Counselor Education, The Chicago School of Professional Psychology, Chicago, USA
| | - Malika Pollard
- grid.412886.10000 0004 0592 769XFaculty of Social Sciences, University of the West Indies, Cave Hill, Wanstead, Barbados
| | - Jamal Prescod
- grid.412886.10000 0004 0592 769XFaculty of Social Sciences, University of the West Indies, Cave Hill, Wanstead, Barbados
| | - Catherine Trotman
- grid.412886.10000 0004 0592 769XFaculty of Social Sciences, University of the West Indies, Cave Hill, Wanstead, Barbados
| |
Collapse
|
29
|
Zaqueu L, Teixeira MCTV, Lowenthal R, Mari JJ, Miguel EC, Rohde LA, Paula CS. Disability in children and adolescents: the extent of the impact on psychiatric disorders and educational deficits. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2021; 43:235-239. [PMID: 34860479 PMCID: PMC8638709 DOI: 10.47626/2237-6089-2020-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/09/2020] [Indexed: 11/26/2022]
Abstract
Introduction Most children/adolescents with disability live in low and middle-income countries and, worldwide, they are more likely to have mental health problems and achieve worse academic performance compared to those with typical development. Objective To assess whether Brazilian children/adolescents with four types of disabilities are more likely to have psychiatric disorders and educational deficits than children/adolescents with typical development. Method A multicenter cross-sectional study involving a school-based probabilistic sample of second to sixth graders (N = 1,674) from public schools in four Brazilian regions. The four types of disabilities (intellectual, visual, hearing, and motor) were assessed using the Ten Questions Questionnaire. Psychiatric disorders were measured with the Schedule for Affective Disorders/Schizophrenia for School-Age Children (K-SADS-PL), and academic performance was evaluated using the Teste de Desempenho Acadêmico – TDE (the academic performance test). Results A logistic regression model with cluster-robust errors identified the following statistically significant associations with three of the four types of disability (the exception was hearing). Intellectual disability was associated with anxiety (p < 0.01), depression (p < 0.01), attention deficit hyperactivity disorder (ADHD) (p < 0.001), school failure (p < 0.01), and poor academic performance (p < 0.01). Visual disability was associated with depression (p < 0.01). Motor disability was marginally associated with ADHD (p = 0.08). Conclusions Presence of disabilities (intellectual, visual, and motor) in children/adolescents was associated with psychiatric disorders, school failure, and academic performance. It is therefore important to identify presence of disabilities and plan and deliver specific interventions and specialized educational care for the needs presented by these children/adolescents. This is particularly important in low and middle-income countries, where these disabilities are frequent among children/adolescents.
Collapse
Affiliation(s)
- Livia Zaqueu
- Programa de Pós-Graduação em Gestão de Ensino da Educação Básica, Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil
| | | | - Rosane Lowenthal
- Departamento de Saúde Mental, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Jair J Mari
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Luís Augusto Rohde
- Departamento de Psiquiatria, Universidade Federal do Rio Grande do Sul (URGS), Porto Alegre, RS, Brazil
| | - Cristiane Silvestre Paula
- Programa de Pós-Graduação em Distúrbios do Desenvolvimento, Universidade Presbiteriana Mackenzie (UPM), São Paulo, SP, Brazil. Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
30
|
Rosencrans M, Tassé MJ, Kim M, Krahn GL, Bonardi A, Rabidoux P, Bourne ML, Havercamp SM. Invisible populations: Who is missing from research in intellectual disability? RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 119:104117. [PMID: 34736107 DOI: 10.1016/j.ridd.2021.104117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/18/2021] [Indexed: 06/13/2023]
Abstract
It is estimated that approximately 41% of adults with intellectual and developmental disability (IDD) are served through the developmental disabilities (DD) system in the US. The remaining 59% include individuals who meet diagnostic criteria but are not actively receiving paid services or may not be known to the DD system. Scholars have referred to this group as the "hidden majority." Very little is known about the health and well-being of these adults. It remains to be seen if the hidden majority is comparably susceptible to mental health difficulties, given how little is known about this population by DD systems. The purpose of this manuscript is to highlight where one may identify individuals belonging to this hidden population and how researchers might effectively recruit from this group so as to ensure more representative samples of all people with IDD.
Collapse
Affiliation(s)
| | - Marc J Tassé
- The Ohio State University Nisonger Center, United States
| | - Minje Kim
- The Ohio State University Nisonger Center, United States
| | | | | | - Paula Rabidoux
- The Ohio State University Nisonger Center, United States
| | - Mary Lou Bourne
- National Association of State Directors of Developmental Disabilities Services, United States
| | | |
Collapse
|
31
|
Verberg F, Helmond P, Otten R, Overbeek G. Effectiveness of the online mindset intervention 'The Growth Factory' for adolescents with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:217-230. [PMID: 34608719 DOI: 10.1111/jar.12941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/29/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study examines participant satisfaction and effectiveness of the online mindset intervention 'The Growth Factory' (TGF) for youth with intellectual disabilities using a randomised controlled trial design. METHOD Youth with mild to borderline intellectual disabilities (N = 119; 12-23 years) were randomly assigned to TGF (n = 60) or control group (n = 59). Primary outcome measures were mindsets and perseverance. Secondary outcomes were empowerment, mental health problems, self-esteem, treatment motivation, therapeutic alliance and challenge seeking. Measurements were conducted at pre-test, post-test and at 3 and 6 months follow-up. RESULTS TGF had positive effects on perseverance, mental health problems, self-esteem and therapeutic alliance at post-test. TGF had follow-up effects on mental health problems (3 months), mindset of intelligence (3 and 6 months) and mindset of emotion and behaviour (6 months). CONCLUSIONS TGF offers a promising add-on intervention complementing usual care programmes accelerating improvements in mindsets and mental health in youth with intellectual disabilities.
Collapse
Affiliation(s)
- Fenneke Verberg
- Research & Development, Pluryn, Nijmegen, The Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Petra Helmond
- Research & Development, Pluryn, Nijmegen, The Netherlands
| | - Roy Otten
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Department of Psychology, REACH Institute, Arizona State University, Tempe, Arizona, USA
| | - Geertjan Overbeek
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
32
|
Sommerstad HS, Kildahl AN, Munkhaugen EK, Karlsen K, Bakken TL. Experiences of ward atmosphere in inpatients with intellectual disability and mental illness: clinical implications for mental health nursing. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 67:339-348. [PMID: 34552729 PMCID: PMC8451695 DOI: 10.1080/20473869.2021.1900507] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 06/13/2023]
Abstract
Background: Patients with intellectual disability in psychiatric services are rarely asked about their experiences when admitted to inpatient units. Aim: To enhance the understanding of ward atmosphere for inpatients with co-occurring intellectual disabilities (ID) and mental illness by exploring patients' experiences from a specialised mental health inpatient unit. Methods: A selected sample of 10 adults with comorbid mental illness and ID were recruited for a qualitative interview study based on Gunderson's conceptualisation of therapeutic components in mental health wards. The patients were interviewed by two experienced clinicians and interviews were analysed using directed content analysis. Results: Patients' experience of their relationships with ward staff seemed central to their experiences of several aspects of mental health nursing. Feeling safe, contained, and validated, were further important aspects. However, the patients seemed to have little influence on treatment choices and did not report participating in shared decision-making. Conclusions: The patients' answers in this study are in line with previous research on ward atmosphere for patients in the general population. However, more research is necessary to inform future mental health nursing for patients with ID, both in inpatient and ambulatory services.
Collapse
Affiliation(s)
| | - Arvid Nikolay Kildahl
- Oslo Universitetssykehus Regional Dep. Mental Health in ID and NevSom - Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias| Oslo Universitetssykehus, Norway
| | - Ellen Kathrine Munkhaugen
- Oslo Universitetssykehus National Advisory Unit on Mental Health in ID| Oslo Universitetssykehus, Norway
| | - Kjersti Karlsen
- Oslo Universitetssykehus National Advisory Unit on Mental Health in ID| Oslo Universitetssykehus, Norway
| | - Trine Lise Bakken
- Oslo Universitetssykehus, Norway [Proxy]
- Oslo Universitetssykehus National Advisory Unit on Mental Health in ID and Oslo Metropolitan University| Oslo Universitetssykehus, Norway
| |
Collapse
|
33
|
Lapshina N, Stewart SL. Traumatic life events, polyvictimization, and externalizing symptoms in children with IDD and mental health problems. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 116:104028. [PMID: 34339937 DOI: 10.1016/j.ridd.2021.104028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 05/22/2021] [Accepted: 07/07/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND AIMS This study aims to examine the rates of potentially traumatic events (PTEs) and polyvictimization, as well as interrelationships among PTE types in children and youth with intellectual developmental disorder (IDD) and co-occurring mental health issues. It also examines the association between polyvictimization (experiencing three or more PTEs) and externalizing symptoms, controlling for IDD severity, sex and age. METHOD The study utilized archival data collected from 2012 to 2020 by trained assessors (e.g., nurses, social workers, psychologists) at intake into clinical mental health services in the Province of Ontario, Canada. The sample included 502 children and youth (age range: 4-18 years) who were assessed using the interRAI Child and Youth Mental Health and Developmental Disability (ChYMH-DD) instrument. Using this standardized assessment, trained clinicians reported on children's demographics, traumatic life events, and externalizing symptoms (proactive and reactive aggression) among other physical and mental health indicators. RESULTS 64.74 % of the children had experienced at least one type of PTE, whereas 33.06 % experienced lifetime polyvictimization. Most of the PTE types were positively correlated, with the strongest associations between physical, emotional abuse, witnessing domestic violence, and parental addiction. In a multivariate model, experiences of three or more PTEs (vs. none), mild or moderate IDD (vs. severe/profound), male sex (vs. female) were associated with greater externalizing symptoms. There was a quadratic relationship between age and externalizing symptoms. CONCLUSION The project advances knowledge on trauma and polyvictimization patterns and their association with IDD severity and externalizing symptoms in this population. Trauma-informed services should be tailored to the specific needs of these children.
Collapse
|
34
|
McLaren JL, Lichtenstein JD, Metcalfe JD, Charlot LR, Drake RE, Beasley JB. Psychotropic Use Among Youths With Intellectual and Developmental Disabilities. Psychiatr Serv 2021; 72:988-997. [PMID: 33882691 DOI: 10.1176/appi.ps.201900465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the prevalence and correlates of psychotropic medication prescribing among outpatient youths with intellectual and developmental disabilities. METHODS The authors reviewed cross-sectional data on medications for 1,333 youths (ages 5-21 years) with intellectual and developmental disabilities who were referred to a community-based mental health crisis service. Descriptive statistics and regression analysis were used to describe the study group and to identify correlates of psychotropic polypharmacy, antipsychotic use, and anticonvulsant use in the absence of a seizure disorder. RESULTS Most youths were taking psychotropic medications (N=1,139, 86%), often three or more medications (N=733, 55%) from two or more drug classes (N=919, 69%). Most youths received antipsychotics (N=863, 65%), and a third (N=432, 32%) were taking anticonvulsants in the absence of a seizure disorder. Greater severity (number of psychiatric diagnoses and recent psychiatric hospitalization), older age, and living in a group home were significantly correlated with these practices. CONCLUSIONS Polypharmacy, antipsychotic use, and anticonvulsant use in the absence of seizure disorders were common among youths with intellectual and developmental disabilities referred to the crisis service. Older age, number of psychiatric diagnoses, living in a group home, and psychiatric hospitalization correlate with these prescribing practices. These elevated prescribing rates in a very vulnerable population warrant further study.
Collapse
Affiliation(s)
- Jennifer L McLaren
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire (McLaren, Lichtenstein); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (McLaren, Lichtenstein); Lebanon Westat, Lebanon, New Hampshire (Metcalfe, Drake); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Charlot); Center for START Services, University of New Hampshire Institute on Disabilities, Concord (McLaren, Beasley)
| | - Jonathan D Lichtenstein
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire (McLaren, Lichtenstein); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (McLaren, Lichtenstein); Lebanon Westat, Lebanon, New Hampshire (Metcalfe, Drake); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Charlot); Center for START Services, University of New Hampshire Institute on Disabilities, Concord (McLaren, Beasley)
| | - Justin D Metcalfe
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire (McLaren, Lichtenstein); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (McLaren, Lichtenstein); Lebanon Westat, Lebanon, New Hampshire (Metcalfe, Drake); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Charlot); Center for START Services, University of New Hampshire Institute on Disabilities, Concord (McLaren, Beasley)
| | - Lauren R Charlot
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire (McLaren, Lichtenstein); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (McLaren, Lichtenstein); Lebanon Westat, Lebanon, New Hampshire (Metcalfe, Drake); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Charlot); Center for START Services, University of New Hampshire Institute on Disabilities, Concord (McLaren, Beasley)
| | - Robert E Drake
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire (McLaren, Lichtenstein); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (McLaren, Lichtenstein); Lebanon Westat, Lebanon, New Hampshire (Metcalfe, Drake); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Charlot); Center for START Services, University of New Hampshire Institute on Disabilities, Concord (McLaren, Beasley)
| | - Joan B Beasley
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire (McLaren, Lichtenstein); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (McLaren, Lichtenstein); Lebanon Westat, Lebanon, New Hampshire (Metcalfe, Drake); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Charlot); Center for START Services, University of New Hampshire Institute on Disabilities, Concord (McLaren, Beasley)
| |
Collapse
|
35
|
Ethics of Organ Transplantation in Persons with Intellectual Disability. J Pediatr 2021; 235:6-9. [PMID: 34029600 DOI: 10.1016/j.jpeds.2021.05.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 11/21/2022]
Abstract
Historically, individuals with intellectual disability and end-stage organ disease were discriminated against by transplant professionals and often excluded from transplantation waitlists. Despite antidiscrimination legislation, some transplant programs continue to include intellectual disability as a relative, if not an absolute, contraindication to listing for an organ; this is true for both pediatric and adult individuals in end-stage organ disease. This commentary opposes the absolute exclusion of patients with intellectual disability and end-stage organ disease from transplantation waitlists provided that the candidates are expected to gain a predefined minimum benefit threshold of life-years and quality-adjusted-life years. Intellectual disability is one of many factors that should be considered in determining transplant eligibility and each candidate should have an individualized interdisciplinary assessment.
Collapse
|
36
|
Bailey DA, Ford L, Knight VF. Exploring perceptions of positive mental health in young adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:160-169. [PMID: 34333824 DOI: 10.1111/jar.12932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite having higher levels of mental health difficulties than the general population, limited research exists about how individuals with intellectual disabilities view mental health. Providing education about mental health literacy can contribute to maintaining positive mental health. Individuals who understand positive mental health are more likely to take steps to improve their mental health. AIMS This study explores how young adults with intellectual disabilities conceptualise and define the concept of positive mental health. MATERIALS & METHODS Eight participants were interviewed using phenomenographic methods. RESULTS Using phenomenography as the approach, four categories of description emerged from the analysis and included defining positive mental health as related to physical health, lack of clarity about positive mental health, positive qualities (emotions and actions) and mental health components. DISCUSSION This study highlights the need for further research, exploring how to provide support through psychoeducation to individuals with intellectual disabilities about mental health.
Collapse
Affiliation(s)
- Darcie-Anne Bailey
- Department of Educational and Counselling Psychology & Special Education, University of British Columbia, Vancouver, Canada
| | - Laurie Ford
- Department of Educational and Counselling Psychology & Special Education, University of British Columbia, Vancouver, Canada
| | - Victoria F Knight
- Department of Educational and Counselling Psychology & Special Education, University of British Columbia, Vancouver, Canada
| |
Collapse
|
37
|
Oudshoorn CEM, Frielink N, Nijs SLP, Embregts PJCM. Psychological eHealth interventions for people with intellectual disabilities: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:950-972. [PMID: 33704872 PMCID: PMC8359285 DOI: 10.1111/jar.12877] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of eHealth, which has accelerated in the wake of the COVID-19 pandemic, could contribute to the access to tailor-made psychological interventions for people with intellectual disabilities. METHOD A scoping review was conducted on peer-reviewed studies between 1996-2019. RESULTS Thirty-three studies reported on the use of psychological eHealth interventions focused on mental health problems and/or challenging behaviour. The vast majority of these studies reported on interventions that were delivered at the individual level. The context in which these interventions were delivered varied, primarily ranging from the home setting to residential settings, as well as day or activity centres and schools. The studies described various types of interventions: telehealth interventions, computerized cognitive behavioural therapy, and interventions focused on (social) learning principles targeting challenging behaviour. CONCLUSIONS eHealth provides new opportunities for both therapists and lay-therapists to deliver psychological interventions. Future studies should focus on the effectiveness of psychological eHealth interventions.
Collapse
Affiliation(s)
- Cathelijn E. M. Oudshoorn
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
- ASVZSliedrechtThe Netherlands
| | - Noud Frielink
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - Sara L. P. Nijs
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - Petri J. C. M. Embregts
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| |
Collapse
|
38
|
Hua LL, Alderman EM, Chung RJ, Grubb LK, Lee J, Powers ME, Upadhya KK, Wallace SB. Collaborative Care in the Identification and Management of Psychosis in Adolescents and Young Adults. Pediatrics 2021; 147:peds.2021-051486. [PMID: 34031232 DOI: 10.1542/peds.2021-051486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians are often the first physicians to encounter adolescents and young adults presenting with psychotic symptoms. Although pediatricians would ideally be able to refer these patients immediately into psychiatric care, the shortage of child and adolescent psychiatry services may sometimes require pediatricians to make an initial assessment or continue care after recommendations are made by a specialist. Knowing how to identify and further evaluate these symptoms in pediatric patients and how to collaborate with and refer to specialty care is critical in helping to minimize the duration of untreated psychosis and to optimize outcomes. Because not all patients presenting with psychotic-like symptoms will convert to a psychotic disorder, pediatricians should avoid prematurely assigning a diagnosis when possible. Other contributing factors, such as co-occurring substance abuse or trauma, should also be considered. This clinical report describes psychotic and psychotic-like symptoms in the pediatric age group as well as etiology, risk factors, and recommendations for pediatricians, who may be among the first health care providers to identify youth at risk.
Collapse
Affiliation(s)
- Liwei L. Hua
- Catholic Charities of Baltimore, Baltimore, Maryland
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Torra Moreno M, Canals Sans J, Colomina Fosch MT. Behavioral and Cognitive Interventions With Digital Devices in Subjects With Intellectual Disability: A Systematic Review. Front Psychiatry 2021; 12:647399. [PMID: 33927655 PMCID: PMC8076520 DOI: 10.3389/fpsyt.2021.647399] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/17/2021] [Indexed: 01/01/2023] Open
Abstract
In recent years, digital devices have been progressively introduced in rehabilitation programs and have affected skills training methods used with children and adolescents with intellectual disabilities (ID). The objective of this review is to assess the effects of the use of digital devices on the cognitive functions and behavioral skills in this population, and to acknowledge their potential as a therapeutic tool. Electronic databases were analyzed until February 2020 using search formulas with free terms related to ID and the use of digital systems with children or adolescents. The risk of bias in randomized controlled trials was assessed by means of the modified Cochrane Collaboration tool and the quality level of the non-randomized studies was assessed using the Newcastle-Ottawa Scale. Forty-four studies were analyzed, most of which were categorized as low quality. Of the executive function studies analyzed, 60% reported significant improvements, most commonly related to working memory. Within the cognitive skills, 47% of the studies analyzed reported significant improvements, 30% of them in language. Significant improvements in the social (50%) and behavioral domains (30%) were also reported. These results suggest that digital interventions are effective in improving working memory and academic skills, and positively affect both the social and behavioral domains. Little information has been published regarding the duration of the effects, which could be limited in time. Further research is necessary to assess long-term effectiveness, the influence of comorbidities, and the effects on subjects with severe ID. The inclusion of smartphones and special education centers is also necessary.
Collapse
Affiliation(s)
- Marta Torra Moreno
- Jeroni de Moragas Private Fundation, Tarragona, Spain
- Jeroni de Moragas Association, Tarragona, Spain
| | - Josefa Canals Sans
- Department of Psychology, Research Center for Behavioral Assessment (CRAMC), Rovira i Virgili University, Tarragona, Spain
| | - Maria Teresa Colomina Fosch
- Department of Psychology, Research Center for Behavioral Assessment (CRAMC), Rovira i Virgili University, Tarragona, Spain
- Research Group in Neurobehavior and Health (NEUROLAB), Tarragona, Spain
| |
Collapse
|
40
|
Smith K, Hogan AL, Will E, Roberts JE. Attention Bias and Prodromal Anxiety Symptoms in Toddlers With Fragile X Syndrome and Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:167-181. [PMID: 33651888 PMCID: PMC8108623 DOI: 10.1352/1944-7558-126.2.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/10/2020] [Indexed: 06/12/2023]
Abstract
Early identification of behavioral risk markers for anxiety is essential to optimize long-term outcomes in children with neurodevelopmental disorders. This study analyzed attentional avoidance and its relation to anxiety and autism spectrum disorder (ASD) symptomatology during social and nonsocial fear conditions in toddlers with fragile X syndrome (FXS) and Down syndrome (DS). Toddlers with FXS and DS exhibited increased nonsocial attentional avoidance relative to typically developing (TD) toddlers. Attentional avoidance was not related to anxiety symptom severity in any group; however, higher ASD symptom severity was related to more social attentional avoidance in the FXS and TD groups. Findings suggest that there may be different underlying mechanisms driving attentional avoidance across neurodevelopmental disorders.
Collapse
Affiliation(s)
- Kayla Smith
- Kayla Smith, Abigail L. Hogan, Elizabeth Will, and Jane E. Roberts, University of South Carolina
| | - Abigail L Hogan
- Kayla Smith, Abigail L. Hogan, Elizabeth Will, and Jane E. Roberts, University of South Carolina
| | - Elizabeth Will
- Kayla Smith, Abigail L. Hogan, Elizabeth Will, and Jane E. Roberts, University of South Carolina
| | - Jane E Roberts
- Kayla Smith, Abigail L. Hogan, Elizabeth Will, and Jane E. Roberts, University of South Carolina
| |
Collapse
|
41
|
Roy A, Courtenay K, Odiyoor M, Walsh P, Keane S, Biswas A, Marston G, Thirulokachandran S, Munir K. Setting priorities for people with intellectual disability/intellectual developmental disorders across the lifespan: a call to action by the World Psychiatric Association. BJPsych Int 2021; 18:54-57. [PMID: 34382957 PMCID: PMC8314992 DOI: 10.1192/bji.2021.6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 01/14/2021] [Indexed: 11/23/2022] Open
Abstract
People with DSM-5 intellectual disability/intellectual developmental disorder (ID/IDD) or ICD-11 disorders of intellectual development (DID) have multiple healthcare needs, but in many countries these needs are neither recognised nor managed effectively. This paper discusses the negative impact that stigma, discrimination and social exclusion have on the identification and care of persons with ID/IDD in low- and middle-income countries (LMICs). It also reviews different models of care for children, adolescents and adults. In discussing some initiatives in LMICs the emphasis is on early diagnosis, with success in providing locally sourced care for affected people and their families. This is where the medical, social and rights-based models of care intersect and is a premise of the person-centred biopsychosocial framework of the World Psychiatric Association's Presidential Action Plan 2020–2023. The plan invites psychiatrists to take a lead in changing the culture of care, as well as medical education, clinical training and research, with a renewed emphasis on workforce integration and service development in terms of community-based rehabilitation strategies.
Collapse
Affiliation(s)
- Ashok Roy
- FRCPsych, Consultant Psychiatrist, Coventry and Warwickshire Partnership NHS Trust, UK.
| | - Ken Courtenay
- FRCPsych, Chair, Intellectual Disability Faculty, Royal College of Psychiatrists, London, UK
| | - Mahesh Odiyoor
- FRCPsych, Strategic Clinical Director, Centre for Autism, Neurodevelopmental Disorders and Intellectual Disabilities, Cheshire and Wirral Partnership NHS Foundation Trust, UK
| | - Patricia Walsh
- MRCPsych, Chair of the Faculty of Learning Disability, College of Psychiatrists of Ireland, Ireland
| | - Sarah Keane
- MRCPsych, Consultant Psychiatrist, HSE Dublin South Mental Health Services, Ireland
| | - Asit Biswas
- FRCPsych, Consultant Psychiatrist, Leicestershire Partnership NHS Trust, UK
| | - Geoff Marston
- FRCPsych, Consultant Psychiatrist, Coventry and Warwickshire Partnership NHS Trust, UK
| | | | - Kerim Munir
- DFAACAP, Director of Psychiatry, University Centre for Excellence in Developmental and Related Disabilities, Boston Children's Hospital, Harvard Medical School, Boston, Ma, USA
| |
Collapse
|
42
|
Oner O, Munir KM. Modified Checklist for Autism in Toddlers Revised (MCHAT-R/F) in an Urban Metropolitan Sample of Young Children in Turkey. J Autism Dev Disord 2020; 50:3312-3319. [PMID: 31414260 DOI: 10.1007/s10803-019-04160-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The study assessed the feasibility of using a Turkish-version of the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R/F) as a screening tool for an urban low risk population of young children. M-CHAT-R/F was completed for 6712 children between ages 16 and 36 months living in Istanbul, Turkey. Autism Diagnostic Observation Schedule-2 was served as the main measure for diagnosis. M-CHAT-R/F screen was positive for 9.8% of children. At follow up interview, 39.7% of initial screen-positive children met criteria for ASD. The study identified 57 (1 in 117) children with ASD (0.8%; 95% CI 0.063-1.05%). M-CHAT-R/F performed comparably in Turkey as in United States. Implications of the study for future universal screening for autism in Turkey is also discussed.
Collapse
Affiliation(s)
- Ozgur Oner
- Department of Child Psychiatry, Bahcesehir University School of Medicine, Istanbul, Turkey.
| | - Kerim M Munir
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
43
|
Dachew BA, Scott JG, Mamun A, Alati R. Hypertensive disorders of pregnancy and emotional and behavioural problems in children: a longitudinal population-based study. Eur Child Adolesc Psychiatry 2020; 29:1339-1348. [PMID: 31758357 DOI: 10.1007/s00787-019-01443-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/12/2019] [Indexed: 12/31/2022]
Abstract
There is evidence that offspring of mothers who have hypertensive disorders of pregnancy (HDP) are at increased risk of adverse health outcomes. This study aims to examine the association between maternal HDP and emotional- and behavioural problems in offspring at age 11 years as reported by teachers and parents. The current study is based on the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective, population-based study that has followed a cohort of offspring since their mothers were pregnant. Childhood emotional- and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ), completed by parents (n = 7196) and the child's teacher (n = 7411). Maternal preeclampsia, but not gestational hypertension, was associated with teacher-reported total behavioural difficulties (RR = 1.62; 95% CI 1.03-2.52) and internalising problems in children [peer problems (RR = 1.48; 95% CI 1.06-2.08) and emotional problems (RR = 1.68; 95% CI 1.13-2.51)]. No associations between preeclampsia and/or gestational hypertension and parent-reported emotional- and behaviour problems were observed. Our study showed that children exposed to preeclampsia had higher risk of teacher-reported total behavioural difficulties and internalising problems compared with unexposed children. The findings suggest emotional- and behavioural difficulties may not be evident in all settings, hence the importance of collecting evidence from multiple informants.
Collapse
Affiliation(s)
- Berihun Assefa Dachew
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Indooroopilly, Brisbane, QLD, 4068, Australia. .,Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - James G Scott
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia.,Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Abdullah Mamun
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Indooroopilly, Brisbane, QLD, 4068, Australia
| | - Rosa Alati
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Indooroopilly, Brisbane, QLD, 4068, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
| |
Collapse
|
44
|
Reckers-Droog V, Goorden M, Kaminer Y, van Domburgh L, Brouwer W, Hakkaart-van Roijen L. Presentation and validation of the Abbreviated Self Completion Teen-Addiction Severity Index (ASC T-ASI): A preference-based measure for use in health-economic evaluations. PLoS One 2020; 15:e0238858. [PMID: 32915870 PMCID: PMC7485871 DOI: 10.1371/journal.pone.0238858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Abstract
Economic evaluations of new youth mental health interventions require preference-based outcome measures that capture the broad benefits these interventions can have for adolescents. The Abbreviated Self Completion Teen-Addiction Severity Index (ASC T-ASI) was developed to meet the need for such a broader measure. It assesses self reported problems in seven important domains of adolescents' lives, including school performance and family relationships, and is intended for use in economic evaluations of relevant interventions. The aim of the current study was to present the ASC T-ASI and examine its validity as well as its ability to distinguish between adolescents with and without problems associated with substance use and delinquency. The validation study was conducted in a sample of adolescents (n = 167) aged 12-18 years, who received in- or outpatient care in a youth mental health and (enclosed) care facility in the Netherlands. To examine its feasibility, test-retest reliability, and convergent validity, respondents completed the ASC T-ASI, as well as the EQ-5D-3L and SDQ at baseline and after a two-week interval using a counterbalanced method. The ASC T-ASI descriptive system comprises seven domains: substance use, school, work, family, social relationships, justice, and mental health, each expressing self reported problems on a five-point Likert scale (ranging from having 'no problem' to having a 'very large problem'). The majority of respondents (>70%) completed the ASC T-ASI within 10 minutes and appraised the questions as (very) easy and (very) comprehensible. Test-retest reliability was adequate (Kw values 0.26-0.55). Correlations with the supplementary measures were moderate to high (rs 0.30-0.50), suggesting convergent validity. The ASC T-ASI is a promising and valid measure for assessing self reported problems in important domains in adolescents' lives, allowing benefits beyond health and health-related quality of life to be included in economic evaluations of youth mental health interventions. Future studies of the ASC T-ASI should consider the comprehensiveness of its domains and sensitivity to change.
Collapse
Affiliation(s)
- Vivian Reckers-Droog
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Rotterdam, the Netherlands
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, the Netherlands
| | - Maartje Goorden
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Rotterdam, the Netherlands
| | - Yifrah Kaminer
- University of Connecticut School of Medicine, Alcohol Research Center and Injury Prevention Center, Farmington, United States of America
| | - Lieke van Domburgh
- VU University Medical Center, Department of Child and Adolescent Psychiatry, Amsterdam, the Netherlands
- Pluryn, Nijmegen, the Netherlands
| | - Werner Brouwer
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Rotterdam, the Netherlands
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, the Netherlands
- Erasmus University Rotterdam, Erasmus School of Economics, Rotterdam, the Netherlands
| | - Leona Hakkaart-van Roijen
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Rotterdam, the Netherlands
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, the Netherlands
| |
Collapse
|
45
|
Peña-Salazar C, Arrufat F, Santos JM, Fontanet A, González-Castro G, Más S, Roura-Poch P, Valdés-Stauber J. Underdiagnosis of psychiatric disorders in people with intellectual disabilities: Differences between psychiatric disorders and challenging behaviour. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2020; 24:326-338. [PMID: 30185101 DOI: 10.1177/1744629518798259] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to assess the level of mental disorders and challenging behaviour in individuals with intellectual disability (ID) supported by specialized services, but without a prior psychiatric diagnosis, and to compare the levels of different disorders depending on the severity of ID. METHODS This is a cross-sectional study (N = 142) of population with ID. Inclusion criteria were the following: adult patients with ID and with no previous psychiatric diagnosis prior to this survey. The Wechsler Adults Intelligence Scale-II, the Psychiatric Assessment Schedule for Adults with Developmental Disability checklist and clinical interview, the Diagnostic Assessment for the Severely Handicapped scale and the Inventory for Client and Agency Planning were the assessment tools. RESULTS A previously undiagnosed mental disorder was found in 29.6% of the sample. The most prevalent mental disorders were major depressive and anxiety disorders. An association between psychiatric comorbidity and challenging behaviour was found only for mild/moderate ID, especially for affective disorders. CONCLUSIONS The presence of a psychiatric as well as a medical comorbidity is associated with severe ID, unlike challenging behaviour. Clinical limitations of the study have been discussed.
Collapse
Affiliation(s)
- Carlos Peña-Salazar
- Hegau-Bodensee-Klinikum Singen, Germany; Universitat de Vic - Central University of Catalonia, Spain
| | | | - Josep Manel Santos
- Universitat de Vic - Central University of Catalonia, Spain; Associació Sant Tomás, Spain
| | | | | | - Silvia Más
- Germanas Hospitalarias Benito Menni, Spain
| | | | | |
Collapse
|
46
|
Sit HF, Huang L, Chang K, Chau WI, Hall BJ. Caregiving burden among informal caregivers of people with disability. Br J Health Psychol 2020; 25:790-813. [PMID: 32472979 DOI: 10.1111/bjhp.12434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/04/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Chinese informal caregivers experience burden due to their caregiving responsibilities that violate their belief of reciprocal parent-child relationship, but little is known about this burden and coping processes among Chinese. It is believed that internal coping (i.e., self-reliance) and external coping (i.e., seeking help from others) better captured cultural characteristics of coping styles observed among Chinese. Thus, the aim of this study was to estimate the prevalence of mental ill health, identify correlates, investigate the impact of caregiving burden on mental health, and explore the potentially moderating role of two coping strategies. DESIGN A purposive sample of 234 informal caregivers of family with intellectual or mental disability in Macao (SAR), China, from August to September 2018 was investigated. METHODS DASS-21, Caregiving Burden Inventory (CBI), Perceived Difficulty Scale (PD), and a modified Chinese Coping Scale were used. Multiple regression analyses were conducted. RESULTS CBI and PD were associated with depression, anxiety, and stress. Whereas internal coping buffered the effect of PD on depression and anxiety, external coping exacerbated the effect of PD on anxiety and the effect of CBI on depression and anxiety. CONCLUSION Poor mental health among caregivers is associated with greater caregiving challenges and burdens. Internal coping helped to buffer but external coping worsened the effect of burdens on mental health outcomes. Interventions that improve internal coping and mental health might be helpful for ageing informal caregivers.
Collapse
Affiliation(s)
- Hao Fong Sit
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao (SAR), China
| | - Lei Huang
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao (SAR), China
| | - Kay Chang
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao (SAR), China
| | - Wai I Chau
- Fuhong Society of Macau, Macao (SAR), China
| | - Brian J Hall
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao (SAR), China.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
47
|
Blasingame GD, York JR. Men With Intellectual Disabilities Who Have Offended Sexually. Curr Psychiatry Rep 2020; 22:29. [PMID: 32377794 DOI: 10.1007/s11920-020-01151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW We review extant and new research focusing on assessment and treatment of men with intellectual disabilities (ID) who have offended sexually. New research findings are applied and integrated with classic assessment and treatment approaches, providing an overview of evidence-based practices. RECENT FINDINGS New research has explored healthy sexuality among people with intellectual disabilities, including making evidence-based sexual information cognitively accessible for people with ID. Research has begun to include men with ID in studies of actuarial risk assessment and dynamic treatment needs and identify forms of sexual deviation. New research has identified the need for access to treatment materials better tailored to clients' cognitive level, as well as understanding normal sexuality among people with ID. The recent research further develops our understanding of men with ID who offended sexually and demonstrates similarities between men with and without ID who have offended sexually. The new research findings provide evidence-based support and guidance for clinicians working with this set of clients and suggest optimism for more positive outcomes as studies from across the globe are focusing on working with men with ID who have offended sexually.
Collapse
|
48
|
Children and adolescents with epilepsy in rehabilitation centers: A French prospective transversal study. Epilepsy Behav 2020; 104:106898. [PMID: 31986442 DOI: 10.1016/j.yebeh.2019.106898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 12/10/2019] [Accepted: 12/30/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The reason why some children and adolescent with epilepsy (CAWE) still challenge the "inclusive" educative policy needs to be explored. METHODS/PATIENTS We conducted a transversal study in French medical, social, and educative rehab centers (MSERCs) dedicated to CAWE to describe the profile of 263 centers-involved (CI)-CAWE. Centers-involved CAWE were prospectively followed from September 2012 to August 2013. Medical, social, and educative rehab centers were dichotomized according to their care-provider agreement (i.e., CAWE of "moderate" (M) vs. "severe" (S) conditions). Clinical factors known to impact clinical outcome and quality of life (QoL) in epilepsy and four disabling conditions at risk to impact school life (i.e., cognitive and psychiatric/behavioral disorders, risk of physical hazards (i.e., refractory seizures with unpredictable loss of tone and/or awareness), and one or more seizure/week) were evaluated. The electronic chart of the French collaborative database (namely GRENAT) was used for data collection allowing comparison with the profile of 731 "normally integrated and schooled" (NIS)-CAWE extracted from GRENAT and matching for generation (i.e., born between 1988 and 2006). RESULTS Centers-involved CAWE's profile was found, after adjustment, to be associated with clinical factors and disabling conditions reflecting the poorest clinical outcome and health-related quality of life (HR-QoL) (all p < 0.001). A cutoff of two disabilities/child highly discriminated NIS-CAWE vs. CI-CAWE. Centers-involved CAWE of S-MSERCs were the most severe (all p < 0.001), and the type of cognitive disability (i.e., intellectual disability (ID) vs. specific learning disorders (SLD)) highly paralleled the types of MSERCs (S vs. M). Using a parent-informant questionnaire, the number of disabilities/child was found to correlate with both the evaluation of the impact of epilepsy (r = 0.47, p < 0.001) and the HR-QoL (r = 0.37, p < 0.001). A satisfactory social life was reported (83.8%) even after S vs. M dichotomization (77.2% vs. 94.7%; p < 0.001). CONCLUSION Multiple disabilities rather than epilepsy per se challenge the inclusive educative policy. Evaluation of disabilities could be the missing bridge to optimize this policy and understand its limits.
Collapse
|
49
|
Abstract
Between 1% and 3% of persons in general population are estimated to have some degree of intellectual disability. A diagnosis of intellectual disability is based on clinical history, level of intellectual ability and level of adaptive function. Both, the intellectual and adaptive functioning are measured using individually administered standardized tests. More than 75% of persons who have intellectual disability have mild intellectual disability and an underlying specific etiology is less likely to be identified; whereas, in a small percentage of persons with severe intellectual disability, an underlying specific biologic cause is highly likely to be identified. Genetic abnormalities, inborn errors of metabolism and brain malformations are major categories of causes identified in severe to profound intellectual disability. The initial clinical presentation and recognition depends on the severity and underlying cause of intellectual disability. The etiology, severity, cognitive abilities, and adaptive function, vary among persons with intellectual disability and need consideration in developing a treatment plan. The physician plays an essential role in the evaluation, treatment of associated medical conditions and preventive care, and in facilitating and coordinating consultative services and community based care.
Collapse
Affiliation(s)
- Dilip R Patel
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Maria Demma Cabral
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Arlene Ho
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Joav Merrick
- Hadassah Hebrew University Medical Center, Jarusalem, Israel.,University of Kentucky, Lexington, USA.,School of Public Health, Georgia State University, Atlanta, USA
| |
Collapse
|
50
|
Health Care Use and Spending of Pediatric Patients With an Intellectual or Developmental Disability. Med Care 2020; 58:468-473. [PMID: 31934953 DOI: 10.1097/mlr.0000000000001293] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health care costs and utilization for those with an intellectual or developmental disability (IDD) have been shown to be higher than the general population. OBJECTIVE To investigate the services that contribute to higher costs and utilization among noninstitutionalized children with an IDD. DESIGN Matched case-control secondary analysis of the 2000-2017 Medical Expenditure Panel Survey. Pediatric (age 0-21) patients with an IDD were matched to non-IDD subjects. Health care utilization and costs were evaluated with zero-inflated negative binomial regressions and generalized linear models, respectively. MEASURES Outcome measures included high-acuity health care utilization [ie, emergency department (ED) visits and hospital admissions], and cost outcomes for total spending, ED use, hospitalization, medications, office visits, home health, and physical therapy. RESULTS There was no statistical difference in utilization of EDs among the 2 groups though subjects with an IDD showed more hospitalizations than their matched cohort (incidence rate ratios=1.63, P=0.00). Total health care spending was higher among patients with an IDD (coefficient=$5831, P=0.00). Pediatric spending was higher in all measures except for ED. The biggest discrepancies in spending were seen in home health (coefficient=$2558, P=0.00) and outpatient visits (coefficient=$1180, P=0.00). CONCLUSIONS Pediatric patients with an IDD had higher health care spending and utilization than non-IDD subjects in all categories except for ED use.
Collapse
|