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Kildahl AN. Bias in assessment of co-occurring mental disorder in individuals with intellectual disabilities: Theoretical perspectives and implications for clinical practice. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024; 28:393-414. [PMID: 36708367 PMCID: PMC11059834 DOI: 10.1177/17446295231154119] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Influence from bias is unavoidable in clinical decision-making, and mental health assessment seems particularly vulnerable. Individuals with intellectual disabilities have increased risk of developing co-occurring mental disorder. Due to the inherent difficulties associated with intellectual disabilities, assessment of mental health in this population often relies on a different set of strategies, and it is unclear how these may affect risk of bias. In this theoretical paper, we apply recent conceptualisations of bias in clinical decision-making to the specific challenges and strategies in mental health assessment in intellectual disabilities. We suggest that clinical decision-making in these assessments is particularly vulnerable to bias, including sources of bias present in mental health assessment in the general population, as well as potential sources of bias which may be specific to assessments in this population. It follows that to manage potential bias, triangulating information from multi-informant, multi-method, interdisciplinary assessment strategies is likely to be necessary.
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Affiliation(s)
- Arvid Nikolai Kildahl
- Arvid Nikolai Kildahl, Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Verkensveien 19, Oslo, Asker 1385, Norway.
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Fiksinski AM, Schneider M, Zinkstok J, Baribeau D, Chawner SJRA, Vorstman JAS. Neurodevelopmental Trajectories and Psychiatric Morbidity: Lessons Learned From the 22q11.2 Deletion Syndrome. Curr Psychiatry Rep 2021; 23:13. [PMID: 33625600 PMCID: PMC7904715 DOI: 10.1007/s11920-021-01225-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The 22q11.2 deletion syndrome (22q11DS) is associated with a broad spectrum of neurodevelopmental phenotypes and is the strongest known single genetic risk factor for schizophrenia. Compared to other rare structural pathogenic genetic variants, 22q11DS is relatively common and one of the most extensively studied. This review provides a state-of-the-art overview of current insights regarding associated neurodevelopmental phenotypes and potential implications for 22q11DS and beyond. RECENT FINDINGS We will first discuss recent findings with respect to neurodevelopmental phenotypic expression associated with 22q11DS, including psychotic disorders, intellectual functioning, autism spectrum disorders, as well as their interactions. Second, we will address considerations that are important in interpreting these data and propose potential implications for both the clinical care for and the empirical study of individuals with 22q11DS. Third, we will highlight variable penetrance and pleiotropy with respect to neurodevelopmental phenotypes in 22q11DS. We will discuss how these phenomena are consistently observed in the context of virtually all rare pathogenic variants and that they pose substantial challenges from both a clinical and a research perspective. We outline how 22q11DS could be viewed as a genetic model for studying neurodevelopmental phenotypes. In addition, we propose that 22q11DS research can help elucidate mechanisms underlying variable expression and pleiotropy of neurodevelopmental phenotypes, insights that are likely relevant for 22q11DS and beyond, including for individuals with other rare pathogenic genetic variants and for individuals with idiopathic neurodevelopmental conditions.
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Affiliation(s)
- Ania M. Fiksinski
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, Toronto General Hospital, University Health Network, Toronto, Canada
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Maude Schneider
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Janneke Zinkstok
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Danielle Baribeau
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Samuel J. R. A. Chawner
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Jacob A. S. Vorstman
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
- The Centre for Applied Genomics, Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON Canada
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Gacek M, Krzywoszanski L. Symptoms of Anxiety and Depression in Students With Developmental Disabilities During COVID-19 Lockdown in Poland. Front Psychiatry 2021; 12:576867. [PMID: 33815160 PMCID: PMC8012510 DOI: 10.3389/fpsyt.2021.576867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 02/24/2021] [Indexed: 02/01/2023] Open
Abstract
Background: In this study we aimed to assess symptoms of anxiety and depression in persons with developmental disabilities during COVID-19 lockdown. Method: Soon after school closures related to the pandemic, we conducted telephone interviews with 64 vocational school students with developmental disabilities, the majority of whom had mild intellectual disability, and their parents. The parents were asked about stressful events experienced during lockdown. The students were assessed with screening measures for anxiety (GAD-7) and depression (PHQ-8). Results: Over one third of the tested students reported mild or more severe symptoms of anxiety and depression, and girls were more affected than boys. The number of experienced lockdown inconveniences predicted the severity of depression symptoms in girls. Discussion: The high prevalence of symptoms of anxiety and depression in persons with developmental disabilities indicates the need for screening studies and the provision of psychological help in situations such as the COVID-19 lockdown.
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Affiliation(s)
- Michal Gacek
- Faculty of Pedagogy and Psychology, Institute of Psychology, Pedagogical University of Krakow, Krakow, Poland
| | - Lukasz Krzywoszanski
- Faculty of Pedagogy and Psychology, Institute of Psychology, Pedagogical University of Krakow, Krakow, Poland
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Buckley N, Glasson EJ, Chen W, Epstein A, Leonard H, Skoss R, Jacoby P, Blackmore AM, Srinivasjois R, Bourke J, Sanders RJ, Downs J. Prevalence estimates of mental health problems in children and adolescents with intellectual disability: A systematic review and meta-analysis. Aust N Z J Psychiatry 2020; 54:970-984. [PMID: 32475125 DOI: 10.1177/0004867420924101] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Children and adolescents with intellectual disability are at risk of developing psychiatric symptoms and disorders; yet, the estimates reported in the literature have been inconsistent, presenting a potential barrier for service planning and delivery. Sources of variability could arise from differences in measurement instruments as well as subgroup membership by severity of intellectual disability, gender and age. This systematic review aimed to address these gaps. METHOD MEDLINE and PsycINFO databases were searched from inception to 2018 and selected studies were reviewed. Studies were included if they reported point prevalence estimates of mental health symptomology or diagnoses in a general population of 6- to 21-year-old individuals with intellectual disability. The Joanna Briggs Institute Prevalence Critical Appraisal Checklist was applied to eligible papers to appraise their scientific strength. Pooled prevalence for mental health symptomology was determined using a random-effects meta-analysis. RESULTS A total of 19 studies were included, including 6151 children and adolescents. The pooled prevalence estimate captured by the Developmental Behaviour Checklist was 38% (95% confidence interval = [31, 46]), contrasting with 49% (95% confidence interval = [46, 51]) captured by the Child Behaviour Checklist; both rates were higher than a non-intellectual disability population. Severity of intellectual disability did not significantly influence the Developmental Behaviour Checklist risks. Insufficient data were available to conduct statistical analyses on the effects of age, gender and socioeconomic status. Of diagnosed psychiatric disorders, attention deficit/hyperactivity disorder (30%), conduct disorder (3-21%) and anxiety disorders (7-34%) were the most prevalent conditions. CONCLUSION This review consists of the largest sample hitherto evaluated. In the intellectual disability population, mental health comorbidities could be better detected by a symptom phenotype than a psychiatric diagnostic phenotype. Crucially, future research needs to address the effect of measurement validity in the intellectual disability population. Estimated prevalence rates were high compared to the general population, indicating the importance of systematic screening, case detection and appropriate management.
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Affiliation(s)
- Nicholas Buckley
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Emma J Glasson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Wai Chen
- Mental Health Service, Fiona Stanley Hospital, Department of Health, Perth, WA, Australia.,Centre for Child and Adolescent Related Disorders, Graduate School of Education, The University of Western Australia, Perth, WA, Australia.,School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.,Current affiliations: Mental Health Service, Fiona Stanley Hospital, Department of Health, Perth, WA, Australia; School of Medicine, Notre Dame University, Fremantle, Perth, WA, Australia and College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
| | - Amy Epstein
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Rachel Skoss
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Peter Jacoby
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Amanda Marie Blackmore
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,Therapy and Other Health Services, Ability Centre, Perth, WA, Australia
| | | | - Jenny Bourke
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | | | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
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Hsieh K, Scott HM, Murthy S. Associated Risk Factors for Depression and Anxiety in Adults With Intellectual and Developmental Disabilities: Five-Year Follow Up. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 125:49-63. [PMID: 31877262 PMCID: PMC7959169 DOI: 10.1352/1944-7558-125.1.49] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A better understanding of the factors associated with depression and anxiety in people with intellectual and developmental disabilities (IDD) is needed to provide guidelines for service providers, clinicians, and researchers as well as to improve the diagnostic process. The current study used a longitudinal dataset to explore demographic, health, and psychosocial risk factors of anxiety and depression in adults with IDD. Women were more likely to have depression while older adults, people with autism, and people with hearing impairments, were more likely to have anxiety. Chronic health conditions were associated with both anxiety and depression, while changes in stressful life events were associated with an increased risk of anxiety. Clinical and research contributions are discussed.
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Affiliation(s)
- Kelly Hsieh
- Kelly Hsieh, Haleigh M. Scott, and Sumithra Murthy, University of Illinois at Chicago
| | - Haleigh M Scott
- Kelly Hsieh, Haleigh M. Scott, and Sumithra Murthy, University of Illinois at Chicago
| | - Sumithra Murthy
- Kelly Hsieh, Haleigh M. Scott, and Sumithra Murthy, University of Illinois at Chicago
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Stadnick NA, Martinez K, Aarons GA, Lee D, Van-Cleave J, Brookman-Frazee L. Pediatric Primary Care Perspectives on Integrated Mental Health Care for Autism. Acad Pediatr 2020; 20:1140-1147. [PMID: 32205263 PMCID: PMC7502427 DOI: 10.1016/j.acap.2020.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Timely identification of mental health needs and linkage to services is critical to provide comprehensive care for children with autism spectrum disorder (ASD). Pediatric primary care is well-positioned to facilitate this process through integrated care approaches. As a first step toward mental health integration, this study applied the Exploration, Preparation, Implementation, and Sustainment framework to characterize determinants of implementing integrated care practices for ASD. METHODS Sixty pediatric primary care providers and leaders from 3 organizations completed focus groups and surveys about identification of mental health needs in children with ASD and access to mental health services. Findings were integrated to examine convergence (ie, do the 2 methods confirm or find similar results) and expansion (ie, do the 2 methods provide insights beyond either method alone). RESULTS Results converged regarding 3 primary influences to integrated care practices for ASD: 1) limited specialized mental health referral options for ASD, 2) unique structural characteristics of the mental health system act as barriers to accessing care, and 3) caregivers differ in the degree to which they understand co-occurring mental health conditions and pursue recommended services. Qualitative results provided expansion by highlighting unique implementation considerations (eg, alignment with health care delivery priorities and values) based on primary care characteristics. CONCLUSIONS Findings confirm need for a tailored approach for linking children with ASD to appropriate mental health treatment. Results yield insight into the needs for organizational capacity to support integrated care and provide direction toward adapting an integrated mental health care model for children with ASD.
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Stadnick NA, Brookman-Frazee L, Mandell DS, Kuelbs CL, Coleman KJ, Sahms T, Aarons GA. A mixed methods study to adapt and implement integrated mental healthcare for children with autism spectrum disorder. Pilot Feasibility Stud 2019; 5:51. [PMID: 30976456 PMCID: PMC6438023 DOI: 10.1186/s40814-019-0434-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 03/15/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is a critical need for effective implementation of integrated healthcare systems for children with autism spectrum disorder (ASD). Children with ASD have many service needs, including the need to access effective mental healthcare, given high rates of co-occurring psychiatric conditions. Pediatric primary care is an ongoing point of healthcare that is well positioned to identify mental health concerns and facilitate linkage to mental health services for children with ASD. However, identifying mental health problems in children with ASD by primary care providers is complex, subject to being overlooked and may significantly vary based on primary care organizational characteristics. Efforts targeting integrated primary-mental healthcare implementation require a tailored approach for children with ASD. METHODS This mixed methods, community-partnered study will apply the Exploration, Preparation, Implementation, Sustainment (EPIS) framework (Aarons et al., 2011; Moullin et al., in press) to adapt and implement an integrated care model, "Access to Tailored Autism INtegrated Care" (ATTAIN), in pediatric practices within three diverse healthcare settings for children ages 4-18 years. Key inner context factors from the Exploration, Preparation, and Implementation phases of the EPIS framework will guide three objectives of this study: (1) to identify targets to improve mental health screening and linkage to mental health services in primary care for children with ASD, (2) to adapt integrated care procedures to facilitate identification of mental health problems and linkage to evidence-based care for children with ASD, and (3) to examine feasibility, acceptability, and uptake of the adapted integrated mental healthcare model through a pilot study in pediatric primary care. DISCUSSION Improving integrated mental healthcare for children with ASD could have a significant public health impact on mental healthcare access, child clinical outcomes, and reduction in healthcare costs. Results from this mixed methods study will inform selection of implementation strategies to conduct larger-scale implementation of tailored integrated mental healthcare for children with ASD that will ultimately help to address the high unmet mental health needs for these children.
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Affiliation(s)
- Nicole A. Stadnick
- Department of Psychiatry, University of California, San Diego, La Jolla USA
- Child and Adolescent Services Research Center, San Diego, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, La Jolla USA
- Child and Adolescent Services Research Center, San Diego, USA
- Rady Children’s Hospital, San Diego, USA
| | - David S. Mandell
- Department of Psychiatry, Center for Mental Health, University of Pennsylvania, Philadelphia, USA
| | - Cynthia L. Kuelbs
- Department of Pediatrics, University of California, San Diego, La Jolla USA
- Rady Children’s Hospital, San Diego, USA
| | - Karen J. Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA
| | - Timothy Sahms
- Department of Pediatrics, University of California, San Diego, La Jolla USA
- San Ysidro Health Center, San Ysidro, USA
| | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla USA
- Child and Adolescent Services Research Center, San Diego, USA
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Brookman-Frazee L, Stadnick N, Chlebowski C, Baker-Ericzén M, Ganger W. Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 22:938-952. [PMID: 28914082 PMCID: PMC6491206 DOI: 10.1177/1362361317712650] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Publicly funded mental health programs play a significant role in serving children with autism spectrum disorder. Understanding patterns of psychiatric comorbidity for this population within mental health settings is important to implement appropriately tailored interventions. This study (1) describes patterns of psychiatric comorbidity in children with autism spectrum disorder who present to mental health services with challenging behaviors and (2) identifies child characteristics associated with comorbid conditions. Data are drawn from baseline assessments from 201 children with autism spectrum disorder who participated in a community effectiveness trial across 29 publicly funded mental health programs. Non-autism spectrum disorder diagnoses were assessed using an adapted Mini-International Neuropsychiatric Interview, parent version. Approximately 92% of children met criteria for at least one non-autism spectrum disorder diagnosis (78% attention deficit hyperactivity disorder, 58% oppositional defiant disorder, 56% anxiety, 30% mood). Logistic regression indicated that child gender and clinical characteristics were differentially associated with meeting criteria for attention deficit hyperactivity disorder, oppositional defiant disorder, an anxiety, or a mood disorder. Exploratory analyses supported a link between challenging behaviors and mood disorder symptoms and revealed high prevalence of these symptoms in this autism spectrum disorder population. Findings provide direction for tailoring intervention to address a broad range of clinical issues for youth with autism spectrum disorder served in mental health settings.
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Affiliation(s)
- Lauren Brookman-Frazee
- University of California, San Diego, USA
- Rady Children’s Hospital, San Diego, USA
- Child and Adolescent Services Research Center, USA
| | - Nicole Stadnick
- University of California, San Diego, USA
- Child and Adolescent Services Research Center, USA
| | - Colby Chlebowski
- University of California, San Diego, USA
- Child and Adolescent Services Research Center, USA
| | - Mary Baker-Ericzén
- Rady Children’s Hospital, San Diego, USA
- Child and Adolescent Services Research Center, USA
| | - William Ganger
- Child and Adolescent Services Research Center, USA
- San Diego State University, USA
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Establishing priorities for psychological interventions in pediatric settings: A decision-tree approach using the DISABKIDS-10 Index as a screening instrument. PLoS One 2018; 13:e0198402. [PMID: 29852026 PMCID: PMC5979027 DOI: 10.1371/journal.pone.0198402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/20/2018] [Indexed: 11/19/2022] Open
Abstract
Most children and adolescents with chronic health conditions have impaired health-related quality of life and are at high risk of internalizing and externalizing problems. However, few patients present clinically significant symptoms. Using a decision-tree approach, this study aimed to identify risk profiles for psychological problems based on measures that can be easily scored and interpreted by healthcare professionals in pediatric settings. The participants were 736 children and adolescents between 8–18 years of age with asthma, epilepsy, cerebral palsy, type-1diabetes or obesity. The children and adolescents completed self-report measures of health-related quality of life (DISABKIDS-10) and psychological problems (Strengths and Difficulties Questionnaire). Sociodemographic and clinical data were collected from their parents/ physicians. Children and adolescents were classified into the normal (78.5%) or borderline/clinical range (21.5%) according to the Strengths and Difficulties Questionnaire cut-off values for psychological problems. The overall accuracy of the decision-tree model was 78.1% (sensitivity = 71.5%; specificity = 79.9%), with 4 profiles predicting 71.5% of borderline/clinical cases. The strongest predictor of psychological problems was a health-related quality of life standardized score below the threshold of 57.5 for patients with cerebral palsy, epilepsy or obesity and below 70.0 for patients with asthma or diabetes. Other significant predictors were low socio-economic status, single-parent household, medication intake and younger age. The model showed adequate validity (risk = .28, SE = .02) and accuracy (area under the Receiver Operating Characteristic curve = .84; CI = .80/.87). The identification of pediatric patients at high risk for psychological problems may contribute to a more efficient allocation of health resources, particularly with regard to their referral to specialized psychological assessment and intervention.
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Austin KL, Hunter M, Gallagher E, Campbell LE. Depression and anxiety symptoms during the transition to early adulthood for people with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:407-421. [PMID: 29473259 DOI: 10.1111/jir.12478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 12/12/2017] [Accepted: 01/18/2018] [Indexed: 05/07/2023]
Abstract
BACKGROUND The transition to adulthood is a major developmental milestone; a time of self-discovery and increased independence. For young adults (YA) with intellectual disabilities (ID), however, this period is especially challenging. The increased incidence of mental health disorders in this population, such as depression and anxiety, make this transition even more difficult, increasing caregiver burden at a time when the young adult would traditionally be gaining independence. It is not clear, however, why YA with ID are more susceptible and what factors may predict mental health symptoms. METHOD Potential risk and protective factors (demographic variables, coping styles, sense of hopelessness, unmet achievement of adulthood milestones, self-reflection and insight) of anxiety and depression symptoms were assessed in 55 YA with ID and a sample of age-matched controls. RESULTS Insight was the strongest predictor of anxiety (with gender in the controls) for YA with and without ID, with increased insight predicting fewer anxiety symptoms. However, YA with ID had significantly less insight than their aged-matched counterparts and significantly higher levels of anxiety. They were also less likely to have achieved traditional adulthood milestones. Maladaptive coping was the strongest predictor of depression for YA with ID. In comparison, both maladaptive coping and insight predicted depression in controls. More maladaptive coping predicted increased depressive symptoms in both populations, whilst increased insight predicted fewer depressive symptoms in controls. CONCLUSIONS Insight and maladaptive coping are potential targets in the treatment of anxiety and depression among YA with ID. Longitudinal intervention studies exploring the efficacy of such targeted programmes in reducing mental health symptoms and improving the transition to adulthood for these young people are recommended.
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Affiliation(s)
- K L Austin
- School of Psychology, Faculty of Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - M Hunter
- School of Psychology, Faculty of Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - E Gallagher
- School of Psychology, Faculty of Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - L E Campbell
- School of Psychology, Faculty of Science, University of Newcastle, Callaghan, New South Wales, Australia
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Eng B, Addison P, Ring H. A guide to intellectual disability psychiatry assessments in the
community. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.113.011213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryPsychiatric assessment in the community is an important part of both the
initial assessment process and delivery of follow-up care in adult
intellectual disability services in the UK. This article examines how such
assessments can be carried out safely and explores the clinical skills
required to perform them effectively. Use of the psychiatric interview and
mental state examination to elicit information is discussed. Communication
difficulties experienced by people with intellectual disabilities and
strategies that may be employed to address these in the assessment process
are also explored. The article is directed at psychiatrists, in particular
specialty trainees, and other healthcare professionals who work with
intellectually disabled people.
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12
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McKechanie AG, Moffat VJ, Johnstone EC, Fletcher-Watson S. Links between Autism Spectrum Disorder Diagnostic Status and Family Quality of Life. CHILDREN-BASEL 2017; 4:children4040023. [PMID: 28368363 PMCID: PMC5406682 DOI: 10.3390/children4040023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/22/2017] [Accepted: 03/27/2017] [Indexed: 12/27/2022]
Abstract
Quality of life is often relatively lowered in families of children with additional needs, and this may be particularly the case where additional needs are accompanied by an autism spectrum disorder (ASD). Here we explore the effects of diagnostic status specifically, comparing families with children with an ASD diagnosis with others who a) have additional needs but no signs of ASD; and b) have additional needs and signs of ASD but no diagnosis. Mothers (n = 76) of children with additional needs completed standardised questionnaires about quality of life, stress, service provision, child behaviour and presence and severity of ASD traits. In addition, a group of mothers of typically developing young people (n = 17) completed standardised questionnaires on individual and family quality of life and on the behaviour of their son or daughter. Mothers of typically developing young people had significantly higher individual and family quality of life scores than each of the three other groups. Increased severity of ASD was associated with increased maternal stress, which in turn was associated with decreased family and maternal quality of life. The group reporting the lowest quality of life and the highest stress were the mothers of individuals with signs of ASD but no diagnosis. This pattern did not seem to be explained by lack of access to services, or rates of intellectual disability or challenging behaviour in this sub-group. The finding that poor quality of life and high stress was most apparent in the sub-group of mothers with children who had signs of ASD but did not have a diagnosis of ASD suggests that an interesting topic for further investigation is whether receipt of a diagnosis itself can positively influence quality of life and levels of maternal stress.
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Affiliation(s)
- Andrew G McKechanie
- Clinical Research Fellow and Honorary Consultant Psychiatrist, The Patrick Wild Centre, The University of Edinburgh, Edinburgh EH10 5HF, UK.
- The Salvesen Mindroom Centre, The University of Edinburgh, Edinburgh EH9 1UW, UK.
| | - Vivien J Moffat
- Division of Psychiatry, The University of Edinburgh, Edinburgh EH10 5HF, UK.
| | - Eve C Johnstone
- Professor Emeritus of Psychiatry and Honorary Assistant Principal, Mental Health Research Development and Public Understanding of Medicine, Division of Psychiatry, The University of Edinburgh, Edinburgh EH10 5HF, UK.
| | - Sue Fletcher-Watson
- The Salvesen Mindroom Centre, The University of Edinburgh, Edinburgh EH9 1UW, UK.
- Chancellor's Fellow, The Patrick Wild Centre, The University of Edinburgh, Edinburgh EH10 5HF, UK.
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van Duijvenbode N, Didden R, van den Hazel T, Engels RCME. Psychometric qualities of a tetrad WAIS-III short form for use in individuals with mild to borderline intellectual disability. Dev Neurorehabil 2016; 19:26-30. [PMID: 24725162 DOI: 10.3109/17518423.2014.893265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the reliability and validity of a Wechsler Abbreviated Scale of Intelligence-based Wechsler Adult Intelligence Scale - third edition (WAIS-III) short form (SF) in a sample of individuals with mild to borderline intellectual disability (MBID) (N = 117; M(IQ) = 71.34; SD(IQ) = 8.00, range: 52-85). METHODS A full WAIS-III was administered as a standard procedure in the diagnostic process. RESULTS The results indicate an excellent reliability (r = 0.96) and a strong, positive correlation with the full WAIS-III (r = 0.89). The SF correctly identified ID in general and the correct IQ category more specifically in the majority of cases (97.4% and 86.3% of cases, respectively). In addition, 82.1% of the full scale IQ (FSIQ) estimates fell within the 95% confidence interval of the original score. CONCLUSIONS We conclude that the SF is a reliable and valid measure to estimate FSIQ. It can be used in clinical and research settings when global estimates of intelligence are sufficient.
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Affiliation(s)
- Neomi van Duijvenbode
- a Behavioural Science Institute, Radboud University Nijmegen , Nijmegen , The Netherlands and
| | - Robert Didden
- a Behavioural Science Institute, Radboud University Nijmegen , Nijmegen , The Netherlands and.,b Trajectum , Zwolle , The Netherlands
| | | | - Rutger C M E Engels
- a Behavioural Science Institute, Radboud University Nijmegen , Nijmegen , The Netherlands and
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Quitmann JH, Bullinger M, Sommer R, Rohenkohl AC, Bernardino Da Silva NM. Associations between Psychological Problems and Quality of Life in Pediatric Short Stature from Patients' and Parents' Perspectives. PLoS One 2016; 11:e0153953. [PMID: 27097033 PMCID: PMC4838264 DOI: 10.1371/journal.pone.0153953] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/06/2016] [Indexed: 11/19/2022] Open
Abstract
Short stature has been associated with psychosocial impairments, but whether treatments and achieved height impact on health-related quality of life (HrQoL) and psychological functioning of children/adolescents is still controversial. This study aimed to examine the effects of height deviation and treatment status on psychosocial adaptation outcomes and to identify clinical and psychosocial determinants of internalizing/externalizing problems in a large cohort of short statured children/adolescents from seven European countries. Participants were 345 children aged 8–18 years with a clinical diagnosis of short stature and 421 parents of 4–18 year-old patients. Children and parents reported on psychological problems (Strengths and Difficulties Questionnaire), generic (KIDSCREEN) and condition-specific HrQoL (QoLISSY). According to analyses of covariance, children/adolescents with current short stature presented more parent-reported internalizing problems and lower self- and parent-reported condition-specific HrQoL, compared to patients with an achieved height above -2SD. Treated children self-reported better HrQoL than the untreated group. Hierarchical regression analysis showed that, rather than height–related clinical variables, children’s sex, younger age and poorer HrQoL were the best predictors of psychological problems, explaining 39% of the variance in patient- and 42% in parent-reported internalizing problems, and 22% of the variance in patient- and 24% in parent-reported externalizing problems. Treatment status also moderated the negative links between patient-reported HrQoL and internalizing problems, explaining 2% of additional variance. These results suggest that children with current short stature are at greater risk for internalizing problems. Routine assessment of HrQoL in pediatric healthcare may help identify children for referral to specialized psychological assessment and intervention.
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Affiliation(s)
- Julia Hannah Quitmann
- University Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
- * E-mail:
| | - Monika Bullinger
- University Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | - Rachel Sommer
- University Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | | | - Neuza Maria Bernardino Da Silva
- University Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
- University of Coimbra, Cognitive and Behavioral Center for Research and Intervention, Coimbra, Portugal
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Jonker D, Sterkenburg PS, Van Rensburg E. Caregiver-mediated therapy for an adult with visual and intellectual impairment suffering from separation anxiety. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 47:1-13. [PMID: 26321690 DOI: 10.1016/j.ridd.2015.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 07/27/2015] [Accepted: 08/05/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Separation anxiety among intellectually disabled (ID) persons with comorbid visual impairment could be rooted in a weak sense of person permanence. Technology-assisted Therapy for Separation Anxiety (TTSA) was used to address this problem. AIMS The primary aim was to determine whether technology alone or including caregivers was the best option, and whether TTSA decreased separation anxiety and challenging behaviour. Also, how the caregivers and the client experienced TTSA. METHODS AND PROCEDURES A pre-experimental, quantitative approach (AB1C1B2C2D) was used for this single-subject study. The frequency of the client's text messages was recorded daily. The variables were monitored with standardised instruments and caregivers rated the intensity and frequency of the client's anxious and challenging behaviour. The social validity was evaluated by means of questionnaires. OUTCOMES AND RESULTS There was a significant decrease in the anxious and angry messages sent, and in anxious and challenging behaviour, in the phase in which the caregivers were included, compared with the phase in which technology alone was used. The client and the caregivers were positive about TTSA. CONCLUSION AND IMPLICATION Technology and the caregivers reactions reduces the anxiety and challenging behaviour. It might also aid the acquisition of the concept of person permanence.
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Affiliation(s)
- D Jonker
- School of Psychosocial Behavioural Sciences: Psychology, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - P S Sterkenburg
- VU University Amsterdam, FPP, Department of Clinical Child and Family Studies and EMGO+, Institute for Health and Care Research, Van der Boechorststraat 1, Amsterdam 1081 BT, the Netherlands; Bartiméus, P.O. Box 87, Doorn 3940 AB, the Netherlands.
| | - E Van Rensburg
- School of Psychosocial Behavioural Sciences: Psychology, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
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Abstract
OBJECTIVE To estimate the rate of psychotropic medication use in children and adolescents with Down syndrome (DS) and to describe age-related trends. METHODS Data were obtained from electronic health records from 2010 to 2013 for a retrospective cohort of 832 children with DS, aged 5 to 21 years, including 5324 visits. The following medication classes: central nervous system (CNS) stimulants, selective serotonin reuptake inhibitors, atypical antipsychotics, and alpha adrenergic agonists were examined. The distribution of rates of medication use across ages was assessed graphically and with the Cochran-Armitage trend test. Between-group comparisons of medication classes were conducted using χ. Repeated measures models with generalized estimating equations were used to assess changes in rates of medication use over time. RESULTS Children aged 12 to 21 years were more likely to be on any medication at some point compared with children aged 5 to 11 years (25% vs 17%, respectively, p = .003). For 5 to 11 year olds, the odds of being on a psychotropic medication increased with age for all medication classes studied. For 12 to 18 year olds, the odds of being on a CNS stimulant significantly decreased with increasing age (odds ratio: 0.73, 95% confidence intervals, 0.58-0.91), whereas the odds of being on a medication from one of the other classes was stable. CONCLUSION Changes in psychotropic medication use across the age span in children with DS suggest that the type and severity of neurobehavioral problems in this population likely also change over time. These findings will inform future research on the common mental health conditions and treatments for children with DS.
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Belva BC, Matson JL. Examining the psychometrics of the Psychopathology Inventory for Mentally Retarded Adults-II for individuals with mild and moderate intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:291-302. [PMID: 25462489 DOI: 10.1016/j.ridd.2014.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 10/05/2014] [Accepted: 10/13/2014] [Indexed: 06/04/2023]
Abstract
With growing recognition of the occurrence of psychological disorders in individuals with intellectual disability (ID), researchers and clinicians alike have placed emphasis on developing measures to assess for psychopathologies in this population. Despite an increased interest in the topic, there is still a dearth of psychometrically robust measures available to assess for psychopathology in adults with mild and moderate ID. The purpose of this study was to examine the psychometric properties of a revised measure for psychopathology in individuals with mild and moderate ID, the Psychopathology Inventory for Mentally Retarded Adults - second edition (PIMRA-II). Internal consistency, inter-rater reliability, and test-retest reliability were investigated. Validity was studied via convergent validity by comparing the PIMRA-II to the Assessment of Dual Diagnosis (ADD) and via discriminate validity by comparing the PIMRA-II to the Social Performance Survey Schedule (SPSS) prosocial scores. Lastly, an exploratory factor analysis was conducted to determine the factor structure of the scale.
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Affiliation(s)
- Brian C Belva
- Louisiana State University, 2124 Cheshire Bridge Road NE, Atlanta, GA 30324, United States.
| | - Johnny L Matson
- Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, United States.
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Vargas-Vargas C, Rafanell A, Montalvo D, Estarlich M, Pomarol-Clotet E, Sarró S. Validity and reliability of the Spanish version of the diagnostic assessment for the severely handicapped (DASH-II). RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:537-542. [PMID: 25462514 DOI: 10.1016/j.ridd.2014.10.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 10/17/2014] [Accepted: 10/23/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND OBJECTIVES The DASH-II scale is a specific instrument for measuring psychopathological symptoms in people with severe and profound intellectual disability (ID). The aim of the study is the validation of the Spanish version, evaluating its reliability and validity. At the same time we examine the prevalence of mental disorders in our sample. MATERIAL AND METHODS Two reviewers independently passed the Spanish version of the DASH-II (DASH-II-S) to 83 users to establish inter-rater reliability. To assess inter-rater reliability or test-retest reliability, fifty participants were reassessed by the same rater within 7 days. RESULTS DASH-II-S showed good internal consistency (Cronbach's α=0.879) and good reliability, both intra and inter-rater reliability. The prevalence of psychopathology in the sample is 94%, and the use of psychotropic drugs is also high, with 61.4% receiving one or more antipsychotics. CONCLUSIONS DASH-II-S is a valid and reliable instrument that can be used for the assessment of psychopathology in people with ID. The translated version retains the psychometric properties of the original English version. Moreover, the high prevalence of mental disorders in this population may explain the widespread use of psychotropic drugs, but it forces us to continuous reassessment and justification.
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Affiliation(s)
- Carmen Vargas-Vargas
- Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, Spain.
| | - Anna Rafanell
- Centre Psicopedagògic Mare de Déu de Montserrat, Caldes de Malavella, Spain
| | - Dúnia Montalvo
- Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, Spain
| | - Montse Estarlich
- Centre Psicopedagògic Mare de Déu de Montserrat, Caldes de Malavella, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; CIBERSAM, Madrid, Spain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; CIBERSAM, Madrid, Spain
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Bennett C. Understanding systemic problems in providing mental health services to people with an intellectual disability and co-morbid mental disorders in Victoria. Australas Psychiatry 2014; 22:48-51. [PMID: 24215972 DOI: 10.1177/1039856213510574] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This paper explores the difficulties the services system in Victoria has in responding to people with intellectual disability (ID) and mental health problems and identifies the underlying assumptions that have led to these. These issues are discussed and where possible put into a Victorian context with the intention of informing service development in the area of Dual Disability (co-morbid mental disorders in people with intellectual disability). CONCLUSIONS People with ID have high levels of mental health need. Generic services have difficulty responding to these needs due to a range of patient, professional and service system factors as well as some of the conceptual issues underpinning policy and legislation.
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Affiliation(s)
- Chad Bennett
- Clinical Director, The Victorian Dual Disability Service, St Vincent's Hospital, Melbourne, VIC, Australia
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Jacola LM, Hickey F, Howe SR, Esbensen A, Shear PK. Behavior and adaptive functioning in adolescents with Down syndrome: specifying targets for intervention. JOURNAL OF MENTAL HEALTH RESEARCH IN INTELLECTUAL DISABILITIES 2014; 7:287-305. [PMID: 28539987 PMCID: PMC5440084 DOI: 10.1080/19315864.2014.920941] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Research suggests that adolescents with Down syndrome experience increased behavior problems as compared to age matched peers; however, few studies have examined how these problems relate to adaptive functioning. The primary aim of this study was to characterize behavior in a sample of adolescents with Down syndrome using two widely-used caregiver reports: the Behavioral Assessment System for Children, 2nd Edition (BASC-2) and Child Behavioral Checklist (CBCL). The clinical utility of the BASC-2 as a measure of behavior and adaptive functioning in adolescents with Down syndrome was also examined. METHODS Fifty-two adolescents with Down syndrome between the ages of 12 and 18 (24 males) completed the Peabody Picture Vocabulary Test, 4th Edition (PPVT-IV) as an estimate of cognitive ability. Caregivers completed the BASC-2 and the CBCL for each participant. RESULTS A significant proportion of the sample was reported to demonstrate behavior problems, particularly related to attention and social participation. The profile of adaptive function was variable, with caregivers most frequently rating impairment in skills related to activities of daily living and functional communication. Caregiver ratings did not differ by gender and were not related to age or estimated cognitive ability. Caregiver ratings of attention problems on the BASC-2 accounted for a significant proportion of variance in Activities of Daily Living (Adj R2 = 0.30), Leadership (Adj R2 = 0.30) Functional Communication (Adj R2 = 0.28, Adaptability (Adj R2 = 0.29), and Social Skills (Adj R2 = 0.17). Higher frequencies of symptoms related to social withdrawal added incremental predictive validity for Functional Communication, Leadership, and Social Skills. Convergent validity between the CBCL and BASC-2 was poor when compared with expectations based on the normative sample. CONCLUSION Our results confirm and extend previous findings by describing relationships between specific behavior problems and targeted areas of adaptive function. Findings are novel in that they provide information about the clinical utility of the BASC-2 as a measure of behavior and adaptive skills in adolescents with Down syndrome. The improved specification of behavior and adaptive functioning will facilitate the design of targeted intervention, thus improving functional outcomes and overall quality of life for individuals with Down syndrome and their families.
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Affiliation(s)
- Lisa M. Jacola
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Steven R. Howe
- Department of Psychology, University of Cincinnati, Cincinnati Ohio
| | - Anna Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paula K. Shear
- Department of Psychology, University of Cincinnati, Cincinnati Ohio
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Zeilinger EL, Nader IW, Brehmer-Rinderer B, Koller I, Weber G. CAPs-IDD: Characteristics of Assessment Instruments for Psychiatric Disorders in Persons with Intellectual Developmental Disorders. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:737-746. [PMID: 23130712 DOI: 10.1111/jir.12003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Assessment of psychiatric disorders in persons with an intellectual developmental disorder (IDD) can be performed with a variety of greatly differing instruments. This makes the choice of an instrument best suited for the intended purpose challenging. In this study, we developed a comprehensive set of characteristics for the evaluation and description of assessment instruments for psychiatric disorders in adult persons with IDD. This simplifies the search for an instrument as it makes an easy and direct comparison possible and hereby allows a more thorough and appropriate decision making when selecting assessment tools. METHOD A mixed-methods approach was used. First, a systematic literature search was conducted to identify existing tools for the description and evaluation of assessment instruments. Second, the content of these tools was combined and missing features and IDD-specific attributes were added. Finally, expert consultations were performed. RESULTS The Characteristics of Assessment Instruments for Psychiatric Disorders in Persons with Intellectual Developmental Disorders (CAPs-IDD) lists characteristics to evaluate and describe instruments for psychiatric disorders in persons with IDD. It comprises two sections: first, the conceptual and measurement model; second, the psychometric properties. Each section consists of various subsections and a detailed response format for coding instruments. CONCLUSIONS The use of the CAPs-IDD helps to identify and choose instruments that best suit the respective purpose. Filled with information, it could be made accessible via new technologies to researchers and practitioners and be updated when new information is available. Thus, it contributes to a more reliable and valid assessment of possible psychiatric disorders in persons with IDD.
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Affiliation(s)
- E L Zeilinger
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - I W Nader
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - I Koller
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - G Weber
- Faculty of Psychology, University of Vienna, Vienna, Austria
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22
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Berger I, Nevo Y. Early Developmental Cues for Diagnosis of Attention Deficit/Hyperactivity Disorder in Young Children. ACTA ACUST UNITED AC 2013; 17:170-9. [DOI: 10.1002/ddrr.1111] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 10/05/2012] [Indexed: 02/02/2023]
Affiliation(s)
- Itai Berger
- Neuro-Cognitive Center, Pediatric Division; Hadassah-Hebrew University Medical Center; Jerusalem; Israel
| | - Yoram Nevo
- Pediatric Neurology Unit; Hadassah-Hebrew University Medical Center; Jerusalem; Israel
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Lambert TL, Farmer KC, Brahm NC. Evaluation of serum prolactin levels in intellectually disabled patients using antipsychotic medications. Int J Endocrinol Metab 2013; 11:57-61. [PMID: 23853622 PMCID: PMC3693656 DOI: 10.5812/ijem.4366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 05/06/2012] [Accepted: 06/27/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with intellectual disabilities may be treated with antipsychotic medications for a variety of diagnoses. Use of this category of medication can increase prolactin levels and place the patient at risk for sexual dysfunction and lower bone mineral density. The proposed mechanism of action is affinity for the dopamine receptor. Use of bromocriptine, a dopamine receptor antagonist, was proposed to attenuate hyperprolactinemia. OBJECTIVES The objectives of this study were to (1) review serum prolactin (PRL) elevations associated with the use of antipsychotic (AP) medications in an intellectually disabled adult population and (2) determine if any association existed between the level of elevation and AP used. PATIENTS AND METHODS Medical records for adult patients at two Oklahoma facilities for the intellectually disabled were reviewed to evaluate prolactin levels for individuals prescribed antipsychotics. A linear regression model was used to evaluate the relationship between prolactin levels with intellectual disability level, bromocriptine use, demographics, and antipsychotic. RESULTS 73 (n = 53 males, n = 20 females) patients met criteria. The average age was 41.2 years. Nearly 70% of the patients had severe to profound levels of disability. 77% were prescribed second generation antipsychotics; 19% received first generation agents. Two variables, gender and bromocriptine use, were found to be significant predictors of prolactin levels. Mean prolactin level for females was 44 ng/mL (normal range: 4-30 ng/mL, males = 4-23 ng/mL). Patients who did not receive bromocriptine had mean levels of 23 ng/mL. No significant difference in prolactin levels was found for type of AP. CONCLUSIONS Mean prolactin levels for females were significantly higher than for males. Both sexes were found to have higher-than-normal levels. Use of bromocriptine was associated with higher prolactin levels. In this population of patients, the type of AP used had no significance on prolactin levels.
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Affiliation(s)
- Tammy L Lambert
- Department of Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma, Oklahoma City, USA
- Corresponding author: Tammy L Lambert, Department of Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma, 1110 N. Stonewall Ave., CPB 135C, Oklahoma City, USA. Tel.: +1-4052716878, Fax: +1-4052713531, E-mail:
| | - Kevin C Farmer
- Department of Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma, Oklahoma City, USA
| | - Nancy C Brahm
- Department of Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma, Oklahoma City, USA
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Brahm N, McKee J. Behavioral activation secondary to antidepressant use in an intellectually disabled woman. Ment Health Clin 2012. [DOI: 10.9740/mhc.n115478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nancy Brahm
- 1 Clinical Professor, University of Oklahoma College of Pharmacy
| | - Jerry McKee
- 2 Associate Director of Behavioral Health Pharmacy Programs, Community Care of North Carolina Administrative Sciences
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Wieland J, Wardenaar KJ, Fontein E, Zitman FG. Utility of the Brief Symptom Inventory (BSI) in psychiatric outpatients with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:843-853. [PMID: 21726320 DOI: 10.1111/j.1365-2788.2011.01440.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Diagnostics and care for people with intellectual disabilities (ID) and psychiatric disorders need to be improved. This can be done by using assessment instruments to routinely measure the nature and severity of psychiatric symptoms. Up until now, in the Netherlands, assessment measures are seldom used in the psychiatric care for this population. The objective of the present paper is to evaluate the use of the Brief Symptom Inventory (BSI), a widely used standardised questionnaire in general psychiatry, in a well-defined sample of people with borderline intellectual functioning or mild ID diagnosed with one or more psychiatric disorders. METHODS A total of 224 psychiatric outpatients with either borderline intellectual functioning or mild ID participated in this study. All participants were new patients of Kristal, Centre for Psychiatry and Intellectual Disability in the Netherlands, in the period between 1 April 2008 and 1 October 2009. All participants were assessed by a multidisciplinary team, including a certified psychiatrist. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria were applied. The mean total intelligence quotient was measured with the Wechsler Adult Intelligence Scale (WAIS-III). The BSI was administered in an assisted fashion. Utility and psychometric properties of the BSI were investigated. Internal consistency coefficients (Cronbach's alphas) were computed. Bivariate correlations between the sub-scales were computed to assess differentiation between the scales. Mean sub-scale scores were compared between different DSM-IV-TR subgroups to investigate the discriminant abilities of the scales. A confirmatory factor analysis was conducted. RESULTS The results suggest that the BSI is practically useful. Internal consistencies ranged from 0.70 to 0.96 and thus are considered good to adequate. Sub-scale inter-correlations showed there is a degree of differentiation between the sub-scales. Discriminant validity was shown for the sub-scales depression, anxiety and phobic anxiety. Confirmatory factor analysis showed that the underlying structure of the BSI could be described by the same nine-factor model as reported in previous studies. CONCLUSIONS As a result of the psychometric properties illustrated, this study supports the use of the BSI as a screener for psychopathology and a general outcome measure in people with ID.
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Affiliation(s)
- J Wieland
- Kristal, Centre for Psychiatry and Intellectual Disability, Leiden, The Netherlands.
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Abstract
Children and adolescents with intellectual disabilities (IDs), often diagnosed with comorbid psychiatric disorders, are a vulnerable population who may be at risk for developing suicidal thoughts and behaviors. Previous research has demonstrated that direct suicide screening can rapidly and effectively detect suicide risk and facilitate further clinical evaluation and management. Currently, there are no measures that screen for suicide risk designed specifically for individuals with ID. A review of the literature was conducted to (1) estimate the prevalence of suicidal thoughts, behaviors, and deaths by suicide in children and adolescents with ID; (2) describe associations between youth with ID and suicide risk; and (3) identify the limitations of commonly used suicide screening measures developed for non-ID youth. The literature review confirms that suicide risk exists in this population; youth with ID think about, attempt, and die by suicide. Standardized suicide risk screening is challenged by the lack of measures developed for this population. A summary of the findings is followed by a discussion of the practical clinical considerations surrounding the assessment of suicide risk in youth with ID.
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Ekstein S, Glick B, Weill M, Kay B, Berger I. Down syndrome and attention-deficit/hyperactivity disorder (ADHD). J Child Neurol 2011; 26:1290-5. [PMID: 21628698 DOI: 10.1177/0883073811405201] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Clinicians might minimize the prevalence of behavioral disorders among mentally retarded people. Decreased attention, hyperactivity, and impulsivity are frequently reported in children with Down syndrome, yet the exact prevalence of attention-deficit/hyperactivity disorder (ADHD) has not been clearly estimated in this population. The objective of this study was to estimate the prevalence of ADHD in children with Down syndrome and to emphasize the possible relationship between ADHD symptoms and the level of mental retardation and common medical comorbidity. In this study, the prevalence of ADHD among Down syndrome children was very high, reaching 43.9%. No significant correlation was found between ADHD symptoms and the level of mental retardation, but significant correlation was found with ophthalmologic problems. We conclude that children with Down syndrome are at increased risk for ADHD. When evaluating children with Down syndrome for attention deficits, psychiatric comorbidity as well as medical problems should be carefully taken into consideration.
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Affiliation(s)
- Sivan Ekstein
- Pediatric Neurology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Hermans H, van der Pas FH, Evenhuis HM. Instruments assessing anxiety in adults with intellectual disabilities: a systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:861-870. [PMID: 21330101 DOI: 10.1016/j.ridd.2011.01.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 01/19/2011] [Accepted: 01/19/2011] [Indexed: 05/30/2023]
Abstract
BACKGROUND In the last decades several instruments measuring anxiety in adults with intellectual disabilities have been developed. AIM To give an overview of the characteristics and psychometric properties of self-report and informant-report instruments measuring anxiety in this group. METHOD Systematic review of the literature. RESULTS Seventeen studies studying 14 different instruments were found. Methodological quality as measured with the Quality Assessment of Diagnostic Accuracy Studies checklist was insufficient for four studies, sufficient for seven, and good for six. For self-report, the Glasgow Anxiety Scale for people with a learning disability appears most promising, with good internal consistency (a = 0.96), high test-retest reliability (r = 0.95), sensitivity (100%) and specificity (100%). For informant-report, the general anxiety subscale of the Anxiety, Depression and Mood Scale may be promising, with good internal consistency (a = 0.83 and a = 0.84) and excellent test-retest reliability (ICC = 0.78 and ICC = 0.92), but poor interrater reliability (ICC = 0.39). CONCLUSIONS Two instruments appear promising. However, these instruments have only been studied once or twice, whereas the methodological quality of these studies was varying.
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Affiliation(s)
- Heidi Hermans
- Department of General Practice, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Brookman-Frazee L, Baker-Ericzén M, Stahmer A, Mandell D, Haine RA, Hough RL. Involvement of Youths with Autism Spectrum Disorders or Intellectual Disabilities in Multiple Public Service Systems. JOURNAL OF MENTAL HEALTH RESEARCH IN INTELLECTUAL DISABILITIES 2009; 2:201-219. [PMID: 19809531 PMCID: PMC2757308 DOI: 10.1080/19315860902741542] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The objectives of this study were to estimate the prevalence of autism spectrum disorders (ASD) and intellectual disability (ID) among youths active in at least one of five public service systems - mental health [MH], educational services for youth with serious emotional disturbance [SED], child welfare [CW], juvenile justice [JJ], and alcohol and drug services [AD].This study also reports the characteristics and patterns of system involvement among these youths. Results indicate that approximately 12% of a random sample of youths involved in these public service systems had ID or ASD. These disabilities were particularly prevalent in youth in the SED (25%), MH (13%), and CW (13%) systems and were less prevalent in the JJ and AD systems (4% each). Youths with ID or ASD were more likely than other youths to be Caucasian, have a higher socioeconomic status, and be more likely to have externalizing psychiatric and other problems. Of those with ASD or ID, approximately one third were served in more than one service system, with the MH and SED systems most likely to be serving youths with externalizing psychiatric disorders. These findings have important implications for service provision, treatment planning, and workforce development.
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Affiliation(s)
- Lauren Brookman-Frazee
- Department of Psychiatry, University of California-San Diego, and Child and Adolescent Services Research Center
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31
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Brahm N, Fast G. Exacerbation of Psychosis: A Case of Possible Varenicline-Mediated Effects in an Intellectually Disabled Adult. ACTA ACUST UNITED AC 2008. [DOI: 10.3371/csrp.2.3.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tenneij NH, Koot HM. Incidence, types and characteristics of aggressive behaviour in treatment facilities for adults with mild intellectual disability and severe challenging behaviour. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2008; 52:114-124. [PMID: 18197950 DOI: 10.1111/j.1365-2788.2007.00968.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Inpatient aggression in treatment facilities for persons with intellectual disability (ID) can have aversive consequences, for co-clients and staff, but also for the aggressors themselves. To manage and eventually prevent inpatient aggressive incidents, more knowledge about their types and characteristics is necessary. METHOD In four facilities, totalling 150 beds, specialized in the treatment of adults with mild ID or severe challenging behaviour, aggressive incidents were registered during 20 weeks using the Staff Observation Aggression Scale-Revised. Characteristics of auto-aggressive and outwardly directed incidents and differences in their incidence in male and female clients in these facilities were compared. RESULTS During the observation period of 20 weeks, 639 aggressive incidents were documented. Most of these (71%) were outwardly directed, predominantly towards staff, while most of the remaining incidents were of an auto-aggressive nature. Of the 185 clients present during the observation period, 44% were involved in outwardly directed incidents (range per client 1-34), and 12% in auto-aggressive incidents (range per client 1-92). Auto-aggressive and outwardly directed incidents differed regarding source of provocation, means used during the incident, consequences of the incident and measures taken to stop the incident. The proportion of men and women involved in each type of incident was comparable, as well as the majority of the characteristics of outwardly directed incidents caused by men and women. CONCLUSIONS Although approximately half of all clients were involved in aggressive incidents, a small minority of clients were responsible for the majority of incidents. Therefore, better management and prevention of aggressive incidents for only a small group of clients could result in a considerable overall reduction of aggressive incidents in treatment facilities. Comparability of aggressive behaviour in these facilities shown by men and women and differences in characteristics of auto-aggressive and outwardly directed incidents are discussed.
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Affiliation(s)
- N H Tenneij
- VU University, Developmental Psychology, Amsterdam, The Netherlands.
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33
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Nota L, Soresi S, Ferrari L. Intellectual disability and psychopathology: The influence of institutionalization and level of intellectual disability and the relation between psychopathological problems and social and functional abilities. ACTA ACUST UNITED AC 2008. [DOI: 10.1515/ijdhd.2008.7.1.57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Di Nuovo SF, Buono S. Psychiatric syndromes comorbid with mental retardation: differences in cognitive and adaptive skills. J Psychiatr Res 2007; 41:795-800. [PMID: 16697412 DOI: 10.1016/j.jpsychires.2006.02.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Revised: 02/23/2006] [Accepted: 02/24/2006] [Indexed: 11/21/2022]
Abstract
The study concerns the specific cognitive and adaptive skills of persons dually diagnosed with mental retardation (MR) and comorbid pathologies, as schizophrenia, personality and mood disorders, pervasive developmental disorders, epilepsy and ADHD. The sample was composed of 182 subjects, diagnosed as mild or moderate MR level, age range from 6 years 8 months to 50 years 2 months, mean age 17.1 (standard deviation 7.9). All the subjects were inpatients in a specialized structure for the diagnosis and the treatment of MR. The instruments of the study were Wechsler Intelligence Scale (WAIS-R or WISC-R according to the chronological age of subjects) and Vineland Adaptive Behavior Scale (VABS). Results confirm that comorbidity is a factor differentiating among mentally retarded subjects. Both verbal processes requiring memory retrieval and visuo-spatial processes are involved as differentiating features. ADHD strongly increases the impairment of cognitive skills, while behavioral disorders are less damaging in MR performance. In adult samples, the differentiating role of comorbid syndromes in MR individuals is reduced for cognitive skills, and limited to some basic verbal abilities, more impaired in mood disorder, less in schizophrenic disorder. The areas of adaptation and socialization, motor and daily living skills, are impaired more in generalized development disturbances than in comorbid schizophrenic and personality and mood disorders. An accurate psychological assessment of dual diagnoses is useful in detecting the specific underlying processes differentiating the comorbid syndromes, and in planning an appropriate rehabilitative treatment.
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Affiliation(s)
- Santo F Di Nuovo
- University of Catania, Faculty of Education, 2 Ofelia, 95124 Catania, Italy.
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35
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Sturmey P, Lindsay WR, Didden R. Special Issue: Dual Diagnosis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2007. [DOI: 10.1111/j.1468-3148.2007.00379.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Tuffrey-Wijne I, McEnhill L, Curfs L, Hollins S. Palliative care provision for people with intellectual disabilities: interviews with specialist palliative care professionals in London. Palliat Med 2007; 21:493-9. [PMID: 17846089 DOI: 10.1177/0269216307082019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Growing numbers of people with intellectual disabilities (ID) are in need of palliative care, but there is inequity of access to palliative care services for this group. This study investigates the issues and difficulties arising for palliative care staff in providing care for people with ID. Semi-structured interviews were conducted with 32 palliative care professionals in London. Factors affecting palliative care provision for people with ID included social issues (home situation and family issues), emotional and cognitive issues (fear, patient understanding, communication, cooperation and capacity to consent), problems with assessment, and the impact on staff and other patients. An underlying theme was the need to take more time and to build trust. Despite the challenges, many palliative care staff managed the care of people with ID well. The importance of collaboration with carers and ID services is highlighted. Further studies are needed to investigate how widespread the problems are.
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Affiliation(s)
- I Tuffrey-Wijne
- Division of Mental Health, St George's, University of London, UK.
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37
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Brahm NC, Farmer KC, Brown RC. Risperidone for the treatment of fecal smearing in a developmentally disabled adult. Am J Health Syst Pharm 2007; 64:382-4. [PMID: 17299177 DOI: 10.2146/ajhp060176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The use of risperidone in decreasing fecal smearing behavior as an expression of nonverbal aggression in a developmentally disabled adult is discussed. SUMMARY A 36-year-old Caucasian man had a history of fecal smearing when he did not get his way or was upset. The patient had profound mental retardation, had an IQ in the range of less than 20 to 25, and was nonverbal. For this patient, fecal smearing was not only a behavioral issue but also a medical concern because he was hepatitis B positive with noncarrier status. Serology also confirmed previous infection with hepatitis A. Risperidone was started at 0.5 mg twice daily. Smearing frequencies during baseline and after risperidone intervention were tracked. During the course of treatment, the risperidone dosage was increased to a total daily dose of 4 mg. The mean +/- S.D. number of episodes per month decreased from 15.2 +/- 3 in the pretreatment period to 6.0 +/- 1.8 at 6 months and 6.7 +/- 1.2 at 12 months posttreatment with risperidone. On follow-up in October 2003, fecal smearing had further decreased to the point where it was no longer formally tracked. A diagnosis of mental retardation, developmental disability, or pervasive developmental disorder increases the possibility for emotional and behavioral problems. Previous medication classes tried in the management of aggressive behaviors have not produced consistent results. Risperidone has been used in the treatment of self-abuse, aggression toward others, and violent behaviors. CONCLUSION Risperidone was effective in decreasing episodes of fecal smearing as an expression of nonverbal aggression in a developmentally disabled adult.
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Affiliation(s)
- Nancy C Brahm
- Department of Pharmacy Practice, University of Oklahom, Tulsa, OK 74135-2512, USA.
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38
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Psychotropic Medication Effects and Side Effects. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s0074-7750(07)34007-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Douma JCH, Dekker MC, De Ruiter KP, Verhulst FC, Koot HM. Help-seeking process of parents for psychopathology in youth with moderate to borderline intellectual disabilities. J Am Acad Child Adolesc Psychiatry 2006; 45:1232-1242. [PMID: 17003669 DOI: 10.1097/01.chi.0000230167.31246.db] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the help-seeking process of parents for emotional or behavioral problems in their child with borderline to moderate intellectual disabilities. METHOD In 2003, in a special education-based sample of 522 youths (ages 10-18 years, response = 77.9%), we studied the parents' perception of their child's problems, their subsequent felt need for professional help, actual help-seeking, and the factors possibly related to taking these steps. RESULTS Even when parents indicated their child's emotional or behavioral functioning as "neither good nor bad," in about 70%, these problems were present according to standardized measures. Of the 213 parents (40.8%) who perceived problems, 70.6% felt a need, and 55.2% of these parents subsequently sought professional help. Parents more often sought help when their child had problems of anxiety and depression, experienced negative life events, and when parents perceived child psychopathology before the past year. Reported barriers to seeking help predominantly related to parents' evaluation of the severity of these problems and wanting to solve the problems themselves. CONCLUSIONS Clinicians and other service providers should address parents' concerns regarding their child's emotional/behavioral functioning and treatment seeking. Also, they should provide information on treatment options and on signs and potential negative prospects of their child's problems.
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Affiliation(s)
- Jolanda C H Douma
- Ms. Douma and Ms. De Ruiter and Drs. Dekker and Verhulst are with the Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands; and Dr. Koot is with the Department of Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands
| | - Marielle C Dekker
- Ms. Douma and Ms. De Ruiter and Drs. Dekker and Verhulst are with the Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands; and Dr. Koot is with the Department of Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands
| | - Karen P De Ruiter
- Ms. Douma and Ms. De Ruiter and Drs. Dekker and Verhulst are with the Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands; and Dr. Koot is with the Department of Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands
| | - Frank C Verhulst
- Ms. Douma and Ms. De Ruiter and Drs. Dekker and Verhulst are with the Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands; and Dr. Koot is with the Department of Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands.
| | - Hans M Koot
- Ms. Douma and Ms. De Ruiter and Drs. Dekker and Verhulst are with the Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands; and Dr. Koot is with the Department of Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands
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Capone G, Goyal P, Ares W, Lannigan E. Neurobehavioral disorders in children, adolescents, and young adults with Down syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2006; 142C:158-72. [PMID: 16838318 DOI: 10.1002/ajmg.c.30097] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The term dual-diagnosis refers to a person with mental retardation and a psychiatric disorder. Most children with Down syndrome (DS) do not have a psychiatric or neurobehavioral disorder. Current prevalence estimates of neurobehavioral and psychiatric co-morbidity in children with DS range from 18% to 38%. We have found it useful to distinguish conditions with a pre-pubertal onset from those presenting in the post-pubertal period, as these are biologically distinct periods each with a unique vulnerability to specific psychiatric disorders. Due to the increased recognition that psychiatric symptoms may co-occur with mental retardation, and are not inextricably linked to cognitive impairment, these conditions are considered treatable, in part, under a medical model. Improvement in physiologic regulation, emotional stability, and neurocognitive processing is one of the most elusive but fundamental goals of pharmacologic intervention in these disorders.
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Affiliation(s)
- George Capone
- Down Syndrome Clinic (DSC) at Kennedy Krieger Institute, 707 N. Broadway, Baltimore MD 21205, USA.
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Abstract
PURPOSE OF REVIEW This review examines an eclectic selection of publications from the past 12 months under the broad heading of 'assessment in intellectual disability'. Being unable to cover all possible publications the authors have concentrated on the assessment of pain (in those with severe intellectual disability), psychopathology, risk assessment and offending, autism, preference and choice, and dementia. RECENT FINDINGS Research into assessment has generally taken the form of developing new instruments, or adapting existing ones, or comparing the performance of a range of scales in a certain area. Researchers are using increasingly sophisticated psychometric analyses and refining the nature and purpose of tools for a range of clinical purposes. SUMMARY The result of recent effort in this area is better instruments, often developed by experienced researchers who have been working in their chosen area of speciality for some years. It has been a very worthwhile period of extension and consolidation.
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Affiliation(s)
- Caroline Mohr
- Monash University Centre for Developmental Psychiatry and Psychology, Capital and Coast District Health Board, Porirua, Wellington, New Zealand.
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