Psychiatric Vulnerability in Adults with Intellectual Disability and Autism: A Literature Review

2017 ◽  
Vol 41 (S1) ◽  
pp. S133-S133
Author(s):  
S. Coli ◽  
D. Scuticchio ◽  
M. Bertelli

IntroductionAdults with Intellectual disability (ID) and Autism Spectrum Disorder (ASD) are more vulnerable to mental health problems than the general population.Objectives/aimsThis study investigates presence and rate of psychiatric disorders in comparison with ID or ASD alone, and appropriateness of assessment and diagnostic procedures or tools.MethodsA systematic mapping of the literature was carried out on the basis of the above mentioned issues. The search was conducted using PubMed and ScienceDirect, according to the following keywords: psychiatric comorbidity, psychiatric disorders, autism, ASD, intellectual disability, mental health problems, adults, assessment tools, diagnosis. Twenty-eight papers were selected for pertinence to mapping issues among more than 500.ResultsMany studies show that ASD is an important vulnerability factor for psychiatric co-morbidity and for challenging behaviors (CBs) in adults with ID. Highest rates were reported for psychotic, mood, anxiety, and obsessive-compulsive disorders. Few studies show that the difference between adults with ID plus ASD and adults with only ID are not statistically significant, but for the presence of CBs in those with ID plus ASD. The disagreement of results is based on a variety of factors such as diagnostic over-shadowing, scarcity of specific assessment tools, consideration of the introspective and communication difficulties, incompleteness of medical records, and low reliability of information sources.ConclusionsAlthough low studies concordance, the literature mapping suggests the presence of ASD in ID to be associated with higher rates of psychopathology. Since the relevant implications for prevention and clinical management, further research with high-level evidence is hoped.Disclosure of interestThe authors have not supplied their declaration of competing interest.

2006 ◽  
Vol 19 (5) ◽  
pp. 842-858 ◽  
Author(s):  
Carrie A. McAiney ◽  
Paul Stolee ◽  
Loretta M. Hillier ◽  
Diane Harris ◽  
Pam Hamilton ◽  
...  

Background: This paper describes an innovative education program for the management of mental health problems in long-term care (LTC) homes and the evaluation of its longer-term sustainability. Since 1998, the [ldquor]Putting the P.I.E.C.E.S. Together[rdquor] learning initiative has been providing education sessions and related learning strategies aimed at developing the knowledge and skills of health professionals who care for older persons with complex physical and mental health needs and associated behaviors, in Ontario, Canada. A major focus of this province-wide initiative was the development of in-house Psychogeriatric Resource Persons (PRPs).Methods: Evaluation of this initiative included the completion of pre- and post-education questionnaires (over three data collection time periods) assessing learner confidence (N = 1,024 and 792, for pre- and post-education, respectively) and session evaluation questionnaires gathering feedback on the session (N = 2,029 across all sessions). A survey of LTC homes in Ontario (N = 439, 79% of the homes in the province) was conducted to assess longer-term sustainability.Results: Ratings of the sessions indicated that they were relevant to learners' clinical practice. There were significant increases in ratings of ability to recognize and understand challenging behaviors and mental health problems, and in ability to use a variety of assessment tools. Few homes (15%) do not have a PRP; over 50% of the staff who completed the first session in 1999 continue to serve as a PRP and to apply learned skills.Conclusions: A learning initiative with supportive and reinforcing strategies can develop in-house PRPs to enhance the care of the elderly in LTC. Incorporation of PRP functions into job descriptions and management support contributed to the success of this initiative. This study highlights the importance of work environments that support and reinforce the use of learned skills to the success of continuing education and quality improvement initiatives in LTC.


Author(s):  
Ewa Pisula ◽  
Alicja Niedźwiecka

Background: Autism spectrum disorder (ASD) may coexist with Down syndrome (DS). Most studies on this topic involve school-age children, adolescents, or adults with DS. This study looked at ASD symptoms, other mental health problems, and challenging behaviors in toddlers with DS at low risk of ASD. Methods: We used screening tools for autism in toddlers; BISCUIT–Parts 1–3 and Q-CHAT. We compared four groups of children aged 17–37 months: DS, ASD, Atypical Development (AD), and Typically Developing (TD). Results: Children with DS showed lower symptoms of ASD than children with ASD (without DS) and higher than TD children, except for repetitive behaviors/restricted interests. For comorbid mental health problems and difficult behaviors, children with DS scored lower than children with ASD. There were no differences between children with DS and TD children in this regard. Conclusions: The study results indicate that BISCUIT–Parts 1–3 are valid instruments to differentiate toddlers with DS from toddlers with ASD. However, they also show that toddlers with DS at low ASD risk are a very heterogeneous group when the ASD symptoms are considered. Autistic characteristics should be taken into account in supporting young children with this genetic condition.


2020 ◽  
Author(s):  
Matthias Schützwohl

Background: People with an intellectual disability (ID) show a great number and complex constellation of support needs. With respect to the planning of services, it is important to assess needs at the population level. ID services need to know to what extent support needs of clients with mental health problems differ from support needs of clients without any mental health problem.Aims: The aim of this study was to compare the prevalence rates of needs in relevant study groups. Methods: Data was generated from the MEMENTA-Study (“Mental health care for adults with intellectual disability and a mental disorder”). The Camberwell Assessment of Need for Adults with Intellectual Disabilities (CANDID) was used to assess met und unmet support needs. Data was available for n=248 adults with mild to moderate ID.Results: Mean total number of needs and unmet needs was associated with mental health status. However, in most particular areas under study, individuals without significant psychiatric symptoms or any behaviour problem needed as much as often help as individuals with such mental health problems. A higher rate of need for care among study participants with significant psychiatric symptoms or any behaviour problem was mainly found with regard to these specific areas (“minor mental health problems”, “major mental health problems”, “inappropriate behaviour”) or with regard to closely related areas (“safety of others”).Conclusions: Differences in prevalence rates mainly occurred in such areas of need that rather fall under the responsibility of mental health services than under the responsibility of ID services. This has implications for service planning.


2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Laura Hull ◽  
Lily Levy ◽  
Meng-Chuan Lai ◽  
K. V. Petrides ◽  
Simon Baron-Cohen ◽  
...  

Abstract Background There is inconsistent evidence for a clear pattern of association between ‘camouflaging’ (strategies used to mask and/or compensate for autism characteristics during social interactions) and mental health. Methods This study explored the relationship between self-reported camouflaging and generalised anxiety, depression, and social anxiety in a large sample of autistic adults and, for the first time, explored the moderating effect of gender, in an online survey. Results Overall, camouflaging was associated with greater symptoms of generalised anxiety, depression, and social anxiety, although only to a small extent beyond the contribution of autistic traits and age. Camouflaging more strongly predicted generalised and social anxiety than depression. No interaction between camouflaging and gender was found. Limitations These results cannot be generalised to autistic people with intellectual disability, or autistic children and young people. The sample did not include sufficient numbers of non-binary people to run separate analyses; therefore, it is possible that camouflaging impacts mental health differently in this population. Conclusions The findings suggest that camouflaging is a risk factor for mental health problems in autistic adults without intellectual disability, regardless of gender. We also identified levels of camouflaging at which risk of mental health problems is highest, suggesting clinicians should be particularly aware of mental health problems in those who score at or above these levels.


2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
H. M. Bjorgaas ◽  
I. Elgen ◽  
T. Boe ◽  
M. Hysing

Introduction. Children with cerebral palsy (CP), one of the most common childhood neurological disorders, often have associated medical and psychological symptoms. This study assesses mental health problems compared to population controls and the ability of a mental health screening tool to predict psychiatric disorders and to capture the complexity of coexisting symptoms.Methods. Children with CP (N=47) were assessed according to DSM-IV criteria using a psychiatric diagnostic instrument (Kiddie-SADS) and a mental health screening questionnaire (SDQ). Participants from the Bergen Child Study, a large epidemiological study, served as controls.Results. Children with CP had significantly higher means on all problem scores including impact scores. Two in three children scored above 90th percentile cutoff on Total Difficulties Score (TDS), and 57% met criteria for a psychiatric disorder, yielding a sensitivity of 0.85 and a specificity of 0.55. Mental health problems coexisted across symptom scales, and peer problems were highly prevalent in all groups of psychiatric disorders.Conclusion. A high prevalence of mental health problems and cooccurrence of symptoms were found in children with CP compared to controls. Screening with SDQ detects mental health problems, but does not predict specific disorders in children with CP. ADHD is common, but difficult to diagnose due to complexity of symptoms. Mental health services integrated in regular followup of children with CP are recommended due to high prevalence and considerable overlap of mental health symptoms.


Author(s):  
Reza Kiani ◽  
Sugato Bhaumik

Visual and hearing impairments, congenital or acquired, are much more common in people with intellectual disability (ID) than the general population. These can be missed or diagnosed with delay if professionals rely just on the subjective reports by the families/care givers rather than objective screening and assessment. People with ID might be unable to complain about a visual or hearing impairment due to their communication difficulties. Therefore, diagnostic overshadowing might occur whereby these conditions might present with atypical signs and symptoms (e.g. loss of skills, isolation, and challenging behaviours) which could be attributed to dementia, depression, or other mental health problems. There has also been an overrepresentation of autistic-like features and autism spectrum disorder reported in people with visual and hearing impairment. Raising awareness of these comorbidities in people with ID will therefore facilitate early diagnosis and implementation of appropriate management strategies that can improve service provision for this vulnerable population.


Author(s):  
Sabyasachi Bhaumik ◽  
Dasari Mohan Michael ◽  
Reza Kiani ◽  
Avinash Hiremath ◽  
Shweta Gangavati ◽  
...  

This chapter focuses on the current knowledge in public health for people with intellectual disability and recognizes the extent of health inequalities these individuals experience. The prevalence of intellectual disability worldwide is discussed with special emphasis on the prevalence of mental health problems. Also highlighted are the population health characteristics, including physical and mental health problems. The issue of barriers to accessibility and the possible reasons are discussed. There is a section on premature mortality of people with intellectual disability and measures to improve the health status for this marginalized population. Recent initiatives, including prevention strategies and health promotional aspects, are discussed and solutions suggested, including those for low-and-middle income countries (LAMICs)emphasized. Training aspects to improve quality of health care in LAMICs is highlighted with the recognition of limitations in creating a sustainable transformation of services unless they are backed by authorities.


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