Psychosis and adults with intellectual disabilities

Objective To determine the point prevalence, incidence, and remission over a 2-year period of psychosis in adults with intellectual disabilities, and to investigate demographic and clinical factors hypothesised to be associated with psychosis. Method A population-based cohort of adults with intellectual disabilities (n = 1,023) was longitudinally studied. Comprehensive face-to-face mental health assessments to detect psychosis, plus review of family physician, psychiatric, and psychology case notes were undertaken at two time points, 2 years apart. Results Point prevalence is 2.6% (95% CI = 1.8–3.8%) to 4.4% (95% CI = 3.2–5.8%), dependant upon the diagnostic criteria employed. Two-year incidence is 1.4% (95% CI = 0.6–2.6), and for first episode is 0.5% (95% CI = 0.1–1.3). Compared with the general population, the standardised incidence ratio for first episode psychosis is 10.0 (95% CI = 2.1–29.3). Full remission after 2 years is 14.3%. Visual impairment, previous long-stay hospital residence, smoking, and not having epilepsy were independently associated with psychosis, whereas other factors relevant to the general population were not. Conclusions The study of psychosis in persons with intellectual disabilities benefits the population with intellectual disabilities, and advances the understanding of psychosis for the general population. Mental health professionals need adequate knowledge in order to address the high rates of psychosis in this population.     

Comorbidity among persons with intellectual disabilities

Within the last three decades, the study of conditions that co-occur with intellectual disabilities has flourished. The present paper provides an analysis of the content of 405 papers that were reviewed on the topic. From these papers, trends emerged. The papers fell into one of three broad categories; comorbid psychopathology, comorbid medical problems, and comorbid challenging behaviors. Also, the volume of studies has been increasing rapidly. Implications of these and related issues are discussed.     

Interviewing alleged victims with intellectual disabilities

Background When interviewing alleged victims of crime, it is important to obtain reports that are as accurate and complete as possible. This can be especially difficult when the alleged victims have intellectual disabilities (ID). This study explored how alleged victims with ID are interviewed by police officers in Sweden and how this may affect their ability to report information as accurately as possible. Methods Twelve interviews with 11 alleged victims were selected from a larger sample. The complainants were interviewed when their chronological ages ranged from 6.1 to 22 years. A quantitative analysis examined the type of questions asked and the numbers of words and details they elicited in response. Results Instead of open‐ended questions, the interviewers relied heavily on focused questions, which are more likely to elicit inaccurate information. When given the opportunity, the witnesses were able to answer directive questions informatively. Conclusions Interviewers need special skills in order to interview alleged victims who have ID. In addition to using more open‐ended questions, interviewers should speak in shorter sentences.     

Aging in adults with intellectual disabilities

A cross-sequential design was used to examine changes related to aging in adults with and without Down syndrome (ns = 55 and 75, respectively). Adults received yearly neuropsychological and medical evaluations. Support for precocious aging in adults with Down syndrome was evident only on a test of verbal fluency, with weaker support obtained on a test of fine-motor skills. Cross-sectional age differences for all adults were obtained on tests of memory and community living skills. General intellectual level, gender, and psychiatric status were consistently related to performance, indicating the need to examine such mediating variables in studies on aging.     

Self-injurious-behavior in children and adolescents with intellectual disabilities

10% of the children and teenagers with intellectual disability develop self-injurious behavior during lifespan. The causes for this are investigated, often various and reach from learn-theoretical up to neurobiological conditions. The available work gives overview of the current state of research to the etiology, further factors of influence as well as the process of self-injurious behavior by intellectual disability. Beyond that current diagnostics procedures, standard of treatment of the last thirty years and their effectiveness are presented and discussed finally.     

Multimorbidity in older adults with intellectual disabilities

Multimorbidity may be related to the supposed early aging of people with intellectual disabilities (ID). This group may suffer more often from multimorbidity, because of ID-related physical health conditions, unhealthy lifestyle and metabolic effects of antipsychotic drug use. Multimorbidity has been defined as two or more chronic conditions. Data on chronic conditions have been collected through physical assessment, questionnaires, and medical files. Prevalence, associated factors and clusters of multimorbidity have been studied in 1047 older adults (≥50 years) with ID. Multimorbidity was prevalent in 79.8% and associated with age and severe/profound ID. Four or more conditions were prevalent in 46.8% and associated with age, severe/profound ID and Down syndrome. Factor analyses did not reveal a model for disease-clusters with good fit. Multimorbidity is highly prevalent in older adults with ID. Multimorbidity should receive more attention in research and clinical practice for targeted pro-active prevention and treatment.     

Reading skills among students with intellectual disabilities

Students with intellectual disabilities (ID) display an extremely wide variety of skills in the field of literacy, and the ability to read and write are central learning aims in the education of students with ID. It is vital to gain detailed knowledge on the literacy skills of students with ID in order to plan instruction, create learning environments, implement educational policies or funding models and specify future fields of research. However, there has been little research into the prevalence and variation of their reading skills. The present study assessed the reading stages of 1629 school-aged students with ID regardless of aetiology (age 6–21) in Bavaria, one of the largest regions in Germany within a randomly chosen and representative sample. Teachers described the reading and writing stages of their students in a questionnaire following the developmental model of Frith. Results indicate that 29.3% do not read at all, 6.8% read at a logographic stage, 31.9% at an alphabetic and 32% at an orthographic level. Writing achievements are lower on average. We analyze and discuss the determinants of literacy in this sample with regard to the sociocultural background of students with ID and draw conclusions for teaching and school policies.     

Life satisfaction in persons with intellectual disabilities

We appraised life satisfaction using the Satisfaction with Life Scale (SWLS), and analysed its psychometric properties in persons with intellectual disability (ID). Ninety-nine persons with ID from four services in Spain participated. A battery of subjective assessments was used, including the SWLS, a Quality of Life measure (WHOQOL-BREF), and health status and sociodemographic information. Psychometric properties of the SWLS were investigated using standard psychometric methods. Overall, our results showed that persons with ID were satisfied with their life (SWLS score 25-29). Internal consistency (Cronbach's alpha) was .79. A factor analysis using principal components method, showed a one factor structure accounting for 55.7% of the variance. Associations, using Spearman's rho correlation coefficients, were confirmed between SWLS with the overall QoL, satisfaction with health and WHOQOL-BREF total score. Regarding 'known group' differences, persons living in residential institutions had lower life satisfaction compared to persons living in community facilities or living at home, though differences were not statistically significant. Student t-tests showed that SWLS scores significantly discriminated between healthy and unhealthy; and those reporting higher satisfaction with their relationships, home environment and their jobs compared to participants with lower satisfaction levels. To our best knowledge, this study is the first to report on the psychometrics properties of the SWLS in persons with ID, both in Spain and internationally. It might be a promising tool to use, with other outcome measures, in appraising persons with ID in different services and types of care; also, it might guide policymakers on the implementation of policies for persons with ID.     

Self-injurious behaviour in individuals with intellectual disabilities

PURPOSE OF REVIEW: In this paper we review literature published in 2004 on self-injurious behaviour in individuals with intellectual disabilities. Reviewed studies examine phenomenology and comorbidity, pharmacological and other interventions, genetic syndromes, and behavioural assessment and treatment. RECENT FINDINGS: Key findings include the possible association between self-injury and impulse control and stereotyped behaviours. Reports on the use of pharmacological interventions provide little evidence for the use such interventions, although the findings of studies on naltrexone seem stronger. In the behavioural phenotype literature the predictors of self-injury in Prader-Willi syndrome are becoming more refined. The behaviour analysis literature reports further development of assessment methodology to cater for idiosyncratic functions and low-rate behaviours. SUMMARY: Developments in the fields of applied behaviour analysis and genetic syndromes highlight the importance of tailored assessments and interventions. Evidence from the pharmacological literature suggests that although significant numbers of individuals are prescribed such interventions, the research evidence for their efficacy is, at best, weak.     

Substance abuse among individuals with intellectual disabilities

Individuals with disabilities are a growing population that confronts multiple disadvantages from social and environmental determinants of health. In particular, the 7-8 million people in the U.S. with an intellectual disability (ID) suffer disproportionately from substance use problems, largely because of a lack of empirical evidence to inform prevention and treatment efforts for them. Although available research could inform future research efforts, studies are scattered across disciplines with the last review synthesizing findings written more than five years ago. To consider more recent findings with earlier works, PubMed, PsychINFO, and Google Scholar were searched and produced 37 peer-reviewed texts across multiple disciplines, 15 from 2006 or later. While the prevalence of alcohol and illicit drug use in this population are low, the risk of having a substance-related problem among ID substance users is comparatively high. Gaps in the research and population subgroups that warrant special attention are identified, such as individuals with borderline and mild ID, individuals with co-occurring mental illness, and individuals who are incarcerated. Compared with substance abusers without ID, ID substance abusers are less likely to receive substance abuse treatment or remain in treatment. Research is needed to better gauge the magnitude of substance use problems, identify prevention strategies, and specify treatment components that meet the unique needs of individuals with ID.     

Forensic aspects in people with intellectual disabilities

PURPOSE OF REVIEW: The past few years have seen a growth in research of forensic issues relating to people with intellectual disabilities. This review examines a broad spectrum covering 2005 and 2006, for which articles are already available. Given the diversity of publications, reference will also be made to some of the main articles of 2004 to provide a context. RECENT FINDINGS: We are now at the stage where people are questioning the existing forensic psychiatry evidence base for people with intellectual disabilities. This review examines the assessment and treatment of three different groups, that is, fire setters, sexual offenders and those with problems of anger and aggression along with service outcome research, the criminal justice system, and a round up of other related research. SUMMARY: The growth of research in this area has aided the development of assessment and treatment instruments and treatment models for people with intellectual disabilities. This has helped to highlight the specialist and complex nature of this group. The review also looks at services from the point of delivery and the difficulty in research methodology and quantifying outcomes that take into account a changing society and current health inequalities.     

Self-assessment of facility-based supports for persons with intellectual disabilities and children with motional disabilities

To improve the support provided at facilities for persons with intellectual disabilities and children with motional disabilities, the author designed a questionnaire to be used for self-appraisal by the personnel of the relevant facilities. Twenty-one facilities participated; these facilities indicated that they needed to improve grievance procedures, the protection of privacy, staff training and collaborations with physicians, though they judged themselves to be able to respond appropriately to requests from individual users. Facilities for children answered that they supplied satisfactory supports, though other facilities such as workshops and community homes did not put regulations on staffs' abuse in statutory form. Grievance procedures and discussion with users are necessary to supply support based on needs of individual users.     

Deinstitutionalization in intellectual disabilities

PURPOSE OF REVIEW: The process of deinstitutionalization for intellectual disability services is at different stages across the world, varying from complete closure in Sweden to a vague hope in Taiwan. This review explores recent literature on deinstitutionalization and intellectual disabilities and focuses on papers published in academic journals mainly during 2006. RECENT FINDINGS: Work on deinstitutionalization continues to show that outcomes are better in the community than in institutional care but recent papers highlight that there is more to deinstitutionalization than just hospital closure. Just moving people out of institutions into community settings does not bring about automatic improvement in quality of life in terms of choice and inclusion as well as self-identity and access to effective healthcare and treatment. This is especially true for people with more severe intellectual disabilities as well as complex needs such as challenging behaviour. Some of the current research illustrates that even offenders with intellectual disability can be successfully supported in the community. SUMMARY: Recent research provides further examples and lessons on how community care can and should work, which it would be hoped will help those countries just starting the process of institutional closure to move more quickly to full deinstitutionalization.     

Supporting parents of youths with intellectual disabilities and psychopathology

Background Parents of children and adolescents with both intellectual disabilities (ID) and psychopathology often experience high levels of parenting stress. To support these parents, information is required regarding the types of support they need and whether their needs are met. Method In a sample of 745 youths (aged 10–24 years) with moderate to borderline ID, 289 parents perceived emotional and/or behavioural problems in their child. They were asked about their needs for support and whether these needs were met. Logistic regression analysis revealed the variables associated with both needing and receiving specific types of support. In addition, we asked those parents who had refrained from seeking support about their reasons. Results Most parents (88.2%) needed some supports, especially a friendly ear, respite care, child mental health care and information. Parents who perceived both emotional and behavioural problems in their child needed support the most. In addition, parents whose child had any of these problems before the past year, who worried most about their child and suffered from psychopathology themselves, more often needed support. Parents of children with moderate ID or physical problems especially needed ‘relief care’, that is, respite care, activities for the child and practical/material help. The need for a friendly ear was met most often (75.3%), whereas the need for parental counselling was met least often (35.5%). Not receiving support despite having a need for it was primarily related to the level of need. Parents who indicated to have a stronger need for support received support more often than parents who had a relatively low need for support. The parents’ main reasons for not seeking support concerned their evaluation of their child’s problems (not so serious or temporary), not knowing where to find support or wanting to solve the problems themselves first. Conclusions Most parents had various support needs that were frequently unmet. Service providers should especially aim at providing information, activities, child mental health care and parental counselling. Furthermore, parents need to be informed about where and how they can obtain what kind of support. A case manager can be of help in this.