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The September Issue of Current Opinion in Psychiatry offers a special section on an often overlooked topic in mental health - people with developmental and intellectual disabilities. The various sections of the review looked at new research, genetics, depression, children and adolescents, ageing and cultural diversity.
Progress in research
According the review, the literature continues to be dominated by case studies reports while clinical effectiveness comparative studies are very rare. There are some advances in research in psychological interventions for people with intellectual disabilities but these are based on the current developments in refining assessment and diagnostic criteria of mental health problems for this population.
Genetics and Behavioral Phenotypes
Some new research on the genetic issues and influences that affect individuals with developmental disabilities has been made including Prader-Willi syndrome, Fragile X syndrome, velocardiofacial syndrome and others. A number of comparatibve studies have demonstrated the significant differences in profiles of psychopathology in genetic disorders causing intellectual disability. The bottom line: research needs to continue and the more we know about the gene-to-behavior pathways in these conditions, the greater the opportunity to develop specific treatments to ameliorate them.
Ageing
Just as with other populations, individuals with developmental and intellectual disabilities are living longer. There are better assessment tools and more research being done to help in preventive and health supportive strategies. New data also helps in our understanding of disorders that affect the elderly. For example, investigation of amyloid deposits in persons with Down syndrome has contributed to our understanding of dementia.
Psychological Interventions
A fresh look at intervention techniques included behavioral, cognitive behavioral, psychodynamic, and psycho-educational approaches. Althought some progress has been made, this report strongly pointed out that there needs to be a standard of care established in each of the modalities and for each type of disability.
The atuthors suggest that a significant development in psychiatric diagnosis (Diagnostic Criteria for Psychiatric Disorder for Use with Adults with Learning Disabilities) needs to be done to guide future progress in intellectual disability research. Continued advances are also needed in assessment.
Depression
This paper examines reviews and research reports on depression in intellectual disability published from January 2003 to March 2004. Primary focus has been on the validity of atypical symptoms of depression and the methodological and conceptual issues hampering research efforts in that area. Despite the shortcomings, research on atypical symptoms has informed the development of modified diagnostic criteria for depression in intellectual disability. New promising instruments have been developed for the assessment of depression/mood at both the mild and more severe levels of intellectual disability. In addition, a number of standard measures were demonstrated to have adequate reliability when used with individuals with a mild to moderate degree of intellectual disability. The psychosocial correlates of depression need to be further studied and little has been published on treatment in depression and developmental disability.
Children and Adolescents
A literature review looking at mental health problems in children and adolescents points out that some progress has been made in the understanding of the nature and prevalence of psychopathology in these youngsters. An interesting study looked at the impact and prevalence of anxiety in Williams syndrome. It was found that 35% met criteria for a diagnosis of a specific phobia and a majority (96%) had subclinical phobias; 16% of the subjects met criteria for a diagnosis of overanxious disorder. Other syndromes described were Sotos and Down syndromes. Family issues affecting children and adolescents with intellectual disability and behavioral and emotional problems were reviewed and there was some discussion of the stresses that affect both the child and family.
Studies evalulating pharmacological treatments for children and adolescents with intellectual disability were included and while research to date suggests that useful medications for aggression in children and adolescents with autism include the atypical antipsychotics, selective serotonin-reuptake inhibitors, mirtazapine, mood-stabilisers, and Alpha2-adrenergic agonists, it is concluded that further research is necessary, particularly in terms of longitudinal research and the examination of the impact of age and developmental level.
Cultural Diversity
Research shows a high prevalence of intellectual disabilities in some minority ethnic communities. According to the authors, this can result in the experience of stigma and isolation, racism and the creation of social barriers, and a lack of cultural sensitivity in service delivery as well as some degree of negative attitudes of professionals. Current research also highlights some of the implications of religious, and other cultural beliefs of families from minority ethnic communities, and calls for more inclusive and culturally sensitive services. The authors conclude that research on cultural diversity and intellectual disability must explore the involvement and participation of people from black and minority ethnic communities, with a view to building acceptable models of culturally sensitive services.
Practice Guideline Review on Developmental Disabilities
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