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Chapter 8 - Diagnosis of Co-occurrent Mental Health Problems in Persons with Intellectual Disability, Major Communication and Insight Difficulties, and Stressor-Related Disorders

Published online by Cambridge University Press:  01 February 2024

By
Marco O. Bertelli ,
Jane McCarthy  and
Krzysztof Krysta
Edited by
Andrea Fiorillo ,
Peter Falkai  and
Philip Gorwood
Andrea Fiorillo
Affiliation:
University of Campania “L. Vanvitelli”, Naples
Peter Falkai
Affiliation:
Ludwig-Maximilians-Universität München
Philip Gorwood
Affiliation:
Sainte-Anne Hospital, Paris
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Summary

The prevalence of psychiatric disorders among patients with intellectual disability (ID) and low-functioning autism spectrum disorder (ASD) is higher than in the general population. The available reports on this comorbidity vary depending on the adopted methodologies, the size of the examined ID population, and the criteria used to diagnose mental disorders. Multiple factors contribute to the significantly different presentation of psychopathological symptoms and syndromes in people with ID and ASD compared to the general population, including cognitive and communicative impairments, developmental peculiarities, and neuro-autonomic vulnerability. Because they have a hard time conceptualizing and articulating their mental states, the diagnosis of their psychopathology must rely on firsthand observation of behaviors in the context of daily life as well as third-party accounts. As a result, diagnostic criteria designed for the general population are ineffective when used in these groups, so for them specific diagnostic procedures and instruments should be a significant determinant of psychiatric diagnosis validity.

Keywords

intellectual disabilityautism spectrum disorderpsychiatric disorderscommunicative impairmentdiagnostic criteriaPTSD
Type
Chapter
Information
Mental Health Research and Practice
From Evidence to Experience
 , pp. 122 - 134
Publisher: Cambridge University Press
Print publication year: 2024

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References

Neece, C. L., Baker, B. L, Crnic, K, and Blacher, J. Examining the validity of ADHD as a diagnosis for adolescents with intellectual disabilities: clinical presentation. J Abnorm Child Psychol, 2013. 41(4): pp. 597–612.CrossRefGoogle ScholarPubMed
Neece, C. L., Baker, B. L, Blacher, J, and Crnic, K. Attention-deficit/hyperactivity disorder among children with and without intellectual disability: an examination across time. J Intellect Disabil Res, 2011. 55(7): pp. 623–35.CrossRefGoogle ScholarPubMed
McCann, B. S. and Roy-Byrne, P.. Attention-deficit/hyperactivity disorder and learning disabilities in adults. Semin Clin Neuropsychiatry, 2000. 5(3): pp. 191–7.CrossRefGoogle ScholarPubMed
Hassler, F. and Thome, J.. Mental retardation and ADHD. Z Kinder Jugendpsychiatr Psychother, 2012. 40(2): pp. 83–93; quiz 93–4.Google ScholarPubMed
Oeseburg, B., Dijkstra, G. J, Groothoff, J. W, et al. Prevalence of chronic health conditions in children with intellectual disability: a systematic literature review. Intellect Dev Disabil, 2011. 49(2): pp. 59–85.CrossRefGoogle ScholarPubMed
Testa, R., Pantelis, C., and Fontenelle, L. F.. Hoarding behaviors in children with learning disabilities. J Child Neurol, 2011. 26(5): pp. 574–9.CrossRefGoogle ScholarPubMed
Bradley, E. and Bolton, P.. Episodic psychiatric disorders in teenagers with learning disabilities with and without autism. Br J Psychiatry, 2006. 189: pp. 361–6.CrossRefGoogle ScholarPubMed
Chadwick, O., Kusel, Y, Cuddy, M, and Taylor, E. Psychiatric diagnoses and behaviour problems from childhood to early adolescence in young people with severe intellectual disabilities. Psychol Med, 2005. 35(5): pp. 751–60.CrossRefGoogle ScholarPubMed
Gothelf, D., Goraly, O, Avni, S, et al. Psychiatric morbidity with focus on obsessive-compulsive disorder in an Israeli cohort of adolescents with mild to moderate mental retardation. J Neural Transm (Vienna), 2008. 115(6): pp. 929–36.Google Scholar
Masi, G. and Luccherino, L.. Psychiatric illness in mental retardation: an update on pharmacotherapy. Panminerva Med, 1997. 39(4): pp. 299–304.Google ScholarPubMed
Campbell, M. and Malone, R. P.. Mental retardation and psychiatric disorders. Hosp Community Psychiatry, 1991. 42(4): pp. 374–9.Google ScholarPubMed
Crews, W. D., Jr., Bonaventura, S., and Rowe, F.. Dual diagnosis: prevalence of psychiatric disorders in a large state residential facility for individuals with mental retardation. Am J Ment Retard, 1994. 98(6): pp. 724–31.Google Scholar
Reiss, S. Prevalence of dual diagnosis in community-based day programs in the Chicago metropolitan area. Am J Ment Retard, 1990. 94(6): pp. 578–85.Google ScholarPubMed
Bailey, N. M. and Andrews, T. M.. Diagnostic criteria for psychiatric disorders for use with adults with learning disabilities/mental retardation (DC-LD) and the diagnosis of anxiety disorders: a review. J Intellect Disabil Res, 2003. 47 Suppl 1: pp. 50–61.CrossRefGoogle ScholarPubMed
Mantry, D., Cooper, S. A, Smiley, E, et al. The prevalence and incidence of mental ill-health in adults with Down syndrome. J Intellect Disabil Res, 2008. 52(Pt 2): pp. 141–55.CrossRefGoogle ScholarPubMed
Khan, A., Cowan, C., and Roy, A.. Personality disorders in people with learning disabilities: a community survey. J Intellect Disabil Res, 1997. 41 (Pt 4): pp. 324–30.CrossRefGoogle ScholarPubMed
La Malfa, G., Lassi, S, Bertelli, M, Salvini, R, and Placidi, G. F. Autism and intellectual disability: a study of prevalence on a sample of the Italian population. J Intellect Disabil Res, 2004. 48(Pt 3): pp. 262–7.CrossRefGoogle ScholarPubMed
La Malfa, G., Notarelli, A, Hardoy, M. C, Bertelli, M, and Cabras, P. L. Psychopathology and mental retardation: an Italian epidemiological study using the PIMRA. Res Dev Disabil, 1997. 18(3): pp. 179–84.CrossRefGoogle ScholarPubMed
Bobinska, K., Florkowski, A., and Galecki, P.. Characteristics of mental disorders in psychiatric patients with mental retardation–preliminary communication. Pol Merkur Lekarski, 2008. 25 Suppl 1: pp. 8–12.Google ScholarPubMed
Freedman, R. I. and Chassler, D.. Physical and behavioral health of adults with mental retardation across residential settings. Public Health Rep, 2004. 119(4): pp. 401–8.CrossRefGoogle ScholarPubMed
Cooper, S. A. Epidemiology of psychiatric disorders in elderly compared with younger adults with learning disabilities. Br J Psychiatry, 1997. 170: pp. 375–80.CrossRefGoogle ScholarPubMed
Smith, K., Shah, A, Wright, K, and Lewis, G. The prevalence and costs of psychiatric disorders and learning disabilities. Br J Psychiatry, 1995. 166(1): pp. 9–18.CrossRefGoogle ScholarPubMed
Ailey, S. H. Beyond the disability: recognizing mental health issues among persons with intellectual and developmental disabilities. Nurs Clin North Am, 2003. 38(2): pp. 313–29.CrossRefGoogle ScholarPubMed
Mazza, M. G., Rossetti, A, Crespi, G, and Clerici, M. Prevalence of co-occurring psychiatric disorders in adults and adolescents with intellectual disability: a systematic review and meta-analysis. J Appl Res Intellect Disabil, 2020. 33(2): pp. 126–38.CrossRefGoogle ScholarPubMed
Cooper, S.-A., Smiley, E, Morrison, J, Williamson, A, and Allan, L. Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. Br J Psychiatry, 2007. 190(1): pp. 27–35.CrossRefGoogle ScholarPubMed
Bertelli, M. Diagnosing psychiatric disorders in people with intellectual disabilities: issues and achievements. Adv Ment Health Intellect Disabil, 2015. 9, pp. 230–42.CrossRefGoogle Scholar
Bertelli, M., Hassiotis, A., Deb, S., and Salvador-Carulla, L.. New contributions of psychiatric research in the field of intellectual disability. In Christodoulou, G. N., Jorge, M., and Mezzich, J. E. (Eds.), Advances in psychiatry (pp. 37–44). Athens: Beta Medical Publishers, 2009.Google Scholar
Luckasson, R., Borthwick-Duffy, S, Buntinx, W. H. E, et al. Mental retardation: definition, classification, and systems of supports. Washington, DC: American Association on Mental Retardation, 2002.Google Scholar
Rutter, M., Tizard, J., and Whitmore, K.. Education, health and behaviour: psychological and medical study of childhood development. London: Longman Group Limited, 1970.Google Scholar
Birch, H. G. Mental subnormality in the community: a clinical and epidemiologic study. United States. 1970.Google Scholar
Dekker, M. C., Koot, H. M, van der Ende, J, and Verhulst, F. C. Emotional and behavioral problems in children and adolescents with and without intellectual disability. J Child Psychol Psychiatry, 2002. 43(8): pp. 1087–98.CrossRefGoogle ScholarPubMed
Platt, J. M., Keyes, K. M, McLaughlin, K. A, and Kaufman, A. S. Intellectual disability and mental disorders in a US population representative sample of adolescents. Psychol Med, 2019. 49(6): pp. 952–61.CrossRefGoogle Scholar
Deb, S., Thomas, M., and Bright, C.. Mental disorder in adults with intellectual disability. 2: the rate of behaviour disorders among a community‐based population aged between 16 and 64 years. J Intellect Disabil Res, 2001. 45(6): pp. 506–514.CrossRefGoogle ScholarPubMed
Bailey, N. Prevalence of psychiatric disorders in adults with moderate to profound learning disabilities. Adv Ment Health Intellect Disabil, 2007. 1(2): pp. 36–44.CrossRefGoogle Scholar
He, P., Chen, G, Wang, Z, et al. Adults with intellectual disabilities in China: comorbid psychiatric disorder and its association with health service utilisation. J Intellect Disabil Res, 2018. 62(2): pp. 106–114.CrossRefGoogle Scholar
Peña-Salazar, C., Arrufat, F, Santos, J. M, et al. Underdiagnosis of psychiatric disorders in people with intellectual disabilities: differences between psychiatric disorders and challenging behaviour. J Intellect Disabil, 2020. 24(3): pp. 326–38.CrossRefGoogle ScholarPubMed
Axmon, A., Björne, P, Nylander, L, and Ahlström, G. Psychiatric diagnoses in older people with intellectual disability in comparison with the general population: a register study. Epidemiol Psychiatr Sci, 2018. 27(5): pp. 479–491.CrossRefGoogle ScholarPubMed
Bradley, E. A., Summers, J. A, Wood, H. L, & Bryson, S. E. Comparing rates of psychiatric and behavior disorders in adolescents and young adults with severe intellectual disability with and without autism. J Autism Dev Disord, 2004. 34(2): pp. 151–161.CrossRefGoogle Scholar
Cervantes, P. E. and Matson, J. L.. Comorbid symptomology in adults with autism spectrum disorder and intellectual disability. J Autism Dev Disord, 2015. 45(12): pp. 3961–3970.CrossRefGoogle ScholarPubMed
Totsika, V., Hastings, R. P, Emerson, E, Lancaster, G. A, and Berridge, D. M. A population‐based investigation of behavioural and emotional problems and maternal mental health: associations with autism spectrum disorder and intellectual disability. J Child Psychol Psychiatry, 2011. 52(1): pp. 91–99.CrossRefGoogle ScholarPubMed
Kurzius-Spencer, M., Pettygrove, S, Christensen, D, et al. Behavioral problems in children with autism spectrum disorder with and without co-occurring intellectual disability. Res in Autism Spectr Disord, 2018. 56: pp. 61–71.CrossRefGoogle Scholar
Cochran, D. M., Dvir, Y., and Frazier, J. A.. “Autism-plus” spectrum disorders: intersection with psychosis and the schizophrenia spectrum. Child Adolesc, 2013. 22(4): pp. 609–627.Google ScholarPubMed
Cohen, D. J., Paul, R., and Volkmar, F. R.. Issues in the classification of pervasive and other developmental disorders: toward DSM-IV. J Am Acad Child Psychiatry, 1986. 25(2): pp. 213–220.CrossRefGoogle ScholarPubMed
Kumra, S., Jacobsen, L. K, Lenane, M, et al. “Multidimensionally impaired disorder”: is it a variant of very early-onset schizophrenia? J Am Acad Child Adolesc Psychiatry, 1998. 37(1): pp. 91–99.CrossRefGoogle ScholarPubMed
Gillberg, C. The ESSENCE in child psychiatry: early symptomatic syndromes eliciting neurodevelopmental clinical examinations. Res Dev Disabil, 2010. 31(6): pp. 1543–1551.CrossRefGoogle ScholarPubMed
Nyhan, W. L. Behavioral phenotypes in organic genetic disease: presidential address to the Society for Pediatric Research, May 1, 1971. Pediatr Res, 1972. 6(1): pp. 1–9.CrossRefGoogle Scholar
Felce, D., Kerr, M., and Hastings, R. P.. A general practice‐based study of the relationship between indicators of mental illness and challenging behaviour among adults with intellectual disabilities. J Intellect Disabil Res, 2009. 53(3): pp. 243–254.CrossRefGoogle ScholarPubMed
Hemmings, C., Gravestock, S, Pickard, M, and Bouras, N. Psychiatric symptoms and problem behaviours in people with intellectual disabilities. J Intellect Disabil Res, 2006. 50(4): pp. 269–276.CrossRefGoogle ScholarPubMed
Rojahn, J. and Meier, L. J.. Epidemiology of mental illness and maladaptive behavior in intellectual disabilities. Int Rev Res Ment Retard, 2009. 38: pp. 239–287.CrossRefGoogle Scholar
Hurley, A. D. Mood disorders in intellectual disability. Curr Opin Psychiatry, 2006. 19(5): pp. 465–469.CrossRefGoogle ScholarPubMed
Tsiouris, J., Mann, R, Patti, P. J, and Sturmey, P. Challenging behaviours should not be considered as depressive equivalents in individuals with intellectual disability. J Intellect Disabil Res, 2003. 47(1): pp. 14–21.CrossRefGoogle Scholar
Melville, C., Johnson, P. C, Smiley, E, et al. Statistical modelling studies examining the dimensional structure of psychopathology experienced by adults with intellectual disabilities: systematic review. Res Dev Disabil, 2016. 53: pp. 1–10.Google ScholarPubMed
Matson, J. L., Kazdin, A. E., and Senatore, V.. Psychometric properties of the psychopathology instrument for mentally retarded adults. Appl Res Ment Retard, 1984. 5(1): pp. 81–89.CrossRefGoogle ScholarPubMed
Matson, J., The diagnostic assessment for the severely handicapped-revised (DASH-II). Baton Rouge: Disability Consultants, LLC, 1995.Google Scholar
Moss, S., Prosser, H, Costello, H, et al. Reliability and validity of the PAS‐ADD Checklist for detecting psychiatric disorders in adults with intellectual disability. J Intellect Disabil Res, 1998. 42(2): pp. 173–183.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association, 2013.Google Scholar
Bertelli, M. O. and Scuticchio, D.. Strumenti di valutazione. In Bertelli, M. O. (Ed.). Diagnosi e valutazione psicopatologica – Disabilità intellettiva e disturbo dello spettro autistico (pp. 89–113). Firenze: Giunti Psychometrics S.r.l., 2019.Google Scholar
Bertelli, M. O. SPAIDD-G - Systematic Psychopathological Assessment for persons with Intellectual and Developmental Disabilities – General screening (Test, Scoring system, and Interpretive Report) Valutazione psicopatologica sistematica per le persone con disabilità intellettiva o dello sviluppo - screening generale (Test, Sistema di Calcolo del Punteggio e Rapporto Interpretativo). 2019.Google Scholar
Bertelli, M., Scuticchio, D, Ferrandi, A, et al. Reliability and validity of the SPAID-G checklist for detecting psychiatric disorders in adults with intellectual disability. Res Dev Disabil, 2012. 33(2): pp. 382–390.CrossRefGoogle ScholarPubMed
Bertelli, M., Francescutti, C., and Brown, I.. Reframing QoL assessment in persons with neurodevelopmental disorders. Ann Ist Super Sanita. 2020. 56(2): pp. 180–192.Google ScholarPubMed
McCarthy, J., Post-traumatic stress disorder in people with learning disability. Adv Psychiatr Treat, 2001. 7(3): pp. 163–169.CrossRefGoogle Scholar
Willott, S., Badger, W., and Evans, V.. People with an intellectual disability: under-reporting sexual violence. J Adult Prot, 2020. 22(2): pp. 75–86.CrossRefGoogle Scholar
McCarthy, J., Blanco, R. A., Gaus, V. L., Razza, N. J., and Tomasulo, D. J.. Trauma- and stressor-related disorders. In Barnhill, J., Cooper, S., and Fletcher, R., Diagnostic manual–intellectual disability 2 (DM-ID): a textbook of diagnosis of mental disorders in persons with intellectual disability. Kingston, NY: NADD, 2017.Google Scholar
Minnis, H., Fleming, G., and Cooper, S. A.. Reactive attachment disorder symptoms in adults with intellectual disabilities. J Appl Res Intellect Disabil, 2010. 23(4): pp. 398–403.CrossRefGoogle Scholar
Schuengel, C., de Schipper, J. C, Sterkenburg, P. S, and Kef, S. Attachment, intellectual disabilities and mental health: Research, assessment and intervention. J Appl Res Intellect Disabil, 2013. 26(1): pp. 34–46.CrossRefGoogle ScholarPubMed
Giltaij, H., Sterkenburg, P., and Schuengel, C.. Psychiatric diagnostic screening of social maladaptive behaviour in children with mild intellectual disability: differentiating disordered attachment and pervasive developmental disorder behaviour. J Intellect Disabil Res, 2015. 59(2): pp. 138–149.CrossRefGoogle ScholarPubMed
Wigham, S. and Emerson, E.. Trauma and life events in adults with intellectual disability. Curr Dev Disord Reps, 2015. 2(2): pp. 93–99.CrossRefGoogle Scholar
Tsakanikos, E., Bouras, N, Costello, H, and Holt, G. Multiple exposure to life events and clinical psychopathology in adults with intellectual disability. Soc Psychiatry Psychiatr Epidemiol, 2007. 42(1): pp. 24–28.CrossRefGoogle ScholarPubMed
Wieland, J., Wardenaar, K. J, Dautovic, E, and Zitman, F. G. 872 – Characteristics of posttraumatic stress disorder in patients with an intellectual disability. Eur Psychiatry, 2013. 28: pp. 1.Google Scholar
Nieuwenhuis, J. G., Smits, H. J. H, Noorthoorn, E. O, et al. Not recognized enough: the effects and associations of trauma and intellectual disability in severely mentally ill outpatients. Eur Psychiatry, 2019. 58: pp. 63–69.CrossRefGoogle ScholarPubMed
McNally, P., Taggart, L., and Shevlin, M.. Trauma experiences of people with an intellectual disability and their implications: a scoping review. J Appl Res Intellect Disabil, 2021. 34(4): pp. 927–949.CrossRefGoogle ScholarPubMed
Hall, J. C., Jobson, L., and Langdon, P. E.. Measuring symptoms of post‐traumatic stress disorder in people with intellectual disabilities: the development and psychometric properties of the Impact of Event Scale‐Intellectual Disabilities (IES‐ID s). Br J Clin Psychol, 2014. 53(3): pp. 315–332.CrossRefGoogle Scholar
Wigham, S., Hatton, C., and Taylor, J.. The Lancaster and Northgate Trauma Scales (LANTS): the development and psychometric properties of a measure of trauma for people with mild to moderate intellectual disabilities. Res Dev Disabil, 2011. 32(6): pp. 2651–2659.CrossRefGoogle ScholarPubMed
Rittmannsberger, D., Weber, G., and Lueger‐Schuster, B.. Applicability of the post‐traumatic stress disorder gate criterion in people with mild to moderate intellectual disabilities: do additional adverse events impact current symptoms of Post Traumatic Stress Disorder in people with intellectual disabilities? J Appl Res Intellect Disabil, 2020. 33(5): pp. 1100–1112.CrossRefGoogle ScholarPubMed
Oakes, P. Crash: what went wrong at Winterbourne View? J Intellect Disabil, 2012. 16(3): pp. 155–162.CrossRefGoogle ScholarPubMed
Mevissen, L. and De Jongh, A.. PTSD and its treatment in people with intellectual disabilities: A review of the literature. Clin Psychol Rev, 2010. 30(3): pp. 308–316.CrossRefGoogle ScholarPubMed
Bakken, T. L., Kildahl, A, Gjersøe, V, et al. Identification of PTSD in adults with intellectual disabilities in five patients in a specialised psychiatric inpatient unit. Adv Ment Health Intellect Disabil, 2014. 8. http://dx.doi.org/10.1108/AMHID-01-2013-0002.CrossRefGoogle Scholar
National Institute for Health and Care Excellence (NICE). Post traumatic stress disorder. Overview, Guidance, NICE. London: 2018.Google Scholar
Courtenay, K. and Perera, B.. COVID-19 and people with intellectual disability: impacts of a pandemic. I J Psychol Med, 2020. 37(3): pp. 231–236.Google ScholarPubMed
Hemm, C., Dagnan, D., and Meyer, T. D.. Identifying training needs for mainstream healthcare professionals, to prepare them for working with individuals with intellectual disabilities: a systematic review. J Appl Res Intellect Disabil, 2015. 28(2): pp. 98–110.CrossRefGoogle ScholarPubMed
Devine, M. Addressing the mental health needs of people with learning disabilities. Nursing Standard, 2008. 22(45): pp. 40–48.CrossRefGoogle ScholarPubMed
Costello, H. and Bouras, N.. Assessment of mental health problems in people with intellectual disabilities. Isr J Psychiatry Relat, 2006. 43(4): p. 241.Google ScholarPubMed
Sowney, M. and Barr, O.. The challenges for nurses communicating with and gaining valid consent from adults with intellectual disabilities within the accident and emergency care service. J Clin Nurs, 2007. 16(9): pp. 1678–1686.CrossRefGoogle ScholarPubMed
Trollor, J. N., Ruffell, B, Tracy, J, et al. Intellectual disability health content within nursing curriculum: An audit of what our future nurses are taught. Nurse Educ Today, 2016. 45: pp. 72–79.CrossRefGoogle ScholarPubMed
Werner, S., Stawski, M, Polakiewicz, Y and Levav, I. Psychiatrists’ knowledge, training and attitudes regarding the care of individuals with intellectual disability. J Intellect Disabil Res, 2013. 57(8): pp. 774–782.CrossRefGoogle ScholarPubMed
Riches, V. C., Parmenter, T. R, Wiese, M, and Stancliffe, R. J. Intellectual disability and mental illness in the NSW criminal justice system. Int J Law Psychiatry, 2006. 29(5): pp. 386–396.CrossRefGoogle ScholarPubMed
Werner, S. and Stawski, M.. Mental health: Knowledge, attitudes and training of professionals on dual diagnosis of intellectual disability and psychiatric disorder. J Intellect Disabil Res, 2012. 56(3): pp. 291–304.CrossRefGoogle ScholarPubMed
Haut, F., Hull, A., and Irons, A.. Learning disability nursing staff: a response to psychiatric teaching. Br J Learn Disabil, 2000. 28(4): pp. 154–156.CrossRefGoogle Scholar
Gibbs, M. and Priest, H. M.. Designing and implementing a “dual diagnosis” module: a review of the literature and some preliminary findings. Nurse Educ Today, 1999. 19(5): pp. 357–363.CrossRefGoogle ScholarPubMed
Holt, G., Costello, H., and Bouras, N.. Training direct care staff about the mental health needs of people with mental retardation. J Intellect Disabil Res, 2000. 44: pp. 323–324.Google Scholar
Mohr, C., Phillips, A, Curran, J and Rymill, A. Interagency training in dual disability. Australas Psychiatry, 2002. 10(4): pp. 356–364.CrossRefGoogle Scholar
Costello, H., Bouras, N., and Davis, H.. The role of training in improving community care staff awareness of mental health problems in people with intellectual disabilities. J Appl Res Intellect Disabil, 2007. 20(3): pp. 228–235.CrossRefGoogle Scholar

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