We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
A small number of people with intellectual disability (ID) (or learning disability; previously mental retardation) offend or are suspected of having offended. Below average intellectual ability appears to be predictive of future offending behaviour [1] but it is not clear whether those who have a significant ID are over-represented in the criminal justice system (CJS) [2]. Recognising and diagnosing ID in the CJS is notoriously difficult despite screening tools having been developed, such as the Learning Disability Screening Questionnaire (LDSQ) [3].
Australian classrooms are becoming increasingly diverse. In addition to a wide range of mathematical abilities, primary teachers of mathematics must meet the needs of children from varied cultural backgrounds, many of whom have had different mathematical experiences. Children who have physical, intellectual, social or emotional difficulties may be included in the mainstream classroom. There may also be children who are classified as gifted and talented in one or more domains. All have the capacity to learn mathematics, and the right to experience mathematics suitable to their learning needs. Although this chapter addresses issues relating to inclusion in primary mathematics classrooms, it does not pretend to provide a special education focus. The needs of children with specific disabilities can be highly technical, and it is well beyond the scope of this chapter to try to deal with all the detailed requirements and concerns that may be encountered. Rather, this chapter aims to help the primary teacher deal with the reality of mathematics teaching in modern classrooms, where there may be children with very diverse learning and mathematical needs. Many students are not categorised as having a disability but have information processing delays. These students will benefit from the same approaches as those with recognised disabilities.
This chapter provides an overview of the practice, research, legislation and services models across the four Nordic countries of Denmark, Sweden, Norway, Finland. There are marked differences in approaches to offenders with neurodevelopmental disorders across the Nordic countries. Most countries have defined thresholds around the functioning of the person in considering a person criminally irresponsible. Still, the approach to identification, care and treatment of offenders with these conditions within the criminal law remains unclear. Treatment facilities reflect the legislation and policy of the country with for example an inclusive perspective as in Sweden which provides no separate treatment facilities for offenders with intellectual disability (ID) or neurodevelopmental disorders. However, Norway and Denmark have taken a different approach and developed special care and treatment units for people with neurodevelopmental disorders who commit offences.
Anger has been shown to be associated with aggression and violence in adults with intellectual disabilities in both community and secure settings. Emerging evidence has indicated that cognitive behavioural anger treatment can be effective in reducing assessed levels of anger and violent behaviour in these patient populations. However, it has been suggested that the effectiveness of these types of interventions is influenced by the experience and training of the therapists.
Method:
In this service evaluation study, the pre- and post-treatment and 12-month follow-up assessment scores of 88 detained in-patient adults with intellectual disabilities and forensic histories who received cognitive behavioural anger treatment were examined in order to investigate whether participants’ responsiveness to treatment was associated with treatment being delivered by qualified versus unqualified therapists.
Results:
Overall significant reductions in self-reported measures of anger disposition and anger reactivity were found with no significant time × therapist experience interaction effects. However, the patients treated by qualified therapists improved significantly on measures of anger control compared with those allocated to unqualified therapists.
Conclusions:
Male and female detained patients with intellectual disabilities and forensic histories can benefit from an individual cognitive behavioural anger treatment intervention delivered by qualified and unqualified therapists, but therapist experience may be important in supporting patients to develop more complex anger control coping skills.
Chapter 5 discusses some of the groups of children and young people who are most vulnerable to mental health challenges. These include children and young people with intellectual disabilities; children and young people with physical health difficulties; children and young people with gender identity difficulties and a range of sexual orientations as well as young carers.
On average, 49–63% of people with intellectual disabilities and/or autism spectrum disorder (ASD) are prescribed psychotropic medications to treat psychopathology, including psychiatric illness, behaviours that challenge and the core symptoms and associated behaviours of these developmental disorders. In many cases, psychotropics, particularly antipsychotics, are used off-label without a proper indication, particularly to manage behaviours that challenge. The RCTs show moderate evidence supporting the efficacy of low-dose risperidone and some preliminary evidence for aripiprazole in treating behaviours that challenge among children with ASD and/or intellectual disabilities. The RCT-based evidence for the other psychotropics is equivocal, so no definitive conclusions can be made on their efficacy. Polypharmacy and the use of high doses of antipsychotics are prevalent in this population, leading to the risk of adverse events and drug–drug interactions. Despite various national and international guidelines, and government initiatives encouraging reduced psychotropic use, there is little evidence of this happening; on the contrary, the use of antidepressants, mood stabilisers and benzodiazepines may be increasing. A concerted multi-agency effort is urgently needed to address this significant public health concern of the overmedication of people with intellectual disabilities and/or ASD.
There is growing evidence for the use of pharmacogenomics in psychotropic prescribing. People with intellectual disabilities are disproportionately prescribed psychotropics and are at risk of polypharmacy. There is an urgent need for safeguards to prevent psychotropic overprescribing but it is equally crucial that this population is not left behind in such exciting initiatives. Understanding how genetic variations affect medications is a step towards personalised medicine. This may improve personalised prescribing for people with intellectual disabilities, especially given the high rate of psychiatric and behavioural problems in this population. Our editorial explores opportunities and challenges that pharmacogenomics offers for the challenges of polypharmacy and overprescribing of psychotropics in people with intellectual disabilities.
Up to a fifth of people with intellectual disabilities display challenging behaviour that has a significant impact on their health and quality of life. Psychotropic medication does not appear to confer any clinical benefits beyond risk reduction in acute situations. However, very few non-pharmacological treatments have clear evidence of clinical and cost-effectiveness and there is therefore often a dearth of advice as to which components or interventions would be helpful. To our knowledge no single model has been developed to provide a clear path from understanding the behaviour to the implementation of a therapeutic approach for such a complex clinical problem. In this article we describe a stepped-care model that needs to be further operationalised in the assessment and management of behaviours that challenge in adults with intellectual disabilities.
Sleep is vital for our physical and mental health. Studies have shown that there is a high prevalence of sleep disorders and sleep difficulties amongst adults with intellectual disabilities. Despite this, sleep is often overlooked or its disorders are considered to be difficult to treat in adults with intellectual disabilities. There is a significant amount of research and guidance on management of sleep disorders in the general population. However, the evidence base for sleep disorders in adults with intellectual disabilities is limited. In this review paper, we look at the current evidence base for sleep disorders in adults with an intellectual disability, discuss collaborative working between intellectual disabilities psychiatrists and sleep medicine specialists to manage sleep disorders, and provide recommendations for future directions.
Offending behaviour and intellectual disabilities have long been associated in the literature. This erroneous linkage has had a significant influence on the development of services for this population. In this chapter, the relationship between intellectual disability and offending behaviour is outlined, along with legislative and criminal justice system issues that have impact on this client group. The historical and current policy context is described before the prevalence of offending and recidivism in this population is considered. Developments in risk assessment and clinical interventions for anger aggression, sexually harmful behavior and firesetting are briefly reviewed. Although over the last 20 years there have been significant developments in policy, service design, clinical assessment and treatment approaches for people with intellectual disabilities who offend or are at risk of offending, more rigorous and larger scale research is required to support further advances.
The prevalence of mental disorders plays an important role in identifying the state of mental health of the community and estimate the required facilities at any time.
Objectives
Therefore, the purpose of this study was to investigate the prevalence of psychological disorders in caregivers of children with intellectual disabilities and motor disabilities in Shiraz.
Methods
The research was descriptive and cross-sectional survey. The statistical population consisted of all mothers of children with disabilities who were admitted to welfare centers and clinics of Shiraz in 2019. Of these families, 35 mothers with children with intellectual disability and 35 mothers with children with motor disability were selected as the sample group. SCL-90-R (1976) was used to collect of data. For analyze the data, MANOVA test was used.
Results
The results of this study showed that the most common psychological disorders in caregivers of children with intellectual disability were aggression (hostility), hypersensitivity to interpersonal relationships, anxiety and depression, and in caregivers of children with motor disabilities were physical complaints, sensitivity to interpersonal relationships, paranoid thoughts and anxiety.
Conclusions
According to the findings of this research, it can be concluded that caregivers of children with special needs in terms of mental health are not in a favorable situation, which is due to the lack of proper adaptation with the disability of their child and the failure to meet their needs.
The International Classification of Functioning, Disability and Health (ICF) provides a framework rooted in patient-centered care and the biopsychosocial model that facilitates a comprehensive description of a person’s health and their level of societal participation. The importance of the ICF for assessing the needs of individuals with mental health problems (MHP) and intellectual disabilities (ID) is growing, especially in the social medicine.
Objective
To describe the benefits and limitations of the ICF in clinical practice, pertaining to the assessment of healthcare needs and societal participation in persons with MHP and ID.
Method
Comprehensive literature search in medical databases using the Keywords: ICF, mental health, intellectual disabilities, social and occupational participation.
Results
ICF-based instruments such as the Mini-ICF-APP, with which impairments and competencies in social and occupational participation can be described, are playing an increasingly important role in healthcare and rehabilitation. In Germany, for example, in accordance with the Federal Participation Act, the entitlement to disability support benefits is assessed using ICF-based instruments, which therefore play a decisive role in social medical care.
Conclusion
The functional descriptions of the ICF provide the opportunity for a standardized, yet individualized assessment of medical needs, general health and societal participation, thus facilitating the provision of a comprehensive package of care and support for people with disabilities. ICF-Core Sets and the Mini-ICF-APP are effective tools to describe level of function. It would be clinically valuable to further develop these instruments for use in persons with ID and MHP in the field of social medicine.
The diagnosis of intellectual disability (ID) alone does not predict the level of required care, functional outcomes or limitations in social and occupational participation. The International Classification of Functioning, Disability and Health (ICF) is a taxonomy of health and health-related domains. It provides a common language and framework for describing the level of functioning of a person within their unique environment. Furthermore, it helps to describe health problems of a person in line with the International Classification of Diseases (ICD-10).
Objective
Introducing the ICF taxonomy exemplary in the care of individuals with ID and mental health problems in Germany.
Method
Comparison of the ICF’s comprehensive multidisciplinary approach to assess an individual’s level of functioning and care in relation to assessing the needs of persons with ID based on clinical experience.
Results
The ICF provides a standardised assessment instrument to determine individual functional needs for the care, rehabilitation and societal integration of individuals with disabilities, which is a statutory requirement in many European countries.
Conclusion
Using the ICF for the assessment and management of patients with chronic health conditions, mental disorders and ID can help to accurately define individual therapeutic goals and monitor functional outcomes. A comprehensive narrative description of the patient’s functional status and clinical needs is comparatively time-consuming, requires greater effort by the assessing clinician and carries a higher risk of omission of pertinent functional domains; furthermore, a single ICF item confers little additional benefit to the patient in terms of the treatment or care they subsequently receive.
This is a systematic review of systematic reviews of secondary health conditions, health promotion interventions, and employment in people with intellectual disabilities. Articles were included if they reported a systematic review of health and employment, secondary health conditions, and health promotion interventions for people with intellectual disabilities. The methodological quality of the included reviews was reviewed using the A MeaSurement Tool to Assess systematic Reviews quality rating system, a measurement tool to assess systematic reviews. Twenty-five systematic reviews were included. There was evidence that people with intellectual disabilities (ID) were at elevated risk for secondary health conditions, health promotion interventions can improve physical and mental health conditions, and employment is associated with better health-related quality of life. Health promotion intervention to help people with ID engage in health promoting behaviors can improve health and their ability to find and maintain employment.
Psychiatric disorders, such as depression and anxiety, are commonly associated with epilepsy in the general population, but the relationship between psychiatric disorders and epilepsy among adults with intellectual disabilities is unclear.
Aims
To conduct a systematic review and meta-analysis to assess whether epilepsy is associated with an increased rate of psychiatric disorders in adults with intellectual disabilities.
Method
We included literature published between 1985 and 2020 from four databases, and hand-searched six relevant journals. We assessed risk of bias by using SIGN 50 and the Cochrane risk of bias tool. Several meta-analyses were carried out.
Results
We included 29 papers involving data on 9594 adults with intellectual disabilities, 3180 of whom had epilepsy and 6414 did not. Of the 11 controlled studies that compared the overall rate of psychiatric disorders between the epilepsy and non-epilepsy groups, seven did not show any significant inter-group difference. Meta-analysis was possible on pooled data from seven controlled studies, which did not show any significant inter-group difference in the overall rate of psychiatric disorders. The rates of psychotic disorders, depressive disorders and anxiety disorders were significantly higher in the non-epilepsy control groups compared with the epilepsy group, with effect sizes of 0.29, 0.47 and 0.58, respectively. Epilepsy-related factors did not show any definite association with psychiatric disorders.
Conclusions
It is difficult to pool data from such heterogeneous studies and draw any definitive conclusion because most studies lacked an appropriately matched control group, which will be required for future studies.
People with severe mental illness and intellectual disabilities are overrepresented in the criminal justice system worldwide and this is also the case in Ireland. Following Ireland’s ratification of the United Nations’ Convention on the Rights of People with Disabilities in 2018, there has been an increasing emphasis on ensuring access to justice for people with disabilities as in Article 13. For people with mental health and intellectual disabilities, this requires a multi-agency approach and a useful point of intervention may be at the police custody stage. Medicine has a key role to play both in advocacy and in practice. We suggest a functional approach to assessment, in practice, and list key considerations for doctors attending police custody suites. Improved training opportunities and greater resources are needed for general practitioners and psychiatrists who attend police custody suites to help fulfill this role.
The policy background is provided that underpins the assessment of needs in intellectual disabilities mental health services. Developments since the publication of the 1st edition of the CANDID are provided along with an updated list of measures and instruments used to assess needs in this population.
The Camberwell Assessment of Need for Adults with Developmental and Intellectual Disabilities (CANDID) is introduced. It was developed at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London in 1999, and published in book form in 2003. It was developed by modification of the Camberwell Assessment of Need (CAN), the most widely used needs assessment approach for people with severe mental health problems. In addition to CANDID, a number of other variants of CAN have been developed including needs assessment for forensic patients, for mothers and pregnant women, for older adults and for people in disaster and relief situations. In this 2nd edition, the need rating for the presence or absence of need and met or unmet needs is discussed. In addition, a need rating algorithm has been introduced. Both changes are in line with changes in the 2nd edition CAN. Moreover, the terminology in this 2nd edition has changed to reflect terminology used in contemporary intellectual disabilities services.
The Camberwell Assessment of Need for adults with Developmental and Intellectual Disabilities (CANDID) is a widely used tool for the assessment of health and social needs of people with intellectual disabilities and mental health problems. It uses the assessment approach adopted by CAN, the world's leading mental health needs assessment measure. Two versions of the CANDID are available: CANDID-S (short version) and CANDID-R (research version). Both versions are aimed at researchers and practitioners working with people with intellectual disabilities, and are suitable for clinical use in community and hospital-based services. Fully updated based on current policy, practice and terminology, this second edition introduces a more intuitive need rating system and an accessible rating algorithm. Guidance on how to use the measures is provided, as well as an overview of research developments since the first edition. The assessment forms are freely available to download from the CAN website (researchintorecovery.com/can) and cambridge.org.
Psychotropics are overprescribed for adults with intellectual disabilities; there are few studies in children and young people.
Aims
To investigate antipsychotic and antidepressant prescribing in children and young people with and without intellectual disabilities, and prescribing trends.
Method
Scotland's annual Pupil Census, which identifies pupils with and without intellectual disabilities, was record-linked to the Prescribing Information System. Antidepressant and antipsychotic data were extracted. Logistic regression was used to analyse prescribing between 2010 and 2013.
Results
Of the 704 297 pupils, 16 142 (2.29%) had a record of intellectual disabilities. Antipsychotic and antidepressant use increased over time, and was higher in older pupils; antipsychotic use was higher in boys, and antidepressant use was higher in girls. Overall, antipsychotics were prescribed to 281 (1.74%) pupils with intellectual disabilities and 802 (0.12%) without (adjusted odds ratio 16.85, 95% CI 15.29–18.56). The higher use among those with intellectual disabilities fell each year (adjusted odds ratio 20.19 in 2010 v. 14.24 in 2013). Overall, 191 (1.18%) pupils with intellectual disabilities and 4561 (0.66%) without were prescribed antidepressants (adjusted odds ratio 2.28, 95% CI 2.03–2.56). The difference decreased each year (adjusted odds ratio 3.10 in 2010 v. 2.02 in 2013).
Conclusions
Significantly more pupils with intellectual disabilities are prescribed antipsychotics and antidepressants than are other pupils. Prescribing overall increased over time, but less so for pupils with intellectual disabilities; either they are not receiving the same treatment advances as other pupils, or possible overprescribing in the past is changing. More longitudinal data are required.