Approximately one third of adults with intellectual and developmental disabilities have emotion dysregulation and challenging behaviors (CBs). Although research has not yet confirmed that existing treatments adequately reduce CBs in this population, dialectical behavior therapy (DBT) holds promise, as it has been shown to effectively reduce CBs in other emotionally dysregulated populations. This longitudinal single-group pilot study examined whether individuals with impaired intellectual functioning would show reductions in CBs while receiving standard DBT individual therapy used in conjunction with the Skills System (DBT-SS), a DBT emotion regulation skills curriculum adapted for individuals with cognitive impairment. Forty adults with developmental disabilities (most of whom also had intellectual disabilities) and CBs, including histories of aggression, self-injury, sexual offending, or other CBs, participated in this study. Changes in their behaviors were monitored over 4 years while in DBT-SS. Large reductions in CBs were observed during the 4 years. These findings suggest that modified DBT holds promise for effectively treating individuals with intellectual and developmental disabilities.

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Background: Dialectical behavior therapy (DBT) is an evidence-based treatment for self-harm and emotion regulation difficulties. A modified version, DBT-Skills System (DBT-SS), has been developed in the USA for individuals with cognitive difficulties. The present study is a pilot study, testing the DBT-SS in a Swedish context. Methods: Six participants were treated with individual therapy and group skills training for 48 sessions each. A case series design was used to follow individual development over time. The primary outcome measure was reduction in challenging behaviors. Secondary outcomes were level of functioning in daily life, hospital admissions, and resilience and vulnerabilities in different risk domains. Data was analyzed using time-series diagrams. Effect sizes of changes were calculated using Cohen's d. Results: Challenging behaviors decreased over time and participants' global level of functioning increased. There was a reduction in number of hospital admissions over time. As for resilience and vulnerabilities, participants' overall level of risk in various areas remained unchanged or decreased after treatment. Conclusions: The results indicate that DBT-SS might be a promising treatment for cognitively challenged individuals with emotion regulation difficulties and challenging behaviors in a Swedish context. The study provides suggestions for a future randomized controlled trial. Supplemental data for this article is available online at here.

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Many individuals with developmental and intellectual disabilities (ID) who are dually-diagnosed with mental health problems experience emotional, cognitive, and behavioural regulation difficulties. The comprehensive, multi-modal approach offered by Dialectical Behaviour Therapy (DBT) addresses the complex intra- and inter-personal challenges that create and maintain patterns of dysregulation and challenging behaviours. This chapter presents information to help DBT therapists understand factors relevant to applying DBT with individuals with dual-diagnosis and emotion regulation skills deficits. Although standard aspects of DBT are critical, adjustments to improve access for individuals with ID are necessary. Therapists treating this population must be competent in standard DBT and in managing factors associated with cognitive load to modify interventions in ways that remain fundamentally DBT. This chapter addresses accommodations that alter delivery mechanisms, not changing core processes, and introduces the Skills System, an adapted curriculum with which the DBT therapist can help individuals with ID improve intrinsic emotion regulation capacities.