Behaviour disorders in children with an intellectual disability

Abstract

T he diagnosis of an intellectual disability (ID) relates to a heterogeneous group of individuals, approximately 3% of the population, whose intelligence quotient is <70. Behaviour disorders are frequent in children with an ID, can create problems in everyday life and can mask, or reveal an organic or psychiatric illness. It is crucial to adopt a multidisciplinary approach in treating these behaviours.In the present review, we first describe some general concepts dealing with the management of behaviour disorders in children with an ID, and then provide an overview of, in our experience, the four most common of these disorders: sleep disturbances, agitation (as it relates to attention-deficit hyperactivity disorder [ADHD]), aggression and self-injury. The treatment of organic problems and psychiatric illnesses that may cause behaviour disorders is beyond the scope of the present article. The present article is based on a conventional and complete literature review, with many of the practical suggestions based on the experience of the authors (ie, group consensus). General concepts assessmentThe first step is to obtain an adequate medical history including onset of the behaviour disorder, evolution over time, extenuating or aggravating factors (eg, environmental stressors that could be impacting the child), functional impairment, a family history of psychiatric problems and the impact of the child's behavioural difficulties on other family members. It is also important to have information on the individual's level of functioning including cognitive, adaptive, social-functioning, levels of receptive understanding and expressive language (1). A thorough physical examination is required in all cases.In cases where parents or tutors 'no longer recognize the child' and there are, for example, autonomic symptoms such as loss of appetite combined with a loss of weight or marked changes in sleep habits, a specific questionnaire dealing with psychiatric symptoms must be completed. A family history of depression, loss of interest in favourite activities, evidence of sadness and recent irritability should suggest the possibility of a depression. In investigating a possible anxiety problem, it is important not only to consider the family history, but also the avoidance of specific situations, difficulties with transitions, difficulties encountered in distancing oneself from attachment figures or the presence of adrenergic symptoms (eg, tachycardia, tremor) during a crisis. A bipolar illness must be considered in the presence of a family history or severe agitation cycles alternating with periods of apathy.In most circumstances, a suspected psychiatric etiology would require evaluation and management by a child psychiatrist. The prevalence rate of psychiatric disturbances, in the population of children with an ID, is 20% to 35%, that is, three to five times higher than that for the general population. It is important to rule out the possibility of a psychiatric disturbance when the patient shows behavioural symptoms of recent...

A Comparative Study on Efficacy of Risperidone versus Risperidone and Sodium Valproate Combination in the Treatment of Aggression in Children and Adolescents with Intellectual Disability

“…Individuals with intellectual disability particularly those with more severe intellectual disability may also exhibit self injurious behaviour, aggression, disruptive behaviours including harm to others or property destruction. 3 Behaviour disorders are frequent in children with intellectual disability, regardless of the underlying etiology 4 Compared to children without Intellectual disability, the most prominent problem behaviours of children with ID are social problems, attention problems and aggressive behaviourfound in nearly 50 % of such children. 5 Research literature shows that the prevalence of aggression among people with intellectual disability and autism ranges from 9-31%.…”

“…Children with ID manifest aggressive behaviour more often than children with average intelligence, Etiology of aggression can be a number of medical neurological psychiatric or environmental factors. 4 Studies show ,The risk of aggressive behaviour is more in greater degrees of intellectual disability, organic etiology, organic brain damage like Temporal Lobe Epilepsy, sensory disabilities, language difficulties, poor social skills poor social support and concomitant psychiatric disorders 6 Common triggers for reactive aggressive behaviour are pain or inability to comprehend a minor event. Self injurious behaviour has been defined as a response that produces physical injury to the individuals own body.…”

“…In children it is most commonly reported in association with an ID at rates ranging from 7-22%. 4 Some studies have shown that more males than females exhibit aggression. Aggressive behaviour is exhibited more frequently or more intensely in adolescents and young adults.…”

“…5 Risperidone or Olanzapine may decrease aggression and Self Injurious Behaviour in children with ID. 4 In an open labelled study using Risperidone to treat disruptive behaviours and self injury in children with Downs syndrome, severe intellectual disability and co morbid autism spectrum disorders, it was found that children with disruptive behaviour and self injury showed the greatest improvement with Risperidone. 8 The short term efficacy of Risperidone was examined in a 6 week multicentered double blind parallel group study of 118 children (aged 5-12 yrs) with severely disruptive behaviours and subaverage intelligence (IQ between 36and 84).…”

A Comparison of Problem Behaviours of Students With Visual Impairments and Typically Developing Students

“…Students who have significant problem behaviours may have serious problems at daily life as well (Elgar, Arlett, & Groves, 2003). It is essential to work with different professionals as a part of a multi-disciplinary team to intervene the problem behaviours of students as early as possible (Ageranioti-Bélanger, Brunet, D'Anjou, Tellier, Boivin, & Gauthier, 2012).…”