Empirically supported psychological treatments: The challenges of comorbid psychiatric and behavioral disorders in people with intellectual disability

Abstract

This paper reviews the current state of knowledge on psychological interventions with empirical evidence of efficacy in treating common psychiatric and behavioral disorders in people with intellectual disability (ID) at all stages of their life. We begin with a brief presentation of what is meant by psychiatric and behavioral disorders in this population, along with an explanation of some of the factors that contribute to the increased psychosocial vulnerability of this group to present with these problems. We then conduct a review of empirically supported psychological therapies used to treat psychiatric and behavioral disorders in people with ID. The review is structured around the three generations of therapies: Applied behavior analysis ( e.g. , positive behavior support), cognitive behavioral therapies ( e.g. , mindfulness-based cognitive therapy), and contextual therapies ( e.g. , dialectical behavior therapy). We conclude with some recommendations for professional practice in the fields of ID and psychiatry.

Psychotropic drugs intake in people aging with intellectual disability: Prevalence and predictors

“…In this regard, there is evidence that the presence of behavioural problems is associated with the start and maintenance of psychotropic drug therapy (Song et al, 2020), which is often chosen over other less invasive alternatives (i.e., psychological therapy; Deb et al, 2009; Valdovinos et al, 2017). Pharmacological interventions are commonly used to manage behavioural problems in spite of its numerous side effects (Sheehan, 2018) and the lack of awareness about the safety of psychotropic medications in population with intellectual disability (Gómez, Navas, Verdugo, & Tassé, 2021). These adverse effects may hinder the diagnosis of other health problems in the population with intellectual disability (Axmon, Ahlström, et al, 2019).…”

Two Genetic Mechanisms in Two Siblings with Intellectual Disability, Autism Spectrum Disorder, and Psychosis

“…ID and ASD are complex disorders with high clinical heterogeneity and etiological complexity. Approximately 33% of patients with ASD are comorbid with ID [ 4 ], while ID often co-occurs with behavioral and psychiatric conditions [ 5 , 6 , 7 ]. ID and ASD have high genetic components in their etiology, and the genetic deficits of ID and ASD are highly heterogeneous, ranging from chromosomal abnormalities and copy number variations of genomic DNA (CNV) to small insertions and deletions (indel) and single nucleotide variants (SNV) [ 8 , 9 ].…”

Co-Occurring Mental Illness and Behavioral Support Needs in Adults with Intellectual and Developmental Disabilities

“…Conversely, study respondents with severe or profound IDD were more likely to have behavioral support needs (without mental health diagnosis) and were also more likely to communicate without using speech. This observation about the role of speech as one’s primary form of communication may suggest the challenge with identifying mental health difficulties among people who do not communicate via speech, which would be logical the challenges of communicating the nuances of mental or emotional unease (Gómez et al, 2021 ). It may also point to the fact that professionals who support people with IDD may need to take more time to understand how people with more severe IDD communicate and express their mental and emotional state in the absence of speech (Gómez et al, 2021 ).…”

“…Until relatively recently, clinicians and researchers believed that people with IDD could not have co-occurring mental health conditions (Gómez et al, 2021 ; Mazza et al, 2020 ). Under this early conceptualization, challenging behaviors, defined as culturally abnormal behaviors that posed a risk to the individual’s safety or ability to interact with the community (Poppes et al, 2010 ), were attributed directly to a person’s disability (Mazza et al, 2020 ).…”

“…Research has increasingly suggested that people with IDD can have a co-occurring mental health condition and may, in fact, have higher rates of mental health problems than people without IDD (Gómez et al, 2021 ; Ricciardi, 2013 ). This new understanding led to a debate in the field about the relationships between behavioral support needs and mental health conditions in people with IDD (Baudewijns et al, 2018 ; Gómez et al, 2021 ; McCarthy et al, 2010 ; Painter et al, 2018 ). Ongoing research is needed to disaggregate the interrelated presentations of mental health conditions and behavioral support needs to ensure that people with IDD and co-occurring conditions receive the proper diagnoses and support.…”