Grief and its Complications in Individuals with Intellectual Disability

Abstract

Bereavement and loss have significant impact on the lives of individuals with intellectual disability (ID). Although there is a growing impetus to define the symptoms of grief that predict long-term functional impairment, little is known about maladaptive grieving among individuals with ID. We examine the literature concerning the phenomenology of traumatic grief (TG) in the general population, along with what is known about the manifestations of grief in individuals with ID. We then apply modern theories of grief and grief resolution to individuals with ID in order to highlight potential areas of vulnerability in this population and to lay the groundwork for interventions that will facilitate their adaptation to loss. We provide a theoretical framework for the proposition that individuals (including children and adults) with ID are more susceptible to TG, based on an increased risk of secondary loss, barriers to communicating about the loss, and difficulty finding meaning in the loss. We conclude that individuals with ID should be considered as potential candidates for targeted bereavement interventions. Further research is required, however, in order to develop population-appropriate measurement scales for testing these hypotheses. Keywords grief; bereavement; intellectual disabilityEarly psychodynamic theories of grief suggest that only those who are capable of understanding the finality of death, and who are able to perform the arduous psychological task of withdrawing emotion from the deceased, will be capable of mourning. [1][2][3][4] Even without a cognitive understanding of death, however, it is possible to notice the absence of a loved one and to react emotionally to that loss. In his formulation of attachment theory, John Bowlby 5-7 provided the first theoretical framework for the proposition that even young children can grieve following the loss of an attachment figure. Since then, studies have confirmed that children react with grief, sadness, and despair to the death of loved ones. 8 Individuals with intellectual disability (ID) have long been considered incapable of griefjust as young children once were. It has been suggested that individuals with ID * do not possess either the necessary capacity to form meaningful relationships 9,10 or the necessary

Owners’ Perceptions of Their Animal’s Behavioural Response to the Loss of an Animal Companion

“…Subjective ratings, observations and reports are a standard component of research within human psychology and include observations by clinicians, caregivers and peers as a substitute for self-report when self-report cannot be obtained [64], for example in the measurement of grief in individuals with intellectual disability, or young children [65,66]. In the case of animals, owners’ assessments are the primary source of information regarding companion animal behaviour problems [67,68,69] with companion animal owners being increasingly utilised as a source of information about their animal’s behaviour [63,70,71].…”

Education as a predictor of antidepressant and anxiolytic medication use after bereavement: a population-based record linkage study

“…Two of the three major theories stating that (i) educational attainment is merely a proxy indicator of socio-economic status and (ii) education is an indicator of the cognitive resources necessary for sense-making and resilience can be explored in more detail from the results [4, 5]. …”

“…The first is that educational attainment is merely a proxy indicator of socio-economic status, which is known to be associated with mental health [4]. The second is that education is an indicator of the cognitive resources necessary for sense-making and resilience [5]. The third is the social capital account, whereby formal education is assumed to increase an individual’s personal and social resources, which has a positive impact on their mental health [6].…”

Bereavement and behavioral changes as risk factors for cognitive decline in adults with Down syndrome

“…There is considerable scientific evidence regarding the negative effects of stressful events on the physical and mental health of the population in general,11–13 regarding the association between depressive symptoms and a progressive decline in cognitive function14 and, more specifically, regarding bereavement as a risk factor for health problems in the elderly 15–17. It is also broadly hypothesized that intellectual disability (ID) is a predictor of mental health problems following bereavement 9,18–21. Nevertheless, there have been few prospective, population-based studies of this topic 22–24.…”

“…Many authors had pointed out that individuals with ID are vulnerable to development of pathological responses to the death of a loved one and negative life events, such responses including aberrant behavior and disease 9,18,19,21,24,33. In a study investigating changes in health status, functional ability, and behavior among individuals with ID, parental death was associated with a behavioral change persisting for more than 2 years 23.…”