Psychological treatments in intellectual disability: the challenges of building a good evidence base

Abstract

Psychological treatments are widely used for the management of mental health and behavioural problems in people with intellectual disabilities. The evidence base, including the cost-effectiveness of such interventions, is limited. This editorial explores the current evidence base and analyses its strengths and limitations. The editorial also highlights current problems in conducting randomised controlled trials in this area and suggests a way forward.

The advance of research governance in psychiatry: one step forward, two steps back

“…We recognize that the system is complex and idiosyncratic, but staff may still not understand that large trials must have clinical equipoise by virtue of having been granted approval to take place. As Bhaumik et al (2011) comment 'developing a research-based evidence base is not only critical to the establishment of new services or interventions, but also necessary to support the value of existing services'. The answer seems to be to train all clinical staff in the principles of RCTs including communicating their value in developing better treatment.…”

Comorbid Conditions in Individuals with Intellectual Disabilities

“…People with mild ID or intellectual abilities falling above 50 may well be able to make effective use of psychotherapeutic interventions, as delivered in the mainstream or the specialist setting, and further evaluation of the strengths and difficulties of services being delivered in each setting would be helpful in future service planning and delivery and indeed regarding staff training. Much more work is needed to explore whether and indeed how psychotherapeutic interventions can be of benefit to people with moderate or severe ID (Bhaumik et al 2011).…”

“…The point prevalence of a major depressive illness in people with ID is between 2 and 7 %, which means that depression can be twice as common in this group as in the general population (Prasher 1999, Cooper et al 2007, Bhaumik 2011.…”

“…A patient's ability to engage with a therapeutic intervention is complex and based on many factors-this applies just as much to an ID population as to a non-ID population. Bhaumik (2011) notes that there is little available evidence regarding how to motivate people to engage in psychotherapeutic interventions.…”

“…Good quality research of all kinds will be invaluable in maintaining existing services and in developing effective, efficient and indeed cost-effective services for people with ID (Bhaumik 2011). Much of the existing research on psychotherapeutic interventions for people with ID does not meet the rigorous standards of the randomised-controlled trial.…”