4p− syndrome 316–17
5p− (cri du chat) syndrome
aetiology-based behavioural research 202–3
indirect behavioural effects 206
specificity of behavioural phenotypes 204–5
within-group genetic variations 208
ABC (Aberrant Behaviour Checklist) 25–6,28
concurrent validity 34–6
criterion group validity 32,35
internal consistency 30,31
test–retest and inter-rater reliability 30–1
abuse, presenting as challenging behaviour 78, 83 see also physical abuse; sexual abuse
acute stress disorder see anxiety disorders
ADAMS assessment tool 121–2
depressed mood subscale 117–18
ADHD (attention deficit hyperactivity disorder)
differentiation from PDD-NOS 216–17
in people with autism 216–17
incidence among children and adolescents with ID 93–6
psychopharmacology 318–19
ADI (Autism Diagnostic Instrument) 98
adjustment disorders
clinical categories 122
DSM-IV-TR criteria 122
adjustment disorders in people with ID
aetiology 122–3
behaviour therapies 124
environmental stress factors 124
identification of physical problems 125
pharmacotherapeutic regimes 123–4
prevalence among people with ID 113
staff training to improve treatment 124–5
symptom presentation 123
treatment by removal of causes 123
treatment methods 123–5
adolescents with ID see children and adolescents with ID
ADOS (Autism Diagnostic Observation Schedule) 98
adrenergics 322–3
affective (mood) disorders 132–3
clinical features, assessment and diagnosis 134,135–7
general principles of treatment 138
non-pharmacological treatments 138
pharmacological treatments 138,316–17
range of community and inpatient services 138–9
see also depression
aggressive behaviour 62–3
anger management training 297–8
behavioural interventions 297–8
behavioural perspective 272–3
biobehavioural assessment and treatment 275–7
consequence analysis 273
functional assessment 272–3
functional assessment and treatment 275–7
functional assessment methods 274–5
genetic syndrome effects 271–2
integrated approach to treatment 277–8
inter-disciplinary treatment programme 275–7
medication side effects 271
neurological disorders 271–2
psychiatric conditions 271–2
psychopharmacology 314–16,319–23
quality-of-life analysis 274
setting events 273
treatment developments 269–70
treatment programme design 275–7
underlying medical conditions 270–1
see also behaviour problems; challenging behaviours; destructive behaviour
agoraphobia see anxiety disorders
Aicardi syndrome 239
alprazolam 315–16
Alzheimer’s disease
baseline neuroimaging 260
in older people with ID 156–9
see also dementia; Down syndrome
amantadine 322
Angelman syndrome
aetiology-based behavioural research 202–3
association with epilepsy 239
specificity of behavioural phenotypes 204–5
anger management training 297–8
see also aggressive behaviour
anticonvulsants 315,316–17,322–3
antipsychotics (neuroleptics) 316,317–18,320–1
tapering and discontinuation 318
tardive dyskinesia risk 317,320–1
anxiety disorders
conditions included 118–19
DSM-IV-TR criteria 118–19
anxiety disorders and ID
aetiology 119–20
assessment 121–2
behavioural interventions 124,295–7
cognitive therapy 334
diagnostic criteria 118–19
diagnostic instruments developed for ID 121–2
environmental stress factors 119–20,124
genetic factors 119
identification of physical problems 125
in people with autism spectrum disorders 218–20,221
link with major life events and trauma 121
link with physical and sexual abuse 119–20
pharmacotherapeutic regimes 123–4
post-traumatic stress disorder 119–20
prevalence among children and adolescents with ID 93–6
prevalence among people with ID 113,119
psychopharmacology 314–16
staff training to improve treatment 124–5
symptom presentation 121
treatment methods 123–5
Anxiety Disorders Interview Schedule 98
Asperger’s syndrome
co-morbid depression and anxiety 219,221
Non-verbal Learning Disability (NLD) 215–16,217–18
obsessive symptoms 220
pragmatic language impairment 217–18
psychiatric co-morbidity 215–16
assessment of children and adolescents with ID 96–7,98
assessment issues 98–101
cognitive ability issues 99
developmental level effects 99
multiple disabilities and medical illness 99–100
psychosocial and family factors 100–1
assessment process (mental health of a person with ID) 43–8
brief assessment screen 45,46
inter-disciplinary assessment 46–8
the first contact 45
venue 43
who should be there 45
atomoxetine 102–3
attention problems in autism spectrum disorders 215–16
autism spectrum disorders
ADHD co-morbidity 216–17
attention problems 215–16
clinical assessment of children and adolescents with ID 98
co-morbid depression and anxiety 218–20
co-morbid Tourette syndrome 220
diagnostic overshadowing 215–16
genetic factors 218–20
in children and adolescents with ID 94,99–100
neuroimaging studies 256–7
pragmatic language impairment 217–18
prevalence of ID 217–18
prevalence of learning disabilities 217–18
psychiatric co-morbidity in adolescence 215–16
relationship to schizophrenia 215–16,220–1
risk for depression 215–16
vocal and motor tics 220
autistic traits associated with challenging behaviours 70–1
baseline exaggeration 9–10,11,52
Beck Depression Inventory 117–18
behaviour disorders, classification criteria 9
behaviour problems
behavioural perspective 272–3
biobehavioural assessment and treatment 275–7
consequence analysis 273
contextual influences 292–3
epilepsy and ID 244–5
functional assessment 272–3
functional assessment and treatment 275–7
functional assessment methods 274–5
genetic syndrome effects 271–2
integrated approach to treatment 277–8
inter-disciplinary treatment programme 275–7
medication side effects 271
neurological disorders 271–2
Positive Behaviour Support 275–7,283–4
psychiatric conditions 271–2
psychopharmacology 319–23
quality-of-life analysis 274
setting events 273
treatment developments 269–70
treatment programme design 275–7
underlying medical conditions 270–1
see also aggressive behaviour; challenging behaviours; destructive behaviour
behaviour shaping (behavioural intervention) 290
behavioural ‘toxicity’ potential of drugs 313–14,322–3
behavioural equivalents 64–5,67,116–17
behavioural interventions
aggressive behaviour 297–8
anger management training 297–8
anxiety disorders 295–7
assessment 286–8
behaviour plan 284
behaviour shaping 290
benefits and future potential 283–4,300–1
choice of techniques 293
combinations of techniques 293
communication training 288
behavioural interventions (cont.)
contextual influences on problem behaviour 292–3
co-ordination with other disciplines 285
depression 298–9
disruptive behaviour 297–8
extinction of behaviours 290
functional assessment 287–8
functional communication training 288
integrated approach 285
inter-disciplinary assessment 286–8
interpersonal skills training 293–4
medical assessment 286
operant model of aggression 297
over-correction 292
phobias 295–6
Positive Behaviour Support 283–4
post-traumatic stress disorder 296–7
preference assessment 289
principles 284
psychiatric assessment 286–7
psychosis 299–300
punishment 291
reinforcement 289
relaxation training 294–5
response cost 291–2
role of carers 285
role of family, teachers and staff 285
self-management 290–1
social skills training 293–4
specific phobias 295–6
staff training in behavioural approach 300
time-out 292
token economy 289–90
video feedback 290–1
behavioural perspective, behaviour problems in people with ID 272–3
behavioural phenotypes 77–8
aetiology-based therapeutic approaches 210
age-related effects 206–7
definition 203
destructive or aggressive behaviour 271–2
developmental and contextual influences 206–7
differences within aetiological groups 208–9
differentiation using maladaptive behaviours 207–8
diversity of behavioural domains 205
equifinality concept 204–5
future research directions 207–10
indirect behavioural effects 206
influence of ‘background’ genetic factors 207
mechanisms associated with maladaptive behaviour 209
progress in aetiology-based behavioural research 202–3
therapeutic advances 210
total vs. partial specificity between syndromes 204–5,207–8
within-group variations 208–9
within-syndrome variability 203,208–9
benzodiazepines 315–16
beta adrenergic antagonists 315,322–3
beta-blockers 102–3
bio-psycho-social-spiritual influences on medical and psychiatric disorders 77–9
biobehavioural assessment and treatment, behaviour problems in people with ID 275–7
Birleson Depression Questionnaire 117–18
brain
neuroimaging in clinical practice 259–61,262
neuroimaging of neurodevelopmental disorders 256–9
neuroimaging studies of normal development 255–6
normal development and ageing 255–6
buspirone 314–15
CAMCOG 165
CAMDEX-DS 165
carbamazepine 102–3,315
carer-completed checklists and rating scales 36
see also mental health assessment and monitoring tools
CDI (Children’s Depression Inventory) 117–18
cerebral dysgenesis, in epilepsy and ID 240
cerebral dysplasias, in epilepsy and ID 240
challenging behaviours
and prevalence of psychiatric disorders 63–4
as consequence of psychiatric disorders 64
association with autistic traits 70–1
behavioural equivalents 64–5
case reports 66
complexity of contributory factors 71–2
conditions which are often overlooked 82–3
cross-sectional studies 67–8
definition 63
diagnostic skills required 71–2
difficulties in assessment 64–5
examples of research approaches 66–9
factor/cluster analytic studies 69
future research directions 69–71
inconsistent terminology and classification 65
intervention studies 68–9
lack of integrated approaches 66
link with psychiatric disorders 62–3
neuroimaging investigation 261
problems faced by researchers 64–6
reasons for link with psychiatric disorders 63–4
see also aggressive behaviour; behaviour problems; destructive behaviour
checklists see mental health assessment and monitoring tools
children and adolescents with ID
ADHD 93–6
applicability of DSM-IV and ICD-10 criteria 94
assessment issues 98–101
autism spectrum disorders 94,98,99–100
classification and diagnosis of psychopathological disorders 93–6
clinical assessment 96–7,98
clinical case example (Bill, aged 13 years) 104–5
clinical case example (Brian, aged 15 years) 105–6
clinical case example (Darren, aged 16 years) 106–9
clinical case example (Susan, aged 7 years) 103–4
depression and anxiety disorders 93–6
developmental level effects 99
Down syndrome 99–100
epilepsy 99–100
fragile X syndrome 99–100
genetic disorders associated with ID 99–100
level of cognitive ability 99
management principles 101–3
multimodal treatment 101–3
multiple disabilities and medical illness 99–100
pharmacotherapy 102–3
phenomenology of psychiatric disorders 93–6
Prader–Willi syndrome 99–100
psychiatric disorders 93
psychosocial and family factors 100–1
studies using DBC 95–6
support for parents and siblings 101–2
Tourette syndrome 99–100
Williams syndrome 99–100
chlorpromazine 317–18
citalopram 314,316–17
classification of challenging behaviours, inconsistency 65
classification of mental disorders
concerns about negative labelling 11–12
criteria for mental and behavioural disorders 9
critiques of classification 11–14
development of systems 3–4
importance and functions 3–4,5
necessary properties of systems 4–7,8
reliability and validity criteria 4–7,8
classification of psychiatric disorders, inconsistency of 65
clinical interview (person with ID) 48–52
asking about symptoms 50–2
considerations for effective interviewing 50–2
difficulties in interpreting symptoms 52
outline for history taking 48–50
clinical practice, use of neuroimaging 259–61,262
clinical services see mental health services for people with ID
‘cloak of confidence’ 50–2
clomipramine 102–3,321
clonazepam 315–16
clonidine 102–3,319
clozapine 320–1
cognitive disintegration 9–10,11,52
cognitive models of distress 334–5
effects of negative social construction 334–5
effects of stigmatization 334–5
cognitive therapy 332–4
assessment 333
‘deficit’ and ‘distortion’ approaches 332–3
for anxiety 334
for depression 334
for psychoses 334
outcomes 334
use for offenders with ID 334
communication training 288
compulsive behaviours and ID, psychopharmacology 314–16
consequence analysis, behaviour problems in people with ID 273
Cornelia de Lange syndrome
association with self-injurious behaviour 228
link with anxiety disorders 119
CPRS (Comprehensive Psychopathological Rating Scale) 117–18
criminal behaviour, neuroimaging investigation 261
Criminal Justice System
characteristics of people with ID who offend 180–2
culpability/criminal responsibility 187–8
diversion out for people with ID 185
fitness to plead/competence to stand trial 185–7
improvements in practice for people with ID 188–9
prevalence of people with ID 177–80
types of crimes committed by people with ID 180–2
vulnerabilities of people with ID 182–5
criminal offending in people with ID
assessment and treatment 189–90
assessment of risk of offending 189–90
changing attitudes towards 173
characteristics of people who offend 180–2
cognitive therapy 334
culpability/criminal responsibility 187–8
diversion out of the CJS 185
fitness to plead/competence to stand trial 185–7
improvements in CJS practice 188–9
past prejudices 173
prevalence (people in the CJS) 177–80
prevalence (total population studies) 173–7
rates of mental health problems 182
risk management 189–90
types of crimes committed 180–2
vulnerabilities in the CJS 182–5
CT (computerized tomography) scanning 252,256
Cushing’s disease, psychiatric symptoms caused by 82
DASH (Diagnostic Assessment for the Severely Handicapped Scale) 28–9
concurrent validity 34–6
criterion group validity 33,35
internal consistency 30,31
test–retest and inter-rater reliability 30–1
DBC (Developmental Behaviour Checklist), studies of children and adolescents with ID 95–6
DBC-A (Developmental Behaviour Checklist for Adults) 27,29
concurrent validity 34–6
criterion group validity 34,35
internal consistency 30,31
test–retest and inter-rater reliability 30–1
DBC-P (Developmental Behaviour Checklist) 25–6,27,29
DC-LD (Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities) 14–15,27,117–18
applicability to children and adolescents 94–5
classification of functional psychoses 132
delirium, causes which are often unrecognized 83
dementia 83
baseline neuroimaging 260
diagnosis in older people with ID 165–6
in older people with ID 156–1
link with Down syndrome 157–9
prevalence in older people with ID 159–61
risk factors in people with ID 157–60
symptoms 160–1
Dementia Scale for Down syndrome 165
Dementia Scale for Persons with Mental Retardation 165
depression
DSM-IV-TR criteria 113–14
dysthymic disorders 113–14,115–16
major depressive disorders 113–14,115–16
depression in people with ID
aetiology 115–16
amelioration of environmental stress factors 124
assessment 117–18
behavioural equivalents (atypical symptoms) 116–17
behavioural interventions 124,298–9
cognitive therapy 334
diagnostic criteria 114–15
diagnostic criteria developed for ID 117–18
genetic and biological factors 115
identification of physical problems 125
in people with autism spectrum disorders 218–20,221
incidence among children and adolescents with ID 93–6
link with stressful life events and trauma 115–16
pharmacotherapeutic regimes 123–4
prevalence 113,114–15
probable under-diagnosis 114–15
risk factors 115–16
staff training to improve treatment 124–5
symptom presentation 116–17
treatment methods 123–5
see also affective (mood) disorders
destructive behaviour 62–3
behavioural perspective 272–3
biobehavioural assessment and treatment 275–7
consequence analysis 273
functional assessment 272–3
functional assessment and treatment 275–7
functional assessment methods 274–5
genetic syndrome effects 271–2
integrated approach to treatment 277–8
inter-disciplinary treatment programme 275–7
medication side effects 271
neurological disorders 271–2
psychiatric conditions 271–2
quality-of-life analysis 274
setting events 273
treatment developments 269–70
treatment programme design 275–7
underlying medical conditions 270–1
see also aggressive behaviour; behaviour problems; challenging behaviours
development of services for people with ID
community-based care 356–7
development of humane forms of care 353–4
historical study of ID 353
human rights and social inclusion 356–7
impacts of eugenics movement 355–6
mental illness and ID 358–60
normalization movement 356–7
reaction to institutional care 356–7
rise of the total institution 354–6
self-worth and social value 356–7
specialist mental health services 358–60
dexamphetamine 102–3
dextromethorphan 322
diagnosis, and access to services and resources 8–9
see also specific conditions
Diagnostic and Statistical Manual see DSM
diagnostic overshadowing 9–10,11,52,81–2,215–16
disruptive behaviour see aggressive behaviour; behaviour problems; challenging behaviours; destructive behaviour
dopamine antagonists 320–1
Down syndrome (trisomy 21)
aetiology and specific drug treatments 313
aetiology-based behavioural research 202–3
aetiology-based therapeutic interventions 210
age-related changes in the brain 258
anxiety disorders link 119
association with epilepsy 238–9
baseline neuroimaging 260
behaviours affected by aetiology 205
CAMDEX-DS 165
cardiac surgery 81–2
dementia diagnosis 260
dementia link 157–9,166
Dementia Scale for Down syndrome 165
depression 115
in children and adolescents with ID 99–100
increased life expectancy 154–5
indirect behavioural effects 206
influence of ‘background’ genetic factors 207
neuroimaging studies 258
possible premature ageing 157–9
predispositions 77–8
side effects of tricyclic antidepressants 316
thyroid disease 82
within-syndrome variability 203
DRAMS (Dynamic Risk Assessment and Management System) 190
drug interactions 314
DSM (Diagnostic and Statistical Manual), development of 3–4
DSM-IV criteria
applicability to children and adolescents with ID 15–16,94
applicability to people with ID 26–7
assessment tools based on 26
definition of mental disorders 9
flexibility in classification system 14
DSM-IV-ID, modified criteria for people with ID 117–18
DSM-IV-TR criteria
depressive disorders 113–14
adjustment disorders 122
dysthymic disorders 113–14,115–16
see also depression
epilepsy and ID
aetiologies 239–40
aggressive behaviour 244–5
‘aura’ 242
behaviour disorders 244–5
carer concerns 245–6
cerebral dysgenesis 240
cerebral dysplasias 240
cognitive impairment 245
concerns among adolescents 245–6
diagnosis of epilepsy 240–1
diagnostic investigations 241
EEG investigations 241
effects of vigabatrin treatment 313
ictal and post-ictal behaviour 242
in children and adolescents with ID 99–100
inter-ictal psychopathology 242–3
Lennox–Gastaut syndrome 239–40
mental health problems 242–5
neuroimaging investigations 241
Neuronal Migration Disorders 240
personality disorders 244
prevalence among genetic syndromes 238–9
prevalence among people with ID 238–9
pro-convulsant effects of some psychotropic drugs 246–7
prodromal phase behaviour 242
psychopathology management 246–7
psychoses 243
quality-of-life effects 245–6
social impacts 245–6
West syndrome 239–40
Epiloia 247
escitalopram 314
eugenics movement 355–6
extinction of behaviours 290
family factors, impacts on children and adolescents with ID 100–1
fenfluramine 318–19
fetal alcohol syndrome, link with depressive disorders 115
fluoxetine 102–3,314,321
fluvoxamine 314,321
fMRI (functional magnetic resonance imaging) 255,256
fragile X syndrome 77–8
aetiology-based behavioural research 202–3
aetiology-based therapeutic approaches 210
association with epilepsy 239
association with self-injurious behaviour 228
behavioural phenotypes 204–5,258
cognitive phenotype 257–8
genetic basis 257
in children and adolescents with ID 99–100
link with anxiety disorders 119
link with depressive disorders 115
neuroimaging studies 257
functional assessment, behaviour problems in people with ID 272–3
functional assessment and treatment, behaviour problems in people with ID 275–7
functional assessment methods, behaviour problems in people with ID 274–5
functional psychoses see psychoses, functional
gabapentin 322
Gedye compulsive behaviour checklist 121–2
genetic factors
in depressive disorders 115
predisposition for psychosis 132
genetic syndromes
aetiology and specific drug treatments 312–13
and behaviour problems in people with ID 271–2
effects in children and adolescents 99–100
link with anxiety disorders 119
genotype, influence on physical and psychiatric disorders 77–8
Glasgow Anxiety Scale for ID 121–2
Glasgow Depression Scale 117–18
glutamate receptor antagonists 322
haloperidol 102–3,317–18
HCR-20 (Historical Clinical Risk-20) 190
health status, mortality and morbidity associated with ID 79–80,81
HFA (high-functioning autism), pragmatic language impairment 217–18
history of treatment of people with ID
community-based care 356–7
development of humane forms of care 353–4
historical study of ID 353
human rights and social inclusion 356–7
impacts of eugenics movement 355–6
mental illness and ID 358–60
normalization movement 356–7
reaction to institutional care 356–7
rise of the total institution 354–6
self-worth and social value 356–7
specialist mental health services 358–60
hypomanic states see affective (mood) disorders
ICD (International Classification of Disease) 3
ICD-10 criteria
applicability to children and adolescents with ID 94
applicability to people with ID 14–15,26–7
assessment tools based on 26
classification of functional psychoses 132
definition of mental disorders 9
modified criteria for people with ID 117–18
schizophrenia related disorders 133–4
The ICD-10 Guide for Mental Retardation 94
ID (intellectual disabilities)
alternative diagnostic criteria for psychiatric disorders 14–17
and self-injurious behaviour 225,227
applicability of criteria for mental disorders 12–13
benefits of complete health checks 83–4
common medical and psychiatric conditions 82–3
complexity of physical and mental health factors 78
genetic influences on medical and psychiatric disorders 77–8
in autism spectrum disorders 217–18
lack of control over life circumstances 78
mental health assessment and monitoring tools 24–7
mortality and morbidity associated with 79–80,81
poor health status associated with 79–80,81
problems in application of mental disorder criteria 9–10,11
problems in making psychiatric diagnoses 9–10,11
psychiatric morbidity 80–1
risks associated with lower socio-economic status 78
under-diagnosis of medical and psychiatric disorders 81–2
unrecognized medical and psychiatric conditions 82–3
ID (intellectual disabilities) diagnosis
and access to services and resources 8–9
changing criteria for 8–9
concerns about negative labelling 11–12
controversy over 11–12,13–14
social justice issues 11–12
variation of rates among groups 11–12
imipramine 102–3
impulse control disorders in ID, psychopharmacology 319–23
insomnia and ID, psychopharmacology 314–16,323
intellectual disabilities see ID
intellectual distortion 9–10,11,52
inter-disciplinary approach, importance of 42
inter-disciplinary assessment 46–8
inter-disciplinary multi-modal diagnostic formulation 57,58
inter-disciplinary treatment programme, for behaviour problems 275–7
International Classification of Disease see ICD
interpersonal skills training 293–4
K-SADS-P diagnostic interview 122
lamotrigine 322
learning disabilities, in autism spectrum disorders 217–18
Lennox–Gastaut syndrome 239–40
Lesch–Nyhan syndrome
association with epilepsy 239
association with self-injurious behaviour 228
specificity of behavioural phenotypes 204–5
life expectancy, increase in people with ID 154–5
lithium 102–3,322–3
lorazepam 315–16
Lowe syndrome, association with epilepsy 239
major depressive disorders 113–14,115–16
see also affective (mood) disorders; depression
manic states see affective (mood) disorders
MDD (Multiplex Developmental Disorder) 216–17
medical and psychiatric disorders
barriers to recognition 81–2
benefits of complete health checks 83–4
bio-psycho-social-spiritual influences 77–9
clinical presentation of conditions 83–4
commonly encountered conditions 82–3
conceptual framework for interactions 76–7
frequently overlooked conditions 82–3
history-taking and complete examination 83–4
influence of genotype 77–8
under-diagnosis in people with ID 81–2
medical conditions
as cause of problem behaviours 270–1
presentations in people with ID 270–1
psychiatric symptoms caused by 82
medication side effects 82–3
and behaviour problems in people with ID 271
see also psychopharmacology in ID
melatonin 323
memantine 322
mental disorder diagnostic criteria 9
alternative approaches 14–17
applicability to people with ID 9–10,11,12–13
behavioural equivalents 15–16
DC-LD diagnostic criteria 14–15
functional assessment and analysis 16–17
individual recommendations for people with ID 14–15
modified criteria 14
problems with application to people with ID 16
reliability and validity for people with ID 16
shortcomings of structuralist approach 16–17
treatment of symptoms 16
mental disorders, classification criteria 9
mental health assessment (multimodal) 47, 52–7
alterations in behaviour 55–6
alterations in mood 55
alterations in thinking 53–5
behavioural approach 56–7
inter-disciplinary diagnostic formulation 57,58
mental state examination 53–6
non-verbal communication 56–7
role of observation 56–7
mental health assessment and monitoring tools
ABC 25–6,28
based on DSM-IV 26
based on ICD-10 26
‘bottom-up’ methodology 25–6
carer-completed checklists and rating scales 36
concurrent validity 34–6
criterion group validity 31–4,35
DASH 28–9
DBC-A 27,29
DBC-P 25–6,27,29
for people with ID 24–7
internal consistency 30,31
key characteristics 27
PAS-ADD 26,27,29
PIMRA 27–8
psychometric properties of tools 29–36
RSMB 25,28
SAS 25
SCAN 29
test–retest and inter-rater reliability 30–1
‘top-down’ methodology 26
use of checklists and rating scales 36–7
see also addtional information under tool names as main headings
mental health assessment process (in ID) 43–8
brief assessment screen 45,46
inter-disciplinary assessment 46–8
the first contact 45
venue 43
who should be there 45
mental health problems, in epilepsy and ID 242–5
mental health services for people with ID
barriers to comprehensive services 366
characteristics of comprehensive services 365–9
conceptualizing service models 365–6
diagnostic overshadowing 364
effects of move to community-based care 364–5
inadequacies of service provision 364–5
overcoming barriers (idealized model) 366–9
prevalence of mental health disorders 364
specialist mental health services 358–60
mental health services for people with ID (idealized model) 366–9
access across service systems 367
community-based with tertiary links 368
comprehensive interdisciplinary services 367–8
credibility 368
direct funding 368
establishment by consensus 366–7
specialized personnel training 368–9
mental health services for people with ID (examples of service models) 369–81
Australia 372–3
Eastern Region Diversion and Support Program (US) 379–80
Eastern Virginia Mental Retardation and Emotional Disturbance Project (US) 378
ENCOR Program (US) 380
European models 369–72
Fairbanks, Alaska Program 380–1
Finland 372
Greater Boston START Model (US) 374–5
Interface Model (US) 377–8
Minnesota Model Crisis Intervention Program (US) 376–7
Netherlands 372
North America 374–81
Queensland model (Australia) 372
Rochester Crisis Intervention Model (US) 375–6
Rock Creek Model (US) 378–9
Southeast London Community Mental Health in Learning Disabilities Service Project 369–70
Toronto MATCH Project 375
UK 369–71
Ulster County Comprehensive Mental Health Model (US) 377
Victorian Dual Disability Service (Australia) 373
Young Adult Institute HMO Model (US) 376
methylphenidate 102–3,318–19
Mini Mental State Examination 165
mood disorders see affective (mood) disorders; depression
MRI (magnetic resonance imaging) 253,256
in clinical practice 259–61,262
MRS (magnetic resonance spectroscopy) 254–5,256
multiple sclerosis, psychiatric symptoms caused by 82
naloxone 102–3
naltrexone 102–3,321–2
NEO-PI (NEO personality inventory) 146–8
neuroimaging and ID
autism 256–7
baseline neuroimaging 260
detection of structural brain abnormalities 259–61,262
Down syndrome 258,260
fragile X syndrome 257
neurodevelopmental disorders 256–9
normal brain development and ageing 255–6
use in clinical practice 259–61,262
use in investigation of behavioural problems 261
use in psychiatric assessment 260–1
velocardiofacial syndrome 258–9
neuroimaging techniques 252–5,256
computerized tomography (CT) scanning 252,256
functional magnetic resonance imaging (fMRI) 255,256
magnetic resonance imaging (MRI) 253,256
magnetic resonance spectroscopy (MRS) 254–5,256
positron emission tomography (PET) 255,256
neurological disorders, and behaviour problems in people with ID 271–2
NLD (Non-verbal Learning Disability) 215–16,217–18
NMD (Neuronal Migration Disorders), in epilepsy and ID 240
NMDA receptor antagonists 322
normalization movement 356–7
obsessive-compulsive disorder (OCD)
link with anxiety disorders 119
symptom presentation in people with ID 121
symptoms 220
see also anxiety disorders
obsessive symptoms
in Asperger’s syndrome 220
in OCD 220
offending behaviour see criminal offending
olanzapine 317–18,320–1
older people with ID
Alzheimer’s disease 156–9
causes of death 155
dementia 156–61
dementia diagnosis 165–6
Down syndrome and dementia 157–9
growing number 154–5
increased life expectancy 154–5
levels of mental ill-health (other than dementia) 161–2
mental ill-health assessment and diagnosis 163–6
physical health profile 155
psychopathology of mental ill-health 163
risk factors for mental ill-health 162
risk of acquiring dementia 166
service provision challenges 156
operant model of aggression 297
opioid antagonists 321–2
over-correction technique (behavioural intervention) 292
pain, conditions which are often unrecognized 82–3
panic disorder see anxiety disorders
paroxetine 314,316–17,321
PAS-ADD (Psychiatric Assessment Schedule for Adults with Developmental Disabilities) 26,27,29,117–18
concurrent validity 34–6
criterion group validity 33–4,35
internal consistency 30,31
interview 122
test–retest and inter-rater reliability 30–1
PCL-R (Psychopathy Checklist – Revised) 145,149–50
PDD-NOS (PDD-not otherwise specified), differentiation from ADHD 216–17
PDDs (pervasive developmental disorders) 115,216
see also autism spectrum disorders
personality disorder (PD)
and ID 145–6
DC-LD criteria 143
diagnosis in people with ID 148
diagnosis reliability problems 143–4
DSM-IV-TR and ICD-10 criteria 143–4
in epilepsy and ID 244
indications of treatment improvement 150
minimum age for diagnosis 143
NEO-PI (NEO personality inventory) 146–8
overlap in traits between categories 143–4
PCL-R (Psychopathy Checklist – Revised) 145,149–50
personality research and ID 146–8
possible effects on treatment outcome 144–5
predictors of aggression and recidivism 145,149–50
prevalence among people with ID 145–6
recent studies of people with ID 149–50
risk for sexual recidivism 149–50
risk for violent behaviour 145,149–50
personality research
and ID 146–8
and personality disorder (PD) 146–8
pervasive developmental disorders see PDDs
PET (positron emission tomography) 255,256
pharmacotherapy see psychopharmacology
phenobarbital, behavioural ‘toxicity’ 313–14,322–3
phenylketonuria
aetiology and specific drug treatments 312–13
association with self-injurious behaviour 228
phobias
behavioural interventions 295–6
common forms in people with ID 121
see also anxiety disorders
physical abuse
link with anxiety disorders in people with ID 119–20
link with PTSD in people with ID 119–20
vulnerability of people with ID 119–20
physical disorders see medical and psychiatric conditions and medical conditions
PIMRA (Psychopathology Instrument for Mentally Retarded Adults) 27–8
concurrent validity 34–6
criterion group validity 31–2,35
internal consistency 30,31
test–retest and inter-rater reliability 30–1
PLI (pragmatic language impairment), in autism spectrum disorders 217–18
Positive Behaviour Support 275–77,283–4
post-traumatic stress disorder (PTSD) 83
behavioural interventions 296–7
link with physical and sexual abuse 119–20
symptom presentation in people with ID 120
Prader–Willi syndrome 77–8
aetiology and specific drug treatments 313
aetiology-based behavioural research 202–3
age-related behavioural effects 206–7
association with ID and psychosis 137
association with self-injurious behaviour 228
behaviours affected by aetiology 205
differentiation using maladaptive behaviours 207–8
in children and adolescents with ID 99–100
indirect behavioural effects 206
influence of ‘background’ genetic factors 207
link with anxiety disorders 119
non-genetic variations 209
paternal deletion form 208–9
rates of maladaptive behaviours 207–8
specificity of behavioural phenotypes 204–5
uniparental maternal disomy (UPD) form 208–9
use of SSRIs 321
within-group genetic variations 208–9
preference assessment, in behavioural interventions 289
primary health physicians’ training
Australia 407–8
Austria 407–8
Canada 407
in ID and mental health problems 405–9
UK 405–6
USA 406–7
professional training
for community care needs of people with ID 400
for mental health problems in people with ID 400,401–9
primary health physicians 405–9
psychiatrists 401–4,408–9
psychologists 404–5,408–9
propranolol 102–3,315
psychiatric and medical disorders
barriers to recognition 81–2
benefits of complete health checks 83–4
bio-psycho-social-spiritual influences 77–9
clinical presentation of conditions 83–4
conceptual framework for interactions 76–7
history-taking and complete examination 83–4
influence of genotype 77–8
under-diagnosis in people with ID 81–2
psychiatric disorders in people with ID 80–1
and behaviour problems 271–2
behavioural equivalents 64–5
difficulties in assessment 64–5
inconsistent terminology and classification 65
influence on challenging behaviours 64
lack of integrated approaches 66
link with challenging behaviours 62–3
prevalence among people with ID 63–4
problems faced by researchers 64–6
psychopharmacology 313–23
research into challenging behaviours 66–9
psychiatric symptoms
syndrome-specific associations 82
underlying physical causes 82
psychiatrists’ professional training
Australia 402–3
Austria 403–4
Canada 402
in ID and mental health problems 401–4,408–9
UK 401
USA 401–2
psychodynamic therapies
access barriers for people with ID 339,340–2
assessment process 343–5
definition and range of therapies 339–40
Department of Health Guidelines 340–2
practice-based evidence 346–7
procedures and aims 339–40
psychological impact of having ID 340
service delivery 340–2
staff consultation and work discussion groups 343
systemic family therapy 342–3
therapist training 339–40
three stages of therapy 345
transport and escort support for people with ID 343
types of problems which can benefit 342
types of therapy used with people with ID 342–3
psychologists’ professional training
Australia 405
Austria 405
Canada 404–5
in ID and mental health problems 404–5,408–9
UK 404
USA 404
psychometric properties of assessment and monitoring tools 29–36
psychopathy, PCL-R (Psychopathy Checklist – Revised) 145,149–50
see also personality disorder
psychopharmacology in ID
ADHD 318–19
adrenergics 322–3
aggressive behaviour 314–16,319–23
anticonvulsants 315,322–3
antidepressants 316–17
antipsychotic drug tapering and discontinuation 318
antipsychotics (neuroleptics) 316,317–18,320–1
anxiety disorders 314–16
behavioural ‘toxicity’ potential of drugs 313–14,322–3
behavioural disorders 319–23
behavioural vs. diagnostic basis for intervention 310–11
benefits and limitations of medications 311
benzodiazepines 315–16
beta-adrenergic antagonists 315,322–3
psychopharmacology in ID (cont.)
buspirone 314–15
children and adolescents with ID 102–3
complex effects of medications 311
compulsive or repetitive behaviours 314–16
concerns about medication use in ID 311
dimensional and categorical approaches 310–11
dopamine antagonists 320–1
drug interactions 314
glutamate receptor antagonists 322
impulse control disorders 319–23
influence of ID aetiology on treatment 312–13
insomnia 314–16,323
melatonin 323
mood disorders 316–17
NMDA receptor antagonists 322
opioid antagonists 321–2
phenobarbital behavioural ‘toxicity’ 313–14,322–3
prevalence of psychotropic medication use 312
psychiatric disorders 313–23
psychosis 317–18
self-injurious behaviour 314–16,319–23
sleep disturbance 314–16,323
SSRIs 314,316–17,321
stimulant medications 318–19
tardive dyskinesia risk 317,320–1
tricyclic antidepressants 316
psychoses
classification of functional psychoses 132
cognitive therapy 334
definition and characteristic features 131–2
functional 131–2
genetic predisposition 132
organic 131–2
psychoses in people with ID
behavioural interventions 299–300
clinical features, assessment and diagnosis 134,135–7
general principles of treatment 138
in epilepsy and ID 243
non-pharmacological treatments 138
pharmacological treatments 138
Prader–Willi syndrome 137
psychopharmacology 317–18
range of community and impatient services 138–9
Usher’s syndrome 137
velocardiofacial syndrome 137
see also affective (mood) disorders; schizophrenia and related disorders 132
psychosocial factors, impacts on children and adolescents with ID 100–1
psychosocial interventions for people with ID
cognitive models of distress 334–5
cognitive therapy 332–4
definitions and types of intervention 330–1
effects of negative social construction 334–5
effects of stigmatization 334–5
social models of disability 334–5
studies of people with ID 331–2
psychosocial masking 9–10,11,52
PTSD see post-traumatic stress disorder
punishment, in behavioural interventions 291
quality-of-life analysis, for behaviour problems 274
rating scales see mental health assessment and monitoring tools
referral of a person with ID 42–3
prioritization criteria 44
screening phase 43,44
reinforcement of behaviour 289
relaxation training for people with ID 294–5
repetitive behaviours and ID, psychopharmacology 314–16
response cost (behavioural intervention) 291–2
Rett syndrome
association with epilepsy 239
association with self-injurious behaviour 228
specificity of behavioural phenotypes 204–5
Reynolds Depressive Symptoms Questionnaire 117–18
risk assessment, people with ID at risk of offending
risperidone 102–3,317–18,320–1
RRASOR (Rapid Risk Assessment of Sexual Offence Recidivism) 190
RSMB (Reiss Screen for Maladaptive Behaviour) 25,28
concurrent validity 34–6
criterion group validity 32–3,35
internal consistency 30,31
test-retest and inter-rater reliability 30–1
Rubenstein–Taybi syndrome
aetiology-based behavioural research 202–3
association with epilepsy 239
link with anxiety disorders 119
SAS (Zung Self-rating Anxiety Scale) 25,121
SCAN (Schedules for Clinical Assessment in Neuropsychiatry) 29
schizophrenia and related disorders 132
and intellectual functioning 134–5
association with ID 134–5
characteristics 133–4
clinical features, assessment and diagnosis 134,135–7
effects of medications 135
general principles of treatment 138
ICD-10 criteria 133–4
neurodevelopmental origins 134–5
non-pharmacological treatments 138
pharmacological treatments 138
range of community and inpatient services 138–9
rates among people with ID 133–4
relationship to autism 220–1
risk factors 134–5
seizure disorders, psychiatric symptoms caused by 82
selective serotonin reuptake inhibitors see SSRIs
self-injurious behaviour in people with ID 62–3,64,66,225,227
and the institutional environment 227–8
assessment and therapy 230–2
association with genetically transmitted conditions 228
attempts to link to medical diagnoses 228
behavioural interventions 297
behavioural theories of causation 228–9
consequences of 226–7
DC-LD diagnostic criteria 225–6
definitions 225–6
effects on quality of life 226–7
epidemiology 226
importance of early intervention 232
neurochemical theories of causation 228–30
prevalence in people with ID 228
psychopharmacology 314–16,319–23
related issues 227–8
relationship with age 227
relationship with gender 227
relationship with IQ 227
theories on causation 228–30
self-management, in behavioural interventions 290–1
SEN (special educational needs) labelling of children 12
sertraline 314,321
service development see development of services for people with ID
setting events, behaviour problems in people with ID 273
sex offenders with ID
neuroimaging investigation 261
use of cognitive therapy 334
sexual abuse
link with anxiety disorders in people with ID 119–20
link with PTSD in people with ID 119–20
vulnerability of people with ID 119–20
sleep disorders and ID, psychopharmacology 314–16,323
Smith–Magenis syndrome
aetiology-based behavioural research 202–3
association with self-injurious behaviour 228
specificity of behavioural phenotypes 204–5
social justice issues in diagnostic labelling 11–12
social models of disability 334–5
effects of negative social construction 334–5
effects of stigmatization 334–5
social phobias see anxiety disorders
social skills training 293–4
SONAR 190
SORAG (Sex Offender Risk Appraisal Guide) 190
specific phobias, behavioural interventions 295–6
SSRIs (selective serotonin reuptake inhibitors) 102–3,314,316–17,321
staff supporting people with ID
characteristics of the workforce 388–9
effects of staff well-being on service users 391–4
interactions between staff and service users 391–4
interventions to improve staff well-being 394
job satisfaction 390,391
lack of mental health training 388,391
organizational challenges 389–91,394
pay and working conditions 388–9
qualifications and experience 388–9
responses to people with ID and mental health problems 391–4
size of workforce 388
staff distress/burnout 389–90,391
staff turnover 388–9,390–1
staff well-being and staff behaviour 391–4
staff well-being studies 389
training in behavioural approach 300
work-related distress/burnout levels 389
Static-99 190
stigmatization, effects of 334–5
stimulant medication 102–3
for ADHD 318–19
Sturge–Weber syndrome
association with epilepsy 239
cerebral dysplasias 240
sulpiride 320–1
SVR-20 (Sexual Violence Risk-20) 190
tardive dyskinesia, risk from antipsychotic medications 317,320–1
thioridazine 312,317–18,320–1
tics (vocal and motor), in autism spectrum disorders 220
time-out (behavioural intervention) 292
token economy (behavioural intervention) 289–90
topiramate 313–14
Tourette syndrome
children and adolescents with ID 99–100
co-morbidity with autism spectrum disorders 220
trazodone 321
treatment methods see specific conditions
tricyclic antidepressants 102–3,316
trisomy 21 see Down syndrome
Tuberous sclerosis
association with epilepsy 239
cerebral dysplasias 240
vigabatrin treatment for epilepsy 313
Unverricht–Lundborg disease 238–9
Usher’s syndrome 137
valproic acid 315
velocardiofacial (VCF) syndrome
aetiology-based behavioural research 202–3
association with ID and psychosis 137
genetic basis 258–9
neuroimaging studies 258–9
specificity of behavioural phenotypes 204–5
video feedback, in behavioural interventions 290–1
vigabatrin 313
violent behaviour 261
see also aggressive behaviour; behaviour problems; challenging behaviours; destructive behaviour
VRAG (Violence Risk Appraisal Guide) 190
West syndrome, and ID 239–40
Williams syndrome
aetiology-based behavioural research 202–3
aetiology-based therapeutic approaches 210
in children and adolescents with ID 99–100
influence of ‘background’ genetic factors 207
link with anxiety disorders 119
link with depressive disorders 115
specificity of behavioural phenotypes 204–5