Interventions for mental health problems in children and adults with severe intellectual disabilities: a systematic review

Leen Vereenooghe, Samantha Flynn, Richard P Hastings, Dawn Adams, Umesh Chauhan, Sally-Ann Cooper, Nick Gore, Chris Hatton, Kerry Hood, Andrew Jahoda, Peter E Langdon, Rachel McNamara, Chris Oliver, Ashok Roy, Vasiliki Totsika, Jane Waite, Leen Vereenooghe, Samantha Flynn, Richard P Hastings, Dawn Adams, Umesh Chauhan, Sally-Ann Cooper, Nick Gore, Chris Hatton, Kerry Hood, Andrew Jahoda, Peter E Langdon, Rachel McNamara, Chris Oliver, Ashok Roy, Vasiliki Totsika, Jane Waite

Abstract

Objective: Mental health problems are more prevalent in people with than without intellectual disabilities, yet treatment options have received little attention. The aim of this study was to identify and evaluate the effectiveness of pharmacological and psychological interventions in the treatment of mental health problems in children and adults with severe and profound intellectual disabilities, given their difficulties in accessing standard mental health interventions, particularly talking therapies, and difficulties reporting drug side effects.

Design: A systematic review using electronic searches of PsycINFO, PsycTESTS, EMBASE, MEDLINE, CINAHL, ERIC, ASSIA, Science Citation Index, Social Science Citation Index and CENTRAL was conducted to identify eligible intervention studies. Study selection, data extraction and quality appraisal were performed by two independent reviewers.

Participants: Study samples included at least 70% children and/or adults with severe or profound intellectual disabilities or reported the outcomes of this subpopulation separate from participants with other levels of intellectual disabilities.

Interventions: Eligible intervention studies evaluated a psychological or pharmacological intervention using a control condition or pre-post design.

Outcomes: Symptom severity, frequency or other quantitative dimension (e.g., impact), as assessed with standardised measures of mental health problems.

Results: We retrieved 41 232 records, reviewed 573 full-text articles and identified five studies eligible for inclusion: three studies evaluating pharmacological interventions, and two studies evaluating psychological interventions. Study designs ranged from double-blind placebo controlled crossover trials to single-case experimental reversal designs. Quality appraisals of this very limited literature base revealed good experimental control, poor reporting standards and a lack of follow-up data.

Conclusions: Mental ill health requires vigorous treatment, yet the current evidence base is too limited to identify with precision effective treatments specifically for children or adults with severe and profound intellectual disabilities. Clinicians therefore must work on the basis of general population evidence, while researchers work to generate more precise evidence for people with severe and profound intellectual disabilities.

Prospero registration number: CRD 42015024469.

Keywords: intellectual disabilities; mental health; pharmacotherapies; psychological therapies; systematic review.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. ID, intellectual disability.

References

    1. Hughes-McCormack LA, Rydzewska E, Henderson A, et al. . Prevalence of mental health conditions and relationship with general health in a whole-country population of people with intellectual disabilities compared with the general population. BJPsych Open 2017;3:243–8. 10.1192/bjpo.bp.117.005462
    1. Deb S, Thomas M, Bright C. Mental disorder in adults with intellectual disability. 1: Prevalence of functional psychiatric illness among a community-based population aged between 16 and 64 years. J Intellect Disabil Res 2001;45:495–505. 10.1046/j.1365-2788.2001.00374.x
    1. Emerson E, Hatton C, Felce D, et al. . Learning disabilities the fundamental facts. London: The Foundation for People with Learning Disabilities, 2001.
    1. Hulbert-Williams L, Hastings RP. Life events as a risk factor for psychological problems in individuals with intellectual disabilities: a critical review. J Intellect Disabil Res 2008;52:883–95. 10.1111/j.1365-2788.2008.01110.x
    1. Cordeiro L, Ballinger E, Hagerman R, et al. . Clinical assessment of DSM-IV anxiety disorders in fragile X syndrome: prevalence and characterization. J Neurodev Disord 2011;3:57–67. 10.1007/s11689-010-9067-y
    1. Richards C, Moss J, O’Farrell L, et al. . Social anxiety in cornelia de lange syndrome. J Autism Dev Disord 2009;39:1155–62. 10.1007/s10803-009-0730-7
    1. Hyman P, Oliver C, Hall S. Self-injurious behavior, self-restraint, and compulsive behaviors in Cornelia de Lange syndrome. Am J Ment Retard 2002;107:146–54. 10.1352/0895-8017(2002)107<0146:SIBSRA>;2
    1. Dykens EM. Anxiety, fears, and phobias in persons with Williams syndrome. Dev Neuropsychol 2003;23:291–316. 10.1207/S15326942DN231&amp;2_13
    1. Krefft M, Frydecka D, Adamowski T, et al. . From Prader-Willi syndrome to psychosis: translating parent-of-origin effects into schizophrenia research. Epigenomics 2014;6:677–88. 10.2217/epi.14.52
    1. Cooper SA, Smiley E, Morrison J, et al. . Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. Br J Psychiatry 2007;190:27–35. 10.1192/bjp.bp.106.022483
    1. Einfeld SL, Tonge BJ. Population prevalence of psychopathology in children and adolescents with intellectual disability: II. Epidemiological findings. J Intellect Disabil Res 1996;40:99–109.
    1. Emerson E, Hatton C. Mental health of children and adolescents with intellectual disabilities in Britain. Br J Psychiatry 2007;191:493–9. 10.1192/bjp.bp.107.038729
    1. Hove O, Havik OE. Developmental level and other factors associated with symptoms of mental disorders and problem behaviour in adults with intellectual disabilities living in the community. Soc Psychiatry Psychiatr Epidemiol 2010;45:105–13. 10.1007/s00127-009-0046-0
    1. Smiley E, Cooper SA, Finlayson J, et al. . Incidence and predictors of mental ill-health in adults with intellectual disabilities: prospective study. Br J Psychiatry 2007;191:313–9. 10.1192/bjp.bp.106.031104
    1. Unwin G, Tsimopoulou I, Kroese BS, et al. . Effectiveness of cognitive behavioural therapy (CBT) programmes for anxiety or depression in adults with intellectual disabilities: A review of the literature. Res Dev Disabil 2016;51-52:60–75. 10.1016/j.ridd.2015.12.010
    1. Nicoll M, Beail N, Saxon D. Cognitive behavioural treatment for anger in adults with intellectual disabilities: a systematic review and meta-analysis. J Appl Res Intellect Disabil 2013;26:47–62. 10.1111/jar.12013
    1. Vereenooghe L, Langdon PE. Psychological therapies for people with intellectual disabilities: a systematic review and meta-analysis. Res Dev Disabil 2013;34:4085–102. 10.1016/j.ridd.2013.08.030
    1. Deb S, Chaplin R, Sohanpal S, et al. . The effectiveness of mood stabilizers and antiepileptic medication for the management of behaviour problems in adults with intellectual disability: a systematic review. J Intellect Disabil Res 2008;52(Pt 2):107–13. 10.1111/j.1365-2788.2007.00965.x
    1. Deb S, Sohanpal SK, Soni R, et al. . The effectiveness of antipsychotic medication in the management of behaviour problems in adults with intellectual disabilities. J Intellect Disabil Res 2007;51:766–77. 10.1111/j.1365-2788.2007.00950.x
    1. Melville CA, Johnson PC, Smiley E, et al. . Problem behaviours and symptom dimensions of psychiatric disorders in adults with intellectual disabilities: An exploratory and confirmatory factor analysis. Res Dev Disabil 2016;55:1–13. 10.1016/j.ridd.2016.03.007
    1. Moher D, Liberati A, Tetzlaff J, et al. . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097 10.1371/journal.pmed.1000097
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edn Wachington DC: American Psychiatric Publishing, 1994.
    1. Felce D, Kerr M, Hastings RP. A general practice-based study of the relationship between indicators of mental illness and challenging behaviour among adults with intellectual disabilities. J Intellect Disabil Res 2009;53:243–54. 10.1111/j.1365-2788.2008.01131.x
    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd edn Washington, DC: American Psychiatric Publishing, 1980.
    1. Petticrew M, Roberts H. Systematic reviews in the social sciences. A practical guide. London: Blackwell Publishing, 2006.
    1. Atkins D, Best D, Briss PA, et al. . Grading quality of evidence and strength of recommendations. Br Med J 2004;328:1490.
    1. Balshem H, Helfand M, Schünemann HJ, et al. . GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011;64:401–6. 10.1016/j.jclinepi.2010.07.015
    1. Guyatt GH, Oxman AD, Vist G, et al. . GRADE guidelines: 4. Rating the quality of evidence--study limitations (risk of bias). J Clin Epidemiol 2011;64:407–15. 10.1016/j.jclinepi.2010.07.017
    1. Singh J. Critical appraisal skills programme. Journal of Pharmacology and Pharmacotherapeutics 2013;4:76–7. 10.4103/0976-500X.107697
    1. Critical Appraisal Skills Programme (CASP), 2014.
    1. Horner RH, Carr EG, Halle J, et al. . The use of single-subject research to identify evidence-based practice in special education. Except Child 2005;71:165–79. 10.1177/001440290507100203
    1. Aman MG, White AJ, Vaithianathan C, et al. . Preliminary study of imipramine in profoundly retarded residents. J Autism Dev Disord 1986;16:263–73. 10.1007/BF01531659
    1. Rosenquist PB, Bodfish JW, Thompson R. Tourette syndrome associated with mental retardation: a single-subject treatment study with haloperidol. Am J Ment Retard 1997;101:497–504.
    1. Lindauer SE, DeLeon IG, Fisher WW. Decreasing signs of negative affect and correlated self-injury in an individual with mental retardation and mood disturbances. J Appl Behav Anal 1999;32:103–6. 10.1901/jaba.1999.32-103
    1. White TJ, Aman MG. Pimozide treatment in disruptive severely retarded patients. Aust N Z J Psychiatry 1985;19:92–4. 10.3109/00048678509158820
    1. Zarkowska EC. A behavioural intervention for Gilles de la Tourette syndrome in a severely mentally handicapped girl. J Ment Defic Res 1981;1989:245–53.
    1. Aman MG, Singh NN, Stewart AW, et al. . The aberrant behavior checklist: a behavior rating scale for the assessment of treatment effects. Am J Ment Defic 1985;89:485–91.
    1. National Insitute for Health and Care Excellence. Mental health problems in people with learning disabilities: prevention, assessment and management (NG54). NICE Guideline 54. 2016. .
    1. Flynn S, Vereenooghe L, Hastings RP, et al. . Measurement tools for mental health problems and mental well-being in people with severe or profound intellectual disabilities: A systematic review. Clin Psychol Rev 2017;57:32–44. 10.1016/j.cpr.2017.08.006
    1. Checklists CASP. Oxford: CASP.
    1. Slosson R. Slosson Intelligence Test for Children and Adults. East Aurora, New York: Slosson Educational Publications, 1975.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit