Mental Illness in Individuals with Intellectual Disabilities

Transcription

1 Mental Illness in Individuals with Intellectual Disabilities James Jordan MA NCC Solutions / Lorain County Community College jjordan@lorainccc.edu

2 Growth of the science Why Study?

3 Why Do Individuals with ID have higher rates than general population? CNS dysfunction Social issues Coping skills (cognitive) Ignorance is not bliss

4 Prevalence Findings 1985 (Lund) 27% 1989 (Iverson and Fox) 36% 1995 (Crews, Bonaventura, and Rowe) 16% 2013 (Cooper, Smiley, Morrison, Williamson, and Allan) between 16 41% DC-LD: 57%; ICD-10: 25%; DSM-IV-TR: 13% Point Prevalence is 41% (Cooper et. al.) Why the wide range?

5 Historical Perspective 1903 Insanity in Imbeciles (Tregold) 1975 (Philips, I., et.al.) 100 mentally retarded children (sic): 38 with psychotic disturbances, 49 with neurotic, behavioral, and situational disorders (Menolascino and Eaton) Retarded individuals (sic) have a greater than average risk for developing psychiatric disorders.

6 Most Common Diagnoses Was Psychosis NOS (it still lingers); Impulse Control Disorders; Autism Spectrum; Affect Disorders Personality Disorders not well established Sexual Disorders may be underdiagnosed

7 History of Autism Eugen Bleuler 1911 Asperger and Kanner 1944, note they do not call it Asperger s Aspersger s did not appear until 1981

8 Much of Asperger s work taken from Grunya Sukhareva

9 Time to Reconsider Schizoid?

10 Table 1. The DSM-5 criteria for autism spectrum disorder compared with the descriptions provided by Grunya Sukhareva. Autism spectrum disorder, DSM-5, 2013 Schizoid personality disorders of childhood, Sukhareva, 1925/1926, examples A. Persistent deficits in social communication and social interaction across multiple contexts An autistic attitude: Tendency toward solitude and avoidance of other people from early childhood onwards; avoids company with other children 1. Deficits in social emotional reciprocity Impulsive, odd behavior Clowning, rhyming Some were speaking endlessly or asking absurd questions of the people around them Affective life flattened Seems odd A tendency toward abstraction and schematization (the introduction of concrete concepts does not improve but rather impedes thought processes) 2. Deficits in non-verbal communicative behaviors used for social interaction 3. Deficits in developing, maintaining and understanding relationships B. Restricted, repetitive patterns of behavior, interests or activities as manifested by at least two of the following 1. Stereotyped or repetitive motor movements, use of objects or speech 2. Insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal or non-verbal behavior 3. Highly restricted, fixated interests that are abnormal in intensity or focus 4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment Lack of facial expressiveness and expressive movements Mannerism; decreased postural tone; oddities and lack of modulation of speech Superfluous movements and synkinesis Nasal, hoarse or high pitched whining voice or lacking in modulation Keep apart from their peers, avoid communal games and prefer fantastic stories and fairy tales Find it hard to adapt to other children Ridiculed by their peers and have low status Tendency towards automatism: Sticking to tasks which had been started and psychic inflexibility with difficulty in adaptation to novelty Tic-like behaviors Grimacing Stereotypic neologisms Repetitive questioning; talking in stereotypic ways Rapid or circumscribed speech A tendency for obsessive-compulsive behavior Lengthy preparation and difficulty stopping Pedantic, follows principles Emotional outbursts If interrupted becomes agitated and starts the story all over again Strong interests pursued exclusively Preservative interests, e.g. conversion marked by repetitive obsessional themes; clings to certain themes Tendency to rationalization and absurd rumination Musically gifted enhanced perception of pitch Sensitivity to noise, seeks quietness Sensitivity to smell

11 Table 1 continued. The DSM-5 criteria for autism spectrum disorder compared with the descriptions provided by Grunya Sukhareva. Autism spectrum disorder, DSM-5, 2013 Schizoid personality disorders of childhood, Sukhareva, 1925/1926, examples A. Symptoms must be present in the early developmental period Onset in early childhood B. Symptoms cause clinically significant impairment in social, occupational or other important areas of current functioning Inability to attend normal school due to their odd behaviors C. These disturbances are not better explained by intellectual disability Intelligence normal or above normal

12 Hans Asperger : Described autistic psychopathy along with Leo Kanner Was Hans Asperger another Oskar Schindler?

13 Autism Spectrum DSM IV contained Autism, Asperger s, Child Disintegrative Disorder, and PDD DSM 5 replaced all of these with a single diagnosis ASD ASD can have specifiers such as poor communication, intellectual deficit, social skills deficit.

14 The Rise of Autism Diagnosis Global Prevalence Rate has increased twenty to thirtyfold since : % (1 in 2,500) 2000: 1 2% CDC Data: in in 50 (CDC, 2013) Lund (1985) institutional survey 27% MR; 4% Autism 45 reported studies in the 1950s to 8575 publications in the (Autism Reading Room, 2013)

15 Autism Diagnosis Better diagnosis and diagnostic change (King and Berman, 2009). Awareness Decrease in ID diagnosis Acceptance of the disorder

16 As Autism Increases

17 Autism - ID No overall increase in the number of students enrolled in special education an 11 year analysis of 6.2 million children (Penn State University, 2015)

18 Most recent intelligence quotient score as of age 8 years among children with autism spectrum disorder for whom test data were available, by sex and site Autism and Developmental Disabilities Monitoring Network, seven sites,* United States, 2010

19 Same issues different diagnosis Overall level of psychopathology higher in autism than ID (Breeton, Tonge, and Einfeld, 2006). Let us go back to ID. How much behavior can be attributed to MH, not Autism (diagnostic overshadowing again).

20 Unresolved Issues Use of antipsychotics to treat multitude of diagnoses (burning down the house to kill the rat). Applying DSM to individuals with ID. I cannot tell you I am depressed

21 Current Trends Acceptance of mental disorders in ID Limited efficacy of psychological interventions alone, but an effective mediator. Multi disciplinary approach

22 Discussion and Questions

23 References Autism Reading Room. (2013). Statistics & trends. Retrieved from org/?page_id=5664 Bailey, N.M., Prevalence of psychiatric disorders in adults with moderate to profound learning disabilities. Advances in Mental Health and Learning Disabilities, 1, Breeton, A. V., Tonge, B. J., and Einfeld, S. L. (2006). Psychopathology in Children with Adolescents and Autism Compared to Young People with Intellectual Disability. Journal of Autism and Developmental Disorders, 36: DOI: /s y Centers for Disease Control and Prevention (CDC). (2013). Autism spectrum disorders. Cooper S., Smiley E., Morrison J., Williamson A., and Allan L (2007) Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. British Journal of Psychiatry 190: Crews, D. W., Bonaventura, S, Rowe, F. (1994). Dual Diagnosis: Prevalence of psychiatric disorders in a large state residential facility for individuals with mental retardation. American Journal on Mental Retardation. 98: Hansen, S.N., Schendel, D. E., and Parner, E.T. (2015). Explaining the Increase in the Prevalence of Asutism Spectrum Disorder: The Proportion Attributable to Changes in Reporting Practices. JAMA Pediatrics 169(1):

24 References (cont) Iverson, J. C. and Fox, R. A., (1989). Prevalence of psychopathology among mentally retarded adults. Research in Developmental Disabilities 10: King, M., and Bearman, (2009). Diagnostic change and the increased prevalence of autism. International Journal of Epidemiology 38: doi: /ije/dyp261 Lund, J., The prevalence of psychiatric morbidity in mentally retarded adults. Acta Psychiatrica Scandinavica, 72: Menolascino, F. J. and Eaton, L. F. (1982). Psychiatric disorders in the mentally retarded: Types, problems, and challenges. The American Journal of Psychiatry 139: Monitor on Psychology (2015). How many psychology bachelor s degree holders work in STEM occupations? Vol 46 (5), 17. Philips, I, and Williams, N. (1975). Psychopathology of mental retardation: A study of 100 mentally retarded children. American Psychiatric Association 132: Tredgold, A.F., (1903) Insanity in Imbeciles. Journal of Mental Science Weiss, J. A. and Riosa, P.B. (2015). Thriving in Youth with Autism Spectrum Disorder and Intellectual Disability. Journal of Autism Developmental Disorders 45: DOI: /s y