People with intellectual disability (ID) are 3-5 times more likely to also have a psychiatric disorder. These disorders are frequently not recognised or are misdiagnosed and therefore not treated appropriately.
Risk factors that make people with ID more vulnerable to develop mental health problems include: biological (e.g. family history of mental illness, genetic disorders, medications), psychological (e.g. poor social skills, limited control over life), and social (e.g. family functioning, lack of social support, adverse life events).
Other factors can include brain damage, epilepsy, repeated loss or separation, communication difficulties, poor coping mechanisms, family difficulties, deficits in social skills, low self-esteem and other psychosocial factors.
ID children are also at risk of exploitation and abuse which can cause mental illness. Several studies found 50-85% of women and 25-50% of men with ID were sexually assaulted before the age of 18. Almost half of those assaulted had been abused more than 10 times!
Mental Problems Overlooked
Though many patients with ID may suffer from mental illness, very few are ever identified or diagnosed with the problem. This is partly because of something called diagnostic overshadowing. It is where the behavioural symptoms are incorrectly assumed to be related to the child’s disability, rather than an underlying mental health issue.
This often makes it difficult to identify mental health problems in children with ID. A misdiagnosis would result in mistreatment and the wrong drugs (if any) prescribed to a child. Only 1 in 10 children and adolescents with co-occurring mental disorders receive specialised mental health services.
Treating Mental Illness in Children with ID
In general, early intervention psychiatric comorbidities should involve addressing basic human needs like social acceptance, social relationships and positive affection. These are essential elements in working towards long term mental health for people with ID. Other types of treatment may include:
Psychopharmacology: This involves medication which has been used to treat mood disorders and other psychotic disorders. Medication should not be used as a standalone treatment, but rather, part of a comprehensive treatment approach.
Psychotherapy: Individual, group and/or family psychotherapy may be included in the treatment plan. Conducted by a psychotherapist, group therapies include skills training groups such as social skills, dating skills, assertiveness and anger management training. Other therapy may focus on specific developmental tasks such as independence or bereavement. Sessions may be structured or unstructured, time-limited or ongoing.
Behavioural Management: Behaviour management plans are developed to deal with inappropriate behaviours and to teach adaptive skills. Systematic behaviour programmes may be implemented by individuals in the person’s environment.
Additionally, treatment should also look into developing the child’s personality, establishing independence and creating a role for the child in his surroundings. It is important to remember that each child functions according to his own ability.