Diagnosis of mental disorders in people with intellectual disabilities

doi:10.1017/CBO9780511543616.002

1 - Diagnosis of mental disorders in people with intellectual disabilities

from Part I - Assessment and diagnosis

Published online by Cambridge University Press: 15 December 2009

Peter Sturmey

Edited by

Nick Bouras and

Geraldine Holt

Show author details

Peter Sturmey: Affiliation:
Professor of Psychology, Department of Psychology, Queens College and The Graduate Centre, City University of New York
Nick Bouras: Affiliation:
King's College London
Geraldine Holt: Affiliation:
King's College London

Book contents

Get access

Summary

Introduction

Classification of mental disorders in people with intellectual disabilities (ID) continues to be a very active field since the last edition of this book (Sturmey, 1999). This chapter reviews the importance and functions of classification as well as psychometric properties that any adequate classification system must have. It then goes on to review classification in relation to intellectual disabilities, mental health and classification of mental health issues in people with ID. The final section highlights the changes that have occurred and areas for future development.

The importance and functions of classification

Classification is often seen as a hallmark of science: atomic theory and the Linnaean system advanced their respective folk technologies into sciences. Yet, nineteenth-century Alienists were reluctant to classify madness beyond insanity and mental deficiency. As psychiatry strived towards scientific respectability, classification progressed vigorously, especially in the twentieth century. Kraepelin (Kihlstrom, 2002) developed taxonomy of insanity into 15 aetiological classes. In the end he had to admit that the effort was in vain, and that classification by course and prognosis was more promising. The precursors of the Diagnostic and Statistical Manual (DSM) implied aetiology, but were based on presenting symptoms, as putative causes could not be observed. Presenting symptoms continue to be cardinal features of DSM and the International Classification of Disease (ICD). Critics of the early DSM-I and II noted that they were both explicitly psychoanalytical in orientation and did not guide the diagnostician as to the specific symptoms and were hence unreliable.

Type: Chapter
Information: Psychiatric and Behavioural Disorders in Intellectual and Developmental Disabilities , pp. 3 - 23

DOI: https://doi.org/10.1017/CBO9780511543616.002 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Aman, M. G. (1990). Assessing psychopathology and behavior problems in persons with mental retardation: A review of available instruments. Rockville, MD: US Department of Health and Human Services.

Bailey, N. M. & Andrews, T. M. (2003). Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities/Mental Retardation (DC-LD) and the diagnosis of anxiety disorders: A review. Journal of Intellectual Disabilities Research, 47, 50–61.Google Scholar

Bayer, R. (1987). Homosexuality and American Psychiatry. The Politics of Diagnosis. With a New Afterword on AIDS and Homosexuality. Princeton, NJ: Princeton University Press.

Beutler, L. E. & Malik, M. L. (2002a, eds.). Rethinking the DSM. A Psychological Perspective. Washington, DC: American Psychiatric Association.

Beutler, L. E. & Malik, M. L. (2002b.) Diagnosis and treatment guidelines: The example of depression. In: Beutler, L. E. & Malik, M. L. (eds.), Rethinking the DSM. A Psychological Perspective, (pp. 251–78). Washington, DC: American Psychiatric Association.

Cain, N. N., Davidson, P. W., Burhan, A. M.et al. (2003). Identifying bipolar disorder in individuals with intellectual disability. Journal of Intellectual Disability Research, 47, 31–8.Google Scholar

Carr, E. G., Horner, R. & Turnbull, A. P. (1999). Positive Behavior Support in People With Developmental Disabilities: A Research Synthesis (Monograph (American Association on Mental Retardation)). Washington, DC: American Association on Mental Retardation.

Center for Disease Control (1996). State-specific rates of mental retardation – United States 1993. Mortality and Morbidity Weekly Review, 45(03), 61–5.

Charlot, L. (2005). Use of behavioral equivalents for symptoms of mood disorders. In Sturmey, P. (ed.), Mood Disorders and People with Mental Retardation. Kingston, NY: National Association for the Dually Diagnosed Press.

Clarke, D. (2003). Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities/Mental Retardation (DC-LD) and psychiatric phenotypes. Journal of Intellectual Disabilities Research, 47, 43–9.Google Scholar

Clarke, D. J. & Gomez, G. A. (1999). Utility of modified DCR-10 criteria in the diagnosis of depression associated with intellectual disabilities. Journal of Intellectual Disabilities Research, 43, 413–20.Google Scholar

Cooper, S. A., Melville, C. A. & Einfeld, S. L. (2003). Psychiatric diagnosis, intellectual disabilities and Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities/Mental Retardation (DC-LD). Journal of Intellectual Disabilities Research, 47, 3–15.Google Scholar

Davis, J. P., Judd, F. K. & Herrman, H. (1997). Depression in adults with intellectual disability. Part 2. A pilot study. Australian and New Zealand Journal of Psychiatry, 31, 243–51.Google Scholar

Deb, S. & Iyer, A. (2005). Clinical Interviews. In Sturmey, P. (ed.), Mood Disorders in People with Mental Retardation. Kingston, NY: National Association for the Dually Diagnosed Press.

Deb, S., Matthews, T., Holt, D. & Bouras, N. (2001). Practice Guidelines for the Assessment and Diagnosis of Mental Health Problems in Adults with Intellectual Disability. Brighton: Pavilion Press.

Department of Education and Skills (2003). Statistics of Education: Special Needs in England, January 2003. Issue no. 09/03, November 2003. London: The Stationary Office.

Didden, R., Duker, P. C. Z. & Korzilius, H. (1999). Meta-analytic study on treatment effectiveness for problem behaviors with individuals who have mental retardation. American Journal on Mental Retardation, 101, 387–99.Google Scholar

Edgerton, R. B. (1967). The Cloak of Competence. Los Angeles, CA: University of California Press.

Finlay, W. M. L. (2005). Psychometric assessment of mood disorders in people with intellectual disabilities. In Sturmey, P. (ed.). Mood Disorders in People with Mental Retardation. Kingston, NY: National Association for the Dually Diagnosed Press.

Flynn, J. R. (1984). The mean IQ of Americans: Massive gains 1932 to 1978. Psychological Bulletin, 95, 29–51.Google Scholar

Flynn, J. R. (1985). Wechsler intelligence tests: do we really have a criterion of mental retardation?American Journal on Mental Deficiency, 90, 236–44.Google Scholar

Flynn, J. R. (1987). Massive IQ gains in 14 nations: What IQ tests really measure. Psychological Bulletin, 101, 171–91.Google Scholar

Gardner, W. I (2002). Aggression and Other Disruptive Behavioral Challenges: Biomedical and Psychosocial Assessment and Treatment. Kingston, NY: National Association for the Dually Diagnosed Press.

Gravestock, S. (2003). Diagnosis and classification of eating disorders in adults with intellectual disabilities: the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities/Mental Retardation (DC-LD). Journal of Intellectual Disabilities Research, 47, 72–83.Google Scholar

Holden, B. & Gitlesen, J. P. (2004). Psychotropic medication in adults with mental retardation: prevalence and prescription practices. Research in Developmental Disabilities, 25, 509–21.Google Scholar

Houts, A. C. (2002). Discovery invention and the expansion of the modern Diagnostic and Statistical Manuals of Mental Disorders. In: Beutler, L. E. & Malik, M. L. (eds.), Rethinking the DSM. A Psychological Perspective, (pp. 17–68). Washington, DC: American Psychiatric Association.

Hurley, A. D. (1996). The misdiagnosis of hallucinations and delusions in persons with mental retardation: A neurodevelopmental perspective. Seminars in Neuropsychiatry, 1, 122–33.Google Scholar

Kahng, S., Iwata, B. A. & Lewin, A. B. (2002). Behavioral treatments of self-injury, 1964–2000. American Journal on Mental Retardation, 107, 212–21.Google Scholar

Keogh, B. K., Forness, S. R. & MacMillan, D. L. (1998). The real world of special education. American Psychologist, 53, 1161–2.Google Scholar

Kihlstrom, J. F. (2002). To honor Kraeplin: From symptoms to pathology in the diagnosis of mental illness. In: Beutler, L. E. & Malik, M. L. (eds.), Rethinking the DSM. A Psychological Perspective, (pp. 279–304). Washington, DC: American Psychiatric Association.

Kirk, S. A. & Kutchins, H. (1992). The Selling of DSM: The Rhetoric of Science in Psychiatry. New York, NY: Lindine de Gruyter.

Lynn, R., Hampson, S. L. & Mullineux, J. C. (1987). A long-term increase in the fluid intelligence of English children. Nature, 328, 797.Google Scholar

Mace, F. C., Webb, M. E., Sharkey, R. W., Mattson, D. M. & Rosen, H. S. (1988). Functional analysis and treatment of bizarre speech. Journal of Behavior Therapy and Experimental Psychiatry, 19, 289–96.Google Scholar

MacMillan, D. L., Gresham, F. M. & Bocian, K. M. (1998). Discrepancy between definitions of learning disabilities and school practices: An empirical investigation. Journal of Learning Disabilities, 31, 314–26.Google Scholar

MacMillan, D. L., Gresham, F. M., Siperstein, G. N. & Bocian, K. M. (1996). The labyrinth of IDEA: School decisions on referred students with subaverage intelligence. American Journal on Mental Retardation, 101, 161–74.Google Scholar

Maheady, L., Towne, R., Algozzine, B., Mercer, J., & Ysseldyke, J. (1983). Minority overrepresentation: A case for alternative practices prior to referral. Learning Disability Quarterly, 6, 448–56.Google Scholar

Malik, M. L. & Beutler, L. E. (2002). The emergence of dissatisfaction with the DSM. In: Beutler, L. E. & Malik, M. L. (eds.), Rethinking the DSM. A Psychological Perspective, pp. 3–16. Washington, DC: American Psychiatric Association.

Marston, G. M., Perry, D. W. & Roy, A. (1997). Manifestations of depression in people with intellectual disabilities. Journal of Intellectual Disability Research, 41, 476–80.Google Scholar

Matson, J. L. (1981a). Assessment and treatment of clinical fears in mentally retarded children. Journal of Applied Behavior Analysis, 14, 287–94.Google Scholar

Matson, J. L. (1981b). A controlled outcome study of phobias in mentally retarded adults. Behavior Research and Therapy, 19, 101–7.Google Scholar

Melville, C. A. (2003). A critique of the use of Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities/Mental Retardation (DC-LD) chapter on non-affective disorders. Journal on Intellectual Disabilities Research, 47, 16–25.

Moss, S., Ibbotson, B., Prosser, H.et al. (1997). Validity of the PAS-ADD for detecting psychiatric symptoms in adults with learning disabilities (mental retardation). Social Psychiatry and Psychiatric Epidemiology, 32, 344–54.Google Scholar

Moss, S., Patel, P., Prosser, H.et al. (1993). Psychiatric morbidity in older people with moderate and severe learning disability. I: Development and reliability of the patient interview (PAS-ADD). British Journal of Psychiatry, 163, 471–80.Google Scholar

Murphy, C. C., Yeargin-Allsopp, M., Decoufle, P. & Drews, C. D. (1995). The administrative prevalence of mental retardation in 10-year-old children in metropolitan Atlanta, 1985 through 1987. American Journal of Public Health, 85, 319–23.Google Scholar

New York State Department of Health (1999a). Clinical Practice Guidelines: Report of the Recommendations. Autism/Pervasive Developmental Disorders. Assessment and Intervention for Young Children (Age 0–3 Years) (Publication No. 4215). Albany, NY: New York State Department of Health.

New York State Department of Health (1999b). Clinical Practice Guidelines: Quick Reference Guide. Autism/Pervasive Developmental Disorders. Assessment and Intervention for Young Children (Age 0–3 Years) (Publication No. 4216). Albany, NY: New York State Department of Health.

New York State Department of Health (1999c). Clinical Practice Guidelines: The Guideline Technical Report. Autism/Pervasive Developmental Disorders. Assessment and Intervention for Young Children (Age 0–3 Years) (Publication No. 4217). Albany, NY: New York State Department of Health.

O'Brien, G. (2003). The classification of problem behaviors in Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities/Mental Retardation (DC-LD). Journal of Intellectual Disabilities Research, 47, 32–7.Google Scholar

Patel, P., Goldberg, D. & Moss, S. (2001). Psychiatric morbidity in older people with moderate and severe learning disability. II: The prevalence study. British Journal of Psychiatry, 163, 481–91.Google Scholar

Ross, E. & Oliver, C. (2003). The assessment of mood in adults who have severe or profound mental retardation. Clinical Psychology Review, 23, 225–45.Google Scholar

Royal College of Psychiatrists (2001). OP48. DC-LD: Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities/Mental Retardation. London: Gaskell.

Rush, A. J. & Frances, A. (2000). The Expert Consensus Guideline Series: Treatment of Psychiatric and Behavioral Problems in Mental Retardation. American Journal on Mental Retardation, 105, 159–228.Google Scholar

Scotti, J. R., Evans, I. M., Meyer, L. H. Z. & Walker, P. (1991). A meta-analysis of intervention research with problem behavior: Treatment validity and standards of practice. American Journal on Mental Retardation, 96, 233–56.Google Scholar

Seager, M. C. & O'Brien, G. (2003). Attention deficit hyperactivity disorder: Review of ADHD in learning disability — the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities/Mental Retardation (DC-LD) criteria for diagnosis. Journal of Intellectual Disabilities Research, 47, 26–31.Google Scholar

Shogren, K. A., Faggella-Luby, M. N., Bae, S. J. & Wehmeyer, M. L. (2004). The effects of choice making as an intervention for problem behavior: A meta-analysis. Journal of Positive Behavioral Interventions, 6, 228–37.Google Scholar

Simpson, N. (2003). Delirium in adults with intellectual disabilities. Journal of Intellectual Disabilities Research, 47, 38–42.Google Scholar

Singh, N. N., Ellis, C. R. & Wechsler, H. (1997). Psychopharmaco-epidemiology of mental retardation: 1966 to 1995. Journal of Child and Adolescent Psychopharmacology, 7, 255–66.Google Scholar

Skinner, B. F. (1953). Science and Human Behavior. New York NY: Free Press.

Smiley, E. & Cooper, S. A. (2003). Intellectual disabilities, depressive episodes, diagnostic criteria and Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities/Mental Retardation (DC-LD). Journal of Intellectual Disabilities Research, 47, 62–71.Google Scholar

Smith, R. G., Vollmer, T. R. & St. Peter, C. (in press). Functional approaches to assessment and treatment of problem behavior in persons with autism and related disabilities. In Sturmey, P. & Fitzer, A. (eds.). Autism Spectrum Disorders: Applied Behavior Analysis Evidence and Practice. Austin, TX: PROED Inc.

Sovner, R. (1986). Limiting factors in the use of DSM-II with mentally ill/mentally retarded persons. Psychopharmacology Bulletin, 22, 1055–9.Google Scholar

Sturmey, P. (1993). The use of ICD and DSM criteria in people with mental retardation: A review. The Journal of Nervous and Mental Disease, 181, 39–42.Google Scholar

Sturmey, P. (1996). Functional Analysis in Clinical Psychology. London: Wiley.

Sturmey, P. (1999). Classification: Concepts, progress and future. In Bouras, N., (ed.), Psychiatric and Behavioral Disorders in Developmental Disabilities and Mental Retardation, pp. 3–17. Cambridge: Cambridge University Press.

Sturmey, P. (2005). Behavioral conceptualization and treatment of depression in people with mental retardation. In Sturmey, P. (ed.), Mood Disorders in People with Mental Retardation. Kingston: National Association for the Dually Diagnosed Press.

Sturmey, P. & Fitzer, A. (in press). Autism Spectrum Disorders: Applied Behavior Analysis Evidence and Practice. Austin, TX: PROED Inc.

Sturmey, P., Reed, J. & Corbett, J. A. (1991). Psychometric assessment of psychiatric disorders in people with learning disabilities (mental handicap): A review of measures. Psychological Medicine, 21, 143–155.Google Scholar

Sturmey, P., Reyer, H., Lee, R. & Robek, A. (2003). Substance-Related Disorders in Persons with Mental Retardation. Kingston, NY: National Association for the Dually Diagnosed Press.

Surgeon General (1999). Mental Health: A Report of the Surgeon General. Washington, DC: Department of Health and Human Services.

Szymanski, L. & King, B. H. (1999). Practice parameters for the assessment and treatment of children, adolescents and adults with mental retardation and comorbid mental disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 38, (Suppl.) 5–31S.Google Scholar

Tsiouris, J. A., Mann, R., Patti, P. J. & Sturmey, P. (2003). Challenging behaviours should not be considered as depressive equivalents in individuals with intellectual disability. Journal of Intellectual Disability Research, 47, 14–21.Google Scholar

US Department of Education. (2002). Twenty-Second Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act. Washington, DC: US Government Printing Office.

World Health Organization (1992.). The International Classification of Diseases (10th edn). Geneva: WHO.

Yeargin-Allsopp, M., Drews, C. D., Decoufle, P. & Murphy, C. C. (1995). Mild mental retardation in black and white children in metropolitan Atlanta: a case-control study. American Journal of Public Health, 85, 324–8.Google Scholar

Yeargin-Allsopp, M., Murphy, C. C., Cordero, J. F., Decoufle, P. & Hollowell, J. G. (1997). Reported biomedical causes and associated medical conditions for mental retardation among 10-year-old children in metropolitan Atlanta, 1985 to 1987. Developmental Medicine and Childhood Neurology, 39, 142–9.Google Scholar