A high proportion of people with disorders of intellectual development (DID) receive medication for both physical and mental health conditions (Deb & Fraser, 1994). Psychotropic medications are commonly used to manage problem behaviours when no diagnosis of a psychiatric disorder can be confirmed. The accurate diagnosis of psychiatric disorders can be particularly difficult in people with DID (Deb et al, 2001; Hemmings et al, 2013). Problem behaviour in this context is defined as ‘socially unacceptable behaviour that causes distress, harm or disadvantage to the person themselves or to other people or damage to property, and usually requires some intervention’ (Deb et al, 2009: p. 182). Other terms have also been used to describe problem behaviours, such as challenging behaviour, behaviour disorder and behaviour difficulty. Examples of problem behaviours include aggression to other people (physical or verbal aggression), property destruction and self-injurious behaviour (for a more detailed description of problem behaviours see Chapter 5).

There is concern about the use of psychotropic medication in people with DID for the management of problem behaviours in the absence of a diagnosed psychiatric disorder. Some of the reasons for this are:

Because of this wide public concern, a national guide on the use of medication for the management of problem behaviours in people with DID was developed in the UK on behalf of the Royal College of Psychiatrists (Unwin & Deb, 2010), and subsequently an adapted version of the UK guide was published as an international guide (Deb et al, 2009) on behalf of the World Psychiatric Association (WPA).