This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders, with one of those focusing on changes made from the DSM-IV to the DSM-5.
Treatment for Individuals with Intellectual Disabilities by Samantha Jimenez
Intellectual Disability, or ID, is a condition that limits life skills and intellectual function. It can be caused by genetic or environmental factors, and the severity varies from mild to profound. Although the range of abilities and needs varies greatly in the ID population, some of the issues that those with ID may face are comorbidity, limitations in speech and language skills, aggression, low self-esteem, emotional dysregulation, challenging behaviors, deficits in adaptive coping skills, and taking care of personal needs. Because there are so many different causes, levels, and needs of individuals with ID, treatment options include an array of supports and services. Likewise, because there are so many variables, limited information is out there on what is effective versus ineffective for this population.
Regarding psychosocial interventions, applied behavior analysis (ABA) is supported as an effective treatment for individuals with ID. ABA can be described as the utilization of various techniques based on how people learn in order to produce positive behavior change. Basically, individuals being treated learn associations between cause and effect by being rewarded for desired behaviors and ignored when they exhibit unwanted behaviors. This process is repeated many times, and each time it is evaluated by a professional to determine what progress is being made. This treatment works well for those who have limited intellectual abilities because the information is concrete, the teaching style is hands-on, and the individual gets immediate and direct feedback. These methods enable the individual to make a straightforward connection between cause and effect. ABA techniques can produce enhancements in self-care, employment, academics, social relationships, and communication skills.
Cognitive behavioral therapy (CBT) is another psychosocial behavioral intervention that has been used to treat individuals with ID, but receives mixed reviews on its effectiveness in this population. This is a treatment that is widely used in a variety of populations; it includes exposure therapy, cognitive retraining to change maladaptive thinking patterns, skills training, and self-instruction. The strongest evidence for CBT in those with intellectual disabilities is for its use in anger management, particularly in a group setting, which is a common issue for this population. Likewise, modified CBT has been noted to improve self-management and emotional problems in mild to moderate ID. Although this treatment may be valuable for people with mild to moderate ID, this therapy relies mostly on language, limiting its effectiveness for severe and profound forms of ID which usually includes significant language skills deficits.
Psychodynamic therapy is a treatment that may prove to be effective given more research. This type of therapy is based on processing how past behavior has influenced present behavior. Like CBT, because psychodynamic therapy depends so much on verbal communication and interaction, its effects are likely to be limited in those with severe and profound ID. However, literature proposes that using this type of therapy could reduce negative symptoms and in turn increase self-esteem in people who have ID.
Another treatment that receives mixed reviews is that of pharmacotherapy for treating psychopathology in people with ID. Pharmacotherapy is simply the use of drugs to treat a disease. Psychotropics are prescribed for about 58% of people with ID, particularly for those exhibiting challenging behaviors such as self-injury, impulsivity, and aggression. The complaint is that drugs are overprescribed and under researched, especially for children. This response is similar for other populations as well, though. Despite this complaint, two psychotropic drugs have gained evidence for use in the ID population; they are methylphenidate for hyperactivity and risperidone for repetitive behaviors. It is likely that research in this area will continue to grow and influence what drugs professionals trust and use for those with ID in the future.
Additionally, sensory interventions have been recommended for people with ID. These include sensory intervention therapy and Snoezelen. These intervention are used to treat problem behaviors by helping consumers learn to interpret sensory input. They have become increasingly popular, but the evidence of effectiveness in individuals with ID is limited and, in some studies, even negative. Overall, sensory interventions are not presently evidence-based practice and should be avoided until more well-conducted studies are done.
Overall, any person seeking treatment for ID should seek a professional who has knowledge and experience in ABA. ABA is the most supported effective treatment for people with ID to reduce negative behaviors, increase positive social interactions, and improve life skills overall. More research is necessary to determine the effectiveness of CBT and psychodynamic therapy and, if sought, should be limited to treating mild to moderate forms of ID. Pharmacotherapy can produce positive results for some symptoms, but caution should be used, particularly for children. Research in sensory interventions is questionable since a variety of negative and positive outcomes have resulted. In addition to behavioral and psychosocial treatments, individuals with ID may need other services as well such as focused physical healthcare and case management. Overwhelmingly, it is suggested that early intervention is best to reduce negative outcomes. Despite the variety of treatments, the primary goal for those with ID is the same: to improve their quality of life.