Children and adolescents with developmental disabilities often have emotional and behavioral problems, and these problems can persist as the person grows older, according to a study in the October 25 issue of JAMA.
Intellectual (developmental) disability affects approximately 1 percent to 3 percent of the population in developed countries. Psychopathology (behavioral or mental disorder) with developmental disability is a major cause of failure of community residential placement, reduced occupational opportunity in the post-school period, and leads to major restrictions in participation in recreational and educational programs, according to background information in the article. Despite this, not much attention has been given to the public health issue of psychopathology in developmental disability and little research has examined the course of these problems over time.
Stewart L. Einfeld, M.D., of the University of Sydney, Australia, and colleagues examined the course of psychopathology in a population of 578 children and adolescents with developmental disability. The participants were recruited in 1991 and were ages 5 years to 19.5 years, from 6 rural and urban regions in Australia, and were followed up for 14 years. Data were obtained from 507 participants, with 84 percent of the initial participants being followed up in 2002-2003. The researchers analyzed various measures, including the Developmental Behaviour Checklist (DBC), a measure of psychopathology in young people with developmental disability, completed by parents or other caregivers; and the Total Behaviour Problem Score (TBPS).
The researchers found that the prevalence of participants meeting criteria for major psychopathology or definite psychiatric disorder was 41 percent at the beginning of the study, which decreased to 31 percent in 2002-2003. Overall severity of psychopathology was similar across mild to severe ranges of developmental disability. Psychopathology decreased more in boys than girls over time, and more so in participants with mild developmental disability compared with those with severe or profound developmental disability. Few of the participants (10 percent) with psychopathology received mental health interventions during the study period.
"The overarching finding was one of a small, albeit significant, decline in severity of overall psychopathology over the 14 years in which the young participants with intellectual disability were followed up. Coupled with the absence of any relationship with age in the TBPS, the small size of this decline demonstrates that psychopathology and behavioral disturbance in young people with intellectual disability is a phenomenon that largely persists through to young adulthood," the authors write.
"The observation that severe psychopathology was already present in a high proportion of the cohort at commencement of the study, and the persistence of these symptoms, suggest the need for effective mental health interventions. This should include support, education, and skills training for their parents who are likely to be stressed by the burden of care. Without effective interventions, these data could lead to the prediction that this sizable and neglected public health problem will also continue to be a burden on families, communities, and governments," the researchers conclude.
(JAMA. 2006;296:1981-1989. Available pre-embargo to the media at www.jamamedia.org.)
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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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