An AAIDD-informed framework for cognitive behavioral case formulation and cognitive behavior therapy for young people with mild intellectual disabilities or borderline intellectual functioning.

Abstract

Young people with mild intellectual disabilities or borderline intellectual functioning (MID-BIF) form a heterogeneous group with a range of cognitive and adaptive (dis)abilities. MID-BIF youth show an increased vulnerability to developing mental health problems due to risk factors in various domains. Despite this increased risk, access to and use of mental health care is low and there is a dearth of evidence-based interventions suitable for use with MID-BIF youth. Cognitive behavioral therapy (CBT) is recommended as the first-line intervention for many psychiatric problems in young people. There is accumulating evidence to suggest that adapted CBT for use with ID adults and young people can lead to treatment success. However, there are few guidelines to help professionals take into account the combination of characteristics of the MID-BIF population. The American Association on Intellectual and Developmental Disabilities (AAIDD) provides a sound theoretical-conceptual framework which can be used to inform systematic decision-making about treatment planning and delivery of CBT for MID-BIF youth. This paper presents the AAIDD framework as a way in which characteristics of MID-BIF youth can be integrated into a cognitive behavioral case formulation. This AAIDD-informed case formulation elucidates the way in which features of MID-BIF contribute to the onset and maintenance of psychiatric problems. In addition, it provides insights into how treatment can be adapted to take into account delays and/or deficits in different areas of functioning. Awareness of the characteristics of the MID-BIF population enables the tailoring of CBT in order to enhance its applicability and optimize treatment effectiveness.

Epidemiology and Diagnosis of Slow Learners (Borderline Intellectual Functioning)

“…Although BIF is defined as a lack of significant abnormalities in adaptive functioning, distinguishing it from IDD, research indicates that individuals with BIF experience various daily living adaptation difficulties compared with those of the general population [ 30 ]. Additionally, compared with those of mild IDD, BIF demonstrates similar psychosocial and adaptive functioning deficits [ 31 ] and may present with more severe psychiatric issues [ 32 ]. This is presumably because individuals with BIF attempt to conceal their need for assistance and strive to act “normally [ 5 , 29 ].” Based on these facts, BIF, while not a disability itself, is associated with a higher probability of psychiatric disorders, complicating the diagnosis and treatment when such disorders arise [ 33 ].…”

Psychometric analysis of the Group Climate Inventory—Revised in adults with mild intellectual disability or borderline intellectual functioning in a secure residential facility

“…Clients with an IQ between 70 and 85 constitute a substantial part of the client population in secure facilities. In addition, they are internationally recognised to share characteristics and needs with clients with mild intellectual disability, as a result of which clients with borderline intellectual functioning are often grouped together with clients with mild intellectual disability (see e.g., Berger et al, 2023;Sauter et al, 2023;Smit et al, 2023;Van Cappellen et al, 2023). Therefore, we grouped participants with both intellectual levels into a single sample.…”

Research and clinical approaches to addressing disparities in therapy access for individuals with ID: A commentary on “An AAIDD-informed framework for cognitive behavioral case formulation and cognitive behavior therapy”.

“…One way to address the immediate clinical need is through training and the dissemination of resources to build the capacity of the existing workforce. In this issue of Clinical Psychology: Science and Practice , Sauter et al (2023) provide clinicians with a framework and corresponding resource for case conceptualization and treatment planning for individuals with mild ID and borderline intellectual functioning (BIF). This framework supplies a crosswalk for the provision of therapy for individuals with BIF and ID for use by clinicians with expertise in cognitive behavior therapy (CBT).…”