Cognitive Behaviour Therapy for People with Intellectual Disabilities—How Far Have We Come?

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

“…Given the complexity of conducting research with this population (Mulhall et al, 2018), experimental case study designs may be trialed first, before conducting RCTs (van den Bogaard et al, 2020). In line with recent suggestions for future research by Hronis (2021), we also support the establishment of a stronger evidence base for adapted treatment for the MID-BIF population, including small- and large-scale evaluations of CBT’s targeting a range of psychopathology, the development and validation of measures suitable for MID-BIF young people (both treatment outcome, as well as those aimed at assessing the domains described in the AAIDD framework which can potentially impact treatment outcome), and the exploration of ways in which third-wave (e.g., mindfulness-based CBT; acceptance and commitment therapy) CBTs can also be adapted to fit the characteristics of the MID-BIF population. Other avenues for potential further studies include the implementation of pre-therapy modules (e.g., training CBT-relevant skills prior to CBT proper), emotion regulation modules, and the augmentation of CBT with other treatment modalities (creative therapy, play therapy, etc.…”

“…The specifiers “mild,” “moderate,” “severe,” or “profound” are used to indicate the severity of the intellectual disability (ID), based on the impact on daily life skills (APA, 2013; Schalock et al, 2021). Young people with an IQ between 70 and 85 (borderline range) are also included in the definition, as they often have significant deficits in their psychosocial and adaptive functioning similar to youth with IQs below 70 (Hronis, 2021; Schalock et al, 2021). This article focuses on young people functioning within the mild to moderate to borderline range; the verbal, language, and cognitive abilities of young people with severe-profound ID limit potential participation in CBT (Hronis, 2021).…”

“…Parents and caregivers of young people with MBID also face challenges in accessing treatment for themselves, such as costs, arranging childcare, and limited availability of mental health care providers (Osborn et al, 2019). Another potential barrier to treatment is the lack of effective interventions available for MID-BIF youth, and the low confidence of mental health professionals in working with them (Dagnan et al, 2015; Hronis, 2021; Hronis et al, 2018). Given the vulnerability of the population and the potential negative short- and long-term consequences of psychological problems for MID-BIF young people, effective and accessible treatments are crucial to protect and promote the developmental potential of this population.…”

“…For young people with MID-BIF, assessment of a range of characteristics of ID (Schalock et al, 2021) and the specific needs of the individual client, is essential. This allows for tailoring necessary for optimizing treatment for this population, rather than just applying treatments developed for young people of the same mental age (Hronis, 2021; Hronis et al, 2017). However, few instruments are available which have norms including MID-BIF young people, let alone measures that have been specifically developed for use with this population (Siegel et al, 2020).…”

The phenomenology of mental imagery in people with intellectual disabilities

“…The ability of people with intellectual disabilities to experience and report complex mental imagery suggests that a range of mental imagery interventions may be appropriate for this population. However, a recent review of CBT interventions within this population found no use of mental imagery interventions (Hronis, 2021 ). Further work should identify, adapt and test mental imagery interventions for prevalent mental health conditions (e.g.…”