Diagnosis and Treatment of Aggression in Individuals with Developmental Disabilities

Antonacci, Diana J.; Manuel, C.; Davis, Ervin

doi:10.1007/s11126-008-9080-4

Cited by 64 publications

(45 citation statements)

References 100 publications

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“…Because the side effects of psychotropic medications create serious health concerns and the lack of strong empirical evidence that they effectively reduce CBs (Antonacci, Manual, & Davis, 2008; Matson, Fodstad, Rivet, & Rojahn, 2009; Matson & Neal, 2009; Oliver-Africano, Murphy, & Tyrer, 2009; P. Tyrer et al, 2008), it is important to identify effective psychosocial treatments for CBs in individuals with IDD in community settings.…”

Section: Treatment Optionsmentioning

confidence: 99%

Treating Individuals With Intellectual Disabilities and Challenging Behaviors With Adapted Dialectical Behavior Therapy

Brown

Dibiasio

2013

Journal of Mental Health Research in Intellectual Disabilities

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Approximately one third of adults with intellectual and developmental disabilities have emotion dysregulation and challenging behaviors (CBs). Although research has not yet confirmed that existing treatments adequately reduce CBs in this population, dialectical behavior therapy (DBT) holds promise, as it has been shown to effectively reduce CBs in other emotionally dysregulated populations. This longitudinal single-group pilot study examined whether individuals with impaired intellectual functioning would show reductions in CBs while receiving standard DBT individual therapy used in conjunction with the Skills System (DBT-SS), a DBT emotion regulation skills curriculum adapted for individuals with cognitive impairment. Forty adults with developmental disabilities (most of whom also had intellectual disabilities) and CBs, including histories of aggression, self-injury, sexual offending, or other CBs, participated in this study. Changes in their behaviors were monitored over 4 years while in DBT-SS. Large reductions in CBs were observed during the 4 years. These findings suggest that modified DBT holds promise for effectively treating individuals with intellectual and developmental disabilities.

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Section: Treatment Optionsmentioning

confidence: 99%

Treating Individuals With Intellectual Disabilities and Challenging Behaviors With Adapted Dialectical Behavior Therapy

Brown

Dibiasio

2013

Journal of Mental Health Research in Intellectual Disabilities

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“…The pharmacological treatment and dedicated community structures sometimes fail to control aggression, which results in negative consequences. 5,22 In the past, posterior hypothalamotomy was performed successfully for the treatment of severe aggressive behavior, but almost all the "psychosurgical" procedures fell into disuse at the beginning of the 1970s because they were perceived to be a brain-disabling therapy or used to control minority groups or because of the worldwide diffusion of antipsychotic drugs as an effective nonsurgical therapy. 67,68 DBS has represented a new treatment modality for severe neurological (e.g., Parkinson disease, dystonia, tremor) and psychiatric (e.g., obsessive-compulsive disorders) disorders in the last decades.…”

Section: Discussionmentioning

confidence: 99%

“…69 Aggressive outbursts can prevent such patients from forming and maintaining relationships and can result in their exclusion from educational, work, and social settings and the breakdown of their living situation. 5 Pharmacological therapy can be effective for treating acute symptoms. 3 However, it often fails to be effective in the long term.…”

Section: The Diseasementioning

confidence: 99%

Exploring the brain through posterior hypothalamus surgery for aggressive behavior

Rizzi

Trezza

Messina

et al. 2017

Neurosurgical Focus

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Neurological surgery offers an opportunity to study brain functions, through either resection or implanted neuromodulation devices. Pathological aggressive behavior in patients with intellectual disability is a frequent condition that is difficult to treat using either supportive care or pharmacological therapy. The bulk of the laboratory studies performed throughout the 19th century enabled the formulation of hypotheses on brain circuits involved in the generation of emotions. Aggressive behavior was also studied extensively. Lesional radiofrequency surgery of the posterior hypothalamus, which peaked in the 1970s, was shown to be an effective therapy in many reported series. As with other surgical procedures for the treatment of psychiatric disorders, however, this therapy was abandoned for many reasons, including the risk of its misuse. Deep brain stimulation (DBS) offers the possibility of treating neurological and psychoaffective disorders through relatively reversible and adaptable therapy. Deep brain stimulation of the posterior hypothalamus was proposed and performed successfully in 2005 as a treatment for aggressive behavior. Other groups reported positive outcomes using target and parameter settings similar to those of the original study. Both the lesional and DBS approaches enabled researchers to explore the role of the posterior hypothalamus (or posterior hypothalamic area) in the autonomic and emotional systems.

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“…33 The most frequent expressions of psychopathology in people with IDD-E are aggressive, impulsive, and oppositional behavior, although mood, anxiety, and psychotic disorders are also common. We lack evidence-based treatment algorithms in the IDD or IDD-E populations 34 to treat agitation, selfinjurious behaviors, and other forms of aggression. Whenever possible, physical and pharmacologic restraint should be avoided or minimized.…”

mentioning

confidence: 99%

Delivery of epilepsy care to adults with intellectual and developmental disabilities

et al. 2015

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Epilepsy is common in people with intellectual and developmental disabilities (IDD). In adulthood, patients with IDD and epilepsy (IDD-E) have neurologic, psychiatric, medical, and social challenges compounded by fragmented and limited care. With increasing neurologic disability, there is a higher frequency of epilepsy, especially symptomatic generalized and treatment-resistant epilepsies. The causes of IDD-E are increasingly recognized to be genetic based on chromosomal microarray analysis to identify copy number variants, gene panels (epilepsy, autism spectrum disorder, intellectual disability), and whole-exome sequencing. A specific genetic diagnosis may guide care by pointing to comorbid disorders and best therapy. Therapy to control seizures should be individualized, with drug selection based on seizure types, epilepsy syndrome, concomitant medications, and comorbid disorders. There are limited comparative antiepileptic drug data in the IDD-E population. Vagus nerve and responsive neural stimulation therapies and resective surgery should be considered. Among the many comorbid disorders that affect patients with IDD-E, psychiatric and sleep disorders are common but often unrecognized and typically not treated. Transition from holistic and coordinated pediatric to adult care is often a vulnerable period. Communication among adult health care providers is complex but essential to ensure best care when these patients are seen in outpatient, emergency room, and inpatient settings. We propose specific recommendations for minimum care standards for people with IDD-E. Living with intellectual and developmental disabilities (IDD) and epilepsy (IDD-E) holds challenges for the individual, caregivers, and family. Activities of daily living and quality of life (QOL) can be affected by comorbid physical, mental, or cognitive disabilities, as well as epilepsy. Despite progress in care, many problems persist, including a failure to provide medical student and resident education about IDD-E populations. Current adult epilepsy services are often unable to adequately address the needs of this population, who face disparities in health care. Medical science has failed to provide evidence-based data on the care of patients with IDD-E. Randomized controlled trials are needed.This article, based on a workshop, highlights areas where a greater understanding of the issues and an application of current knowledge could improve the quality of care and QOL in the IDD-E population. We identify areas in which a change in clinical management should be considered and recommend minimum care standards that have excellent face validity but are not evidence-based, reflecting a paucity of rigorous research in this population.FOCUS ON MANAGEMENT CHANGE The following key questions can be asked of the neurology community, to which a positive answer would undoubtedly lead to major improvements in care of adult patients with

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Diagnosis and Treatment of Aggression in Individuals with Developmental Disabilities

Cited by 64 publications

References 100 publications

Treating Individuals With Intellectual Disabilities and Challenging Behaviors With Adapted Dialectical Behavior Therapy

Treating Individuals With Intellectual Disabilities and Challenging Behaviors With Adapted Dialectical Behavior Therapy

Exploring the brain through posterior hypothalamus surgery for aggressive behavior

Delivery of epilepsy care to adults with intellectual and developmental disabilities

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