Diverse diagnostic and behavioural patterns amongst people with a dual diagnosis

Abstract

People who have both an intellectual disability and a mental illness diagnosis are gaining more attention in the mental health and developmental disabilities service systems. This interest is partly because of the challenging behaviours and the complexities of the problems in this population. The present study analyses the diagnoses, behaviour problems and demographic characteristics of a group of people with a dual diagnosis to determine if specific patterns are evident which distinguish this set of subjects. A group of 940 people who were part of a class action lawsuit in North Carolina, USA, were investigated. A factor analysis was conducted to determine whether or not distinct patterns or factors were evident. This analysis revealed six distinct patterns primarily based on the behaviour problems of this group and secondarily based on their diagnoses. These six factors are referred to as: (1) aggressive/disturbing behaviour; (2) withdrawal/asocial behaviour; (3) inappropriate behaviours; (4) sociopathic characteristics; (5) suicidal or runaway crises; and (6) pica disorder. The findings suggest that mental illness is a prominent characteristic of some of the six factors but not of others. Furthermore, an intellectual disability diagnosis and the particular level of intellectual disability are reflected very differently amongst all of these factors.

People with learning disabilities admitted to an assessment and treatment unit: impact on challenging behaviours and mental health problems

“…There is little doubt that for some people with learning disabilities who challenge a co-morbidity between mental illness and challenging behaviour occurs (Rush & Frances 2000, IASSID 2001, Ross & Oliver 2002. Many people with learning disabilities present mental health problems through displaying challenging behaviours (Dudley et al 1999) and this is referred to as atypical presentation of mental illness; or conversely challenging behaviour may act to socially isolate an individual or cause them personal distress, which contributes to the development of a mental health problem. The difficulty is exasperated as mental illnesses can be 'cloaked' or hidden by the person's learning disabilities and behaviours; a concept referred to as 'diagnostic overshadowing' (Reiss et al 1982).…”

The diagnosis of eating disorders in adults with learning disabilities: Conceptualisation and implications for clinical practice

“…ED in this population therefore seems to be diagnosed as characteristics of a behavioural profile (e.g. Dudley et al, 1999;Reid & Ballinger, 1995) or as a cluster of symptoms which achieve a diagnosis (e.g. Bouras & Drummond, 1992;Felstrom et al, 2005).…”

“…Since ED are associated with more severe LD (Danford & Huber, 1982;Reid et al, 1978), multiple physical and mental disabilities (Dudley et al, 1999), lower adaptive behaviour (Dudley et al, 1999) and poorer social and verbal skills (Matson et al, 2006), it is possible that some ED in people with LD may be manifestations of poor functioning, physical or mental health problems. Holt, Bouras, and Watson (1988) report that rather than evidencing AN, the onset of food refusal in a client with Down's syndrome coincided with a throat infection and admission to hospital.…”

Screening for Psychiatric Disorders in a Total Population of Adults with Intellectual Disability and Challenging Behaviour Using the PAS‐ADD Checklist

“…(2006) found an association between affective symptoms and self‐injury and aggression; screaming and destructive behaviours appeared to be associated with autistic type features. Dudley et al. (1999) identified six different behavioural patterns in a sample of 940 participants using factor analytic methods.…”

“…Thus, Hemmings et al (2006) found an association between affective symptoms and self-injury and aggression; screaming and destructive behaviours appeared to be associated with autistic type features. Dudley et al (1999) identified six different behavioural patterns in a sample of 940 participants using factor analytic methods. These were as follows: aggressive ⁄ disturbing behaviour, with-drawal ⁄ asocial behaviour, inappropriate behaviour, sociopathic characteristics, suicidal or absconding and pica.…”