Interventions for mental health problems in children and adults with severe intellectual disabilities: a systematic review

Abstract

ObjectiveMental health problems are more prevalent in people with than without intellectual disabilities, yet treatment options have received little attention. The aim of this study was to identify and evaluate the effectiveness of pharmacological and psychological interventions in the treatment of mental health problems in children and adults with severe and profound intellectual disabilities, given their difficulties in accessing standard mental health interventions, particularly talking therapies, and difficulties reporting drug side effects.DesignA systematic review using electronic searches of PsycINFO, PsycTESTS, EMBASE, MEDLINE, CINAHL, ERIC, ASSIA, Science Citation Index, Social Science Citation Index and CENTRAL was conducted to identify eligible intervention studies. Study selection, data extraction and quality appraisal were performed by two independent reviewers.ParticipantsStudy samples included at least 70% children and/or adults with severe or profound intellectual disabilities or reported the outcomes of this subpopulation separate from participants with other levels of intellectual disabilities.InterventionsEligible intervention studies evaluated a psychological or pharmacological intervention using a control condition or pre-post design.OutcomesSymptom severity, frequency or other quantitative dimension (e.g., impact), as assessed with standardised measures of mental health problems.ResultsWe retrieved 41 232 records, reviewed 573 full-text articles and identified five studies eligible for inclusion: three studies evaluating pharmacological interventions, and two studies evaluating psychological interventions. Study designs ranged from double-blind placebo controlled crossover trials to single-case experimental reversal designs. Quality appraisals of this very limited literature base revealed good experimental control, poor reporting standards and a lack of follow-up data.ConclusionsMental ill health requires vigorous treatment, yet the current evidence base is too limited to identify with precision effective treatments specifically for children or adults with severe and profound intellectual disabilities. Clinicians therefore must work on the basis of general population evidence, while researchers work to generate more precise evidence for people with severe and profound intellectual disabilities.PROSPERO registration numberCRD 42015024469.

Conceptualising the therapeutic alliance: exploring the relevance of Bordin’s model for adults with intellectual disabilities

“…The participants in this study were all people with intellectual disabilities who could give consent to be part of the study and their measured IQ scores were across the full span of the mild learning disability range. Further theoretical and empirical work is required to consider the nature of therapeutic relationships with people with moderate and severe learning disabilities; although therapy with people with more severe disabilities is an area where there is very limited evidence (Vereenooghe et al , 2018). Finally, we acknowledge that the development of the schedule for the interviews in this study would have been improved with input from people with intellectual disabilities themselves.…”

Psychological interventions for depression in children and young people with an intellectual disability and/or autism: systematic review

“…7 Further, children and young people with severe intellectual disability are a particularly vulnerable group, and often neglected in research of mental health problems and intervention. 62 As highlighted in a recent systematic review, future research into psychological treatments for depression for children and young people with intellectual disability and/or autism should also be supported by the development of appropriate outcome measures of any mental health symptoms for this population. 63…”

A systematic review of the behaviours associated with depression in people with severe–profound intellectual disability

“…There is however a dearth of research in this area. In a recent review of interventions for mental health problems in people with severe ID (Vereenooghe et al 2018), only two treatment interventions for depression were identified, neither of which would have been included in our review due to a lack of a reported clinical/research diagnosis of depression. We must also consider that our findings on the behaviours associated with depression in severe ID are limited by the range of behaviours investigated in research to date.…”