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People with intellectual disabilities are at increased risk of dental anxiety and poor oral health. In addition, people with intellectual disabilities are at increased risk of potentially traumatic experiences, such as violence and sexual abuse, and appear to be more vulnerable to developing trauma‐related disorders following such experiences. While psychological trauma is associated with poor oral health and dental anxiety in the general population, the potential link between dental anxiety, poor oral health and psychological trauma is yet to be explored in people with intellectual disabilities. In this conceptual paper, we provide an overview of recent findings concerning the relationships between oral health and intellectual disabilities, psychological trauma and intellectual disabilities, as well as between psychological trauma and oral health, and discuss the relevance of these findings related to dental care for people with intellectual disabilities. We conclude that psychological trauma is likely to contribute to dental anxiety and poor oral health also in people with intellectual disabilities. Implications include an urgent need for research exploring how trauma affects oral health and experiences of dental care for people with intellectual disabilities, as well as the importance of individualized and trauma‐informed dental care for these individuals. [ABSTRACT FROM AUTHOR]

Autistic people with co-occurring intellectual disability have a high risk of mental disorders. This study aimed to investigate specialized mental health services for this group, emphasizing inpatient/outpatient treatment, patient characteristics, interventions, and outcomes. The current study used data from a Norwegian multicenter study (the AUP study), 151 participants were included. Statistical analyses included comparisons of the two treatment groups and multiple analyses of variance on outcome measures of behavioral and mental health symptoms for all patients. Seventy-four patients received outpatient treatment and 77 received inpatient treatment. The inpatients had significantly more "severe" mental disorders and received a higher number of interventions. Both groups improved significantly during treatment, inpatients slightly more. Psychotherapy was associated with positive outcomes. Psychopharmacological treatment or duration were not associated with outcomes. Treatment of mental disorders is effective in autistic people with co-occurring intellectual disability. Psychotherapy may be beneficial for these patients. [ABSTRACT FROM AUTHOR]

Influence from bias is unavoidable in clinical decision-making, and mental health assessment seems particularly vulnerable. Individuals with intellectual disabilities have increased risk of developing co-occurring mental disorder. Due to the inherent difficulties associated with intellectual disabilities, assessment of mental health in this population often relies on a different set of strategies, and it is unclear how these may affect risk of bias. In this theoretical paper, we apply recent conceptualisations of bias in clinical decision-making to the specific challenges and strategies in mental health assessment in intellectual disabilities. We suggest that clinical decision-making in these assessments is particularly vulnerable to bias, including sources of bias present in mental health assessment in the general population, as well as potential sources of bias which may be specific to assessments in this population. It follows that to manage potential bias, triangulating information from multi-informant, multi-method, interdisciplinary assessment strategies is likely to be necessary. [ABSTRACT FROM AUTHOR]

Autistic adults with intellectual disabilities (ID) seem to be particularly vulnerable to potentially traumatic experiences and post-traumatic stress disorder (PTSD). Furthermore, this population may be at risk for a different set of traumatic experiences than the general population. However, knowledge is sparse concerning PTSD symptom manifestations in individuals with severe ID. Exploration of PTSD symptom trajectories and manifestations in an adult, autistic man with severe ID. Altered arousal/reactivity and problematic avoidance were the most easily observable symptoms. Avoidance seemed to become more generalised over time, and the impact of PTSD on behaviour, level of functioning, and quality of life was severe. Negligence and coercion in services for autistic adults with ID may involve a traumatic potential for these individuals. Increased awareness of this risk is needed in service providers and mental health professionals. [ABSTRACT FROM AUTHOR]

Phelan-McDermid syndrome (PHMDS)/22q13.3 deletion syndrome is a rare genetic disorder associated with autism spectrum disorder (ASD), intellectual disability (ID), and bipolar disorder. While numerous cases have been reported describing successful pharmacological treatment of bipolar disorder in PHMDS, there is currently little guidance available on how to organize and execute such treatment. The aim of the current case study was to explore how pharmacological treatment of bipolar disorder in PHMDS may be organized and evaluated in an outpatient setting. Through a complex process of try and fail, including systematic evaluation of any change to the intervention and never implementing more than one change at the time, the patient gradually improved, regaining his communicative and adaptive skills. Four years passed from referral to this result was achieved. Organizing assessment and treatment as a collaborative effort involving specialized mental health professionals, professional caregivers and the patient's family proved feasible. Many of the challenges present in assessment of psychiatric disorder in individuals with ASD and ID are likely to be present also in evaluation of treatment effects, particularly in disorders where symptoms occur in phases. The approach described in the current paper may contribute to reducing the impact of these challenges. [ABSTRACT FROM AUTHOR]

Introduction: Anxiety disorders are highly prevalent in individuals with autism spectrum disorder (ASD), but knowledge is limited regarding identification and treatment of these disorders in individuals with ASD and more severe levels of intellectual disability (ID). The current case study aims to explore and describe the inpatient, psychiatric assessment in an adolescent male with ASD, severe ID and self-injurious behaviour (SIB) who was diagnosed with a co-occurring anxiety disorder. The study further aims to explore the implications of this diagnosis for subsequent intervention and care, including management of SIB. Materials and methods: Case study including multimodal, psychiatric assessment and subsequent intervention. Results: Following changes in care strategies attempting to incorporate the understanding of anxiety/trauma as contributing to SIB, a reduction of SIB was observed, and this reduced frequency was maintained when the patient was discharged from the inpatient setting. Conclusions: Though no causal inferences are possible, these experiences indicate that further research is needed regarding possible associations between SIB and anxiety in individuals with ASD, including implications for treatment. Experiences from the current case further indicate that it is possible to recognize and diagnose anxiety disorder in complex cases involving ASD, severe ID, limited verbal language skills, and severe SIB. [ABSTRACT FROM AUTHOR]

Background: The identification and treatment of psychiatric disorders in individuals with autism spectrum disorders (ASD) and ID presents many challenges. We describe the development of a professional network, together with a standardized protocol for clinical assessment, designed to promote clinical competence and professional development in eight clinical centers responsible for providing mental health services to autistic individuals with ID across all four health regions of Norway. Specific aims to describe: (1) patterns of psychiatric and behavior problems in patients treated by the network, (2) patterns of change over time, and (3) the relationship between psychiatric disorders and behavior problems. Method: A standardized protocol was used to assess individual progress in 132 patients (inpatients and outpatients) with autism and ID over 2 years (at referral (T1), after 1 year (T2), and after 2 years (T3)). Changes in psychiatric symptoms and behavior problems were assessed with the Psychopathology in Autism Checklist (PAC) and Aberrant Behavior Checklist (ABC). Results: Patients showed significant (p <.001) improvements from T1 to T2 on the psychosis, depression and anxiety subscales of the PAC, but no significant improvement on the obsessive compulsive disorder (OCD) subscale. Improvements were maintained from T2 to T3. Patients showed significant (p <.01) improvements on the ABC total score and on all ABC subscales except inappropriate speech from T1 to T2; these improvements were maintained from T2 to T3. Discussion The combination of a professional network and a standardized protocol for clinical assessment has promise as a strategy for improving professional competence and facilitating specialized mental health services for autistic individuals with ID and psychiatric disorders across an extensive geographical area. [ABSTRACT FROM AUTHOR]

Background: Individuals with autism spectrum disorder (ASD) and intellectual disability (ID) are at increased risk of potentially traumatic events and may be at increased risk of post‐traumatic stress disorder (PTSD). However, knowledge regarding identification of PTSD in this population is limited. The aim of this study was to investigate clinical experience regarding PTSD and trauma assessment in individuals with co‐occurring ASD and ID. Method: Interpretative phenomenological analysis was used to explore experiences of identifying PTSD in this population among 18 mental health clinicians working with ASD and ID. Results: Informants viewed PTSD in individuals with ASD and ID as equivalent to PTSD in the general population, but with causes and expressions potentially differing. Several factors were described to contribute to challenges in identification. Conclusions: Trauma may have severe impact in individuals with ASD and ID. Multidimensional, individualized assessment strategies seem necessary to recognize PTSD or trauma‐related symptoms in this population. [ABSTRACT FROM AUTHOR]

Background: Individuals with intellectual disability (ID) and autism spectrum disorder (ASD) are at increased risk of sexual abuse. However, little is known about facilitating detection and disclosure. One year after discharge from a specialised psychiatric ward, a young man with mild ID and ASD disclosed previously unknown sexual abuse. The aim of the present study was to explore clinicians' perceptions of their failure to detect abuse. Method: Interpretative phenomenological analysis was used to explore five staff members' perceptions, with data being collected through an individual, semi-structured interview. Results: Staff reported behaviours that, in retrospect, they understood as possible indicators of abuse and/or attempts by the patient to disclose. Factors contributing to non-detection included insufficient trauma sensitivity, lack of exploration, and diagnostic overshadowing. Conclusions: Symptoms of trauma should be routinely explored in individuals with ASD and ID referred for psychiatric assessment – even in the absence of known trauma or abuse. [ABSTRACT FROM AUTHOR]

Purpose: Psychiatric assessment in adults with autism spectrum disorder (ASD) and intellectual disability (ID) is complex and challenging. With co-occurring congenital blindness, this complexity is increased. Systematic knowledge about psychiatric assessment in this combination of challenges is virtually non-existing, and there is little guidance available for clinicians faced with this task. The paper aims to discuss these issues. Design/methodology/approach: Experiences from comprehensive psychiatric assessments in two adults with congenital blindness, ASD, and ID are explored and discussed. Findings: Adaptation of assessment procedures usually employed for individuals with ASD and ID involved no major alteration, but co-operation between mental health and visual impairment professionals was important, as was the involvement of the families of the individuals in question. In both cases, the patient met criteria for an anxiety disorder, underlining the vulnerability and the challenges involved in living with this combination of challenges. Research limitations/implications: There is an urgent need for research into mental health issues for this group, including case studies describing successful treatment or intervention for these issues. Practical implications: Psychiatric assessment in individuals with this combination of challenges may be feasible, but requires involvement of professionals specializing in mental health in developmental disabilities, and professionals in visual impairment. Assessments need to be individually adapted. Originality/value: This is the first study systematically describing psychiatric assessment in this group involving the use of checklists and assessment tools. Strategies and tools that were useful are described and discussed to aid other clinicians faced with similar challenges. [ABSTRACT FROM AUTHOR]

Purpose: Autism spectrum disorder (ASD) is an exclusion criterion for one of the two attachment disorders in the DSM 5. However, previous findings indicate that ASD and attachment disorder are unrelated conditions and may co-occur. The purpose of this paper is to explore the diagnostic assessment of an adolescent male with ASD, intellectual disability (ID), severe challenging behaviour and a suspected attachment disorder. Design/methodology/approach: Case study methodology was chosen because of its suitability in the exploration of complex clinical phenomena where prior knowledge is sparse. Findings: It was possible to identify symptoms of attachment disorder in a case involving ASD, ID, anxiety and severe challenging behaviour. The Disturbances of Attachment Interview was particularly useful in this assessment, as was assessment of ASD symptoms and developmental history. Differentiating the two attachment disorders proved challenging. Research limitations/implications: There is a need for further research in ASD and attachment disorders not limited by current diagnostic categories. Practical implications: Co-occurring symptoms of attachment disorder may be identified in individuals with ASD and ID, and exploration of these symptoms in assessments of children and adolescents with ASD/ID and challenging behaviour may be beneficial. Originality/value: The study adds to previous findings on attachment disorder in ASD, demonstrating that identification of attachment disorder is possible even in the presence of a highly complex clinical picture involving severe challenging behaviour. It may also assist other clinicians in identifying and making more accurate assessment of attachment disorder in ASD and ID. [ABSTRACT FROM AUTHOR]

Background: People with 22q11.2 deletion syndrome (DS) are assumed to be especially vulnerable to developing mental illness such as psychosis. Aim: The study was established to contribute to knowledge about metyrosine medication in patients with 22q11.2 DS and psychosis. Methods: A case study was established including a woman with intellectual disability, 22q11.2 DS, and psychosis. Metyrosine medication was implemented, as conventional anti-psychotic medication was unsuccessful. Results: Effect of metyrosine medication included both psychotic symptom relief with decreased aggressive behaviour. Adjunctive milieu therapy contributed to complience. Conclusion: For patients with 22q11.2 DS and psychosis, metyrosine medication may prove effective. However, there are significant ethical dilemmas related to metyrosine medication for psychotic symptoms. [ABSTRACT FROM AUTHOR]

Purpose: There are few publications on personality disorder in adults with intellectual disability (ID), and on borderline personality disorder (BPD) specifically. Publications concerning treatment are sparse, despite the high symptom burden in these patients. This paper aims to discuss these issues. Design/methodology/approach: Six patients with BPD and ID were recruited from the same inpatient unit. Behaviour problems and mental health symptoms were scored on admission and discharge. Information about treatment, length of stay, etc. was taken from case files. Findings: Both mental health symptoms measured by the SCL-90-R, and behaviour problems measured by the Aberrant Behaviour Checklist were significantly reduced on discharge. In the active treatment period, the two main aspects of treatment were validation and practicing new solutions when emotional and behavioural problems occur, i.e. skills training. Research limitations/implications: The limitations related to this study are that the study is conducted in one milieu only. Another limitation is that the patients were admitted over a five-year period, where, some changes were made in the treatment approach. Practical implications: Inpatient treatment of this patient group seems to be effective if individually adjusted to the patient's psychopathology, ID and communication style. Close co-operation between the individual therapist and milieu therapists is essential. Originality/value: There is a need for intervention studies on BPD in ID. This study may be a valuable contribution. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe and discuss interventions of stabilisation of emotions and behaviour in adults with post-traumatic stress disorder (PTSD). This topic is understudied in persons with intellectual disability. Design/methodology/approach – The aim of this study was to investigate interventions of stabilisation in persons with more severe intellectual disability; i.e. persons with moderate or severe intellectual disabilities. Five patients in a specialised psychiatric inpatient unit for patients with intellectual disabilities were included. Information about treatment of the patients was collected through case files, observations, and interviews. The authors of this paper followed a training programme for trauma therapists in addition to the inpatient treatment of the five patients. Findings – Six main areas of stabilisation of emotions and behaviour were identified: validation, anxiety relief, treatment of depressed mood, increased mastering of daily activities, protection against anxiety triggers, and facilitated staff communication. Protection from anxiety triggers seems to be a core element of milieu therapy interventions. Interventions for neurotypical PTSD patients, such as exposure therapy may be contraindicated for patients with more severe intellectual disabilities. Originality/value – Research on interventions of stabilisation towards adults with more severe intellectual disabilities is still in its infancy. The case reports may help milieu therapists to facilitate interventions towards patients with moderate or severe intellectual disabilities. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe and discuss assessment of post-traumatic stress disorder (PTSD) in adults with intellectual disabilities. Existing research in this area encompasses case studies, and includes, for the most part, persons with mild intellectual disabilities. Design/methodology/approach – The aim of this study is to investigate symptom presentation and subsequent identification of PTSD in persons with more severe intellectual disabilities; i.e. persons with moderate or severe intellectual disabilities. Five patients in a specialised psychiatric inpatient unit for patients with intellectual disabilities were included. Information about the patients was collected through case files and interviews with key informants: family, milieu therapists, and caregivers in community settings, and observations through inpatient admission. The authors of this paper followed a training programme for trauma therapists in addition to the inpatient treatment of the five patients. The five patients all met criteria for PTSD according to the Diagnostic Manual – Intellectual Disability. Findings – Previously, it was not suspected that the five patients suffered from PTSD, although they had experienced terrifying incidents. All patients displayed severe changes in behaviour, which may have overshadowed symptoms of PTSD. PTSD in persons with more severe intellectual disabilities may be interpreted as challenging behaviour, or other psychiatric disorders such as psychosis. Research limitations/implications – The limitation of the study is the small number of participants. Practical implications – Practical implication is linked to clinical practice related to identification of PTSD in persons with intellectual disabilities. Originality/value – The paper may encourage more research into how PTSD can be identified in persons with moderate and severe intellectual disabilities. The case reports may help clinicians to look for traumatic experiences in persons with intellectual disabilities who have experienced terrifying incidents. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article titled "Schizophrenia in Autistic People with Intellectual Disabilities. Treatment and Interventions" published in the Journal of Autism and Developmental Disorders. The correction addresses an error in the author's name and the order of authors in the original article. The corrected version of the article is available under a Creative Commons Attribution 4.0 International License. The authors are affiliated with Oslo University Hospital and Helse Fonna Health Trust in Norway. [Extracted from the article]