Textbook of Psychiatry for Intellectual Disability and Autism Spectrum Disorder

Description

This textbook provides a state of the art of the knowledge on the prevalence, risk and etiological factors, clinical features, assessment procedures and tools, diagnostic criteria, treatment, and prognosis of the psychiatric disorders encountered in people with intellectual disability (ID) and low-functioning autism spectrum disorder (ASD). ID and ASD represent two meta-syndromic groups of several different conditions, each with particular cognitive and communication features. People with ID/ASD display an increased prevalence of a variety of psychiatric disorders, including psychotic disorders, mood disorders, anxiety and stress-related disorders, somatoform disorders, and obsessive-compulsive disorder, as well behavioral syndromes, personality disorders, and disorders due to psychoactive substance use. This book will enable readers to understand the specificities of psychiatric disorders in the context of ID/ASD. It explains clearly how diagnostic criteria and assessment procedures for psychiatric disorders that were created for the general population have to be modified for use with ID/ASD. Above all, it will enable clinicians to overcome difficulties in diagnosis and to deliver more effective care that meets the particular needs of patients with ID/ASD.    Foreword Preface Acknowledgments Contents About the Editors Contributors 1: Intellectual Disability/Intellectual Developmental Disorder 1.1 Introduction 1.2 Historical Evolution 1.3 Definition and Terminology 1.4 Nosology 1.4.1 Diagnostic Criteria 1.4.1.1 Early Cognitive Impairment 1.4.1.2 Limitations in Adaptive Behavior 1.4.1.3 Severity/Extent (Subtypes) 1.4.1.4 Age of Onset and Course 1.5 Clinical and Functional Properties 1.6 Adaptive Behavior and Skill 1.6.1 Assessment 1.6.2 Intervention 1.7 IQ and Cognitive Functions 1.7.1 Uni-component Models of Intelligence 1.7.2 Multicomponent Models of Intelligence 1.7.3 Specific Cognitive Functions and Executive Functions 1.7.4 Integration of Cognitive and Emotional Processes 1.7.5 Concluding Considerations on IQ and Cognitive Functions 1.8 Development 1.8.1 Infancy 1.8.2 Early Childhood 1.8.3 Childhood 1.8.4 Adolescence 1.8.5 Adulthood 1.8.6 Aging 1.8.7 Emotional Development 1.8.8 Conclusive Considerations on Development 1.9 Integrated Assessment 1.9.1 Integrated (Multidimensional) Assessment 1.9.2 Comprehensive Assessment and Evaluation 1.9.2.1 Medical and Personal History 1.9.2.2 Definition of the Condition of ID/IDD Language Adaptive Skills Emotional Development 1.9.2.3 Physical Assessment 1.9.2.4 Mental State Assessment 1.9.2.5 Assessment of Problem Behaviors (ABA and Others) 1.9.2.6 Support Needs (Support Intensity Scale and Similar Measures) 1.9.2.7 Quality of Life General References for an Integrated (Multidisciplinary) Assessment Box 1.1 Advice for a multidisciplinary approach and inter-agency collaboration References 2: Prevalence and Aetiopathogenesis of Intellectual Developmental Disorders 2.1 Introduction 2.2 Prevalence of Intellectual Disabilities 2.3 Incidence of Intellectual Disabilities 2.4 Mortality in Intellectual Disabilities 2.5 Prevalence of Co-Occurring Autism Spectrum Disorder 2.6 Aetiological Factors and Physical and Psychological Conditions Associated with Intellectual Disabilities 2.6.1 Prenatal Causes 2.6.1.1 Genetic Factors 2.6.1.2 Epigenetic Mechanisms 2.6.1.3 Biological and Environmental Factors 2.6.2 Perinatal Causes 2.6.3 Postnatal Causes 2.7 Psychological and Physical Comorbid Conditions 2.8 Mental Health Services for People with Intellectual Disabilities 2.9 Gaps in Knowledge and Future Research Needs 2.10 Conclusion References 3: Psychological Distress and Physical Vulnerability 3.1 Psychological Distress 3.1.1 Introduction 3.1.2 High Risk Among Individuals with Intellectual Disabilities 3.1.3 Causes of Psychological Distress 3.1.4 Manifestation of Psychological Distress 3.1.5 Assessing Psychological Distress 3.1.6 Life Events and Traumatic Experiences 3.2 Physical Vulnerability 3.2.1 Life Expectancy 3.2.2 Causes of Death 3.2.3 Aetiological Factors for Physical Illnesses and Vulnerability 3.2.4 Common Physical Health Problems 3.2.4.1 Prevention 3.2.5 Improving Health Care and Reducing Physical Vulnerabilities 3.3 Lifespan and Transitions 3.3.1 Introduction 3.3.2 Adolescence 3.3.3 Education 3.3.4 Sexuality 3.3.5 Adulthood 3.3.6 Ageing References 4: Borderline Intellectual Functioning 4.1 Introduction 4.2 Prevalence 4.3 BIF and Cognition 4.4 BIF and Health 4.5 Social and Legal Aspects of BIF 4.6 Organisational Issues and Service Delivery Box 4.1 Types of Instruments Used in Assessments of Individuals Suspected as Having BIF 4.7 Concluding Considerations References 5: Diagnostic Issues 5.1 Introduction 5.2 Developing Assessment Protocols 5.3 Differences from the General Population 5.4 Cultural Factors 5.5 Factors Linked to Cognitive and Developmental Peculiarities 5.6 Behavioural Equivalence of Psychopathological Symptoms 5.7 Presentation of Symptoms and Diagnostic Criteria 5.8 Assessor, Informant and Setting Box 5.1 Common Causes of Behavioural Alterations in Persons with LF-ASD Box 5.2 Suggestions for Appropriate Communication Box 5.3 Usefulness of Developmental His tory 5.9 Focusing on the Individual References 6: Psychopathology and Mental Status Examination 6.1 Introduction 6.2 General Psychopathology 6.2.1 Cognition 6.2.2 Affectivity/Affection 6.2.3 Volition/Will 6.3 Present State Examination 6.3.1 Availability 6.3.2 Accessibility 6.3.3 Appearance 6.3.4 Behavior and Motor Activity 6.3.5 Speech 6.3.6 Cognitive Functions 6.3.6.1 Consciousness 6.3.6.2 Insight 6.3.6.3 Judgment Skills 6.3.6.4 Orientation 6.3.6.5 Attention 6.3.6.6 Memory 6.3.7 Sense Perception 6.3.8 Mood 6.3.9 Anxiety 6.3.10 Will 6.3.11 Thought 6.4 Final Considerations and Future Directions References 7: Problem Behaviour 7.1 Introduction 7.2 Terminology 7.3 Prevalence of Problem Behaviour Among People with Intellectual Disabilities 7.4 The Impact of the Behaviour 7.5 Natural History of Problem Behaviour 7.6 Risk Factors Associated with Problem Behaviour 7.6.1 Age 7.6.2 Gender 7.6.3 Severity of Intellectual Impairment 7.6.4 Verbal Communication 7.6.5 Physical Health 7.6.6 Psychiatric Disorders 7.6.7 Neurodevelopmental Disorders (ASD and ADHD) 7.6.8 Epilepsy 7.6.9 Life Events 7.7 Environmental/Contextual Risk Factors for Problem Behaviour 7.8 Behavioural Phenotypes 7.9 Assessment of Problem Behaviour 7.9.1 Behaviour 7.9.2 Medical and Organic Factors 7.9.3 Psychological/Psychiatric Factors 7.9.4 Social Factors 7.10 Assessment Methods/Tools 7.11 Functional Assessment 7.12 Conclusion References Further Reading 8: Instrumental Assessment 8.1 Introduction 8.2 Why Use a Structured Assessment? 8.3 Structured Assessments and Developmental Level 8.4 Fundamental Dimensions of Structured Assessments 8.4.1 Different Models of Mental Disorder 8.4.1.1 The Psychiatric Approach 8.4.1.2 The Behavioural Approach 8.4.1.3 Reconciling These Two Approaches 8.4.1.4 The Statistical Approach 8.5 The Coverage of the Assessment 8.5.1 The Level of Structure, Detail, Precision, Guidance and Analysis 8.6 Clinical Interviewing 8.7 Interviewing People with ID 8.8 Psychometric Properties 8.8.1 Reliability 8.8.2 Validity 8.8.3 Factor Structure 8.9 Some Examples of Structured Assessments 8.9.1 Fully Diagnostic Interview 8.9.1.1 The PAS-ADD Clinical Interview 8.9.2 Other Structured Interviews 8.9.2.1 The PIMRA 8.9.2.2 The DASH 8.9.2.3 Mini PAS-ADD and ChA-PAS 8.9.2.4 The CIS 8.9.3 Full-Spectrum Questionnaires 8.9.3.1 The P-AID 8.9.3.2 The DBC 8.9.3.3 The BSI 8.9.3.4 The PPS-LD 8.9.4 Screening Checklists 8.9.4.1 The PAS-ADD Checklist 8.9.4.2 The ADD 8.9.4.3 The RSMB 8.9.4.4 The ABCL 8.9.4.5 The SPAIDD-G 8.9.5 Assessments Focusing on a Specific Area 8.9.5.1 Mood Disorders 8.9.5.2 The SRDQ 8.9.5.3 The IDMS 8.9.5.4 The ADAMS 8.9.5.5 The MIPQ 8.9.5.6 The GDS-LD 8.9.5.7 The MASS 8.9.5.8 The InterRAI ID Anxiety Disorders Autism Spectrum Disorders Dementia Personality Disorders 8.9.6 Structuring the Whole Case Formulation 8.9.6.1 The PAS-ADD Clinical Interview: Formulation Section 8.9.6.2 The SPAIDD: An Integrated System of Tools 8.9.7 Other Structured Assessments 8.10 Choosing a Structured Assessment 8.10.1 Measuring Change 8.10.2 Diagnosis and Formulation 8.11 Structured Assessments as Part of a Protocol References 9: Epidemiology of Psychiatric Disorders in Persons with Intellectual Disabilities 9.1 Introduction 9.2 Prevalence of Psychiatric Disorders 9.3 Prevalence of Psychiatric Disorders Compared with General Population 9.4 Prevalence of Psychiatric Disorders in Persons with Co-occurring Intellectual Disabilities and Autism Spectrum Disorder 9.5 Aetiology of Psychiatric Disorders 9.6 Incidence and Course of Psychiatric Disorders 9.7 Conclusion References 10: Aetiology and Pathogenesis 10.1 Introduction 10.2 Biological Factors 10.3 Psychological Factors 10.4 Social Factors 10.5 Comorbidities 10.5.1 Autism 10.5.2 ADHD 10.5.3 Epilepsy 10.5.4 Cerebral Palsy References 11: Psychopharmacology 11.1 Introduction 11.1.1 Frequent Use, Polypharmacy and High Dose 11.1.1.1 Polypharmacy 11.1.1.2 High-Dose Anti-psychotics 11.1.2 Quality of Evidence 11.1.3 Indication 11.1.4 Off-Label Use 11.1.5 Safety and Tolerability 11.1.6 Types and Rate of Anti-psychotic Adverse Effects 11.1.7 Withdrawal Studies 11.1.7.1 Withdrawal Symptoms 11.1.7.2 Factors Affecting Withdrawal 11.1.7.3 Need for a Structured Pathway 11.1.8 Outcome Measures 11.1.9 Ethical Issues 11.2 Pharmacological Classes 11.2.1 Anti-psychotic Medications 11.2.1.1 Old-Generation Anti-psychotics 11.2.1.2 New-Generation Anti-psychotics Risperidone Aripiprazole Other Newer Anti-psychotic Medications 11.2.2 Anti-depressants 11.2.3 Mood Stabilisers (Lithium and Anti-epileptic Medications) 11.2.4 Opioid Antagonists 11.2.5 Anti-anxiety Medications 11.2.6 Beta-Blockers 11.2.7 Psychostimulants 11.2.8 Vitamins and Others 11.3 Conclusion References Further Reading 12: Nonpharmacological Interventions 12.1 Introduction 12.2 Client-Oriented Approaches 12.2.1 Behavioral Interventions Case Study 1: Treatment of Aggression in an Adult Man with Severe Intellectual Disability by Pairing Staff Presence with Reinforcement and Using a Shaping Procedure Case Study 2: Treatment of Self-Injury in a Child with Severe Intellectual and Physical Disability by Teaching a Replacement Behavior [9] Case Study 3. Treatment of Depression Disorder and Challenging Behaviors in an Adult with  Severe ID 12.2.2 Cognitive Behavior Therapy Box 12.1: Cognitive Restructuring: An Example Box 12.2: Common Components of CBT 12.2.2.1 Manualized CBT 12.2.2.2 Adapting CBT to Individuals with ID 12.2.2.3 Evidence-Base of CBT 12.2.2.4 CBT Expanding to Other Domains 12.2.3 Trauma-Focused CBT and Eye Movement Desensitization and Reprocessing 12.2.4 Relaxation 12.2.5 Psychodynamic Psychotherapy 12.2.6 Mindfulness and ACT as Examples of Third Wave of Behavioral Therapies Case Study 4: Acceptance and Commitment Treatment (ACT) for an Adult with Mild ID 12.3 Contextual Approaches 12.3.1 Parent Training 12.3.2 Parent Therapy 12.3.3 Staff Behavioral Training 12.3.4 Staff Psychological Therapy 12.3.5 Systemic Approaches 12.4 Conclusion References 13: Integrated Care 13.1 Introduction 13.2 Integrated Care and Person-Centred Approach in Intellectual and Developmental Disabilities 13.3 Integrated Care and Physical Ill-Health 13.4 Integrated Care and Mental Ill-Health Box 13.1: Reasons for Integrated Psychiatric Care in Persons with IDD Experiencing Mental Disorders 13.5 Conclusion References 14: Outcome Measures and Inclusion 14.1 Introduction 14.2 Outcome Measures 14.2.1 Heterogeneity of Outcome Measures 14.2.2 Validity and Reliability 14.2.3 Functioning 14.2.4 Empowerment 14.2.5 Person-Centered Outcome 14.2.6 Subjective Well-Being 14.2.7 Quality of Life 14.3 Inclusion 14.3.1 Overall Benefits and Current Outcomes 14.3.2 Outcomes of Inclusion in School Programs 14.3.3 Inclusion for Adults 14.3.4 Outcomes for Community Members 14.3.5 The Measurement of Inclusion Outcomes References 15: Quality of Life as an Outcome Measure 15.1 Introduction 15.2 Understanding Outcomes and Quality of Life as Outcome Measures 15.3 The Importance of Quality of Life as an Outcome Measure 15.4 Two Approaches to Quality of Life Measurement in Health 15.5 When to Use Shared and Unique Aspects of Human Life as Outcome Measures 15.5.1 Measuring Uniqueness that Enhances Quality of Life 15.5.2 Measuring the Quality of Shared Life Domains 15.6 Relating QOL Measurement to the Lived Experience of Individuals and Families 15.6.1 Individual Lived Experience 15.6.2 Family Lived Experience 15.7 Putting It All Together 15.8 Moving Ahead References 16: Autism Spectrum Disorder 16.1 Introduction 16.2 Prevalence 16.3 Etiopathogenesis 16.3.1 Genetics 16.3.2 Epigenetics 16.3.3 Environmental Factors 16.4 Diagnostic Criteria and Clinical Features 16.4.1 Definition and Diagnostic Criteria 16.4.2 Onset and Presentation 16.4.3 Communication and Social Interaction 16.4.4 Interest and Behavior 16.4.5 The Anomalies of Reactivity to Stimuli 16.4.6 Mental Functioning 16.5 Psychiatric Comorbidity in ASD 16.5.1 Prevalence of Psychiatric Disorders 16.6 Specific Assessment 16.6.1 Diagnostic Challenges 16.6.2 Diagnostic Assessment 16.6.3 Diagnostic Instruments 16.6.4 Differential and Co-occurrent Diagnoses 16.7 Treatment 16.7.1 Pharmacological 16.7.1.1 Antipsychotics 16.7.1.2 Antidepressants 16.7.1.3 Anti-anxiety Medications 16.7.1.4 Mood Stabilizers 16.7.1.5 Stimulants and Atomoxetine 16.7.1.6 Other Medications 16.7.1.7 New Therapeutic Strategies Cholinergic Agents Glutamatergic Agents Melatonin Neuropeptides 16.7.2 Nonpharmacological 16.7.2.1 Intensive Behavioral and Develop 16.7.2.2 Focused ABA Treatment 16.7.2.3 Successes and New Challenges in Nonpharmacological Treatment References 17: Attention Deficit Hyperactivity Disorder 17.1 Introduction 17.2 Trajectory of ADHD 17.3 Prevalence 17.4 Lack of Evidence 17.5 Diagnostic Classification 17.6 Clinical Symptoms 17.6.1 Inattention 17.6.2 Hyperactivity and Impulsivity 17.7 Diagnostic Validity 17.8 Psychiatric Assessment 17.9 Rating Scales for ADHD in ID 17.10 Aetiology and Associated Conditions 17.11 Management of ADHD in ID 17.11.1 Medication Choice: Children Aged 5 Years and Over and Young People 17.11.2 Medication Choice for Adults 17.11.3 Further Medication Choices 17.11.4 Medication Choice: People with Coexisting Conditions 17.11.5 Considerations When Prescribing ADHD Medication 17.12 Pharmacological Management 17.12.1 Psychostimulants 17.12.1.1 Methylphenidate 17.12.1.2 Different Methylphenidate Preparations 17.12.1.3 Dexamfetamine 17.12.1.4 Lisdexamfetamine Mesilate 17.12.2 Non-stimulant Medication 17.12.2.1 Atomoxetine 17.12.2.2 Guanfacine 17.12.3 General Principles of Prescribing for People with ID 17.13 Non-pharmacological Treatment References 18: Specific Learning Disorders, Motor Disorders, and Communication Disorders 18.1 Introduction 18.2 Specific Learning Disorders (Specific Developmental Disorders of Scholastic Skills) 18.2.1 Prevalence 18.2.2 Aetiopathogenesis 18.2.3 Criteria and Clinical Features 18.2.4 Specific Assessment 18.2.5 Treatment 18.2.6 Prognosis 18.3 Motor Disorders 18.3.1 Developmental Coordination Disorder 18.3.2 Stereotypic Movement Disorder 18.3.3 Tic Disorders 18.4 Communication Disorders 18.4.1 Speech Sound Disorder 18.4.2 Childhood Onset Fluency Disorder (Stuttering) 18.4.3 Social (Pragmatic) Communication Disorder 18.4.4 Unspecified Communication Disorder 18.4.5 Strategies to Support People with ID Who Have Communication Difficulties References 19: Behavioural and Emotional Disorders with Onset Usually Occurring in Childhood and Adolescence 19.1 Disruptive, Impulse-Control, and Conduct Disorders 19.1.1 Introduction 19.1.2 Issues in the Use of Diagnosis in Intellectual Disabilities 19.1.3 Assessment of Behaviour 19.1.3.1 Assessment of Medical and Organic Factors Should Include 19.1.3.2 Assessment of Psychological and Psychiatric Factors 19.1.3.3 Assessment of Social Factors 19.1.4 Conduct Disorder 19.1.4.1 Aggression to People and Animals 19.1.4.2 Destruction of Property 19.1.4.3 Deceitfulness or Theft 19.1.4.4 Serious Violations of Rules 19.1.5 Oppositional Defiant Disorder 19.1.6 Intermittent Explosive Disorder 19.1.7 Disruptive Mood Dysregulation Disorders 19.1.8 Pyromania 19.1.9 Kleptomania 19.1.10 Trichotillomania 19.1.11 Excoriation (Skin-Picking) Disorder 19.1.12 Gambling Disorder 19.2 Secondary Impulse Control Disorders 19.2.1 Hoarding Disorder 19.2.2 Compulsive Sexual Behaviour Disorders 19.3 Body-Focussed Repetitive Behaviour Disorder 19.3.1 Stereotypic Movement Disorder References Further Reading 20: Psychotic Disorders 20.1 Introduction 20.2 Psychosis and Intellectual Disabilities 20.3 Diagnostic Criteria and Clinical Presentation Box 20.1: Comparative Schema of Classification of Schizophrenia Spectrum Between ICD-10, ICD-11, and DSM-5 Box 20.2: Schizophrenia Spectrum Disorders Defined in ICD-10 20.4 Incidence and Prevalence 20.5 Issues Related to Diagnosis in Persons with ID 20.6 Aetiology 20.7 Differential Diagnosis Box 20.3: Differential Diagnoses 20.8 Comorbidity with Autism Spectrum Disorder 20.9 Psychosis in Adults with Severe or Profound ID 20.10 Psychosis in Children and Adolescents with ID 20.11 Principles of Treatment and Management 20.12 Psychopharmacology References 21: Mood Disorders 21.1 Introduction 21.2 Diagnostic Peculiarities and Behavioural Equivalents 21.3 Prevalence 21.3.1 Depression 21.3.2 Prevalence of Depression in People with ID 21.3.3 Prevalence of Depression in People with ID/ASD 21.4 Criteria and Clinical Features 21.4.1 Depression 21.4.2 Bipolar Disorder 21.4.3 Prevalence of Bipolar Disorder 21.4.4 Prevalence of Bipolar Disorder in People with ID 21.4.5 Prevalence of Bipolar Disorder in People with ID/ASD 21.4.6 Other Specific Mood Disorders: Criteria and Clinical Features 21.4.6.1 Mania Without Psychotic Symptoms 21.4.6.2 Bipolar Affective Disorder 21.4.6.3 Cyclothymia/Cyclothymic Disorder 21.4.6.4 Severe Depressive Episode with Psychotic Symptoms 21.4.6.5 Moderate Depressive Episode 21.4.6.6 Premenstrual Dysphoric Disorder 21.5 Aetiopathogenesis 21.5.1 Depression 21.5.2 Bipolar Disorder 21.6 Specific Assessment 21.7 Treatment 21.7.1 Depression 21.7.1.1 Psychotherapeutic Approaches 21.7.1.2 Pharmacotherapy 21.7.1.3 Mania and Mixed Mood Episodes 21.7.1.4 Light Therapy 21.7.1.5 Electroconvulsive Therapy (ECT) 21.8 Prognosis References 22: Anxiety and Stress-Related Disorders in People with Intellectual Disability/Disorders of Intellectual Development 22.1 Introduction 22.2 Classification and Diagnosis 22.2.1 ICD/DSM Diagnostic Criteria for Anxiety Disorders and PWID/DID 22.3 Comorbidity 22.4 Epidemiology 22.5 Clinical Features 22.6 Aetiology and Risk Factors 22.7 Pathophysiology 22.8 Aetiopathogenic Models 22.9 Neurobiology 22.10 Management and Treatment 22.11 Pharmacological Treatment 22.12 Prognosis References 23: Somatic Symptom and Related Disorders 23.1 Introduction 23.2 Somatic Symptom and Related Disorders 23.2.1 Prevalence 23.2.2 Aetiopathogenesis 23.2.2.1 Biological Factors 23.2.2.2 Psychological and Environmental Factors 23.3 Somatic Symptom Disorder 23.3.1 Criteria and Clinical Features 23.3.2 Diagnosis of SSD in Persons with Intellectual Disability 23.4 Illness Anxiety Disorder 23.4.1 Criteria and Clinical Features 23.4.2 Diagnosis of Illness Anxiety Disorder in Persons with Intellectual Disability 23.5 Conversion Disorder (Functional Neurological Symptom Disorder) 23.5.1 Criteria and Clinical Features 23.5.2 Diagnosis of Conversion Disorder (Functional Neurological Symptom Disorder) in Persons with Intellectual Disability 23.6 Psychological Factors Affecting Other Medical Conditions 23.6.1 Criteria and Clinical Features 23.6.2 Diagnosis of Psychological Factors Affecting Other Medical Conditions in Persons with Intellectual Disability 23.7 Factitious Disorders 23.7.1 Criteria and Clinical Features 23.7.2 Diagnosis of Factitious Disorders in Persons with Intellectual Disability 23.8 Other Specified (or Unspecified) Somatic Symptoms and Related Disorders 23.8.1 Criteria and Clinical Features 23.9 Treatment 23.10 Case Example References 24: Obsessive-Compulsive and Related Disorders 24.1 Introduction 24.2 Diagnostic Criteria 24.3 The Relationship Between OCRD, Repetitive/Stereotypic, and Addiction Behaviors 24.4 Boundary Problems Created by Co-occurring Neurodevelopmental Disorders 24.5 Neuroethology of OCRD 24.6 Neurophysiological Models: Search for Biomarkers and Endophenotypes 24.7 The Use of Research Domain and Intermediate Endophenoytypes 24.8 Neuropsychological and Neurobehavioral Models 24.9 Gaps Between Diagnosis and Treatment Planning 24.10 Cognitive-Behavioral, Exposure-Response Prevention, and Habit-Reversal Therapies 24.11 Psychopharmacology 24.12 Rationale for Combined Therapies 24.13 Neuromodulation and Neurophysiology 24.14 Summary and Conclusions: How Pathophysiology Guides Treatment References Review Articles for Additional Readings 25: Feeding, Eating and Weight Disorders 25.1 Introduction 25.2 Recent Classifications of FEEDs 25.2.1 DSM-5 Criteria for Feeding and Eating Disorders 25.3 Prevalence of Feeding and Eating Disorders 25.4 Aetiopathogenesis of FEEDs 25.4.1 Physical, Sexual Abuse and Neglect in Individuals with Intellectual Disability: Potential Risk Factors for Eating Disorders 25.4.2 Aetiology and Pathogenesis of Specific FEEDs in Persons with ID and Low-Functioning ASD 25.4.2.1 Anorexia Nervosa 25.4.2.2 Bulimia Nervosa and Binge-Eating Disorder 25.4.2.3 Avoidant/Restrictive Food Intake Disorder 25.4.2.4 Rumination Disorder 25.4.2.5 Pica 25.5 Diagnosing Issues in Persons with ID and Low Functioning ASD 25.5.1 Specific Diagnostic Approaches for FEEDs in People with ID 25.6 Presentation and Clinical Issues of FEEDs in Intellectual Disability 25.6.1 Abnormal Eating Behaviours: Clinical Features and Hypothetical Meanings 25.6.2 Key Aspects of Clinical Presentation and Differential Diagnosis of Specific FEEDs 25.6.2.1 Anorexia Nervosa 25.6.2.2 Bulimia Nervosa 25.6.2.3 Binge Eating Disorder 25.6.2.4 Avoidant/Restrictive Food Intake Disorder 25.6.2.5 Rumination Disorder 25.6.2.6 Pica 25.6.3 Feeding Disorders: Quantitative and Qualitative Medical Implications 25.7 Anorexia Nervosa and Autism Spectrum Disorder 25.8 Treatment References 26: Sleep Disorders/Sleep-Wake Disorders 26.1 Introduction 26.2 Prevalence 26.3 Development and Maturation of Physiological Sleep Timing 26.4 Etiopathogenesis of Sleep Abnormalities in Neurodevelopmental Disorders 26.4.1 Biological Factors 26.4.2 Genetic Factors 26.4.3 Psychosocial Factors 26.4.4 Developmental Factors Through the Lifespan 26.5 Criteria and Clinical Features 26.5.1 Children with Intellectual Disability 26.5.2 Adults with Intellectual Disabilities 26.6 Specific Assessment 26.6.1 Issues Related to Diagnosis in People with Neurodevelopmental Disorders 26.6.2 Differential Diagnosis 26.7 Functional Consequences 26.8 Treatment References 27: Sexual Dysfunctions 27.1 Introduction 27.2 Prevalence 27.3 Aetiopathogenesis 27.3.1 Biological Factors 27.3.2 Genetic Factors 27.3.3 Psychosocial Factors 27.3.4 Developmental Factors Through the Lifespan 27.4 Criteria and Clinical Features 27.5 Treatment 27.6 Course and Prognosis References 28: Dementia in People with Intellectual Disabilities 28.1 Introduction 28.1.1 Dementia in Persons with Intellectual Disabilities Who Do Not Have Down Syndrome 28.1.2 Dementia in Persons with Down Syndrome 28.1.3 Diagnostic Criteria 28.1.4 Diagnosis of Dementia in Persons with Intellectual Disabilities and Down Syndrome 28.1.5 Clinical Features of Dementia in Intellectual Disabilities and Down Syndrome 28.2 Etiopathogenesis 28.2.1 Down Syndrome-Related Alzheimer’s Dementia Neuropathology 28.2.2 The Amyloid Cascade Hypothesis and Down Syndrome-Related Alzheimer’s Dementia 28.2.3 The Pathophysiology of Down Syndrome-Alzheimer’s Dementia 28.3 Risk Factors and Biomarkers 28.4 Diagnostic or Screening Instruments 28.4.1 Informant-Rated Scales 28.4.2 Neuropsychological Tests 28.5 Differential Diagnosis/Co-morbidities 28.6 Assessment 28.7 Management Options 28.7.1 Pharmacological and Medical Interventions 28.7.2 Non-pharmacological Management 28.8 Service Needs 28.8.1 Cross-Cutting Management Issues 28.9 Conclusion References Further Reading 29: Disorders Due to Brain Damage and Dysfunction and to Physical Diseases (Excluding Neurocognitive Disorders) 29.1 Introduction 29.2 Specific Clinical Disorders 29.2.1 Organic Hallucinosis 29.2.2 Organic Catatonic Disorder 29.2.3 Organic Delusional [Schizophrenia-Like] Disorder 29.2.4 Organic Mood [Affective] Disorder 29.2.5 Organic Anxiety Disorder 29.2.6 Organic Dissociative Disorder 29.2.7 Organic Emotionally Labile [Asthenic] Disorder 29.2.8 Organic Personality Disorder 29.2.9 Postencephalitic Syndrome 29.2.10 Post-Concussion Syndrome 29.3 Conclusive Considerations 29.4 Prognosis 29.5 Therapy 29.6 Epilepsy in Intellectual Disability and Autism Spectrum Disorder 29.6.1 Introduction 29.6.2 Epilepsy and ID 29.6.3 Epilepsy, ID, and Psychopathology 29.6.4 Epilepsy and ASD 29.6.5 Pharmacological Treatment for ID and ASD 29.6.6 Psychosocial Treatment for ID and ASD References 30: Substance-Related and Addictive Disorders in Intellectual Disability 30.1 Introduction 30.1.1 Terminology 30.1.2 Research Limitations 30.2 Prevalence and Risk Factors 30.3 Criteria and Clinical Features 30.4 Specific Assessment 30.5 Treatment 30.6 Future Perspectives and Conclusion References 31: Personality Disorder in People with Intellectual Disability or Those with Intellectual Disability and Autism Spectrum Disorder 31.1 Introduction 31.2 Diagnosis and Classification 31.3 Epidemiology 31.3.1 Prevalence 31.3.2 Prevalence of Specific Personality Disorders 31.4 Comorbidity 31.5 Assessment/Research Instruments Used in People with ID 31.6 Aetiology and Risk Factors 31.7 Treatment 31.7.1 Dialectical Behaviour Therapy 31.7.2 Schema Therapy 31.7.3 Therapeutic Community 31.7.4 Nidotherapy 31.7.5 Education and Occupational/Vocational Rehabilitation 31.7.6 Pharmacotherapy 31.7.7 Long-Term Treatment Outcomes References 32: Co-Occurrence and Differential Diagnosis 32.1 Differential Diagnosis 32.1.1 Issues Specific to ASD 32.1.2 Issues Specific to ID and ASD 32.1.3 Issues Specific to ASD and Schizophrenia 32.1.4 Issues Specific to Schizophrenia Spectrum Disorders and ASD in ID 32.1.5 Issues Specific to ASD and Social Anxiety Disorder 32.1.6 Issues Specific to ASD and Major Depressive Disorder 32.1.7 Issues Specific to ASD and Obsessive-Compulsive Disorder 32.1.8 Issues Specific to ASD and Obsessive-Compulsive Personality Disorder 32.1.9 Issues Specific to ASD and Avoidant Personality Disorder 32.1.10 Issues Specific to ASD and Schizotypal Personality Disorder 32.1.11 Issues Specific to ASD and Schizoid Personality Disorder 32.2 Categorical and Dimensional Approaches 32.3 The Neurodevelopmental Perspective References 33: Intellectual Disability and Sensory Impairment 33.1 Introduction 33.2 Definition and Epidemiology 33.2.1 Visual Impairment and Intellectual Disability 33.2.2 Hearing Impairment and Intellectual Disability 33.2.3 Dual Sensory Impairment and Intellectual Disability 33.3 Intellectual Disability, Sensory Impairment and Autism 33.4 Intellectual Disability, Sensory Impairment and Challenging Behaviour 33.5 Intellectual Disability, Sensory Impairment and Psychiatric Disorders 33.6 Practical Conclusions 33.6.1 Structured Time and Environment 33.6.2 Interpersonal Communication References 34: Educational and Training Opportunities 34.1 Introduction 34.2 Challenges for Education and Training in ID Mental Health 34.3 Mandatory Formal Education and Training in Psychiatry and Clinical Psychology 34.3.1 Psychiatrists 34.3.2 Psychologists 34.4 Non-Mandatory Formal Training Options in ID Mental Health 34.4.1 University Based Programmes in ID Mental Health 34.4.2 Associations Promoting Advances in ID Mental Health 34.4.2.1 EASPD 34.4.2.2 ARFIE 34.4.2.3 EAMHID 34.4.3 ID Mental Health: European Consortium-Driven Training Programmes 34.4.3.1 TRINNODD 34.4.3.2 AGID 34.5 World Perspectives 34.6 Further Considerations 34.7 Conclusion and Outlook References 35: Mental Health Services 35.1 Introduction 35.2 Quality of Services 35.3 Service Utilisation 35.4 Service Models and Development of Services 35.4.1 Service Planning 35.4.2 International Perspective 35.4.3 Example of a National Service Model from England References Further Reading 36: Costing Intellectual Disability Services and Support 36.1 Introduction 36.2 Economics of Intellectual Disability Service Provision 36.2.1 Population Changes 36.2.2 Changing Expectations 36.2.3 Legislation 36.2.4 Resources 36.3 Efficiency Versus Equity 36.4 Financial and Economic Costs 36.5 Opportunity Costs 36.6 Perspective 36.7 Steps in Cost Estimation 36.7.1 Identification 36.7.2 Measurement 36.7.3 Sources of Resource Use Data 36.7.4 Valuation 36.8 Costing Intellectual Disability Services and Support 36.8.1 Training 36.8.2 Accommodation 36.8.3 Non-accommodation Service Costs 36.8.3.1 Costing Non-accommodation Services 36.8.4 Caregiver Inputs 36.8.4.1 Measurement of Caregiver Time 36.8.4.2 Valuation of Caregiving Inputs References Further Reading 37: Residential Care and Community Living 37.1 Introduction 37.2 What Is “Residential Care”? 37.3 Deinstitutionalisation 37.3.1 What Is It? 37.3.2 What Drives the Process? 37.3.3 Deinstitutionalisation of Services for People with Intellectual Disability: The Example of the United Kingdom 37.4 The Paradigm of Community Living 37.5 Types of Living Arrangements Used by People with Intellectual Disabilities 37.5.1 Congregate Settings 37.5.2 Clustered Settings 37.5.3 Community-Based Residential Care Homes, Group Homes and Individualised Services 37.6 Quality and Outcomes of Residential Care and Community Living 37.6.1 What Do We Know from Official Statistics? 37.6.2 What Do We Know from Research? 37.7 Benefits, Risks and Solutions References 38: Work and Occupation 38.1 Introduction 38.2 Employment Rate and Labor Force Participation in the Population with Intellectual and Developmental Disabilities 38.3 Employment Outcomes in Selected Groups of People with Co-occurring Intellectual and Developmental Disabilities and Mental Health Problems 38.4 Framing Services and Practices for Employment of People with Intellectual and Developmental Disabilities and Related Research 38.4.1 Target Population 38.4.2 Labor Market 38.4.3 Employability 38.4.4 Employment Services and Practices for People with ID and ASD 38.4.5 Development of Work Skills 38.5 Employment-Related Outcomes 38.6 Employability: Workplace Characteristics and Employers’ Attitude 38.6.1 Access to Work for Persons with Disabilities: Legal Protection and Reasonable Accommodation 38.6.2 Employer Attitude and Practice References 39: Cultural Issues 39.1 Introduction 39.2 Diagnosis and Services for People with Intellectual Disability and Autism Spectrum Disorder in Different Cultures and Contexts 39.3 Informal Caregiving 39.4 Organizational Culture and Context in Programs and Services References 40: Spiritual Issues 40.1 Introduction and Overview 40.2 Definition 40.3 Spirituality and Health/Mental Health 40.4 Spirituality and Quality of Life 40.5 Cognitive and Spiritual Development 40.6 Spiritual Life in People with ID 40.6.1 Importance of Spirituality/Religion 40.6.2 Understanding of Spiritual or Religious Concepts 40.6.3 Expression of Spiritual Life in People with ID 40.6.4 Impact of Spirituality or Religion in People with ID 40.7 Family Spirituality 40.8 Spiritual Care for People with ID 40.9 Inclusion in Faith Communities 40.9.1 Religious Approaches to Disability in General 40.9.2 Inclusion and Participation in Faith Communities 40.9.3 Characteristics of Inclusive Faith Communities 40.10 Conclusion and Policy Statements References Further Reading Resources 41: Forensic Issues in Intellectual Disability and Autism Spectrum Disorder 41.1 Introduction 41.2 Epidemiology 41.3 Risk Factors for Offending Behaviour 41.4 Offence Types 41.4.1 Fire-Setting 41.4.2 Sex Offending 41.4.3 Violence 41.5 Risk Assessment 41.6 Services in the United Kingdom References Further Reading 42: Human Rights 42.1 Introduction 42.2 Rights of Persons with Disorders of Intellectual Development and the UN Convention on the Rights of Persons with Disabilities 42.3 Fundamental Principles 42.3.1 Equality, Non-discrimination, and Dignity 42.3.2 Autonomy and Self-Determination 42.3.3 Independent Life and Social Inclusion 42.3.4 Quality of Life 42.4 Access and Quality of Physical and Mental Health Care 42.5 Monitoring the Rights of Persons with Disabilities: An Overview 42.6 Conclusion References 43: Teleassistance and Telerehabilitation: COVID-19, Other Epidemic Situations and Future Prospects 43.1 COVID-19 Outbreak and Associated Vulnerability and Support Needs for People with Intellectual Disability and Autism Spectrum Disorder with High and Very High Support Needs 43.2 Care Needs Manageable Through Telemedicine Services 43.3 General Objectives of Teleassistance and Telerehabilitation Services 43.4 General Principles for Teleassistance and Telerehabilitation Services Implementation 43.5 Effectiveness and Limits of Teleassistance and Telerehabilitation 43.6 Prerequisites for Teleassistance and Telerehabilitation Services 43.6.1 Conditions Referring to the Telecommunications Infrastructure 43.6.2 Conditions Referring to the Treatment Services Provider and the Territorial Healthcare Organization 43.6.3 Conditions Referring to Personal-Data Security and Digital Devices at the User’s Home 43.6.4 Conditions Referring to the In-Home Patient’s Capability to Cooperate 43.7 Type of Teleassistance and Telerehabilitation Services 43.8 Other Indications for Organizing and Delivering Teleassistance and Telerehabilitation Services 43.9 Indications for Delivering Psychological Support 43.10 Future Prospects References