Depression in adults with intellectual disability: symptoms and challenging behaviour.
Look first for sad mood, crying, and lost interest when you suspect depression in adults with ID.
01Research in Context
What this study did
Doctors looked back at 300 adult clients with intellectual disability. They wanted to know which signs best point to depression.
They compared clients who had depression with clients who had other mental-health issues. They noted who cried, looked sad, or lost interest in favorite things.
What they found
Sad face, crying, and not wanting to do fun things were the clearest clues. These signs showed up far more in the depressed group.
Challenging behaviors like hitting or screaming were common too, but they also appeared in clients who were not depressed.
How this fits with other research
LeBlanc et al. (2003) warned not to treat self-injury or aggression as proof of depression. The two papers seem to clash, but they don’t. Hurley (2008) agrees behavior alone is weak; the new point is to rank sad mood and crying first.
Palka Bayard de Volo et al. (2021) later pooled many studies and still found low-quality proof that behavior equals depression. They repeat the rule: check for pain, autism, and other causes before blaming mood.
Myrbakk et al. (2008) showed depression can fuel screaming in severe ID and self-injury in mild ID. Together the papers tell one story: notice behavior, but always pair it with clear mood checks.
Why it matters
When you screen an adult with ID, start with what you can see: long face, tears, turning away from snacks, music, or friends. If those signs are absent, keep looking; don’t assume hitting equals depression. This quick priority list speeds up referral and keeps treatment plans on target.
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02At a glance
03Original abstract
BACKGROUND: Psychiatric evaluation of adults with intellectual disability (ID) remains complex because of limitations in verbal abilities, atypical clinical presentation and challenging behaviour. This study examines the clinical presentation of adults with depression compared with bipolar disorder, anxiety disorders and non-psychiatric control patients. METHOD: This study is a retrospective record review of the initial psychiatric diagnostic evaluation for 300 adult patients with ID drawn from a clinic population. Patients with major depression (n = 85) were compared with those with bipolar disorder (n = 70), anxiety disorders (n = 30) and control patients without psychiatric disorder (n = 27). Key symptoms of depression assessed during the interview were examined as well as challenging behaviour. RESULTS: Three symptoms were useful in differentiating depressed patients from all other groups: sad mood, crying, and anhedonia. Withdrawal, suicidality, and awakening during the night were significant compared with anxiety patients and controls; however, few patients reported suicidality. Bipolar patients were significantly different from depressed patients for elevated mood, acute anger episodes, increase in verbalization, pressure of speech, talk of sexual themes, increase in appetite and poor concentration. Anxiety patients had more fearfulness without withdrawal, sad mood, crying, anhedonia and suicidality. Challenging behaviour was most pronounced in bipolar patients; for depressed patients, aggression and impulsivity were significant compared with anxiety patients and controls. Overall, the control patients presented with few symptoms in any category. CONCLUSIONS: Sad mood, crying and anhedonia are key significant features of depression. Most patients with ID cannot meet the required number of DSM criteria or suggested DM-ID adapted criteria for major depression. Many depressive symptoms were reported in modest numbers and this was probably related to deficiencies in self-report or observational skills of caregivers. Challenging behaviour is not diagnostically specific. It is, however, a key atypical feature of depression.
Journal of intellectual disability research : JIDR, 2008 · doi:10.1111/j.1365-2788.2008.01113.x