Psychiatric disorders and behavior problems in people with intellectual disability.
Severe behavior in ID often signals depression, so screen for mood before you write a behavior plan.
01Research in Context
What this study did
Myrbakk et al. (2008) compared two groups of people with intellectual disability. One group had moderate or severe behavior problems. The other group had few or no behavior problems.
They used standard checklists to count psychiatric symptoms in both groups. Then they looked at which behaviors matched which disorders.
What they found
The group with behavior problems showed far more psychiatric symptoms. Depression was the key link.
In severe or profound ID, depression often looked like screaming or hitting. In mild or moderate ID, depression often looked like self-injury.
How this fits with other research
Martin et al. (1997) first mapped this idea: mood disorders in severe ID can hide inside aggression. Even et al. added matched-group numbers to prove it.
Reiss et al. (1993) found aggression raised depression risk about four times. Even et al. show the same link holds when you use fuller psychiatric screens.
Palka Bayard de Volo et al. (2021) later pooled many studies and warned that pain, autism, and poor sleep can mimic depression. Their caution does not cancel Even et al.; it tells you to rule those factors out before you treat.
Why it matters
If a client with ID starts screaming, hitting, or biting themselves, think depression first, not just "attention seeking." Run a mood screen, check for pain, review meds, and track sleep. Treating the mood can melt the behavior faster than teaching a replacement skill alone.
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02At a glance
03Original abstract
The relationship between behavior problems and psychiatric disorders in individuals with intellectual disability is still unresolved. The present study compares the prevalence and pattern of psychiatric disorders in individuals with intellectual disability who were assessed on the ABC to have moderate and severe behavior problems and a matched group of individuals without such problems. Both groups were living in community settings and had their intellectual disability varied from mild to profound degrees. The participants were screened for psychiatric disorders using four different instruments; the Reiss Screen, the Mini PAS-ADD, the DASH-II and the ADD. The group with moderate and severe behavior problems showed significantly more symptoms of psychiatric disorders than the group without such problems when items related to behavior disorders were omitted, and the majority of the participants with behavior problems had symptoms of the main psychiatric disorders. The participants with mild and moderate intellectual disability showed more symptoms of psychosis and depression than the participants with severe and profound intellectual disability. There were no direct associations between individual behavior problems and psychiatric disorders, but the group with mild/moderate intellectual disability showed a somewhat different pattern of associations than the group with severe/profound intellectual disability. Depression was associated with screaming and aggression in the participants with severe and profound intellectual disability, and with self-injury in the participants with mild and moderate intellectual disability. The finding that the majority of the participants with behavior problems showed symptoms of psychiatric disorders suggests that many behavior problems may be (unconventional) symptoms of psychiatric disorders or reflect a difficult life situation caused by a psychiatric disorders, or that a difficult life situation may contribute to both psychiatric disorders and behavior problems in individuals with intellectual disability.
Research in developmental disabilities, 2008 · doi:10.1016/j.ridd.2007.06.002