Co-Occurring Mental Illness and Behavioral Support Needs in Adults with Intellectual and Developmental Disabilities.
Adults with IDD in Virginia usually have extra mental health needs that never make it into their charts.
01Research in Context
What this study did
Dembo et al. (2023) looked at every adult with IDD who used Virginia’s Medicaid waiver in one year. They counted how many also had mental health or severe behavior plans on file.
The team used state records, not new tests. They wanted to see if doctors outside the disability system were catching these extra needs.
What they found
Most adults carried both a mental health label and a behavior support plan. Community clinics often listed only the disability, missing the second diagnosis.
In short, the service system sees a double load but treats a single one.
How this fits with other research
Amaral et al. (2019) used the same Virginia registry and showed that adults with mental illness plus IDD land in the ER more often. S et al. now tell us why: the mental half of the problem is mostly invisible.
Fradet et al. (2025) tracked Oklahoma waiver adults and found most take more than one psychotropic drug. S et al. show the diagnosis behind those prescriptions is often unofficial, explaining the heavy pill load.
Nuebling et al. (2024) found HIV testing in this group is almost zero. Together the three papers paint the same picture — adults with IDD get screened for almost none of the major health risks that accompany their disability.
Why it matters
If you write behavior plans, assume mental health symptoms are present even when the chart is silent. Ask for psychiatric consults early and push for formal diagnoses. A clear second label unlocks therapy, appropriate meds, and crisis beds that pure IDD funding will not cover. One extra checkbox at intake can prevent a 3 a.m. ER run later.
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02At a glance
03Original abstract
People with intellectual and developmental disabilities (IDD) have higher incidences of mental health conditions and behavioral support needs than people without IDD but may not receive needed care from community providers. We examined rates of co-occurring conditions in a representative sample of adults with IDD who use state funded services in Virginia. Using data from two datasets, we identified four categories of mental health and behavioral conditions. We used these categories to examine differences in individual- and system-level factors in people with and without co-occurring conditions. We found high rates of co-occurring conditions in our sample. We found important disability factors and system-level characteristics that were associated with having a diagnosed mental health condition or behavioral support needs. Differing patterns of diagnosis and treatment for co-occurring conditions suggests more work needs to be done to support people with IDD and co-occurring mental health conditions living in the community.
, 2023 · doi:10.1007/s10597-023-01091-4