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Editor’s Choice : Aetiology Based Diagnosis and Treatment Selection in Intellectually Disabled People with Challenging Behaviours
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Abstract: Since both intellectual disability and challenging behaviour are entities encompassing heterogeneous clinical conditions and current taxonomies are of limited use in this field of psychiatry, diagnosing psychiatric symptoms in intellectually disabled patients is still very complex. In the diagnostic process of psychiatric symptoms and behavioural abnormalities, the first step should be genome profiling using the latest techniques in order to detect pathogenic CNVs or single gene mutations that are causative for the developmental delay. Their importance can be derived from the scientific observation that several genetic syndromes are associated with a specific behavioural, psychiatric, neuropsychological or neurological symptom profile, relevant for both choice of treatment and prognosis. Second, it has to be stressed that psychiatric disorders, especially from the depression and anxiety spectrum, frequently manifest with atypical symptoms that may hamper adequate pharmacological treatment. With respect to challenging behaviours in general, it should be emphasized that these are essentially dependent on contextual variables for which no rational pharmacological treatment is available and behavioural interventions are primarily warranted. Prescription of psychotropics has been demonstrated to be marginally effective only and to induce regularly unwanted side effects or even an increase of abnormal behaviours. It is therefore recommended to measure always the plasma concentration of psychotropics and antiepileptics and to perform, preferably prior to the start of treatment, genotyping of relevant cytochrome isoenzymes. In is concluded that, apart from the a priori genetic analysis, careful investigation of the here described data sources is needed to formulate a diagnostic hypothesis and treatment proposal. Keywords: Psychiatric diagnosis, DSM, genetic etiology, psychotropics, pharmacogenetics, behaviour, behavioural phenotype.Download Full Article |
Editor’s Choice : Comprehensive Multi-Disciplinary Assessment Protocol for Autism Spectrum Disorder
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Abstract: Legal mandates established under IDEA specify a student must be assessed in all areas of suspected disability. Never is this task more overwhelming than its application to the assessment of a student suspected of a diagnosis of autism. The assessment of an individual suspected of an autism spectrum disorder (ASD) diagnosis is a complex task and is dependent on the integration of information gleaned from assessments conducted by an array of professionals, each with their own distinct area of expertise. The purpose of this article is to introduce the Comprehensive Multidisciplinary Assessment Protocols-Autism Spectrum Disorder, referred to as the CMAPs, as a mechanism for organizing multidisciplinary team assessments. The CMAPs were developed in response to the challenges experienced by school-based assessment teams in developing appropriate and legally defensible assessment plans. The CMAPs provide teams a systematic, organizational, and comprehensive platform to organize the assessment of students across the spectrum of the disorder with the goal of making the task less overwhelming. Each assessment protocol considers the assessment needs of individuals with ASD using their communication skills as a preliminary starting point. Keywords: Autism spectrum disorder, assessment, multidisciplinary.Download Full Article |
Editor’s Choice : Discrepancy between Motor and Cognitive Control in Adults with Intellectual Disabilities
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Abstract: Purpose: To investigate the relationship between motor and cognitive control in adults with intellectual disabilities (ID), focusing on two aspects, speed and accuracy. Method: Participants were 62adults with ID aged 20 to 47 years. Their intelligence quotients (IQ) ranged from 13 to 61. Nine of the adults with ID had Down syndrome, and 8 of the adults had autism. We conducted three tasks: seal affixation task, tray-carrying task, and the Matching Familiar Figures Test (MFFT). The seal affixation and tray-carrying tasks are motor tasks we devised that can separately measure the speed and accuracy of motor control. MFFT is a cognitive control task that can be used to evaluate cognitive styles, such as impulsive-reflective. Results:Adults with ID showed high motor accuracy and similar motor speed regardless of their MFFT performance. That is, discrepancies between motor and cognitive control existed in adults with ID. Conclusions:The results of this study indicate that some types of motor control problem may become unclear with growth. A longitudinal investigation focused on the motor skill development of persons with ID is therefore necessary. Keywords: Motor control, cognitive control, intellectual disability, speed and accuracy.Download Full Article |
Editor’s Choice : Intellectual Disability and Psychiatric Diagnoses of Children and Adolescents with a History of Stressful Events and Social Deprivation in Brazil: Preliminary Results. IQ, Depression and Stress
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Abstract: Background: Studies have shown that stressful events in childhood are associated with impairments in cognitive functions and intellectual disability. Objective:Compare the intellectual functioning in groups of Brazilian children and adolescents with a history of stressful events with lifetime history of depression and without lifetime history of depression. Method: 30 children and adolescents underwent psychiatric evaluation and neuropsychological assessment of estimated intellectual quotient (EIQ), verbal knowledge, and visuospatial skills. Results: 15 patients (50%) had EIQ within the average and 6 had EIQ in the lower average (20%) for Brazilian standardized norms. The other part had at least some degree of intellectual disability and they were classified as: 2 mild mental retardation (6.7%) and 7 borderline (23.3%). Also, half of the sample had at least one lifetime depressive episode, and the performance in EIQ and visuospatial skills was worse in this group. Conclusion: 50% of the children and adolescents with a history of early stressful events and social deprivation had at least some degree of intellectual disability. In addition, a subgroup with history of depressive episodes had worse EIQ performance when compared to those without depression, possibly due to a greater impairment in visuospatial skills. The specific role of impaired right cerebral hemisphere, corpus callosum, and prefrontal cortex associated with depressive disorders and maltreatment should be investigated in further studies. Keywords: Stress, children, adolescent, IQ, depression, intellectual disability.Download Full Article |
