Psychiatric and Behavioral Problems

Intellectual disability is fairly common, and it occurs in approximately 1 to 2 percent of people. Psychiatric and behavior problems occur three to six times more in these individuals than in the general population, so the assessment of these patients is important in treating these issues.

How Is Intellectual Disability Diagnosed?

Intellectual disability is normally diagnosed before the age of 18 and is defined as when an IQ of a person is 75 or lower. Individuals will show signs of difficulty in two areas of adaptive skills, such as social skills, health, or safety. Significant psychiatric or behavioral problems are normally present, although the IQ is not necessarily related to an underlying psychiatric disorder. A person with intellectual disability may need pharmacological or behavioral treatment if he is diagnosed with:

• Major depressive disorder
• Bipolar disorder
• Obsessive-compulsive disorder
• Schizophrenia
• Posttraumatic stress disorder
• Anxiety disorder

Treatment for this type of condition needs to be based on the specific needs of the individual; for example, a patient with epilepsy may react to certain medication very differently than someone without, so it’s important to keep the treatment as specific as possible. It can be more difficult to diagnose behavior or psychological conditions as the intellectual disability becomes more severe, however.

What Kind of Behavior Problems Are Treated?

Behavior problems in an individual with intellectual disability might be treated with medication or behavior therapy. If your family member has an intellectual disability and has any of these behaviors, treatment may be needed:

• Self-injury
• Physical aggression
• Destruction of property
• Hyperactivity
• Impulsivity
• Excessive dependency
• Sexually aggressive behavior

Other behaviors may also be treatable, which is why it is important to speak with a doctor or medical staff about a diagnosis.

How Will I Be Assessed?

If someone in your family has intellectual disability, that person will be assessed by a doctor. Functional behaviors will be assessed. This includes an interview with the family and caregivers, a direct observation of the behavior, and an assessment of the behavior on a rating scale. This helps the medical provider decide the best course of treatment. Once a treatment plan is in place, an ongoing assessment will be completed. This will include repeated observation of the behaviors and will require the doctor to place the behaviors on a rating scale again at different times. A medical history will be taken, and a physical exam is always given. People with mild or moderate intellectual disability will be more likely to receive a standard psychiatric interview for diagnosis, but even severe cases can be treated. You or a caregiver must give informed consent to have these tests and evaluations completed. If the individual with intellectual disability is able, he or she will sign off the tests. If not, it will be up to the legally authorized representative.

What Will a Doctor Look For?

For those with intellectual disability who are suffering from psychological or behavioral problems, doctors will start by looking for stressors in the environment. This could be the cause of worsening symptoms or things that could trigger symptoms. Some things to watch for include:

• The loss of a parent or friend
• Romantic breakups
• Being fired or losing a job
• Excessive noise
• School or work stress
• A lack of stimulation
• A lack of support from friends or family members
• Neglect
• Physical or sexual abuse
• Illness
• Sensory defects
• Seizures
• Trouble communicating
• A change of location

All of these things may increase the likelihood of increased behavioral issues.

What Is Psychosocial Treatment?

Psychosocial treatment is a multidisciplinary team approach. This means that you will be a part of your family member’s treatment, as the cooperation of the family and the patient is very important. The care will need to be continuous, and the environment will need to meet the needs of the individual with the behavioral or psychological problems. The family will need to provide timely access to care, to reduce psychosocial stress, and to increase support. The residence will need to meet the functional level of the patient, and the environment should be as nonrestrictive as possible.

Families can change the environment of the patient, which can help. For example, changing activities to make them easier or changing the physical environment can reduce some behavior issues. The family needs to discuss ways to manage the behavioral or psychological condition. Social and communication skills training is normally part of this process. Reinforcement procedures can help interrupt problem behaviors and reinforce positive behaviors.

How Can I Deal with Behavioral Issues?

Some problems can be helped with simple home strategies. For those with trouble sleeping, a regular bedtime routine can help. Restricting caffeine, promoting exercise, and avoiding hunger at bedtime may make it easier to sleep. For those with weight gain issues, making sure to watch signs of weight gain carefully when taking new medications is important. Structured meals, eating the right foods, and providing and encouraging fun exercises are important as well.

Will Medication Be Prescribed?

Medication is most likely to be prescribed when the presence of an identifiable diagnosis is possible. If that is not possible, treatment should focus on the specific behavioral problems, which may or may not be controlled with the use of medication. Individuals with intellectual disability who take medications will need to be monitored to prevent drug interactions, as they may end up on more medications than the general population. Some strategies for medication delivery include:

• Keeping the medication regiment as easy as possible. This could mean once-a-day pills or extended-release pills.
• Start will smaller amounts of medications
• Avoid drug changes unless they are necessary

Medication will likely be provided if an individual is diagnosed with:

• Schizophrenia
• Bipolar disorder, manic or depressed
• Major depressive disorder
• Psychotic disorder
• Obsessive-compulsive disorder
• ADHD
• Panic disorder

Medication may also be recommended for those who have symptoms that interfere with their ability to interact or those who pose a physical risk to others due to aggression.

For more on the topic of Psychiatric and Behavioral Problems, we’ve included the following expert consensus documents as reference materials:

• Psychiatric and Behavioral Problems in MR: An Update.

View Resources

• WebMD – Intellectual disability information
• NCBI – Co-morbidity of psychiatric disorder and intellectual disabilities
• Connecticut Social Services – Americans with disabilities act
• Pubmed – Assessing mental health problems in people with intellectual disabilities
• SAMHSA – Myths and facts about mental health
• NIHPA – Bases of mental disorders