Psychiatric disorders are 2 to 3 times more common in people with intellectual disability. Estimates of prevalence vary widely. In children and adolescents with developmental disability, the prevalence of comorbid psychiatric disorders is very high (ranging from 30 to 50%) compared to the general population.
Biological, psychological and social factors increase the risk or complexity of psychiatric illness in people with developmental disability of all ages; see Risk factors for psychiatric disorders in people with developmental disability . Similar factors are also found in the general population, but are often overlooked or exacerbated in people with developmental disability, due to communication and cognitive difficulties. Where modifiable, these risk factors should be addressed.
Children and adolescents with developmental disability have additional predisposing factors for psychiatric disorders that must be considered during assessment and addressed by management.
Table 1. Risk factors for psychiatric disorders in people with developmental disability
- underlying structural brain abnormality or injury (eg fetal alcohol spectrum disorder)
- genetic disorders with a behavioural phenotype (eg fragile X syndrome and social anxiety, 22q11.2 deletion [velocardiofacial] syndrome and psychosis)
- family history of psychiatric disorder
- comorbid medical conditions (eg epilepsy, hypothyroidism)
- concurrent medications (eg mood stabilisers, psychotropics) or recreational drug use
- intellectual disability or impaired cognitive skills
- autism spectrum disorder
- communication impairment
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- lack of control and agency over life circumstances
- vulnerability to repeated losses or separations
- impaired acquisition of social, recreational, coping and interpersonal skills
- low self-esteem from perceived failure, rejection from others and physical differences
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- high incidence of physical, sexual and emotional abuse and neglect
- lack of social support, lack of contact with friends, family and intimate partners
- adverse life events and circumstances, low socioeconomic status (eg homelessness, poverty)
- rejection, stigmatisation, discrimination
- conflict at home, disability group home, workplace or day placement
- reduced access to education and employment opportunities
- carer stress
- sensory hyper- or hypostimulation
- boredom
- sleep problems
- lack of exercise, poor diet
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