Additional considerations in children and adolescents

Risk factors for psychiatric disorders in children and adolescents with developmental disability are outlined in Risk factors for psychiatric disorders in people with developmental disability ; however, children are more vulnerable to their effects as these factors can significantly affect neurodevelopment from an early age (by age 3 in those with intellectual disability). Risk factors and vulnerability to their effects may be especially heightened during adolescence, due to psychosexual changes, transition to adult care and social exclusion. Lack of access to specialist mental health services for children and young people with developmental disability, and lack of support for families, can further exacerbate problems.

Low socioeconomic conditions increase the risk of developmental trauma in children with developmental disability, due to cumulative exposure to adverse childhood events. Children and adolescents with intellectual disability are more sensitive to the effects of cumulative stress from adverse childhood events than the neurotypical population, which increases the risk for developing psychiatric disorders.

Attachment-related trauma is significant in children and adolescents with developmental disability; it can result from a disrupted child–caregiver relationship (eg due to parental grieving, guilt, fatigue) and precipitate childhood psychiatric disorder. In turn, the mental wellbeing of parents is highly impacted by the severity of the co-occurring mental disorder in the young person.

Common psychiatric disorders in children and adolescents with developmental disability include:

• anxiety disorders
  • generalised anxiety
  • phobias
  • obsessive compulsive disorder (OCD)
  • separation anxiety and school refusal
• attention deficit hyperactivity disorder (ADHD)
• conduct disorders
• major depression.

For general advice on psychiatric disorders in children and adolescents, see the Psychotropic guidelines.

Comorbid psychiatric disorders in children and adolescents with developmental disability are highly correlated with autism spectrum disorder, and include childhood psychosis and attention deficit hyperactivity disorder (ADHD).

Common comorbidities, overlapping symptoms and complex contributing factors for psychiatric disorders in children and adolescents require a systems approach to assessment and management that takes into consideration child-specific factors, family dynamics and the wider social systems around the child.

Behaviours of concern often occur concurrently with psychiatric symptoms and other neurodevelopmental features—they may indicate or exacerbate an evolving psychiatric disorder. Positive behaviour support is an important component of risk minimisation and management; see Challenging behaviour in people with developmental disability.