Text adapted from "Intellectual and developmental disabilties" in Psychiatry in primary care by Yona Lunsky and Johanna Lake, (CAMH, 2019).
The primary care IDD guidelines (Sullivan et al., 2018) make the following recommendations for helping to prevent mental health problems and for making a psychiatric diagnosis:
- People with IDD have increased vulnerability to mental stress compared with people in the general population. Screen for antecedents, life events and triggers of psychiatric distress. Explore the importance of the event for your patient and obtain collateral history.
- Be proactive. Work with your patient, caregivers and appropriate services to address predictable developmental challenges and stressors and to ensure that supports will be in place, such as when high school ends, when a staff member leaves or when a sibling moves away from home.
- Offer or facilitate supportive counselling before developmental challenges and life stressors occur.
- Screen for psychiatric disorders, which includes looking for changes from baseline in mental state and behaviour.
- Seek interprofessional assessment from specialists in psychiatry, psychology or speech-language pathology, preferably with expertise in IDD. Review previous psychiatric diagnoses, and consider using self-report and informant questionnaires developed for people with IDD.
- Consult information on behavioural phenotypes associated with specific syndromes—that is, syndromes with a chromosomal or genetic etiology (e.g., autism spectrum disorder, fetal alcohol spectrum disorder, Williams syndrome).
- Explore for trauma. A patient’s history of trauma may not be known to new care providers. Watch for signs of posttraumatic stress disorder, such as re-experiencing (e.g., psychotic presentations and behavioural enactments; avoidance, which might be interpreted as noncompliance; increased arousal, which can present as irritability).
- Work with an interprofessional team to help you to clarify diagnoses in patients with limited or atypical use of language.
- Screen for hearing and vision impairments.
- Work with caregivers to ensure communication and inclusion and to prevent social isolation.