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intellectual disability
TERHI KOSKENTAUSTA, MATTI IIVANAINEN, FREDRIK ALMQVIST
126
consist of seizures, self-injurious behaviours, and sensory and motor impairments. Moreover, speci c aetiologies, such as foetal alcohol, fragile X, Williams,
Prader-Willi, Smith-Magenis, Down and 5p-syndromes,
have been linked with certain behavioural and psychiatric problems.
Estimates about the prevalence of psychiatric disorders among adults with intellectual disability are highly
variable, ranging from about 10% to 70% (2, 3). The
lowest rates have generally been obtained in large population surveys of case les, whereas higher rates have
been reported in surveys in which the psychiatric diagnosis has been identi ed using behaviour rating scales
or structured interviews (3). The prevalence of psychiatric disorders among children and adolescents with
intellectual disability has also varied between 10% and
60% (4 12).
Types of psychiatric disorders have been investigated
in a few studies. Koller et al. (7) found that 29% of
children with intellectual disability had emotional disturbance, 12% hyperactive behaviour, 33% aggressive
conduct disorder and 27% antisocial behaviour. Gillberg et al. (6) reported the following frequencies of
psychiatric disorders in children with mild (IQ 50 70)
versus severe (IQ B 50) mental retardation: depressive
syndrome: 4% vs. 1.5%, emotional disorder: 10% vs.
4.5%, conduct disorder: 12% vs. 4.5%, psychosomatic
disorder: 4% vs. 3%, hyperactive disorder: 11% vs. 0%,
2002 Taylor & Francis
PSYCHIATRIC
DISORDERS IN CHILDREN
127
T. KOSKENTAUSTA
ET AL .
Psychiatrically disturbed
children (n 51)
59
45
104
57
43
100
33
18
51
65
35
100
92
63
155
59
41
100
13
10
12
14
13
24
12
6
104
13
10
12
13
13
23
12
6
102*
4
4
3
8
10
6
11
5
51
8
8
6
16
20
12
22
10
102*
17
14
15
22
23
30
23
11
155
11
9
10
14
15
19
15
7
100
94
5
5
104
90
5
5
100
47
3
1
51
92
6
2
100
141
8
6
155
91
5
4
100
63
15
11
15
104
61
14
11
14
100
24
15
7
5
51
47
29
14
10
100
87
30
18
20
155
56
19
12
13
100
68
36
104
65
35
100
32
19
51
63
37
100
100
55
155
65
35
100
Results
128
PSYCHIATRIC
DISORDERS IN CHILDREN
Table 2. Number of children with psychiatric diagnoses in case les (DSM-III R) and with new ICD-10 diagnoses based on
re-examination of les.
Diagnosis based on re-examination of the case le
F331
F502
F843
F904
F91 5
F936
F997
Total
16
16
8
1
6
2
34
51
8
1
1
1
1
1
11
20
6
1
3
10
1
1
4
1
1
2
Hyperkinetic disorders.
Conduct disorders.
Intellectual
disability
Mild
Moderate
Severe
Profound
Total no.
of children
(n )
87
30
18
20
Children with
psychiatric
disorder (n )
24
15
7
5
%
28
50
39
25
Discussion
129
T. KOSKENTAUSTA
ET AL .
130
of epilepsy has improved, which likely has had a positive effect on the mental health of children with
epilepsy and may explain the present nding.
Some limitations are present in the generalizability of
results. Although our study population is fairly representative of the population in Finland, it does not fully
represent the largest urban populations which, however,
comprise a relatively small portion of the Finnish population overall. The Paajarvi Rehabilitation Centre provides services for intellectually disabled persons residing
in its catchment area, and the patient register certainly
includes most of the intellectually disabled people living
in the area. In addition, intellectually disabled children
belonging to the basic sample were located in special
schools and hospitals used by the population. Assessment of psychiatric disorders was based on diagnoses
made by an experienced clinician according to the case
les. As the case les did not include all data needed for
reliable diagnoses, the frequencies found in this study
are still underestimations.
Knowledge about neuropsychiatric disorders has recently increased greatly. This must be kept in mind
when comparing distributions of psychiatric disorders
in different studies carried out at different times. The
comparability of studies is expected to gradually improve as structured assessment methods become
available.
In conclusion, we suggest that at least one-third of
children with intellectual disability have a psychiatric
disorder. Although all symptoms and signs are present,
many of these disorders fail to be diagnosed. This may
be due to inadequate diagnostic skills of professionals
working with intellectually disabled persons, and diagnostic overshadowing. Therefore, doctors working with
children with intellectual disability need further
education.
Most intellectually disabled children live with their
families and many of them are integrated in normal
schools. Emotional and behavioural problems should
be identi ed and treated as early in childhood as possible, because effective treatment and rehabilitation obviously promotes the individual development of the
disabled child, enhances the management of the medical
and intellectual disorder and supports the adoption of a
better social life.
Acknowledgements This study was supported by the Paajarvi Rehabilitation Centre, Lammi, Finland, the Research Foundation for
Child Psychiatry, Finland, and the Rinnekoti Research Foundation,
Espoo, Finland.
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DISORDERS IN CHILDREN
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