Deinstitutionalization of young people with intellectual disability means that
they are now cared for by families and served by community-based professionals.
Normalization, which has been the guiding philosophy for this re-integration,
has challenged child psychiatry to accept its responsibility for the mental
health of this special needs group. It is argued that this group, with its
special mental health needs, has had an influence on the conceptual framework of
child psychiatry, particularly our understanding of development. This article
examines the influence of the psychiatry of intellectual disability on child
psychiatry and the influence of child psychiatry on the understanding of the
mental health needs of those with intellectual disability. In particular, the
management of young people with intellectual disability has required child
psychiatry to expand its understanding of a biopsychosocial approach. Some of
the resulting changes and challenges are presented to illustrate the benefits
for both child psychiatry and the psychiatry of intellectual disability. The
interaction of different conceptual biases has led to a new and broader
conceptual spectrum of developmental neuropsychiatry. Developmental
neuropsychiatry recognizes the need to integrate social science and preventative
strategies at one end of the spectrum, with the genetics, molecular biology of
human behaviour and targeted pharmacology at the other, and consider the
developmental and interactive nature of such models. This article argues that
this emerging, dynamic and broader conceptual framework of developmental
neuropsychiatry enhances our understanding of the child mental health of all
children. The article looks at some of the implications for assessment,
diagnosis and treatment. As mental health needs become a greater public health
priority, the advances in basic sciences will reinvigorate this medical
specialty and training programmes will need to reflect these.
Ainsworth, M.
(1973). The development of infant-mother attachment. In
B.M. Caldwell &
H.N. Ricciuti
(Eds.), Review of child development research (Vol. 3, pp.
1-93).
Chicago: University of Chicago Press
.
2.
American Psychiatric Association
. (1994). Diagnostic and statistical manual of mental
disorders (DSM-IV).
Washington, DC: American Psychiatric Press
.
3.
Arranz, M.
,
Munro, J.
,
Birkett, A.
,
Bolonna, D.
,
Mancama, D.
,
Sodhi, M.
,
Lesch, K.
,
Meyer, J.
,
Sham, P.
,
Collier, D.
,
Murray, R.
, &
Kerwin, R.
(2000).
Pharmacogenetic prediction of clozapine response
. Lancet, 355,
1615-1616
.
4.
Azrin, N.
, &
Fox, R.
(1971).
A rapid method of toilet training the institutionalised retarded
. Journal of Applied Behavioural Analysis, 4,
89-96
.
5.
Bailey, D.
,
Skinner, D.
,
Correa, V.
,
Arcia, E.
,
Reyes-Blanes, M.
,
Rodriquez, P.
,
Vazquez-Montilla, E.
, &
Skinner, M.
(1999).
Needs and supports reported by Latino families of young people with
developmental disabilities
. American Journal on Mental Retardation, 104,
437-451
.
6.
Baxter, L.
,
Achermann, R.
,
Swerdlow, N.
,
Brody, A.
,
Saxena, S.
,
Schwartz, J.
,
Gregortich, J.
,
Stoessel, P.
, &
Phelps, M.
(2000). Specific brain system mediation of obsessive
compulsive-disorder responsive to either medication or behaviour
therapy. In
W. Goodman
(Ed.), Obsessive compulsive disorder: Contemporary issues in treatment.
Personality and clinical psychology series.
Mahwah, NJ: Erlbaum
.
7.
Bicknell, J.
(1984).
The psychopathology of handicap
. Annual Progress in Child Psychiatry & Child
Development,
346-363
.
8.
Bicknell, J.
(1993).
The inner worlds of handicapped children: ‘He is not a burden. He
is my brother.’Educational & Child Psychology, 10(1),
28-35
.
9.
Blacher, J.
, &
Meyers, B.
(1983).
A review of attachment formation and disorder of handicapped children
. American Journal of Deficiency, 87,
359-371
.
10.
Black, I.D.
(2001). The dying of Enoch Wallace: Life, death and the
changing brain.
New York: McGraw
.
11.
Bolton, P.
, &
Griffiths, P.
(1997).
Association of tuberous sclerosis of temporal lobes with autism and
atypical autism
. Lancet, 349(9049),
392-395
.
12.
Brown, F.
(1991).
Creating daily scheduling, a non-intrusive approach to challenging
behaviour in community residences
. Journal of Association of Persons with Severe Handicaps,
16,
75-84
.
13.
Burt, C.
(1921). Mental and scholastic tests.
London: London County Council
.
14.
Cameron, R.
, &
Meichenbaum, D.
(1980).
Cognition and behaviour change. Australian &New Zealand Journal of Psychiatry, 14,
121-125
.
15.
Carr, E.G.
, &
Durant, V.M.
(1985).
Reducing behaviour problems through functional communication training
. Journal of Applied Behavioural Analysis, 18,
111-126
.
16.
Cashden, A.
, &
Jeffree, D.
(1966).
The influence of home background on the development of severely subnormal children
. British Journal of Medical Psychology, 39,
313-318
.
17.
Cautcha, J.R.
, &
Groden, J.
(1978). Relaxation: A comprehensive manual for adults and
children with special needs.
Champaign IL: Research Press
.
18.
Cicchetti, D.
(1984).
The emergence of developmental psychopathology
. Child Development, 55,
1-7
.
19.
Coffey, C.E.
, &
Brumback, R.A.
(1998). Textbook of paediatric neuropsychiatry.
Washington, DC: American Psychiatric Press
.
20.
Constantino, J.N.
, &
Todd, R.D.
(2000).
Genetic structure of reciprocal social behaviour
. American Journal of Psychiatry, 157,
2043-2044
.
21.
Constantino, J.N.
,
Przybeck, T.
,
Friesen, D.
, &
Todd, R.D.
(2000).
Reciprocal social behaviour in children with and without pervasive
developmental disorders
. Journal of Developmental & Behavioural Pediatrics,
21(1),
2-11
.
22.
Craft, A.
(1994).
Issues in sex education for people with learning disabilities in the United Kingdom
. Sex and marital Therapy, 9,
145-157
.
23.
Crome, L.
, &
Stern, J.
(1972). Pathology of mental retardation.
Edinburgh: Churchill Livingstone
.
24.
Daly, B.
,
Addington, J.
,
Kerfoot, S.
, &
Sigston, A.
(1985). Portage: The importance of parents.
Windsor, UK: NFER-Nelson
.
25.
Davis, H.
(1985).
Counselling parents of children who have intellectual disabilities
. Early Child Development & Care,
22(1),
19-35
.
26.
Davis, H.
,
Day, C.
,
Cox, A.
, &
Cutler, L.
(2000).
Child and adolescent mental health needs assessment and service
implications in an inner city area
. Clinical Child Psychology and Psychiatry, 5,
169-188
.
27.
Dawkins, R.
(1996). Climbing Mount Improbable.
London: Penguin
.
28.
Department of Health and Social Security
. (1981). HC(81)13. Health services management: The membership
of District Health Authorities.
Heywood: Department of Health and Social Security
.
29.
Dossetor, D.
(1997)
The hit and miss of magic bullets: A guide to psychotropic medication for
young people with intellectual handicap
. Clinical Child Psychology and Psychiatry, 2,
65-94
.
30.
Dossetor, D.
(2004).
The evolution of the ‘photon catcher’: Implications for
social development and autism
. Clinical Child Psychology and Psychiatry, 9,
443-451
.
31.
Dossetor, D.R.
(1991). A study of the dependency needs of adolescents with
developmental retardation: An evaluation of short-term care usage, expressed
emotion in the primary carer, and the contribution of community services.
Doctorate of Medicine, University of Cambridge, UK
.
32.
Dossetor, D.R.
(2001).
Parenting a child with intellectual disability: The chosen and those that choose
. The Clinician, 1(1),
61-63
. Available: www.camhsnet.org
33.
Dossetor, D.R.
,
Nicol, A.R.
, &
Stretch, D.D.
(1993).
Hostel-based respite care for adolescents with developmental retardation:
The need for normalised resources
. Journal of Child Psychology and Psychiatry, 34,
391-412
.
34.
Edgerton, R.
(1967). The cloak of competence: Stigma in the lives of the
mentally retarded.
Berkeley: University of California Press
.
35.
Einfeld, S.
, &
Tonge, B.
(1992). Manual for the Developmental Behaviour Checklist
(DBC).
Sydney: University of NSW, School of Psychiatry
.
36.
Einfeld, S.
, &
Tonge, B.
(1999).
Observations on the use of the ICD-10 guide for mental retardation
. Journal of Intellectual Disability Research, 43,
408-412
.
37.
Epstein, N.
, &
Bishop, D.
(1981). Problem centred systems therapy of the
family. In
A. Gurman
&
D. Kniskern
(Eds.), Handbook of family therapy (pp.
444-482).
New York: Brunner/Mazel
.
38.
Ernst, M.
, &
Rumsey, J.
(2000). Functional neuroimaging in child psychiatry.
Cambridge: Cambridge University Press
.
39.
Ferris, C.
, &
Friso, T.
(1996). Understanding aggressive behaviour in
children. Annals of the New York Academy of Sciences, 784.
40.
Fransella, F.
(1995). Key figures in counselling and psychotherapy.
London: Sage
.
41.
Frish, G.
,
Simensen, R.
,
Tarleton, J.
,
Chalifoux, M.
,
Holden, J.J.
,
Carpenter, N.
,
Howard-Peebles, P.
, &
Maddelena, A.
(1996).
Longitudinal study of cognitive abilities and adaptive behavior levels in
fragile X males: A prospective multicenter analysis
. American Journal of Medical Genetics, 64,
356-361
.
42.
Frison, S.
,
Wallander, J.
, &
Browne, D.
(1998).
Cultural factors enhancing resilience and protecting against maladjustment
in African American adolescents with mild mental retardation
. American Journal on Mental Retardation, 102,
613-626
.
43.
Gazzaniga, M.S.
,
Ivry, R.B.
&
Margun, G.R.
(1998). Cognitive neuroscience - The biology of the
mind.
London: Norton
.
44.
Gilberg, C.
(1995). Clinical child neuropsychiatry.
Melbourne: Cambridge University Press
.
45.
Gilberg, I.
, &
Gilberg, C.
(1989).
Asperger’s syndrome: Some epidemiological considerations
. Journal of Child Psychology and Psychiatry, 30,
631-638
.
46.
Goodman, R.
(1997).
Who needs child psychiatrists?Child Psychology and Psychiatry Review, 2(1),
15-19
.
47.
Happe, F.
(1994). Autism: An introduction to psychological
theory.
London: UCL Press
.
48.
Harris, J.
(1995). Developmental neuropsychiatry.
Oxford: Oxford University Press
.
49.
Hay, D.
,
Pawlby, S.
,
Sharp, D.
,
Asten, P.
,
Mills, A.
, &
Kumar, R.
(2001).
Intellectual problems shown by 11-year-old children whose mothers had
postnatal depression
. Journal of Child Psychology and Psychiatry and Allied
Disciplines, 42,
871-889
.
50.
Hoare, P.
(1991).
Psychosocial adjustment of children with chronic epilepsy and their families
. Developmental Medicine and Child Neurology, 34,
201-215
.
51.
Hodapp, R.
,
Burack, R.
, &
Zigler, E.
(1990). Issues in the developmental approach to mental
retardation.
Cambridge: Cambridge University Press
.
52.
Holland, A.
, &
Oliver, C.
(1995).
Down’s syndrome and the links with Alzheimer’s disease
. Journal of Neurology, Neurosurgery, and Psychiatry,
59,
111-114
.
53.
Holland, A.
, &
Wong, J.
(1999).
Genetically determined obesity in Prader-Willi syndrome: The ethics and
legality of treatment
. Journal of Medical Ethics, 25,
230-236
.
54.
Howlin, P.
(1998). Children with autism and Asperger’s
syndrome. A guide for practitioners and carers.
Chichester: Wiley
.
55.
Iwata, B.
,
Pace, G.
,
Dorsey, M.
,
Zarcone, J.
,
Vollmer, T.
,
Smith, R.
,
Rodgers, T.
,
Lerman, D.
,
Shore, B.
, &
Mazalesk, J.
(1994).
The functions of self-injurious behaviour. An experimental-epidemiological analysis
. Journal of Applied Behaviour Analysis, 27,
215-240
.
56.
Kempermann, G.
, &
Gage, F.
(1999).
New cells for the adult brain
. Scientific American, 280(5),
38-57
.
57.
Keshavan, M.
, &
Murray, R.
(1997). Neurodevelopment and adult psychopathology.
Cambridge: Cambridge University Press
.
58.
Kumar, R.
(1994).
Postnatal mental illness: A transcultural perspective
. Social Psychiatry and Psychiatric Epidemiology,
29,
250-264
.
59.
Kutcher, S.
(1997). Child and adolescent psychopharmacology.
Philadelphia: W.B. Saunders
.
60.
LaVigna, G.W.
, &
Donnellan, A.
(1986). Alternatives to punishment: Solving behaviour
problems with non-aversive strategies.
New York: Irvington
.
61.
Le Doux, J.
(1999). The emotional brain - The mysterious underpinnings of
emotional life.
London: Orion
.
62.
Lewis, M.
(1996). Child and adolescent psychiatry: A comprehensive
textbook (2nd ed.).
Baltimore: Williams and Wilkins
.
63.
Lord, C.
,
Rutter, M.
, &
Le Couteur, A.
(1994).
Autism Diagnostic Interview-Revised: A revised version of a diagnostic
interview for caregivers of individuals with possible pervasive
developmental disorders
. Journal of Autism and Developmental Disorders, 24,
659-685
.
64.
Lord High Chancellor
. (1999). Making decisions. Government proposal for making
decisions on behalf of ‘mentally incapacitated
adults’. A report issued in the light of responses to the
consultation document ‘Who decides?’ (Cm 4465).
London: Stationery Office
. Available: http://www.apt.repsych.org/cgi/content/full/7/5/381%23BIBL
65.
Lovaas, I.
(1966). A programme for the establishment of speech I
psychotic children. In
J. Wing
(Ed.), Early infantile autism: Clinical educational and social
aspects.
Oxford: Pergamon Press
.
66.
Marteau, T.
, &
Lerman, C.
(2001).
Genetic risk and behavioural change
. British Medical Journal, 322(7293),
1056-1059
.
67.
Marteau, T.M.
(2001).
Genotype or genohype?Psychologist, 14(3),
148-149
.
68.
Maurice, C.
(1996). Behavioural intervention for young children with
autism: A manual for parents and professionals.
Austin, TX: Pro-ed
.
69.
McGuffin, P.
,
Owen, M.
, O’
Donovan, M.
,
Thapar, A.
, &
Gottesman, I.
(1994). Seminars in psychiatric genetics.
London: Royal College of Psychiatrists
.
70.
Moore, J.
, &
Farmer, A.
(2002). Personality and illness. In
M. Rutter
&
E. Taylor
(Eds.), Child and adolescent psychiatry (4th ed., chapter
42).
Oxford: Blackwell Scientific
.
71.
Murphy, K.
,
Jones, L.
, &
Owen, M.
(1999).
High rates of schizophrenia in adults with velo-cardio-facial syndrome
. Archives of General Psychiatry, 56,
940-945
.
72.
Newman, D.
, &
Beail, N.
(2002).
Monitoring change in psychotherapy with people with intellectual
disabilities: The application of the assimilation of problematic behaviour
experiences scale
. Journal of Applied Research in Intellectual Disabilities,
15,
48-60
.
73.
Nunn, K.P.
(1996).
Personal hopefulness: A conceptual review of the relevance of the perceived
future to psychiatry
. British Journal of Medical Psychology, 69,
227-245
.
O’Brien, G.
, &
Yule, W.
(1995). Behavioural phenotypes.
San Diego: MacKeith Press
.
76.
Paykel, E.
, &
Jenkins, R.
(1994). Prevention in psychiatry.
London: Royal College of Psychiatrists
.
77.
Prior, M.
,
Eisenmajer, R.
,
Leekam, S.
,
Wing, L.
,
Gould, J.
,
Ong, B.
, &
Dowe, D.
(1998).
Are there subgroups within the autistic spectrum? A cluster analysis of a
group of children with autistic disorders
. Journal of Child Psychology and Psychiatry, 39,
893-902
.
78.
Raphael, B.
(Ed.). (1993). Scope for prevention in mental health.
Canberra: NHMRC
.
79.
Reiss, D.
, &
Neiderhiser, J.
(2000).
The interplay of genetic influences and social processes in developmental
theory: Specific mechanisms are coming into view
. Development & Psychopathology, 12,
357-374
.
80.
Rhodes, P.
(2003).
Behavioural and family systems interventions in developmental disability:
Towards a contemporary and integrative approach
. Journal of Intellectual and Developmental Disability,
28,
51-64
.
81.
Richie, J.
, &
Zappella, M.
(1989).
Holding
. Association of Child Psychology and Psychiatry,
11(1),
3-9
.
82.
Ridley, M.
(1999). The human genome: The autobiography of a species in
23 chapters.
London: Fourth Estate
.
83.
Robertson, J.
,
Tanguay, P.
, L’
Ecuyer, S.
,
Sims, A.
, &
Waltrip, C.
(1999).
Domains of social communication handicap in autism spectrum disorder
. Journal of the American Academy of child and Adolescent
Psychiatry, 38,
738-745
.
84.
Rosenberg, D.
,
Holttum, S.
, &
Gershon, S.
(1994). Textbook of pharmacotherapy for child and adolescent
psychiatric disorders.
New York: Brunner/Mazel
.
85.
Rutter, M.
(1980). Scientific foundations of developmental
psychiatry.
London: Heinemann
.
86.
Rutter, M.
(Ed.). (1983). Developmental neuropsychiatry.
New York: Guildford Press
.
87.
Rutter, M.
(1997).
Implications of genetic research for child psychiatry
. Canadian Journal of Psychiatry, 42,
569-576
.
88.
Rutter, M.
(1999).
Resilience concepts and findings: Implications for family therapy
. Journal of Family Therapy, 22,
119-144
.
89.
Rutter, M.
,
Graham, P.
, &
Yule, W.
(1970).
A neuropsychiatric study of childhood
. Clinics in Developmental Medicine,
35/36
.
90.
Rutter, M.
, &
Hersov, L.
(1985). Child and adolescent psychiatry: Modern
approaches.
Oxford: Blackwell Scientific
.
91.
Rutter, M.
, &
Rutter, M.
(1992). Developing minds: Challenge and continuity across the
life span.
London: Penguin
.
92.
Rutter, M.
, &
Taylor, E.
(2002). Child and Adolescent Psychiatry (4th
ed.).
Oxford: Blackwell Scientific
.
93.
Schaffer, H.R.
(1971). The growth of sociability.
Harmondsworth: Penguin
.
94.
Schultz, R.T.
,
Gauthier, I.
,
Klin, A.
,
Fulbright, R.K.
,
Anderson, A.W.
,
Volkmar, F.
,
Skudlarski, P.
,
Lacadie, C.
,
Cohen, D.J.
,
Gore, J.C.
(2000).
Abnormal ventral temporal cortical activity during face discrimination
among individuals with autism and Asperger syndrome
. Archives of General Psychiatry, 57,
331-340
.
95.
Sensky, T.
(1985).
Family stigma and physical deformity
. General Hospital Psychiatry, 7,
385-386
.
96.
Sigafoos, J.
(1997).
Review of communication intervention programs for people with developmental disability
. Behaviour Change, 14,
125-138
.
97.
Sinason, V.
(1992). Mental handicap and the human condition: New
approaches from theTavistock.
London: Free Association
.
98.
Slater, M.
, &
Wikler, L.
(1986).
‘Normalized’ family resources for families with a
developmentally disabled child
. Social Work, 31,
385-390
.
99.
Sloper, P.
,
Cunningham, C.
,
Knussen, C.
, &
Turner, S.
(1988). A study of the process of adaptation in a cohort of
children with Down’s syndrome and their families.
Hester Adreian Research Centre, Manchester University, UK
.
100.
Stahl, S.
(1996). Essential psychopharmacology.
Cambridge: Cambridge University Press
.
101.
Stainton, T.
, &
Besser, H.
(1998).
The positive impact of children with an intellectual disability on a family
. Journal of Intellectual Disability, 23,
57-70
.
102.
Stevens, A.
, &
Price, J.
(1996). Evolutionary psychiatry: A new beginning.
London: Routledge
.
103.
Szatmari, P.
,
Bremner, R.
, &
Nagy, J.
(1989).
Asperger’s syndrome: A review of clinical features
. Canadian Journal of Psychiatry, 34,
554-560
.
104.
Thapar, A.
(1996).
Genetic influences on life events in childhood
. Psychological Medicine, 26,
813-820
.
105.
Thapar, A.
,
Holmes, J.
,
Poulton, K.
, &
Harrington, R.
(1999).
Genetic basis of attention deficit hyperactivity disorder
. British Journal of Psychiatry, 174,
105-111
.
106.
Trivier, E.
,
De Cesare, D.
,
Jacquot, S.
,
Pannetier, S.
,
Zackai, E.
,
Young, I.
,
Mandel, J.L.
,
Sassone-Corsi, P.
, &
Hanauer, A.
(1996).
Mutations in the kinase Rsk-2 associated with Coffin-Lowry syndrome
. Nature, 384,
567-570
.
107.
Westley, W.
, &
Epstein, N.
(1960). The silent majority.
San Francisco: Jossey-Bass
.
108.
Whitman, T.
(1990).
Development of self-regulation in persons with mental retardation
. American Journal on Mental Retardation, 94,
373-376
.
109.
Willis, T.W.
,
LaVigna, G.W.
, &
Donnellan, A.M.
(1993). Behaviour assessment guide.
Los Angeles: Institute of Applied Behaviour Analysis
.
110.
Wing, L.
(1981). A schedule for deriving profiles of handicaps in
mentally retarded children. In
B. Cooper
(Ed.), Assessing the handicaps and needs of mentally retarded
children (pp. 133-142).
London: Academic Press
.
111.
Wing, L.
(1991). Closing Darenth Park Hospital for adults with
mental handicaps. In
P. Bebbington
(Ed.), Social psychiatry: Theory, methodology and practice (pp.
367-387).
New Brunswick, NJ: Transaction
.
112.
Wing, L.
(1999). Diagnostic Interview for Social and Communication
Disorders.
London: National Autistic Society
.
113.
Wing, L.
, &
Gould, J.
(1979).
Severe impairments of social interaction and associated abnormalities in
children: Epidemiology and classification
. Journal of Autism and Childhood Schizophrenia, 9,
11-29
.
114.
Winnicott, D.
(1984). The child, the family and the outside world.
London: Penguin
.
115.
Wolfensberger, W.
(1972). Normalisation: The principle of normalisation in
human services.
Toronto: National Institute for Mental Retardation
.
116.
Wong, J.
,
Clare, I.
,
Gunn, M.
, &
Holland, A.
(1999).
Capacity to make health care decisions: Its importance in clinical practice
. Psychological Medicine, 29,
437-446
.
117.
Zigler, E.
(1963). Metatheoretical issues in developmental
psychology. In
M. Marx
(Ed.), Theories in contemporary psychology (p. 344).
New York: Macmillan
.
