Kaplan + Sadock's Synopsis of Psychiatry, 11e

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Chapter 31: Child Psychiatry

mandates were created by the passage of Public Law 94–142, the Education for all Handicapped Children Act of 1975, and expanded with the addition of the Individuals with Disabilities Act (IDEA) of 1990. Through these laws, public schools must develop and provide an individualized educational program for each student with intellectual disability, determined at a meet- ing designated as the Individualized Education Plan (IEP) with school personnel and the family. The education must be pro- vided for the child in the “least restrictive environment” that will allow the child to learn. Supports A wide variety of organized groups and services are avail- able for children with intellectual disability and their families. These include short-term respite care, which allow families a break and is generally set up by state agencies. Other programs include the Special Olympics, which allows children with intellectual disability to participate in team sports and in sports competitions. Many organizations also exist for families who wish to connect with others who have children with intellectual disability. R eferences American Association on Intellectual and Developmental Disabilities. Overview of intellectual disability: Definition, classifications and systems of support. 2010. Arnold LE, Farmer C, Kraemer HC, Davies M, Witwer A, Chuang S, DiSil- vestro R, McDougle CJ, McCracken J, Vitello B, Aman M, Scahill L, Posey DJ, Swiezy NB. Moderators, mediators, and other predictors of risperidone response in children with autistic disorder and irritability. J Child Adolesc Psy- chopharmacol. 2010;20:83–93,196–1205. Boulet S, Boyle C, Schieve L. Trends in health care utilization and health impact of developmental disabilities, 1997–2005. Arch Pediatr Adolesc Med. 2009;163:19–26. Correia Filho AG, Bodanase R, Silva TL, Alvarez JP, Aman M, Rohde LA. Com- parison of risperidone and methylphenidate for reducing ADHD symptoms in children and adolescents with moderate intellectual disability. J Am Acad Child Adolesc Psychiatry. 2005;44:748. Ellison JW, Rosengeld JA, Shaffer LG. Genetic basis of intellectual disability. Annu Rev Med. 2013 Fowler MG, Gable AR, Lampe MA, Etima M Owor M. Perinatal HIV and its pre- vention: Progress toward an HIV-free generation. Clin Perinatol. 2010;37:699– 719. Gothelf D, Furfaro JA, Penniman LC, Glover GH, Reiss AL. The contribution of novel brain imaging techniques to understanding the neurobiology of intel- lectual disability and developmental disabilities. Ment Retard Dev Disabil Res Rev. 2005;11:331. Ismail S, Buckley S, Budacki R, Jabbar A, Gallicano GI. Screening, diagnosing and prevention of fetal alcohol syndrome: Is this syndrome treatable? Dev Neu- rosci. 2010;32:91–100. Obi O, Braun KVN, Baio J, Drews-Botsch C, Devine O,Yeargin-Allsopp M. Effect of incorporating adaptive functioning scores on the prevalence of intellectual disability. Am J Intellect Dev Disabil. 2011;116:360–370. Reyes M, Croonenberghs J, Augustybs I, Eerdekens M. Long-term use of ris- peridone in children with disruptive behavior disorders and subaverage intel- ligence: Efficacy, safety, and tolerability. J Child Adolesce Psychopharmacol. 2006;16:60–27. Rowles BM, Findling RL. Review of pharmacotherapy options for the treatment of attention-deficit/hyperactivity disorder (ADHD) and ADHD-like symptoms in children and adolescents with developmental disorders. Dev Disabil Res Rev. 2010;16:273–282. Stuart H. United Nations convention on the rights of persons with disabilities: A roadmap for change. Curr Opin Psychiatry. 2012;25:365–369. Sturgeon X, Le T, Ahmed MM, Gardiner KJ. Pathways to cognitive deficits in Down syndrome. Prog Brain Res. 2012;197:73–100. United Nations General Assembly. Convention on the Rights of Persons with Dis- abilities (CRPD). Geneva: United Nations; December 13, 2006. Wijetunge LS, Chatterji S, Wyllie DJ, Kind PC. Fragile X syndrome: From targets to treatments. Neuropharmacology. 2013;68:83–96. Willen EJ. Neurocognitive outcomes in pediatric HIV. Ment Retard Dev Disabil Res Rev. 2006;12:223–228.

Atomoxetine has been shown to be efficacious in children diagnosed with ASD and prominent ADHD features, and it is used clinically in the intellectually disabled population. Depressive Disorders.  The identification of depressive dis- orders among individuals with intellectual disability requires careful evaluation, since it may be inadvertently overlooked when behavioral problems are prominent. There have been anecdotal reports of disinhibition in response to SSRIs (e.g., fluoxetine [Prozac], paroxetine [Paxil], and sertraline [Zoloft]) in intellectually disabled individuals with ASD. Given the rela- tive safety of SSRI antidepressants, a trial is indicated when a depressive disorder is diagnosed in a child or adolescent with intellectual disability. Stereotypical Motor Movements.  Antipsychotic medica- tions—historically, haloperidol (Haldol) and chlorpromazine, and currently, the atypical antipsychotics—are used in the treatment of repetitive self-stimulatory behaviors in children with intellectual disability when these behaviors are either harmful to the child or disruptive. Anecdotal reports indicate that these agents may diminish self-stimulatory behaviors; however, there is no improvement seen in adaptive behavior. Obsessive-compulsive symptoms often overlap with the repet- itive stereotypical behaviors seen in children and adolescents with intellectual disability, particularly in those with comor- bid ASD. SSRIs such as fluoxetine, fluvoxamine (Luvox), paroxetine, and sertraline have been shown to have efficacy in treating obsessive-compulsive symptoms in children and adolescents and may have some efficacy for stereotyped motor movements. Explosive Rage Behavior.  Antipsychotic medications, particu- larly risperidone, have been shown to be efficacious for the treatment of explosive rage. Systematic controlled studies are indicated to confirm the efficacy of these drugs in the treatment of rage outbursts. b -Adrenergic receptor antagonists (beta- blockers), such as propranolol (Inderal), have been reportedly anecdotally to result in fewer explosive rages in some children with intellectual disability and ASD. Services and Support for Children with Intellectual Disability Early Intervention Early intervention programs serve individuals for the first 3 years of life. Such services are generally provided by the state and begin with a specialist visiting the home for several hours per week. Since the passage of Public Law 99–447, the Educa- tion of the Handicapped Amendments of 1986, early interven- tion services for the entire family are emphasized. Agencies are required to develop an Individualized Family Service Plan (IFSP) for each family, which identifies specific interventions to best help the family and child. School From ages 3 to 21 years, school is responsible by law to pro- vide appropriate educational services to children and adoles- cents with intellectual disability in the United States. These