Categories: ASD and DD, Adult-focused
By Margaret Walsh, M.A., BCBA
Many individuals with intellectual disabilities (ID) also have co-occurring psychiatric conditions such as Attention Deficit Hyperactivity Disorder (ADHD), major depression, and bipolar disorder. For these men and women, the challenges that accompany ID – limitations in conceptual, social, and practical skills – are compounded.
Fortunately, evidence-based psychiatric care can greatly improve their quality of life.
While some adults with ID may be able to advocate for themselves, many cannot. Therefore, it is often necessary for those of us who care for these individuals to help them obtain the psychiatric services they need.
First, it is a good idea to prepare the person with ID for a visit with a psychiatric professional. Discuss the reasons for the visit in terms the individual can understand, and provide him or her with examples of what may happen during the appointment.
Next, be prepared to provide accurate and concise information to the psychiatrist. It is important to help the psychiatrist understand the person’s history during the initial visit. If the individual with ID has communication and/or behavior deficits that would prevent him or her from reporting this information accurately, it is imperative that someone who knows him or her well attends the appointment. That caregiver should be ready to explain what typical behavior is for this person, and try to answer questions honestly and objectively.
Generally, the psychiatrist will ask when problem behaviors are most likely to occur, with whom, and if he or she has any medical conditions. Even small details can be very enlightening. This allows the doctor to establish what is normal for the patient and can help when there are significant changes to his or her functioning. Armed with accurate information, the psychiatrist will be able to make the correct diagnosis and provide effective treatment.
If the doctor prescribes a medication, it is important to closely observe its effects on the person’s behavior. Everyone working with the individual with ID should know when the medication was started or ended, what it is supposed to treat, and what side effects may occur.
After the medication regimen has begun, record any changes in behavior, if possible. In my line of work, one of the most common reasons we record data is to objectively monitor a medication’s effects on behavior. This may not be possible for some adults with ID, as there may not be someone available to record their data on a regular basis.
Before an appointment, the people supporting the individual with ID should discuss how the medication is working for that person. Talk about any changes in the person’s life, any current or potential medical issues, and if there have been any side effects noticed.
It is helpful to write these things down and have a list of questions to ask the psychiatrist because it is easy to forget to talk about key details during an appointment. These details help everyone decide what is the best way to proceed and can prevent unnecessary medication changes.
It often takes a team of people working together in a methodical manner to help an individual with ID build a strong relationship with a psychiatrist. It is well worth the effort, however, because it will ensure that the person will receive the best treatment possible. And effective, evidence-based psychiatric care can make an enormous difference in the life of an individual with ID.
Margaret Walsh, M.A., BCBA, is the Clinical Director for the western Massachusetts division of the May Center for Adult Services. She can be contacted in West Springfield at 413-734-0300 (ext. 262) or at firstname.lastname@example.org.