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Chapter 31: Child Psychiatry
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
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.
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