Skip to main content

Advertisement

SpringerLink
Log in

The Prevalence and Incidence of Mental Ill-Health in Adults with Autism and Intellectual Disabilities

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

The prevalence, and incidence, of mental ill-health in adults with intellectual disabilities and autism were compared with the whole population with intellectual disabilities, and with controls, matched individually for age, gender, ability-level, and Down syndrome. Although the adults with autism had a higher point prevalence of problem behaviours compared with the whole adult population with intellectual disabilities, compared with individually matched controls there was no difference in prevalence, or incidence of either problem behaviours or other mental ill-health. Adults with autism who had problem behaviours were less likely to recover over a two-year period than were their matched controls. Apparent differences in rates of mental ill-health are accounted for by factors other than autism, including Down syndrome and ability level.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. Mental ill-health is used to describe all forms of psychiatric disorders or problem behaviour, excluding autism. Problem behaviour is used as the preferred term to describe behavioural disorders or challenging behaviour. Operationalised criteria for problem behaviours are provided in the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities/Mental Retardation (Royal College of Psychiatrists 2001).

  2. Psychopathology refers to any symptoms of emotional and behavioural disturbance elicited during the process of assessment. This information is then used to provide a diagnosis based on agreed criteria contained in a standardised classification system.

  3. The term problem behaviours encompasses all those listed in DC-LD (Royal College of Psychiatrists 2001) including: verbally aggressive behaviour; physically aggressive behaviour; destructive behaviour; self-injurious behaviour; sexually inappropriate behaviour; oppositional behaviour; excessively demanding behaviour, wandering behaviour and other problem behaviour.

  4. The Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities / Mental Retardation was developed as a diagnostic classificatory system for use with adults with intellectual disabilities, in recognition of the limitations of ICD-10 and DSM-IV.

  5. See footnote 3.

References

  • Allen, D. G., Lowe, K., Moore, K., & Brophy, S. (2007). Predictors, costs and characteristics of out of area placement for people with intellectual disability and challenging behaviour. Journal of Intellectual Disability Research, 51, 409–416.

    Article  PubMed  Google Scholar 

  • Aman, M. G., Burrow, W. H., & Wolford, P. L. (1995). The Aberrant behavior checklist-community: factor validity and effect of subject variables for adults in group homes. American Journal on Mental Retardation, 100, 283–292.

    PubMed  Google Scholar 

  • American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Revised (DSM-IV-TR) APA.

  • Baird, G., Simonoff, E., Pickles, A., Chandler, S., Loucas, T., Meldrum, D., & Charman, T. (2006). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: The special needs and sutism project (SNAP). Lancet, 368, 210–215.

    Article  PubMed  Google Scholar 

  • Bertrand, J., Mars, A., Boyle, C., Bove, F., Yeargin-Allsopp, M., & Decoufle, P. (2001). Prevalence of autism in a United States population: The Brick Township, New Jersey, investigation. Pediatrics, 108, 1155–1161.

    Article  PubMed  Google Scholar 

  • Bhaumik, S., Branford, D., McGrother, C., & Thorp, C. (1997). Autistic traits in adults with learning disabilities. British Journal of Psychiatry, 170, 502–506.

    Article  PubMed  Google Scholar 

  • Billstedt, E., Gillberg, C., & Gillberg, C. (2005). Autism after adolescence: Population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood. Journal of Autism and Developmental Disorders, 35, 351–360.

    Article  PubMed  Google Scholar 

  • Borthwick-Duffy, S. A., & Eyman, R. K. (1990). Who are the dually diagnosed? American Journal on Mental Retardation, 94, 586–595.

    PubMed  Google Scholar 

  • Bradley, E. A., & Bolton, P. (2006). Episodic psychiatric disorders in teenagers with learning disabilities with and without autism. British Journal of Psychiatry, 189, 362–366.

    Article  Google Scholar 

  • Bradley, E. A., Summers, J. A., Wood, H. L., & Bryson, S. E. (2004). Comparing rates of psychiatric and behavior disorders in adolescents and young adults with severe intellectual disability with and without autism. Journal of Autism and Developmental Disorders, 34, 151–161.

    Article  PubMed  Google Scholar 

  • Brereton, A. V., Tonge, B. J., & Einfeld, S. L. (2006). Psychopathology in children and adolescents with autism compared to young people with intellectual disability. Journal of Autism and Developmental Disorders, 36, 863–870.

    Article  PubMed  Google Scholar 

  • Brylewski, J., & Duggan, L. (2004). Antipsychotic medication for challenging behaviour in people with learning disability. Cochrane Database of Systematic Reviews, CD000377.

  • Chakrabarti, S., & Fombonne, E. (2001). Pervasive developmental disorders in preschool children. JAMA, 285, 3093–9.

    Article  PubMed  Google Scholar 

  • Chakrabarti, S., & Fombonne, E. (2005). Pervasive developmental disorders in preschool children: confirmation of high prevalence. American Journal of Psychiatry, 162, 1133–1141.

    Article  PubMed  Google Scholar 

  • Collacott, R. A., Cooper, S.-A., Branford, D., & McGrother, C. (1998). Behaviour phenotype for Down’s syndrome. British Journal of Psychiatry, 172, 85–89.

    PubMed  Google Scholar 

  • Cook, T. D., & Campbell, D. T. (1979). Quasi-experimentation: design and analysis issues for field settings. Chicago: Rand McNally College Publishing Company.

    Google Scholar 

  • Cooper, S. A. (1997). Epidemiology of psychiatric disorders in elderly compared with younger adults with learning disabilities. British Journal of Psychiatry, 170, 375–380.

    PubMed  Google Scholar 

  • Cooper, S. A., Smiley, E., Morrison, J., Williamson, A., & Allan, L. (2007a). Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. British Journal of Psychiatry, 190, 27–35.

    Article  PubMed  Google Scholar 

  • Cooper, S. -A., Smiley, E., Morrison, J., Allan, L., & Williamson, A. (2007b). An epidemiological investigation of affective disorders with a population-based cohort of 1,023 adults with intellectual disabilities. Psychological Medicine, 37, 873–882.

    Article  PubMed  Google Scholar 

  • Cooper, S. -A., Smiley, E., Morrison, J., Allan, L., Williamson, A., Finlayson, J., & Jackson, A. (2007c). Psychosis and adults with intellectual disabilities. Prevalence, incidence, and related factors. Social Psychiatry and Psychiatric Epidemiology, 42, 530–536.

    Article  PubMed  Google Scholar 

  • Curtice, L., Cooper, S. -A., Espie, C., Morrison, J., Ibbotson, T., Long, L. & Allan, L. (2001). Implementing partnership for health: Piloting health checks for people with learning disabilities in Glasgow—A final report. Glasgow: Greater Glasgow Primary Care NHS Trust R&D Directorate.

  • Davidson, P. W., Cain, N. N., Sloane-Reeves, J. E., Van Speybroech, A., Segel, J., Gutkin, J., Quijano, L. E., Kramer, B. M., Porter, B., & Shoham, I. (1994). Characteristics of community-based individuals with mental retardation and aggressive behavioral disorders. American Journal on Mental Retardation, 98, 704–716.

    PubMed  Google Scholar 

  • Dawson, G., & Watling, R. (2000). Interventions to facilitate auditory, visual, and motor integration in autism: A review of the evidence. Journal of Autism and Developmental Disorders, 30, 415–421.

    Article  PubMed  Google Scholar 

  • Deb, S., Clarke, D., & Unwin, G. (2006). Using medication to manage behaviour problems among adults with a learning disability. Birmingham: University of Birmingham.

  • Deb, S., Thomas, M., & Bright, C. (2001). Mental disorder in adults with intellectual disability. 2: The rate of behaviour disorders among a community-based population aged between 16 and 64 years. Journal of Intellectual Disability Research, 45, 506–514.

    Article  PubMed  Google Scholar 

  • Didden, R., Korzilius, H., van Oorsouw, W., & Sturmey P. (2006). Behavioral treatment of challenging behaviors in individuals with mild mental retardation: meta-analysis of single-subject research. American Journal on Mental Retardation, 111, 290–298.

    Article  PubMed  Google Scholar 

  • Didden, R., Duker. P. C., & Korzilius, H. (1997). Meta-analytic study on treatment effectiveness for problem behaviors with individuals who have mental retardation. American Journal on Mental Retardation 101, 387–399.

    PubMed  Google Scholar 

  • Farmer, R., Rohde, J., & Sacks, B. (1993). Changing services for people with learning disabilities. London: Chapman & Hall.

    Google Scholar 

  • Filipek, P. A., Accardo, P. J., Ashwal, S., Baranek, G. T., Cook, E. H., Jr., Dawson, G., Gordon, B., Gravel, J. S., Johnson, C. P., Kallen, R. J., Levy, S. E., Minshew, N. J., Ozonoff, S., Prizant, B. M., Rapin, I., Rogers, S. J., Stone, W. L., Teplin, S. W., Tuchman, R. F., & Volkmar, F. R. (2000). Practice parameter: Screening and diagnosis of autism: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology, 55, 468–479.

    PubMed  Google Scholar 

  • Ghaziuddin, M., Alessi, N., & Greden, J. F. (1995). Life events and depression in children with pervasive developmental disorders. Journal of Autism and Developmental Disorders, 25, 495–502.

    Article  PubMed  Google Scholar 

  • Ghaziuddin, M., Ghaziuddin, N., & Greden, J. (2002). Depression in persons with autism: Implications for research and clinical care. Journal of Autism and Developmental Disorders, 32, 299–306.

    Article  PubMed  Google Scholar 

  • Glasgow U. C. E. D. D. (2001). The C21st Health Check. Glasgow: University of Glasgow.

  • Hill, J., & Furniss, F. (2006). Patterns of emotional and behavioural disturbance associated with autistic traits in young people with severe intellectual disabilities and challenging behaviours. Research in Developmental Disabilities, 27, 517–528.

    Article  PubMed  Google Scholar 

  • Holden, B., & Gitlesen, J. P. (2006). A total population study of challenging behaviour in the county of Hedmark, Norway: Prevalence, and risk markers. Research in Developmental Disabilities, 27, 456–465.

    Article  PubMed  Google Scholar 

  • Holmes, N., Shah, A., & Wing, L. (1982). The disability assessment Schedule: A brief screening device for use with the mentally retarded. Psychological Medicine, 12, 879–890.

    PubMed  Google Scholar 

  • Hotopf, M. (2004). The case-control study. In M. Prince, R. Stewart, T. Ford, & M. Hotopf (Eds.), Practical psychiatric epidemiology (pp 131–54). Oxford: Oxford University Press.

    Google Scholar 

  • Jones, S., Cooper, S-A., Smiley, E., Allan, L., Williamson, A., Morrison, J. (2008). The prevalence of problem behaviours for adults with intellectual disabilities, and associated factors. Journal of Nervous and Mental Disease (in press).

  • Kern, J. K., Trivedi, M. H., Garver, C. R., Grannemann, B. D., Andrews, A. A., Savla, J. S., Johnson, D. G., Mehta, J. A., & Schroeder, J. L. (2006). The pattern of sensory processing abnormalities in autism. Autism, 10, 480–494.

    Article  PubMed  Google Scholar 

  • Konstantareas, M. M., & Hewitt, T. (2001). Autistic disorder and schizophrenia: diagnostic overlaps. Journal of Autism and Developmental Disorders, 31, 19–28.

    Article  PubMed  Google Scholar 

  • Kwok, H. W. M. (2003). Psychopharmacology in autism spectrum disorders. Current Opinion in Psychiatry, 16, 529–534.

    Article  Google Scholar 

  • Lecavalier, L., Leone, S., & Wiltz, J. (2006). The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. Journal of Intellectual Disability Research, 50, 172–183.

    Article  PubMed  Google Scholar 

  • Leonard, H., & Wen, X. (2002). The epidemiology of mental retardation: challenges and opportunities in the new millennium. Mental Retardation & Developmental Disabilities Research Reviews, 8, 117–134.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Mantry, D., Cooper, S.-A., Smiley, E., Morrison, J., Allan, L., Williamson, A., Finlayson, J., & Jackson, A. (2007). The prevalence and incidence of mental ill-health in adults with Down syndrome. Journal of Intellectual Disability Research, 52, 141–155.

    Google Scholar 

  • Matson, J. L., Baglio, C. S., Smiroldo, B. B., Hamilton, M., Packlowskyi, T., Williams, D., & Kirkpatrick-Sanchez, S. (1996a). Characteristics of autism as assessed by the diagnostic assessment for the severely handicapped-II (DASH-II). Research in Developmental Disabilities, 17, 135–143.

    Article  PubMed  Google Scholar 

  • Matson, J. L., Benavidez, D. A., Compton, L. S., Paclawskyj, T., & Baglio, C. (1996b). Behavioral treatment of autistic persons: A review of research from 1980 to the present. Research in Developmental Disabilities, 17, 433–465.

    Article  PubMed  Google Scholar 

  • McClintock, K., Hall, S., & Oliver, C. (2003). Risk markers associated with challenging behaviours in people with intellectual disabilities: A meta-analytic study. Journal of Intellectual Disability Research, 47, 405–416.

    Article  PubMed  Google Scholar 

  • McGrother, C. W., Bhaumik, S., Thorp, C. F., Watson, J. M., & Taub, N. A. (2002). Prevalence, morbidity and service need among South Asian and white adults with intellectual disability in Leicestershire, UK. Journal of Intellectual Disability Research, 46, 299–309.

    Article  PubMed  Google Scholar 

  • Morgan, C., Roy, M., & Chance, P. (2003). Psychiatric comorbidity and medication use in autism: A community survey. Psychiatric Bulletin, 27, 378–381.

    Article  Google Scholar 

  • Moss, S., Prosser, H., Costello, H., Simpson, N., Patel, P., Rowe, S., Turner, S., & Hatton, C. (1998). Reliability and validity of the PAS-ADD Checklist for detecting psychiatric disorders in adults with intellectual disability. Journal of Intellectual Disability Research, 42, 173–183.

    Article  PubMed  Google Scholar 

  • National Initiative: Autism Screening, Assessment (2003). National Autism Plan for Children. London: National Autistic Society.

    Google Scholar 

  • Public Health Institute of Scotland (2001). Autistic spectrum disorders. needs assessment report. Glasgow: Public Health Institute of Scotland.

  • Reese, R. M., Richman, D. M., Belmont, J. M., & Morse, P. (2005). Functional characteristics of disruptive behavior in developmentally disabled children with and without autism. Journal of Autism and Developmental Disorders, 35, 419–428.

    Article  PubMed  Google Scholar 

  • Robertson, J., Emerson, E., Gregory, N., Hatton, C., Kessissoglou, S., & Hallam, A. (2000). Receipt of psychotropic medication by people with intellectual disability in residential settings. Journal of Intellectual Disability Research, 44, 666–676.

    Article  PubMed  Google Scholar 

  • Royal College of Psychiatrists (2001). DC-LD [Diagnostic criteria for psychiatric disorders for use with adults with learning disabilities/mental retardation]. London: Gaskell Press.

  • Scottish Intercollegiate Guideline Network (2007). Assessment, diagnosis and clinical interventions for children and young people with autism spectrum disorders: a national guideline. Edinburgh: NHS QIS.

    Google Scholar 

  • Simpson, N. (1999). Psychiatric disorders in people with learning disabilities: Measuring prevalence and validating a screening instrument. University of Manchester.

  • Smiley, E., Cooper, S. A., Finlayson, J., Allan, L., Mantry, D., McGrother, C. W., McConnachie, A., Morrison, J., & Jackson, A. (2007). The incidence, and predictors of mental ill-health in adults with intellectual disabilities. British Journal of Psychiatry, 191, 313–319.

    Article  PubMed  Google Scholar 

  • Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (1984). A Revision of the Vineland’s Social Maturity Scale by E.A. Doll. American Guidance Service, Inc.

  • Stewart, M. E., Barnard, L., Pearson, J., Hasan, R., & O’Brien, G. (2006). Presentation of depression in autism and Asperger syndrome: A review. Autism, 10, 103–116.

    Article  PubMed  Google Scholar 

  • Sturmey, P., Newton, J. T., Cowley, A., Bouras, N., & Holt, G. (2005). The PAS-ADD Checklist: Independent replication of its psychometric properties in a community sample. British Journal of Psychiatry, 186, 319–323.

    Article  PubMed  Google Scholar 

  • Tsakanikos, E., Costello, H., Holt, G., Bouras, N., Sturmey, P., & Newton, T. (2006). Psychopathology in adults with autism and intellectual disability. Journal of Autism and Developmental Disorders, 36, 1123–1129.

    Article  PubMed  Google Scholar 

  • Tsakanikos, E., Costello, H., Holt, G., Sturmey, P., & Bouras, N. (2007). Behaviour management problems as predictors of psychotropic medication and use of psychiatric services in adults with autism. Journal of Autism and Developmental Disorders, 37, 1080–1085.

    Article  PubMed  Google Scholar 

  • Tyrer, F., McGrother, C. W., Thorp, C. F., Donaldson, M., Bhaumik, S., Watson, J. M., & Hollin, C. (2006). Physical aggression towards others in adults with learning disabilities: Prevalence and associated factors. Journal of Intellectual Disability Research, 50, 295–304.

    Article  PubMed  Google Scholar 

  • van Schrojenstein Lantman-de Valk, H., Wullink, M., van den, A. M., Heurn-Nijsten, E. W., Metsemakers, J. F., & Dinant, G. J. (2006). The prevalence of intellectual disability in Limburg, the Netherlands. Journal of Intellectual Disability Research, 50, 61–68.

    Article  PubMed  Google Scholar 

  • Wing, L., Leekam, S. R., Libby, S. J., Gould, J., & Larcombe, M. (2002). The diagnostic interview for social and communication disorders: Background, inter-rater reliability and clinical use. Journal of Child Psychology and Psychiatry, 43, 307–325.

    Article  PubMed  Google Scholar 

  • World Health Organisation (1992). Schedules of clinical assessment in neuropsychiatry. Geneva: World Health Organisation.

    Google Scholar 

  • World Health Organisation (1993). ICD-10 Classification of Mental and Behavioural Disorders- Diagnostic Criteria for Research. Geneva: WHO.

    Google Scholar 

  • Wullink, M., Van Schrojenstein Lantman de-Valk, H.M.J., Dinant, G.J., & Metsemakers, J.F. (2007). Prevalence of people with intellectual disability in the Netherlands. Journal of Intellectual Disability Research, 51, 511–519.

    Article  PubMed  Google Scholar 

  • Yeargin-Allsopp M, Rice C, Karapurkar T, Doernberg N, Boyle C, & Murphy C. (2007). Prevalence of autism in a US metropolitan area. JAMA, 289, 49–55.

    Article  Google Scholar 

Download references

Acknowledgments

The research at T1 was funded by Greater Glasgow Health Board and the West of Scotland R&D Mental Health Programme. At T2 the research was funded by the Chief Scientist Office, Scottish Executive Health Department (reference CZH/4/96). We wish to thank the participants and their carers for participating in this study. We are grateful to Patricia Peters and Afshan Fairley for secretarial support, Andrew Williamson for data handling, and the NHS Greater Glasgow primary care liaison team.

Author information

Authors and Affiliations

  1. Section of Psychological Medicine, Division of Community Based Sciences, Faculty of Medicine, Academic Centre, Gartnavel Royal Hospital, University of Glasgow, 1055 Great Western Road, Glasgow, G12 OXH, Scotland, UK

    Craig A. Melville, Sally-Ann Cooper, Elita Smiley, Linda Allan, Alison Jackson & Janet Finlayson

  2. Section of General Practice and Primary Care, Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, Glasgow, UK

    Jill Morrison

  3. NHS Greater Glasgow and Clyde, Glasgow, UK

    Dipali Mantry

Authors
  1. Craig A. Melville
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sally-Ann Cooper
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jill Morrison
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elita Smiley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Linda Allan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alison Jackson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Janet Finlayson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dipali Mantry
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sally-Ann Cooper.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Melville, C.A., Cooper, SA., Morrison, J. et al. The Prevalence and Incidence of Mental Ill-Health in Adults with Autism and Intellectual Disabilities. J Autism Dev Disord 38, 1676–1688 (2008). https://doi.org/10.1007/s10803-008-0549-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-008-0549-7

Keywords

Search

Navigation