The Co-Occurrence of Mental Illness and Developmental Disability
Well-conducted, population-based studies tell us that up to 40 percent of people with intellectual disabilities have significant psychiatric or behavioral problems that require some sort of intervention. In addition to increased risks of anxiety, depressive, and psychotic disorders, people with intellectual disabilities also experience problems that are not typically seen in the general population, including social and communicative deficits, self-injury, and repetitive, restrictive behaviors. Researchers, clinicians, and families are increasingly aware of these co-occurrences, and the field now has a host of psychometrically sound measures to assess these problems.
Where we fall short, however, is moving beyond descriptive or epidemiological studies to tackle mechanisms that underpin these problems, as well as evidence-based treatments for them. This paucity of data is especially true for the substantial group of individuals without a known etiology for their intellectual disability. Indeed, relative to this group, our understandings of psychiatric vulnerabilities have leapt forward in such genetic disorders as Down, fragile X, Prader-Willi, Williams, and 22q deletion syndromes.
This year, the 2014 Gatlinburg Conference plenary speakers will help us think more critically and deeply about social, environmental, genetic and neural factors associated with high rates of psychopathology in people with intellectual disabilities. Given high rates of inappropriate polypharmacy in this population, speakers will also address the need for evidence-based treatments, including research on behavioral, psychotropic, cognitive-behavioral, mindfulness and other therapies.
All too often, co-occurring psychiatric and behavioral disorders are to blame for less-than-optimal outcomes in children or adults with intellectual disabilities in their schools, homes and communities. Our 2014 Gatlinburg Conference theme is thus rich with research, practice, and policy implications. As usual, we look forward to your contributions on a broad range of research topics in the intellectual and developmental disabilities field. But the theme committee hopes that we all leave the conference with a new appreciation for the importance of multidisciplinary research on psychiatric disorders in this vulnerable population.
Sheila Eyberg, Ph.D., ABPP
Talk Title: Treatment of Young Children with Co-Occurring Disruptive Behavior Disorders and IDD
Bio: Sheila Eyberg is Distinguished Professor Emeritus in the Department of Clinical and Health Psychology, Pediatrics, and Psychology at the University of Florida. She obtained her PhD from the University of Oregon in Clinical Psychology and completed clinical internship and post-doc at the Oregon Health and Sciences University (OHSU).
As a post doc, she developed parent-child interaction therapy (PCIT) and its related assessment measures, the Dyadic Parent-Child Interaction Coding System, the Eyberg Child Behavior Inventory, and the Therapy Attitude Inventory.
She has published over 150 research articles and papers related to assessment and treatment of preschoolers, which contributed to the designation of PCIT as an “empirically supported treatment” for disruptive behavior and a “best practices” treatment for child abusive parenting.
Dr. Eyberg has served on several National Institute of Mental Health review committees and has been Associate Editor of the Journal of Clinical Child and Adolescent Psychology, and Behavior Therapy.
She is a Fellow of American Psychological Association (APA) and has served as President of three child-focused Divisions of the APA including the Society of Pediatric Psychology, the Society of Clinical Child and Adolescent Psychology, and the Society for Child and Family Policy and Practice.
Dr. Eyberg has received a number of awards for her work with children, including the the Lee Salk Award for Distinguished Service to Pediatric Psychology, the Distinguished Career Award from Division 53 of APA, and the Nicholas Hobbs Award for Child Advocacy from Division 37. In 2007 she received the Distinguished Contributions to Education and Training Award from the American Psychological Association.
She founded PCIT International in 2009 and currently serves as its first President.
Susan Hepburn, Ph.D.
Talk Title: Extending Evidence-Based Practices to Improve Access to Services for Youth with Autism Spectrum Disorder and Anxiety
Abstract: There is increasing evidence for the efficacy of manualized psychosocial interventions focused on improving mental health in youth with ASD; however, these highly specialized interventions are not readily available to many families of psychiatrically complex youth with ASD. Families who live far from specialty medical centers or who have children whose anxiety precludes consistent participation in clinic-based services require a different form of service delivery.
In this presentation, I will describe the efforts of our research group at JFK Partners of the University of Colorado to develop, evaluate, and extend a manualized, family-focused, cognitive-behavioral group treatment targeting anxiety reduction in youth with ASD (i.e., Facing Your Fears (FYF); Reaven et al, 2011). In an effort to improve access to mental health services for those families unable to participate in groups in our center, we developed the TeleCopes Project, which is a modified version of FYF, designed to be delivered through commercially available videoconferencing software that allows for home-to-clinic real-time interactions. Feasibility and preliminary efficacy data will be shared and implementation challenges will be discussed, in the hopes of providing practical strategies for other researchers and clinicians considering telehealth delivery of evidence-based practices.
Funding: This work has been funded by grants from HRSA (R40 MC15593-01-00), Autism Speaks, the Organization for Autism Research (OAR) and the Doug Flutie Foundation.
Bio: Susan Hepburn is a clinical psychologist and Associate Professor of Psychiatry and Pediatrics at the University of Colorado School of Medicine. As Director of Research for JFK Partners (which is the University Center for Excellence in Developmental Disabilities for Colorado) she oversees the diagnostic qualification and family recruitment activities for several projects, focusing her own work on developing, evaluating and disseminating interventions for school-aged youth with ASD. Working primarily in schools and with families, Dr. Hepburn has been exploring novel ways of supporting evidence-based practice in rural areas.
Bryan H. King, M.D.
Talk Title: Sex, Drugs, and Diagnostic Rigamaroles
Abstract: One of the recurring themes revealed in the history of medicine is that as underlying causes for disorders are identified, not only are more effective treatments developed, but also the boundaries around the disorders themselves are invariably redrawn. Illustrating the protean manifestations associated with a disorder with known cause, Osler coined the term “the great imitator” for neurosyphilis. He observed that to know this disorder would be “to have all things clinical opened up to you.” In the years following the introduction of the DSM-3 and DSM-4 criteria for neuropsychiatric disorders, advances in genetics coupled with a significant increase in the prevalence of PDDs laid the foundation for the changes that were incorporated in DSM-5. But even as the ink was drying on the DSM-5 there were calls to revisit the entire system in favor of an approach that is organized around dimensions of neurobiology and observable behavior. This talk will highlight genetic and other studies that have begun to challenge the demarcation of the boundaries between phenotypically quite distinct, diagnostic entities such as autism and schizophrenia. We are at the threshold of being able to chart these disorders from the inside out. In so doing, the door is opened to the consideration of new therapeutics that are developed based upon molecular, synaptic, and systems targets common to both.
Bio: Dr. King is Professor and Vice Chair of Psychiatry and Behavioral Sciences and Director of Child and Adolescent Psychiatry at the University of Washington and Seattle Children’s Hospital. He is also Director of the Autism Center at Seattle Children's. He joined the University from Dartmouth Medical School where he held a similar position as well as serving as the Medical Director for New Hampshire’s Division of Developmental Services.
Dr. King completed his medical training at the Medical College of Wisconsin, and subsequently did his medical internship and psychiatric training at the UCLA Medical Center and Neuropsychiatric Institute. He obtained his clinical and research training in Child and Adolescent Psychiatry at UCLA and at the Merck Neuroscience Research Center in England with sponsorship of the National Institutes of Health. Dr. King’s clinical and research interests have been focused on psychiatric aspects of developmental disorders, repetitive movements, and upon the pathogenesis and treatment of severe behavioral disturbance in particular and he has been continuously funded by the NIH since 1990. He recently served on the DSM-5 workgroup for neurodevepmental disorders. King has written extensively in the medical literature relating to this field, and has received lifetime achievement awards from the American Academy of Child and Adolescent Psychiatry, and from the American Psychiatric Association, for his work in the field of Developmental Disabilities. He has been recognized for his clinical care in several venues including having received the Outstanding Physician award by the nursing staff of the UCLA Neuropsychiatric Institute and the Family Choice Award at Seattle Children’s Hospital.
Luc Lecavalier, Ph.D.
Talk Title: The Nature and Treatment of Behavior and Emotional Problems in Young People with Autism Spectrum Disorders
Abstract: The past decade has witnessed a surge in writings on psychopathology in young people with autism spectrum disorder (ASD). Evidence suggests that children and adolescents with ASD have high rates of behavioral and emotional problems, especially so-called disruptive behaviors and anxiety. The exact reasons why this is the case remain elusive. In fact, the very conceptualization, measurement and classification of these problems remain onerous and contentious issues. The overlap with intellectual and language delays, and the reliance on caregiver reports are examples of why the measurement of psychopathology in ASD is complex. In spite of all of these challenges, a significant quantity of treatment research on the topic has recently been published. Some of this treatment literature will be reviewed, focusing on psychopharmacology and psychological interventions such as parent training, cognitive behavior therapy, or social skills training. The discussion will focus on efficacy/effectiveness and outcome measurement, but also on trends in the field, methodological progresses and obstacles, and general observations and reflections based on the studies in which I have been involved.
Bio: Luc Lecavalier is a Professor of Psychology and Psychiatry at Ohio State University. He obtained a B.A. in Psychology from the University of Ottawa (Canada). He obtained a Ph.D. in Psychology from the Université du Québec à Montréal (Canada) in 2001. He then completed a postdoctoral fellowship at the University of North Carolina at Chapel Hill. Dr. Lecavalier is interested in diagnosis and treatment of behavior/psychiatric problems in individuals with intellectual disability and/or autism spectrum disorder (ASD). He has authored or co-authored more than seventy scholarly publications. In 2008, he was recipient of the Early Career Awards given by the American Association on Intellectual and Developmental Disabilities (AAIDD) and Division 33 of the American Psychological Association (APA). He is currently site PI on two multisite NIH-funded studies. One of these studies examines the efficacy of parent training on behavior problems in preschoolers with ASD. The other study will adapt and validate existing anxiety measures for use in children and adolescents with ASD. He is Associate Editor of Autism: International Journal of Research and Practice and is a member of several Editorial Boards including the Journal of Autism and Developmental Disorders . At the Nisonger Center, he is Director of the Child Unit of Behavior Support Services.