Assessment and treatment of posttraumatic stress disorder in individuals with intellectual disabilities

Individuals with intellectual disabilities (ID), including individuals with borderline intellectual functioning (BIF; IQ 70-85), are a large minority in mental health care services. Evidence indicates that they are more often exposed to potentially traumatic events than individuals without ID. They also display an increased risk for the development of posttraumatic stress disorder (PTSD), a mental health condition leading to severe and long-term impairments, high costs of care and low levels of quality of life. A review of the literature published until 2010 showed that prevalence rates of posttraumatic stress disorder (PTSD) in people with ID were lacking, that it was unknown how PTSD manifests itself in individuals with ID, and that there were no studies on PTSD treatments for individuals with ID. That was the reason for the present research project. For the assessment of PTSD in ID, a clinical interview, the Adapted ADIS-C PTSD, was developed and validated. Based upon this work we found no evidence that PTSD would manifest atypically in individuals with ID. More importantly, the guideline treatment for PTSD, EMDR-therapy, proved applicable and effective for both children and adults, irrespective of their level of ID. The findings of the current research project are of great importance because they not only offer opportunities for timely detection of trauma-related psychopathology, but also for the application of evidence based treatment for PTSD in this vulnerable target group

PTSD and its treatment in people with intellectual disabilities: a review of the literature

Although there is evidence to suggest that people with intellectual disabilities (ID) are likely to suffer from Post-Traumatic Stress Disorder (PTSD), reviews of the evidence base, and the potential consequences of this contention are absent. The purpose of this article is to present a comprehensive account of the literature on prevalence, assessment, and treatment of PTSD in people with ID. Some support was found for the notion that people with ID have a predisposition to the development of PTSD. Differences in comparison with the general population may consist of the expression of symptoms, and the interpretation of distressing experiences, as the manifestation of possible PTSD seems to vary with the level of ID. Since reliable and valid instruments for assessing PTSD in this population are completely lacking, there are no prevalence data on PTSD among people with ID. Nine articles involve treatment of PTSD in people with ID. Interventions reported involve those aimed to establish environmental change, the use of medication and psychological treatments (i.e., cognitive behavioral therapy, EMDR and psychodynamic based treatments). Case reports suggest positive treatment effects for various treatment methods. Development of diagnostic instruments for assessment of PTSD symptomatology in this population is required, as it could facilitate further research on its prevalence and treatment

Treatment of PTSD in people with severe intellectual disabilities: a case series

Objective: There is a dearth of information regarding the treatment of PTSD in people with severe intellectual disabilities (ID). The purpose of the present case studies was to assess the applicability and effects of an evidence-based treatment method for psychological trauma with this population. Methods: The treatment of four single cases with Eye Movement Desensitization and Reprocessing (EMDR) was evaluated. Participants included adults and children with a variety of symptoms, as well as different histories of negative life events. Results: In all cases PTSD symptoms decreased. In all but one case, the gains were maintained at 15.5 months to 2.5 years following treatment. Depressive symptoms and physical complaints diminished and social and adaptive skills improved. Conclusion: EMDR seems to be an applicable treatment method for clients with severe ID. Reduction and maintenance of PTSD symptoms in individuals with severe ID appears to be both desirable and obtainable

Do persons with intellectual disability and limited verbal capacities respond to trauma treatment?

Background There is not one case report of successful trauma treatment with the use of an evidence-based treatment method in people with substantially limited verbal capacities. This paper assessed the applicability of eye movement desensitisation and reprocessing (EMDR) in two clients with moderate ID, serious behavioural problems, and histories of negative life events. Method The 8-phase protocol of EMDR, a first-line treatment for psychological trauma, was applied. Results In both cases, posttraumatic stress disorder (PTSD)-like symptoms decreased in a total of only 6 and 5 sessions, respectively. Gains were maintained at 32 and 10 months’ follow-up. Conclusions EMDR seems to be an applicable psychological trauma treatment for persons with limited verbal capacities. Considering the importance of these findings, further and more rigorous research is required