Behavioral Pain Indicators in People With Intellectual Disabilities: A Systematic Review

People with intellectual disabilities (IDs) have a higher risk of painful medical conditions. Partly because of the impaired ability to communicate about it, pain is often undertreated. To strengthen pain assessment in this population, we conducted a systematic review to identify behavioral pain indicators in people with IDs by using Embase, PubMed, PsycINFO, CINAHL, and Cochrane. Inclusion criteria were 1) scientific papers; 2) published in the last 20 years, that is, 1992 to 2012; 3) written in English, 4) using human subjects, 5) intellectual disabilities, 6) pain, 7) behavior, and 8) an association between observable behavior and pain experience. From 527 publications, 27 studies were included. Pain was acute in 14 studies, chronic in 2 studies, both acute and chronic in 2 studies, and unspecified in 9 studies. Methodological quality was assessed with the Mixed Methods Appraisal Tool. Of the 14 categories with behavioral pain indicators, motor activity, facial activity, social-emotional indicators, and nonverbal vocal expression were the most frequently reported. Most of the behavioral pain indicators are reported in more than 1 study and form a possible clinical relevant set of indicators for pain in people with IDs. Determination of a behavioral pattern specific for pain, however, remains a challenge for future research. Perspective: This review focuses on categories of behavior indicators related to pain in people with IDs. The quality of evidence is critically discussed per category. This set of indicators could potentially help clinicians to recognize pain in this population, especially when unique individual pain responses are also identified. (C) 2013 by the American Pain Societ

Prevalence of Mental, Behavioural, and Neurobehavioural Disorders

Individuals with intellectual and developmental disabilities (IDD) are known to be at high risk of developing a comorbid mental or behavioural disorder. However, there has only recently been an increased focus on the epidemiology of such disorders in the older population of people with IDD. Attempting to precisely quantify the prevalence and incidence of disorders in this cohort remain difficult, due to complications associated with diverse sampling methodologies, differing definitions of ‘older’, and variations in diagnostic criteria. Nonetheless, the expanding research base since the 1980s indicates that mental and behavioural disorders occur at higher rates among older people with IDD when compared to their mainstream peers. The prevalence of mental disorders for the older cohort tends to decrease in relation to the severity of the intellectual disability, but the reverse is true for behavioural disorders. Estimated prevalence rates for mental disorders vary considerably, but many studies report rates in the 20–30% range, which is higher than for the general community. Behavioural disorders are also very common in older people with IDD but are again hard to quantify precisely. Observed differences in prevalence between people with IDD and the general community may diminish over the age of 70 as dementias become more commonplace in both populations. Finally, some research indicates a greater likelihood of mental disorder amongst the older female population of people with IDD