Skip to main content
Log in

Issues in the taxonomy of psychopathology in mental retardation

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

Abstract

Several factors appear to impede the development of a valid taxonomy of psychopathology in children and adolescents wth mental retardation. These include (a) the lack of a widely accepted definition of psychopathology in mental retardation, (b) disagreement on the nature of the relationship between mental retardation and psychopathology, and (c) insufficient evidence for the reliability and validity of current DSM or ICD systems in this population. In this article, we offer a definition of psychopathology in children with mental retardation; review concepts of the relationship between psychopathology and mental retardation; argue that in moving toward a valid taxonomy factors to be considered should include data from multivariate studies, findings related to behavior phenotypes, and diagnostic considerations with stereotypic behavior and self-injury, organic brain syndromes and pervasive developmental disor-ders. Finally, we outline a research strategy that may serve as a useful framework for developing a valid taxonomy of psychopathology in this population.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Achenbach, T. M., & Edelbrock, C. S. (1978). The classification of child psychopathology: A review and analysis of empirical efforts.Psychological Bulletin, 85, 1275–1301.

    Google Scholar 

  • Aman, M. G. (1991a).Assessing psychopathology and behavior problems in persons with mental retardation: A review of available instruments. (DHHS Publication No. ADM 91-1712). Rockville, MD: U.S. Department of Health and Human Services.

    Google Scholar 

  • Aman, M. G. (1991b). Review and evaluation of instruments for assessing emotional and behavioral disorders.Australia and New Zealand Journal of Developmental Disabilities, 17, 127–145.

    Google Scholar 

  • Aman, M. G. Singh, N. N., Stewart, A. W., & Field, C. J. (1985). The Aberrant Behavior Checklist: A behavior rating scale for the assessment of treatment effects.American Journal of Mental Deficiency, 89, 485–491.

    Google Scholar 

  • American Psychiatric Association. (1980).Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (1987).Diagnostic and statistical manual of mental disorders (3rd ed., rev.) Washington, DC: Author.

    Google Scholar 

  • Andreasen, N. C., Rice, J., Endicott, J., Reich, T., & Coryell, W. (1986). The family history approach to diagnosis.Archives of General Psychiatry, 43, 421–429.

    Google Scholar 

  • APA Task Force on Laboratory Tests in Psychiatry. (1987). The dexamethasone suppression test: An overview of its current status in psychiatry.American Journal of Psychiatry, 144, 1253–1262.

    Google Scholar 

  • Arana, G. W., Baldessarini, R. J., & Ornsteen, M. (1985). The dexamethasone suppression test for diagnosis and prognosis in psychiatry.Archives of General Psychiatry, 42, 1193–1204.

    Google Scholar 

  • Ballinger, B. R., & Reid, A. H. (1977). Psychiatric disorder in an adult training center and a hospital for the mentally handicapped.Psychological Medicine, 7, 525–528.

    Google Scholar 

  • Balthazar, E. E., & English, G. E. (1969). A factorial study of unstructured ward behaviors.American Journal of Mental Deficiency, 74, 353–360.

    Google Scholar 

  • Borthwick, S. A. (1988). Maladaptive behavior among the mentally retarded: The need for reliable data. In J. A. Stark, F. J. Menolascino, M. H. Albarelli, & V. C. Gray (Eds.),Mental retardation and mental health: Classification, diagnosis, treatment, services (pp. 30–40). New York: Springer-Verlag.

    Google Scholar 

  • Bruininks, R. H., Hill, B. K., & Morreau, L. E. (1988). Prevalence and implications of maladaptive behavior and dual diagnosis in residential and other service programs. In J. A. Stark, F. J. Menolascino, M. H. Albarelli, & V. C. Gray (Eds.),Mental retardation and mental health: Classification, diagnosis, treatment, services (pp. 3–29). New York: Springer-Verlag.

    Google Scholar 

  • Campbell, M., Fish, B., David, R., Shapiro, T., Collins, P., & Koh, C. (1972). Response to triiodothyronine and dextroamphetamine: A study of preschool schizophrenic children.Journal of Autism and Childhood Schizophrenia, 2, 343–358.

    Google Scholar 

  • Campbell, M., Small, A. M., Collins, P. J., Friedman, E., David, R., & Genieser, N. (1976). Levodopa and levoamphetamine: A crossover study in young schizophrenic children.Current Therapeutic Research, 19, 70–86.

    Google Scholar 

  • Carroll, B. J., Feinberg, M., Greden, J. F., Tarika, J., Albala, A. A., Haskett, R. F., James, N. M., Kronfol, Z., Lohr, N., Steiner, M., de Vigne, J. P., & Young, E. (1981). A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility.Archives of General Psychiatry, 38, 15–22.

    Google Scholar 

  • Collacott, R. A. (1993). Down's syndrome.Current Opinion in Psychiatry, 6, 650–654.

    Google Scholar 

  • Corbett, J. A. (1979). Psychiatric morbidity and mental retardation. In F. E. James & R. P. Snaith (Eds.),Psychiatric illness and mental handicap (pp. 11–25). London: Gaskell Press.

    Google Scholar 

  • Costello, A. (1982). Assessment and diagnosis of psychopathology. In J. Mason (Ed.),Psychopathology in the mentally retarded. Orlando, FL: Grune and Stratton.

    Google Scholar 

  • Coulter, D. L. (1991). Frontal lobe seizures: No evidence of self-injury.American Journal of Mental Retardation, 96, 81–85.

    Google Scholar 

  • Crome, L., & Stern, J. (19782).Pathology of mental retardation. Edinburgh: Churchill Livingstone.

  • Curry, J. F., & Thompson, R. J. (1982). Patterns of behavioral disturbance in developmentally disabled children: A replicated cluster analysis.Journal of Pediatric Psychology, 7, 61–73.

    Google Scholar 

  • Curry, J. F., Thompson, R. J. (1985). Patterns of behavioral disturbance in developmentally disabled and psychiatrically referred children: A cluster analytic approach.Journal of Pediatric Psychology, 10, 151–167.

    Google Scholar 

  • Eaton, L. F., Menolascino, F. J. (1982). Psychiatric disorders in the mentally retarded: Types, problems, and challenges.American Journal of Psychiatry, 139, 1297–1303.

    Google Scholar 

  • Einfeld, S. L. (1992). Clinical assessment of psychiatric symptoms in mentally retarded individuals.Australian New Zealand Journal of Psychiatry 26, 48–63.

    Google Scholar 

  • Einfeld, S. L., & Hall, W. (1992). Invited Editorial Comment: Behavioral phenotype of the fragile X syndrome.American Journal of Medical Genetics, 43 (1/2), 56–60.

    Google Scholar 

  • Einfeld, S. L., and Hall, W. (1994). When is a behavior phenotype not a phenotype?Developmental Medicine and Child Neurology, 36, 467–470.

    Google Scholar 

  • Einfeld, S. L., & Tonge, B. J. (1994).Manual for the Developmental Behavior Checklist, Primary Carer Version (DBC-P). Sydney & Melbourne: University of New South Wales & Monash University.

    Google Scholar 

  • Einfeld, S. L., & Tonge, B. J. (1991). Psychometric and clinical assessment of psychopathology in developmentally disabled children.Australia and New Zealand Journal of Developmental Disabilities, 17, 147–154.

    Google Scholar 

  • Einfeld, S. L., Tonge, B. J., & Florio, T. (1994). Behavioral and emotional disturbance in fragile X syndrome.American Journal of Medical Genetics.

  • Einfeld, S. L., & Wurth, P. (1989). Letter: manic-depression disorder in mental handicap.Australian and New Zealand Journal of Developmental Disabilities, 15, 155–156.

    Google Scholar 

  • Ewart, A. K., Jin, W., Atkinson, D., Morris, C. A., & Keating, M. T. (1994). Supravalvular aortic stenosis associated with a deletion disrupting the elastin gene.Journal of Clinical Investigation, 93(3), 1071–1077.

    Google Scholar 

  • Fergusson, D. M., Horwood, L. J., & Lynsky, M. T. (1993). Prevalence and comorbidity of DSM-III-R diagnoses in a birth cohort of 15 years olds.Journal of the American Academy of Child and Adolescent Psychiatry, 32, 1127–1134.

    Google Scholar 

  • Frost, J. B. (1984). Behavioral disturbance in mentally handicapped adults. In J. M. Berg (Ed.),Perspectives and progress in mental retardation: Vol. 2, Biomedical aspects (pp. 299–308). Baltimore: University Park Press.

    Google Scholar 

  • Gedye, A. (1989). Extreme self-injury attributed to frontal lobe seizures.American Journal of Mental Retardation, 94, 20–26.

    Google Scholar 

  • Gillberg, C., Persson, E., Grufman, M., & Thimmer, U. (1986). Psychiatric disorders in mildly and severely retarded urban children and adolescents: Epidemiological aspects.British Journal of Psychiatry, 149, 68–74.

    Google Scholar 

  • Gostason, R. (1985). Psychiatric illness among the mentally retarded: A Swedish population study.Acta Psychiatrica Scandinavica, 71 (Suppl. 318).

    Google Scholar 

  • Greenswag, L. R. (1987). Adults with Prader-Willi syndrome: A survey of 232 cases.Developmental Medicine and Child Neurology, 29, 145–152.

    Google Scholar 

  • Gualtieri, C. T. (1989). The differential diagnosis of self-injurious behavior in mentally retarded people.Psychopharmacology Bulletin. 25, 358–63.

    Google Scholar 

  • Gunn, P., Berry, P., & Andrews, R. J. (1981). The temperament of Down's syndrome infants: A research note.Journal of Child Psychology and Psychiatry, 22, 189–194.

    Google Scholar 

  • Hagberg, B., Aicardi, J., Dias, K., & Ramos, O. (1983). A progressive syndrome of autism, dementia, ataxia and loss of purposeful hand use in girls: Rett's syndrome: Report of 35 cases.Annals of Neurology, 14, 471–479.

    Google Scholar 

  • Hauser, P., Zametkin, A. J., Martinez, P., Vitiello, B., Mtaochik, J. A. Mixson, A. J., & Weintraub, B. D. (1993). Attention deficit hyperactivity disorder in people with generalized resistance to thyroid hormone.New England Journal of Medicine, 328, 997–1001.

    Google Scholar 

  • Hyman, S. L., Fisher, W., Mercugliano, M., & Cataldo, M. F. (1990). Children with self-injurious behavior.Pediatrics, 85, 437–441.

    Google Scholar 

  • Jacobson, J. W. (1988). Problem behavior and psychiatric impairment in a developmentally disabled population III: Psychotropic medication.Research in Developmental Disabilities, 9, 23–28.

    Google Scholar 

  • Jacobson, J. W. (1991). Assessing the prevalence of psychiatric disorders in a developmentally disabled population. In E. Dibble & D. B. Gray (Eds.),Assessment of behavior problems in persons with mental retardation living in the community (DHHS Publication No. ADM 90-1642). Rockville, MD: U.S. Department of Health and Human Services.

    Google Scholar 

  • Kendell, R. E. (1975).The role of diagnosis in psychiatry (Chapters 8 & 9). Oxford: Blackwell.

    Google Scholar 

  • Karno, M., & Norquist, G. S. (1989). In H. I. Kaplan & B. J. Sadock (Ed.),Comprehensive textbook of psychiatry, Vol. 4, Baltimore: Williams and Wilkins.

    Google Scholar 

  • Kirman, B. (1979). Mental illness and mental handicap: Reflections on diagnostic problems and prevalence. In F. E., James & R. E. Snaith (Eds.),Psychiatric illness and mental handicap. London: Gaskell.

    Google Scholar 

  • Kraus, R. P., Grof, P., & Brown, G. M. (1988). Drugs and the DST: Need for a reappraisal.American Journal of Psychiatry, 145, 666–674.

    Google Scholar 

  • Leudar, I., & Fraser, W. I. (1987). Behavior disturbance and its assessment. In J. Hogg & N. V. Raynes (Eds.),Assessment in mental handicap: A guide to assessment practices, tests, and checklists (pp. 107–128). London: Croom Helm.

    Google Scholar 

  • Leudar, I., Fraser, W. I., & Jeeves, M. A. (1984). Behavior disturbance and mental handicap: Typology and longitudinal trends.Psychological Medicine, 14, 923–935.

    Google Scholar 

  • Loosen, P. T., & Prange, A. J., Jr. (1982). Serum thyrotropin-releasing hormone in psychiatric patients: A review.American Journal of Psychiatry, 139, 405–416.

    Google Scholar 

  • Lott, I. T. (1982). Down's syndrome, ageing and Alzheimer's disease: A clinical review.Annals of the New York Academy of Sciences, 396, 15–27.

    Google Scholar 

  • MacLean, W. E. (1991). Issues in the assessment of aberrant behavior among persons with mental retardation. In E. Dibble & D. B. Gray (Eds.),Assessment of behavior problems in persons with mental retardation living in the community (pp. 135–145). (DHHS Publication No. ADM 90-1642). Rockville, MD: U.S. Department of Health and Human Services.

    Google Scholar 

  • Martin M. A. (1991). The Training Resource Unit—an outreach model.Australian and New Zealand Journal of Developmental Disabilities, 17(2).

  • Matson, J. L. (1988).The PIMRA manual. Orlando Park, IL: International Diagnostic Systems.

    Google Scholar 

  • Matson, J. L., Gardner, W. I., Coe, D. A., & Sovner, R. (1991). A scale for evaluating emotional disorder in severely and profoundly mentally retarded persons. Development of the Diagnostic Assessment for the Severely Handicapped (DASH) Scale.British Journal of Psychiatry, 159, 404–409.

    Google Scholar 

  • Meiselas, K. D., Spencer, E. K., Oberfield, R., Peselow, E. D., Angrist, B., & Campbell, M. (1989). Differentiation of stereotypies from neuroleptic-related dyskinesias in autistic children.Journal of Clinical Psychopharmacology, 9, 207–209.

    Google Scholar 

  • Menolascino, F. J. (1988). Mental illness in the mentally retarded: Diagnostic and treatment issues. In J. A. Stark, F. J. Menolascino, M. H. Albarelli, & V. C. Gray (Eds.),Mental retardation and mental health: Classification, diagnosis, treatment, services (pp. 109–123). New York: Springer-Verlag.

    Google Scholar 

  • Murphy, G. (1987). Direct observation as an assessment tool in functional analysis and treatment. In J. Hogg and N. V. Raynes (Eds.),Assessment in mental handicap, London: Croom Helm.

    Google Scholar 

  • Myers, B. A. (1987). Psychiatric problems in adolescents with developmental disabilities.Journal of the American Academy of Child and Adolescent Psychiatry, 26, 74–79.

    Google Scholar 

  • Nihira, K. (1978).Dimensions of maladaptive behavior in institutionalized mentally retarded persons. Paper presented at the annual Western Conference on Mental Retardation, Corpus Christi, TX.

  • Penner, K., Johnston, J., Faircloth, B. H., Irish, P., & Williams, C. A. (1993). Communication, cognition and social interaction in the Angelman syndrome.American Journal of Medical Genetics, 46, 34–39.

    Google Scholar 

  • Philips, I. (1967). Psychopathology and mental retardation.American Journal of Psychiatry, 124: 1.

    Google Scholar 

  • Pirodsky, D. M., Gibbs, J. W., Hesse, R. A.,. Hsieh, M. C. Krause, R. B., & Rodriguez, W. H. (1985). Use of the dexamethasone suppression test to detect depressive disorders of mentally retarded individuals.American Journal of Mental Deficiency, 90, 245–252.

    Google Scholar 

  • Quay, H. C. (1986). Classification. In H. C. Quay & J. S. Werry (Eds.),Psychopathological disorders of childhood (3rd ed., pp. 1–34). New York: Wiley.

    Google Scholar 

  • Quine, L., & Pahl, J. (1989).Stress and coping in families caring for a child with severe mental handicap: A longitudinal study. University of Kent at Canterbury.

    Google Scholar 

  • Reid, A. H. (1982).The psychiatry of mental handicap. Boston: Blackwell Scientific.

    Google Scholar 

  • Reid, A. H. (1983). Psychiatry of mental handicap: A review.Journal of the Royal Society of Medicine, 76, 587–592.

    Google Scholar 

  • Reid, A. H. (1989). Schizophrenia in mental retardation: Clinical features.Research in Developmental Disabilities, 10, 241–249.

    Google Scholar 

  • Reid, A. H., Ballinger, B. R., & Heather, B. B. (1978). Behavioral syndromes identified in a sample of 100 severely and profoundly retarded adults.Psychological Medicine, 8, 399–412.

    Google Scholar 

  • Reid, A. H., Maloney, A. F. J., & Aungle, P. G. (1978). Dementia in aging mental defectives: A clinical and neuropathological study.Journal of Mental Deficiency Research, T22, 233–241.

    Google Scholar 

  • Rey, J. M., Plapp, J. M., & Stewart, G. W. (1989). Reliability of psychiatric diagnosis in referred adolescents.Journal of Child Psychology and Psychiatry.30, 879–888.

    Google Scholar 

  • Richardson, S. A., Roller, H., Katz, M., & McLaren, J. (1984). Patterns of disability in a mentally retarded population between ages 16 and 22 years. In J. Berg (Ed.),Perspectives and progress in mental retardation (Vol. 12, pp. 25–38). Baltimore, MD: University Park Press.

    Google Scholar 

  • Roach, E. S. (1988). Diagnosis and management of neurocutaneous syndromes.Seminars in Neurology, 8, 83–86.

    Google Scholar 

  • Rojahn, J. (1986). Self-injurious and stereotypic behavior of noninstitutionalized mentally retarded people: Prevalence and classification.American Journal of Mental Deficiency, 91, 268–276.

    Google Scholar 

  • Rojahn, J. (1994). Epidemiology and topographic taxonomy of self-injurious behavior. In T. Thompson (Ed.),Destructive behavior in developmental disabilities: Diagnosis and treatment (pp. 49–67). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Rojahn, J., & Helsel, W. J. (1991). The Aberrant Behavior Checklist in children and adolescents with dual diagnosis.Journal of Autism and Developmental Disorders, 21, 17–28.

    Google Scholar 

  • Rojahn, J., & Sisson, L. (1990). Stereotyped behavior. In J. L. Matson (Ed.),Handbook of behavior modification with the mentally retarded (2nd ed., pp. 181–223). New York: Plenum Press.

    Google Scholar 

  • Russell, A. T. (1985). The mentally retarded, emotionally disturbed child and adolescent In M. Sigman (Ed.),Children with emotional disorders and developmental disabilities: Assessment and treatment (pp. 111–135). Orlando, FL: Grune and Stratton.

    Google Scholar 

  • Russell, A. T. (1988). The association between mental retardation and psychiatric disorder: Epidemiological issues. In J. A. Stark, F. J. Menolascino, M. h. Albarelli, & V. C. Gray (Eds.),Mental retardation and mental health: Classification, diagnosis, treatment, services (p. 41–49). New York: Springer-Verlag.

    Google Scholar 

  • Russell, A. T., & Tanguay, P. E. (1981). Mental illness and mental retardation: Cause or coincidence?American Journal of Mental Deficiency, 85, 570–574.

    Google Scholar 

  • Rutter, M. (1989). Annotation: Child psychiatric disorders in ICD-10.Journal of Child Psychology and Psychiatry, 30, 499–513.

    Google Scholar 

  • Rutter, M., & Gould, M. (1985). Classification. In M. Rutter & L. Hersov (Eds.),Child and adolescent psychiatry: Modern approaches (pp. 304–321). Oxford: Blackwell Scientific.

    Google Scholar 

  • Rutter, M., & Schopler, E. (1992). Classification of pervasive developmental disorders: Some concepts and practical considerations.Journal of Autism and Developmental Disorders, 22, 459–482.

    Google Scholar 

  • Rutter, M., Tizard, J., & Whitmore, K. (1970).Education health and behavior. London: Longmans.

    Google Scholar 

  • Sovner, R. (1986). Limiting factors in the use of DSM-III criteria with mentally ill/mentally retarded persons.Psychopharmacology Bulletin, 22, 1055–1059.

    Google Scholar 

  • Spivack, G., & Spotts, J. (1966).Devereux Child Behavior Rating manual. Devon, PA: Devereux Foundation Press.

    Google Scholar 

  • Stark, J. A., Menolascino, F. J., Albarelli, M. H., & Gray, V. C. (Eds.). (1988).Mental retardation and mental health: Classification, diagnosis, treatment, services. New York: Springer-Verlag.

    Google Scholar 

  • Sturmey, P., Reed, J., & Corbett, J. (1991). Psychometric assessment of psychiatric disorders in people with learning difficulties (mental handicap): A review of measures.Psychological Medicine, 21, 143–155.

    Google Scholar 

  • Szymanski, L. S. (1988). Integrative approach to diagnosis of mental disorders in the mentally retarded. In J. A. Stark, F. J. Menolascino, M. A. Albarelli, & V. C. Gray (Eds.),Mental retardation and mental health: Classification, diagnosis, treatment, services (pp. 124–139). New York: Springer-Verlag.

    Google Scholar 

  • Task Force on DSM-IV. (1991).DSM-IV options book: Work in progress. Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Udwin, O., & Yule, W. (1991). A cognitive and behavioral phenotype in Williams syndrome.Journal of Clinical & Experimental Neuropsychology, 13, 232–244.

    Google Scholar 

  • Van Bourgondien, M. E., Marcus, L. M., & Schopler, E. (1992). Comparison of DSM-III-R and Childhood Autism Rating Scale diagnoses of autism.Journal of Autism and Developmental Disorders, 22, 493–506.

    Google Scholar 

  • Volkmar, F. R., Cicchetti, D. V. Bregman, J., & Cohen, D. J. (1992). Three diagnostic systems for autism: DSM-III, DSM-III-R, and ICD-10.Journal of Autism and Developmental Disorders, 22, 483–492.

    Google Scholar 

  • Werry, J. S., Carlielle, J., & Fitzpatrick, J. (1983). Rhythmic motor activities (stereotypes) in children under five: Etiology and prevalence.Journal of the American Academy of Child Psychiatry, 22, 329–336.

    Google Scholar 

  • Zametkin, A. J., Nordahl, T. E., Gross, M., King, A. C., Semple, W. E., Rumsey, J., Hamburger, S., & Cohen, R. M. (1990). Cerebral glucose metabolism in adults with hyperactivity of childhood onset.New England Journal of Medicine, 323, 1361–1366.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Einfeld, S.L., Aman, M. Issues in the taxonomy of psychopathology in mental retardation. J Autism Dev Disord 25, 143–167 (1995). https://doi.org/10.1007/BF02178501

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02178501

Keywords

Navigation