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Intellectual disability and mental disorders in a US population representative sample of adolescents

Published online by Cambridge University Press:  12 July 2018

Jonathan M. Platt Open the ORCID record for Jonathan M. Platt [Opens in a new window] ,
Katherine M. Keyes ,
Katie A. McLaughlin  and
Alan S. Kaufman
Jonathan M. Platt*
Affiliation:
Department of Epidemiology, Columbia University, New York, NY, USA
Katherine M. Keyes
Affiliation:
Department of Epidemiology, Columbia University, New York, NY, USA
Katie A. McLaughlin
Affiliation:
Department of Psychology, University of Washington, Seattle, Washington, USA
Alan S. Kaufman
Affiliation:
Child Study Center, School of Medicine, Yale University, New Haven, Connecticut, USA
*
Author for correspondence: Jonathan Manion Platt, E-mail: jmp2198@cumc.columbia.edu
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Abstract

Background

Most research on the prevalence, distribution, and psychiatric comorbidity of intellectual disability (ID) relies on clinical samples, limiting the generalizability and utility of ID assessment in a legal context. This study assessed ID prevalence in a population-representative sample of US adolescents and examined associations of ID with socio-demographic factors and mental disorders.

Methods

Data were drawn from the National Comorbidity Survey Adolescent Supplement (N = 6256). ID was defined as: (1) IQ ⩽ 76, measured using the Kaufman Brief Intelligence Test; (2) an adaptive behavior score ⩽76, and (3) age of onset ⩽18 measured using a validated scale. The Composite International Diagnostic Interview assessed 15 lifetime mental disorders. The Sheehan disability scale assessed disorder severity. We used logistic regression models to estimate differences in lifetime disorders for adolescents with and without ID.

Results

ID prevalence was 3.2%. Among adolescents with ID, 65.1% met lifetime criteria for a mental disorder. ID status was associated with specific phobia, agoraphobia, and bipolar disorder, but not behavior disorders after adjustment for socio-demographics. Adolescents with ID and mental disorders were significantly more likely to exhibit severe impairment than those without ID.

Conclusions

These findings highlight how sample selection and overlap between ID and psychopathology symptoms might bias understanding of the mental health consequences of ID. For example, associations between ID and behavior disorders widely reported in clinical samples were not observed in a population-representative sample after adjustment for socio-demographic confounders. Valid assessment and understanding of these constructs may prove influential in the legal system by influencing treatment referrals and capital punishment decisions.

General Scientific Summary

Current definitions of intellectual disability (ID) are based on three criteria: formal designation of low intelligence through artificial problem-solving tasks, impairment in one's ability to function in his/her social environment, and early age of onset. In a national population sample of adolescents, the majority of those with ID met criteria for a lifetime mental disorder. Phobias and bipolar disorder, but not behavior disorders, were elevated in adolescents with ID. Findings highlight the need to consider how behavioral problems are conceptualized and classified in people with ID.

Keywords

Adaptive behavioradolescenceintellectual disabilityintelligencemental disorderspsychopathology
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 6 , April 2019 , pp. 952 - 961
Copyright
Copyright © Cambridge University Press 2018 

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References

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Washington, DC: American Psychiatric Pub.Google Scholar
Bain, SK and Jaspers, KE (2010) Test review: review of Kaufman Brief Intelligence Test: Kaufman, AS, & Kaufman, NL (2004). Kaufman Brief Intelligence Test, Bloomington, MN: Pearson, Inc. Journal of Psychoeducational Assessment 28, 167–174.Google Scholar
Bakken, TL, Helverschou, SB, Eilertsen, DE, Heggelund, T, Myrbakk, E and Martinsen, H (2010) Psychiatric disorders in adolescents and adults with autism and intellectual disability: a representative study in one county in Norway. Research in Developmental Disabilities 31, 1669–1677.Google Scholar
Brue, AW and Wilmshurst, L (2016) Essentials of Intellectual Disability Assessment and Identification. Hoboken, NJ: John Wiley & Sons.Google Scholar
Cain, N, Davidson, P, Burhan, A, Andolsek, M, Baxter, J, Sullivan, L, Florescue, H, List, A and Deutsch, L (2003) Identifying bipolar disorders in individuals with intellectual disability. Journal of Intellectual Disability Research 47, 31–38.Google Scholar
Canivez, GL, Neitzel, R and Martin, BE (2005) Construct validity of the Kaufman brief intelligence test, Wechsler intelligence scale for children-and adjustment scales for children and adolescents. Journal of Psychoeducational Assessment 23, 15–34.Google Scholar
Cantwell, DP, Lewinsohn, PM, Rohde, P and Seeley, JR (1997) Correspondence between adolescent report and parent report of psychiatric diagnostic data. Journal of the American Academy of Child & Adolescent Psychiatry 36, 610–619.Google Scholar
Caseau, DL, Luckasson, R and Kroth, RL (1994) Special education services for girls with serious emotional disturbance: a case of gender bias? Behavioral Disorders 20, 51–60.Google Scholar
Cooper, S-A, Smiley, E, Morrison, J, Williamson, A and Allan, L (2007) Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. The British Journal of Psychiatry 190, 27–35.Google Scholar
Dekker, MC and Koot, HM (2003) DSM-IV disorders in children with borderline to moderate intellectual disability. I. Prevalence and impact. Journal of the American Academy of Child & Adolescent Psychiatry 42, 915–922.Google Scholar
Duncan, GJ, Brooks-Gunn, J and Klebanov, PK (1994) Economic deprivation and early childhood development. Child Development 65, 296–318.Google Scholar
Einfeld, SL, Ellis, LA and Emerson, E (2011) Comorbidity of intellectual disability and mental disorder in children and adolescents: a systematic review. Journal of Intellectual and Developmental Disability 36, 137–143.Google Scholar
Emerson, E (2003) Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability. Journal of Intellectual Disability Research 47, 51–58.Google Scholar
Floyd, RG, Reynolds, MR, Farmer, RL and Kranzler, JH (2013) Are the general factors from different child and adolescent intelligence tests the same? Results from a five-sample, six-test analysis. School Psychology Review 42, 383.Google Scholar
Flynn, JR (1984) The mean IQ of Americans: massive gains 1932 to 1978. Psychological Bulletin 95, 29–51.Google Scholar
Gillberg, C, Persson, E, Grufman, M and Themnér, U (1986) Psychiatric disorders in mildly and severely mentally retarded urban children and adolescents: epidemiological aspects. The British Journal of Psychiatry 149, 68–74.Google Scholar
Halfon, N and Newacheck, PW (1999) Prevalence and impact of parent-reported disabling mental health conditions among US children. Journal of the American Academy of Child & Adolescent Psychiatry 38, 600–609.Google Scholar
Harris, JC (2006) Intellectual Disability: Understanding Its Development, Causes, Classification, Evaluation, and Treatment. New York, NY: Oxford University Press.Google Scholar
Harrison, PL and Oakland, T (2015) ABAS-3. Torrance, CA: Western Psychological Services.Google Scholar
Hatton, C and Emerson, E (2004) The relationship between life events and psychopathology amongst children with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities 17, 109–117.Google Scholar
Homack, SR and Reynolds, CR (2007) Essentials of Assessment with Brief Intelligence Tests, vol 41. Hoboken, NJ: John Wiley & Sons.Google Scholar
Kaufman, AS (2009) IQ Testing 101. New York, NY: Springer Publishing Company.Google Scholar
Kaufman, AS, Johnson, CK and Liu, X (2008) A CHC theory-based analysis of age differences on cognitive abilities and academic skills at ages 22 to 90 years. Journal of Psychoeducational Assessment 26, 350–381.Google Scholar
Kaufman, AS, Kaufman, JC, Liu, X and Johnson, CK (2009) How do educational attainment and gender relate to fluid intelligence, crystallized intelligence, and academic skills at ages 22–90 years? Archives of Clinical Neuropsychology 24, 153–163.Google Scholar
Kaufman, AS and Kaufman, NL (1990 a) K-BIT: Kaufman Brief Intelligence Test. Circle Pines, MN: American Guidance Service.Google Scholar
Kaufman, AS and Kaufman, NL (1990 b) K-BIT: Kaufman Brief Intelligence Test Manual. Circle Pines, MN, USA: American Guidance Service.Google Scholar
Kaufman, AS and Wang, J-J (1992) Gender, race, and education differences on the K-BIT at ages 4 to 90 years. Journal of Psychoeducational Assessment 10, 219–229.Google Scholar
Kaufman, SB, Reynolds, MR, Liu, X, Kaufman, AS and McGrew, KS (2012) Are cognitive g and academic achievement g one and the same g? An exploration on the Woodcock–Johnson and Kaufman tests. Intelligence 40, 123–138.Google Scholar
Keiley, MK, Bates, JE, Dodge, KA and Pettit, GS (2000) A cross-domain growth analysis: externalizing and internalizing behaviors during 8 years of childhood. Journal of Abnormal Child Psychology 28, 161–179.Google Scholar
Kessler, RC, Avenevoli, S, Costello, EJ, Georgiades, K, Green, JG, Gruber, MJ, He, J, Koretz, D, McLaughlin, KA and Petukhova, M (2012 a) Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Archives of General Psychiatry 69, 372–380.Google Scholar
Kessler, RC, Avenevoli, S, Costello, EJ, Green, JG, Gruber, MJ, Heeringa, S, Merikangas, KR, Pennell, B, Sampson, NA and Zaslavsky, AM (2009 a) Design and field procedures in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). International Journal of Methods in Psychiatric Research 18, 69–83.Google Scholar
Kessler, RC, Avenevoli, S, Green, J, Gruber, MJ, Guyer, M, He, Y, Jin, R, Kaufman, J, Sampson, NA and Zaslavsky, AM (2009 b) National comorbidity survey replication adolescent supplement (NCS-A): III. Concordance of DSM-IV/CIDI diagnoses with clinical reassessments. Journal of the American Academy of Child & Adolescent Psychiatry 48, 386–399.Google Scholar
Kessler, RC, Avenevoli, S, McLaughlin, K, Green, JG, Lakoma, M, Petukhova, M, Pine, D, Sampson, N, Zaslavsky, A and Merikangas, KR (2012 b) Lifetime co-morbidity of DSM-IV disorders in the US national comorbidity survey replication adolescent supplement (NCS-A). Psychological Medicine 42, 1997–2010.Google Scholar
Keyes, KM, Platt, J, Kaufman, AS and McLaughlin, KA (2016) Association of fluid intelligence and psychiatric disorders in a population-representative sample of us adolescents. JAMA Psychiatry 74, 179–188.Google Scholar
Kwok, H and Cheung, PW (2007) Co-morbidity of psychiatric disorder and medical illness in people with intellectual disabilities. Current Opinion in Psychiatry 20, 443–449.Google Scholar
Leon, AC, Olfson, M, Portera, L, Farber, L and Sheehan, DV (1997) Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. The International Journal of Psychiatry in Medicine 27, 93–105.Google Scholar
Luckasson, R, Polloway, E, Reiss, S, Schalock, R, Snell, M, Spitalnik, D and Stark, J (1992) Mental Retardation: Definition, Classification and Systems of Supports. Washington DC: American Association on Intellectual & Developmental Disabilities, 9 edition.Google Scholar
Maulik, PK, Mascarenhas, MN, Mathers, CD, Dua, T and Saxena, S (2011) Prevalence of intellectual disability: a meta-analysis of population-based studies. Research in Developmental Disabilities 32, 419–436.Google Scholar
McDermott, S, Durkin, MS, Schupf, N and Stein, ZA (2007) Epidemiology and etiology of mental retardation. In Jacobson, JW, Mulick, JA and Rojahn, (eds), Handbook of Intellectual and Developmental Disabilities. Berlin/Heidelberg, Germany: Springer, pp. 3–40.Google Scholar
McLaughlin, KA, Costello, EJ, Leblanc, W, Sampson, NA and Kessler, RC (2012 a) Socioeconomic status and adolescent mental disorders. American Journal of Public Health 102, 1742–1750.Google Scholar
McLaughlin, KA, Green, JG, Hwang, I, Sampson, NA, Zaslavsky, AM and Kessler, RC (2012 b) Intermittent explosive disorder in the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry 69, 1131–1139.Google Scholar
McLaughlin, KA, Koenen, KC, Hill, ED, Petukhova, M, Sampson, NA, Zaslavsky, AM and Kessler, RC (2013) Trauma exposure and posttraumatic stress disorder in a national sample of adolescents. Journal of the American Academy of Child & Adolescent Psychiatry 52, 815–830.Google Scholar
Mercer, JR (1974) Latent functions of intelligence testing in the public schools. In Miller, L (ed.), The Testing of Black Students. Upper Saddle River: Prentice Hall, pp. 77–94.Google Scholar
Merikangas, K, Avenevoli, S, Costello, J, Koretz, D and Kessler, RC (2009) National comorbidity survey replication adolescent supplement (NCS-A): I. Background and measures. Journal of the American Academy of Child and Adolescent Psychiatry 48, 367–369.Google Scholar
Morgan, VA, Croft, ML, Valuri, GM, Zubrick, SR, Bower, C, McNeil, TF and Jablensky, AV (2012) Intellectual disability and other neuropsychiatric outcomes in high-risk children of mothers with schizophrenia, bipolar disorder and unipolar major depression. The British Journal of Psychiatry 200, 282–289.Google Scholar
Morgan, VA, Leonard, H, Bourke, J and Jablensky, A (2008) Intellectual disability co-occurring with schizophrenia and other psychiatric illness: population-based study. The British Journal of Psychiatry 193, 364–372.Google Scholar
Raven, JC (1936) Mental Tests Used in Genetic Studies: The Performance of Related Individuals on Tests Mainly Educative and Mainly Reproductive (Unpublished master's thesis), University of London.Google Scholar
Reynolds, MR, Floyd, RG and Niileksela, CR (2013) How well is psychometric g indexed by global composites? Evidence from three popular intelligence tests. Psychological Assessment 25, 1314.Google Scholar
Salthouse, T (2010) Major Issues in Cognitive Aging, vol. 49. New York, NY: Oxford University Press.Google Scholar
Schalock, RL (2010) Intellectual disability. In The Encyclopedia of Clinical Psychology. Hoboken, NJ: Wiley, pp. 1–7.Google Scholar
Schalock, RL, American Association on Intellectual and Developmental Disabilities. User's Guide Workgroup (2012) User's guide: to accompany the 11th edition of intellectual disability: definition, classification, and systems of supports: applications for clinicians, educators, organizations providing supports, policymakers, family members and advocates, and health care professionals. Washington, DC: American Association on Intellectual and Developmental Disabilities.Google Scholar
Schalock, RL, Borthwick-Duffy, SA, Bradley, VJ, Buntinx, WHE, Coulter, DL, Craig, EM, Gomez, SC, Lachapelle, Y, Luckasson, R, Reeve, A, Shogren, KA, Snell, ME, Spreat, S, Tasse, MJ, Thompson, JR, Verdugo-Alonso, MA, Wehmeyer, ML and Yeager, MH (2010) Intellectual disability: definition, classification, and systems of supports, 7th Edn. Washington, DC: American Association on Intellectual and Developmental Disabilities.Google Scholar
Schultz, D and Vile, JR (2015) The Encyclopedia of Civil Liberties in America. New York, NY: Routledge.Google Scholar
Seguin, E (1846) Traitement moral, hygiène et éducation des idiots et des autres enfants arriérés. Paris, France: JB Baillière.Google Scholar
Simonoff, E, Pickles, A, Wood, N, Gringras, P and Chadwick, O (2007) ADHD symptoms in children with mild intellectual disability. Journal of the American Academy of Child & Adolescent Psychiatry 46, 591–600.Google Scholar
Sparrow, SS, Balla, DA, Cicchetti, DV, Harrison, PL and Doll, EA (1984) Vineland Adaptive Behavior Scales. Circle Pines, MN: American Guidance Service.Google Scholar
Sparrow, SS, Cicchetti, DV and Saulnier, CA (2016) Vineland-3: Vineland Adaptive Behavior Scales. Hoboken, NJ: PsychCorp.Google Scholar
Tassé, MJ, Schalock, RL, Balboni, G, JrBersani, H, Borthwick-Duffy, SA, Spreat, S, Thissen, D, Widaman, KF and Zhang, D (2012) The construct of adaptive behavior: its conceptualization, measurement, and use in the field of intellectual disability. American Journal on Intellectual and Developmental Disabilities 117, 291–303.Google Scholar
Wang, J-J and Kaufman, AS (1993) Changes in fluid and crystallized intelligence across the 20-to 90-year age range on the K-BIT. Journal of Psychoeducational Assessment 11, 29–37.Google Scholar
Weiss, LG (2010) Considerations on the Flynn effect. Journal of Psychoeducational Assessment 28, 482–493.Google Scholar
Woods, G, Freedman, D and Derning, T (2015) Intellectual disability and comorbid disorders. In Polloway, EA (ed.), The Death Penalty and Intellectual Disability. Washington, DC: American Association on Intellectual and Developmental Disabilities, pp. 279–292.Google Scholar
Yell, ML, Shriner, JG and Katsiyannis, A (2006) Individuals with disabilities education improvement act of 2004 and IDEA regulations of 2006: implications for educators, administrators, and teacher trainers. Focus on Exceptional Children 39, 1.Google Scholar
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