1. Behavioural and emotional problems in young children with intellectual disabilities and/or autism: Implications for Early Intervention
Richard Hastings
Cerebra Chair of Family Research, University of Warwick
Monash Warwick Professor, Department of Psychiatry, Monash University, Australia

2. Neglect of mental ill-health
Historically, psychology and psychiatry tended to deny that people with ID might experience mental health problems
Psychodynamically-orientated therapists questioned whether people with ID could truly have mental health problems given their intellectual deficits and associated abnormalities in ego development
There remains a lack of recognition that underlying mental health problems may partly explain problems that bring people with ID into contact with services

3. Diagnostic over-shadowing
Reiss et al. (1982) coined the term - tendency to inaccurately assess the degree of mental ill health in people with ID compared with people without ID
In vignette-based research, this leads to a high level of false negative judgements with the implication that diagnosis may be similarly insensitive
Treatment may also be less likely to be suggested when a case is identified with ID
Review by Jopp and Keys (2001) - lack of evidence for the bias in actual clinical settings
Is this an historical bias?

4. Existing research
Case-control studies typically include referred and self-referred (volunteer) children and families
Population-based samples are needed
Diagnosis of ID or ASD not always confirmed clinically, by a recognised diagnostic assessment, or some other method
Need samples that include clear method for identification of ID/ASD

5. ONS mental health surveys
N= 18,415 children age 5-16 years; population based sample across the UK with high response rate (80% across both surveys – 1999 and 2004)
Structured clinical interview used with all children leading to ICD-10 diagnoses (carer interview, plus child interview 11+ and able to participate)
Emerson identified a sub-sample with likely ID (N= 641), 3.5% of total sample
Emerson & Hatton (2007) compared prevalence of childhood psychiatric disorders in ID and non-ID groups. Found increased risk of comorbidity

6. Emerson & Hatton (2007)

7. 1 in 7 children with MH problems in the UK also have ID
Emerson & Hatton (2007)
1 in 7 children with MH problems in the UK also have ID

8. Early emergence N = 15,246 from the Millennium Cohort Study Wave 3
Secondary analysis by Totsika, Hastings et al (2011)
ID: British Ability Scales 3.07% (n = 479)
ASD: parental report 0.92% (n = 143†)
Child outcomes: hyperactivity, emotional symptoms, conduct problems (SDQ)
† sample weighted

9. 5

10. Why the differences? Family socio-economic adversity
Exposure to negative life events
Lack of access to MH services (Toms et al., 2015: 27.9% ID/MH population past 12 mo., Salamone et al., 2014: 25% children with ASD/MH)
Parents’ own mental health problems
Poorer quality parent-child relationships
Difficulty learning effective coping skills, communicating needs, identifying emotions

11. What can we do?
Mental health of children with ID and/or autism is a mainstream (i.e., a big!) MH, and EI, policy issue
Children with ID and/or autism face a mental health inequality: reduce inequality by targeting identified factors
Improve awareness, recognition, training, availability of services, evidence base for “treatments” (esp. for severe ID), and Early Intervention/support
EI: focus on parent-child relationships, family patterns of interaction, parent health, advocacy skills
NICE: Autism in under 19s: Support and management (August, 2013); Mental Health Problems in People with Learning Disabilities (September 2016)

12. R.Hastings@warwick.ac.uk @ProfRHastings

14. Mothers – Kessler 6

15. Child positive well-being
[Totsika et al RASD]

16. Siblings, not just parents
[Hastings et al RASD]
60 Families
Behavioural and emotional problems – child with ASD
Behavioural and emotional problems – child with ASD
Sibling behavioural and emotional problems
Maternal depression
2.5 to 3 years later