- Email: [email protected]
7.4 Behavior Analytic Approaches to Problem Behavior in Intellectual and Developmental Disabilities
INSTITUTES 7.2 — 7.4
Objectives: The review of the DSM-5 revision resulted in a new category, neurodevelopmental disorders, a name change from mental retardation to intellectual disability (ID) (intellectual developmental disorder, IDD) and revised diagnostic criteria that emphasize adaptive functioning. Methods: A review of the DSM-5 neurodevelopmental group procedures and review of the evidence base led to the new definition. Results: The inclusion of the new category neurodevelopmental disorders in DSM-5 parallels that of major neurocognitive disorder (e.g., dementia). Both are viewed in DSM-5 as health conditions. The elimination of axis 2 meant that a definition of ID (IDD) by IQ number as in DSM-IV would no longer suffice for a defined mental disorder in DSM-5. Thus, a consensus definition of intelligence is incorporated in the criteria for the first time to define deficits in general mental functioning. Intellectual functions include reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience confirmed by both clinical assessment and individualized, standardized intelligence testing. Although IQ testing is required, adaptive functioning is emphasized, with emphasis placed on how well a person copes with the common tasks of everyday life in three general domains: conceptual, social, and practical. Intelligence and adaptive functioning are linked through adaptive reasoning. IQ scores no longer designate mild, moderate, severe, and profound levels of severity. These specifiers are based on adaptive functioning in the three domains. The new definition identifies gullibility and lack of risk awareness as characteristic features. Assessment requires a face-to-face clinical psychiatric evaluation. Conclusions: The new classification and text descriptions of ID (IDD) have important implications for assessment, epidemiologic studies, intervention, service provision, forensics, and outcome.
ID, ND, PSP http://dx.doi.org/10.1016/j.jaac.2017.07.559
7.2 DIAGNOSING CO-OCCURRING MENTAL DISORDERS IN CHILDREN AND ADOLESCENTS WITH INTELLECTUAL DISABILITY/INTELLECTUAL DEVELOPMENTAL DISORDER Kerim M. Munir, MD, DSc, Boston Children’s Hospital and Harvard Medical School, [email protected] Objectives: This presentation describes the co-occurrence and assessment of mental disorders (MD) in children and adolescents with intellectual disability (ID) and intellectual developmental disorders (IDD). The presentation offers modifications in assessment techniques for differential diagnosis of MD, with a particular emphasis on DSM-5 conceptualization of ID and IDD that include both intellectual and adaptive functioning deficits. Methods: The clinical and epidemiological literature on MD in children and adolescents with ID/IDD is reviewed. The modifications for assessment of MD in ID/IDD include the following: the use of broad- and narrow-band behavior rating scales of symptoms and symptom domains, any corresponding DSM scales, and use of multiple informant sources; direct and indirect interview techniques, with special attention to modifications for use with nonverbal children and adolescents; and consideration of neurological, medical, and genetic syndromes that may transform expression of co-occurring MD. Results: Children and adolescents with ID/IDD are at greater risk for MD compared with the general population. Both the prevalence and clinical presentation of MD are modified by child and adolescent age, gender, and ID/IDD severity. Most common MD in children and adolescent with ID/IDD include the following: other neurodevelopmental disorders (e.g., ASD, ADHD, specific learning, and stereotyped movement with and without self-injurious behaviors, and other specified and unspecified neurodevelopmental disorders); anxiety, depression, mood disorder, psychosis, and trauma- and stressrelated disorders; OCD-related disorders; and disruptive, impulse-control, and conduct disorders. Pitfalls in diagnosis include an over-reliance on the use of partial criteria, incomplete review of the overarching clinical syndrome, short-circuiting of differential diagnosis, and premature use of psychopharmacological interventions that may alter manifestation of MD and delay their targeted treatment.
S148
www.jaacap.org
Conclusions: The diagnosis of MD in children and adolescents with ID/IDD entail a systematic review of multiple factors within a requisite biopsychosocial framework and integrated consideration of home, education, and social environments.
CM, ID, ND http://dx.doi.org/10.1016/j.jaac.2017.07.560
7.3 RECOGNIZING THE BEHAVIORAL PHENOTYPE IN NEUROGENETIC SYNDROMES AND POTENTIAL INTERVENTIONS Robert L. Hendren, DO, University of California, San Francisco, [email protected] Objectives: In this session, we will do the following: 1) discuss the value of recognizing the behavioral phenotype in genetic disorders, such as 22q11.2, tuberous sclerosis, fragile X syndrome, Angelman syndrome, and phenylketonuria (PKU); 2) apply these behavioral phenotypes to psychiatric disorders, such as schizophrenia, depression, autism, and ADHD; and 3) explore targeting treatments at shared metabolic mechanisms of gene expression. Methods: This presentation will review significant advances occurring in genetics, gene expression, and metabolomics research to identify the behavioral phenotype and associated neurobiological mechanisms of several single and complex genetic neurodevelopmental disorders and treatments successfully targeting these mechanisms. Results: The behavioral phenotype connects to underlying neurodevelopmental processes and is beginning to explain the ongoing developmental metabolic processes shown to be treatment targets for biomedical and penetrating psychosocial interventions. These interventions can improve gene x environment interactions, enhance developmental progression, reverse neurobiological dysfunction, protect through high-risk periods, and promote or create healthy neurodevelopment. Evidence for several processes, including oxidative stress, immune and inflammatory; mitochondrial dysfunction; g-aminobutyric acid (inhibitory) and glutamate (stimulatory); free fatty acid metabolism; and the microbiome and epigenetic processes that show commonalities across several neurodevelopmental disorders, will be discussed. Treatments targeted at one or more of these common pathways that demonstrate usefulness will also be discussed. Several clinical examples with vignettes will be presented Conclusions: Effective treatments for single and complex genetic disorders are increasingly focused on common behavioral phenotypes and the underlying gene expression through metabolic processes that become targets for process enhancing or correcting interventions. Many challenges exist for designing and carrying out clinical trials to demonstrate the efficacy of targeted biomedical treatments, but treatment paradigms are increasingly shifting from those that target diagnoses to those that target gene expression processes.
GS, ID, ND http://dx.doi.org/10.1016/j.jaac.2017.07.561
7.4 BEHAVIOR ANALYTIC APPROACHES TO PROBLEM BEHAVIOR IN INTELLECTUAL AND DEVELOPMENTAL DISABILITIES Louis Hagopian, PhD, Kennedy Krieger Institute, hagopian@ kennedykrieger.org Objectives: The goals of this session are to review behavioral interventions for problem behavior (aggression, self-injury, disruptive behavior, etc.) in persons with intellectual disability (ID) and to summarize currently used assessment and treatment procedures and their empirical support. Methods: This presentation describes applied behavior analysis, its empirical support, and its use for addressing problem behavior in persons with ID and intellectual developmental disabilities (IDD). A neurobehavioral model that integrates behavioral analytic and psychiatric
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
INSTITUTES 7.5 — 7.7
approaches is also described. Case examples illustrating behavioral and pharmacological interventions and their coordinated application will be presented. Results: In the context of deficits in communication, adaptive behavior, and intellectual functioning associated with IDD, problem behavior can emerge and come to be strengthened by reinforcement in the environment. Decades of research show that in at least two-thirds of cases, problem behavior is maintained by socially mediated variables (e.g., problem behavior functions to escape tasks, access attention, gain access to preferred items). Behavioral treatments based on an understanding of the behavioral function are highly effective in reducing problem behavior and teaching adaptive skills, but in many cases, problems with emotion regulation also necessitate the use of medications. Conclusions: Problem behavior in persons with IDD can have a range of determinants, including environmental, biological, and psychiatric variables. Functional behavioral assessment procedures can precisely identify environmental variables maintaining problem behavior and thus help delineate what remaining dimensions of the clinical presentation seem biological and would require psychopharmacologic intervention. Singlecase design methodologies used to evaluate behavioral intervention effects are also ideally suited to objectively evaluate psychopharmacological interventions.
CBT, DBD, ID http://dx.doi.org/10.1016/j.jaac.2017.07.562
7.5 PHARMACOTHERAPY FOR CO-OCCURRING PSYCHIATRIC CONDITIONS IN INTELLECTUAL DISABILITY AND AUTISM SPECTRUM DISORDER Robert L. Findling, MD, MBA, Kennedy Krieger Institute and Johns Hopkins University, [email protected] Objectives: The goal of this session is to provide a review of what is known (and what is not known) about the pharmacological treatment of co-occurring psychiatric conditions in patients suffering from intellectual disability (ID) and autism spectrum disorder (ASD). Furthermore, medication treatment data on neurogenetic syndromes that are associated with ID/ASD will also be considered. The clinical relevance of the extant research data and evidence-based treatment approaches will be discussed. Methods: For this presentation, data from published clinical trials for ID and ASD will be reviewed. In addition, information from relevant scientific meetings will be considered. Results: In patients with ID, the most methodologically stringent data suggest that symptoms of ADHD may improve with methylphenidate. Similarly, the cautious use of antipsychotic drugs may be beneficial for children with ID and substantive and impairing disruptive behavior disorders (DBDs). Data for patients with ID and other psychiatric conditions are limited. For patients with ASD, there is evidence to support the assertion that patients with ADHD and DBDs may benefit from certain pharmacotherapies. Selective serotonin re-uptake inhibitors do not have the data to support their efficacy in reducing repetitive behaviors in ASD. Conclusions: More rigorous study is needed to examine what role, if any, medication management may have in youths with ID who are suffering from mood and anxiety disorders. In addition, for patients with ID, there are limited data on the long-term safety and effectiveness of treatment with psychotropic agents. Compared with patients with ID, more is known about the medication treatment of patients with ASD. For this reason, evidence-based decisions about prescribing psychiatric agents to these vulnerable patients with ASD can be made more frequently. However, most studies that have reported efficacy for medications in those with ASD are generally of short duration. As a result, the ability to draw definitive conclusions about long-term tolerability or effectiveness is limited.
CM, ID, PPC http://dx.doi.org/10.1016/j.jaac.2017.07.563
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
7.6 FAMILY INTERVENTIONS FOR CHILDREN WITH NEURODEVELOPMENTAL DISABILITIES AND CO-OCCURRING BEHAVIORAL AND MENTAL DISORDERS Elisabeth Dykens, PhD, Vanderbilt Kennedy Center and Vanderbilt University Medical Center, elisabeth.dykens@ Vanderbilt.Edu Objectives: The goals of this sessions are to do as follows: 1) discuss key findings on the health and mental health vulnerabilities of parents of offspring with neurodevelopmental disorders, including autism spectrum disorders, Down syndrome, rare genetic syndromes, and mental illness; and 2) demonstrate the need for novel interventions that directly address the stress and distress of these parents. Methods: This presentation will summarize research on family care providers and the nascent literature on effective interventions for them, including cognitive behavioral therapies, thematic and informational groups, and mindfulness practices. Results: Neurodevelopmental disorders are the most prevalent chronic health conditions among our nation’s children, and the health and mental health problems in parents of these children now have become an urgent public health concern. Beyond elevated stress, depression, anxiety, sleep, and health problems, these parents also show reduced immune function, shorter telomere length, and blunted diurnal cortisol trajectories—all indicative of stress chronicity. Results will be shared from our large, randomized clinical trial in parents of children with autism and other disabilities comparing mindfulness-based stress reduction to an intervention based on principles of positive psychology. Our trial demonstrated significant effects of both mindfulness and positive psychology practices in reducing these problems in the short- and long-term. Mindfulness practices led to more immediate reductions in depression and anxiety, with large effect sizes. Findings also demonstrated the utility of using trained, supervised peer mentors to deliver treatments. Conclusions: Interventions are sorely needed that reduce parental distress and enhance their health and well-being. As most adults with intellectual and other disabilities co-reside with their aging parents, such interventions can position parents to more effectively care for their children in the long-term. New disability policies are needed to support such efforts.
FAM, ID, PAT http://dx.doi.org/10.1016/j.jaac.2017.07.564
7.7 LEGAL, ETHICAL, AND FORENSIC ISSUES IN INTELLECTUAL AND DEVELOPMENTAL DISABILITIES Ludwik S. Szymanski, MD, Boston Children’s Hospital and Harvard Medical School, [email protected] Objectives: This presentation will review legislation, legal entitlements, techniques of forensic psychiatric assessment in criminal and civil proceedings, and ethical issues pertinent to persons who have an intellectual and developmental disability (ID/DD). Methods: Both federal and state legislations and laws, as well as case law, are pertinent here; thus, their principles will be reviewed. Although state laws may differ from one another, the important underlying principles are usually similar and will be discussed and illustrated with case examples Results: Persons with ID may be involved in civil proceedings, which may include determining general legal competence; need for guardianship; assessment of competence to enter into a contract, including marriage, to provide informed consent (such as for medical treatment or participation in a research study); and parental competence in child protection and custody cases. The diagnosis of ID does not automatically imply legal incompetence, which has to be determined through court decision, usually based on assessment by a clinical team, focused on a person’s ability to make rational and informed decisions. Assessment in criminal proceedings may include determination of competence to stand trial, criminal responsibility, and competence to testify as a witness. Psychiatric testimony on whether the
www.jaacap.org
S149
Objectives: The review of the DSM-5 revision resulted in a new category, neurodevelopmental disorders, a name change from mental retardation to intellectual disability (ID) (intellectual developmental disorder, IDD) and revised diagnostic criteria that emphasize adaptive functioning. Methods: A review of the DSM-5 neurodevelopmental group procedures and review of the evidence base led to the new definition. Results: The inclusion of the new category neurodevelopmental disorders in DSM-5 parallels that of major neurocognitive disorder (e.g., dementia). Both are viewed in DSM-5 as health conditions. The elimination of axis 2 meant that a definition of ID (IDD) by IQ number as in DSM-IV would no longer suffice for a defined mental disorder in DSM-5. Thus, a consensus definition of intelligence is incorporated in the criteria for the first time to define deficits in general mental functioning. Intellectual functions include reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience confirmed by both clinical assessment and individualized, standardized intelligence testing. Although IQ testing is required, adaptive functioning is emphasized, with emphasis placed on how well a person copes with the common tasks of everyday life in three general domains: conceptual, social, and practical. Intelligence and adaptive functioning are linked through adaptive reasoning. IQ scores no longer designate mild, moderate, severe, and profound levels of severity. These specifiers are based on adaptive functioning in the three domains. The new definition identifies gullibility and lack of risk awareness as characteristic features. Assessment requires a face-to-face clinical psychiatric evaluation. Conclusions: The new classification and text descriptions of ID (IDD) have important implications for assessment, epidemiologic studies, intervention, service provision, forensics, and outcome.
ID, ND, PSP http://dx.doi.org/10.1016/j.jaac.2017.07.559
7.2 DIAGNOSING CO-OCCURRING MENTAL DISORDERS IN CHILDREN AND ADOLESCENTS WITH INTELLECTUAL DISABILITY/INTELLECTUAL DEVELOPMENTAL DISORDER Kerim M. Munir, MD, DSc, Boston Children’s Hospital and Harvard Medical School, [email protected] Objectives: This presentation describes the co-occurrence and assessment of mental disorders (MD) in children and adolescents with intellectual disability (ID) and intellectual developmental disorders (IDD). The presentation offers modifications in assessment techniques for differential diagnosis of MD, with a particular emphasis on DSM-5 conceptualization of ID and IDD that include both intellectual and adaptive functioning deficits. Methods: The clinical and epidemiological literature on MD in children and adolescents with ID/IDD is reviewed. The modifications for assessment of MD in ID/IDD include the following: the use of broad- and narrow-band behavior rating scales of symptoms and symptom domains, any corresponding DSM scales, and use of multiple informant sources; direct and indirect interview techniques, with special attention to modifications for use with nonverbal children and adolescents; and consideration of neurological, medical, and genetic syndromes that may transform expression of co-occurring MD. Results: Children and adolescents with ID/IDD are at greater risk for MD compared with the general population. Both the prevalence and clinical presentation of MD are modified by child and adolescent age, gender, and ID/IDD severity. Most common MD in children and adolescent with ID/IDD include the following: other neurodevelopmental disorders (e.g., ASD, ADHD, specific learning, and stereotyped movement with and without self-injurious behaviors, and other specified and unspecified neurodevelopmental disorders); anxiety, depression, mood disorder, psychosis, and trauma- and stressrelated disorders; OCD-related disorders; and disruptive, impulse-control, and conduct disorders. Pitfalls in diagnosis include an over-reliance on the use of partial criteria, incomplete review of the overarching clinical syndrome, short-circuiting of differential diagnosis, and premature use of psychopharmacological interventions that may alter manifestation of MD and delay their targeted treatment.
S148
www.jaacap.org
Conclusions: The diagnosis of MD in children and adolescents with ID/IDD entail a systematic review of multiple factors within a requisite biopsychosocial framework and integrated consideration of home, education, and social environments.
CM, ID, ND http://dx.doi.org/10.1016/j.jaac.2017.07.560
7.3 RECOGNIZING THE BEHAVIORAL PHENOTYPE IN NEUROGENETIC SYNDROMES AND POTENTIAL INTERVENTIONS Robert L. Hendren, DO, University of California, San Francisco, [email protected] Objectives: In this session, we will do the following: 1) discuss the value of recognizing the behavioral phenotype in genetic disorders, such as 22q11.2, tuberous sclerosis, fragile X syndrome, Angelman syndrome, and phenylketonuria (PKU); 2) apply these behavioral phenotypes to psychiatric disorders, such as schizophrenia, depression, autism, and ADHD; and 3) explore targeting treatments at shared metabolic mechanisms of gene expression. Methods: This presentation will review significant advances occurring in genetics, gene expression, and metabolomics research to identify the behavioral phenotype and associated neurobiological mechanisms of several single and complex genetic neurodevelopmental disorders and treatments successfully targeting these mechanisms. Results: The behavioral phenotype connects to underlying neurodevelopmental processes and is beginning to explain the ongoing developmental metabolic processes shown to be treatment targets for biomedical and penetrating psychosocial interventions. These interventions can improve gene x environment interactions, enhance developmental progression, reverse neurobiological dysfunction, protect through high-risk periods, and promote or create healthy neurodevelopment. Evidence for several processes, including oxidative stress, immune and inflammatory; mitochondrial dysfunction; g-aminobutyric acid (inhibitory) and glutamate (stimulatory); free fatty acid metabolism; and the microbiome and epigenetic processes that show commonalities across several neurodevelopmental disorders, will be discussed. Treatments targeted at one or more of these common pathways that demonstrate usefulness will also be discussed. Several clinical examples with vignettes will be presented Conclusions: Effective treatments for single and complex genetic disorders are increasingly focused on common behavioral phenotypes and the underlying gene expression through metabolic processes that become targets for process enhancing or correcting interventions. Many challenges exist for designing and carrying out clinical trials to demonstrate the efficacy of targeted biomedical treatments, but treatment paradigms are increasingly shifting from those that target diagnoses to those that target gene expression processes.
GS, ID, ND http://dx.doi.org/10.1016/j.jaac.2017.07.561
7.4 BEHAVIOR ANALYTIC APPROACHES TO PROBLEM BEHAVIOR IN INTELLECTUAL AND DEVELOPMENTAL DISABILITIES Louis Hagopian, PhD, Kennedy Krieger Institute, hagopian@ kennedykrieger.org Objectives: The goals of this session are to review behavioral interventions for problem behavior (aggression, self-injury, disruptive behavior, etc.) in persons with intellectual disability (ID) and to summarize currently used assessment and treatment procedures and their empirical support. Methods: This presentation describes applied behavior analysis, its empirical support, and its use for addressing problem behavior in persons with ID and intellectual developmental disabilities (IDD). A neurobehavioral model that integrates behavioral analytic and psychiatric
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
INSTITUTES 7.5 — 7.7
approaches is also described. Case examples illustrating behavioral and pharmacological interventions and their coordinated application will be presented. Results: In the context of deficits in communication, adaptive behavior, and intellectual functioning associated with IDD, problem behavior can emerge and come to be strengthened by reinforcement in the environment. Decades of research show that in at least two-thirds of cases, problem behavior is maintained by socially mediated variables (e.g., problem behavior functions to escape tasks, access attention, gain access to preferred items). Behavioral treatments based on an understanding of the behavioral function are highly effective in reducing problem behavior and teaching adaptive skills, but in many cases, problems with emotion regulation also necessitate the use of medications. Conclusions: Problem behavior in persons with IDD can have a range of determinants, including environmental, biological, and psychiatric variables. Functional behavioral assessment procedures can precisely identify environmental variables maintaining problem behavior and thus help delineate what remaining dimensions of the clinical presentation seem biological and would require psychopharmacologic intervention. Singlecase design methodologies used to evaluate behavioral intervention effects are also ideally suited to objectively evaluate psychopharmacological interventions.
CBT, DBD, ID http://dx.doi.org/10.1016/j.jaac.2017.07.562
7.5 PHARMACOTHERAPY FOR CO-OCCURRING PSYCHIATRIC CONDITIONS IN INTELLECTUAL DISABILITY AND AUTISM SPECTRUM DISORDER Robert L. Findling, MD, MBA, Kennedy Krieger Institute and Johns Hopkins University, [email protected] Objectives: The goal of this session is to provide a review of what is known (and what is not known) about the pharmacological treatment of co-occurring psychiatric conditions in patients suffering from intellectual disability (ID) and autism spectrum disorder (ASD). Furthermore, medication treatment data on neurogenetic syndromes that are associated with ID/ASD will also be considered. The clinical relevance of the extant research data and evidence-based treatment approaches will be discussed. Methods: For this presentation, data from published clinical trials for ID and ASD will be reviewed. In addition, information from relevant scientific meetings will be considered. Results: In patients with ID, the most methodologically stringent data suggest that symptoms of ADHD may improve with methylphenidate. Similarly, the cautious use of antipsychotic drugs may be beneficial for children with ID and substantive and impairing disruptive behavior disorders (DBDs). Data for patients with ID and other psychiatric conditions are limited. For patients with ASD, there is evidence to support the assertion that patients with ADHD and DBDs may benefit from certain pharmacotherapies. Selective serotonin re-uptake inhibitors do not have the data to support their efficacy in reducing repetitive behaviors in ASD. Conclusions: More rigorous study is needed to examine what role, if any, medication management may have in youths with ID who are suffering from mood and anxiety disorders. In addition, for patients with ID, there are limited data on the long-term safety and effectiveness of treatment with psychotropic agents. Compared with patients with ID, more is known about the medication treatment of patients with ASD. For this reason, evidence-based decisions about prescribing psychiatric agents to these vulnerable patients with ASD can be made more frequently. However, most studies that have reported efficacy for medications in those with ASD are generally of short duration. As a result, the ability to draw definitive conclusions about long-term tolerability or effectiveness is limited.
CM, ID, PPC http://dx.doi.org/10.1016/j.jaac.2017.07.563
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
7.6 FAMILY INTERVENTIONS FOR CHILDREN WITH NEURODEVELOPMENTAL DISABILITIES AND CO-OCCURRING BEHAVIORAL AND MENTAL DISORDERS Elisabeth Dykens, PhD, Vanderbilt Kennedy Center and Vanderbilt University Medical Center, elisabeth.dykens@ Vanderbilt.Edu Objectives: The goals of this sessions are to do as follows: 1) discuss key findings on the health and mental health vulnerabilities of parents of offspring with neurodevelopmental disorders, including autism spectrum disorders, Down syndrome, rare genetic syndromes, and mental illness; and 2) demonstrate the need for novel interventions that directly address the stress and distress of these parents. Methods: This presentation will summarize research on family care providers and the nascent literature on effective interventions for them, including cognitive behavioral therapies, thematic and informational groups, and mindfulness practices. Results: Neurodevelopmental disorders are the most prevalent chronic health conditions among our nation’s children, and the health and mental health problems in parents of these children now have become an urgent public health concern. Beyond elevated stress, depression, anxiety, sleep, and health problems, these parents also show reduced immune function, shorter telomere length, and blunted diurnal cortisol trajectories—all indicative of stress chronicity. Results will be shared from our large, randomized clinical trial in parents of children with autism and other disabilities comparing mindfulness-based stress reduction to an intervention based on principles of positive psychology. Our trial demonstrated significant effects of both mindfulness and positive psychology practices in reducing these problems in the short- and long-term. Mindfulness practices led to more immediate reductions in depression and anxiety, with large effect sizes. Findings also demonstrated the utility of using trained, supervised peer mentors to deliver treatments. Conclusions: Interventions are sorely needed that reduce parental distress and enhance their health and well-being. As most adults with intellectual and other disabilities co-reside with their aging parents, such interventions can position parents to more effectively care for their children in the long-term. New disability policies are needed to support such efforts.
FAM, ID, PAT http://dx.doi.org/10.1016/j.jaac.2017.07.564
7.7 LEGAL, ETHICAL, AND FORENSIC ISSUES IN INTELLECTUAL AND DEVELOPMENTAL DISABILITIES Ludwik S. Szymanski, MD, Boston Children’s Hospital and Harvard Medical School, [email protected] Objectives: This presentation will review legislation, legal entitlements, techniques of forensic psychiatric assessment in criminal and civil proceedings, and ethical issues pertinent to persons who have an intellectual and developmental disability (ID/DD). Methods: Both federal and state legislations and laws, as well as case law, are pertinent here; thus, their principles will be reviewed. Although state laws may differ from one another, the important underlying principles are usually similar and will be discussed and illustrated with case examples Results: Persons with ID may be involved in civil proceedings, which may include determining general legal competence; need for guardianship; assessment of competence to enter into a contract, including marriage, to provide informed consent (such as for medical treatment or participation in a research study); and parental competence in child protection and custody cases. The diagnosis of ID does not automatically imply legal incompetence, which has to be determined through court decision, usually based on assessment by a clinical team, focused on a person’s ability to make rational and informed decisions. Assessment in criminal proceedings may include determination of competence to stand trial, criminal responsibility, and competence to testify as a witness. Psychiatric testimony on whether the
www.jaacap.org
S149