New insights on psychopathological assessement in persons with intellectual disability and low-functioning autism spectrum disorder

Saturday, 25th September 2021 Keynote Marco Bertelli 11:00am - 11:45pm Room: Humboldt

Intellectual disability (ID) and autism spectrum disorder (ASD) are associated with a broad vulnerability to concomitant health issues, especially psychiatric disorders, with a prevalence up to four times higher than in the general population. ID and ASD often co-occur, and their differentiation may be difficult, especially in the context of increasing severity of cognitive impairment.

In persons with ID and/or low-functioning autism spectrum disorder (LF-ASD) the presentation of psychopathological symptoms and syndromes can considerably vary from that of the general population, for a number of reasons including cultural factors, cognitive and communicative impairments, developmental peculiarities, and neuroautonomic vulnerability. Psychiatric symptomatology can present scarcely defined, chaotic, mixed, intermittent, atypical or masked. Even key elements of some syndromes, such as delusions, hallucinations or suicidal ideation, are often very hard to recognize, especially in persons with low or absent verbal communication skills, who may only be able to express themselves through changes in behaviour.

Some problem behaviours have been identified as symptoms, or groups of symptoms, specific to some psychiatric disorders (PD), taking the name of "behavioural equivalents" (BE), especially in persons with low functioning and low adaptive skills. These BEs have to be carefully distinguished from other problem behaviours, based on some characteristic, such as onset, development, maintenance and extinction, especially in respect to other concurrent possible symptoms of a PD. Some BEs have been included in the last adaptations to ID/LF-ASD of the DSM and ICD diagnostic criteria for the general population.

Instrumental assessment can usefully support clinicians in the identification of BEs, although available tools show considerable differences in structural and psychometric characteristics.
In the present talk a new comprehensive set of tools is presented, whose automatic score reporting includes odds indicators of behavioural equivalence for every significant behavioural change, specifically “relative syndromic weight”, “syndromic specificity”, and syndromic clinical relevance. This new tool battery, called SPAIDD (Systematic Psychopathological Assessment for persons with Intellectual and Developmental Disabilities), has been designed to meet all the different practical needs related to every phase of the clinical intervention (general psychopathological screening, diagnostic categorical specification, dimensional diagnosis, and symptoms monitoring) and can be used by mental health professionals with different background and by the whole multidisciplinary team working with people with ID and LF-ASD. Authors of this tool system also tried to overcome the other main limits of previous tools, such as impossibility of being used across the range of cognitive and communication impairments, misalignment with DSM or ICD, lack of some main symptoms or syndromes, lack of chronological criteria, and high time expenditure.

The increasing availability of personal digital devices equipped with sensors offers new opportunities to continuously and passively measure human behavior in relation to mental health states and environmental context and may help to increase our understanding of behavioural symptoms of different PD.

Simple and to the point:

  • People with intellectual disability and autism often have additional mental health conditions
  • These show up differently than in the normal population and are often difficult to detect
  • Especially people with autism who do not speak can be mentally ill without being noticed
  • The combination of different problematic behaviors is typical for different mental conditions
  • The Systematic Psychopathological Assessment for persons with Intellectual and Developmental Disabilities (SPAIDD) is a combination of different scales for status and progression diagnosis
  • In addition, personal digital devices with sensors can be used to improve diagnostics