According to numerous studies, people with intellectual disability can not only experience mental health problems such as anxiety, stress and depression. They’re actually four times more susceptible to these conditions than the general population. However, they are less likely to be correctly diagnosed, let alone treated.
Owing to something known as ‘diagnostic overshadowing’, health care professions may attribute symptoms to the patient’s disability, rather than an underlying mental health issue.
Also, we don’t expect children and adolescents with moderate to severe intellectual disability to be affected by stress or anxiety. How could they be, when they are blissfully unaware of the worries most often associated with these feelings?
They’re under no pressure to be successful, hold down a demanding job or earn a living. Not for them the stress of battling traffic jams or worrying about being late for an appointment. Since they don’t read the newspapers, they don’t feel anxious about everything from the state of the country to the soaring petrol price. Stressed and depressed? Surely not?
It may come as a surprise to learn that even those with severe intellectual disability are capable of experiencing feelings of isolation, exclusion or worthlessness, which can lead to depression. Or that they can pick up other people’s negative or discriminatory attitudes. After all, if the child is unable to communicate effectively, how would we even know they have these feelings?
Non-verbal communication techniques
Not being able to communicate with parents or caregivers is one of the biggest barriers to a successful diagnosis. It’s important to explore other, non-verbal communication methods. At LITTLE EDEN, we frequently use large emoticons to encourage the children to share how they are feeling. There is also a wonderful series of books, Books beyond Words, which uses pictures to help children and adults with intellectual disability communicate feelings.
‘Sonia’s Feeling Sad’ helps people with intellectual disability understand and cope with depression. ‘Feeling Cross and Sorting It Out’ is helpful for those who are overwhelmed by their emotions, or unable to process feelings of anger. ‘Belonging’, and ‘Making Friends’ are useful in helping people with intellectual disability understand relationships and explore feelings.
Apps for iPads or similar devices are also available, with pictures that people with intellectual disability can use to communicate feelings to a parent or carer.
Changes in behaviour
Often, the person closest to the child or adult with intellectual disability, is able to pick up mental health issues, based on changes in their behaviour. Like anyone else who feels depressed, those with intellectual disability may withdraw from activities or social interactions they previously enjoyed. They may turn their faces away when you try to talk to them, or stare at the ceiling, indicating a withdrawal from the conversation.
You may notice an increase in the severity of compulsive, repetitive behaviours. Rocking, hand waving or grunting can help someone with intellectual disability soothe unpleasant feelings or emotions.
Lack of energy or tiredness is another symptom commonly associated with depression. However, this may also be caused by a physical illness. It’s important for a doctor to first rule out any physical causes before diagnosing depression.
Life events
Like anyone else, people with intellectual disability may become anxious and depressed as a result of a change in routine or emotional trauma. Triggers include:
• Death of a loved one
• Change of primary carer (staff leave or change jobs)
• Moving home or starting a new school
• Physical illness or chronic pain
• Experiencing crime – a home invasion or car hi-jacking
Depression can also be triggered by loneliness or boredom, as well as by certain types of medication.
Treatment options
Treatment will depend on the severity of the problem and may include:
• Cognitive behavioural therapy (CBT)
• Family therapy
• Medication
If you suspect that your loved one with intellectual disability is experiencing mental health problems, make an appointment with your health care profession for a full assessment. Depression and anxiety are real problems that can rob us of the joy of living. And that joy is equally important for those living with intellectual disability.