Pharmacological approaches have also been used to alleviate co-morbid psychiatric diagnoses associated with ID. Treatment for these co-morbid diagnoses includes
25 medications (Sadock & Sadock, 2007). Treatment for co-morbid diagnoses such as autism often involves social skills interventions (Matson, Matson & Rivet, 2007).
Other psychological treatments include therapy such as cognitive behavioural therapy (CBT) (Sadock & Sadock, 2007). CBT has previously been used for the treatment of anxiety
disorders as well as depression (Sadock & Sadock, 2007). Shenk and Brown (2007) made use of CBT for the treatment of an adolescent sexual offender who also suffered from ID. They suggest that this may be seen as useful treatment when exposure and response prevention is added for adolescent sexual offenders with ID (Shenk & Brown, 2007).
3.2.3.1 Behavioural difficulties
Behaviours such as increased levels of aggression are also commonly associated with ID. More prominent treatments for alleviating these behavioural difficulties often include behaviour therapies, functional assessment, interventions early on and pharmacological interventions (Sturmey, n.d.).
Functional assessment has shown remarkable results in identifying the cause of problem behaviours (Chezan, Drasgow & Martin, 2014; Sturmey, n.d.). Functional assessment is a “full range of strategies used to identify the antecedents and consequences that control problem behaviour” (Horner, 1994, p. 401). Functional assessments allow for a more
directed approach. By using functional assessment it becomes more clear which behaviours form which function and why (Lloyd & Kennedy, 2014). Once this has been established it becomes easier to develop function-based interventions (Lloyd & Kennedy, 2014).
Functional communication training (FCT) has shown significant results in helping adults with ID (Chezan et al., 2014). FCT can be defined as a treatment which is used to replace challenging behaviour with more appropriate communicative behaviours (Falcomata & Wacker, 2013). FCT would therefore be the intervention which follows after completing functional assessments. Chezan et al. (2014) found that FCT has significantly reduced
26 problem behaviour through learning to communicate instead of using behaviour. Chezan et al. (2014) used only three individuals in their study – one showing signs of attention difficulty and the other two having shown aggressive behaviour.
Other behavioural techniques such as positive and negative reinforcement have also been used to help with behaviour difficulties. Differential reinforcement interventions appeared to be effective in eliminating challenging behaviour (Lloyd & Kennedy, 2014). According to Lloyd and Kennedy (2014), differential reinforcement is the process of extinction through which negative behaviours are not reinforced – for example, not giving the child the toy because he or she is crying. Crying in this instance is the negative behaviour, and by giving the toy that behaviour would be reinforced. The next step in differential reinforcement would then be to reinforce positive behaviour (Lloyd & Kennedy, 2014). This would be done by giving the toy to the child after he or she has said ‘toy please’ or anything similar. FCT makes differential reinforcement easier. By teaching the individual effective communication strategies the individual reinforcement would encourage positive behaviours (Lloyd & Kennedy, 2014).
Sturmey (n.d.) noted that by identifying the cause of the aggressive behaviour through functional analysis, one can accurately identify the causes and tailor interventions according to the needs of the person. Sturmey (n.d.) noted that if a child is aggressive due to lack in routine or structure, a tailored schedule should help reduce those aggressive symptoms. Recently Pinar (2015) used time-based attention schedules to reduce problem behaviour in children with and without intellectual disabilities. It was found that with such a time-based schedule task behaviour had increased and problem behaviour decreased (Pinar, 2015). Lloyd and Kennedy (2014) describe a similar time-based process as non-contingent reinforcement (NCR). With NCR a fixed timed schedule independent of responding is used to reinforce behaviour (Lloyd & Kennedy, 2014). When negative behaviour is noticed no
27 reinforcement is given, irrespective of the time schedule (Lloyd & Kennedy, 2014). According to them this method has been greatly effective in decreasing problem behaviour (Lloyd & Kennedy, 2014).
Although behavioural interventions has shown significant effects in eliminating challenging behaviour, it is important to note that it is not the only method that can be used to address challenging behaviour in children suffering from ID. Swan and Ray (2014) found that with child-centred play therapy they were able to decrease signs of irritability and hyperactivity in two children. Their study however consisted of only two children, ages 6 and 7 (Swan & Ray, 2014), therefore making the sample too small to generalise any findings. Other methods for decreasing challenging behaviours include pharmacological treatments.
3.2.3.2 Pharmacological Treatments
The difficulty that people with ID experience with communication, makes it more challenging to establish the extent to which any co-morbid diagnoses may exist (Hurley, 2006). Hurley (2006) noted that often behavioural signs such as aggression or irritability could point to mood disorders. Treatment such as electroconvulsive therapy (ECT) and pharmacological treatments have been deemed effective (Hurley, 2006). Antipsychotic medications have also been used to treat challenging behaviours in individuals with ID (McQuire, Hassiotis,
Harrison & Pilling, 2015).
Anti-depressants such as selective serotonin reuptake inhibitors (SSRI’s) and clomipramine have been effective in alleviating symptoms of depression in individuals with ID (Hurley, 2006). According to McQuire, et al. (2015) studies have shown mixed results with medications such as risperidone, olanzapine, piracetam, aripiprazole, topiramate and n- acetylcysteine to alleviate challenging behaviours. Other medications include ritalin and risperidone which have been effectively used to reduce symptoms of hyperactivity, lithium which has decreased symptoms of aggression and self-injurious behaviour and beta
28 blockers which have been effective in reducing explosive rage symptoms (Sadock & Sadock, 2007). There is however certainty that these medications have significant side effects
(McQuire et al, 2015). Anitpsychotics such as risperidone indicated that individuals have weight gain, increased levels of prolactin and sedation (McQuire et al., 2015). However, most studies do not provide the long-term outcome of using pharmacological treatments (McQuire et al., 2015; Sadock & Sadock, 2007). Despite the evidence of side effects and no long-term evidence, antipsychotic medication is still commonly prescribed for challenging behaviours in individuals with ID (McQuire et al., 2015).