Treatments for children and adolescents with intellectual disabilities are based on an assessment of each individual’s social, educational, psychiatric, and environmental needs.
Primary prevention is focused on eliminating or reducing the conditions that led to the development of the intellectual disability, as well as associated disorders. Examples include:
Secondary and Tertiary Prevention
Prompt attention to medical and psychiatric complications of intellectual disability can diminish their course and minimize the disability. Hereditary metabolic and endocrine disorders, such as PKU and hypothyroidism, can be treated effectively at an early stage by dietary control or hormone replacement therapy.
Education for children with intellectual disabilities should include a comprehensive program that addresses academics and training in adaptive skills, social skills, and vocational skills. Particular attention should focus on communication and efforts to improve the child’s quality of life.
Behavioral and Cognitive-Behavioral Therapy
Behavior therapy has been used for many years to shape and enhance social behaviors and to control and minimize aggressive and destructive behaviors in individuals with intellectual disabilities. Positive reinforcement for desired behaviors and benign punishment (e.g., loss of privileges) for objectionable behaviors are helpful. Cognitive therapy, such as dispelling false beliefs and relaxation exercises, is also recommended for intellectually disabled persons who can follow instructions. Psychodynamic therapy has been used with patients and their families to decrease conflicts about expectations that result in persistent anxiety, rage, and depression. Psychiatric treatment methods require modifications that consider the patient’s level of intelligence.
One of the most important areas of treatment in addressing intellectual disability in a child or adolescent is educating the patient’s family about ways to enhance competence and self-esteem while maintaining realistic expectations for the patient. Parents may benefit from continuous counseling or family therapy and should be allowed opportunities to express their feelings of built, despair, anguish, recurring denial, and anger about their child’s disorder and future.
One of the most prevalent problems among individuals with intellectual disabilities is a sense of social isolation and social skill deficits. Therefore, a critical part of care should focus on improving the patient’s quantity and quality of social competence. Special Olympics International is the largest recreational sports program supporting this population, providing opportunities to not only improve physical fitness but to enhance social interactions, friendships, and self-esteem. A recent study confirmed the positive effects of Special Olympics on the social competence of the intellectually disabled adults who participated.
Aggression, Irritability, and Self-Injurious Behavior
Risperidone is helpful in treating disruptive behaviors in children with below-average intelligence and has a good overall safety and tolerability profile. Studies have demonstrated small but significant improvement in cognitive ability with risperidone use.
Studies of methylphenidate (Ritalin) treatment in mildly intellectually disabled patients with ADHD has shown significant improvement in the ability to maintain attention and to stay focused on tasks. Risperidone also has been found to be beneficial in reducing symptoms of ADHD.
Clonidine has been used to ameliorate hyperactivity and impulsivity, and clinical ratings by parents and clinicians suggest its efficacy. Atomoxetine has been shown to be effective in children diagnosed with autism spectrum disorder and prominent ADHD features and is used clinically in the intellectually disabled population.
SSRI antidepressants have a relatively safe treatment record and are recommended when a depressive disorder is diagnosed in a child or adolescent with an intellectual disability.
Stereotypical Motor Movements
Antipsychotic medications, including haloperidol (Haldol) and chlorpromazine, as well as atypical antipsychotics, are used in the treatment of repetitive self-stimulatory behaviors in children with intellectual disability when these behaviors are either harmful to the child or disruptive.
Obsessive-compulsive (OCD) Symptoms
Obsessive-compulsive symptoms often overlap with the repetitive stereotypical behaviors seen in children and adolescents with intellectual disabilities, particularly in those with an autism spectrum disorder. SSRIs such as fluoxetine, fluvoxamine (Luvox), paroxetine, and sertraline have been shown to be effective in treating OCD symptoms in children and adolescents.
Explosive Rage Disorder
Antipsychotic medications, particularly risperidone, have been shown to be effective for the treatment of explosive rage. B-Adrenergic antagonists (beta-blockers) such as propranolol (Inderal) have been anecdotally reported to result in fewer explosive rages in some children with intellectual disability and an autism spectrum disorder.