Developmental Disabilities From Childhood to Adulthood: What Works for Psychiatrists in Community and Institutional Settings

While reading Developmental Disabilities From Childhood to Adulthood, one realizes how complex this group of patients can be and the challenges that arise in treatment. Despite these challenges, the rewards can be astounding, especially when the patients make progress.

This text is a collaboration of many authors and comprises 15 chapters arranged in five parts: development disabilities, etiology and assessment, community living, interventions, and special issues. The editors were wise to allow the wide range of topics; the result provides the reader a solid reference for learning more. Joel D. Bregman, M.D., begins the book with an overview of developmental disabilities and discusses controversies in definitions and conceptions, stating “they have ranged from structure vs. function to defect vs. differences to transient delay vs. permanent impairment to disability vs. differential ability.” Since the 1990s, there has been a shift from considering tested intelligence to considering adaptive functioning as the primary indicator of severity. Dr. Bregman states that this shift provided researchers little direction and created confusion, because adaptive functioning has little standardization. Adding to that confusion is the term “developmental delay,” used to describe children with problems in development. Dr. Bregman refers to a 1998 study that advised that the term “delay” is best used as a chief complaint or presenting symptom rather than a diagnosis. He completes the chapter by discussing epidemiology, etiology, risk factors, and finally specific genetic and clinical groups associated with developmental disabilities.

When assessing patients who may be nonverbal, many psychiatrists struggle and must depend on caretakers or family members to describe problematic behaviors or symptoms. The excellent chapter on assessment by Stephanie Hamarman, M.D., presents many issues to consider for thorough assessments. She defines “diagnostic overshadowing” in which mental retardation “overshadows” other psychiatric diagnoses, such as depression, anxiety, and psychosis, and results in a failure to make the additional diagnosis. Many states separate mental retardation from mental health services, with the effect of blocking treatment of psychiatric disorders. The authrodiscusses studies showing the prevalence of both mental retardation and psychiatric disorders (dual diagnosis) and questions whether traditional DSM or ICD diagnosis is applicable for persons with mental retardation who are not able to participate fully in an assessment. As severity of retardation increases, so too does the difficulty in recognizing and distinguishing a psychiatric diagnosis. Behaviors that require psychiatric intervention include hyperactivity, inattention, irritability, and aggression, which can improve with medications even if the diagnosis is not clearly established. Dr. Hamarman completes the chapter with a discussion of diagnostic scales, including autism instruments, medical conditions, speech delay, eating disorders, and psychosis.

Dr. Combrinck-Graham's chapter, “A Life Cycle Approach to Developmental Disabilities,” reviews Erik Erikson's eight stages of development. It is useful to consider how difficult it must be for limited individuals to master these stages, and educating families and caregivers about these milestones can be helpful. She diagrams the family life cycle to be a continuous spiral in which the relationships of three generations of traditional families interact. However, this concept is difficult to apply to patients from broken homes who are in the care of child services.

Other chapters cover community living; interventions, including legal aspects of special education, pharmacotherapy, and behavioral interventions; and ethical issues and advocacy. Most chapters include a case example to illustrate the particular area of study. Developmental Disabilities From Childhood to Adulthood is written for community psychiatrists, but other mental health practitioners who turn to this volume will also benefit and can use it as a reliable textbook.